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PubMed2000

Better Medicare Cost Report data are needed to help hospitals benchmark costs and performance.

To evaluate costs and achieve cost control in the face of new technology and demands for efficiency from both managed care and governmental payers, hospitals need to benchmark their costs against those of other comparable hospitals. Since they typically use Medicare Cost Report (MCR) data for this purpose, a variety of cost accounting problems with the MCR may hamper hospitals' understanding of their relative costs and performance. Managers and researchers alike need to investigate the validity, accuracy, and timeliness of the MCR's cost accounting data.

Accounting↗
PubMed1999

Service utilization and cost of community care for discharged state hospital patients: a 3-year follow-up study.

OBJECTIVE: This study examined the mental health service utilization and costs of 321 discharged state hospital patients during a 3-year follow-up period compared with costs if the patients had remained in the hospital. METHOD: The study subjects were long-stay patients discharged from Philadelphia State Hospital after 1988. A longitudinal integrated database on all mental health and medical services reimbursed by Medicaid and Medicare as well as state- and county-funded services was used to construct service utilization and unit cost measures. RESULTS: During the 3-year period after discharge, 20%-30% of the patients required rehospitalization an average of 76-91 days per year. The percentage of rehospitalized patients decreased over time, but the number of hospital days increased. All of the discharged patients received case management services, and a majority also received outpatient mental health care (66%-70%) and residential services (75%) throughout the follow-up period. The total treatment cost per person was approximately $60,000 a year after controlling for inflation, with costs rising slightly over the 3-year period. The estimated cost of state hospitalization, with the use of 1992 estimates, would have been $130,000 per year if the patients had remained institutionalized. CONCLUSIONS: This analysis suggests that most former long-stay patients are able to live in residential settings while receiving community outpatient treatment and intensive case management services at a reduced cost. There is no indication of cost shifting from the psychiatric to the health care sector; however, some cost shifting from the state mental health agency to the Medicaid program has occurred, since most psychiatric hospital care now takes place in community hospitals.

Adult↗
PubMedDate not supplied

Trendstar at Flinders Medical Centre.

Trendstar provides Flinders Medical Centre with a reliable management tool that facilitates appropriate resource allocation and ensures that those resources are utilised efficiently. The system supports our aim to provide high quality, cost effective care for our clients.

Accounting↗
PubMedDate not supplied

Cardiovascular physiology as a basis for clinical and financial outcomes.

This article examines a test program that requires documentation of clinical outcomes before reimbursement will be issued. The battle between financial responsibility and clinical success at any cost is being driven by many influences, and health care professionals are in the middle.

Accounting↗
PubMedDate not supplied

Using cost-effectiveness/cost-benefit analysis to allocate health resources: a level playing field for prevention?

INTRODUCTION: Prevention is being promoted as a means to improve health status and to save health care costs. Economic evaluations of prevention (i.e., cost-effectiveness and cost-benefit analyses) indicate that some prevention activities, like many treatments, do not save money, although many are relatively cost-effective. It has been suggested, however, that prevention is held to a higher standard than treatment because prevention programs are expected to demonstrate cost savings, and that the methods of economic evaluation understate the cost-effectiveness of prevention. Although the converse assertion is less commonly made, economic evaluations may also overstate the cost-effectiveness of prevention. The purpose of this article is to examine how the methods of economic evaluation may systematically understate, or overstate, the cost-effectiveness (or net benefits) of prevention. METHODS: We examine three key methods: (1) how future costs and benefits are valued ("discounting"), (2) how costs and benefits to people beyond those who are the users of prevention are valued ("externalities"), and (3) how nonmonetary costs and benefits to individuals are valued ("intangibles"). RESULTS: We discuss several recommendations for each key method, and we use a hypothetical example of the cost-effectiveness of a vaccine to prevent human immunodeficiency virus (HIV) to illustrate our points. CONCLUSIONS: We conclude that the methods of economic evaluation may both understate and overstate the cost-effectiveness of prevention.

Cost-Benefit Analysis↗
PubMed2005

A life history model of somatic damage associated with resource acquisition: damage protection or prevention?

