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PubMedDate not supplied

Combining the benefits of decision science and financial analysis in public health management: a county-specific budgeting and planning model.

State public health agencies are charged with providing and overseeing the management of basic public health services on a population-wide basis. These activities have a re-emphasized focus as a result of the events of September 11, 2001, the subsequent anthrax events, and the continuing importance placed on bioterrorism preparedness, West Nile virus, and emerging infectious diseases (eg, monkeypox, SARS). This has added to the tension that exists in budgeting and planning, given the diverse constituencies that are served in each state. State health agencies must be prepared to allocate finite resources in a more formal manner to be able to provide basic public health services on a routine basis, as well as during outbreaks. This article describes the use of an analytical approach to assist financial analysis that is used for budgeting and planning in a state health agency. The combined benefits of decision science and financial analysis are needed to adequately and appropriately plan and budget to meet the diverse needs of the populations within a state. Health and financial indicators are incorporated into a decision model, based on multicriteria decision theory, that has been employed to acquire information about counties and public health programs areas within a county, that reflect the impact of planning and budgeting efforts. This information can be used to allocate resources, to distribute funds for health care services, and to guide public health finance policy formulation and implementation.

Budgets↗
PubMedDate not supplied

Impact of Medicare's prospective payment system on hospitals, skilled nursing facilities, and home health agencies: how the Balanced Budget Act of 1997 may have altered service patterns for Medicare providers.

The prospective payment system is one of many changes in reimbursement that has affected the delivery of health care. Originally developed for the payment of inpatient hospital services, it has become a major factor in how all health insurance is reimbursed. The policy implications extend beyond the Medicare program and affect the entire health care delivery system. Initially implemented in 1982 for payments to hospitals, prospective payment system was extended to payments for skilled nursing facility and home health agency services by the Balanced Budget Act of 1997. The intent of the Balanced Budget Act was to bring into balance the federal budget through reductions in spending. The decisions that providers have made to mitigate the impact are a function of ownership type, organizational mission, and current level of Medicare participation. This article summarizes the findings of several initial studies on the Balanced Budget Act's impact and discusses how changes in Medicare reimbursement policy have influenced the delivery of health care for the general public and for Medicare beneficiaries.

Budgets↗
PubMed1997

Physician responses to global physician expenditure budgets in Canada: a common property perspective.

Global expenditure budgets in the fee-for-service physician sector create management problems for both funders and physicians. Global expenditure cap policies must be designed, and appropriate institutional structures created, to mitigate perverse utilization incentives, manage collective utilization, and diffuse the internal professional and the funder-profession tensions created by a capped budget. Two Canadian provinces that adopted different approaches to the design of their physician expenditure cap policies experienced different outcomes in utilization growth. The outcomes, however, are the opposite to what one would predict based on an analysis of the incentive structures embodied in the two provinces' policies. An analytic framework developed for the study of common-property resources is applied to the differing physician responses to global budgets across the two provinces. The insights offered by this framework can guide policy design for global physician budgets, and they indicate the critical importance of physician acceptance of such a policy.

Alberta↗
PubMed2005

Using pooled budgets to integrate health and welfare services: a comparison of experiments in England and Sweden.

The lack of collaboration between health, social and other welfare services is believed to impair efficiency and reduce effectiveness in addressing the complex problems of patients. Differences in funding streams, political accountabilities, organisational structures and professional cultures are all alleged to contribute to barriers between services. Drawing on their respective evaluations, this paper describes experiments in England and Sweden that use pooled budgets between services to improve interagency and interprofessional collaboration and presents evidence on their impact. Despite differences in the funding and organisation of health and welfare services in each country, some similar conclusions are reached. Among senior managers and politicians, budget pooling broadened their awareness of interdependencies with other agencies and professionals in promoting patients' welfare. However, these broadened perspectives were not immediately shared by professionals working at the front line, with whom patients had immediate contact. Moreover, neither experiment yielded unequivocal evidence of improved cost-effectiveness or of the benefits of budget pooling on the outcomes for service users. These experiments also raise questions about the equity and accountability of welfare services because in both countries only a limited range of services has been integrated under the umbrella of the pooled budgets.

Budgets↗
PubMed2005

Health policy roundtable--policy by numbers: the role of budget estimates and scoring in health care reform.

The purpose of this roundtable is to explore the imperfect art of estimating the budget costs of health insurance proposals-called scoring when done by government agencies. The panel addresses the complexities involved in generating these estimates, which usually depend on many untested and untestable assumptions. For example, the Medicare prescription drug "donut hole" was invented so that policymakers could achieve budget targets. These budget scores play a critical role in the design of health policies, as well as in the reform proposals put forth by candidates in an election. The roundtable discusses how policymakers can and do use health policy estimates and budget scores.

