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At least 739 records · Page 41Linked to original sources
PubMed1993

[The accuracy of intravenous digital subtraction angiography regarding kidney arteries in hypertensive patients. A contribution to cost control in diagnostic medicine].

In a retrospective study the results of intravenous digital subtraction angiography (DSA) of renal arteries from 149 hypertensive outpatients investigated 1984 to 1989 at the University of Berne were evaluated. 118 i.v. DSA's (79%) were normal, 10 (7%) were inconclusive and 21 (14%) revealed stenosis. In 16 patients the course of the vessel and the degree of stenosis were verified by intraarterial DSA. In nine patients (6%) a significant stenosis was confirmed and subsequently treated by percutaneous transluminal angioplasty. Renal size was not a predictive parameter for stenosis in this population. Accessory renal arteries were found in 44% of patients with stenosis and only in 18% of those without. The late phase images of i.v. DSA revealed many morphologic abnormalities. The indication for i.v. DSA was assessed according to internationally accepted criteria: 1. severe hypertension, 2. hypertension refractory to treatment, 3. hypertension of sudden onset or aggravation, 4. onset of hypertension in patients younger than 20 or older than 50 years. In the group without stenosis (n = 118) 52 patients (44%) did not fulfill a single one of these criteria, whereas the patients with stenosis (n = 9) had at least one criterion fulfilled. Hypertensive patients should, therefore, only be studied by i.v. DSA if at least one criterion applies. 22,000 SFr. could thus have been saved without loss of medical quality and the treatment options.

Angiography, Digital Subtraction↗
PubMed1988

Using DRGs and standard costs to control nursing labor costs.

Nursing care is a very significant part of a healthcare organization's costs. However, until recently, methods of controlling nursing costs were largely ineffective. With the implementation of the prospective payment system and the use of diagnosis related groups, budgeting and controlling nursing costs are now possible with the use of standard costing. In this article, methods and procedures are discussed and explained for controlling inpatient nursing costs with the use of DRGs and standard costs.

Accounting↗
PubMed1985

Surgical streams in the flow of health care financing. The role of surgery in national expenditures: what costs are controllable?

The dollar flow in United States medical care has been analyzed in terms of a six-level model; this model and the gross 1981 flow data are set forth. Of the estimated $310 billion expended in 1981, it is estimated that $85-$95 billion was the "surgical stream", i.e., that amount expended to take care of surgical patients at a variety of institutional types and including ambulatory care and surgeons' fees. Some of the determinants of surgical flow are reviewed as well as controllable costs and case mix pressures. Surgical complications, when severe, increase routine operative costs by a factor of 8 to 20. Maintenance of high quality in American surgery, despite new manpower pressures, is the single most important factor in cost containment. By voluntary or imposed controls on fees, malpractice premiums, case mix selection, and hospital utilization, a saving of $2.0-$4.0 billion can be seen as reachable and practical. This is five per cent of the surgical stream and is a part of the realistic "achievable" savings of total flow estimated to be about +15 billion or 5 per cent.

Cost Control↗
PubMed1994

Preparing for managed competition.

Without the demands of managed competition or economic incentives to control costs, providers have little reason to invest in systematic data analysis about their patients. Information technologies in the hands of health care managers and physician executives primarily are tools for cost control, and, if cost control is not an important issue for them, they do not learn how to do it. The rules of the game have already changed for providers where managed care dominates the medical community and will change for the entire nation under managed competition. Managed competition gives providers strong incentives to identify the costs of care and unnecessary variations in those costs, to introduce new processes of care to reduce unnecessary administrative and clinical costs, to implement practice guidelines to reduce variations in outcomes of care, and to document statistics indicating excellent quality.

Computer Communication Networks↗
PubMed1998

Interpreting cost analyses of clinical interventions.

