Allocating the costs of parental free exercise: striking a new balance between sincere religious belief and a child's right to medical treatment.
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Adolescent↗
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Results for “Cost Allocation”
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[Medical resource utilization and allocation in Japan--evaluation of surgical expenditures].
We evaluated the appropriateness of medical cost allocation in Japan from the global aspect especially the percentage of the national budget for medical cost to gross national product (GDP). Base on OECD-Health Data in 2002, Japan was ranked high in the world in terms of medical services but was ranked the second lowest in terms of the percentage of medical cost to GDP (7.6%) among G7 advanced countries. In addition, at surgical departments, allocated medical cost is mostly used for surgical supplies and instruments, and only negligibly for doctor's fee. Unless this situation is improved, the surgical department in Japan will decline. Improvement measures should be taken without delay.
Fees, Medical↗
Estimates of costs by DRG in Sydney teaching hospitals: an application of the Yale cost model.
The results are reported of a first round of costing by DRG in seven major teaching hospital sites in Sydney using the Yale cost model. These results, when compared between the hospitals and with values of relative costs by DRG from the United States, indicate that the cost modelling procedure has produced credible and potentially useful estimates of casemix costs. The rationale and underlying theory of cost modelling is explained, and the need for further work to improve the method of allocating costs to DRGs, and to improve the cost centre definitions currently used by the hospitals, is emphasised.
Accounting↗
Allocating physicians' overhead costs to services: an econometric/accounting-activity based-approach.
Using the optimizing properties of econometric analysis, this study analyzes how physician overhead costs (OC) can be allocated to multiple activities to maximize precision in reimbursing the costs of services. Drawing on work by Leibenstein and Friedman, the analysis also shows that allocating OC to multiple activities unbiased by revenue requires controlling for revenue when making the estimates. Further econometric analysis shows that it is possible to save about 10 percent of OC by paying only for those that are necessary.
Accounting↗
Health Care Financing Administration--Medicare program; cost reporting requirements for home health agencies. Final rule.
This amendment to the Medicare regulations requires that: (1) certain types of home health agencies (HHA) use the "step-down" method of allocating costs to various cost centers; and (2) all HHAs use a single method of apportioning costs between Medicare and non-Medicare patients. The revised regulation will assist in the application of cost limits to HHAs by requiring the use of uniform and improved methods of determining the cost by type of service.
Cost Allocation↗
Collecting unit cost data in multicentre studies. Creating comparable methods.
International comparisons of health care systems and services have created increased interest in the comparability of cost results. This study compared top-down and bottom-up approaches to collecting unit cost data across centres in the context of examining the cost-effectiveness of dialysis therapy across Europe. The study tested whether health care technologies in different countries can be costed using consistent and transparent methods to increase the comparability of results. There was more agreement across the approaches for peritoneal dialysis than for than haemodialysis, with differences, respectively of Euro 91-1,687 vs. 333-7,314 per patient per year. Haemodialysis results showed greatest differences where dialysis units were integrated as part of larger hospitals. Deciding which approach to adopt depends largely on the technology. However, bottom-up costing should be considered for technologies with a large component of staff input or overheads, significant sharing of staff or facilities between technologies or patient groups and health care costing systems which do not routinely allocate costs to the intervention level. In these circumstances this costing approach could increase consistency and transparency and hence comparability of cost results.
Costs and Cost Analysis↗
Health systems costs and resource allocation.
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Cost Allocation↗
Efficiency gains in broiler production through contract parameter fine tuning.
This paper reports on an analysis of existing broiler production contracts, with an attempt to establish the degree of efficiency gains possible from contract alteration. With the use of settlement cost and farm level data, an assessment is made of optimal grower input decisions given contract specifications. Using this analytical framework, alternative contract designs are simulated by searching over possible contract parameter values. The foci of the analysis are three contract parameters: base payment, bonus factor, and the utilities cost allocation factor. In the first two cases, the simulation generated ambiguous results. In the third case, results seem to indicate that switching part of the electricity cost from the grower's cost into the settlement cost may result in a mutual welfare gain.
Animal Husbandry↗
[The economic and sociomedical efficiency of innovations in the practice of health protection].
