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PubMed2005

Survey of emergency medicine resident debt status and financial planning preparedness.

OBJECTIVES: Most resident physicians accrue significant financial debt throughout their medical and graduate medical education. The objective of this study was to analyze emergency medicine resident debt status, financial planning actions, and educational experiences for financial planning and debt management. METHODS: A 22-item questionnaire was sent to all 123 Accreditation Council on Graduate Medical Education-accredited emergency medicine residency programs in July 2001. Two follow-up mailings were made to increase the response rate. The survey addressed four areas of resident debt and financial planning: 1) accrued debt, 2) moonlighting activity, 3) financial planning/debt management education, and 4) financial planning actions. Descriptive statistics were used to analyze the data. RESULTS: Survey responses were obtained from 67.4% (1,707/2,532) of emergency medicine residents in 89 of 123 (72.4%) residency programs. Nearly one half (768/1,707) of respondents have accrued more than 100,000 dollars of debt. Fifty-eight percent (990/1,707) of all residents reported that moonlighting would be necessary to meet their financial needs, and more than 33% (640/1,707) presently moonlight to supplement their income. Nearly one half (832/1,707) of residents actively invested money, of which online trading was the most common method (23.3%). Most residents reported that they received no debt management education during residency (82.1%) or medical school (63.7%). Furthermore, 79.1% (1,351/1,707) of residents reported that they received no financial planning lectures during residency, although 84.2% (1,438/1,707) reported that debt management and financial planning education should be available during residency. CONCLUSIONS: Most emergency medicine residency programs do not provide their residents with financial planning education. Most residents have accrued significant debt and believe that more financial planning and debt management education is needed during residency.

Adult↗
PubMed2001

An information system to improve financial management, resource allocation and activity planning: evaluation results.

UNLABELLED: An important strategy for improving resource management and cost containment in health care is to develop information systems that assist hospital managers in financial management, resource allocation, and activity planning. A crucial part of such development is a rigorous evaluation to assess whether the system accomplishes it's intended goals. PURPOSE: To evaluate CLASSICA, a Decision Support System (DSS), that assists nurse managers in financial management, resource allocation, staffing, and activity planning. METHODS: Using a pre-post test design with control units, CLASSICA was evaluated in four test units. Baseline data and simultaneous parallel measures were collected prior to system implementation at test sites and control units. Using expense reports, staffing and financial statistics, surveys, interviews with nurse managers, and logs as data sources, CLASSICA was evaluated on: cost reduction, quality of management information; usefulness as decision support for improved financial management and decision-making; user satisfaction; and ease of use. RESULTS: Evaluation results showed a 41% reduction in expenditures for overtime and extra hours as compared to a 1.8% reduction in control units during the same time period. Users reported a significant improvement in management information; nurse managers stated that they had gained control over costs. The system helped them analyze the relationships between patient activity staffing, and cost of care. Users reported high satisfaction with the system, the information and decision support it provided, and its ease of use. These results suggest that CLASSICA is a DSS that successfully assists nurse managers in cost effective management of their units.

Attitude to Computers↗
PubMed2004

Changes in elderly disability rates and the implications for health care utilization and cost.

Recent research indicates declining age-adjusted chronic disability among older Americans, which might moderate health care costs in the coming decades. This study examines the trend's underlying components using data from the 1984-1999 National Long-Term Care Surveys to better understand the reasons for the declines and potential implications for acute and long-term care. The reductions occurred primarily for activities like financial management and shopping. Assistance with personal care activities associated with greater frailty fell less, and independence with assistive devices rose. Institutional residence was stable. More needs to be known about the extent to which these declines reflect environmental improvements allowing greater independence at any level of health, rather than improvements in health, before concluding that the declines will mean lower costs.

Activities of Daily Living↗
PubMed2005

Productivity growth in Norwegian psychiatric outpatient clinics for children and youths.

