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 1,027 records · Page 57Linked to original sources
PubMed1996

An economic evaluation of propofol/fentanyl compared with midazolam/fentanyl on recovery in the ICU following cardiac surgery.

A comparison was made of the drug costs and nursing dependency of patients undergoing elective cardiac surgery and routine postoperative recovery for two anaesthetic techniques using either propofol with low dose fentanyl or midazolam with high dose fentanyl. Estimates of resource use were based on a randomised clinical trial undertaken at the Northern General Hospital, Sheffield. Times from entry to the intensive care unit until extubation and discharge were recorded for 70 patients and were transformed to nursing shifts. Nursing dependency was calculated on the basis of one nurse per ventilated patient and 0.5 nurse from the start of the shift after extubation. Nursing costs were allocated on the basis of the patient's status at the beginning of each shift in line with the hospital's staffing policy. All drugs used from the morning of the operation until discharge were recorded. Costs of nursing and drugs were calculated. The total cost of patients in the propofol group was 13.3% less than midazolam patients (p = 0.043, for geometric means Cl 0.4% to 27.8%). The clinical study was not designed for economic endpoints; however, it demonstrated achievable savings in propofol-treated patients.

Adult↗
PubMed1996

Hospital cost shifting, a continuing debate.

This Issue Brief examines the evidence on hospital cost shifting. It defines cost shifting, explores the incentives facing hospitals and payers, reviews and critiques the new evidence on cost shifting, and discusses the policy concerns that arise from the new learning. Cost shifting has a precise and easily understood meaning. It does not mean that some payers pay different prices than others. Different prices are commonplace throughout the economy. Rather, cost shifting exists when the prices faced by one group of payers are higher because another group pays less. To be able to cost shift, a hospital must have market power, and it must not yet have fully exercised that power. There has been a spate of recent cost-shifting studies. The better known studies focus on industrywide, revenue-to-cost margins by payer. They find that the extent of cost shifting declined in the mid-1990's. The methods underlying these studies have been criticized in the academic literature, with the strong suggestion that the studies overstate any true cost shifting. Cross-sectional studies compared measures of prices across individual hospitals. These studies have failed to find evidence of hospital cost shifting. However, they suffer from a potential inability to control for levels of service, quality, and amenities that may simultaneously have changed as well. Dynamic studies compare individual measures of hospital prices through time and allow each hospital to serve as its own control. These studies find no evidence of hospital cost shifting. As one analysis concluded: "We found no evidence to suggest that cost-shifting strategies that might protect hospital revenues in the face of financial pressure were undertaken successfully." Rather than cost shifting, the existing evidence points to hospital competition limiting the provider's ability to raise prices. Whatever market power hospitals once enjoyed is disappearing--and with it the ability to cost shift. This research suggests that Medicare reform or Medicaid restructuring will have little direct effect on the hospital prices that employers and their workers pay for health care. The author argues that cost shifting is dead. However, the increased hospital competition necessarily squeezes hospital profits. This reduces the amount of charity care they can provide. Expect to see more and more examples of hospitals unable to provide care to nonpaying patients. This also suggests that care for the indigent will become a more pronounced public issue. This is a form of "cost" shifting, one that the "system" will need to deal with.

Cost Allocation↗
PubMed1991

New Mexicare.

An inexpensive plan is offered that provides access to basic, outpatient, primary, and preventive health care for all uninsured citizens of the State of New Mexico. New Mexicare rewards hospitals and hospital-affiliated specialists for inpatient care that is now unreimbursed. The establishment of a Health Care Trust Fund would create a mechanism that could influence the allocation of scarce and expensive resources to areas of need. New Mexicare would be set up within the State Medicaid Division and would be predicated on a mandate that all employers must provide health insurance with reasonable cost sharing by higher paid employees. It would not have great fiscal impact on small businesses, require complicated new tax rules, or impact current state revenues. New Mexicare solves the problem of the uninsured in incremental fashion and does not create an enormous administrative or budgetary burden to the state. It may be a suitable model for other states that share New Mexico's demography. New Mexicare could easily and rapidly be dissolved in the event that the federal government finally acts and provides universal access with some type of national plan.

