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PubMed1975

Control of cost and medical relevance in clinical microbiology.

Government and third-party payers are applying increasing effort to control rising medical laboratory costs by restricting laboratory budgets. This threatens quality in clinical microbiology, where lack of automation has hampered increased productivity. A solution was sought by curtailing work on duplicates and specimens of poor quality using empirically derived objective criteria. One to 43% of specimens of various types were of insufficient quality to warrant planting, and 6-95% of isolates obtained in mixed culture were not subject to complete bacteriologic work-up because of evidence of superficial contamination. Combined with other controls this reduced bacteriology laboratory costs by 12%. Simultaneously, preliminary reports of examination of direct smears were provided for most specimens, and telephone reports were rendered when processing was incomplete to allow prompt resubmission of specimens. The impression that the information contributed to more rapid accurate diagnosis and treatment of infectious disease was gained.

Cervix Uteri↗
PubMed1983

Diuretic regimens in essential hypertension. A comparison of hypokalemic effects, BP control, and cost.

Intolerable side effects and hypokalemia during thiazide treatment of hypertension frequently necessitate a change in diuretic regimen. The hypokalemic effects, effectiveness in controlling BP, and cost of several alternate diuretic regimens were evaluated. Prevalences of serum K+ values less than 3.5 mEq/L were as follows for the various regimens: hydrochlorothiazide, 50 mg daily, 11.0% (n = 500); chlorthalidone, 25 mg daily, 8.1% (n = 37); triamterene, 100 mg, plus hydrochlorothiazide, 50 mg daily, 5.3% (n = 357); hydrochlorothiazide, 25 mg daily, 2.2% (n = 183); and furosemide, 40 mg daily, 3.5% (n = 284). In paired studies comparing hydrochlorothiazide with alternate diuretic regimens, potassium conservation was comparable with furosemide, the triamterene/hydrochlorothiazide combination, the spironolactone/hydrochlorothiazide combination, and adding potassium, 37 mEq daily. All alternate diuretic regimens were as effective as hydrochlorothiazide in controlling BP. Furosemide reduced serum glucose and calcium levels compared with hydrochlorothiazide. When these factors and costs are considered, furosemide appears to be the most cost-effective alternative in patients with hypertension in whom intolerable side effects or hypokalemia develops while taking hydrochlorothiazide.

Blood Pressure↗
PubMed1975

State regulation of health care costs.

State regulation of health care costs has been increasing at the same time as criticism of governmental regulation in other sectors of the economy has been increasing. The authors examine major system elements necessary to effect cost control in health care, present normative models of value preferences which underlie alternative state cost control systems, and indicate control foci and intervention strategies for state government under the alternative models. The authors conclude that state governments should assume responsibility for controlling health care costs. Presently, state regulatory agencies should emphasize development of adequate information systems, strengthening of state regulatory capability, and implementation of experimental reimbursement programs rather than comprehensive and detailed rate setting.

Fees and Charges↗
PubMedDate not supplied

Hospitalization costs of total knee arthroplasty with a continuous femoral nerve block provided only in the hospital versus on an ambulatory basis: a retrospective, case-control, cost-minimization analysis.

