Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Cost Allocation”

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 973 records · Page 54Linked to original sources
PubMed2001

Activity cost analysis: a tool to cost medical services and improve quality of care.

This paper suggests an activity-based cost (ABC) system as the appropriate cost accounting system to measure and control costs under the microstatistical episode of care (EOC) paradigm suggested by D. W. Emery (1999). ABC systems work well in such an environment because they focus on activities performed to provide services in the delivery of care. Thus, under an ABC system it is not only possible to accurately cost episodes of care but also to more effectively monitor and improve the quality of care. Under the ABC system, costs are first traced to activities and then traced from the activities to units of episodic care using cost drivers based on the consumption of activity resources.

Accounting↗
PubMed2003

Costs of dialysis for elderly people in the UK.

BACKGROUND: Growing acceptance rates of elderly patients for dialysis requires a careful planning of renal services expansion. As little is known about the actual resource use in patients 70 years and over, we evaluated the entire range of costs related to treatment, hospitalization, medication and other health and social service use, and assessed the impact of socio-demographic and clinical factors on costs. METHODS: Service use and costs were assessed in a 12-month prospective cohort study of 171 dialysis patients, 70 years of age and over, from four hospital-based renal units in London, UK. RESULTS: Total costs ranged between 14,940 pounds and 58,250 pounds per annum. The average annual cost was 22,740 pounds [95% confidence interval (CI), 21,470-24,020 pounds]. The majority of costs were allocated to dialysis treatment and transport (70%), hospitalizations (12%) and medication (12%). Other health and social services accounted for only 6% of total costs. Dialysis and hospitalization costs were pound 68.4 per day on average. Univariate subgroup analyses showed no significant difference between patients on peritoneal dialysis (64.5 pounds) and haemodialysis (71.5 pounds, P = 0.13). Age 80 years and over and presence of peripheral vascular disease (PVD) were associated with higher daily costs of 73.3 pounds compared with 63.2 pounds in the 70-74 age group (P = 0.033) and 76.9 pounds vs 63.8 pounds in patients without PVD (P = 0.022), respectively. Proximity to death was associated with a nearly pound 40 increase in daily costs (96.8 vs 59.7 pounds; P < 0.001). Multiple linear regression analyses confirmed these findings and showed that age 80 years and over and presence of peripheral and cerebrovascular disease were significant predictors of costs. There was a large but marginally significant difference in costs in patients with cancer. We found no evidence that diabetes was associated with higher dialysis and hospitalization costs. CONCLUSIONS: The costs of providing dialysis for patients 70 years and over are largely shaped by the treatment costs rather than by use of community health and social services. Though age above 80 and co-morbidity are associated with increased resource use, average treatment costs are not higher than estimates for dialysis patients in general. This suggests that there is no case for providing treatment to younger patients and denying it to elderly patients on grounds of cost.

Aged↗
PubMed2004

The risk-adjusted vision beyond casemix (DRG) funding in Australia. International lessons in high complexity and capitation.

Hospitals throughout the world using funding based on diagnosis-related groups (DRG) have incurred substantial budgetary deficits, despite high efficiency. We identify the limitations of DRG funding that lack risk (severity) adjustment for State-wide referral services. Methods to risk adjust DRGs are instructive. The average price in casemix funding in the Australian State of Victoria is policy based, not benchmarked. Average cost weights are too low for high-complexity DRGs relating to State-wide referral services such as heart and lung transplantation and trauma. Risk-adjusted specified grants (RASG) are required for five high-complexity respiratory, cardiology and stroke DRGs incurring annual deficits of $3.6 million due to high casemix complexity and government under-funding despite high efficiency. Five stepwise linear regressions for each DRG excluded non-significant variables and assessed heteroskedasticity and multicollinearlity. Cost per patient was the dependent variable. Significant independent variables were age, length-of-stay outliers, number of disease types, diagnoses, procedures and emergency status. Diagnosis and procedure severity markers were identified. The methodology and the work of the State-wide Risk Adjustment Working Group can facilitate risk adjustment of DRGs State-wide and for Treasury negotiations for expenditure growth. The Alfred Hospital previously negotiated RASG of $14 million over 5 years for three trauma and chronic DRGs. Some chronic diseases require risk-adjusted capitation funding models for Australian Health Maintenance Organizations as an alternative to casemix funding. The use of Diagnostic Cost Groups can facilitate State and Federal government reform via new population-based risk adjusted funding models that measure health need.

