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PubMedDate not supplied

Rethinking Medicare reform.

Many health policy analysts argue that demographic pressures, the inflationary nature of fee-for-service payment, and the uncontrollable nature of defined-benefit insurance make Medicare unsustainable in its current form. They assert that Medicare can remain fiscally viable in the next century only by embracing a voucher system and exposing beneficiaries to the economic consequences of their medical care decisions. We argue here, however, that Medicare need not rely on vouchers or on placing financial incentives on individual beneficiaries to control costs. Instead, we contend that Medicare can control expenditures the way most other industrial democracies do: through budgetary caps and centralized regulation of provider payments.

Aged↗
PubMed1975

Input-output analysis and the hospital budgeting process.

Two hospitals budget systems, a conventional budget and an input-output budget, are compared to determine how they affect management decisions in pricing, output, planning, and cost control. Analysis of data from a 210-bed not-for-profit hospital indicates that adoption of the input-output budget could cause substantial changes in posted hospital rates in individual departments but probably would have no impact on hospital output determination. The input-output approach promises to be a more accurate system for cost control and planning because, unlike the conventional approach, it generates objective signals for investigating variances of expenses from budgeted levels.

Accounting↗
PubMed1999

Economic impact of a rational use of antibiotics in intensive care.

OBJECTIVE: To evaluate the economic impact of a rational policy in antibiotic treatment. DESIGN: Comparative study with a retrospective and a prospective part. SETTING: An 11-bed intensive care unit (ICU) in a general hospital. PATIENTS: All patients admitted to the unit in 1994, 1995 and 1996. INTERVENTIONS: In 1995, a program of cost control was started and a contract of agreed objectives signed with the director of the hospital. This contract included a commitment to refund the eventual savings in order to improve the quality of care. Prescribing protocols were established by consensus as guidelines for a rational policy in antibiotic therapy. MEASUREMENTS AND RESULTS: The cost of antibiotic therapy, the patients' characteristics and the incidence of nosocomial infection were compared prior to and during the program. The expenses for antibiotic drugs decreased by 19% in 1995 and by 22% in 1996. Most of the savings were refunded to the ICU and contributed to the employment of an additional nurse and the purchase of new material. In number of patients, type of disease, mean age, Simplified Acute Physiology Score, occupancy rate, length of stay, omega score, artificial ventilation, readmission within 7 days, mortality and incidence of nosocomial infection, no significant difference was found. CONCLUSIONS: We proved a positive economic impact of a rational policy in antibiotic therapy realized with a contract of agreed objectives. The savings made while applying our program of cost control were used to improve the quality of care.

Anti-Bacterial Agents↗
PubMed1978

Ohio congressman has keen grasp of health care issues.

A hospital trustee himself, Rep. Willis Gradison Jr. (R-OH) believes that mandatory cost controls would weaken the financial capacity of hospitals, greatly reduce their access to the capital market, and ultimately lead to hospitals' ap,lying to the federal government for direct aid in order to operate. It does not make sense, he says, to put cost controls on hospitals and not on other segments of the economy.

Delivery of Health Care↗
PubMed1992

Critical strategies for successful rural hospitals.

Not all rural hospitals are in a depressed financial situation. Many can and have achieved financial performance levels which match their urban counterparts. Cost control is the single most important management strategy which differentiates the successful from the unsuccessful rural hospital. Labor productivity is much higher in the financially successful rural hospital than in the unsuccessful hospitals. Reduced length of stay is also especially critical in the overall cost containment program.

Capital Expenditures↗
PubMedDate not supplied

Commentary: health care reform and specialists: the results are not very positive!

The present study explored the effects of the current round of health care reforms on practicing physicians in terms of income, cost of care, and improvements in the quality of care. Six neurologists from various parts of the country, all facing widely differing environmental factors, were interviewed. The results demonstrate that health care reform has forced physicians to work more hours to maintain their incomes, has done little to control costs, and has generated little interest in quality improvement plans. In fact, due to referral patterns, quality levels may have decreased under capitated payment plans. The conclusion is that health care must be reformed at the local level and involve physicians with a wide array of specialties.