The article discusses techniques for assessing the economic and medico-social efficiency of innovations introduced into health care practice starting from the example of a new procedure (prodigiosin inhalations) in prevention of ENT disorders and of influenza in preschool children. The analysis bears on the role and importance of evaluations of this type in the implementation of scientific findings, as well as in restructuring the health care sector and reorienting biomedical research. The authors contend that the expanding area of innovation use does not trigger more than insignificant rises in costs (costs allocated to scientific research, for instance), whereas cost containment is almost directly proportional to the expanding applications. It can, therefore, be concluded that imposing limitations and delays in the implementation of efficient innovations bars cost savings and diminishes the actual economic efficiency of biomedical research.
Child, Preschool↗
Hospital profit planning under Medicare reimbursement.
The federal Medicare regulations reimburse hospitals on a pro rata share of the hospital's cost. Hence, to meet its financial requirements, a hospital is forced to shift more of the financial burdens onto its private patients. This procedure has contributed to double digit inflation in hospital prices and to proposed federal regulation to control the rate of increase in hospital revenues. In this regulatory environment, we develop nonlinear programming pricing and cost allocation models to aid hospital administrators in meeting their profit maximizing and profit satisfying goals. The model enables administrators to explore tactical issues such as: (i) studying the relationship between a voluntary or legislated cap on a hospital's total revenues and the hospital's profitability, (ii) identifying those departments within the hospital that are the most attractive candidates for cost reduction or cost containment efforts, and (iii) isolating those services that should be singled out by the hospital manager for renegotiation of the prospective or "customary and reasonable" cap. Finally the modeling approach is helpful in explaining the departmental cross subsidies observed in practice, and can be of aid to federal administrators in assessing the impacts of proposed changes in the Medicare reimbursement formula.
Cost Allocation↗
Development of a practical costing method for hospitals.
To realize an effective cost control, a practical and accurate cost accounting system is indispensable in hospitals. In traditional cost accounting systems, the volume-based costing (VBC) is the most popular cost accounting method. In this method, the indirect costs are allocated to each cost object (services or units of a hospital) using a single indicator named a cost driver (e.g., Labor hours, revenues or the number of patients). However, this method often results in rough and inaccurate results. The activity based costing (ABC) method introduced in the mid 1990s can prove more accurate results. With the ABC method, all events or transactions that cause costs are recognized as "activities", and a specific cost driver is prepared for each activity. Finally, the costs of activities are allocated to cost objects by the corresponding cost driver. However, it is much more complex and costly than other traditional cost accounting methods because the data collection for cost drivers is not always easy. In this study, we developed a simplified ABC (S-ABC) costing method to reduce the workload of ABC costing by reducing the number of cost drivers used in the ABC method. Using the S-ABC method, we estimated the cost of the laboratory tests, and as a result, similarly accurate results were obtained with the ABC method (largest difference was 2.64%). Simultaneously, this new method reduces the seven cost drivers used in the ABC method to four. Moreover, we performed an evaluation using other sample data from physiological laboratory department to certify the effectiveness of this new method. In conclusion, the S-ABC method provides two advantages in comparison to the VBC and ABC methods: (1) it can obtain accurate results, and (2) it is simpler to perform. Once we reduce the number of cost drivers by applying the proposed S-ABC method to the data for the ABC method, we can easily perform the cost accounting using few cost drivers after the second round of costing.
Accounting↗
Plasticity versus canalization: population differences in the timing of shade-avoidance responses.
The reliability of environmental cues and costs of a fixed phenotype are two factors determining whether selection favors phenotypic plasticity or environmental specialization. This study examines the relationship between these two factors and the evolution of plant competitive strategies (plastic vs. fixed morphologies). In natural plant populations, shifts in light quality associated with foliar shade reliably indicate the presence of neighbors. These cues mediate plastic stem-elongation responses that often increase competitive ability and access to light. Using experimental light treatments (full sun, neutral shade, and foliar shade), genetic differences among populations of Abutilon theophrasti (velvetleaf) in average elongation and plasticity to foliar-shade cues were examined. Six populations, two from each of three site types (fields in continuous corn cultivation, fields undergoing corn-soy rotation, and weedy sites), were exposed to the light treatments at two stages in their life history. At the seedling stage, populations derived from cornfield sites exhibited higher, average elongation than populations from either rotating corn-soy fields or weedy areas. Because seedling elongation may delay shading of velvetleaf by corn, population differences may reflect adaptive responses to directional selection imposed by competitive conditions. However, the effects of simulated foliar shade on elongation were three times as great as the average population differences, and these comparatively higher levels of elongation were associated with an allocation cost. These results are consistent with the hypothesis that phenotypic plasticity may limit the evolution of specialists; reliable environmental cues enable individuals to facultatively adopt highly elongated, costly phenotypes in crowded patches while avoiding the costs of that phenotype in less crowded microsites. At later life-history stages, populations experiencing competition with corn exhibited lower plasticity to light quality than populations derived from weedy areas. Elongation at later nodes is maladaptive in cornfields because velvetleaf is ultimately incapable of overtopping corn; individuals that elongate therefore experience the cost of allocating to stems but fail to improve leaf exposure. The decreased responsiveness of cornfield populations to light quality is consistent with theoretical predictions in which reduced plasticity is favored when environmental cues fail to mediate an adaptive response.