A resource acquisition-allocation model is developed to examine the trade-off between reproduction and somatic protection. Unlike previous studies, resource intake is not assumed to be constrained: instead, resource intake is free to vary, with increased intake being associated with an increased risk of somatic damage. This gives rise to an optimal resource intake as well as an optimal allocation strategy. This paper studies the relative importance of acquisition and allocation strategies in regulating acquisition-related mortality. Under the optimal allocation strategy mortality rate increases with age, in accordance with the disposable soma theory of aging. Contrary to the usual interpretation of the disposable soma theory, this increase in mortality can arise from an increase in the resource acquisition effort rather than a decrease in the resources allocated to protection. At early ages resource acquisition is found to be the primary path for regulating life history costs, whilst allocating resources to protection becomes more important later in life. Models for targeted and non-targeted damage repair are considered and the robustness of our results to the structure and parameterization of the model is discussed. The results from our models are discussed in light of published data. Resource acquisition is shown to be a potentially important mechanism for controlling somatic damage which deserves further study.

Aging↗
PubMed2004

Economic aspects on drug therapy of dementia.

The great number of people suffering from dementia present a great challenge for the health care and social support systems. In a situation where resources are scarce, health economical aspects of dementia care are of great importance in order to identify cost-effective care. However, the literature in this field is limited. There are also aspects where there methodological development is necessary (e.g. informal care, quality of life, long term effects). In the absence of prospective long term data, it is necessary to use pharmacoeconomical models. It is also important to have population based data for the description of how resources and costs are allocated between the different care sectors. Current data show that there is a strong relationship between cognitive functioning and costs. The number of pharmacoeconomical evaluations of drugs influencing on the symptomatology of dementia is low. Available data show that there is support for a view that treatment is cost-neutral or perhaps cost saving which in combination with positive effects in terms of efficacy may indicate cost-effectiveness.

Caregivers↗
PubMedDate not supplied

[Health at cost? Meeting of the FICOSSER Inter-Center Collaborative Research Group on Health Cost Containment Policies (Barcelona, Spain, 19-21 April 1993)].

The Catalunyan Health Service describes its innovating approach based on the conventional bedday average cost for allocating resources to hospital. The model developed at the University of Newcastle, New South Wales, Australia, aims at reducing cost through quality improvement. The Center for Health Policy Research, University of Florida, USA, suggests a renovated DRG's model of reimbursement based on hospital outcomes. A typology of reimbursement to providers is designed by the National School of Public Health of Brazil. The health cost experience and the impact of co-payment policy in Korea is described by the Institute for Health Services Research of the University Yonsei in Seoul. The paper presented by the Australian National University, Canberra, tries to identify the factors contributing to curbing growth rate of health costs in Australia. Drug utilization in Poland is analyzed by the Department of Social Medicine of the Medical University of Lodz, Poland. The current reform of the Hungarian health system is described by the Department of Social Medicine of the Medical University of Debrecen, Hungary. The specific issues of a health system in a fast-growing economy, which however will be burdened by population aging in less than 3 decades, are analyzed by the Division of Health Care of the National University of Singapore. The Center for Health Policy Research of the American Medical Association displays economic calculations which show that, from the consumer's point of view, health costs are far from being too high. The Université de Bourgogne lays down the economic foundations for a containment policy based on professional ethics.

Cost Control↗
PubMedDate not supplied

Projecting the cost of essential services in Bangladesh.

Utilizing a study of the costs of providing essential services in rural areas in Bangladesh projections of the cost of expanding services to the entire rural population are derived. These estimates are based on the current system of primary care, the demographic structure of the population and normatives for desired utilization. Scenarios make use of known demographic characteristics of average rural areas together with information on disease prevalence. The estimates highlight a number of difficulties involved in deriving costs and in comparing the cost-effectiveness of service provision. The integrated nature of much primary care, both in terms of the technical exploitation of joint costs and clinical diagnostic and treatment protocols, means that treating services in isolation is likely to lead to inexact estimates of service cost. The context of any costs derived is required in order to make comparisons.

Bangladesh↗
PubMed2003

The effect of activity-based financing on hospital efficiency: a panel data analysis of DEA efficiency scores 1992-2000.

Activity-based financing (ABF) was implemented in the Norwegian hospital sector from 1 July 1997. A fraction of the block grant from the state to the county councils has been replaced by a matching grant depending upon the number and composition of hospital treatments. As a result of the reform, the majority of county councils have introduced activity-based contracts with their hospitals. This paper studies the effect of activity-based funding on hospital efficiency. We predict that hospital efficiency will increase because the benefit from cost-reducing efforts in terms of number of treated patients is increased under ABF as compared with global budgets. The prediction is tested using a panel data set from the period 1992-2000. Efficiency indicators are estimated by means of data envelopment analysis (DEA) with multiple inputs and outputs. Using a variety of econometric methods, we find that the introduction of ABF has improved efficiency when measured as technical efficiency according to DEA analysis. The result is less uniform with respect to the effect on cost-efficiency.