Cost Control↗
PubMed1996

Occupational health programs: envisioning the next generation.

1. As the health care system changes, occupational health programs will play a key role in defining the new relationship between employers and health care providers. 2. Occupational health program development in the 1980s concentrated on treating injuries and increasing the revenues for the health care provider. 3. As employers become more sophisticated and cost sensitive, they will require occupational health programs to improve quality and control costs. 4. To succeed in this new environment, occupational health programs will need to focus on the prevention of illness and injury, develop more cost effective treatments, and use superior information systems which allow them to measure and improve outcomes.

Cost Control↗
PubMed1997

[The Canadian health system and its financing].

This work stems from a brief visit in 1993 to the Canadian health services as part of the PAHO International Health Training Program and the subsequent research, discussion, and analysis relating to that experience. By no means is this paper an exhaustive account of the system, but rather a close look at one of its aspects: financing. The main objective is to identify some of the virtues and limitations of a health system that is considered one of the most efficient, effective, and equitable in the world. Although the Canadian health system is financed by the federal government and the provincial governments, cost containment is a constant concern, since factors such as the growing use of highly complex technologies, hospital care, and long-term treatment of chronic and degenerative illnesses tend to increase costs. The progressive reduction in the federal budget has lead to more efficient use of resources and the rationalization of installed capacity. At the same time, the relative simplicity of the system's operation has permitted administrative costs to be kept low. In addition, alternative forms of care, such as local centers for community-based care, care at home and in special institutions to promote the maximum level of self-sufficiency, and the use of volunteers, have been devised in order to partially control cost increases. The people's participation in planning and decision-making permit them to guide the development of the health services. Nevertheless, given the current situations, it is essential that the system be modified to prepare it for the challenges the twenty-first century will bring.

Canada↗
PubMed2002

Lifetime cancer-attributable cost of care for long term survivors of colorectal cancer.

OBJECTIVES: We aimed to determine cancer-related medical care costs for long term survivors of colorectal cancer. METHODS: The SEER-Medicare database was used to measure lifetime cancer-attributable costs of care for those with colorectal cancer surviving at least 5 yr versus age- and gender-matched controls. Costs were directly estimated, stratified by age at diagnosis and stage at diagnosis, for years 6-11 after diagnosis and then modeled to estimate lifetime costs. Cost differences between cancer cases and controls were compared to expected costs based on published guidelines for postcancer surveillance. RESULTS: Lifetime medical costs for long term survivors (future years not discounted) were up to $19,516 higher than control costs, and were highest for younger age groups and those with early-stage disease. Excess costs for cancer survivors exceeded expected surveillance costs by $2,223-8,822 for years 6-10 from the date of initial diagnosis. CONCLUSIONS: Cancer-attributable medical costs can be substantial for long term survivors, and exceed expected costs of surveillance. Future research is need to determine the components of excess cost in this survivor group.

Age Factors↗
PubMed2000

Understanding the intersection between quality improvement, managed behavioral health accreditation, and the private practitioner.

The many parties, which now possess a role in behavioral health care services, are each concerned about the quality of these services. The concept of accreditation of MBHOs differs little from the board certification and licensure mechanisms used to ensure a minimal standard of care among practitioners. In the same way that behavioral health patients use licensure to seek competent providers, payers use accreditation as a way to ensure that MBHOs, given the task of cost control, are also active in ensuring that cost containment does not translate into decreased quality of care. Accreditation has established standards that fundamentally require MBHOs to implement QI programs directed at assessing and implementing efforts to improve care on a systemic level. NCQA accreditation of MBHOs reflects an effort to both regulate a novel industry as well as establish standards that reflect an ideal of health care. Currently, relatively few MBHOs receive full accreditation. This suggests that NCQA maintains its ideals but also that many MBHOs do not have the quality improvement programs that adequately demonstrate an interest in assessing and improving upon continuity and population-based quality care. As a fledgling industry, MBHOs are subject to unique market demands and trial and error. These forces have alienated many practitioners who provide services to MBHO members; however, practitioners must be able to tease out those aspects of managed care that facilitate quality care for their patients. Fundamental to this is the need for practitioners to understand and contribute meaningfully to QI initiatives directed at meeting NCQA standards. Despite their impositions, the new demands they place on practitioners, and the conflicted relationship in which they take place, QI efforts reflect an effort on the part of accrediting organizations and MBHOs to define, through empirical assessment and improvement efforts, quality care at a systemic level. Such care directly relates to effective behavioral health care by ensuring that a population of members receives care over a continuum of time and setting. Accreditation standards ultimately translate into quality of care and service, which patients and practitioners as well as the other stakeholders in the health care marketplace, agree is important.

