Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Cost Control”

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 991 records · Page 55Linked to original sources
PubMedDate not supplied

Blueprint for integrating nurse extenders in critical care.

As more and more hospitals use the techniques of work restructuring to reduce their operating budget, no nursing department can escape change. Intensive care units can effectively and economically change skill mix by using a design that incorporates essential staff input and a structured educational program. Implementing a Patient Care Specialty Technician role in critical care serves as a driving force to control costs while maintaining quality care and patient satisfaction.

Cost Control↗
PubMed1994

Alternative volume performance standards for Medicare physicians' services.

The Omnibus Budget Reconciliation Act of 1989 (OBRA89) established volume performance standards (VPSs) as a key element in Medicare physician reform. This policy requires making choices along three dimensions: the risk pool, the scope and nature of the standard, and the application of the standard. VPSs have most effectively controlled expenditures and changed physician behavior when they use states as the risk pool, are composed entirely of Medicare Part B services, and establish per capita utilization targets. The institution of separate standards for voluntarily formed physician groups would pose substantial administrative challenges and has the potential to effect adverse outcomes. Instead, Congress should continue to encourage prepaid plans for the purpose of lowering health care use. Under current law, VPSs will be used to adjust future price increases. Congress may not wish to emulate the example of countries that have imposed expenditure ceilings to control costs unless the current method of using VPSs proves unsuccessful.

Canada↗
PubMed1994

Physicians in health care management: 5. Payment of physicians and organization of medical services.

The financing, payment and organization of medical services are closely related. Canada's health care system is financed publicly, from tax revenue, and administered in each province by a single government payer. Although the chief method of payment to physicians is fee for service (FFS), the need to control costs and organize practice more efficiently has led to increased interest in FFS variants, such as capping payments at a certain level or fixing a budget, and alternative payment methods such as capitation-based payment, salary and combinations of these methods. Although solo practice is reportedly still the chief method of practice organization, it is being steadily replaced by arrangements in which physicians share expenses or calls, and by formal partnerships and group and team practices. As medical practice in Canada continues to shift from solo to group and team practice alternative payment methods that facilitate these models will become more common.

Canada↗
PubMed1995

Point of care computing and its relevance to the United States' health care reform movement.

Reform of the U.S. health care delivery system is underway. In a nation spending close to 14% of its gross national product on health care, more than any other nation, and with an estimated 40 million Americans left uninsured, it is likely that significant changes will occur as part of this era of reform [1]. Innovative and judicious technology applications will serve as enablers as the U.S. seeks to provide universal access to health care services while controlling costs. The ability to access, collate, and interpret information at the point of care is essential to the basic restructuring of health care service delivery. This paper will present changes occurring within the U.S. health care industry and describe how information technology can be applied to reshaping the health care delivery system to optimize services at the point of care.

Catchment Area, Health↗
PubMed1996

A new paradigm for increasing access to dental care: the Oregon Health Plan.

The Oregon Health Plan, one of the most controversial health care proposals to emerge in recent years, was implemented on February 1, 1994. The plan's intent was to control cost and increase access to health care for Oregon's low-income and Medicaid population. A key feature was limiting covered services to a state-approved list created by an open public process. Services were ranked from most important to least important, with covered services to be determined by available funding. For the first time, the listing included a merged set of medical and dental services, with many dental services ranked higher than medical services. Oregon's Medicaid program, which previously did not cover any adult dental care, now has one of the most generous set of Medicaid dental benefits in the United States. From the perspective of increasing access to dental care, this article suggests that the dental profession should re-examine its current policy supporting the separation of medical and dental benefit packages.

Adolescent↗
PubMed1997

[Internal medicine in the last 40 years].

