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PubMed2002

Nosocomial infections in developing countries: cost effective control and prevention.

OBJECTIVES: To review the efficient and cost-effective preventive, control and surveillance measures that could be employed against nosocomial infections in developing countries. DATA SOURCES: Literature search on compact disk-read only memory (CD-ROM), Medline and Internet, using the key words: nosocomial infection, prevention and control, use of antibiotics and use of computers. Some articles were manually reviewed. STUDY SELECTION: Relevant studies or articles on nosocomial infections in developing and developed countries were included in the review. DATA EXTRACTION: From individual studies or articles. DATA SYNTHESIS: Information on nosocomial infections from developing and developed countries with some emphasis on Kenya is synchronized under the headings; introduction, historical background of nosocomial infections. Current situation of nosocomial infections and predisposing factors, nosocomial infections and antimicrobial resistance, consequences of nosocomial infections, hospital infection control programme and use of computers in nosocomial infection surveillance, and the cost benefit of infection prevention and control programme. CONCLUSION: Nosocomial infections may be contained more effectively by having an infection prevention and control programme. Computer-assisted epidemiological surveillance appears to be the most important aspect of monitoring infection control programmes, and to identify changes in risk factors that can increase the infection rate. Even minimally, effective infection control programmes are cost-effective. For the war against nosocomial infections to be won, the whole exercise should be handled as a global project with significant inputs from developing countries.

Causality↗
PubMed1981

The regulation strategy for controlling hospital costs.

Three regulatory mechanisms have been used to control the rise in hospital costs: assessments of patients' records by professional standards review organizations (PSROs), approval of capital expenditures by certificate-of-need agencies, and limits on hospital reimbursement by state rate-setting groups. The available evidence indicates that neither PSROs nor certificate-of-need programs have exerted an appreciable influence on costs. However, rate setting through mandatory "prospective reimbursement" appears to slow the growth of hospital expenditures and seems to be the only regulatory tool that has been effective. Any regulatory process that markedly restrains expenditures can ultimately be expected to affect patient care adversely and to create social and political tension within the health-care system.

Certificate of Need↗
PubMed1989

Outpatient treatment of patients with chronic pain: an analysis of cost savings.

To control costs, the University of Tennessee Center for Pain Management added an ambulatory pain rehabilitation program to its existing inpatient hospitalization program. The impact of this program was assessed by comparing the first 25 patients treated in 1985 (prior to the introduction of outpatient management) with the first 25 patients treated in 1987 (after outpatient management was established). Twenty of the 25 patients seen in 1985 required hospitalization, while in 1987 nine patients were hospitalized and 10 patients were placed in outpatient rehabilitation. The total cost for treating 25 patients in 1985 was $571,200 but decreased to $191,000 in 1987. Hospital charges were the greatest single cost factor in 1985 ($321,500) but were only $61,000 in 1987. Success rates as measured by a return to previous employment were not significantly changed (13 of 25 returned to work in 1985, and 11 of 25 returned to work in 1987).

Adult↗
PubMed1983

Diabetes--the cost of illness and the cost of control. An estimate for Sweden 1978.

This study estimates the economic cost of diabetes mellitus in Sweden 1978. It also addresses the question of potential savings from improved metabolic control. Economic costs of illness include direct costs for medical care and indirect costs from lost production due to morbidity and premature death. The total costs of diabetes are estimated at 1300 million SEK in Sweden 1978. The direct costs for medical care accounted for 43% of these costs. Lost production due to permanent disability is the dominating indirect costs, and accounts for 60% of indirect costs and one third of the total costs. Institutional care accounts for two thirds of the direct costs. The costs for drugs and medical devices amount to 128 million SEK or 1000 SEK per insulin- or oraldependent diabetic. Costs for control of diabetes are estimated to 20% of the total cost and 50% of direct costs. The conclusion is that there are great potential benefits to be expected from improved self control of diabetes.

Adolescent↗
PubMed1988

Controlling pharmacy costs.