Cost Allocation↗
PubMed1998

The cost of treating paediatric malaria admissions and the potential impact of insecticide-treated mosquito nets on hospital expenditure.

OBJECTIVE: To calculate the costs at Kilifi District Hospital (KDH) and Malindi Sub-district Hospital (MSH) of treating paediatric malaria admissions including three common presentations of severe paediatric malaria, i.e. cerebral malaria, severe malaria anaemia and malaria-associated seizures; and to estimate the implications for hospital expenditure of a reduction in paediatric malaria admissions. METHODS: Patient data were obtained from hospital records. All costs were allocated to departments that provided direct patient care by a four-stage step-down procedure. Laboratory and drug costs of treating paediatric malaria admissions were separately identified. RESULT: Unit recurrent costs per admission in KDH ranged from US $57 for 'other' paediatric malaria to US $105 for cerebral malaria, and in MSH from US $33 to US $44 for the same categories. The annual recurrent cost of treating all paediatric malaria admissions to KDH prior to the trial was estimated at US $78 900. Adjusting for preintervention differences in malaria admission rates and age between intervention and control areas, the ITBN trial found a 41% reduction in paediatric malaria admissions. The reduction in admissions resulted in an estimated saving of US $6240 in the cost of treating paediatric malaria admissions from the intervention area. CONCLUSION: There would be a substantial reduction in costs of treating paediatric malaria admissions if the intervention were introduced in the whole catchment area of the hospital. Actual savings would depend on the proportion of potential savings that can in practice be realised, and on the effectiveness of the intervention when routinely implemented.

Anemia↗
PubMed1995

A review of cost studies of intensive care units: problems with the cost concept.

OBJECTIVE: To study methods for costing hospital services, specifically in relation to multi-unit studies of activity, case mix, severity of illness, outcome, and resource use in adult intensive care units (ICUs). DATA SOURCES: Twenty published cost studies of adult ICUs. The studies are all published in English and are both European and American. STUDY SELECTION: Cost studies of adult ICUs published in international journals (English language). DATA EXTRACTION: Literature survey, where the articles were obtained through MEDLINE and other database searches. DATA SYNTHESIS: Cost of intensive care therapy was compared across the 20 studies. However, as stressed in the article, to compare costs of intensive care therapy across units is not possible for a number of reasons. One of the reasons for this limitation is that the studies employed different approaches to costing and thereby introduced a methodologic bias. In addition, the costing methodology applied in the majority of the studies was wrongly specified in relation to the purpose and viewpoint of the studies. CONCLUSIONS: The methodologies for costing ICU therapy are flawed and fail to provide correct answers. In most studies, the study question is not adequately specified and the cost concept used in the studies is not tailored to the purposes of the study. Standardizing the cost model would lead to better, faster, and more reliable costing. This standardized cost model should not be rigid, but adaptable to different decision situations. A decision tree or taxonomy is proposed as a way toward better costing of ICU activity.

Bias↗
PubMed1992

Cost of urology: financial audit in a clinical department.

OBJECTIVES: To cost a clinical unit over one month in 1991, to cost treatment of individual patients from audit data, and to compare this costing method with the hospital charging system. DESIGN: A financial breakdown was obtained for one month's work. Ward stay, operating time, investigations, and outpatient visits were costed and a formula (episode = days on ward+hours of operating+investigations+outpatient visits) was used to cost patient episodes from audit data. SETTING: The adult urology unit in a teaching hospital. MAIN OUTCOME MEASURES: Costs for each part of patients' treatment. RESULTS: Total cost was 147,796 pounds for 159 admissions, 738 inpatient days, 131 operations in 29 operating lists, and 615 outpatient visits. An uncomplicated transurethral prostatectomy cost 1140 pounds but complications increased this to 1500 pounds in another patient. The costs of diagnostic cystoscopy were 130 pounds in outpatients, 240 pounds in day surgery, and 430 pounds in inpatients. Hospital charges do not reflect the individual costs of treatment, charges being greater than costs for some patients and lower than costs for others. CONCLUSIONS: Clinicians can produce a financial analysis of their work and cost their patients' treatment. Audit is strongly advocated as a resource planning tool.

Adult↗