Internal medicine in the last 40 years has known many eminent teachers at universities, such as Hijmans van den Bergh, Van Buchem, Borst, Mulder, Lindeboom, De Langen, Hulst, Jordan, Formijne, Major, Snapper, Groen and Querido, and others outside universities such as Stuyt, Van Hees, Eindhoven, Pannekoek, Schalm, Bruins Slot, Heeres, Stolte and Pompen. The main scientific platform on which the bequeathors assembled in the first few decades after World War II was the Algemene Ziektekundige Vereniging ('General Medical Association'), which met in Utrecht. Important medical steps forward in that period were the virtually complete eradication of tuberculosis in the Netherlands, the developing of vaccines against smallpox and polio, but also against the various types of virus hepatitis, and the progress in intensive care, transplantation and molecular biology. The Nederlandsche Internisten Vereeniging ('Dutch Association of Internists') has had its own scientific journal since 1958. Essentials in modern internal medicine are appropriate care and demonstrated usefulness of a treatment (evidence-based medicine); standards, values and ethics are core issues, as are quality control and cost control. Change is also in progress in the doctor-patient relationship, as manifested in the Wet Geneeskundige Behandelingsovereenkomst ('Medical Treatment Accord Act').

Critical Care↗
PubMed1998

Demand management: another marketing tool or a way to quality care?

Demand management tools are population-based strategies used to control costs and improve utilization of services by assisting health consumers in maintaining their health and seeking appropriate health care. These tools are increasingly used by health care delivery systems and, in the US, by fiscal intermediaries, such as insurance companies. If these tools are not properly applied, there is a clear possibility that their use may lead a reduction of health care services with no improvement in clinical, humanistic, or economic outcomes. Demand management effectiveness has not been rigorously examined by the medical industry or academia. Before adopting or purchasing demand management technologies, health care systems should examine them carefully to determine how the tools were developed and who they were intended to serve. Once implemented, careful tracking of population outcomes is as necessary with these technologies as with any other technologies that can affect health care.

Cost Control↗
PubMedDate not supplied

Overtime reduction with the press of a button. An unexpected outcome of computerized documentation.

Overtime takes its toll on the staff and creates an opportunity to control cost. The purpose of this research was to investigate actual and perceived overtime amounts of nursing staff members before and after the implementation of a handheld computerized patient documentation system. Overtime amounts have decreased 29% since implementation of the system. Advantages and disadvantages of the system are also discussed.

Cost Control↗
PubMed1994

[Analysis of direct costs of controlling arterial hypertension].

OBJECTIVE: To analyse the number of attendances and the direct cost of pharmaceutical prescription arising from a year-long monitoring of hypertense patients. SETTING: Health Centre. DESIGN: A prospective observation study. PATIENTS: 220 hypertense patients, undergoing arterial pressure (AP) monitoring, were chosen by means of systematic random sampling. MEASUREMENTS AND MAIN RESULTS: The variables of age, gender, cardiovascular risk factors, AP, monitoring level (criterion AP < 160-90 mmHg), attendances and treatment used were analysed. The pharmaceutical cost was calculated in line with the dosages and according to the 1990 Vademecum. The monitoring level was 43.6%. The total number of attendances per patient were 12.8 +/- 6.43 and those for hypertension, 7.9 +/- 3.5. Diabetics attended more for hypertension (8.8 vs 7.5, p < 0.05). Pharmaceutical treatment was prescribed for 183 people (83.2%). The number of drugs was correlated with the severity of the hypertension and the number of attendances. Overall drug cost was 429,571 pesetas per month. Average monthly cost per patient was 2,348.69 +/- 2,318.92 pesetas (range 90.5-12,856.5). Angiotensin enzyme conversion inhibitors (AECI) made for the greatest monthly mean cost per patient (4,352.9 pesetas) and diuretics, the least (322.2 pesetas). CONCLUSION: Frequency of attendance is related to the presence of diabetes and the number of drugs prescribed. The introduction of AECI and Calcium antagonists into first-line treatment represents an important increase in the cost of controlling Hypertension.

Adult↗
PubMed2004

Tiered chemical testing: a value of information approach.

