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PubMed2004

Reference pricing of pharmaceuticals for Medicare: evidence from Germany, The Netherlands, and New Zealand.

This paper describes three prototypical systems of therapeutic reference pricing (RP) for pharmaceuticals--Germany, the Netherlands, and New Zealand--and examines their effects on the availability of new drugs, reimbursement levels, manufacturer prices, and out-of-pocket surcharges to patients. RP for pharmaceuticals is not simply analogous to a defined contribution approach to subsidizing insurance coverage. Although a major purpose of RP is to stimulate competition, theory suggests that the achievement of this goal is unlikely, and this is confirmed by the empirical evidence. Other effects of RP differ across countries in predictable ways, reflecting each country's system design and other cost-control policies. New Zealand's RP system has reduced reimbursement and limited the availability of new drugs, particularly more expensive drugs. Compared to these three countries, if RP were applied in the United States, it would likely have a more negative effect on prices of onpatent products because of the more competitive U.S. generic market, and on research and development (R&D) and the future supply of new drugs, because of the much larger U.S. share of global pharmaceutical sales.

Cost Control↗
PubMed2003

Perception differences between groups of employees identifying the factors that influence a return to work after a work-related musculoskeletal injury.

Employee health and productivity losses as a result of work-related injury are estimated to be US dollars 1.2 trillion annually to US companies. This is approximately 14.3% of the gross domestic product [6,8,11,35]. Workers' compensation, medical care, and short and long-term disability are a part of these costs. Controlling or eliminating these costs is a problem for US employers [3,6,14,21,29]. The study discussed in this article examined the perceptions of manufacturing employees in identifying factors that influence a return to work after a work-related musculoskeletal injury. The classification of employees who participated in this study were safety professionals, supervisors and workers from the manufacturing industry in central Kentucky. The worker group consisted of material handlers, assembly line workers and quality control inspectors. The participants completed a developed survey instrument, the Return to Work Perception Survey. This survey instrument examined the perception of the participants on factors related to return to work: company policies and procedures, job satisfaction, worker relationships and work environment. The results indicated safety professionals and supervisors perceptions differ from workers on the variables of job satisfaction, worker relationships and work environment. Their perceptions did not differ on the variable relating to company policies and procedures. In addition, the safety professional and supervisor groups rated the items addressing job satisfaction higher than did the worker group. The worker group did not differ from one another on any of the factors. Implications of this study for manufacturing companies suggest (a). identifying those issues contributing to employee job satisfaction, (b). developing a plan for achieving increased job satisfaction and employee recognition at the workplace among all workers, and (c). consider allowing employees to develop new capacities and new learning, thus fostering motivation and job satisfaction [18,20].

Adult↗
PubMed2000

Empirical evidence on the demand for carve-outs in employment group mental health coverage.

BACKGROUND AND AIMS OF THE STUDY: The use of specialized behavioral health companies to manage mental/health benefits has become widespread in recent years. Recent studies have reported on the cost and utilization impacts of behavioral health carve-outs. Yet little previous research has examined the factors which lead employer-based health plans to adopt a carve-out strategy for mental health benefits. The examination of these factors is the main focus of our study. Our empirical analysis is also intended to explore several hypotheses (moral hazard, adverse selection, economies of scale and alternate utilization management strategies) that have recently been advanced to explain the popularity of carve-outs. METHODS: The data for this study are from a survey of employers who have long-term disability contracts with one large insurer. The analysis uses data from 248 employers who offer mental health benefits combined with local market information (e.g. health care price proxies, state tax rates etc), state regulations (mental health and substance abuse mandate and parity laws) and employee characteristics. Two different measures of carve-out use were used as dependent variables in the analysis: (1) the fraction of health plans offered by the employer that contained carve-out provisions and (2) a dichotomous indicator for those employers who included a carve-out arrangement in all the health plans they offered. RESULTS: Our results tended to support the general cost-control hypothesis that factors associated with higher use and/or costs of mental health services increase the demand for carve-outs. Our results gave less consistent support to the argument that carve-outs are demanded to control adverse selection, though only a few variables provided a direct test of this hypothesis. The role of economies of scale (i.e., group size) and the effectiveness of alternative strategies for managing moral hazard costs (i.e., HMOs) were confirmed by our results. DISCUSSION: We considered a number of different hypotheses concerning employers' demands for mental health carve-outs and found varying degrees of support for these hypotheses in our data. Our results tended to support the general cost-control hypothesis that factors associated with higher use and/or costs of mental health services increase the demand for carve-outs. LIMITATIONS: Our database includes a small number of relatively large employers and is not representative of employers nationally. Our selection criteria, concerning size and the requirement that some employees are covered by LTD insurance, probably resulted in a study sample that offers richer benefits than do employers nationally. Our employers also report a higher percentage of salaried employees relative to the national data. Another deficiency in the current study is the lack of detailed information on the socio-demographic and behavioral characteristics of covered employees. Finally, the cross-sectional nature of our analysis raises concerns about susceptibility of our findings to omitted variables bias. IMPLICATIONS FOR FURTHER RESEARCH: Research with more information on covered employee characteristics will allow for a stronger test of the general hypothesis that factors associated with a higher demand for services are also associated with a higher demand for carve-outs. Also, future analyses that capture the experience of states that have recently passed mandate and parity laws, and that use pooled data to control for omitted variables bias, will provide more definitive evidence on the relationship between these laws and carve-out demand.