Accreditation↗
PubMedDate not supplied

[Costs analysis of ambulatory blood pressure monitoring in mild hypertension].

BACKGROUND: To contrast the costs of conventional and ambulatory blood pressure monitoring (ABPM) methods in the diagnosis, treatment and follow-up of mild hypertensive patients. METHODS: Among patients with conventional diagnosis of mild hypertension, the ABPM would discriminate patients with sustained hypertension, who would receive drug treatment, from patients with white coat hypertension (WCH), who would be only followed up. The diagnosis, treatment and control costs were obtained from 446 mild hypertensive patients from the Primary Health Care Center Aranbizkarra II (Vitoria, Spain) during 1996. For each gender, the overall costs per patient were estimated in both conventional and ABPM methods in terms of mean diagnosis age and WCH percentage. RESULTS: For 45 years old patients and 30% of WCH, the overall costs per patient among men were 414,999 and 371, 101 pesetas with conventional and ABPM methods, respectively. From 30 to 60 years old patients, the ABPM method turned up to be less expensive as long as the WCH percentage was higher than 6%. Similar results were obtained among women with mild hypertension. CONCLUSIONS: ABPM can be accepted as an useful clinical tool for the screening of patients with conventional diagnosis of mild hypertension. On the one hand, ABPM allows to select patients with low cardiovascular risk (WCH). On the other hand, the savings resulting from treatment reduction and fewer physician visits are higher than the additional costs of ABPM recordings.

Aged↗
PubMedDate not supplied

Canaries in a coal mine: California physician groups and competition.

Health care organizations may compete by developing organized processes to improve quality and increase efficiency, or may focus on growing to increase negotiating leverage and on controlling costs through withholding appropriate care and avoiding sick patients. This paper describes key ways in which public and private policy decisions create incentives that influence the competitive focus of physician groups in California, a state in which physician groups and health maintenance organizations are prevalent. These policies do not manage competition in optimal ways: They reward groups for market leverage and controlling costs while failing to fully reward quality and efficiency.

California↗
PubMed1999

Health care consolidation and the changing health care marketplace. A review of the literature and issues.

This Issue Brief examines the academic literature and issues in consolidation of the hospital sector in the context of responses to changes in the competitive environment. It analyzes the motivations for consolidation as well as its effects. Hospital merger activity has increased dramatically in recent years. The current wave of mergers is primarily a reaction to a competitive environment that is placing a greater emphasis on controlling costs and forcing high-cost providers out of the market. The growth of managed care has placed considerable pressure on providers of health care and, in particular, on hospitals. The evolution of insurance companies' behavior helps explain the recent hospital consolidation movement. As managed care has become the dominant type of coverage in the last decade, insurance companies have become more active in trying to control costs--a reversion to their previous practices before the advent of managed care. Insurance companies have placed cost constraints on providers, both in the early years of health insurance and currently, when there are strong competitive forces. Hospitals claim that their primary merger motives are improving efficiency and the quality of care. The empirical evidence on this claim is mixed. Vertical integration (between suppliers and buyers of health care services, such as between hospitals and physicians) has appealed to hospitals because of their need to obtain more patients. More research is needed to explore the effects of vertical integration in the health care sector. In one of the more significant recent legal rulings, the U.S. Justice Department lost a 1997 case challenging the merger of two hospitals in the New York City metropolitan area. This, along with other recent losses by the antitrust authorities, does not bode well for the government's ability to prevent hospital mergers in metropolitan areas. It is difficult to generalize on an appropriate antitrust policy for hospital mergers. Hospital consolidation is likely to continue at a rapid pace. Since some developments may reduce the cost of employee benefits while others may increase the cost of these benefits, the final effect on the provision of health care benefits by employers is uncertain. Employers must pay close attention to the hospital consolidation movement because it will lead to important changes in the provision of health care benefits.