BACKGROUND: Norwegian government policy is to increase the supply of psychiatric services to children and young persons, both by increasing the number of personnel, and by increasing productivity in the psychiatric outpatient clinics. Increased accessibility is observed for the last years, measured as the number of children receiving services each year. AIMS OF THE STUDY: The paper aims to estimate change in productivity among outpatient clinics, and whether any change is related to personnel mix, budget growth or financial incentives. METHODS: We use a non-parametric method called Data Envelopment Analysis (DEA) to estimate a best-practice production frontier. A Malmquist output-based technical productivity index is calculated and decomposed in technical efficiency change, scale efficiency change and frontier shifts. Bootstrapping methods are used to estimate standard errors and confidence intervals for the technical productivity index and its decomposition. In a second stage, the technical productivity index is regressed on variables that may potentially be statistically associated with productivity growth. The paper analyses panel data for the period of 1996-2001. RESULTS: The results indicate increased overall technical productivity by about 4.5 per cent a year in the period, mostly due to frontier shift, but with important contribution from increased technical efficiency. Scale efficiency does not change. Personnel growth has a negative influence on productivity growth, whilst a growth in the portion of university educated personnel improves productivity. The financial reform of 1997 that gave greater weight to interventions per patient led to lower productivity growth in the subsequent period for those that had an initial budgetary gain from the reform. DISCUSSION: Technical productivity has increased substantially during the period of study, implying a degree of success in the government plan for increasing psychiatric health care. While the decomposition of technical productivity change is less robust to outliers than the Malmquist productivity index itself, the results indicate that both clinics that were previously efficient, and those that were inefficient, have increased their productivity, the latter somewhat more than the former. The size of the clinic is not related to its technical productivity growth. A growth in the budget affects technical productivity negatively. While the clinics seem to respond to "mild coercion'' by increasing productivity, this growth is slowed down by a policy that at the same time increases the availability of resources. IMPLICATIONS FOR HEALTH POLICY: The instruments used in the government psychiatric plan have been adequate in stimulating the productivity and availability of psychiatric services. On the other hand it may be difficult to maintain the pressure for increasing the service level without stronger financial incentives, especially since the service suppliers are receiving strong activity based financial incentives for somatic care. IMPLICATIONS FOR FURTHER RESEARCH: Further research should focus on the effects of various organisational models of outpatient-clinics on both the level of, and change in, productivity. In this context the positive effect of increasing the portion of university educated personnel could provide a fertile starting point. It is also of interest to study whether productivity growth is accompanied by increased availability or increased treatment intensity.

Adolescent↗
PubMed2006

Impact of promotion of mango and liver as sources of vitamin A for young children: a pilot study in Burkina Faso.

OBJECTIVE: To assess the effectiveness of a behaviour change approach, with or without financial support, in improving vitamin A (VA) intake and serum retinol concentration through mango and liver consumption by children. DESIGN: A parallel design (no control area) was used to assess changes in VA intake and serum retinol over a 15-week period. SETTING AND SUBJECTS: A pilot study was implemented in the Department of Kokologho, a rural area in central west Burkina Faso. One hundred and fifty children aged 2-3 years were randomly selected and assigned to two treatment groups: PA$$ (promotional activities and financial support) and PA (promotional activities). RESULTS: The intervention significantly increased (P < 0.001) total VA intake by 56% in PA$$ and by 50% in PA. VA intake from liver increased significantly (P < 0.001) from 12.7 +/- 23.5 to 155.3 +/- 56.3 microg retinol activity equivalents (RAE) in PA$$ and from 21.6 +/- 29.7 to 135.3 +/- 44.9 microg RAE in PA. Changes in VA intake from liver were significantly higher (P = 0.004) in PA$$ compared with PA. Mean serum retinol concentration increased significantly by 26% (P < 0.001) in PA$$ and 30% (P < 0.001) in PA. Changes in serum retinol concentration (0.13 micromol l(-1) in PA$$ vs. 0.17 micromol l(-1) and in PA) did not differ significantly (P = 0.455) between groups over the intervention. CONCLUSION: Promotional activities on mango and liver intake effectively increased VA intake and serum retinol concentrations. Although an additional beneficial effect of financial support on liver intake was observed, this did not translate into a further increase in serum retinol concentration.