Journal Article↗
PubMed2005

Automated Water Analyser Computer Supported System (AWACSS) Part II: Intelligent, remote-controlled, cost-effective, on-line, water-monitoring measurement system.

A novel analytical system AWACSS (Automated Water Analyser Computer Supported System) based on immunochemical technology has been evaluated that can measure several organic pollutants at low nanogram per litre level in a single few-minutes analysis without any prior sample pre-concentration or pre-treatment steps. Having in mind actual needs of water-sector managers related to the implementation of the Drinking Water Directive (DWD) [98/83/EC, 1998. Council Directive (98/83/EC) of 3 November 1998 relating to the quality of water intended for human consumption. Off. J. Eur. Commun. L330, 32-54] and Water Framework Directive (WFD) [2000/60/EC, 2000. Directive 2000/60/EC of the European Parliament and of the Council of 23 October 2000 establishing a framework for Community action in the field of water policy. Off. J. Eur. Commun. L327, 1-72], drinking, ground, surface, and waste waters were major media used for the evaluation of the system performance. The first part article gave the reader an overview of the aims and scope of the AWACSS project as well as details about basic technology, immunoassays, software, and networking developed and utilised within the research project. The second part reports on the system performance, first real sample measurements, and an international collaborative trial (inter-laboratory tests) to compare the biosensor with conventional anayltical methods. The systems' capability for analysing a wide range of environmental organic micro-pollutants, such as modern pesticides, endocrine disrupting compounds and pharmaceuticals in surface, ground, drinking and waste water is shown. In addition, a protocol using reconstitution of extracts of solid samples, developed and applied for analysis of river sediments and food samples, is presented. Finally, the overall performance of the AWACSS system in comparison to the conventional analytical techniques, which included liquid and gas chromatographic systems with diode-array UV and mass spectrometric detectors, was successfully tested in an inter-laboratory collaborative trial among six project partners.

Algorithms↗
PubMed1988

A call for randomized controlled cost-effectiveness analysis of percutaneous transluminal coronary angioplasty.

A rapidly evolving technology, percutaneous transluminal coronary angioplasty, is increasingly favored over bypass surgery for treating some types of coronary stenosis because of its less traumatic invasion, better recovery response, and lower initial cost. However, substantially higher failure rates in initial procedures offset PTCA's savings to an unknown extent and cloud analysis of its overall impact. Lack of randomized clinical data precludes valid cost-effectiveness comparison of the technologies at this time. Criteria for establishing valid data and evaluations of currently available data are described in this paper.

Angioplasty, Balloon↗
PubMed1990

The increasing cost of health care--doctors suffer as well!

At long last there does appear to be general agreement that all is not well with the American health care system. Costs are out of control and the bureaucracy that has been spawned to control costs and administer the financial aspects of health care has developed a mind of its own. Two recent problems within our own department at the University of California, San Francisco, have shown that even doctors can be on the receiving end of these problems, with amusing but potentially serious consequences.

