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At least 1,225 records · Page 68Linked to original sources
PubMed2006

Cost-effective control of interdependent water pollutants.

Excess nutrient loads to coastal waters lead to increased production of algae, which when decaying cause oxygen depletion in bottom sediments, which in turn leads to major changes in marine ecosystems. A cost-minimization model was investigated in which nitrogen and phosphorus were assumed to interact with respect to algae production. It was investigated under what conditions only a single nutrient should be decreased and when it is cost-effective to decrease both nutrients. The model was applied to the Baltic Proper, which is the largest of the seven major basins in the Baltic Sea. Results showed that the stringency of the environmental target, as well as assumptions regarding substitutability between nutrients, are important factors to determine the nutrient on which to focus. Uniform decrease rates for emissions are often used in international agreements, and the results of this model showed that the costs of making such proportional decreases could be substantial.

Ecosystem↗
PubMed1977

Controlling health care costs: strengthening the private sector's hand.

The council on Wage and Price Stability recently has discovered evidence suggesting "an unackonwledged potential of the private sector to exert influence and control in the area of health care cost inflation." This article examines the limitations on private-sector cost-control efforts and suggests actions which would permit and encourage private decision makers to be more effective. In particular, private health insurers' potential role in cost control is explored, and some promising insurer strategies are adumbrated. Carefully designed coverage limitations and plan-initiated reviews to exclude nonessential care from coverage are suggested, together with wider use of fixed indemnity payments or negotiated fees and charges (instead of paying unusual and customary rates or incurred costs). Among the steps needed to permit insurers to provide this added service to cost-conscious customers is enforcement of the antitrust laws to prevent doctors' organized resistance to unwanted measures. In general, it is argued that private-sector efforts are likely to be more effective than government-sponsored controls as well as more appropriate in a pluralistic society.

Cost-Benefit Analysis↗
PubMedDate not supplied

How low can you go? The impact of reduced benefits and increased cost sharing.

Amid escalating health care costs and a managed care backlash, employers are considering traditional cost control methods from the pre-managed care era. We use an actuarial model to estimate the premium-reducing effects of two such methods: increasing employee cost sharing and reducing benefits. Starting from a baseline plan with rich benefits and low cost sharing, estimated premium savings as a result of eliminating five specific benefits were about 22 percent. The same level of savings was also achieved by increasing cost sharing from a 15 dollars copayment with no deductible to 20 percent coinsurance and a 250 dollars deductible. Further increases in cost sharing produced estimated savings of up to 50 percent. We discuss possible market- and individual-level effects of the proliferation of plans with high cost sharing and low benefits.

Actuarial Analysis↗
PubMed1986

Health planning programs: the past suggests the future.

Federally supported health systems agencies are a thing of the past. Now is the time to explore some possible changes to the health planning structure instead of accepting the demise. A considerable historical record illustrates achievements and problems as well as opportunities for shaping a continued health planning program, whether under federal or state legislative sanction. The dominant focus of many HSAs was cost control and bed reduction. These strategies did not reflect that reimbursement changes, peer review systems and competitive forces had a more significant impact on bed reduction and cost containment than traditional regulatory planning approaches. In any future reconfiguration, health planning must go beyond its traditional cost control emphasis and assume greater responsibilities for promoting competition in health care. Should HSAs be reorganized under a state setting, they must strive to preserve the principle of local advocacy and not become subservient to a new form of centralized planning control.

Economic Competition↗
PubMed1993

Economic impact of cost-containment strategies in third party programmes in the US (part I).

The rising cost of healthcare has strained the resources of governments, private third parties and individuals with responsibility to pay for it. Various strategies have been used in an attempt to control costs. This article examines the economic impact of 4 such strategies: (a) cost sharing; (b) prescription limits; (c) rebates; and (d) cost limits. Cost sharing has been successful at reducing utilisation of prescription drugs, although the effects have not been uniform across therapeutic categories. However, the long term effect on cost and utilisation of other medical services, and the impact on overall health status, remain largely unknown. Some evidence suggests that utilisation of other services may increase. The available data regarding drug rebate programmes have been descriptive in nature. However, the designs employed in this research do not establish a direct causal relationship between rebate programmes and changes in Medicaid drug expenditure. Furthermore, still unknown is the degree of cost shifting and the effect of the rebate programme on other large public and private drug purchasers. The Maximum Allowable Cost programme led to direct savings in drug costs, but the size of these savings was variable and uncertain because of administrative costs of the programme. The Estimated Acquisition Cost programme has not resulted in significant savings.

