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PubMed2004

Workers' compensation costs: still a challenge.

The workers' compensation system in the United States, comprised of independent state based and national programs for federal workers, covers approximately 127 million workers and has evolved and grown since its inception in 1911. Coverage has significantly broadened in scope to allow for the inclusion of most occupational injuries and illnesses. The cost of workers' compensation care has also increased. Some of the cost drivers have been identified,and various approaches have been taken to address medical cost containment. There is a need to balance cost control with ensuring benefit adequacy and quality of medical care. It is likely that managing workers' compensation costs will continue to be a challenge in the foreseeable future. The cost of workers' compensation care affects all stakeholders including workers, employers,providers, state workers' compensation regulators, legislatures,and insurers. A continued commitment to quality, accessibility to care, and cost containment, and being alert to emerging issues that can affect these elements, will help ensure that workers are afforded accessible, high quality, and cost-effective care.

Cost Control↗
PubMed1994

Hospitals become cost centers in managed care scenario.

In a risk-bearing managed care enterprise, acute-care facilities will change from being profit centers to being cost centers, and this transformation will require a focus on controlling costs rather than increasing admissions. This article details the elements of change that healthcare financial managers should consider, from the increased difficulty of matching revenue to expense, to the expanded role of clinical engineers.

Accounting↗
PubMed1986

CFOs put the squeeze on the hospital's big ticket purchases.

As resources shrink in every aspect of hospital operations, CFOs are looking for ways to cut costs. One area where the CFO can take steps to control costs and contribute to the bottom line in hospital revenue is equipment acquisition. Instead of sitting back and approving whatever equipment is requested, the CFO can take an active role in assessing the equipment's feasibility and negotiating a good price.

Capital Expenditures↗
PubMed2005

Health risk management: well-being for the employee and the bottom line.

For most employers, a small percent of the employee/participant population accounts for a large percent of health care costs. However, the population of this high-cost group changes from year to year. The fundamental problem is keeping employees out of the high-risk/high-cost segment, something plan design changes cannot address but that integrated health risk management (IHRM) can help achieve. This article explains how employers can implement an IHRM program to significantly lower health care costs to a degree unattainable through traditional cost-control strategies, while simultaneously raising workers' productivity and well-being.

Cost Control↗
PubMed1981

[System control and regulatory politics in health care].

System Control and Regulatory Policy in the Health Care Sector. Experiences with cost control measures in the Federal Republic of Germany demonstrate that policies and interventions in the Health Care Sector must take account of the particularities of its "non-market-system". It is important to use and combine the potential to influence every one of the involved aggregates. Regulatory Policy does not aim at the "big reform", rather at a step-by-step development of this complex system.

Ambulatory Care↗
PubMed2005

High and rising health care costs. Part 2: technologic innovation.

Technologic innovation, in combination with weak cost-containment measures, is a major factor in high and rising health care costs. Evidence suggests that improved health care technologies generally increase rather than reduce health care expenditures. Greater availability of such technologies as magnetic resonance imaging, computed tomography, coronary artery bypass graft, angioplasty, cardiac and neonatal intensive care units, positron emission tomography, and radiation oncology facilities is associated with greater per capita use and higher spending on these services. Because the spread of new technologies is relatively unrestrained in the United States, many of these technologies are used to a greater extent than in other nations, and the United States thereby incurs higher health care costs. Nations with a greater degree of health system integration have relied on expenditure controls and global budgets to control costs. Although diffusion of technology takes place more slowly in more tightly budgeted systems, the use of innovative technologies in those systems tends to catch up over time.

Budgets↗
PubMed1998

Financing structure dynamics and other determinants of Medicaid pharmaceutical expenditures, 1993-1996.

Medicaid budgets, growing two to three times faster than total state budgets, constitute the fastest growing component of state budgets. Due to their high expenditure growths, pharmaceutical benefits, a cost-effective provision of the indigent health program, gradually began restructuring in the early 1980s. More recent policy shifts (beginning in the early 1990s) toward managed Medicaid (federal HCFA Waivers 1115 and 1915b) are placing renewed emphasis on minimizing program expenditures, expanding access, and reducing cost-ineffective interventions. Therefore, this article investigates the roles that changes in the Medicaid finance configurations, cost-control policies, and program design attributes play as determinants of indigent drug expenditures of states. (Medicaid Compilation Data for 1993 and 1996, obtained from the National Pharmaceutical Council, were used in multiple regression analysis.) Cost containment policy recommendations for managing the drug program expenditures are discussed.

Budgets↗
PubMedDate not supplied

The effect of managed care on hospital marketing orientation.