Biological Evolution↗
A pilot study of the cost of educating undergraduate medical students at Virginia Commonwealth University.
PURPOSE: To develop a model isolating the annual per-student cost of, and the fund sources for, educating undergraduate medical students at the Virginia Commonwealth University Medical College of Virginia School of Medicine. METHOD: For 1994-95, hours that faculty spent in direct scheduled contact with students and time that students spent in direct scheduled contact with faculty were inventoried. Student, faculty, and resident contact hours for clinical clerkships and electives were estimated. Faculty contact hours and average faculty workload profiles were used to compute the number of full-time-equivalent faculty positions required to deliver the undergraduate medical curriculum. Support staff and operating budget requirements were based on the number of required faculty, and actual salary averages were used to compute faculty and staff costs. Other institutional costs that indirectly support undergraduate medical education were estimated. Using faculty contact hours and actual cost data, fund sources that support undergraduate medical education were identified. RESULTS: Medical school faculty spent more than 89,000 scheduled hours teaching 674 undergraduate medical students. The faculty-student ratio was 1:3.35. Residents spent nearly 79,000 hours training undergraduate medical students. The total annual cost of undergraduate medical education was $69,992 per student. State funds contributed less than a third of the required financial resources; faculty clinical practice funds provided nearly half. CONCLUSION: Although there are inherent complexities, isolating the cost and fund sources of undergraduate medical education is an essential first step toward providing categorical funding. The model developed during the study provides a basis for assigning costs, allocating resources among instructional programs, and predicting incremental costs (or savings) and revenue requirements. The model may be of use to other medical schools contemplating new strategies for financing undergraduate medical education.
Costs and Cost Analysis↗
Medicare program; changes to the inpatient hospital prospective payment system and fiscal year 1991 rates--HCFA. Final rule.
We are revising the Medicare inpatient hospital prospective payment system to implement necessary changes arising from legislation and our continuing experience with the system. In addition, in the Addendum to this final rule, we are describing changes in the amounts and factors necessary to determine prospective payment rates for Medicare inpatient hospital services. In general, these changes are applicable to discharges occurring on or after October 1, 1990. We also set forth rate-of-increase limits for hospitals and hospital units excluded from the prospective payment system. This final rule also responds to comments received concerning changes to hospital payments made in an April 20, 1990 final rule with comment. These changes include mid-year changes to the inpatient hospital prospective payment system that implemented provisions of the Omnibus Budget Reconciliation Act of 1989; and adjustments applicable to prospective payment hospitals and to the target amounts of hospitals and units excluded from the prospective payment system due to the elimination of the day limitation on covered inpatient hospital days made by the Medicare Catastrophic Coverage Act of 1988 and later repealed by provisions in the Medicare Catastrophic Repeal Act of 1989. The April 20, 1990 final rule with comment also incorporated changes to these provisions made by the Family Support Act of 1988, which clarified the criteria for adjusting the target amounts and implementation date. In addition, this final rule clarifies the documentation requirements necessary to support the cost allocation of teaching physicians and the allowability of costs for rotating residents in determining payment for the direct costs of an approved graduate medical education program. This clarification is being made as a result of a September 29, 1989 final rule that made changes in Medicare policy concerning payment for the direct graduate medical education costs of providers associated with approved residency programs in medicine, osteopathy, dentistry, and podiatry.
Centers for Medicare and Medicaid Services, U.S.↗
Act now to maximize Medicare payments for capital.
