Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Cost Control”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 883 records · Page 49Linked to original sources
PubMed2001

Reducing community dyspepsia drug costs: a controlled trial.

BACKGROUND: Dyspepsia drug costs account for nearly 0.5% of the National Health Service budget. We hypothesised that improved management of dyspepsia would lead to reduced drug costs. AIM: To determine whether a multifaceted educational strategy for general practitioners aimed at improving quality of dyspepsia management can control dyspepsia costs without increasing demand for endoscopy. METHODS: A multifaceted educational intervention was delivered to general practitioners in West Gloucestershire but not to those in the east of the county. Dyspepsia drug costs, the primary outcome measure, were obtained from the Prescription Pricing Authority and compared between the two sides of the county. Referral rates for endoscopy, admission to the gastrointestinal bleed unit, and delayed diagnosis of gastric cancer were secondary measures recorded in West Gloucestershire only. RESULTS: Following the intervention, drug costs declined and then stabilised in West Gloucestershire. Drug costs peaked in the control group 15 months after those in the intervention group. Using an autoregressive integrated moving average model it was estimated the overall costs in the intervention group reduced by 57.9 pence per head of population per half year (95% confidence interval 45.8-69.9 pence/half year; p<0.0001) in comparison with the control group. This difference was maintained for three consecutive years resulting in a cumulative saving of pound1.13 million. Referral rates for upper gastrointestinal endoscopy remained stable during the study period. CONCLUSION: A multifaceted educational intervention for general practitioners designed to improve the quality of care of patients with dyspepsia is an effective means of controlling dyspepsia drug costs without increasing demand for endoscopy.

Aged↗
PubMed2003

Practical steps to controlling medical costs.

There are no silver bullets to control medical costs. And some costs are beyond plan sponsors' control. But plan sponsors can reduce the annual medical trend by taking control of the high-cost drivers of medical expenses while, at the same time, improving employees' perception of the medical plan. Patient care management, disease management and health status improvement support (with member involvement) are key.

Case Management↗
PubMed1989

How to bring equipment maintenance costs under control.

As healthcare organizations strive to control equipment maintenance costs, they should discard service options that create unnecessary expense. Saving money begins with an organized effort to review current upkeep expenses, compare them with other organizations, and make purchasing decisions based in part on servicing costs.

Cost Control↗
PubMed1984

Comparative analysis of drug distribution costs for controlled versus noncontrolled oral analgesics.

Total costs for controlled substance oral analgesics and non-controlled analgesics were compared for patients at a 548-bed university hospital. During 1983, all cost elements involved in drug delivery (excluding large-volume parenterals) were identified. Direct and indirect pharmacy labor costs were determined. Personnel costs were calculated from time studies of nurses (in 1979-80) and pharmacy technicians (in 1982). Other pharmacy costs, based on the hospital's 1982 data, included inventory holding costs, computer services, supplies, and drug acquisition costs. Costs were calculated for four oral analgesics--acetaminophen with codeine, aspirin with codeine, ibuprofen, and zomepirac sodium--used during a 30-day period in 1981. For all medications, total average cost per dose for 1,949,418 doses was $2.44, of which 41% was drug acquisition cost. Personnel costs for pharmacy and nursing accounted for 43% and 11%, respectively, of total costs. For 46% of 5111 oral analgesic doses, frequency of administration was at least four times daily. Average purchase cost per dose for the oral analgesics was $0.15, while total costs for the controlled and non-controlled drugs were $1.02 and $0.50, respectively. For the four oral analgesics in this study, cost was affected by dosage schedule and controlled or noncontrolled status. Calculation of the total average cost per dose is useful in projecting annual costs and in identifying areas for cost reduction.

Administration, Oral↗
PubMed2003

The costs of New Zealand pathology.

This paper focuses on methods for costing and funding hospital pathology services, and their relevance for government cost-control goals. Cost is an elusive, socially constructed phenomenon. As such it is context dependent and can be defined in different ways for different purposes. Misunderstanding of the contexts and purposes creates confusion and leads to contradictions and 'costly' mistakes for the New Zealand taxpayer. The cost to the taxpayer is not synonymous with the costs incurred in laboratories. The calculations of the latter, in a hospital setting, are so complex that often those responsible for running the cost systems do not understand the inscriptions produced by computer translations. In this paper, two costing initiatives potentially useful for non-competitive cost containment are outlined. The paper argues that the multiple funding methods resulting from New Zealand's public/private health care mix perpetuate perverse incentives that drive laboratory test volume escalation and discourage the full exploitation of potential economies-of-scale. The long-held objective of successive New Zealand governments to divert health funding away from hospitals and into preventive health care, is being subverted by the retention, at laboratory service level, of a competitive contracting system that was initially set up to contain test prices. The result for the New Zealand taxpayer is that costs are excessive, with millions of dollars passing to foreign-owned laboratories, which have incentives to take the tests, as well as the profits, offshore.

