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At least 1,207 records · Page 67Linked to original sources
PubMed1999

Estimating economic thresholds for pest control: an alternative procedure.

An alternative methodology to determine profit maximizing economic thresholds is developed and illustrated. An optimization problem based on the main biological and economic relations involved in determining a profit maximizing economic threshold is first advanced. From it, a more manageable model of 2 nonsimultaneous reduced-from equations is derived, which represents a simpler but conceptually and statistically sound alternative. The model recognizes that yields and pest control costs are a function of the economic threshold used. Higher (less strict) economic thresholds can result in lower yields and, therefore, a lower gross income from the sale of the product, but could also be less costly to maintain. The highest possible profits will be obtained by using the economic threshold that results in a maximum difference between gross income and pest control cost functions.

Animals↗
PubMedDate not supplied

Nonclinical outcomes of hospital-based palliative care.

Evidence-based outcomes are commonly used in making decisions about clinical care. For healthcare executives, evidence-based outcomes also can be useful in making decisions about hospital services. Finkler and Ward (2003) suggest a model whereby cost measurement, cost control, and value assessment can be used as nonclinical, evidence-based outcome measures to provide decision support and to guide management decisions. The Finkler and Ward framework is used to understand the financial implications of establishing an inpatient palliative care unit (PCU). A longitudinal study was conducted to examine the nonclinical outcomes associated with opening and operating an inpatient PCU at a large academic medical center during the first four years of the unit's operation. First, the cost of providing inpatient palliative care was measured. Results indicated that the cost per day to care for patients hospitalized in the last 20 days leading up to their death was significantly less on the PCU than on intensive care units and non-PCUs. Average daily total charges exceeded reimbursement on the ICU and non-PCUs, but the cost on the PCU for the same population was equal to or below the average daily total charges. Second, ways to control costs when operating an inpatient PCU were identified and measured. Evidence from one organization suggests that costs can effectively be controlled by admitting patients directly to the PCU and by appropriate use of hospital resources, including staff, ancillary services, and pharmaceuticals. Third, the study assessed the value to the institution of operating an inpatient PCU. Results indicated that the inpatient PCU yielded a cost savings of nearly 1 million dollars by the third year of operations. This study highlights the nonclinical outcomes of one institution's inpatient PCU and provides guidelines for healthcare executives and managers to use in making decisions about adopting such programs.

Ancillary Services, Hospital↗
PubMed1994

Leukocyte reduction of cellular blood components. Effectiveness, benefits, quality control, and costs.

Cellular blood components contain passenger donor leukocytes. Transfusion of passenger leukocytes may be associated with alloimmunization to leukocyte antigens, febrile transfusion reactions, refractoriness to platelet transfusion, severe pulmonary dysfunction, graft-vs-host disease, the transmission of infectious diseases, and immune modulation. Advanced leukocyte-reduction filters enable the removal of up to 99.9% of leukocytes from cellular blood components. Clinical trials suggest that the use of leukocyte-reduction filters may prevent or diminish the probability of febrile transfusion reactions, alloimmunization, and cytomegalovirus infection, but controversy exists regarding the effectiveness of leukocyte reduction in preventing immune modulation. There is no evidence that available techniques will prevent graft-vs-host disease. Cost-benefit analyses support the use of leukocyte-reduction filters for well-defined indications. Standards for leukocyte reduction of red blood cells have been defined, but issues regarding the quality control of leukocyte-reduced blood components require additional study.

Cost-Benefit Analysis↗
PubMedDate not supplied

Cost shifting: the final straw in federalization of health care.

While cost controls applied by Medicare and indemnity insurance programs initially helped curtail abusive medical billing practices, creative billing techniques have since resulted in runaway medical costs and rising insurance premiums. Employers have been forced to increase employee's contributions to health care by increasing deductibles, copayments, and coinsurance or by simply dropping health care benefits. If National Health Insurance comes to pass, and that is a cry now coming from major employers, it will be followed in time by federalization of all health care delivery systems, including Workers' Compensation. It is the providers who shift their fees into Workers' Compensation, which pays from the first dollar, who will cause the business community to petition Washington for relief. It will claim the need for cost controls in Workers' Compensation to keep American business competitive in world markets.

Cost Allocation↗
PubMed2007

Cordectomy by CO2 laser or radiotherapy for small T1a glottic carcinomas: costs, local control, survival, quality of life, and voice quality.