There are many costs associated with parenteral nutrition: physician time, nursing time, biochemical monitoring, patient education, ancillary equipment and the nutrition solutions themselves. The solutions are easily identified as responsible for a large proportion of these costs. There are several strategies that can be used to help control pharmacy costs, such as selection of ingredients, purchasing contracts, standardized formulae and prescribing procedures, preprinted doctor's order forms, automated manufacturing and labelling processes, patient monitoring, all-in-one preparation, and contracted manufacturing services. Individual pharmacies need to know what options are available in order to select those that, in the context of their own institutions, can lead to cost savings and improved efficiency.

Canada↗
PubMed2004

Low cost quality control human serum: method of preparation, validation of values and its comparison with the commercial control serum.

OBJECTIVE: To prepare low-cost quality controls (QC) human serum and scientifically evaluate its advantages/disadvantages when compared with commercially available sera. METHODS: The home made QC serum was prepared as per WHO recommended protocol from four healthy volunteers. It was screened for HIV, HCV and HBV, pooled together and stabilized with ethylene glycol. The initial 40 values were used for calculation of means, SDs and CVs for seventeen routinely measured analytes and results were compared with those of commercially available lyophilized human sera. RESULTS: The average concentrations of seventeen commonly analyzed constituents were found to be near the middle of the physiological range of healthy subjects and the home made serum could be a good substitute for the commercial serum of normal range. The narrower CVs of the analytes imply a lesser vial to vial variation in the home made sera. Additional advantages include easy preparation, no need for reconstitution and lower cost. CONCLUSION: Home made serum is a good substitute for the commercial serum of the normal range especially in developing countries like Pakistan.

Blood Chemical Analysis↗
PubMed1979

Controlling the cost of dental care.

Methods for controlling dental care expenditures are taking on greater importance with the rapid increase in prepaid dental plans. The use of regulatory systems to monitor provider performance are necessary to prevent gross over-utilization but are unlikely to result in net savings of more than five per cent of total gross premiums. Theoretically, prepaid group dental practice (PGDP) may reduce expenditures by changing the mix of services patients receive. The modest estimated savings and the small number of PGDPs presently in operation limit the importance of this alternative for the next five to ten years. If substantial reductions in dental expenditures are to be obtained, it will be necessary to limit dental insurance plans to cover only those services which have demonstrated cost-effectiveness in improving health for the majority of people. The concept that richer benefit plans may have small marginal effects on improving oral health may not be easy for the public to accept but, until they do, expenditures for dental care will be difficult to control.

Cost Control↗
PubMed2001

Understanding the relationship between market competition and students' ratings of the managed care content of their undergraduate medical education.

PURPOSE: The increase in managed care has led to questions about the inadequacy of instruction undergraduate medical students receive in curricular areas related to managed care. This study examined (1) the percentages of graduating medical students who felt they had received inadequate instruction in six curricular content areas (CCAs): primary care, care of ambulatory patients, health promotion and disease prevention, medical care cost control, teamwork with other health professionals, and cost-effective medical practice; and (2) whether the market competitiveness of these students' medical schools affected their reports of inadequacy of instruction in these CCAs. METHOD: Data from the Association of American Medical Colleges' Graduation Questionnaires (GQs) from 1994 to 1997 were analyzed. The GQ asked graduating students to rate the adequacy of instruction they had received in the six CCAs. Students' ratings were collapsed into the dichotomous variables "inadequate" and "not inadequate." The market competitiveness of medical schools was determined using the four-stage Market Evolution Model developed by the University HealthSystem Consortium. Only responses from students graduating from medical schools that could be staged for all four years of the study were analyzed. Statistical analyses were performed to determine trends for each CCA by year, across the entire study period, by market stage, and by market stage across the entire study period. RESULTS: A total of 39,136 respondents from 86 medical schools were used in the study. The percentages of graduating medical students who reported inadequate instruction decreased over the study period for five of the six CCAs: primary care (27.6% in 1994 to 13.7% in 1997), ambulatory care (37.4% to 23. 9%), medical care cost control (62.9% to 52.9%) cost-effectiveness of medical practice (62.7% to 53.9%), and health promotion and disease prevention (44.4% to 23.7%); all at p <0.001. The responses for inadequacy of instruction for teamwork with other health professionals remained steady from 1994 to 1996 (10.2% to 10.6%), then increased 21.8% in 1997. Over the course of the study, students graduating from schools in more competitive markets (Stage 3 or Stage 4) were more likely to report inadequate instruction in three CCAs, primary care, ambulatory care, and health promotion and disease prevention, than were those graduating from schools in less competitive markets (Stage 1 and Stage 2). Conversely, students graduating from schools in the more competitive health care markets were less likely to report inadequate instruction in cost-effectiveness and cost control than were students from schools in less competitive markets. CONCLUSION: Graduating students' reports of inadequacy of instruction decreased over the study period for five of the six CCAs, increasing only for teamwork with other professionals. Findings were mixed with regard to the relationship of medical schools' market competitiveness and graduating students' reports of inadequacy of instruction. More research is needed to confirm graduating students' perceptions of the inadequacy of their instruction in CCAs related to managed care, particularly once they have gained experience treating patients in managed care environments.