Benchmarking↗
PubMed2001

[Ongoing health management control by cost monitoring through tracer indicators].

OBJECTIVE: To determine the operational cost of a hospital's surgical unit, compare those results with standards, and determine the incidence of the costs; to produce an effective methodology for this purpose that can be applied to all kinds of medical units using any low-cost widely available computer database system, with that methodology being utilized for ongoing management control. METHODS: This study was carried out in 1999 in the Orthopedics and Traumatology Unit of the "Domingo Funes" Public Hospital, in the province of Córdoba, Argentina. Of the 817 patients who underwent diagnostic or therapeutic procedures in that unit during the year, we selected the 154 of them who were hospitalized and required surgical or instrumental procedures. The study used the tracer event method described by Kessner. Through a consensus process, medical specialists and health economists selected and defined these indicators, which were categorized in relation to their complexity (high, medium, limited, or none). Direct and indirect costs were assessed in order to study their contribution to total cost. Total cost was estimated using nine variables that were applied to the different tracer events. RESULTS: The largest portion of total cost, both real and standard, was based on the "bed-day" variable. Of this bed-day cost for all tracer events, 51.2% was due to an indirect cost of "social hospitalization" (keeping patients hospitalized for such reasons as transportation difficulties or delays in receiving requested medical supplies) and 48.8% to a direct cost of true therapeutic hospitalization. This bed-day cost was 117% higher for the real costs as compared to the standard costs. The indirect costs of social hospitalization and of therapeutic supplies made up nearly half of the total real cost. Excluding the indirect costs, the real cost of all the tracer events exceeded the standard cost by only 6.4%. Including the indirect costs of social hospitalization and of therapeutic supplies, the real cost exceeded the standard cost by 39.8%. The amount spent on medical staff and support personnel represented just 11.5% of the total cost. DISCUSSION: Suggestions are provided in various areas, including solutions for the high cost of social hospitalization and therapeutic supplies, the cost-control benefits of creating protocols for procedures and treatments, and the rational utilization of technology in order to improve efficiency and reduce risks. The wider application of this procedure is recommended for cost-management control in all hospital units carrying out surgery or other medical procedures.

Argentina↗
PubMed2006

Total cost minimization control scheme for biological wastewater treatment process and its evaluation based on the COST benchmark process.

This paper proposes a new cost minimisation control scheme for a predenitrification type of biological wastewater treatment process and evaluates the validity of the control scheme based on the benchmark process presented by Copp. The control scheme adopting a hierarchical control structure incorporates lower-level controllers that consist of a set of local dynamic controllers and a higher-level static optimiser that provides the set points of the lower-level controllers based on the total cost index of Vanrolleghem and Gillot. Prior to benchmarking, this paper derives a simplified process model used for the optimiser, which is able to approximate the benchmark process model effectively as well as is simplified sufficiently for faster set point optimisation for on-line purposes. Numerical experiments evaluate the effectiveness of the proposed control scheme from various viewpoints including process operational and optimisation viewpoints.

Benchmarking↗
PubMed1999

Cost-effective malaria control in Brazil. Cost-effectiveness of a Malaria Control Program in the Amazon Basin of Brazil, 1988-1996.

Malaria transmission was controlled elsewhere in Brazil by 1980, but in the Amazon Basin cases increased steadily until 1989, to almost half a million a year and the coefficient of mortality quadrupled in 1977-1988. The government's malaria control program almost collapsed financially in 1987-1989 and underwent a turbulent reorganization in 1991-1993. A World Bank project supported the program from late 1989 to mid-1996, and in 1992-1993, with help from the Pan American Health Organization, facilitated a change toward earlier and more aggressive case treatment and more concentrated vector control. The epidemic stopped expanding in 1990-1991 and reversed in 1992-1996. The total cost of the program from 1989 through mid-1996 was US$616 million: US$526 million for prevention and US$90 million for treatment. Compared to what would have happened in the absence of the program, nearly two million cases of malaria and 231,000 deaths were prevented; the lives saved were due almost equally to preventing infection and to case treatment. Converting the savings in lives and in morbidity into Disability-Adjusted Life Years yields almost nine million DALYs, 5.1 million from treatment and 3.9 million from prevention. Nearly all the gain came from controlling deaths and therefore from controlling falciparum. The overall cost-effectiveness was US$2672 per life saved or US$69 per DALY, which is low compared to most previous estimates and compares favorably to many other disease control interventions. Contrary to much previous experience, case treatment appears more cost-effective than vector control, particularly where falciparum is prevalent and unfocussed insecticide spraying is relatively ineffective. Halting the epidemic by better targeted vector control and emphasizing treatment paid off in much reduced mortality from malaria and in significantly lower costs per life saved.

