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At least 973 records · Page 54Linked to original sources
PubMed2000

Sedation and sedationless endoscopy.

Sedation and analgesia are provided routinely for patients undergoing endoscopic procedures. This article reviews the clinical experience with the medications commonly used for this purpose. Furthermore, advantages and disadvantages of alternative agents are also discussed. There are multiple practice guidelines available to the gastrointestinal endoscopist and both the attributes and limitations of these guidelines are presented. In an effort to control costs and improve productivity, sedationless endoscopy has been introduced into the practice of some endoscopists. The advantages and limitations of sedationless endoscopy, as well as the clinical experience to date, are reviewed.

Analgesia↗
PubMedDate not supplied

Improving system performance: a case study in the application of the theory of constraints.

To thrive in a capitated managed care environment, health systems must enroll more lives to increase revenue, yet they must also control costs to remain viable. This article is a case study of how a team of junior managers and frontline providers solved this conflict for their government-owned health system. The team used a simple, elegant combination of a basic continuous improvement model and the theory of constraints. Using these tools, the team: Exposed a fundamental assumption that was hampering daily throughput; Shifted resources to key processes, improving overall system performance; Significantly increased primary care access with no increase in cost; and Devised a plan to increase capacity with a resource investment that has a payback period of less than two months. The effort has been so successful that the organization's leadership now requires all managers to attend theory of constraints training and has developed short-term and long-term plans to further exploit the team's gains. Although specific issues will be different in other organizations, the approach used is powerful in its simplicity and is easily replicable.

Cost Control↗
PubMed2000

Financial managers' costing expertise is needed in clinical trials.

In addition to providing comparable and verifiable evidence regarding outcomes, clinical trials could also serve as sources of accurate and replicable financial information. Trial reports that identify expenses associated with effective diagnostic and therapeutic interventions enable cost controls. Standardized cost calculations could help clinicians and administrators identify more efficient health care technologies. Unfortunately, relatively few published trials include economic analyses and when they do, data are incomplete. Based on analyses of 97 clinical trial reports, this article proposes a standard costing format. Health care financial managers have the costing expertise necessary to implement and interpret standardized cost calculations for clinical trials. With the active involvement of financial managers, a standard costing format for clinical trials can be achieved.

Clinical Trials as Topic↗
PubMed2000

Bumps on the managed care road: the search for an alternative model to reduce collisions between HMOs, physicians, and patients.

Managed care is experiencing political, litigious, and financial bumps on the road. There are various reasons for this bumpy ride: out-of-control costs, prescription drug expense, negative media reports, public revolt at denials of care or limited access to specialists, bad physician relations, patients' rights legislation, dropping health maintenance organization (HMO) stock prices, the ripple effect of the Harvard Pilgrim bankruptcy, and threat of massive litigation against HMOs. Two reasons not often mentioned, but explored in this article, are the orthodox managed care's flawed market model and lack of enough understanding of physician culture and emerging consumer trends to effectively address these two key constituencies.

Conflict, Psychological↗
PubMed2001

Capitation: a strategy that could have a future.

Capitation can be successful if hospitals, physicians, and payers share risk to align financial incentives to control costs. Payers need to help hospitals that accept risk to achieve success under managed care agreements. Many failures in hospital capitation might be preventable if hospitals improve internal operations and commit themselves to making the changes necessary for successful risk-based payment.

Aged↗
PubMed2004

Issues and challenges for managed care in the treatment of asthma and chronic obstructive pulmonary disease.

Managed care organizations (MCOs) and payers have become increasingly aware of the impact of asthma and chronic obstructive pulmonary disease on healthcare expenditures. The prevalence and incidence of both conditions continue to increase, even as new therapeutic modalities enter the market to offer treatment alternatives for these conditions. Although viewed by most payers as long-term conditions with expenditures that will not diminish, MCOs and payers have become more concerned with controlling costs and ensuring appropriate utilization.

Asthma↗
PubMed2005

Asthma treatment guidelines: how do we measure up?

The use of clinical guidelines for the management of asthma can help improve patient outcomes and control costs. This article explores ways that managed care organizations can encourage physicians to follow guidelines more consistently to achieve better asthma management outcomes among their patients and reduce healthcare spending.

Adult↗
PubMed1991

Priority setting: a sensible approach to Medicaid policy?