BACKGROUND: The clinical results of radiotherapy and endoscopic cordectomy for T1a glottic carcinoma are reported to be similar, but costs of both treatments may differ. Therefore, we retrospectively evaluated the costs, voice quality, quality of life, and clinical results of both treatments. METHODS: Costs and effects from the first visit up to 2 years of follow-up were calculated, based on chart data of 35 and 54 patients who were treated with curative intent for T1a glottic carcinoma from 1995 to 1999 with radiotherapy and endoscopic cordectomy, respectively. Voice quality and quality of life were evaluated by means of patient questionnaires. RESULTS: Total costs (in Euros) of radiotherapy and CO(2)-laser cordectomy were 8322 euro and 4434 euro, respectively, including the costs of treating possible recurrences. The effects of both treatments were equal, including voice quality and quality of life. CONCLUSIONS: We conclude that endoscopic cordectomy is an efficient alternative for radiotherapy for these patients.

Adult↗
PubMed1988

Psychiatric consultations with depressed medical inpatients: a randomized controlled cost-effectiveness study.

Nonspecific, supportive psychiatric consultations were performed with a random sample of thirty-three general medical inpatients scoring thirteen or more on the Beck Depression Inventory. The control group consisted of thirty-five patients, matched for sex, marital status, somatic history, and seriousness of illness. The number of patients receiving no analgesic and/or psychotropic medication in the consult group (39%) was significantly greater than that in the control group (17%). When compared with their mean BDI score on admission, the BDI score just before discharge had decreased significantly in the consult group (from 20 to 13), but not in the control group (from 19 to 16). Probably because the patient sample was too heterogeneous, with too low a prevalence of mental disorders (45%), a significant reduction in other medical care expenditures and in length of hospital stay could not be demonstrated.

Cost-Benefit Analysis↗
PubMed2002

The impact of reimbursement systems on occupational therapy practice in Canada and the United States of America.

Different funding and cost-control mechanisms in Canada and the United States of America (USA) have a powerful influence on occupational therapy practice in each country. Canada's public health insurance system emphasizes access to health care services based on medical need. Costs are controlled at the provincial government level by limiting the capacity of facilities and personnel. Occupational therapists in publicly-funded settings have considerable professional autonomy to use occupational therapy theoretical models and to be client-centred. The measurement of outcomes is not always required and the interventions of individual occupational therapists are infrequently scrutinized. The USA has no universal, publicly-funded, comprehensive health insurance. Health care policies are driven by financial priorities and cost control occurs at the service delivery level. Insurance companies define the scope of occupational therapy practice by identifying what services they will pay for and they scrutinize occupational therapy interventions. The emphasis on effectiveness and efficiency leads to critical examination of interventions by therapists. Canadian occupational therapists can learn much from their colleagues in the USA in this area.

Canada↗
PubMed2005

How positive affect modulates cognitive control: the costs and benefits of reduced maintenance capability.

Adaptive action in a constantly changing environment requires the ability to maintain intentions and goals over time and to flexibly switch between these goals in response to significant changes. argued that positive affect modulates these antagonistic control demands in favor of a more flexible but also more distractible behavior. In the present paper, the author will present further evidence for the affective modulation of cognitive control: mild positive affect reduced maintenance capability in a simple cuing paradigm (the AX Continuous Performance Task) as compared to negative and neutral affect. This reduced maintenance capability results in costs when a to be maintained goal has to be executed and conversely results in benefits when a to be maintained goal unexpectedly changes. The data will be discussed with respect to existing theories on positive affect, cognitive control, and dopamine.

Adolescent↗
PubMed1996

Successful implementation of laboratory budget holding by Pegasus Medical Group.

AIMS: To evaluate the effectiveness of budget holding by Pegasus Medical Group for laboratory services expenditure and reasons for the successes observed. METHODS: Two pilot groups and a nonpilot group of general practitioners were formed with the pilots receiving active feedback, educational programmes and test form redesign within the incentive of savings being retained by the group for improved primary care services. RESULTS: Overall savings of 22.7% were achieved within the budget over a 13 month period. There was a highly significant reduction in expenditure per member especially in the mean and standard deviation of cost per consultation indicating a marked narrowing of the variance in cost between members in the pilot groups compared with the nonpilot group. CONCLUSION: The study illustrates the effectiveness of a comprehensive strategy of education, active feedback and test form redesign and especially the importance of the incentive of retaining budgetary savings for service improvements. It also illustrates the importance of collaborative as compared with competitive strategies in achieving cost control and value for money gains in health services. However, more work is needed to establish the appropriateness of lower laboratory expenditure by linking test requests to diagnosis.

Budgets↗
PubMed1997

The changing role of the psychiatrist in board-and-care homes.

The role of the psychiatrist in board-and-care homes has been changing dramatically since a job description was published in 1989. The role has become more complex as a result of advances in psychopharmacology, the trend toward polypharmacy regimens, the necessity to evaluate the interaction potentials of drug combinations, and the emergence of more sophisticated treatment algorithms. Broad social trends have added to the complexity of board-and-care treatment, such as the tendency to release more severely disturbed patients from long-term-care facilities because of the increasing costs associated with institutionalization. However, treatment of these patients will continue to be expensive because of the higher costs of new drugs and of using medication combinations. Continued high-cost treatment will increase pressure to control costs by managed care companies, third-party payers, and government agencies. Although this paper describes the effects of these trends on board-and-care psychiatrists, they are also relevant to psychiatrists in general and to other practitioners.