Cost Allocation↗
PubMed2006

Effects of socioeconomic and geographic variations on survival for adult glioma in England and Wales.

BACKGROUND: To investigate the effects of SES and geographic variations on survival for adult patients with glioma, we analyzed data from 30489 patients from the Cancer Registry in England and Wales. METHODS: Median survival and CSRs for 8 variables (age, sex, morphology, World Health Organization [WHO] grade, tumor site, SES, geographic regions, and periods of diagnosis) are calculated using the Kaplan-Meier method. Distributions among different variables are compared using chi(2) test. Cox regressions are performed for estimating HRs to death. RESULTS: The median survival and the 1-, 5-, and 10-year CSR in this population are 0.42 years, 29.1%, 12.0%, and 7.7%, respectively. There is a gradient in SES from the south to the north (chi(2) test, P < .001) and a gradual increment in higher SES from the early to the recent period (chi(2) test, P < .001). Mono- and multivariate analyses reveal that all the 8 variables influenced the survival (P < .05). Age (HR, 1.04 per year from 15 years, P < .001), WHO grade (1.21 per grade from grade I, P < .001), and morphology (HR from 1.23 to 1.89, compared with ependymoma, P < .05) are the most influential factors. However, there are also independent effects from SES (HR, 1.03 per quintile of deprivation, P < .001) and geographic regions (HR, 1.10 for outside southern England; P < .001) on the survival. CONCLUSIONS: Although age and tumor characteristics (morphology, WHO grade, tumor site) are well-known prognostic factors, SES and geographic variations also play a slight but significant role, and for more cost-effective allocation of health resources, alleviation on these 2 modifiable factors should be considered.

Adult↗
PubMed1985

Identifying costs of medical care. An essential step in allocating resources.

Financial constraints are imposing an urgent requirement on American medicine to control the increasing costs of medical care. Valid data on "true" costs are required to make optimum trade-offs between quality-availability and cost of medical services; unfortunately, these data are generally lacking. Standard accounting procedures provide information on expenditures for items such as utilities, pharmaceuticals, and payroll; however, these procedures cannot identify personnel costs related to a specific medical service. The Laboratory Workload Recording Method developed by the College of American Pathologists offers a proved method for calculating personnel costs in performing each type of procedure in the clinical laboratory as well as projected costs of alternative management actions. Similar principles could be applied in other areas of health care.

Canada↗
PubMed1998

Suitability of casemix classification for output funding of blood services in Victoria. Victorian Blood Users Group.

OBJECTIVE: To study the suitability of diagnosis-related groups (DRGs) to quantify blood use in order to fund hospitals directly for fresh blood components. DESIGN: (i) Retrospective empirical analysis of hospital inpatient separation data, matching DRG classification with blood usage. (ii) Prediction of blood usage based on actual DRGs and comparison with actual blood products issued from the blood service. SETTING: Eight large public hospitals, April 1994-March 1995, the Department of Human Services and the Australian Red Cross Blood Service in Victoria, 1994-1997. MAIN OUTCOME MEASURES: Requirement for transfusion according to DRG; quantity of blood or blood products transfused; and statistical reliability of measuring blood component usage by DRG. RESULTS: A match between patient records and transfusion records for 287,117 patient separations showed that the patients had received 51,115 units of red cells, 30,451 units of platelet concentrates, 9043 units of fresh frozen plasma and 1273 units of cryoprecipitate. Ten per cent of DRGs (527) accounted for over 70% of blood product usage. The numbers of DRGs in which blood products were used for at least 30 separations (with a relative SEM [for units of blood used per separations using blood] of up to 20% at a 95% confidence level) were 56 for red cells, 8 for platelets and 4 for fresh frozen plasma. Estimates of red cell usage calculated from actual DRGs for three consecutive years (1994-1997) showed that DRGs predicted aggregate issues of red cells by the Red Cross Blood Service (ratio of actual red cells issued to red cell usage estimates were 1.036 for 1994-95, 0.994 for 1995-96, and 1.021 for 1996-97, respectively). CONCLUSION: DRGs are moderately good predictors of blood product usage, and could be used to allocate funds for blood products to hospitals instead of to the blood service. However, DRG data are not designed to manage blood issue policies, because DRGs do not represent single diagnoses or procedures and some are surrogate descriptions of procedures.