Burkina Faso↗
PubMed2004

Using activity-based costing in surgery.

ACTIVITY-BASED COSTING is an accounting technique that allows organizations to determine actual costs associated with their services based on the resources they consume. THIS TECHNIQUE can be used in a variety of ways, including targeting high-cost activities, forecasting financial baselines, and supporting resource allocation. FOUR STEPS should be followed when applying activity-based costing to surgical procedures. THIS ARTICLE explores how Froedtert Memorial Lutheran Hospital, Milwaukee, used activity-based costing.

Accounting↗
PubMed1989

Health economics in developing countries.

The interpretation of health economics chosen for this paper is broad. It includes the relation between economic and other factors in health development. This interpretation has been chosen lest the acceptance of a disciplinary approach in the commissioning of papers should have the unintended effect of excluding some key areas of research which require the consideration of crucial interrelationships between disciplines. The only justification for covering this area in a paper on economics rather than, for example, epidemiology is that increasingly there is and indeed has to be a heavy focus on costs in considering alternative paths to health development. The word 'research' is loosely interpreted and not restricted to the type of activity which could lead to the award of a PhD. The compilation of experience in many areas is, in the view of the author, a priority need, to plan where further research and experiment is needed.

Cost-Benefit Analysis↗
PubMed1992

Management preparedness criteria: a study of nursing home administrators.

The observations from this study seem to suggest that there are some correlations between education, experience, age, and sex on the level of preparedness in the practice domains identified. Specifically, this study finds that years of experience have a significant negative correlation with the practice domains of physical plant/building management, fiscal reimbursement, financial management, and overall preparedness in both Oklahoma and Connecticut respondents. Experience level further correlates negatively with all other practice domains (except licensing standards) in Oklahoma respondents. Education level, on the other hand, did not correlate with any practice domain (except licensing standards among Oklahoma respondents). Age correlated positively with financial management activities but only with Oklahoma respondents, while sex correlated positively with physical plant/building management (Oklahoma and Connecticut) and with financial management in Connecticut only. Sex, however, had a negative correlation with basic nursing activities among Connecticut respondents. This study suggests that the nursing home administrators from Connecticut in our study felt that they were more prepared in the practice domains identified as compared to those responding from Oklahoma. This can be attributed to the fact that Connecticut respondents had almost a 13 percent higher average of experience years. This was also demonstrated in the correlation table. Other factors such as sex, age at onset of administrator career, and educational level had no or very limited effect on the practice domains identified in the study (p greater than 0.05). This holds true for both Oklahoma and Connecticut respondents. Therefore, the hypothesis stating that education has a direct effect on job performance and preparedness of nursing home administrators does not hold true with this study. It is the years of experience that has a direct effect on performance and preparedness of nursing home administrators.

Adult↗
PubMedDate not supplied

Private physicians' provision of contraceptive services.

Private physicians provide family planning services to the majority of American women. According to data from the National Ambulatory Medical Care Survey, office-based physicians received on average 13.5 million visits annually for contraceptive services during 1990-1992. Private insurance was the expected from of payment for 38% of visits, while managed care covered 22% of visits, and Medicaid or another source of public assistance subsidized 12%; 22% were self-paid and 6% covered by other sources. The majority of patients who received contraceptive services gave a reason other than general family planning or care regarding a specific contraceptive as the primary purpose for their visit, although women covered by a managed care plan or through public funding were the most likely to give general family planning needs as the main reason. Women whose visit was listed as publicly funded were less likely to have a contraceptive prescribed or provided or to obtain a Pap test than were those expected to pay with private insurance.

Adolescent↗