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At least 1,441 records · Page 80Linked to original sources
PubMed1989

Evolutions in utilization and quality management. A crisis for psychiatric services?

Psychiatric services have evolved into another time of crisis. Following a 30-year period of growth in psychiatric science, services, and benefits, payors are now retracting and restructuring funding for services they believe are no longer affordable. A number of utilization and quality management initiatives have been instituted to reduce avoidable outlays--some promising and many with deleterious consequences. The precise directions that future competitive and regulatory influences will take in affecting availability and quality of psychiatric services remain unclear. Managed mental health services now appear to be gaining favor with payors because of their use of professional case management resources. Other cost control initiatives do not appear so favorable to psychiatric services.

Cost Control↗
PubMedDate not supplied

Technology assessment and equipment management: a practical approach to cost reduction.

The Medical University of South Carolina (Charleston, SC) responded to the necessity of reducing costs in a competitive marketplace by developing a program called Technology Assessment and Equipment Management. The program uses a process that systematically evaluates clinical equipment acquisitions and provides over sight on equipment management within the 587-bed tertiary care center. This article reviews how equipment is evaluated and purchased emphasizing cost control.

Academic Medical Centers↗
PubMedDate not supplied

Should public policy seek to control the growth of health care spending?

Debate about whether to restrain health care spending is intensifying. Much of the debate revolves around efficient research allocation. The possible impact of cost control on the advance of medical technology merits more attention. Public and private efforts to slow growth of health spending have not enjoyed much success. Most recently, managed care failed because administrators lacked political legitimacy. Politically established budget limits can hold down spending, but the United States seems unwilling to adopt them; even if it were, the technology to administer them rationally does not exist. In this situation, efforts to hold down cost growth carry grave risks.

Budgets↗
PubMed1984

Cost containment through P & T committee drug utilization review.

Provoked by changes that are occurring in health care, hospitals are currently formulating and implementing strategies to identify and control costs while maintaining the highest quality of care. Because drug costs account for a significant proportion of the hospital supply budget (5 to 10%), there is an increased need for the P & T Committee to become involved in the cost containment effort. This article will demonstrate how an existing program of drug utilization review (DUR) has reduced drug expenses without sacrificing the quality of care or imposing unnecessary restrictions on formulary items. Furthermore, implementation of the DUR program has not resulted in conflict between pharmacy, medical, nursing or administrative staffs within the institution.

Cost Control↗
PubMed1982

Corporate rationalization of American health care: a visitor's appraisal.

This paper uses elements of the macrotheory of advanced capitalist societies developed by Jurgen Habermas and other "critical theorists" to locate and explore the implications of the containing corporatization of the U.S. health care sector. It questions the often-dominant view that cost is the major problem of current U.S. arrangements, and shows how most recent government policies have reinforced the corporate rationalization of health care, or at least proved neutral towards it. Yet it can be argued that it is precisely this "rationalization" which renders more difficult both cost-control and the much-needed broadening of the agenda of the health care debate to important issues other than cost.

Cost Control↗
PubMedDate not supplied

New model helps find missing link between financial and clinical health care management.

U.S. health care is missing a link between the financial managers and clinical health managers of defined patient populations. Utilization and cost management try to bridge the gap by focusing on restricted access to care or tightly managed provider reimbursement to control costs. But frequently, they do not take clinical outcomes or health status into consideration. Take a look at another method based on the science of epidemiology that brings a more balanced knowledge of the clinical world to financial managers and more financial insight to clinicians.

Community Health Planning↗
PubMed2004

Managing workers' compensation costs: success of initiatives to change outcomes.

The cost of workers' compensation health care has been a challenge during the past few decades. Various programs have been initiated on the local, state, and national levels to address this issue. The purpose of this article is to examine some of the programs that have initiated cost control measures. Most of those published claim successful outcomes. The initiatives reviewed herein were instituted at medical centers in Maryland and Pennsylvania, at casino hotels in Nevada, at an occupational health clinic in Ohio, at an electrical union in New York State, and at an insurance company. Initiatives in Minnesota and Washington State are also described. Sharing the outcomes of initiatives may allow such research to be translated into action on a broader scale.

Cost Control↗
PubMed2004

The Washington state workers' compensation system: a case study.

Washington State workers' compensation has researched applying managed care in workers' compensation through a series of research projects. In 1995 and 1996, the managed care project evaluated the impact of managed care on medical outcomes, patient satisfaction, and the cost control of medical care and disability. The managed care project also evaluated the long-term outcome of the cases by reviewing the participants 2 years after the injury. Finally,the managed care project evaluated the satisfaction of the employer with managed care. The Department of Labor and Industries Centers of Occupational Health and Education project currently is evaluating the impact of an occupational medicine-directed,education-oriented, protocol-guided pilot project.

Cost Control↗
PubMed1993

A prescription for national health care reform.