Marketing is a central activity of modern organizations. To survive and succeed, organizations must know their markets, attract sufficient resources, convert these resources into appropriate services, and communicate them to various consuming publics. In the hospital industry, a marketing orientation is currently recognized as a necessary management function in a highly competitive and resource-constrained environment. Further, the literature supports a marketing orientation as superior to other orientation types, namely production, product and sales. In this article, the results of the first national cross-sectional study of the marketing orientation of U.S. hospitals in a managed care environment are reported. Several key lessons for hospital executives have emerged. First, to varying degrees, U.S. hospitals have adopted a marketing orientation. Second, hospitals that are larger, or that have developed strong affiliations with other providers that involve some level of financial interdependence, have the greatest marketing orientation. Third, as managed care organizations have increased their presence in a state, hospitals have become less marketing oriented. Finally, contrary to prior findings, for-profit institutions are not intrinsically more marketing oriented than their not-for-profit counterparts. This finding is surprising because of the traditional role of marketing in non-health for-profit enterprises and management's greater emphasis on profitability. An area of concern for hospital executives arises from the finding that as managed care pressure increases, hospital marketing orientation decreases. Although a marketing orientation is posited to lead to greater customer satisfaction and improved business results, a managed care environment seems to force hospitals to focus more on cost control than on customer satisfaction. Hospital executives are cautioned that cost-cutting, the primary focus in intense managed care environments, may lead to short-term gains by capturing managed care business, but may not be sufficient for long-term success and survival. Understanding consumer needs and perceptions, and using appropriate marketing strategies to ensure greater customer satisfaction and repeat business, will be among the key tasks for hospital executives in the future.

Bed Occupancy↗
PubMed1997

What surgeons need to know to help patients receive quality medical care in managed care settings.

BACKGROUND: Americans spend more than $3,300 per person per year on health care, an amount businesses, government, and citizens alike consider too high. MATERIAL REVIEWED: Managed care attempts to offer services at a lower cost, about 10% below that of indemnity insurance, and attempts to controls costs by modifying decisions historically made by physician and patient. Many techniques have been used to modify the decision-making process, with varying effects on quality. CONCLUSIONS: Surgeons can help sustain easily accessible, high-quality care through various personal behaviors and through choosing their managed care partners well.

Accreditation↗
PubMed1996

Economic and cost-effectiveness issues in breast cancer treatment.

The need for cost-effectiveness analyses is based on the unfortunate but universal situation of limited financial resources that ideally should be used to maximal benefit. Formal cost-effectiveness analyses assume a societal utilitarian perspective with the objective of maximizing net health benefit for members of a population within a limited level of resources. This societal perspective is in stark contrast to the clinician's perspective, whose goal is to maximize his or her patient's health status (no matter what effect those decisions have on other patients or resources). This difference in perspective and objectives explains why many clinicians object to the use of cost-effectiveness analysis in setting policies. When considering the natural history of breast cancer from screening, evaluation of suspicious lesions, primary therapy, staging, adjuvant therapy, monitoring, metastatic disease, and palliative care, it is striking that most cost-effectiveness studies have been related to screening or the use of adjuvant drug therapies. In prior work our group has shown that the use of chemotherapy in node-negative breast cancer and of tamoxifen alone or in combination with chemotherapy in premenopausal women are cost-effective compared with other common medical treatments. Given the increasing pressure to contain costs in contemporary medicine, one should remember that cost effectiveness is related to value, value defined as quality/costs. Examples are discussed when the controversy focuses on increasing quality (eg, valued outcomes, such as additional years of life or years of breast preservation) and on controlling costs (eg, integrating multidisciplinary care, minimizing superfluous testing, or reducing surgical biopsy rates). Efforts should be directed at both sides of this ratio.

Antineoplastic Agents, Hormonal↗
PubMed1991

An American approach to health system reform.

In terms of the major objectives one would have for health system reform, this plan makes the following choices: 1. It would cover everyone, through Medicare (the elderly), employer-based coverage (some workers and dependents) or a state-level public program that would replace Medicaid (the poor, unemployed, and other workers and dependents). 2. There would be a standard minimum package of required benefits for employer-based and public programs, with legislative requirements on maximum cost-sharing. Choice of provider might be restricted in some states. 3. Administration of the private programs would be the responsibility, as now, of the employers and/or insurance companies. Administration of the public program would be the responsibility of the states, with the objective of maximizing responsiveness to local needs and conditions. 4. It would control costs through giving the states a substantial financial stake in ensuring that the public program costs did not grow faster than nominal GNP. State control would also allow the testing of different mechanisms for cost control, with the ultimate objective of identifying the most effective cost-containment strategies. 5. The cost would be borne by employers, employees, and taxpayers. Employers would be protected from exorbitant costs by being allowed the option of paying into a public plan rather than providing health insurance themselves. The poor and unemployed would be protected by having their coverage under the public program subsidized on a sliding scale. 6. The political feasibility test would be met by retaining a major role for insurance companies and by retaining the role of employer-based coverage--thus reducing the tax increase needed to ensure universal coverage. By allowing flexibility in design of cost-containment strategy, some of the controversy over this issue would also be deflected. Our proposal is also not without problems. First, our approach would still have adverse effects on the profitability of small businesses and on the employment prospects for low-wage workers--although these effects would be less than under conventional mandates and less than under proposals with higher tax rates. Second, some states may not want the responsibility we envision or have the capacity to carry it out. But several Canadian provinces are relatively small and are able to perform the same administrative functions within the Canadian national health system. In addition, since the federal government would continue to administer the Medicare program, states would have the option of tying their policies for hospital and physician payment and utilization control to those of Medicare.(ABSTRACT TRUNCATED AT 400 WORDS)