Brazil↗
PubMed2003

European healthcare policies for controlling drug expenditure.

In the last 20 years, expenditures on pharmaceuticals - as well as total health expenditures - have grown faster than the gross national product in all European countries. The aim of this paper was to review policies that European governments apply to reduce or at least slow down public expenditure on pharmaceutical products. Such policies can target the industry, the wholesalers and retailers, prescribers, and patients. The objectives of pharmaceutical policies are multidimensional and must take into account issues relating to public health, public expenditure and industrial incentives. Both price levels and consumption patterns determine the level of total drug expenditure in a particular country, and both factors vary greatly across countries. Licensing and pricing policies intend to influence the supply side. Three types of pricing policies can be recognised: product price control, reference pricing and profit control. Profit control is mainly used in the UK. Reference pricing systems were first used in Germany and The Netherlands and are being considered in other countries. Product price control is still the most common method for establishing the price of drugs. For the aim of fiscal consolidation, price-freeze and price-cut measures have been frequently used in the 1980s and 1990s. They have affected all types of schemes. For drug wholesalers and retailers, most governments have defined profit margins. The differences in price levels as well as the introduction of a Single European Pharmaceutical Market has led to the phenomenon of parallel imports among member countries of the European Union. This may be facilitated by larger and more powerful wholesalers and the vertical integration between wholesalers and retailers. To control costs, the use of generic drugs is encouraged in most countries, but only few countries allow pharmacists to substitute generic drugs for proprietary brands. Various interventions are used to reduce the patients' demand for drugs by either denying or limiting reimbursement of products and providing an incentive for patients to reduce their consumption of drugs. These interventions include defining a list either of drugs reimbursed (positive list) or one of drugs not reimbursed (negative list), and patient co-payments, which require patients to pay a proportion of the cost of a prescribed product or a fixed charge. Policies intended to affect physicians' prescribing behaviour include guidelines, information (about price and less expensive alternatives) and feedback, and the use of budgetary restrictions.

Cost Control↗
PubMed1985

Monetary incentive for pharmacists to control drug costs.

An incentive program that paid hospital pharmacists at United Hospitals Incorporated (UHI) and Children's Hospital Incorporated (CHI) a percentage of the money saved by the pharmacy on drug and i.v. expenses in 1984 is described. Hospital administration, as part of a hospitalwide incentive program, approved the pharmacy department's proposal for a monetary incentive program. Pharmacy managers hoped that, by rewarding all pharmacists for their efforts to control costs, they could potentiate other cost-containment programs (stronger formulary control and improved purchasing and inventory control) and improve clinical services while maintaining quality of care. The incentive calculation was derived from the percentage of expenses saved on drugs and i.v. solutions and sets relative to budget. The payout, to be applied to 1984 salaries of pharmacists, could not exceed 10% of salary or more than 35% of the total savings to the hospital. A screening mechanism was established to protect the hospital from paying an incentive if the total pharmacy expenses exceeded budget. In fiscal 1984, drug and i.v. expenses per adjusted case decreased 1.55%, which led to each full-time pharmacist receiving an average payout of $500. This payout was less than had been anticipated because of a nursing strike at other hospitals, which resulted in an influx of intensive-care patients. The monetary incentive program for pharmacists is a useful tool for controlling drug and i.v. expenses and for rewarding pharmacists for successful cost-saving approaches.

Cost Control↗
PubMedDate not supplied

Managed care and psychiatric-mental health nursing services: implications for practice.

Our current health care system is in a period of major change. To help control rising costs and improve management, health care reforms have been proposed, prompting the rapid development of managed care. The impact of managed care on the psychiatric-mental health system has become quite evident over the past few years with a resultant restriction of services, closing of inpatient units, and shift from inpatient to outpatient care. These cost control measures raise serious concerns regarding the quality and availability of necessary services. Managed care could have a devastating effect on the progress made in mental health treatment over the last 40 years if these issues are not addressed and remedied. The issue of how managed care influences mental health services is addressed, and implications for practice are presented.

Cost Control↗
PubMed2000

National data sources on the care and outcomes of patients with community acquired pneumonia.

