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.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,063 records · Page 59Linked to original sources

PubMed1993

Citation patterns in the health sciences: implications for serials/monographic fund allocation.

This study sought to determine optimal serial-to-monograph ratios for collection development by comparing citation frequency with current library practice. Internal medicine literature cited an average of 88% serial references and 12% monographs. In an observational study, teaching physicians on internal medicine rounds cited 89.5% serials and 10.5% monographs to student teams. By contrast, health sciences libraries included in the Houston statistics spend an average of 79% of acquisitions budgets for serials and 21% for monographs. An 88:12 acquisitions budget ratio would be more appropriate, reflecting actual use of serials and monographs in the health sciences.

Budgets↗

PubMed1991

Partnership as a new strategy in mental health policy: the case of Québec.

The notion of partnership is increasingly adopted as a sine qua non for the successful resolution of strategic problems in the field of human services. In this paper, I examine Québec's recent mental health policy and its operational definition of the concept. I then suggest some of the roots and reasons behind this province's adoption of le partenariat as the basis for policy. I suggest that it is a response to four key strategic problems: (1) the exhaustion of resources and allocation of losses; (2) the loss of faith in government and the consequent need to redefine the role of the state; (3) the loss of faith in professional knowledge and the increasingly forceful voice of alternative and "psychiatric survivor" groups; (4) the problem of overload in pluralist and competitive democracy and, related to this, the ubiquitous search for consensus and frictionless solutions. I conclude that in adopting the language of partnership, policymakers in Québec and elsewhere are being seduced by the possibilities of neocorporatist ideas applied to the management of human services.

Cost Allocation↗

PubMed1989

Ancillary service consumption by Military Health Service System special programs: implications for diagnosis related group resource allocation.

An analysis was conducted of consumption of ancillary services by medical treatment facility special programs within the Military Health Service System (MHSS). This workload would not receive explicit credit under the new weighted ambulatory visit/inpatient disposition workload credit system mandated by the National Defense Authorization Act for Fiscal Year 1987. Results indicated that ancillary workload consumption by facility special programs was substantial. When the weighted visit/disposition workload credit system is implemented throughout MHSS, appropriate adjustments must be made to reflect ancillary workload generated by MHSS facilities in support of direct patient care missions but lost under this type of credit system.

Ancillary Services, Hospital↗

PubMed1979

"Positive programming": the use of data in planning for the rural health initiative.

A data-driven approach to allocating federal resources for primary care systems in rural areas is presented. This approach was developed and implemented by the Public Health Service (PHS) when it undertook its Rural Health Initiative Program. Nationally available small-area data were used to identify "priority counties" and PHS regional office staffs were asked to take an active role in developing rural health system projects in these counties. This approach was adopted to avoid the problem of the many communities eligible for and in need of funds that do not get them because they lack the organization and knowledgeable personnel required to develop a project grant application. The paper defines and discusses the "positive programming" approach (believed to be the first attempt to allocate federal health service delivery resources actively on the basis of small-area data), discusses the present shortcomings of the approach (including data limitations), and presents the results of implementing the approach. In the first year, 23% of the priority counties and 13% of the nonpriority counties were served, while in the second year 39% of the priority counties and 17% of the nonpriority counties were served. The substantial increase in the percentage of priority counties served reflects the effectiveness of the positive programming effort.

Community Health Services↗

PubMed1997

Biomedical ethics and the biomedical engineer: a review.

Biomedical engineering is responsible for many of the dramatic advances in modern medicine. This has resulted in improved medical care and better quality of life for patients. However, biomedical technology has also contributed to new ethical dilemmas and has challenged some of our moral values. Bioengineers often lack adequate training in facing these moral and ethical problems. These include conflicts of interest, allocation of scarce resources, research misconduct, animal experimentation, and clinical trials for new medical devices. This paper is a compilation of our previous published papers on these topics, and it summarizes many complex ethical issues that a bioengineer may face during his or her research career or professional practice. The need for ethics training in the education of a bioengineering student is emphasized. We also advocate the adoption of a code of ethics for bioengineers.

Animal Testing Alternatives↗

PubMed2000

In the rationing of healthcare in indigent African populations, which services should come first?