In December 2000 the EPA initiated the Voluntary Children's Chemical Evaluation Program (VCCEP) by asking manufacturers to voluntarily sponsor toxicological testing in a tiered process for 23 chemicals selected for the pilot phase. The tiered nature of the VCCEP pilot program creates the need for clearly defined criteria for determining when information is sufficient to assess the potential risks to children. This raises questions about how to determine the "adequacy" of the existing information and assess the need to undertake efforts to reduce uncertainty (through further testing). This article applies a value of information analysis approach to determine adequacy by modeling how toxicological and exposure data collected through the VCCEP may be used to inform risk management decisions. The analysis demonstrates the importance of information about the exposure level and control costs in making decisions regarding further toxicological testing. This article accounts for the cost of delaying control action and identifies the optimal testing strategy for a constrained decisionmaker who, absent applicable human data, cannot regulate without bioassay data on a specific chemical. It also quantifies the differences in optimal testing strategy for three decision criteria: maximizing societal net benefits, ensuring maximum exposure control while net benefits are positive (i.e., benefits outweigh costs), and controlling to the maximum extent technologically feasible while the lifetime risk of cancer exceeds a specific level of risk. Finally, this article shows the large differences that exist in net benefits between the three criteria for the range of exposure levels where the optimal actions differ.

Animals↗
PubMed1998

Fundamentals of financial statement analysis for academic physician managers.

Academic medical centers (i.e., teaching hospitals) and academic medical practices are under pressure to control costs to compete with for-profit health care institutions. The authors explain how academic physician managers who want to control costs wisely must first understand the cost structure of the medical center or practice and compare that structure with those of for-profit institutions. Doing this requires a firm understanding of how to use a valuable tool, financial statement analysis, to assess an institution's health and performance. Such analysis consists of calculating a variety of financial ratios (e.g., operating income divided by revenues; net income divided by total assets) and then comparing them with the corresponding ratios that are considered industry norms. Three types of financial statements (defined in detail) lend themselves to this approach: the balance sheet, income statement, and statement of cash flows. The authors define standard financial ratios, point out their uses and limitations, and emphasize that a ratio's meaning derives from comparing it with the corresponding benchmark ratio in the industry as a whole. Ratios should be used not as the end point of assessing financial status, but as ways to identify possible problems that require further investigation. Analysis of trends of ratios over time within an institution is a complementary approach. The authors then discuss the use of ratios in three standard types of institutional evaluation: of performance, of liquidity and leverage, and of strategic planning. In addition, they present the financial statement of a fictitious academic medical center as an example of how to use ratios for financial statement analysis. The authors emphasize that the key to using the ratios they discuss and hundreds of others is first to decide what question needs answering and then to choose the relevant ratios to provide a basis for finding the answer.

Academic Medical Centers↗
PubMed2000

Detection of Bordetella pertussis in a clinical laboratory by culture, polymerase chain reaction, and direct fluorescent antibody staining; accuracy, and cost.

Control of Bordetella pertussis in the community is hampered by slow and insensitive diagnostic tests. We therefore examined the accuracy and cost of culture, direct fluorescent antibody (DFA) staining, and PCR in a routine clinical laboratory. Six hundred thirty seven nasopharyngeal swabs and aspirates in casamino acids transport medium were cultured, stained with polyclonal (Difco), and monoclonal (BL-5 and Accu-Mab) anti-B. pertussis reagents, and amplified by an IS481-specific PCR. PCR products were detected by a hybridization-enzyme immunoassay kit (Gen-eti-k DEIA, DiaSorin), with confirmation by a second PCR in a separate laboratory. Sensitivities and specificities of culture, polyclonal DFA, monoclonal DFA, and PCR were 36 and 100%, 11.4 and 94.6%, 8.3 and 98. 4%, and 95.0 and 99.3%, respectively, with a prevalence of 15.7%. The DFA tests were the most economical, and the PCR cost was 31% higher than culture. This study suggests that with minor improvements in economy, pertussis PCR can be implemented in a clinical laboratory with marked improvement in diagnostic accuracy.