Cost Control↗
PubMed1996

GAO's role in the evaluation of federal health programs.

The General Accounting Office (GAO) is a legislative branch agency whose mission is to support the oversight role of Congress. Health policy issues have constituted a substantial part of GAO's recent workload. Whereas GAO's work on health has ranged broadly, it has often focused on fraud and abuse in federal programs, particularly Medicare and Medicaid; the lack of meaningful indicators and other information, particularly on outcomes in health programs; access to care, increasingly connected to managed care; quality of care; and issues related to cost control.

Cost Control↗
PubMedDate not supplied

The Clinton plan: with malice toward none and health security for all.

President Clinton's health reform proposal brings together the means generally associated with conservatives--market competition--to achieve the ends advocated by liberals--health security for all Americans. Exactly how the White House, Congress, and the American public reach consensus is open to negotiation and compromise. But certain fundamental principles such as universal coverage and cost control are not.

Cost Control↗
PubMed1989

Taking stock of a money-saving system. Now may be the time for just-in-time.

The urgent need to trim costs is apparent in hospitals across the country. One target for internal belt-tightening is business forms. Pick-and-pack programs are computerized just-in-time storage and delivery systems developed specifically to reduce a facility's administrative costs for forms. Under pick-and-pack, business forms are stored in a central location, which is connected to either the facility's or a vendor's computer system. Forms are shipped directly to the requesting user as needed. The result is substantial reduction in labor, inventory investment, and storage space. The system provides all the information necessary to keep inventory at optimum levels, while meeting stocking needs and minimizing inventory investment. Better yet, pick-and-pack provides a monthly summary billing, significantly reducing administrative processing costs. Of additional help to the hospital is a report that allocates charges by cost center and includes important data for budgeting and cost control.

Cost Control↗
PubMed1994

Remodeling health care.

Standard models of patient demand for health care and health care suppliers' response to that demand imply that some manner of manipulation of the prices faced by patients must be chief among the mechanisms of systemic cost control. However convenient econometrically, these standard models cannot reflect the complexity of patient demand behavior, and they say little about the predominant causes of health-care cost escalation. This paper describes a richer Jevonian political-economic model that sensibly portrays patient demand and physician and corporate supply behaviors and suggests a range of cost-controlling and care-enhancing compensatory steps, some professional, some societal. This new model implies that reformers in the United States could take respectful advantage of the fundamentally self-regulating nature of patient demand for health care by shifting their attention away from its further discouragement and toward the modulation of other factors.

Cost Sharing↗
PubMed1979

Quality assurance strategies in U.S. and Canadian psychiatry.

Quality Assurance Strategies in Psychiatry and Medicine in general have developed rapidly and have been applied widely in the last few years, particularly in the United States. This paper reviews some of those developments both from a methodological and a socio-political point of view. The relevance to the Canadian scene is evaluated, and it is concluded that, although quality assurance is now accepted as an obligation of the health profession, some of the strategies being widely applied in the United States are of questionable value in themselves, and some, particularly cost control techniques, would seem to be irrelevant to the Canadian health field which already has a variety of checks and balances in its universal health insurance system. Though cost control and quality control logically overlap, at times they are allowed to merge and cause conceptual confusion. Finally, as systems are developed in Canada, it is suggested that a means of self-assessment be built in so that the validity and reliability are not in doubt.

Accreditation↗
PubMedDate not supplied

Painful medicine: managed care and the fate of America's major teaching hospitals.

Healthcare spending in the United States has risen steadily throughout the post-World War II period as the American healthcare system has been transformed from cottage industry to big business. The increasing rate of social investment in healthcare also transformed America's major teaching hospitals. As a case in point, the University of Iowa Hospitals and Clinics saw annual operating revenues rise from $1 million in 1945 to more than $350 million in 1995, which was accompanied by an extraordinary expansion in its physical facilities and in its multifaceted operations. In the 1970s and even more so in the 1980s, however, the unceasing climb in healthcare spending fueled concern among policy experts, politicians, employers, and insurers alike. In turn, the search for effective cost controls led to the current managed care revolution. While the end of that revolution is not yet in sight, managed care has, it appears, effected significant cost savings, but at no small cost to America's major teaching hospitals and their social missions of teaching, research, and patient care. Whether those missions can survive--and, if so, in what form--in a healthcare system dominated by the managed care ethos is an increasingly important concern.

Centers for Medicare and Medicaid Services, U.S.↗