BACKGROUND AND OBJECTIVES: After total knee arthroplasty (TKA), hospitalization may be shortened by allowing patients to return home with a continuous femoral nerve block (CFNB). This study quantified the hospitalization costs for 10 TKA patients receiving ambulatory CFNB versus a matched cohort of 10 patients who received CFNB only during hospitalization. METHODS: We examined the medical records (n = 125) of patients who underwent a unilateral, primary, tricompartment TKA with a postoperative CFNB by 1 surgeon at one institution in an 18-month period beginning January 2004. Each of the 10 patients discharged home with an ambulatory CFNB (cases) was matched with a patient with a hospital-only CFNB (controls) for age, gender, body mass index, and health status. Financial data were extracted from the hospital microcosting database. RESULTS: Nine patients with ambulatory CFNB (cases) were discharged home on postoperative day (POD) 1 and 1 on POD 4. Of the controls, 3 were discharged home on POD 3, 6 on POD 4, and 1 on POD 5. The median (range) costs of hospitalization (excluding implant and professional fees) was US dollars 5,292 (US dollars 4,326-US dollars 7,929) for ambulatory cases compared with US dollars 7,974 (US dollars 6,931-US dollars 9,979) for inpatient controls (difference = US dollars 2,682, 34% decrease, P < .001). The total charges for hospitalization, the implant, and professional fees was US dollars 33,646 (US dollars 31,816-US dollars 38,468) for cases compared with US dollars 39,100 (US dollars 36,096-US dollars 44,098) for controls (difference = US dollars 5,454, 14% decrease, P < .001). CONCLUSIONS: This study provides evidence that ambulatory CFNB for selected patients undergoing TKA has the potential to reduce hospital length of stay and associated costs and charges. However, the current study has significant inherent limitations based on the study design. Additional research is required to replicate these results in a prospective, randomized, controlled trial and to determine whether any savings exceed additional CFNB costs such as from complications, having caregivers provide care at home, and additional hospital/health care provider visits.

Aged↗
PubMed1997

Determining consumer preferences for a cash option: Arkansas survey results.

As long-term care (LTC) expenditures have risen, policymakers have sought ways to control costs while maintaining consumer satisfaction. Concurrently, there is increasing interest within the aging and disability communities in consumer-directed care. The Cash and Counseling Demonstration and Evaluation (CCDE) seeks to increase consumer direction and control costs by offering a cash allowance and information services to persons with disabilities, enabling them to purchase needed assistance. The authors present results from a telephone survey conducted to assess consumer preferences for a cash option in Arkansas and describe how findings from the four-State CCDE can inform consumer information efforts and policymakers.

Arkansas↗
PubMed2004

Cost-effective control of SO2 emissions in Asia.

Despite recent efforts to limit the growth of SO(2) emissions in Asia, the negative environmental effects of sulphur emissions are likely to further increase in the future. This paper presents an extension of the RAINS-Asia integrated assessment model for acidification in Asia with an optimisation routine that can be used to identify cost-effective emission control strategies that achieve environmental targets for ambient SO(2) concentrations and sulphur deposition at least costs. Example scenarios developed with this optimisation module demonstrate a potential for significant cost savings in Asia, if emission controls are allocated to those sources that have the largest environmental impact and are cheapest to control. It is shown that strategies that simultaneously address harmful population exposure and the risk of vegetation damage from acid deposition result in the most cost-effective use of resources spent for emission controls.

Air Pollutants↗
PubMed1992

Universal health care, American style: a single fund approach to health care reform.

With increasing momentum for health care reform, attention is shifting to finance reform that will provide for direct methods for controlling health care spending. This article outlines the two principal paths to direct cost control and outlines a national plan that retains our multiple sources of payment, yet also contains a powerful direct cost control technique: a single fund to finance all health care.

Cost Control↗
PubMed1977

The effect of physician-controlled health insurance. U.S. v. Oregon State Medical Society.

The trial record in an antitrust case against the Oregon State Medical Society, finally decided in 1952, was examined to reconstruct the behavior of a competitive market for health insurance coverage. Health insurers, called "hospital associations," were found to have engaged individually in cost-control efforts similar to, but possibly more aggressive than, today's utilization review under professional sponsorship. The subsequent disappearance of these insurer-initiated cost controls in Oregon is traced to the medical society's organization of a competing Blue Shield plan as a model of insurer conduct and to a simultaneous boycott by physicians of the hospital associations as long as they persisted in questioning doctors' practices. Some modern parallels are noted, and the advantages of fostering privately sponsored cost-control efforts are suggested.

Hospitals↗
PubMed2006

[Comparative analysis of the therapeutic costs to control the recurrent acute otitis media].