Bordetella pertussis↗
PubMed2004

The consumer-driven approach: defining and measuring success.

Employers' reluctance to implement consumer-driven health plans (CDHPs) is at least in part due to their not understanding how to define and measure the success of CDHPs. To assist employers, the authors define potential points of success for CDHPs in the areas of consumer engagement, consumer financial considerations and employee health and productivity. They then offer ways of measuring success in those areas, as well as in the area of employer cost control. By taking a carefully considered approach to the decision of whether to offer a CDHP, employers can grasp potential opportunities to control health care costs.

Adult↗
PubMed2001

WellPoint taking new approach to controlling 'vampire drugs'.

Are pharmaceutical costs sucking too much money out of the system? A California health plan is getting ready to introduce the newest thing in drug cost controls--reference pricing. They'll tell what they'll pay for, and stop talking about what they won't pay for.

Cost Control↗
PubMed2004

Rate control is more cost-effective than rhythm control for patients with persistent atrial fibrillation--results from the RAte Control versus Electrical cardioversion (RACE) study.

Aims To evaluate costs between a rate and rhythm control strategy in persistent atrial fibrillation. Methods and results In a prospective substudy of RACE (Rate control versus electrical cardioversion for persistent atrial fibrillation) in 428 of the total 522 patients (206 rate control and 222 rhythm control), a cost-minimisation and cost-effectiveness analysis was performed to assess cost-effectiveness of the treatment strategies. After a mean follow-up of 2.3+/-0.6 years, the primary endpoint (cardiovascular morbidity and mortality) occurred in 17.5% (36/202) of the rate control patients and in 21.2% (47/222) of the rhythm control patients. Mean costs per patient under rate control were euro 7386 and euro 8284 under rhythm control. Cost-effectiveness analysis showed that per avoided endpoint under rate control, the cost savings were euro 24944. Under rhythm control, more costs were generated due to electrical cardioversions, hospital admissions and anti-arrhythmic medication. Costs were higher in older patients, patients with underlying heart disease, those who reached a primary endpoint and women. Heart rhythm at the end of study, did not influence costs. Conclusions Rate control is more cost-effective than rhythm control for treatment of persistent atrial fibrillation. Underlying heart disease but not heart rhythm largely accounts for costs.

Aged↗
PubMed2002

Agents.

Although health care is inherently an economic activity, it is inadequately described as a market process. An alternative, grounded in organizational economic theory, is to view professionals and many others as agents, contracted to advance the best interests of their principals (patients). This view untangles some of the ethical conflicts in dentistry. It also helps identify major controllable costs in dentistry and suggests that dentists can act as a group to increase or decrease agency costs, primarily by controlling the bad actors who damage the value of all dentists.

Clinical Competence↗
PubMed2002

The effect of a health care management initiative on reducing workers' compensation costs.

The effect of both a cost control and health care management initiative (HCMI) on Workers' Compensation costs at a self-insured University Hospital was assessed. Seven cohorts of injured workers were studied. Cost control measures started in 1993 included early return to work and injury prevention programs, internal administration of legal cases, and utilization of modified duty assignments. The health care management initiative fully in place in 1997 included aggressive case management and preferred provider panel utilization. Workers' Compensation indemnity costs and lost workdays incurred by each cohort were compared. A 41 to 59% reduction in indemnity payments and 46 to 67% reduction in lost time cases were realized after the health care management initiative was fully in place. During this time, accepted claims were reduced by 10 to 15%. The quality of the provider panel, as measured by academic credentials, experience and board certification, did not change. Cost control measures, without comprehensive case management, did not decrease these parameters significantly. The health care management initiative realized reductions in lost time cases and Workers' Compensation indemnity costs.

Costs and Cost Analysis↗