The state of Oregon is attempting a controversial restructuring of its Medicaid program that promises to apply effectiveness research to set priorities for medical care. Will the application of such methods control costs and improve access to necessary care for the poor as intended? This paper argues that the answer may depend more on the system used to deliver care than on the priority list itself. Capitated delivery systems may provide the flexibility to be responsive to individual patient needs, while "rationing" in the fee-for-service system risks denying some necessary services to the poor.

Cost Control↗
PubMedDate not supplied

Nursing services administration in Norway.

Despite the importance of nurse administrators to a nation's hospitals and health service, there are few systematic studies analyzing the environmental context of nursing administration and how nurses function to improve the quality of care, control costs and maintain morale. To rectify this situation--which is as true for Norway as for most nations of the world--an in-depth study was conducted of chief nurses in Norwegian hospitals. The aim was to improve understanding of 1) what nursing administration is like, 2) the demands made of nurse administrators in a variety of organizational and geographical contexts, and 3) the skills that are needed to be successful. Below, a report of the study.

Cost Control↗
PubMed1990

Managed care and the reorganization of Navy medicine.

Reports completed in 1988 by the Navy Inspector General and a Blue Ribbon Panel evaluated Navy medicine. They found serious problems and expressed dissatisfaction with both the organization and effectiveness of management. These findings formed the basis for a reorganization that was recommended to the Vice Chief of Naval Operations. A program of managed care was proposed to help control costs. The reorganization establishes a partnership between line officers, who will have command over medical facilities, and a more specialized healthcare establishment that will focus on resource planning and providing quality care.

Cost Control↗
PubMed1990

Legislation, litigation, health policy and optometry.

Significant changes in health policy have occurred during the past 25 years. Directed primarily by congressional legislation and judicial opinion, many of these changes have resulted from efforts to control costs, improve quality and increase access. Optometric parity, reimbursement reform, freedom of choice, mandated benefits, commercial speech, self-insurance, competition and peer review are some of the issues that surround many of the more recent attempts at change in the health care market. Optometry has been and will continue to be affected by changes in health policy, especially with regard to issues of cost, quality and access.

Cost Control↗
PubMed1990

Promotion of extended-release niacin tablets at a Veterans Affairs medical center.

A program to modify the prescribing of antilipemic agents by promoting the use of extended-release niacin tablets is described. Between December 1987 and August 1988, pharmacists at a 1188-bed Veterans Affairs medical center observed a large increase in the number of outpatient prescriptions for antilipemic agents. In an attempt to control costs, a program to promote the use of extended-release niacin tablets for treating hyperlipemia was conducted during August and September 1988. Various educational materials on niacin were distributed to physicians. A display on therapy of hyperlipemia was featured at the monthly drug fair, and articles on niacin were presented during a journal club meeting of ambulatory-care clinicians. Pharmacists succeeded in having extended-release niacin tablets placed on the formulary in September. Data on the number of prescriptions filled for antilipemic agents were collected before and after the niacin promotional program. The number of prescriptions filled for extended-release niacin 500-mg tablets increased steadily during a six-month study period after the program ended; the number of prescriptions filled for regular niacin decreased by 50%. As prescribing of extended-release niacin increased, prescribing of colestipol, gemfibrozil, and probucol declined. The promotional program was well received by most of the medical staff. A program of education and formulary management successfully changed physician prescribing habits for antilipemic agents.

Cost Control↗
PubMed1990

Volume performance standards: can they control growth in Medicare services?

Congress has adopted volume performance standards (VPSs), a system using collective incentives, as a means to control costs of physicians' services under the Medicare program. Past efforts to curb expenditures failed to focus sufficiently on providing direct incentives to individual providers or consumers, and did not achieve desirable results. West German and Canadian experiences suggest that mechanisms to contain costs may work best when their scope is regional rather than national, prompting the view that the VPS system should operate on a state level. The system's efficacy may also require Medicare officials to analyze utilization patterns assiduously, and states' medical and professional organizations to monitor physicians' practices and formulate due practice guidelines.

Cost Control↗
PubMed1979

Benefits of self-insured hospitalization programs.

As part of hospitals' continuing efforts to control costs, many have begun to consider implementing self-insured hospitalization programs for their employees. Not only can self-insurance provide cash flow savings and actual cost savings but it can also promote prevention among hospital employees.