Anticipating a change in the way Medicare pays for capital costs, healthcare organizations should evaluate their capital expenditure plans. To maximize payments under the current system, they should create an equipment acquisition plan that brings the greatest capital costs during the equipment's early life. They then should determine a cost allocation method that assigns the greatest allowable capital costs to Medicare.
Capital Expenditures↗
A pharmacoeconomic evaluation of oral triptans in the treatment of migraine in Italy.
AIM: The goal of this economic evaluation was to compare the cost-efficacy of oral triptans currently used in the treatment of migraine in Italy. METHODS: The cost analysis of drugs was conducted through a structured decision tree, built up taking into account the National Healthcare System perspective. Data on the clinical efficacy and tolerability of oral triptans were derived from a published meta-analysis of 53 randomized, controlled trials. Drug cost-allocation included either the oral triptans price and costs related to management of treatment-associated chest and central nervous system (CNS) adverse events. Necessary resources for management of the unwanted events were identified by asking an experienced panel of experts how they would treat patients with triptan-related chest and CNS adverse events. To further improve the economic scenario and to allow a broader inference of pharmacoeconomic analysis, the number needed to treat (NNT) to attain 100 sustained pain free (SPF) patients, and 100 patients with SPF and no adverse events (SNAE) were also calculated. RESULTS: Study results show cost-effective differences among oral triptans. The best cost-efficacy ratios were attained by almotriptan 12.5 mg and rizatriptan 5 mg, with 18.47 Euro and 26.37 Euro respectively per patient successfully treated (SPF). Similarly, the NNT analysis favoured almotriptan, which requires 386 patients to attain 100 SPF patients, and 393 patients to attain 100 SNAE patients. Rizatriptan 10 mg resulted the closest competitor, requiring 395 and 457 patients, respectively. CONCLUSIONS: On the basis of published data and within the limitations of this model analysis that included several assumptions, results suggest the economical advantage of almotriptan 12.5 mg among the oral triptans approved for the treatment of migraine in Italy. This evidence could drive selection of the most appropriate oral treatment for acute migraine attacks based on both individual patient's needs and cost-effective drugs.
Administration, Oral↗
The cost-effectiveness of routine post myocardial infarction exercise stress testing.
The cost-effectiveness of the strategy of a routine pre-discharge exercise test (followed by coronary angiography and coronary artery bypass surgery if indicated) in patients with an uncomplicated myocardial infarction was compared with a policy of no routine exercise testing. Using data from the literature, a decision tree was developed to estimate the number of lives saved by the routine exercise test strategy (12 lives saved per 1000 tests), as well as the number of angiograms and coronary artery bypass procedures that would be performed. It was assumed that surgery decreases one year mortality by 25%. The resources consumed by bypass surgery were obtained from a chart review and the costs were estimated using a method of fully allocated costing. Both direct and indirect costs were included. The average cost of coronary artery bypass surgery was $14,958 (1985 Canadian dollars). The cost of routine exercise testing was $255,726 per life saved. With sensitivity analyses this varied from $139,487 (coronary bypass surgery 50% effective) to $1,022,904 (bypass surgery 7.5% effective). A routine post myocardial infarction stress test is an example of how a relatively inexpensive technology, by leading to other expensive clinical actions, can consume a significant amount of resources.
Angiography↗
A cost construction model to assess the cost of a family practice residency program.
BACKGROUND AND OBJECTIVES: This study uses a cost construction approach to evaluate the cost of training family practice residents in a university-based residency program. The approach calculates the cost of the educational program from a global institutional perspective, including all monetary and nonmonetary costs, independently of how they are financed. METHODS: Cost construction analysis is used to compute the instructional cost, which includes the cost of faculty and resident time directly related to teaching and the support of the teaching program. The value of the clinical care and supervision provided by the family practice residents is assessed as a replacement cost. Sensitivity analysis examines a range of assumptions concerning residents' productivity, replacement costs, and the cost allocation of activities that jointly produce clinical care and education. RESULTS: For a junior resident, the instructional cost is $94,835 per year, and the replacement cost is $65,052 per year. The value of the teaching and clinical services provided by senior residents, $124,247 per year, exceeds the cost of the resources used to educate them, $98,364 per year. CONCLUSIONS: The cost construction model can be used as a tool to allocate resources, negotiate for funding, and estimate variations in cost due to changes in curriculum and in the health care environment.
Costs and Cost Analysis↗