Emergency Medical Services↗
PubMed1978

Approaches to controlling the costs of medical care: short-range and long-range alternatives.

Cost containment requires changes either in patterns of consumption or in the way services are provided. Although the former includes prevention, changing social expectations and finding suitable substitutes for some types of care, the latter involves mix of personnel technologic inputs, auspices of care and the content of encounters. Ultimately, the future of medical care and cost containment depends on advances in biomedical and health-services research. In the short run, costs will be contained increasingly by rationing mechanisms. Whereas cost sharing is intended to affect consumer behavior, implicit rationing, as through capitation and prospective budgeting, is intended to encourage physicians to make tougher allocation decisions. Explicit rationing, in contrast, depends more on administrative decisions that limit physician discretion. A better understanding of the effects of different rationing technics on patient and physician behavior and the quality of care, as well as on cost, is required.

Attitude↗
PubMed1994

Controlling the cost of nurse recruitment: an administrator's challenge.

One of hospital administrators' many challenges is the recruitment of nursing staff. This article explores eight hospitals' recruitment strategies as well as these methods' direct and indirect costs. It also provides suggestions for administrators on how to improve their recruitment procedures.

Advertising↗
PubMed2002

Managed care education: what medical students are telling us.

PURPOSE: To examine graduating medical students' perceptions of the adequacy of instruction in managed care and in 11 curricular content areas identified by experts as a necessary part of managed care education. This study sought to determine whether medical students perceived these content areas as relevant to managed care and to evaluate the extent to which students' perceptions of the adequacy of instruction varied as a function of managed care penetration in the locations of their respective medical schools. METHOD: Data from the Association of American Medical Colleges' 1999 Medical School Graduation Questionnaire (GQ) were analyzed. Students' ratings of adequacy of instruction were summarized. Correlations between ratings of instruction in managed care and 11 related content areas were calculated, as well as correlations between managed care penetration in the locations of the students' schools and the proportion of students rating instruction as inadequate. RESULTS: A majority of 1999 medical school graduates (60%) rated instruction in managed care as inadequate; other content areas to which majorities of graduates gave inadequate ratings were practice management (72%), quality assurance (57%), medical care cost control (57%), and cost-effective medical practice (56%). Ratings in these four content areas were highly correlated with ratings of instruction in managed care. The correlation between managed care penetration and rating of instruction in managed care was statistically significant (r = -.37); correlations between managed care penetration and instruction in the other content areas were not. CONCLUSIONS: On the 1999 GQ, a majority of medical students responded that they felt they had not received adequate instruction in managed care. Further, the responses suggest that these medical students defined managed care in terms of managing costs, rather than managing health care, or developing population-based approaches to the delivery of health care.

Attitude of Health Personnel↗
PubMed1980

Preliminary methodology for controlled cost-benefit study of drug impact: the effect of cimetidine on days of work lost in a short-term trial in duodenal ulcer.

The phase II/III U.S. clinical drug trials for cimetidine (Tagamet) in duodenal ulcer were examined for their potential application to cost-benefit analysis. Data on "time lost from work" were obtained from a special protocol added to these short-term, double-blind trials of cimetidine. Sixty-four outpatients from the clinical trials remained from an original pool of 217 after exclusion of those subjects who were either retired, unemployed, or of uncertain employment status. Cimetidine was significantly more effective than placebo in reducing "time lost from work" during ulcer disease. The patients' "time lost from work" occurred as a strikingly all-or-nothing phenomenon. We conclude that a prospective clinical trial is appropriate for gathering economic data.

Absenteeism↗
PubMed1995

Case management. A means to improve quality and control the costs of cure in children with acute myelogenous leukemia.

UNLABELLED: Acute myelogenous leukemia (AML) is a costly disease to treat, as patients experience many hospital stays secondary to chemotherapy, the side effects of treatment, and bone marrow transplantation. The trend for some medical centers has been to reduce costs and increase quality through case management. The case manager uses critical pathways and one-on-one interaction to facilitate the patients' progress through the hospital system and to decrease delays and duplication. CONCLUSION: Case management and critical pathways could become an indispensable tool for the management of pediatric patients with cancer.

Adolescent↗