Accounts Payable and Receivable↗
PubMed1983

Cost analysis and cost justification of automated data processing in the clinical laboratory.

Prospective cost analysis of alternative data processing systems can be facilitated by proper selection of the costs to be analyzed and realistic appraisal of the effect on staffing. When comparing projects with dissimilar cash flows, techniques such as analysis of net present value can be helpful in identifying financial benefits. Confidence and accuracy in prospective analyses will increase as more retrospective studies are published. Several accounts now in the literature describe long-term experience with turnkey laboratory information systems. Acknowledging the difficulty in longitudinal studies, they all report favorable effects on labor costs and recovery of lost charges. Enthusiasm is also expressed for the many intangible benefits of the systems. Several trends suggest that cost justification and cost effectiveness will be more easily demonstrated in the future. These are the rapidly decreasing cost of hardware (with corresponding reduction in service costs) and the entry into the market of additional systems designed for medium to small hospitals. The effect of broadening the sales base may be lower software prices. Finally, operational and executive data management and reporting are destined to become the premier extensions of the LIS for cost justification. Aptly applied, these facilities can promote understanding of costs, control of costs, and greater efficiency in providing laboratory services.

Computers↗
PubMed1984

The private management of public hospitals.

Since the public sector traditionally has provided the public goods viewed as unprofitable by the private sector, the growing trend to manage public hospitals under outside private contract raises some fundamental issues of concern. It is hypothesized here that the system maintenance and output goals of privately managed public hospitals become increasingly similar to those of investor-owned hospitals. The thesis is empirically tested using documented effects of private contract management on the operative goals of short-term, general hospitals owned by local governmental bodies. Traditionally managed public hospitals matched with the study hospitals on important characteristics serve as the control group. Costs do appear to be reduced under private contract management, but the service structure becomes somewhat altered. It is the task of public health policymakers to reconcile the cost-control and efficiency mechanisms brought about by private management with the community's right of access to comprehensive medical care. Carefully structured regionalization plans--a possible means of providing both--will require the stimulation of more government involvement during an era of cutbacks.

Contract Services↗
PubMed1980

The primary care network--a new type of HMO for private practice physicians.

A new type of health maintenance organization has been developed to encourage primary care physicians in private practice to become coordinators and financial managers for all medical care. Each patient chooses one internist, family or general physician, or pediatrician and must be referred by that physician for all hospital admissions and care by specialists. The primary care physician authorizes all payments from his own account for care provided to his patients. He shares any deficit or surplus remaining at the end of the year. Hospital admission rates and length of stay are lower than those of Blue Cross, with only one of three dollars paid to hospitals. The plan is providing care to 38,000 persons with 750 participating physicians in Northern California, Washington and Utah. This plan represents an attempt by physicians to control costs without government regulation.

Cost Control↗
PubMed1995

The abnormal mammogram in women with clinically normal breasts.

OBJECTIVES: To assess the impact of unnecessary referrals to breast surgeons as a result of abnormal mammograms in women with clinically normal breasts and to determine measures to make the management of such women more efficient. DESIGN: A case study. SETTING: A breast clinic in a university-affiliated hospital. PATIENTS: From among 6477 women referred for surgical breast assessment, 475 with asymptomatic, clinically normal breasts were referred solely on the basis of an abnormal mammogram. INTERVENTIONS: Mammography and breast biopsy. MAIN OUTCOME MEASURES: Need for surgical assessment as a result of mammographic findings, number of biopsies and the diagnosis of cancer. RESULTS: Clinically a breast abnormality was evident in 63 (13%) women and a malignant lesion in 14 of them (2.9% of the total). Of the 412 women who were confirmed as having clinically normal breasts, only 139 (33.7%) had mammograms originally reported as suspicious for cancer. After the mammograms were reviewed, 79% of women with such a suspicious mammogram underwent mammographic localization and biopsy: a malignant lesion was confirmed in 36.4% of these. Of the 475 women referred for assessment, only 202 (42.5%) had a significant clinical or mammographic abnormality. Of the 412 women with clinically normal breasts only 110 (26.7%) required a biopsy and only 40 (9.7%) had cancer. CONCLUSIONS: Most women referred because of an abnormal mammogram have no significant problem or have one that can be resolved without surgical referral. Screening efficiency can be improved, patient anxiety controlled and cost controlled by a number of recommended measures.

Adult↗