Cost Control↗
PubMed1991

Minding our Ps and Qs? Financial incentives for efficient hospital behaviour.

In this paper, the empirical evidence addressing the particular issue of how hospitals may be reimbursed is reviewed. Most forthcoming is the indeterminate effect of prospective payment systems using diagnosis-related groups as a means of controlling costs. Such systems, by controlling only the price of hospital care, remain vulnerable to compensatory increase in patient throughput, cost-shifting and patient-shifting despite hospital cost per case being reduced. Health maintenance organisations have been shown to reduce hospital costs, but their effects on patients selection and patient outcome are unclear. Selective contracting in California (similar to the U.K. Government's proposed internal market) has also been shown to reduce costs by affecting both the price and quantity of hospital care. But these effects have occurred only in areas with high concentrations of hospitals. Global and clinical budgeting (which control price times quantity) seem to offer the most potential for cost reduction whilst maintaining patient outcome. By monitoring both cost and outcome within clinical budgets it should be possible to reduce wasteful variations in health care and so establish more efficient hospital practice.

Australia↗
PubMed2000

Preparing Taft-Hartleys for the 21st century: health care leads list of challenges for plan administrators.

Rising health care costs are a major challenge facing administrators of Taft-Hartley health and welfare plans. Managing costs while continuing to provide coverage that meets members' expectations and needs will require a delicate balancing act. Among areas that require close scrutiny are legislative activity, retiree medical benefits, prescription drugs, funding and cost-control methods.

Cost Control↗
PubMed1998

Contagious bovine pleuropneumonia. The costs of control in Central/southern Africa.

Contagious bovine pleuropneumonia (CBPP) caused by Mycoplasma mycoides subspecies mycoides small colony (M. mycoides) has been endemic in many parts of Africa for the greater part of this century. Because of an international vaccination campaign the disease was almost eliminated from the continent. With the deteriorating economic situation of many countries, vaccination programs have been allowed to slip; drought conditions have resulted in great movements of livestock and the disease has spread rapidly to the east and south. For Government Veterinary Departments, the implications of this resurgence of CBPP, are serious. The costs threaten to overwhelm completely under-funded government, services. Where cost-recovery measures are introduced, the charging for vaccines may damage rapport with communities and erode the credibility of the government services. Farmers may find the loss of cattle and the costs of vaccine severe burdens which threaten their livelihoods and social well-being (Zambia) and even, in extreme cases, their survival (Botswana). Controlling the disease today presents new possibilities which include increased cross-border collaboration (Malawi/Tanzania), increased emphasis on monitoring (N. Zambia) and the greater involvement of communities in disease control (W. Zambia).

Abattoirs↗
PubMed2001

Consumer and surrogate preferences for a cash option versus traditional services: Florida adults with developmental disabilities.

As long-term service expenditures have risen, policymakers have sought ways to control costs while maintaining consumer satisfaction. Concurrently, there is increasing interest in the disability community in consumer direction. 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. Because the disability community is composed of diverse subgroups, needs of these consumer communities must be assessed individually. Results from a telephone survey conducted to assess the interest in a cash option for Florida adults with developmental disabilities is presented, the three-state CCDE described, how survey findings can inform consumer information efforts discussed, and policy issues highlighted.

Adult↗
PubMed1995

Is subacute care feasible?

As healthcare executives attempt to control costs and enhance revenue in an increasingly competitive market, many are considering converting acute care units into subacute care units (Medicare-certified skilled nursing units). Such a conversion can help control costs by providing care in a less expensive setting that is appropriate for patients who require less intensive care than traditional acute care. In addition, converting an acute care unit into a subacute care unit can optimize reimbursement for Medicare patients. A detailed feasibility analysis that addresses clinical, regulatory, space, and financial considerations should be conducted before healthcare executives decide to convert acute care beds into subacute care beds. Only after a feasibility analysis is performed can healthcare executives determine whether creating a subacute care unit is a realistic, beneficial option.

Bed Conversion↗
PubMed1992

Cost containment and new priorities in the European community.

