[Theory of justice and resource allocation in the field of health].
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Cost Allocation↗
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"First-come first-served": analysis of an allocation principle.
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Cost Allocation↗
Cost accounting of radiological examinations. Cost analysis of radiological examinations of intermediate referral hospitals and general practice.
The purpose of this study was to analyse the cost structure of radiological procedures in the intermediary referral hospitals and general practice and to develop a cost accounting system for radiological examinations that takes into consideration all relevant cost factors and is suitable for management of radiology departments and regional planning of radiological resources. The material comprised 174,560 basic radiological examinations performed in 1991 at 5 intermediate referral hospitals and 13 public health centres in the Pirkanmaa Hospital District in Finland. All radiological departments in the hospitals were managed by a specialist in radiology. The radiology departments at the public health care centres operated on a self-referral basis by general practitioners. The data were extracted from examination lists, inventories and balance sheets; parts of the data were estimated or calculated. The radiological examinations were compiled according to the type of examination and equipment used: conventional, contrast medium, ultrasound, mammography and roentgen examinations with mobile equipment. The majority of the examinations (87%) comprised conventional radiography. For cost analysis the cost items were grouped into 5 cost factors: personnel, equipment, material, real estate and administration costs. The depreciation time used was 10 years for roentgen equipment, 5 years for ultrasound equipment and 5 to 10 years for other capital goods. An annual interest rate of 10% was applied. Standard average values based on a sample at 2 hospitals were used for the examination-specific radiologist time, radiographer time and material costs. Four cost accounting versions with varying allocation of the major cost items were designed. Two-way analysis of variance of the effect of different allocation methods on the costs and cost structure of the examination groups was performed. On the basis of the cost analysis a cost accounting program containing both monetary and nonmonetary variables was developed. In it the radiologist, radiographer and examination-specific equipment costs were allocated to the examinations applying estimated cost equivalents. Some minor cost items were replaced by a general cost factor (GCF). The program is suitable for internal cost accounting of radiological departments as well as regional planning. If more accurate cost information is required, cost assignment employing the actual consumption of the resources and applying the principles of activity-based cost accounting is recommended. As an application of the cost accounting formula the average costs of the radiological examinations were calculated. In conventional radiography the average proportion of the cost factors in the total material was: personnel costs 43%, equipment costs 26%, material costs 7%, real estate costs 11%, administration and overheads 14%. The average total costs including radiologist costs in the hospitals were (FIM): conventional roentgen examinations 188, contrast medium examinations 695, ultrasound 296, mammography 315, roentgen examinations with mobile equipment 1578. The average total costs without radiologist costs in the public health centres were (FIM): conventional roentgen examinations 107, contrast medium examinations 988, ultrasound 203, mammography 557. The average currency rate of exchange in 1991 was USD 1 = FIM 4.046. The following formula is proposed for calculating the cost of a radiological examination (or a group of examinations) performed with a certain piece of equipment during a period of time (e.g. 1 year): a2/ sigma ax*ax+ b2/ sigma bx*bx+ d1/d5*dx+ e1 + [(c1+ c2) + d4 + (e2 - e3) + f5 + g1+ g2+ i]/n.
Accounting↗
On approximations in treatment costing.
As detailed costing may be a time-consuming and expensive exercise within an evaluation, economists will be conscious of the possibilities of taking short-cuts. To explore the viability of such approaches in the context of acute care (the surgical treatment for colorectal cancer), we compare the results of a detailed costing study with reduced list costing and econometric estimation. We conclude, first, that use of a reduced list is likely to generate substantial research economies only at the expense of inaccuracy. Second, crude costing, based upon average costs of the specialty, is acceptable when the frame of reference is the aggregate. Such crude costing, however, is vulnerable to bias when specific sub-samples of patients are to be considered. Finally, total costs are predictable from a restricted list of cost and event variables, and with a high degree of accuracy, although ex ante specification of the functional form is problematic.
Acute Disease↗
You are in charge of cost.