In order to assess a cost analysis in the management of recurrent acute otitis media (RAOM) in children, we performed a prospective study with data obtained from 80 patients with RAOM, evaluated between january 1998 and february 2000. A good outcome with the antibiotic prophylaxis was obtained in 67 cases (83,7%), with either amoxicillin or azythromicin. Applying the model of assumptions the control of RAOM with ear tube insertion was obtained in 66 children (82,5%). Thus, the cost of antibiotic chemoprophylaxis was Euro 83,60 for the amoxicillin patients and Euro 116,60 for the azythromicin ones. Surgical approach of this entity with the use of ear tubes costs Euro 392,95 per case. To sum up, in pediatric patients, without medical contraindications, the initial treatment for RAOM is chemoprophylaxis, with ear tubes reserved its failure.

Acute Disease↗
PubMed1998

Long-term pharmaceutical cost reduction using a data management system.

UNLABELLED: Cost containment is an important issue in medicine today, and the ability to control costs and maintain quality patient care presents a challenge to practitioners. Educating practitioners about drug costs has been identified as an effective method, but the benefits of education are usually short-lived. To evaluate the role of education in cost control, pharmaceutical use and performance improvement data were analyzed at a tertiary care institution during two time periods. A total of 4,530 anesthesia records and associated performance improvement data from March to June 1993 were analyzed as a baseline. These data were shared with the clinicians of an anesthesia department and used to educate practitioners regarding the costs and use of injectable pharmaceuticals and to identify areas in which cost savings could be achieved. The same information from 10,600 cases during January to October 1996 were compared with the early group. The expenditures for injectable pharmaceuticals to provide anesthesia were decreased by more than $30,000 per month, or $32 per case, without changing the performance indicators that were monitored, and has been maintained for >3 yr. IMPLICATIONS: By using a data management system, the cost for medications to provide anesthesia has been reduced without changing the quality of patient care.

Anesthesia↗
PubMed1995

Cost containment in emergency departments.

Traditionally, cost effectiveness has been overlooked in emergency departments because of a mandate to provide emergency care in every community regardless of expense. However, in the current era of managed care, reduced reimbursement, and cost controls, emergency departments are being examined more carefully to determine whether their costs can be contained or even whether they can become profit centers. Detailed billing, cost accounting, enhanced communication among emergency departments within a community, and linking of suburban and inner-city emergency departments are several means by which emergency departments can control costs and raise revenues.

Cost Control↗
PubMed1991

Myths of competitive reform.

During the 1980s, private economists and government policy-makers promoted market competition as a means of controlling costs and improving quality in the health services industry. However, inflation-adjusted costs rose faster during the 1980s than during the 1970s, and most of the expected benefits were not realized. Competitive reform failed because government and private payors were unwilling or unable to force providers to compete primarily on price and quality. Despite its failure to control costs, competitive reform has created a "mythology" that continues to influence health policy to the detriment of effective reform.

Cost Allocation↗
PubMedDate not supplied

Controlling information technology costs, Part 2.

Health care executives are increasingly frustrated by Information Technology (IT). Although our industry is often accused of underinvesting in technology (hospitals average 2-3 percent of their costs in IT, compared to other industry's 8-10 percent), when IT investments are made, they fail to reflect demonstrable return to the bottom line. Yet the effective deployment of technology is so critical to the success of the organization and can in itself cause the failure of a health care system. While being forced to invest significant amounts of resources in the past two years preparing for Y2K, health care organizations have come under increasing financial pressures due to other industry developments.

Capital Expenditures↗
PubMed2004

Evaluating emergency medical services: controlling the rising cost of saving lives.

A combination of recent changes in the way Emergency Medical Services are reimbursed by Medicare for ambulance services and escalating costs have prompted many EMS providers to seek new ways to meet the needs of the communities they serve in a more cost-effective manner. This article reports one such study of a county in the Southeastern United States with a population of over 100,000 distributed over an area of 600 square miles. The study used industrial techniques, including a combination of historical data analysis and time studies, to recommend ways to cut costs without adversely affecting either the emergency coverage or patient case provided. Based on usage data, reducing the number of service units during time of least demand was suggested. The time studies indicated that it might be possible to combine some jobs (e.g. billing personnel and dispatchers), The usage data also showed that the existing geographical distribution of the units matched demand. The study demonstrated that industrial engineering techniques can be usefully employed in the evaluation of the efficiency and effectiveness of public services.

Alabama↗