Despite improved understanding and treatment of community acquired pneumonia (CAP), variations in clinical practice and patient outcomes still exists, resulting in excess healthcare dollars spent and decreased patient satisfaction. The use of treatment and outcomes research data can help providers improve their methods and standardize techniques to control costs and provide the best care for their patients. To better understand the utility and capabilities of this research, this article will compare several administrative and clinical databases. Two, data sources in particular, the EPI-Q Inc. CAP-Compare database and the University HealthSystem Consortium's (UHC) CAP Benchmarking Program contain clinical and utilization data specific to CAP. In addition there are several government and non-government sponsored data sources that include administrative data on many diagnosis including CAP. These include: Healthcare Benchmarking Systems International's EXPLORE database, the Center for Healthcare Industry Performance Studies database, the National Center for Health Statistics'--National Hospital Discharge Survey, and the Medicare Provider Analysis and Review data files.

Benchmarking↗
PubMed1981

The success of medicare's end-stage renal-disease program: the case for profits and the private marketplace.

The 92nd Congress extended Medicare benefits to patients with end-stage renal disease (ESRD), sparing patients the financial burden of treating this catastrophic illness. The costs of the ESRD program have been contained better than those of health care generally; payment was originally limited by a screen of $138 per dialysis but could be higher if higher cost was documented. About 48 per cent of patients receive dialysis in units outside hospitals. The majority of these units are operated for profit, in which physicians share. The payment to these facilities has remained constant while payment to the nonprofit hospitals' unit has increased markedly. Physicians in for-profit units have a strong incentive to learn about costs and control them. They are involved in medical economic management as well as clinical management; this results in integrated administration of health care. The success of the ESRD program in expanding service to meet demand while controlling costs and maintaining quality has been due primarily to the combined effect of setting a price and creating a system of incentives that involves physicians in the medical marketplace.

Adult↗
PubMedDate not supplied

Criteria and benchmarks for laparoscopic cholecystectomy in a free-standing ambulatory center.

BACKGROUND AND OBJECTIVES: Keys to economic survival in an era of decreasing reimbursement include controlling costs and avoiding complications. In an effort to reduce costs, laparoscopic cholecystectomy has been performed with same-day discharge from a hospital setting. The free-standing ambulatory surgery center offers even greater cost savings if safety can be assured. Facility charges, surgical technique and instrument selection influence the costs of the procedure. METHODS: A database was accumulated prospectively on the first 100 laparoscopic cholecystectomies performed in a free-standing ambulatory surgery center to assess costs, logistical constraints, and safety. RESULTS: Laparoscopic cholecystectomies were accomplished in 99 of 100 patients. One patient was suspected of having cancer during laparoscopy and was transferred to a nearby hospital for open cholecystectomy. There were no other postoperative hospitalizations for complications. The fixed facility charge for the procedure was $2,990, and the total costs for all routinely disposable items (gowns, gloves, instruments, and adhesive bandages was $98. The mean OR time was 29 minutes (standard deviation 13.7). CONCLUSIONS: The free-standing ambulatory surgery center is an appropriate facility for an experienced operating team to perform laparoscopic cholecystectomy in selected patients. The surgeon's selection of appropriate energy sources and instruments is essential to complete the operation in a most cost-effective manner.

Adult↗
PubMed2002

Medical Savings Accounts in publicly funded health care systems: enthusiasm versus evidence.

Medical Savings Accounts (MSAs) have been suggested as a possible solution to Canada's health care funding woes. This approach is intended to reduce demand for health services by making individuals financially responsible for their pattern of consumption. MSAs may have appeal in the private insurance industry. A review of the scant literature on the experience in the public systems of Singapore and China, where such plans have been implemented, and on a simulation using United States Medicare data, suggests that the approach alone has not controlled costs and may increase inequalities in publicly funded systems. The conclusion is that current knowledge of MSAs is too limited to recommend their incorporation into the Canadian health care system.

Canada↗
PubMed1989

A comparison of hospital performance under the partial-payer Medicare PPS and state all-payer rate-setting systems.

Although the passage of PL 98-21 was accompanied by a flurry of interest in all-payer rate regulation, the popularity of all-payer systems has waned recently. This article attempts to determine if the move away from all-payer systems constitutes a lost opportunity. The performance of the partial-payer Medicare PPS is contrasted with that of the all-payer systems in Maryland and New Jersey. The analysis suggests that all-payer systems not only control costs more effectively than partial-payer systems, but also have inherent structural features conductive to limiting cost shifting and to funding uncompensated care. Analysis of data suggests that from the perspectives of payers, providers, and patients, all-payer rate-setting is more equitable than partial-payer systems.

Cost Control↗
PubMed1997

The future of dental benefits.

The past twenty years have seen dramatic growth and consolidation in DHMO and PPO segments of the dental benefits industry. Purchasers and patients are becoming more vocal in their demands, primarily for controlling costs. It is predicted that emerging trends will include greater emphasis on quality (and its relationship to cost) and on dental practice management companies. It is less clear what role organized dentistry will play in these changes.

Cost Control↗