Australia↗
PubMed2005

A strategy for allocating central funds to support new faculty recruitment.

Requests for central funding for recruiting new faculty in academic health centers (AHCs) typically exceed available resources. The administration's prioritization of the requests, therefore, involves implicit or explicit predictions of the value of the potential faculty member to the institution. Optimal management dictates that the value of the recruit be assessed both on the extent to which they contribute to the organization's mission and on their capacity to generate revenues. The first premise of this article is that faculty recruits can be considered as "projects," and their potential value to the organization can be estimated in this context. The second premise is that the best way to determine a project's financial worth is by determining the net present value of each potential faculty recruit. The author models the combination of these premises and demonstrates that the approach allows for the more systematic prioritization of resource allocation for faculty recruitment in AHCs.

Academic Medical Centers↗
PubMed1978

Resource allocation. Some problems in applying the national formula to area and district revenue allocations.

The inadequacy of the current national formula in dealing with flows of patients across administrative boundaries is illustrated. In particular, the problems of dealing with varying admission rates for inpatients and in allocating revenues for outpatient services are discussed. We draw attention to an oversight in the recommendations concerning psychiatric services and criticise the general approach to the allocation of revenue under this heading. It is concluded that the national formula should not be applied for revenue allocation at district level in an unmodified form.

Catchment Area, Health↗
PubMed2006

The importance of comorbidity in analysing patient costs in Swedish primary care.

BACKGROUND: The objective was to explore the usefulness of the morbidity risk adjustment system Adjusted Clinical Groups (ACG), in comparison with age and gender, in explaining and estimating patient costs on an individual level in Swedish primary health care. Data were retrieved from two primary health care centres in southeastern Sweden. METHODS: A cross-sectional observational study. Data from electronic patient registers from the two centres were retrieved for 2001 and 2002, and patients were grouped into ACGs, expressing the individual combination of diagnoses and thus the comorbidity. Costs per patient were calculated for both years in both centres. Cost data from one centre were used to create ACG weights. These weights were then applied to patients at the other centre. Correlations between individual patient costs, age, gender and ACG weights were studied. Multiple linear regression analyses were performed in order to explain and estimate patient costs. RESULTS: The variation in individual patient costs was substantial within age groups as well as within ACG weight groups. About 37.7% of the individual patient costs could be explained by ACG weights, and age and gender added about 0.8%. The individual patient costs in 2001 estimated 22.0% of patient costs in 2002, whereas ACG weights estimated 14.3%. CONCLUSION: ACGs was an important factor in explaining and estimating individual patient costs in primary health care. Costs were explained to only a minor extent by age and gender. However, the usefulness of the ACG system appears to be sensitive to the accuracy of classification and coding of diagnoses by physicians.

Acute Disease↗
PubMed1993

Hospital pricing: cost shifting and competition.