Actuarial Analysis↗
PubMed2004

Budget negotiation for industry-sponsored clinical trials.

The specialty of anesthesia is well suited to attract industry-sponsored clinical trials and research revenues because of its fundamental contributions to surgery, critical care, and pain medicine. However, the performance and budgeting of industry-sponsored clinical research over the past decade has been significantly altered by the rapid growth of commercially oriented networks of contract-research organizations and site-management organizations. Further, the competitive nature of today's clinical research climate can make the planning and negotiating of study budgets and contracts stressful, time consuming, frustrating, and full of pitfalls. Because a clinical trial contract is a fixed-price agreement, investigators are obligated to perform the work described in the contract, even if the actual costs exceed the study contract. Successful budgeting for the performance of an industry-sponsored clinical trial thus requires a thorough understanding of the direct and indirect costs associated with performing clinical research. We reviewed budget and contractual considerations for the successful negotiation and performance of industry-sponsored clinical research.

Budgets↗
PubMedDate not supplied

Budget bills and Medicare policy: the politics of the BBA.

With the Balanced Budget Act (BBA) of 1997 and a balanced federal budget, the link may be broken between the budget and Medicare policy's timing and direction. However, despite a balanced budget, Medicare's eventual financial crisis must be addressed. The BBAs of 1995 and 1997 provide two models of Medicare legislation: one based on conflict and another on consensus. Because the 1997 act became law and the 1995 act did not, the consensus model has proved to be politically feasible. However, this model appears to be inadequate for devising a solution to Medicare's long-term financial problems.

Budgets↗
PubMed2001

Developing guidance for budget impact analysis.

The role of economic evaluation in the efficient allocation of healthcare resources has been widely debated. Whilst economic evidence is undoubtedly useful to purchasers, it does not address the issue of affordability which is an increasing concern. Healthcare purchasers are concerned not just with maximising efficiency but also with the more simplistic goal of remaining within their annual budgets. These two objectives are not necessarily consistent. This paper examines the issue of affordability, the relationship between affordability and efficiency and builds the case for why there is a growing need for budget impact models to complement economic evaluation. Guidance currently available for such models is also examined and it is concluded that this guidance is currently insufficient. Some of these insufficiencies are addressed and some thoughts on what constitutes best practice in budget impact modelling are suggested. These suggestions include consideration of transparency, clarity of perspective, reliability of data sources, the relationship between intermediate and final end-points and rates of adoption of new therapies. They also include the impact of intervention by population subgroups or indications, reporting of results, probability of re-deploying resources, the time horizon, exploring uncertainty and sensitivity analysis, and decision-maker access to the model. Due to the nature of budget impact models, the paper does not deliver stringent methodological guidance on modelling. The intention was to provide some suggestions of best practice in addition to some foundations upon which future research can build.

Budgets↗
PubMed2000

The Balanced Budget Act of 1997: its impact on U.S. teaching hospitals.

The Balanced Budget Act of 1997 had a profound impact on the financing and organization of many health care services. The Act disproportionately affected U.S. teaching hospitals, leading to substantial budget reductions in many institutions and the threat of cuts in major programs and services that teaching hospitals provide to communities. This paper examines the overall financial and organizational impact of the Balanced Budget Act on teaching hospitals and considers its effect on residency education. It also discusses to what degree the Balanced Budget Refinement Act of 1999 will mitigate these effects and posits other solutions to the serious financial issues facing teaching hospitals in the United States.

Budgets↗
PubMed1991

Special report. When they want to cut your security budget: some options to consider.

The financial woes of the health care industry may dictate further budget cuts in all departments, including security. A strategy to avoid further cuts or to minimize them is essential. In this special report, we will look at how security directors can try to prevent budget cutbacks before they occur. We will also examine the need for planning--what every security director should do to prepare for budget cuts--and various ways to trim the budget without leaving the hospital unprotected.

Budgets↗
PubMed1995

Have you seen your budget lately?

Managers talk about budgets, about being over or under budget, but are they really using budgets as management and planning tools? With several types of budgeting, one or two types will certainly help agencies remain stable in the evolving home care market.

Budgets↗
PubMed1996

The budget battle. What's at stake for employers, what's likely to emerge.

At B&H press time, Republicans and the White House had finally agreed to sit down for serious talks. Numbers and details of the proposals were highly fluid but core positions remained consistent. What follows is a comparison of the key health-care and health benefits-related measures contained in the Balanced Budget Act of 1995-the massive seven-year GOP budget-balancing plan--with those in the Clinton Administration's revised seven-year budget plan released on December 7. President Clinton vetoed the Balanced Budget Act on December 6. All numbers and positions are as of December 20 and are based on the differing "baseline" economic and fiscal assumptions both sides were using as of that date.

