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PubMed1993

[Health care politicians are not concerned about maximum health gain per crown].

A survey among 150 members and deputy members of County Health and Social Welfare Committees in Norway showed little support of the idea of maximizing health gain when allocating scarce resources among different patient groups. The majority would distribute resources equally between groups that were equally ill but differed in respect of life expectancy and degree of potential improvement in health. A procedure for setting priorities is called for which makes it possible to weigh the severity of the condition against the effect of treatment, and strike a balance between these two factors in quantitative terms.

Cost Allocation↗
PubMed2001

A quality-adjusted cost function in a regulated industry: the case of Dutch nursing homes.

The primary objective of this paper is to examine the cost structure of the Dutch nursing home industry, using econometric techniques. In this paper we present a model that combines economic behaviour and quality of services measured by a latent variable. We propose a simple method for identifying and estimating cost functions in the presence of endogenous, unobserved quality. Estimating this quality-adjusted cost function and the corresponding cost share equations indicates that quality is negatively related to the input prices of nurses and other personnel, indicating that nursing homes have a preference for labour. We also show that the quality-adjusted model is superior to a model with exogenous quality.

Aged↗
PubMed2002

A simple method for calculating the financial balance of a hospital, based on proportional dividing.

It is necessary to estimate financial status to determine hospital management policy. The costs and revenues (financial balance) of each hospital division are one good index. However, it is difficult to calculate the financial balance for each division, since clinics and central services are intricately involved with each other There are no reports on a pragmatic method for calculating the financial balance. We devised a simple method based on proportional dividing. Consequently, one individual was able to complete the calculation for our hospital, which consists of 1300 beds and 23 clinics, without using the central hospital computer system.

Accounting↗
PubMed1987

Product costing for health care firms.

Product costing is an important management function for today's health care executive. A standard costing approach may be used based on two sets of standards: a standard cost profile and a standard treatment protocol.

Accounting↗
PubMed1993

Developing actual costs of patient services: the University of Alberta Hospitals.

Analysis of the costs of diagnostic and therapeutic services provided to patients yields a multitude of useful results: a sophisticated tool to assist in streamlining the underlying processes of patient care; an improved understanding of the nature and extent of case-based resource requirements; maximization of existing patient information collected through various feeder systems; a key step in the direction of measuring quality and the cost of quality, when linked to patient outcomes realization of the strategic significance of information management in today's complex, data-intensive health industry.

Alberta↗
PubMed1998

Accounting for the move to ambulatory patient groups.

This article focuses on the cost accounting challenge an ambulatory patient group (APG)-like-based prospective payment system presents to providers and the issues associated with that challenge. In particular, how can costs be identified, how can the differences in costs be associated with alternative settings, and how do costs identified through a detailed resource costing methodology compare to estimates using alternative measures? The results presented suggest that decisions made based on current measures of ambulatory cost (i.e., charge-based measures) need to be reexamined. These decisions could include which services to provide, what setting is appropriate, and where marketshare opportunities exist.

Accounting↗
PubMed1997

Research without billing data. Econometric estimation of patient-specific costs.

OBJECTIVES: This article describes a method for computing the cost of care provided to individual patients in health care systems that do not routinely generate billing data, but gather information on patient utilization and total facility costs. METHODS: Aggregate data on cost and utilization were used to estimate how costs vary with characteristics of patients and facilities of the US Department of Veterans Affairs. A set of cost functions was estimated, taking advantage of the department-level organization of the data. Casemix measures were used to determine the costs of acute hospital and long-term care. RESULTS: Hospitalization for medical conditions cost an average of $5,642 per US Health Care Financing Administration diagnosis-related group weight; surgical hospitalizations cost $11,836. Nursing home care cost $197.33 per day, intermediate care cost $280.66 per day, psychiatric care cost $307.33 per day, and domiciliary care cost $111.84 per day. Outpatient visits cost an average of $90.36. These estimates include the cost of physician services. CONCLUSIONS: The econometric method presented here accounts for variation in resource use caused by casemix that is not reflected in length of stay and for the effects of medical education, research, facility size, and wage rates. Data on non-Veteran's Affairs hospital stays suggest that the method accounts for 40% of the variation in acute hospital care costs and is superior to cost estimates based on length of stay or diagnosis-related group weight alone.