Shifts in medical reimbursement dictate that physicians become knowledgeable about resource consumption. Price drives cost. The patient is now a cost center. Various models of physician-hospital integration are presented. A completely integrated staff in the hospital has the greatest potential for economic efficiency. The best method of cost accounting will include activity-based costs in a format that is understandable for physician education. Hospital cost management involves human resources, ordering practices, length of stay, purchasing, capital requirements, and benchmark targets. As health reform takes shape, physicians should be fully cognizant of cost, understand healthcare issues, and commit to improving the environment in which they practice medicine. The purpose of these activities is to improve the value of healthcare delivery for all patients.
Accounting↗
Revisiting Rogowski and Newhouse on the indirect costs of teaching: a note on functional form and retransformation in Medicare's payment formulas.
In 1992 Rogowski and Newhouse identified errors in functional form and retransformation in the econometric model that underlies Medicare's payments to teaching hospitals. We re-estimate their model and expand on their work, with data from the following decade. We find: (1) the functional form imposed by Health Care Financing Administration's original specification of the teaching variable is supported by the data; (2) there is no evidence of a threshold effect when the teaching intensity variable is appropriately specified; (3) there is no longer evidence of heteroscedasticity across teaching hospital types, consequently there is no need to incorporate re-transformation factors into the payment formula. We attribute the differences in our findings to secular changes in the hospital industry and improvements in variable measurement.
Cost Allocation↗
Inpatient cost of primary total joint arthroplasty.
The financial and medical records of 98 patients undergoing either primary total hip or total knee arthroplasty were analyzed to determine the inpatient cost of their surgery. Eleven patients were excluded, leaving a total of 87 patients available for analysis who underwent 50 primary total hip and 37 primary total knee arthroplasties. Ten separate cost centers such as implant, anesthesia/operating room, nursing/hospital room, physical therapy, and laboratory were included in the evaluation. Correlations between total cost and demographic parameters such as patient sex, age, and length of stay were determined. Seventy-six percent of the inpatient cost of all total joint procedures consisted of implant, anesthesia/operating room, and nursing/hospital room costs. Reductions in the cost of these components represent a potential for cost containment. The strongest correlate for total cost was hospital length of stay (P < .0005). Unfortunately, there is evidence that length of stay has reached a plateau and cannot be reduced further without affecting the quality of care and the incidence of complications.
Adult↗
The cost of breast cancer recurrences.
Information about the costs of recurrent breast cancer is potentially important for targeting cost containment strategies and analysing the cost-effectiveness of breast cancer control programmes. We estimated these costs by abstracting health service and consumable usage data from the medical histories of 128 patients, and valuing each of the resources used. Resource usage and costs were summarised by regarding the recurrence as a series of episodes which were categorised into five anatomical site-based groups according to the following hierarchy: visceral, central nervous system (CNS), bone, local and other. Hospital visits and investigations comprised 78% of total costs for all episodes combined, and there were significant differences between the site-based groups in the frequency of hospital visits and most investigations. Total costs were most accurately described by separate linear regression models for each group, with the natural logarithm of the cost of the episode as the dependent variable, and predictor variables including the duration of the episode, duration squared, duration cubed and a variable indicating whether the episode was fatal. Visceral and CNS episodes were associated with higher costs than the other groups and were more likely to be shorter and fatal. A fatal recurrence of duration 15.7 months (the median for our sample) was predicted to cost $10,575 (Aus + 1988; or 4,877 pounds). Reduction of the substantial costs of recurrent breast cancer is likely to be a sizable economic benefit of adjuvant systemic therapy and mammographic screening. We did not identify any major opportunities for cost containment during the management of recurrences.
Adult↗
The development of a method for comparative costing of individual intensive care units. The Intensive Care Working Group on Costing.
Intensive care is one of the most costly areas of hospital care. Unfortunately, because of the diversity of case mix, costing intensive care is difficult. Many described costing methods previously are limited by being cumbersome, laborious to apply and expensive. The aim of this study was to develop a method for costing intensive care which can be applied with ease but facilitate meaningful cost comparisons between intensive care units. The method developed was based on cost blocks where the major components were identified and costed in a 'top-down' manner. Using strict definitions, the cost blocks attempted to measure the costs of equipment, estates, nonclinical support services (such as hospital management costs), clinical support services (such as physiotherapy, laboratory services), consumables (such as drugs, fluids and disposables) and staff. The study found that clinical support services, consumables and staff costs accounted for approximately 85% of the total costs.