Antitrust Laws↗
PubMed1994

Progress and promise.

Efforts to control costs and improve quality are working. Now Congress will determine how best to control future health care costs and extend care to the nation's uninsured.

Cost Control↗
PubMed1991

Global budgeting and the control of hospital costs.

This paper attempts to answer the question: Would global budgeting control hospital costs in the United States? It reviews the development of health insurance and the growth of specialization in the United States, as well as the experience of Canada in attempting to control costs in a fee-for-service national medical care program. It concludes that the main causes of cost escalation in the U.S. are fee-for-service and overspecialization, and urges adoption of the NAPHP proposal for payment of physicians in a national program, i.e. global budgeting for the entire package of ambulatory and institutional services. It also presents a nine-point program for immediate State action to lower costs.

Canada↗
PubMed1990

Cost categories, behavior patterns, and break-even analysis.

Nurse executives budget and control costs, use those budgets and other management tools to control departmental costs, identify existing programs to drop or change, target new programs and services, and determine fees for nursing services. Knowledge of costs and their behavior patterns assist nurse executives in all of these activities. The author identifies the two cost categories (direct and indirect), explains the basic cost behavior patterns (fixed and variable), and helps nurse executives identify these cost categories and behavior patterns in their own departments.

Budgets↗
PubMed2004

How physicians' organizations compete: protectionism and efficiency.

This article develops a framework that distinguishes four types of competitive strategies that physicians' organizations can adopt in their interactions with health plans. Two types of strategies protect physicians' incomes and autonomy from incursion and control by insurers; the other two enhance the efficiency of health care markets by controlling costs and embedding physicians' caregiving in a community of professionals. The mix of strategies that each organization adopts at any given time depends on the market conditions and regulatory policies it faces, as well as its organizational capacity. The article reviews recent developments in the field that indicate that today's markets and regulations create neither the pressures nor the capacity for physicians' organizations to adopt strategies that enhance efficiency. The managed care backlash has led to a relaxation of pressures to control costs, and the lack of a business case for quality has discouraged embedded caregiving. These developments instead have encouraged and enabled physicians' organizations to adopt strategies that protect their members from the bargaining power and micromanagement of health plans. The article therefore proposes changes in purchasing and regulatory policies to alter the pressures and improve the capacity of physicians' organizations to pursue efficiency and eschew protectionism.

Delivery of Health Care↗
PubMed2005

Plan and operation of Cycle 6 of the National Survey of Family Growth.

OBJECTIVES: This report describes how Cycle 6 of the National Survey of Family Growth (NSFG) was designed, planned, and implemented. The NSFG is a national survey of women and men 15-44 years of age designed to provide national estimates of factors affecting pregnancy and birth rates; men's and women's health; and parenting. Cycle 6, conducted in 2002, was the first time the NSFG included a sample of males. METHODS: The survey used in-person, face-to-face interviews conducted by trained female interviewers. One person per household was interviewed from a national area probability sample in about 120 sample areas, with oversamples of teenagers, African Americans, and Hispanics. The data collection used computer-assisted personal interviewing (CAPI). Separate questionnaires were used for female and male respondents. The last section of the questionnaires used a technique called audio computer-assisted self-interviewing (ACASI). In order to control costs and nonresponse errors, survey managers statistically analyzed results from interviewers' visits to sampled households each day, and used those results to allocate interviewer labor and other resources more efficiently. This management improved response rates and made the sample more representative. RESULTS: Over 12,500 interviews were completed, about 7,600 with females and about 4,900 with males. The response rate was about 80 percent for females and about 78 percent for males. The survey procedures were adapted during the fieldwork to achieve the desired response rates and to control costs.

Adolescent↗