OBJECTIVE: In the present era of cost containment, physicians need reliable data about specific interventions. The objectives of this study were to assist practitioners in interpretation of economic analyses and estimation of their own costs of implementing recommended interventions. DATA SOURCES: MEDLINE search from 1966 through 1995 using the text words cost or expense and medical subject heading (MeSH) terms costs and cost analysis, cost control, cost of illness, cost savings, or cost-benefit analysis. STUDY SELECTION: The 4 eligibility criteria were clinical trial with random assignment; health care quality improvement intervention tested; effects measured on the process or outcome of care; and cost calculation mentioned in the report. DATA EXTRACTION: After independent abstraction and after consensus development, financial data were entered into a costing protocol to determine which costs related to the intervention were provided. DATA SYNTHESIS: Of 181 articles, 97 (53.6%) included actual numbers on the costs of the intervention. Of 97 articles analyzed, the most frequently reported cost figures were in the category of operating expenses (direct cost, 61.9%; labor, 42.3%; and supplies, 32.0%). General overhead was not presented in 91 (93.8%) of the 97 studies. Only 14 (14.4%) of the 97 studies mentioned start-up costs. The text word $ in the abstract and the most useful MeSH index term of cost-benefit analysis appeared with nearly equal frequency in the articles that included actual cost data (37.1 % vs 35.1%). Two thirds of articles indexed with the MeSH term cost control did not include cost figures. CONCLUSIONS: Statements regarding cost without substantiating data are made habitually in reports of clinical trials. In clinical trial reports presenting data on expenditures, start-up costs and general overhead are frequently disregarded. Practitioners can detect missing information by placing cost data in a standardized protocol. The costing protocol of this study can help bridge care delivery and economic analyses.

Clinical Protocols↗
PubMed1996

Health care trends and holding the line on costs.

The increasing reliance on third party payment of health care costs has resulted in people assuming less personal financial responsibility for their own health care. Lessened personal financial responsibility has resulted in greater use of the Health Care System and so has led to greater costs for health care. This increased cost has focused attention on cost control and implementation of measures designed to control costs. The cost control measures, however, are flawed. Were the purchase of health care once again to become subject to consumers' buying decisions, health care costs would be brought under control.

Health Care Costs↗
PubMed1997

Save medical personnel's time by improved user interfaces.

Common objectives in the industrial countries are the improvement of quality of care, clinical effectiveness, and cost control. Cost control, in particular, has been addressed through the introduction of case mix systems for reimbursement by social-security institutions. More data is required to enable quality improvement, increases in clinical effectiveness and for juridical reasons. At first glance, this documentation effort is contradictory to cost reduction. However, integrated services for resource management based on better documentation should help to reduce costs. The clerical effort for documentation should be decreased by providing a co-operative working environment for healthcare professionals applying sophisticated human-computer interface technology. Additional services, e.g., automatic report generation, increase the efficiency of healthcare personnel. Modelling the medical work flow forms an essential prerequisite for integrated resource management services and for co-operative user interfaces. A user interface aware of the work flow provides intelligent assistance by offering the appropriate tools at the right moment. Nowadays there is a trend to client/server systems with relational databases or object-oriented databases as repository. The work flows used for controlling purposes and to steer the user interfaces must be represented in the repository.

Cost Control↗
PubMed1986

Controlling the cost of quality control.

In the present era of expanding technology coexisting with economic constraint, appropriate quality control criteria to monitor laboratory performance must take into consideration not only analytic precision and medical utility, but also cost effectiveness. In this review, the effect of existing criteria on the clinical laboratory, the regulator, and the vendor is explored. Factors that contribute to excessive quality control cost are delineated. Strategies for developing a cost-effective quality control program are proposed.

Costs and Cost Analysis↗
PubMed2001

Using forecasting models to estimate the effects of changes in the composition of claims for selective serotonin reuptake inhibitors on expenditures.

BACKGROUND: The use of selective serotonin reuptake inhibitors (SSRIs) as antidepressant therapy has increased considerably since the introduction of fluoxetine in 1989. By 1999, 3 of the 4 available SSRIs were among the top 10 most frequently used drugs in the United States. In addition, SSRIs were one of the major contributors to the growth in psychotropic medication expenditures during the past 5 years. OBJECTIVE: The purpose of this article was to examine the utilization patterns of the 4 most commonly used SSRIs and their contribution to rising antidepressant medication expenditures among claimants in a publicly funded drug program. Using the results of forecasting models, we explored possible ways to control these growing expenditures. METHODS: Cross-sectional antidepressant claims and expenditure data from the Ontario Drug Benefits program for 1992 to 1998 were examined. Five scenarios were modeled in which future SSRI expenditures and claims were predicted using exponential smoothing models. RESULTS: If the historical patterns of use continued, a 20% increase in the 1998 level of expenditures was expected to occur by the year 2000. Predicted expenditures are sensitive to the composition of the SSRI claims. Exclusive use of 1 of the 4 major SSRIs (fluvoxamine, fluoxetine, paroxetine, and sertraline) could decrease projected expenditures by 30% or increase them by 11%. An "equal shares" approach, in which each of the 4 SSRIs are used in equal proportions in the population, may reduce expenditures by approximately 8%. CONCLUSIONS: The current trends in the utilization data suggest that sertraline and paroxetine are being used as first-line treatments. The results of the forecasting models suggest that growing expenditures could be curbed if these 2 antidepressants were not used in that manner. Short of limiting the drugs available on benefit formularies, there may be a way to control costs through the use of a prescribing algorithm. Although our results support the use of fluoxetine for first-line SSRI treatment as a cost-control measure, we do not definitively recommend its adoption. These findings contribute to the discussion about using fixed versus flexible formularies as a potential cost-control mechanism.