Ambulatory Care↗
PubMed2000

Pharmaceutical expenditure in Spain: cost and control.

In recent years, the Spanish government has been battling to keep pharmaceutical expenditures under control. Its measures include control of prices, introduction of a "negative list" of drugs no longer reimbursed, increased cost-sharing, and introduction of overall budgets for pharmaceutical expenditures. Although the average prices of old pharmaceutical products declined by 39 percent over the last 15 years and consumption in value increased by only 10 percent, real pharmaceutical expenditures in Spain increased by 264 percent over that period. The main reason for the continuing rise in these expenditures and the failure of cost-containment measures is the introduction of new, more expensive drugs, which often fail to offer any real therapeutic advantages over products already on the market. This situation is exacerbated by a lack of effective demand-side measures such as budgets for doctors and lack of a generics market.

Cost Control↗
PubMedDate not supplied

The Medicare prescription drug benefit: how will the game be played?

Most recent proposals to add a prescription drug benefit to the Medicare program suggest using pharmacy benefit managers (PBMs) to control costs and promote quality. However, the proposals give little detail on the institutional arrangements that would govern PBM operations and drug procurement. The recent Congressional Budget Office cost estimate of the Clinton administration's proposal reflects this lack of detail on how PBMs would function. We sketch an approach for structuring PBM operations that focuses on competition among PBMs, manufacturers, and distributors; incentive pricing; and risk sharing with PBMs.

Cost Control↗
PubMedDate not supplied

The impact of a national prescription drug formulary on prices, market share, and spending: lessons for Medicare?

Several recent bills in Congress to add a Medicare prescription drug benefit would allow the use of formularies to control costs. However, there is little empirical evidence of the impact of formularies among elderly and disabled populations. We assess the effect of a closed formulary implemented by the Veterans Health Administration (VHA) in 1997 on drug prices, market share, and drug spending. We find that the VHA National Formulary was effective at shifting prescribing behavior toward the selected drugs, achieving sizable price reductions from manufacturers, and greatly decreasing drug spending.

Aged↗
PubMed1993

A better pill to swallow.

New pharmaceutical technologies, new drugs, new formulations of existing drugs and changing patterns of consumption are contributing to rising pressure on pharmaceutical budgets. But even as the NHS drugs bill hits a new high, politicians are giving notice that action must be taken to control costs. Managers will be able to do so only if they understand the implications.

Cost Control↗
PubMedDate not supplied

[Quality is expensive].

Over the past decade, as pressure to control costs has accelerated, the term cost effective has come increasingly into common usage. The central purpose of cost-effectiveness analysis is to compare the relative value of different interventions in creating better health. This article presents the rationale for using such an approach to prioritize public and private healthcare programmes.

Cost Control↗
PubMed2002

[A review of methods for controlling medical costs from the point of view of cost-effectiveness].