Cost Allocation↗
PubMedDate not supplied

The cost-shift payment 'hydraulic': foundation, history, and implications.

The cost-shift payment "hydraulic" is an integral component of the fragmented U.S. health care financing system. If private payers' acceptance of the cost-shifting burden were to erode, our system of health care financing could become unstable. This is especially true for the hospital industry. In this paper we provide a series of examples of cost shifting and a historical profile of the cost shift in the hospital industry since 1980, noting that cost-shifting pressures seem to fluctuate over time and across health care markets. Cost shifting need not be dollar per dollar, as hospitals can absorb some degree of cost-shifting pressure through increased efficiency and decreases in service provision.

Cost Allocation↗
PubMed2005

Role of microalbuminuria in the assessment of cardiovascular risk in essential hypertension.

Accurate cardiovascular risk evaluation is a prerequisite for devising cost-effective therapeutic strategies in patients with essential hypertension. In fact, the knowledge of concomitant risk factors, diabetes, target organ damage, or associated clinical conditions may be useful when deciding both treatment and BP goals. Thorough evaluation of target organ damage is the key to sensitive assessment of global risk, but cost-effective allocation of economic resources should also be taken into consideration. Thanks to its low cost and widespread availability, the search for microalbuminuria is a first-line tool for identifying hypertensive patients who are at higher cardiovascular risk.

Albuminuria↗
PubMed1994

Excess demand and cost relationships among Kentucky nursing homes.

This article examines the influence of excess demand on nursing home costs. Previous work indicates that excess demand, reflected in a pervasive shortage of nursing home beds, constrains market competition and patient care expenditures. According to this view, nursing homes located in underbedded markets can reduce costs and quality with impunity because there is no pressure to compete for residents. Predictions based on the excess demand argument were tested using 1989 data from a sample of 179 Kentucky nursing homes. Overall, the results provide partial support for the excess demand argument. Factors that may counteract the influence of excess demand are considered. Finally, the role of competition in nursing home markets and difficulties associated with making it operational are discussed.

Bed Occupancy↗
PubMedDate not supplied

Developing radiology procedure cost standards.

Containing costs is at the forefront of healthcare management, particularly as managed care replaces fee-for-service care. The first step in costs is to gain an understanding of the "building blocks" or components of procedure costs. The department of radiology at Duke University Medical Center and Health System, in conjunction with the department of management engineering, developed labor and supply standards to predict direct procedure costs throughout the radiology department, where 285,000 procedures are performed annually. This team concept resulted in a consistent approach to building procedure standards that predict direct costs across all sections. Step by step instructions are given for the following standards. Variable labor standards represent the average amount of staff time required for each procedure. Variable supply standards represent the average amount of consumable supply resources required per procedure. Fixed labor time standards predict the amount of fixed time resources necessary to operate the department of radiology at Duke University hospital. Cost per procedure uses the standards developed in the other sections. These basic steps will help readers determine their own direct costs per procedure for most radiology procedures (excluding capital and indirect costs). When these standards and costs are identified, the next step is to identify the areas to reduce such costs without affecting the quality of patient care.

Cost Allocation↗
PubMedDate not supplied

Case costing's contribution to utilization review activities: a review of a laparoscopic cholecystectomy patient population.

The Ottawa General Hospital is one of 13 Ontario hospitals participating in the Ontario Case Cost Project. The hospital has been collecting clinical and financial information based on the patient-specific use of products and services since April 1, 1993. The resulting decision-support database that is evolving enhances the traditional utilization review process. The author presents the analysis and conclusions regarding laparoscopic cholecystectomy patients as an example of the hospital's use of the data in utilization review activities.

Case Management↗
PubMedDate not supplied

Survival of nurse-managed centers: the importance of cost analysis.

Despite the explosive growth in nurse-managed centers (NMC) in the past 20 years, most have been unable to achieve financial self-sufficiency, and many have closed. Combining costing techniques with outcome measures provides essential information needed by NMC for making operating decisions and for marketing NMC performance. These outcome data can be persuasive to policy makers and institutional decision makers and are crucial for NMC to improve their competitiveness in the health care market place.

Birthing Centers↗