Canada↗
PubMed1997

Use DM strategies to reign in out-of-control workers' comp costs.

A medical director who manages a large national health plan's workers' comp cases claims appropriate standards of care are not applied to workplace injuries and costs are out of control as a result. But there is some good news: Managed care organizations could reap huge benefits if they applied disease management methods to workers' comp cases.

Cost Control↗
PubMed1999

Will the real elasticity of substitution 'in Norwegian dentistry' please stand up?

The non-homothetic production cost structure in Norwegian private dentistry involves more than two factor inputs. Consequently, this paper implements-separately for solo and group practices-three conceptually different measures of factor substitutions to infer the precise nature of input associations using translog cost model estimates based on 1993 data. We calculate own- and cross-price elasticities of factor demands, pairwise elasticities of substitution and their approximate S.E.s. We find that: (1) dentists and dental assistants cannot be consistently aggregated as one homogeneous labour input; (2) input demands are inelastic; (3) the theoretically restrictive Allen-Uzawa and the less restrictive shadow and Morishima elasticities of substitution are not equivalent; (4) dentists and auxiliary dental personnel relate as significant substitutes in solo practices and as significant complements in group practices; (5) 'supplies' (e.g., dental materials) in the aggregate are substitutes for the two types of dentistry labour; and (6) there appears to be a wider scope for factor substitutions in group rather than solo practices. Due to inelastic factor demands, opportunities for cost controls are limited despite some tendencies for factor interchange. Finally, future researchers of production costs involving more than two inputs should investigate the less restrictive, alternative measures of factor substitutions.

Cost Control↗
PubMed2007

Cancer care, money, and the value of life: whose justice? Which rationality?

Cost-containment in oncology is a moral issue. While economists use the word "rationing" to describe all limitations on resource utilization that result from human choice, the ordinary language distinction between allocation and rationing is morally meaningful and can help oncologists to determine their proper moral role in cost-containment. It is argued that oncologists should not be required to ration at the bedside, nor should they be given financial incentives to practice frugally, nor should they be subjected to a variety of bureaucratic mechanisms to control costs indirectly. In addition, it is argued that the fact that treatments have a price does not logically imply that patients have a price. Cost-effectiveness analysis is often suggested as a means of deciding how best to allocate resources, but some of its many ethical limitations are discussed. The alternative is an open, public, participatory process about how to ration care, abandoning the formulaic pretenses of cost-effectiveness analysis, but with a commitment to reason, good will, and common sense. Oncologists would then be free to advocate for their patients within the constraints imposed by this public process.

Cost Control↗
PubMed1994

Adoption of costing systems by U.S. hospitals.

This article re-examines the use of costing information in hospitals. While previous research reports that hospitals are increasingly adopting costing methodologies, survey results indicate that costing systems and cost methodologies have not been widely implemented. A telephone survey of 94 hospital executives revealed only 26 percent routinely collect procedure-level costs and only 12 percent apply basic costing techniques described in prior health care management literature. It appears that despite cost accounting's benefits, immediate cost-control problems are answered with short-term, focused cost-cutting solutions. While these short-term measures allow hospitals to survive in the current environment, health care reform and other pressures to control revenue growth will make sophisticated cost management a necessity for hospitals in the near future.

Accounting↗
PubMed2001

Cost containment and the backdraft of competition policies.

This article offers an explanation of why governments and other purchasers found competition policies attractive, and it summarizes a set of new case studies. Faced with economic slowdown and the need to retrench social services, governments felt their legitimacy threatened and sought a new approach that would legitimize controlling costs. Starting in the 1980s, a group of pro-capitalist "moral entrepreneurs" launched an international business movement focused on reducing waste in governmental and welfare services through competition and privatization. Political leaders in a number of the developed industrialized countries enthusiastically embraced "managed competition" as a way to control the costs of health care services and to make them more accountable. The dangers of implementation and the extensive market failures that are ever-present in medicine, however, led most governments to pull back. Most nations that implemented competition policies experienced a political backdraft of protest from patients and providers that swept them out of office.

Cost Control↗