Governments, worldwide, have enormous difficulties in affording adequate funds for healthcare and its maintenance. In developing populations, almost all of whom are indigent, the diverse health problems being faced with limited funds are insufficiently appreciated. Information is given, for both developed and developing populations, principally those in sub-Saharan Africa, regarding various countries' gross national product (GNP) per capita, the percentage of GNP devoted to health services, and the allocation of health funds per capita. To illustrate the formidable health problems prevailing, some data are given on the magnitudes of morbidity/mortality situations, both for communicable and non-communicable diseases. Some examples are provided which exemplify opposing points of view regarding strongly contesting health claims for priorities in monetary support. Additionally, examples are given of some impoverished countries, which, despite highly adverse circumstances, have achieved enviable health statistics. In this respect it would be highly beneficial were the circumstances and means employed in these and similar contexts given wide publicity.

Adult↗

PubMed2003

A comparison of three techniques for acute postoperative pain control following major abdominal surgery.

STUDY OBJECTIVES: To compare the analgesic efficacy of a nonsteroidal antiinflammatory drug (NSAID) alone (basic pain treatment) with that of NSAID in conjunction with either intravenous (IV) patient-controlled analgesia (IV-PCA) or intermittent epidural morphine (epidural morphine), among patients recovering from major intraabdominal surgery; and to assess the fixed and variable costs of providing the respective acute pain treatment modalities. DESIGN: Prospective, nonrandomized study. SETTING: Postanesthesia care unit (PACU) and surgical departments of a large referral hospital. PATIENTS: All patients (n = 358) treated by our Acute Pain Service (APS) who were recovering from major intraabdominal surgery (colectomy, cholecystectomy, colostomy, gastrectomy, splenectomy). MEASUREMENTS AND MAIN RESULTS: The structure of our APS, analgesic regimens, and the associated patient monitoring and event-response algorithms are detailed. Data of 358 patients recovering from major intraabdominal surgery and treated according to one of the three treatment protocols were collected and analyzed. The cost of providing our APS and the nursing time required to monitor and treat patients in each treatment group were also calculated. The median visual analog scale (VAS) scores were low in all three treatment groups (23.5 mm vs. 6 mm vs. 4, for the basic pain treatment, IV-PCA, and epidural morphine groups, respectively). However, the median VAS was significantly (p < 0.04) lower among patients who received epidural morphine than either the IV-PCA or basic pain treatment groups. Similarly, the number of patients who had at least one episode of a pain VAS >30 mm was significantly (p < 0.04) lower in the epidural morphine group than either of the other two groups. The frequency of nausea and vomiting was similar among the groups. However, the frequency of postoperative pruritus was significantly (p < 0.001) higher in the epidural morphine group than the other two groups. Patient satisfaction was unaffected by group allocation. Institutional costs per patient and the nursing time required to provide the APS were lowest in the basic pain treatment group. CONCLUSIONS: Considering the respective pain profiles, complication rates, and institutional costs associated with the three analgesic regimens analyzed, the basic pain Treatment alone constitutes a useful alternative to the other two analgesic regimens assessed.

Abdomen↗

PubMedDate not supplied

Strategic planning: preparing for the twenty-first century.

If educational institutions for nursing are to survive these uncertain times and to experience new life in the advent of the 21st century, careful planning for the future must be undertaken. Strategic planning, a relatively new term in nursing education, is a concept designed to achieve goals in dynamic, competitive environments through the judicious allocation of resources. The primary purpose of strategic planning is to achieve success with mission while linking the institution's future to anticipated changes in the environment. Strategic planning enables an institution to function in such a manner that the acquisition of resources exceeds their depletion. The purposes of this article are to (1) provide an overview of the strategic planning process and (2) describe the strategic planning experience of one private, liberal arts college in a midwestern state. Although the case example focuses on a liberal arts college, the strategic planning process is applicable to other types of educational settings.

Cost Allocation↗

PubMed1993

Allocating practice expense under the Medicare fee schedule.

Currently, relative value units for practice expense are determined under the Medicare fee schedule (MFS) using historical physician charges. This seems inconsistent with the goal of a resource-based fee schedule. A specialty resource-based method of determining practice expense payments is presented and simulated here. The method assumes that, for each service, the payment for practice expense should be the same proportion of the total payment as actual physician practice expenses are of total practice revenues. A comparison with the approach developed by the Physician Payment Review Commission (PPRC) shows similar fees, but the specialty-based method proposed here requires no data beyond what is already employed in the MFS.

Computer Simulation↗

PubMedDate not supplied

The role of the hospital administrator in the control of nosocomial infections.