This article reports on the author's survey of the cost-control measures for health care in 12 European countries during the period from 1983 to 1990. Among these countries the greatest convergence was in the use of the budget as a system of control, reinforced by manpower controls. Budgets were constructed to restrict hospital costs and payments to doctors practicing outside of hospitals. Another strategy was cost sharing for purchase of drugs and, in some cases, for dentistry. Most countries took steps to control expensive medical equipment; others, to restrict entry to medical schools. The European experience demonstrates the technical feasibility of the government's controlling health care costs by regulating supply rather than demand. The key to Europe's success in the use of monopsony power, whereby one purchaser dominates the market. The author contends that regulation works in Europe and questions whether the United States can exert similar control over its coalition of insurers and providers in order to rein in its health care expenses.

Ambulatory Care↗
PubMed2002

Triage in the nation's medicine cabinet: the puzzling scarcity of vaccines and other drugs.

For a variety of reasons, vaccines and other critical pharmaceutical products have become increasingly scarce in the last few years, and persistent shortages involving dozens of essential drugs may imperil the public health. Pressures emanating from regulatory agencies, the courts, and insurers have conspired to make some lines of the pharmaceutical business less than attractive. Although concerns about unpredictable tort liability received most of the blame in the past, two other factors may help to account for the latest round of drug shortages: stringent federal control of manufacturing facilities and aggressive cost-containment efforts that further erode profit margins. Whatever the cause, scarce supplies necessitate efforts at rationing that pose their own difficulties for health care providers. Policymakers could avoid putting physicians to such tough choices regarding patients by focusing on ways to ensure the production of adequate quantities of these highly cost-effective medical technologies. Some commentators have called for greater public sector involvement, but this Article concludes that, in addition to bolstering its emergency stockpiles, the federal government instead needs to take steps designed to encourage private manufacturers to continue supplying critical pharmaceuticals. To this end, the government should adopt more flexible regulations governing manufacturing facilities, provide companies with greater protection from the vagaries of tort liability, and avoid pursuing excessive cost-control strategies. Otherwise, patients may continue to lose access to important therapeutic products.

Cost Control↗
PubMed2001

Wall Street comes to Washington: market watchers and policy analysts evaluate the health care system.

As health care costs surge again, most insured consumers are enjoying greater access to care, many health plans are prospering and employers are wringing their hands over how to pay for it all, according to market and health policy analysts at the Center for Studying Health System Change's (HSC) sixth annual Wall Street roundtable. Panelists discussed the outlook for managed care, including the Medicare+Choice program, hospitals and pharmaceutical costs; the untapped promise of evidence-based medicine to help control costs; and the growing animosity between health plans and providers.

Cost Control↗
PubMed2004

Consumer-driven health plans: design features to promote quality improvement.

The most prevalent form of consumer-driven health plans (CDHPs) presents risks in terms of the cost, quality and appropriate use of health care. This article identifies those risks and shows employers how they can reduce them without compromising the overall cost-control potential of CDHPs. A good CDHP strategy should work on both the demand and supply sides of the market.

Adult↗
PubMed1985

Cost-effective control of rheumatic fever in the community.

Rheumatic fever is declining rapidly in importance in the developed countries, but is still a major public health problem in the developing countries. Primary prevention techniques, consisting of the detection and antibiotic treatment of streptococcal infections of the pharynx, are both feasible and effective, but are also costly, as only 10-20% of all pharyngeal infections are due to the beta-hemolytic Streptococcus, and only a small proportion of those actually develop into rheumatic heart disease. A different concerted approach, which is both effective and economically entirely justifiable, is to use antibiotics as a prophylaxis to prevent secondary infection, i.e. relapses of rheumatic fever. A multi-centre study conducted by the WHO has shown that the cost of antibiotics used for secondary prevention was less than the savings resulting from the lower incidence and shorter hospital stays of recurrencies of rheumatic fever. Given economic restrictions, therefore, priority is given to organized and systematic secondary prevention.

Community Health Services↗
PubMed1997

The impact of China's health sector reform on county hospitals.

The article describes the impact of China's health sector reform on relatively small hospitals in rural counties. It uses one county hospital to illustrate how pressures to increase revenue, combined with distortionary pricing policies, have led to cost increases. It argues that the introduction of hospital insurance could accelerate the cost increases unless measures are taken to control costs. These measures will include improvements to hospital management and changes to mechanisms of payment for hospital services. Government will have to play an active role to ensure that county hospitals serve the needs of rural people.

China↗