Budgets↗
PubMed1997

Capital equipment budgeting: changing an art to a science.

In today's integrated healthcare environment, one component of financial management remains antiquated in many facilities--the budgeting process for capital equipment. Many institutions budget for capital equipment based upon individual departmental wish lists and hopeful dreams. These highly inefficient practices are being replaced with automated systems that create departmental data exchanges, utilization analyses, life-cycle cost justifications and enterprise-wide budget roll-ups. This article shows how automated capital budgeting systems help reduce capital spending by identifying utilization trends, providing for demand matching, and maintaining cost control data which enable the financial manager or asset steward to analyze and justify appropriate acquisitions.

Budgets↗
PubMed1989

Being accountable for care of the poor. CHA's social accountability budget helps facilities keep track of charitable activity.

The Catholic Health Association's social accountability budget is a set of tools to help Catholic healthcare facilities plan for, administer, and report benefits provided to their communities, especially the poor. It defines a full roster of community benefits that a healthcare organization may provide. The benefits fall into three major categories: activities and services, policies and procedures, and community leadership. The social accountability budget also presents guidelines for assessing the facility's existing services, activities, policies, and procedures and discusses how the facility can conduct or be part of a community needs assessment. Information collected through this assessment is used in the planning and budgeting processes. This ensures that uncompensated care and charitable services receive consideration along with traditional planning and budgeting items. Additional guidelines show the facility how to track and measure its services to the community. The final step, often absent from Catholic healthcare facilities' programs, is reporting community benefits.

Budgets↗
PubMed2003

An overview of recent state HCBS budget cuts.

This policy brief, covering the period FY 2002- FY 2004, examines state budget cuts and other state policy changes affecting long term care (LTC) services for the elderly, focusing on home and community based services (HCBS). In the second year of budget deficits, states made deeper Medicaid cuts and focused on LTC services because of their contribution to Medicaid budgets (fifteen states say LTC is one of the top three Medicaid spending drivers). In all, states made or planned an estimated 64 cuts to LTC services in the last three fiscal years. Reflecting overall budget-cutting strategies, many states first targeted LTC provider payments and have only more recently considered reducing LTC benefits or eligibility.

Aged↗
PubMed2005

Budget impact of tegaserod on a managed care organization formulary.

We sought to develop a budget impact model that assesses the economic effect of adding tegaserod for the management of irritable bowel syndrome (IBS) with constipation to the formulary of a managed care organization (MCO). The model estimates the per patient economic impact and the per member, per month (PMPM) economic impact of patients 6 months before and 6 months after the initiation of tegaserod. Resource utilization data, taken from medical and pharmacy administrative claims data, were based on a retrospective, longitudinal study of 3365 patients administered tegaserod through a large, geographically diverse MCO. Costs were estimated for 2 patient subgroups, women with IBS and other gastrointestinal (GI) diagnoses. Sensitivity analyses were performed by varying several model input parameters. The base-case model resulted in an incremental PMPM budget impact associated with the use of tegaserod of 0.01 dollars. Total per patient budget impact (for all resources, including tegaserod) for a 6-month period was 274.34 dollars for women with IBS and 301.84 dollars for women with other GI diagnoses. Overall, 25.9% (29.0% for women with IBS group and 21.9% for women with other GI diagnoses group) of the cost of tegaserod was offset by decreases in resource utilization. Key drivers of post-tegaserod reductions in resource costs were hospital stays, outpatient office visits, emergency department visits, endoscopic procedures, and nonendoscopic procedures. Tegaserod therapy can decrease GI-related resource utilization, resulting in a significant cost-offset percentage. When the associated budget impact of adding tegaserod to its formulary is absorbed across an entire MCO population, the PMPM impact of tegaserod is small.

Adult↗
PubMed2006

Beyond budgeting in an IDS: the Park Nicollet experience.

Beyond budgeting transcends the limitations of traditional budgeting by replacing fixed financial targets with targets based on key performance indicators. For Park Nicollet Health Services, the decision to implement beyond budgeting coincided with a larger move to adopt a Lean approach to management. Park Nicollet's process to implement beyond budgeting-from submission of the initial proposal through two test runs with process refinements to full implementation-lasted about one year, from January 2005 to January 2006.

Budgets↗
PubMedDate not supplied

Performance budgeting.

A performance budget is a budget for the activities of a cost center or organization. Performance budgeting evaluates performance in terms of goals for a variety of activities, rather than a single budgeted output level, such as patient days.

Budgets↗