Australia↗
PubMed2001

Measuring efficiency of long-term care units in Finland.

Data Envelopment Analysis (DEA) was used to measure the nursing care efficiency of 64 long-term care units in Finland. New approaches introduced for evaluating efficiency were unit/ward level analysis, and the case-mix classification Resource Utilization Groups (RUG-III). Efficiency determinations were based on four DEA measures: cost, technical, allocative, and scale efficiency. The results indicated considerable variation in efficiency between units, suggesting that efficiency could be improved through better management and allocation of resources. Larger units seemingly operated more efficiently than smaller units. Allocative inefficiency resulted from using too many registered nurses and aides, and too few licensed practical nurses.

Cost-Benefit Analysis↗
PubMed1998

Two-part transfer pricing improves IDS financial control.

To help coordinate patient care services across its various provider entities, an integrated delivery system (IDS) must address two financial control matters: design of responsibility centers and selection of an appropriate transfer pricing methodology. Although designating an HMO as a profit center is appropriate, such a designation is inappropriate for an IDS's provider entities. Instead, these entities are more appropriately designated as standard expense centers. Further, an HMO owned and operated by an IDS should purchase patient care from the delivery entities by means of two-part transfer prices, that is, having fixed costs paid for in a lump sum and variable costs paid for on the basis of the actual volume and mix of services provided. The IDS's management must recognize, however, that both case mix and volume lie largely outside a hospital's control and that financial controls should focus on a combination of the hospital's fixed costs and variable costs associated with resources per case, efficiency of resource delivery, and factor prices.

Accounting↗
PubMed2006

Responses to selection on phenoloxidase activity in yellow dung flies.

Maintaining an immune system is costly. Resource allocation to immunity should therefore trade off against other fitness components. Numerous studies have found phenotypic trade-offs after immune challenge, but few have investigated genetic correlations between immune components and other traits. Furthermore, empirical evidence for the costs of maintaining an innate immune system in the absence of challenges is rare. We examined responses to artificial selection on phenoloxidase (PO) activity, an important part of the insect innate defense against multicellular pathogens, in yellow dung flies, Scathophaga stercoraria (L.). After 15 generations of successful selection on PO activity, we measured reproductive characters: clutch size, egg hatching rates, adult emergence rates, and adult longevity. We found no evidence for negative genetic correlations between PO activity and reproduction. In fact, flies of lines selected for increased PO activity had larger first clutches, and flies of lines selected for decreased PO activity had smaller ones. However, flies from high-PO lines died earlier than did low-PO flies when no food was available; that is, there is a survival cost of running at high PO levels in the absence of challenge. Variation in resource acquisition or use may lead to positive genetic correlations between PO and fertility and fecundity. The negative correlation between PO and longevity under starvation may indicate that variation for resource acquisition is maintained by a cost of acquisition, based on a genotype-environment interaction.

Animals↗
PubMed1989

St Bartholomew's resources allocation scheme.

This scheme has three main features: it relates the output of work and materials from the department to the funding input (resource allocation), it enables the funding bodies to determine the level of output they are willing to support and it creates spare capacity to permit income generation either through charging for work done in excess of allocations made under the scheme or by attracting outside business. The system devolves upon the work unit as a measure of resource and this is made up of a combination of materials and time depending on the product. Derivation of work unit cost is given as a function of all reckonable operating costs of the department. Different profit margins may be applied according to category of request. Income is returnable to the funding bodies in the same ratio as their original provision to the service (for the current year of operation) after a deduction for reinvestment. The scheme allows for central funding to be progressively reduced to zero.