The issue of cost shifting has taken on enormous policy implications. It is estimated that unsponsored and undercompensated hospital costs--one measure of cost shifting--has totaled $21.5 billion in 1991. The health services research literature indicates that hospitals set different prices for different payers. However, the empirical evidence on hospitals' ability to raise prices to one payer to make up for unsponsored care or lower payments by other payers is mixed at best. No study has concluded that hospitals have raised prices to fully adjust for such actions. The extent of cost shifting is limited by the market. When a hospital has market power, it is able to set prices above marginal costs. However, when a buyer has enough patient/subscribers and a willingness to direct them to particular providers based on price considerations, hospitals have less flexibility in raising prices above costs. Thus, the extent of cost shifting is limited by the market. Cost shifting is not as easy as it may have been in the past because the nature of hospital and insurer competition has changed radically in the last decade. While hospital quality, services, and amenities still matter, some buyers are increasingly concerned about the price they pay. Evidence from studies of PPO and HMO negotiations with hospitals suggests that hospitals' market power is eroding, at least in some areas. In areas with relatively few hospital competitors and little PPO or HMO activity, Medicaid and Medicare price reductions and uncompensated care burdens will be partially absorbed by higher prices paid by private payers. In more price sensitive markets and in markets in which prices to private payers have risen to those commensurate with the market power of local hospitals, such cost shifting will not occur. A market-based approach in hospital pricing requires an explicit policy for the uninsured. In a competitive market, a hospital that traditionally cared for the uninsured by spending some of its profits on them will be unable to do so, at least to the same extent as it did in the past. Increased competition in health care without consideration of the uninsured will decrease the uninsured's access to care.

Contract Services↗
PubMed1998

Needlesticks: who pays the price when costs are cut on safety.

Here is a syringe whose spring-loaded needle automatically retracts into the barrel of the syringe almost quicker than the eye can register--If you've never seen one, you're not alone. Despite the prevalence of needles engineered with safety features to prevent needlesticks, few organizations are using them. The reasons why go far beyond the expense of the syringe.

Blood-Borne Pathogens↗
PubMed1981

Medicare program; schedule of limits on hospital per diem inpatient general routine operating cost for cost reporting periods beginning on or after July 1, 1981: Health Care Financing Administration.

This notice sets forth a schedule of limits on hospital per diem impatient general routine operating costs that may be reimbursed under Medicare for cost reporting periods beginning on or after July 1, 1981. This is an annual update of the schedule, and will replace the current schedule, which was published in the Federal Register on June 20, 1980 (45 FR 41868). This schedule does not apply to the costs of special care units or ancillary services, to capital-related costs or costs of malpractice insurance, or to the costs a hospital allocates to the interns and residents (in approved programs) or nursing school cost centers on its Medicare cost report. The notice explains the methodology we used to compute the revised schedule of limits.

Cost Allocation↗
PubMed2000

Understanding the financial impact of covering new screening technologies. The case of automated Pap smears.

OBJECTIVE: To develop a decision tool facilitating understanding of the potential financial impact on managed care plans associated with automated primary screening for Pap smears. STUDY DESIGN: A baseline decision analytic model was developed with claims data from two managed care plans to replicate the treatment costs patients accrue subsequent to receiving a routine Pap smear with initial human review. Probabilities that a patient was at a particular decision point, as well as payments associated with that patient, were also determined empirically from the claims data. Clinical trial results for the AutoPap System (TriPath Imaging, Inc., Burlington, North Carolina) were incorporated into the model to develop an alternate scenario with 15% fewer false positives and 32% fewer false negatives. Sensitivity analyses were performed to model likely "real world" variation in laboratory results and treatment costs. Marginal costs associated with automated screening were calculated. Financial impacts were calculated in per member per month (PMPM) terms and included an incremental $20 payment for automated primary screening. Given that total PMPMs associated with health care delivery vary widely across the U.S., incremental impacts were also calculated from baseline PMPMs ranging from $80 to $160. RESULTS: PMPMs increased 5-10 cents, depending on baseline PMPM, test performance and treatment costs. CONCLUSION: Although costs rose with automated Pap smears, the costs shifted to the diagnosis and treatment of true positives.

Adolescent↗
PubMed2005

Measuring information technology investment among Canadian academic health sciences centres.