The hospital administrator is responsible for the allocation of resources at the disposal of the institution and therefore plays an important role in the control of nosocomial infections. The problem of determining what proportion of these resources can be allocated to the control of nosocomial infections is complicated by the fact that there remain many unanswered questions concerning this problem, such as whether is is possible to prevent many of the infections acquired in hospital, what the most efficient method of infection surveillance is, and whether the use of antibiotics should be controlled. In such a climate of uncertainty, particularly in a milieu that demands severe budgetary reductions, the hospital administrator will need the assistance of clinicians and epidemiologists to provide data on nosocomial infections so that the limited resources available may be used most effectively.

Anti-Bacterial Agents↗

PubMed1978

Subregional resource allocations in the National Health Service.

The Resource Allocation Working Party in its report Sharing Resources for Health in England proposes a formula for the identification of both regional and district financial targets (Department of Health and Social Security, 1976). In this paper it is argued that the national formula is not a valid instrument for the latter purpose. Furthermore, research into medical needs and outcomes will not be adequate to bring about real changes in resource distribution at local levels unless it is recognised that the health authorities can meet needs in different ways and that a change in resource management from institutional to service budgeting is required.

Catchment Area, Health↗

PubMed1980

A framework for optimizing resource allocation for health education programs.

Health education programs conventionally are implemented in four sites: school, clinical, occupational, and community settings. One problem encountered by health education specialists, community health planners, and policy makers, is ascertaining the optimal allocation of health education resources to these four settings. This paper proposes a framework to assist in making this decision. The framework incorporates considerations of the target group, the health problem, the desired health behaviors, and administrative aspects of the program, which are broken down into 26 different "criteria", (e.g., age of target group, stage of disease intervention). Each of the 26 criteria has its respective "dimensions" (e.g., age of target group: preschool children, school children, and adults), and each dimension in turn suggests the optimal health education setting(s). An improved understanding of the advantages and disadvantages of implementing health education programs in the different sites will facilitate better coordination between practitioners in school, clinical, occupational, and community settings.

Child, Preschool↗

PubMed2004

Identifying patients at risk of intraoperative and postoperative transfusion in isolated CABG: toward selective conservation strategies.

BACKGROUND: Allogeneic blood product use during cardiac operation is often reported to exceed 40% despite published guidelines and costly blood conservation strategies. We developed a predictive model, based on eight preoperative risk factors, of allogeneic blood product transfusion rates in patients undergoing a cardiac procedure. METHODS: All 3,046 consecutive, isolated coronary artery bypass graft (CABG) procedures at a university hospital from 1995 to 1998 were included. A logistic regression model was created to identify independent predictors of allogeneic blood product transfusion. This model was validated using a prospective patient sample. RESULTS: Overall use of allogeneic blood products was 23% with a crude operative mortality of 2.1%. In isolated, elective, first-time CABG cases, 16.9% received allogeneic blood products. Independent predictors of blood product usage in CABG patients were preoperative hemoglobin 12.0 or less, emergent operation, renal failure, female sex, age 70 years or older, left ventricular ejection fraction 0.40 or less, redo procedure, and low body surface area. Prospective validation of this model on 2,117 consecutive isolated CABG patients demonstrated an observed-to-expected allogeneic blood product transfusion rate ratio of 1.06. CONCLUSIONS: This internally validated logistic regression risk model is a sensitive and specific predictor of allogeneic blood product use in patients undergoing isolated CABG. Utilization of this model allows for preoperative risk stratification and may allow for more rational resource allocation of costly blood conservation strategies and blood bank resources.

Adult↗

PubMed2005

A budget model to determine the financial health of nursing education programs in academic institutions.

In the allocation of resources in academic settings, hierarchies of tradition and status often supersede documented need. Nursing programs sometimes have difficulty in getting what they need to maintain quality programs and to grow. The budget is the crucial tool in documenting nursing program needs and its contributions to the entire academic enterprise. Most nursing programs administrators see only an operating expense budget that may grow or shrink by a rubric that may not fit the reality of the situation. A budget is a quantitative expression of how well a unit is managed. Educational administrators should be paying as much attention to analyzing financial outcomes as they do curricular outcomes. This article describes the development of a model for tracking revenue and expense and a simple rubric for analyzing the relationship between the two. It also discusses how to use financial data to improve the fiscal performance of nursing units and to leverage support during times of growth.

Budgets↗

PubMed2001

Incidence of four adverse outcomes in the elderly population: implications for home care policy and research.