Cost Allocation↗
PubMed2002

[Resource allocation and justice in distribution of services in medical management of elderly patients].

This paper presents the most important arguments in medical allocation based on an analysis of the relevant literature. The main arguments of rationing scarce medical resources are scrutinized. Especially the use of age limit considerations are critically reviewed. The discussion takes place against a backdrop of aggravating pressure on old people as cost factors. As a basis for further discussion, the authors give a brief history of theories of justice in philosophy. Finally minimum requirements for a constructive and responsible discussion are stated.

Aged↗
PubMed1978

Principles of allocation of health care resources.

The methods and principles of allocating centrally provided health care resources to regions and areas are reviewed using the report of the Resource Allocation Working Party (RAWP) (Department of Health and Social Security, 1976) and the consultative document (Department of Health and Social Security, 1976a) as a basis. A range of practical problems arising from these papers (especially the report of the RAWP) is described and traced to the terms of reference. It is concluded that the RAWP misinterpreted aspects of social and administrative reality, and it failed to recognise clearly that the several principles on which it had to work conflicted with each other and demanded decisions of priority. The consequential errors led to (a) an injudicious imposition of 'objectivity' at all levels of allocation, (b) an unjustified insistence that the same method be used at each administrative level in an additive and transitive manner, (c) the exclusion of general practitioner services from their considerations, (d) a failure to delineate those decisions which are in fact political decisions, thus to concatenate them, inappropriately, with technical and professional issues. The main requirement in a revised system is for a mechanism which allocates different priorities to different principles at each appropriate administrative and distributive level, and adapts the working methods of each tier to meet separately defined objectives.

Cost Allocation↗
PubMed1998

More equitable systems for allocating general practice deprivation payments: financial consequences.

BACKGROUND: The allocation of general practitioner (GP) deprivation payments has been a controversial topic since they were first proposed. It has recently been suggested that the current system could be made more equitable if the payments were allocated at enumeration districts and if there was a more graded relationship between Jarman score and funding. However, the implications of these changes on the distribution of deprivation payments have not been worked out. AIM: To explore the resource implications of the proposed changes to the methods of allocating GP deprivation payments within Northern Ireland, one of the few places in the United Kingdom (UK) where this can be done. METHOD: Three alternatives to the present system, incorporating the proposed changes, were modelled. The reallocation of deprivation payments between areas was determined. RESULTS: The proportion of population attracting GP deprivation payments depends on the scheme chosen. A system that entails a lower threshold Jarman score and more payment bands will bring between two and three times more areas and people within the scheme. Each of the three alternatives would redirect funds away from areas within the current payment bands towards those that previously failed to attract any deprivation payments. The loss would be greatest for those areas within the present 'low' payment band and least for those in the 'high' payment band. CONCLUSIONS: More equitable alternatives for allocating GP deprivation payments are feasible, although they will lead to significant movements of funds between areas. This may necessitate the introduction of further transitional payments.

Cost Allocation↗
PubMed1998

[The cost of sickness in the Netherlands in 1994; the main determinants were advanced age and disabling conditions].

OBJECTIVE: To estimate the costs of health care in 1994, the development of the costs assigned to specific diseases, and the future costs. DESIGN: Descriptive. SETTING: Erasmus University, Department of Public Health, Rotterdam, the Netherlands. METHOD: For each health care sector, costs were allocated to 62 diagnostic groups, age and sex making maximal use of national registries and other sources with data on health care use in the Netherlands. RESULTS: More than 80% of the 60 billion Dutch guilders that were spent on health care in 1994 could be assigned to specific diseases. Most costs were made for non-fatal diseases like mental deficiency, dementia and musculoskeletal disease. Except for cardiovascular disease, the share of major causes of death in the total costs was not significant. Average costs per inhabitant were low during youth and adulthood but increased exponentially with age from age 50 onwards. Between 1988 en 1994, health care costs experienced an annual growth rate of 5.2%, caused by price and wage increases (one half), ageing (a quarter) and other effects on health care costs such as epidemiological and technological change (a quarter). CONCLUSION: The main determinants of health care use in the Netherlands were old age and disabling conditions. Due to ageing and other influences, real health care costs in the years to come will increase by an average annual rate of 2.4%.