Many recent studies have attempted to accurately measure the expenditure by hospitals in the area of new information technology (IT), for example see Leonard 1998 and Pink et al. 2001. This is usually done as an exercise to compare the healthcare sector with other industries that have had much more success in implementing and leveraging their IT investment (Willcocks 1992; Chan 2000). It is normally hoped that such investigation would help explain some of the differences among the various industries and provide insight into where (and how much) future IT spending should occur in healthcare (Leonard 2004). Herein, we present the results from a study of eight Canadian academic health sciences centres that contributed data in order to analyze the amount of information technology spending in their organizations. Specifically, we focus on one specific indicator: the IT spend ratio. This ratio is defined as the percentage of total IT net costs to total hospital net operating costs, and aims to provide a "relative (or percentage) measure of spending" so as to make the comparisons meaningful. One such comparison shows that hospitals spend only 55% of the amount the financial services sector spends.

Academic Medical Centers↗
PubMed1995

Evaluation of medical cost lost due to smoking in Chinese cities.

Smoking induces substantial diseases on both individual and the whole society. To identify the true smoking-attributable economic loss, we introduce medical cost accounting as a means to calculate disease-specific medical cost, including inpatient and outpatient cost of those diseases caused by smoking. Medical cost is defined as health resource consumption in terms of money. Cost is allocated to department and services according to coefficient of benefit and operation time. The study in 1988 indicates that total smoking-attributable medical cost is 2.32 billion RMB Yuan in China, 1.70 billion RMB Yuan for outpatient, 0.62 billion RMB Yuan for inpatient. If indirect cost is included, the cost will be greater. Chronic obstructive emphysema has the highest proportion (55.41%) in smoking attributable medical cost.

Ambulatory Care↗
PubMedDate not supplied

Dynamic cost shifting in hospitals: evidence from the 1980s and 1990s.

The purpose of this paper is to determine whether dynamic cost shifting occurred among acute care hospitals during the period from the early 1980s to the early 1990s and, if so, whether market factors affected the ability to shift costs. Evidence from this study of California acute care hospitals during three time intervals shows that the hospital did practice dynamic cost shifting, but that their ability to shift costs decreased over time. Surprisingly, hospital competition and HMO penetration did not influence cost shifting. However, increasing HMO penetration (measured as the HMO percentage of hospital discharges) did decrease both net prices and costs for the early part of the study, but later was associated with increases in both.

California↗
PubMed1995

Geographical resource allocation in the English National Health Service, 1971-1994: the tension between normative and empirical approaches.

The policy response to the problem of developing a geographical resource allocation formula sensitive to relative population needs for hospital and community health services resources in the National Health Service demonstrates a continuing tension between normative and empirical solutions. Since 1988, the balance has shifted in favour of a more empirical approach to identifying and weighting population needs indicators in response to concerns about the theoretically justified, but essentially approximate, nature of the Resource Allocation Working Party formula introduced in 1977-1978. However, judgements and assumptions about the nature of 'need' have still to be made in order to construct a usable resource allocation formula since empirical data on what is cannot provide a complete guide to what ought to be a fair distribution of resources in relation to need.

Capital Financing↗
PubMed2006

Economic and social impact of epidemic and pandemic influenza.

Amidst the human suffering caused an influenza epidemic it is all too easy to overlook the disease's wider social and economic impact. Not only does influenza impose huge infrastructure demands on health care systems, but it exacts substantial economic costs in terms of sickness-related absenteeism, disrupted work schedules and lost productivity to society at large. Influenza accounts for around 10% of sickness-related absence from work in Europe where the likely cost of lost productivity in France and Germany, for example, ranges from 5.6 billion pounds to 8.5 billion pounds per year, according to ESWI estimates. But how to assess the full economic impact of influenza? The direct costs are easily enough identified, but what about the indirect costs? How should these be measured? How for example, does one assess the cost of lost opportunities, and what are the economic gains of vaccination regarding avoided costs? Finally, which target groups for vaccination would generate the greatest avoided costs? Leaving aside the moral implications of such a question, the fact remains that politicians and health policymakers need the cold hard figures to optimally allocate the costs of vaccination and preventative health campaigns. These issues and more were clearly delineated during this session, co-chaired by Drs. T. Szucs of the University of Zurich and K. Nichol of the University of Minnesota

Cost of Illness↗