Cost Allocation↗
The cost of inappropriate admissions: a study of health benefits and resource utilization in a department of internal medicine.
OBJECTIVES: High rates of inappropriate hospital admissions have been found in numerous studies, suggesting that a high percentage of hospital resources are, in effect, wasted. The degree to which this is true depends on how costly inappropriate admissions are compared to other admissions. This study aimed to estimate both the percentage and cost of inappropriate admissions. SETTING: Department of internal medicine at a teaching hospital. SUBJECTS: Consecutively admitted patients during a six-week study period. MAIN OUTCOME MEASURES: Assessments of inappropriateness were based on estimates of health benefit and necessary care level. These estimates were made by expert panels using a structured consensus method. Health benefit was estimated as gain in quality-adjusted life years, or degree of short-term improvement in quality of life during or shortly after the hospital stay. The direct costs to the hospital of each stay were estimated by allocating the costs of labour, 'hotel' and overhead according to length of stay and adding to this the cost of ancillary resources used by each individual patient. RESULTS: A total of 422 admissions were included. The 102 (24%) judged to be inappropriate had a lower mean cost (US$ 2532) than the other 320 (US$ 5800) (difference 3268; 95% confidence interval 1025-5511). The inappropriate admissions accounted for 12% of the total costs. CONCLUSIONS: Denying care for inappropriate admissions does not generate cost reductions of the same magnitude. Policy makers should be cautious in projecting the cost savings potential of excluding inappropriate admissions.
Cost Savings↗
Budget-holding: the answer to Australian primary care reform?
In common with other Organisation for Economic Cooperation and Development (OECD) countries, Australia is experiencing growth in expenditure on health care. However, while many other nations continue to pursue some variation of managed competition to address these problems, Australia has chosen a more incremental reform path, with initiatives such as the General Practice Strategy, restrictions in doctor supply and coordinated care trials. This article reviews the likely effectiveness of such initiatives in the light of experience and evidence of budget-holding in achieving similar objectives overseas. It concludes that budget-holding offers a more effective strategy than current 'piecemeal' reforms to contain costs and increase efficiency within Australian health care.
Australia↗
Phase plane analysis: applying chaos theory in health care.
This article applies the new science of nonlinearity to administrative issues and accounts receivable management in health care, and it provides a new perspective on common operating and quality control measures.
Accounts Payable and Receivable↗
Promoting efficiency in the NHS: problems with the labour productivity index.
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Abstracting and Indexing↗
Symposium on health care reform.
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Cost Allocation↗
Can hospitals and physicians shift the effects of cuts in Medicare reimbursement to private payers?
Leaders of health insurance companies, hospital systems, and physician organizations believe that when Medicare and Medicaid reduce payment rates to hospitals or physicians, these providers respond by raising prices to private insurers to offset a portion of the loss in revenue. This would mean that payment reductions in public programs contribute to increasing premiums for private insurance. But on both theoretical and empirical grounds, economists have been skeptical about the existence of this "cost shifting." I show that more realistic models of the behavior of hospitals and physicians than exist in basic economics texts provide a conceptual basis for cost shifting.
Cost Allocation↗
Operational restructuring for patient focused care: the facility implications.
In the typical hospital, customer service lags behind clinical care. In spite of the promised efficiencies of quality control/quality assurance, costs have continued to soar, whilst the concept of patient focused care has been overlooked. More than 50% of costs are accounted for at 'operational level', due to historical trends towards centralization of ancillary services. Operational restructuring to emphasize 'patient focused' delivery of care implies a number of facility changes which are described below.
Architecture↗
New ventures and target profits.
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Cost Allocation↗
The incidence of mandated maternity benefits.
I consider the labor-market effects of mandates which raise the costs of employing a demographically identifiable group. The efficiency of these policies will be largely dependent on the extent to which their costs are shifted to group-specific wages. I study several state and federal mandates which stipulated that childbirth be covered comprehensively in health insurance plans, raising the relative cost of insuring women of childbearing age. I find substantial shifting of the costs of these mandates to the wages of the targeted group. Correspondingly, I find little effect on total labor input for that group.
Adult↗