Adolescent↗
PubMed2000

Activity-based costing in radiology. Application in a pediatric radiological unit.

PURPOSE: To get an informative and detailed picture of the resource utilization in a radiology department in order to support its pricing and management. MATERIAL AND METHODS: A system based mainly on the theoretical foundations of activity-based costing (ABC) was designed, tested and compared with conventional costing. The study was performed at the Pediatric Unit of the Department of Radiology, Oulu University Hospital. The material consisted of all the 7,452 radiological procedures done in the unit during the first half of 1994, when both methods of costing where in use. Detailed cost data were obtained from the hospital financial and personnel systems and then related to activity data captured in the radiology information system. RESULTS: The allocation of overhead costs was greatly reduced by the introduction of ABC compared to conventional costing. The overhead cost as a percentage of total costs dropped to one-fourth of total costs, from 57% to 16%. The change of unit costs of radiological procedures varied from -42% to +82%. CONCLUSION: Costing is much more detailed and precise, and the percentage of unspecified allocated overhead costs diminishes drastically when ABC is used. The new information enhances effective departmental management, as the whole process of radiological procedures is identifiable by single activities, amenable to corrective actions and process improvement.

Child↗
PubMed1991

The health care of poor persons living in wealthy areas.

This paper describes the problems inherent in targeting new health care initiatives to disadvantaged communities rather than to disadvantaged persons in the 100 wealthiest counties in the United States. The barriers to care experienced by such persons are generally comparable to those of other poor persons. Deprivations in access to care appear to be caused by poverty per se and not by the characteristics of the places in which the poor live. It is suggested that per capita income not be used as a criterion for the allocation of health care resources. The actual number of poor persons in a geographic area is a better criterion for determining the need for public health care programs.

Cost Allocation↗
PubMed1997

Risk sharing in an integrated delivery system.

Development of an effective risk-sharing plan within an integrated delivery system (IDS) involves a complex decision-making process, in which the IDS should carefully assess its options to determine which will best suit its needs. In general, an IDS needs to consider four basic issues: how centralized the financial control of the risk-sharing plan should be; how the plan should be structured (eg, the number and size of budgets, interim provider payment, and the method for allocating surpluses and deficits to provider groups and individual providers); what risk-sharing strategies should be pursued; and how to avoid potentially catastrophic risk.

Budgets↗
PubMed1997

Managed care organizations and public health: exploring collaboration on adolescent immunizations.

Managed care organizations (MCOs) joined local and state public health agencies in a pilot effort to improve hepatitis B immunization rates of adolescents in an urban and a suburban/rural school district. The pilot also explored issues inherent in public and private collaboration on population health improvement. Local public health agencies provided links to schools in their communities, took the lead in implementing school-based immunization programs, and provided health education materials. MCOs contributed financial support necessary for the project. The final cost per fully vaccinated student, not taking into account the work group's planning and coordination time, was little more than the catalog price of the vaccine alone. Managed care organizations face challenges that complicate their participation and funding of school-based vaccinations: 1) Limited data on health plans of participating students complicate allocation of costs to each MCO; 2) Double-paying occurs for MCOs paying clinics a monthly, per-member rate that already includes adolescent immunizations; 3) When schools provide adolescent immunizations, MCOs lose the "hook" that draws adolescents to clinics for comprehensive health services. When self-consenting is permitted, schools can achieve a high consent and completion rates for multi-dose adolescent immunizations such as hepatitis B. At the same time, MCOs have the responsibility to provide members with comprehensive care and should continue to examine both internal modifications and external partnerships as opportunities to improve their services to adolescents.

Adolescent↗