Cost-effectiveness analysis is a method used to evaluate the outcomes and costs of treatments or interventions designed to improve health. It has been widely regarded as an important aid to providing health care services efficiently. This paper reviews several measures for controlling medical costs in Japan, where a fee-for-service system is employed to remunerate for medical services provision. From the point of view of cost-effectiveness, the first step in health care reform for controlling medical costs should be minimizing useless medical services because the cost-effectiveness ratio of these tends to infinity. For the purpose of minimizing unserviceable provision in the field of medicine, two approaches must be considered. One is establishing a system so that physicians can act as perfect agencies for their patients. The other is encouraging academic research on the effectiveness of medical services.

Cost Control↗
PubMed1997

Economic reduction of acidifying deposition in Finland by decreasing emissions in Finland, Estonia and Russia.

Here we consider cost-effective solutions of emission control measures in Finland and the nearby areas of Estonia, St. Petersburg region, Karelia and Kola, in order to limit the acidifying deposition in Finland. In the study, the emission control costs of SO2, NOx and NH3 are assessed for the areas studied and an optimisation model developed for calculation of cost-optimal deposition control policies. The input data of the model consist of the cost functions describing the emission control costs to achieve lower emission levels for the gases and areas considered and of dispersion coefficients which describe the deposition due to an emission source in the deposition receptor grid squares. In addition, the model includes a description to calculate the acidifying load. The optimisation is based on linear programming. When the acidifying load of Southern Finland is reduced by minimising the total control costs, approx, three quarters of the total control costs are due to measures in the nearby areas, Estonia, St. Peterburg region, Karelia and Kola, and approx. one quarter due to measures in Finland. The distribution of costs in the cost-optimised cases depends relatively little on the level to which the acidifying load due the source areas considered are required to be reduced. If the load reduction target is moderate, the emission control measures should mainly be allocated to sulphur emissions and to some extent to ammonia emissions and, if the load reduction target is stricter, also to the emissions of nitrogen oxides.

Acid Rain↗
PubMed2004

Comprehensive care of the epilepsy patient--control, comorbidity, and cost.

Traditionally, control of seizures in patients with epilepsy is viewed as the most important clinical outcome. Yet, current antiepileptic drugs (AEDs) do not always achieve this. Around 30-40% of patients remain uncontrolled despite pharmacological intervention. Poor tolerability of AEDs is a large part of the problem and contributes as much to the overall effectiveness of therapy as efficacy. Comorbid conditions are present in many patients, and appropriate management of these can further improve seizure control and quality of life. Patients with epilepsy often experience--among other disorders--neuropsychological effects, migraines, and psychological problems (especially anxiety and depression). Sleep disturbances are also common and have been shown to contribute to the intractability of seizures in some patients. Many anticonvulsant treatments have the potential to improve--or in some cases worsen--these concurrent conditions, and these properties should therefore be considered in the total care of the patient. Finally, the costs of uncontrolled epilepsy are measured not only in terms of direct healthcare-related costs, but also in terms of lost productivity and opportunity. The indirect costs of epilepsy are substantial and account for 70-85% of total disease-related costs. Patients with uncontrolled seizures contribute disproportionately to healthcare costs, reinforcing the need for the development of newer AEDs with improved profiles of efficacy and tolerability, but with minimal adverse effects on behavior, cognition, and sleep.

Anticonvulsants↗
PubMedDate not supplied

Controlling workers' compensation costs for prescribed medication.

The rise in prescription drug costs in workers' compensation cases has become alarming. According to the National Council on Compensation Insurance (NCCI), the prescription drug share of total medical costs by accident year increased from 6.5% in 1997 to 9.6% in 2001. Today, 10 cents of every dollar spent on medical care for workers' comp is spent on prescription drugs. Why the increase? The reasons vary; however, whatever the reason, it is critical to determine whether a prescribed drug is treating a work-related injury or another ailment unrelated to the injury. Knowing what questions to ask and where to go for additional information can help keep prescription medication costs under control.

Cost Control↗