Adult↗
PubMed1998

Three strategies to promote sustainability of CEMOPLAF clinics in Ecuador. Céntros Médicos de Orientación y Planificación Familiar.

The continuing trend of donor attention and resources away from Latin America threatens the sustainability of nongovernmental family planning organizations in that region. Managers can improve sustainability through cost control, cost recovery, and income generation. The Population Council's INOPAL II and INOPAL III projects and Family Health International assisted CEMOPLAF, an Ecuadoran private voluntary organization, in carrying out operations research in each of these areas. Studies included cost-savings analysis from altering IUD revisit norms (cost control), an ability-to-pay study that showed potential gains from increased prices for reproductive health services (cost recovery), and a feasibility study to estimate income from ultrasound services (income generation). Results indicate that any one intervention will probably have a limited impact, and that managers likely will need to undertake several initiatives simultaneously to make significant progress toward sustainability.

Adolescent↗
PubMed1991

A simultaneous equations model of employer strategies for controlling health benefit costs.

We estimated a simultaneous equations model of employer health insurance cost control strategies and their effectiveness in reducing health plan premiums. We hypothesized that as premiums increase, employers will shop more actively for health plans, place incentives on providers to control medical care costs, increase employee cost sharing for medical care, and be more likely to offer an HMO. In turn, we expected each of these strategies, except offering an HMO, to reduce average health plan premiums. The model was estimated with 1985 data from a sample of 922 Minnesota employers. We found that high premiums are related to three of the proposed cost control strategies. Employers with higher premiums shop more, are more likely to seek provider incentives, and offer an HMO. However, these employers appear to have lower employee cost sharing. Employers with higher employee cost sharing and those that offer an HMO had lower health plan premiums.

Community Participation↗
PubMedDate not supplied

Mass retreat: the demise of Massachusetts hospital rate regulation.

Massachusetts recently deregulated its 16-year-old hospital rate regulation system, after earlier voting in favor of a delay of its "play-or-pay" universal health care mandate. This retreat holds important lessons for the rest of the nation. Specific flaws in the design of the system weakened regulation's effectiveness and undermined its political support. The failure to control costs led to the postponement of universal access. Massachusetts' experience illustrates that neither competition nor regulation--as currently practiced--are adequate to meet the access and cost control challenges facing the nation.

Cost Control↗
PubMed2005

Effects of New Zealand's health reengineering on nursing and patient outcomes.

BACKGROUND: In 1993, New Zealand (NZ) implemented policies aimed at controlling costs in the country's public health care system through market competition, generic management, and managerialism. The cost control focus was similar to reengineering efforts implemented by other countries struggling with escalating health care costs, particularly the United States. OBJECTIVE: The study's purpose was to examine the effects hospital reengineering may have on adverse patient outcomes and the nursing workforce. RESEARCH DESIGN: The study was a retrospective, longitudinal analysis of administrative data. Relationships between adverse outcome rates and nursing workforce characteristics were examined using autoregression analysis. SUBJECTS: All medical and surgical discharges from NZ's public hospitals (n = 3.3 million inpatient discharges) from 1989 through 2000 and survey data from the corresponding nursing workforce (n = 65,221 nurse responses) from 1993 through 2000 were examined. MEASURES: Measures included the frequency of 11 nurse sensitive patient outcomes, average length of stay, and mortality along with the number of nursing full time equivalents (FTEs), hours worked, and skill mix. RESULTS: After 1993, nursing FTEs and hours decreased 36% and skill mix increased 18%. Average length of stay decreased approximately 20%. Adverse clinical outcome rates increased substantially. Mortality decreased among medical patients and remained stable among surgical patients. The relationship between changes in nursing and adverse outcomes rates over time were consistently statistically significant. CONCLUSIONS: In the chaotic environment created in NZ by reengineering policy, patient care quality declined as nursing FTEs and hours decreased. The study provides insight into the role organizational change plays in patient outcomes, the unintended consequences of health care reengineering and market approaches in health care, and nursing's unique contribution to quality of care.

Adult↗