The cost-effective allocation of home care resources requires knowledge of the incidence of institutionalization, hospitalization, functional impairment, and mortality. We therefore assembled a database containing 176 rates abstracted from 71 longitudinal studies published between 1985 and 1998 that examine one or more of these outcomes in the 65 and over population in the United States. Where possible we calculate median values for the estimated annual rate of each outcome for different types of studies-nationally representative, sub-national probability, and convenience sample-and specific subgroups-community residents, hospital admissions and discharges, and nursing home admissions and discharges. We find comparatively low rates of institutionalization and mortality, relatively high rates of hospitalization and functional impairment, similar rates for national and sub-national probability samples, and rates from convenience samples, which greatly exceed probability-based rates. While the rates for institutionalization, hospitalization and mortality are quite stable, the rates for functional impairment display considerably more variability. We conclude by discussing the implications of our findings for researchers and policymakers.

Activities of Daily Living↗

PubMed1997

Ownership and governance of university teaching hospitals: let form follow function.

Under the best of circumstances, the complex decision-making and resource-allocation processes of a state university (and often of a variety of state agencies important to the university) significantly hinder the ability of the university-owned hospital to make changes critical to its financial and, hence, its programmatic success. At worst, as was the case for the University of Maryland Hospital a decade ago, the hospital can become capital-starved and operationally deficient under the bureaucratic mantle of the state and university and find itself unable to respond to the fast-changing market, placing its viability in jeopardy. To remedy this situation at the University of Maryland Hospital, in 1984 the state created a separate not-for-profit corporation, the University of Maryland Medical System ("the Medical system"), governed by its own board of directors, with a mandate to assure sound business practices, outstanding patient care, access to patients from across the state for tertiary care, access for the local disadvantaged community for comprehensive care, and attention to the academic mission of the university and its school of medicine. The results include strong financial performance, the ability to recapitalize outmoded facilities and technology, growth of strong programs, and the recruitment of excellent chairs and faculty. The Medical System's success suggests that university teaching hospitals, which necessarily depend on patient care revenues, may best be served by (1) removing them from university governance, thus allowing them to give primacy to their mission of patient care, and (2) removing them from state ownership, thus allowing them to use sound business practices in the competitive health care environment. The challenge under this arrangement is to ensure that the teaching hospitals can still support the educational and research programs that distinguish them. By establishing its independent, actively involved board of directors, the Medical System has successfully responded to this challenge.

Baltimore↗

PubMed1996

Use of a pharmacy and medical claims database to document cost centers for 1993 annual asthma expenditures.

OBJECTIVE: To demonstrate the utility of a combined pharmacy and medical claims database in the assessment of the incidence and the cost centers of asthma care in a managed health care system. DESIGN: A retrospective observational study to document annual cost for asthma therapy by cost center during 1993. SETTING: Four affiliated health maintenance organizations. PARTICIPANTS: A total of 25,614 asthmatics identified from a population of approximately 673,000 members in the health maintenance organization. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Annual charges by cost center for asthma care analyzed by age and gender. RESULTS: The period prevalence of asthma was 3.8%. Annual direct medical charges for asthma were $467.40 per member. Inpatient hospital and emergency department charges were greater in children than adults. Adolescent girls had increased use of the emergency department and inpatient hospital facilities and lower charges for medications than their male counterparts. Their increased use of acute care facilities was responsible for 25% greater charges for total asthma care. The gender differences in cost centers continued for adults, with increased charges for inpatient hospital and emergency department charges and lower expenses for medications for women. CONCLUSIONS: Charges for acute care were inversely related to the dollars spent on pharmaceuticals. This study demonstrates the ability of a combined medical and pharmacy database to document the charges for care and possibly identify indicators of undertreated populations.

Adolescent↗

PubMed1996

Practice revenue and cost distribution for ophthalmology, 1988 to 1993.

As opthalmologists need to better manage their practices, information regarding distribution of practice costs becomes more relevant. In this study, we compare revenues and costs from published sources to determine changes over time and across surveys. We also evaluate the reliability and validity of these statistics. Data were obtained from the Health Care Financing Administration (for 1988), the American Medical Association (for 1988, 1990, 1992, and 1993), and the Medical Group Management Association (for 1988, 1990, 1992, and 1993) and were compared across years and surveys. We found large differences among the surveys in both dollar amounts and percentages of total revenue for some of the reported cost categories. Analysis of the data over time showed less of a decline in physician earnings than expected, although there were large increases in the category "other costs." We found considerable divergence among the statistical results. Opthalmologists, public policymakers, and managed care organizations must exercise great caution in interpreting such data and in applying their findings to individual ophthalmic practices and practitioners.

American Medical Association↗