Insurance systems for controlling costs--quality assurance, preadmission clearance, length-of-stay control--actually add to costs, and also subtract from the quality of patient care. Step one: Eliminate those systems.

Delivery of Health Care↗
PubMed2003

Salmonella control programs in Denmark.

We describe Salmonella control programs of broiler chickens, layer hens, and pigs in Denmark. Major reductions in the incidence of foodborne human salmonellosis have occurred by integrated control of farms and food processing plants. Disease control has been achieved by monitoring the herds and flocks, eliminating infected animals, and diversifying animals (animals and products are processed differently depending on Salmonella status) and animal food products according to the determined risk. In 2001, the Danish society saved U.S.$25.5 million by controlling Salmonella. The total annual Salmonella control costs in year 2001 were U.S.$14.1 million (U.S.$0.075/kg of pork and U.S.$0.02/kg of broiler or egg). These costs are paid almost exclusively by the industry. The control principles described are applicable to most industrialized countries with modern intensive farming systems.

Animals↗
PubMed1979

Jefferson Medical College Student Model Utilization Review Committee.

A Student Model Utilization Review Committee Project is in progress at Jefferson Medical College. Students participate in the program for 90 minutes during the six weeks of their clerkship in family medicine at the university hospital. Information collected from participants and controls before and after the program indicates that the experimental group has greater knowledge and more positive attitudes about utilization review and cost control in the health care field than do the controls. Students express positive feelings about the program. More importantly, one year later, as seniors, those in the experimental group demonstrated clinical behavior which was more consistent with the objectives of the program than other students. These results have led the Department of Family Medicine to incorporate the utilization review program into its formal curriculum beginning in the 1979-1980 academic year.

Cost Control↗
PubMed1991

The new role of material managers in hospital strategic planning.

The future direction and challenges of hospital strategic planning require the knowledge and skills of material managers. The approach taken in participating in hospital planning efforts is not as important as the level of involvement. Understanding the strategic planning process at the hospital and knowing what information is critical to that process will improve the ability of the material manager to become an active participant and a valuable contributor to the strategic planning process. Cost management will continue to be the overriding concern of the health care industry in the 1990s. Hospitals will reorganize to control cost and improve productivity, while striving to maintain the quality of care. Material managers must align their departments with hospital strategic goals and assert their new roles in achieving those goals.

Cost Control↗
PubMed1994

A quality-based protocol for management of musculoskeletal injuries. A ten-year prospective outcome study.

Musculoskeletal injuries in the workplace are recognized as a major health and economic problem; however, little has been done to develop strategies that emphasize both quality and cost control. The purpose of this ten-year perspective investigation was to evaluate the use of quality-based standardized diagnostic and treatment protocols as part of an unbiased injury surveillance system. The program was evaluated in a public utility company with more than 5300 employees, and resulted in a measurable and long-term improvement in all outcome parameters measured: (1) The number of days lost from work and the number of new injuries reported fell by 55 and 51%, respectively. (2) The average time lost per injury dropped by 40%. (3) The number of surgeries performed decreased by 67%, and the operative success rate increased dramatically. (4) Finally, as an added benefit, there was a 60% reduction in expenditures for lost time and replacement wages, resulting in a cumulative ten-year savings of more than 4.1 million dollars. The program accomplished the goal of ensuring quality care in a prospective concurrent fashion. As an additional benefit, the program also reduced unjustified lost time and compensation costs through early functional return, efficient use of diagnostic studies, and avoidance of surgery whenever possible. Future emphasis on health-care delivery in the workers' compensation setting should concentrate on high-quality medical care, which will, in turn, lead to secondary cost savings.

Algorithms↗
PubMed1997

Medicaid: a comparison of Oklahoma and surrounding states, 1990-1994.

Medicaid has been the "safety net" for certain low-income people. In recent years, many states, including Oklahoma, have determined to enroll beneficiaries in managed care plans in an attempt to hold down the costs. Oklahoma began enrolling people in 1995, and the issue will be: was the managed care approach successful at least in controlling costs? To prepare, expenditures for the four years prior to the managed care approach have been analyzed. Comparison with surrounding states indicates that Oklahoma was already successful with negative average annual growth rates for the period 1992-1994, and that Oklahoma was more successful than surrounding states.

Cost Control↗
PubMed1991

An analysis of capitation rates for prescription medication benefits from an insurance perspective.

The use of capitation payment systems to control costs for prescription medication benefits appears to be increasing. In such a system, risk is transferred to a pharmacist or group of pharmacists. The author examines the nature of that risk, factors that must be considered in setting capitation rates and ways to control risk in a capitation system. An insurance pricing model is used to calculate risk-adjusted capitation rates using observed and hypothetical data, and implications for pharmacists and insurers are discussed.

Capitation Fee↗
PubMed1988

The costs of schistosomiasis control in a Sahelian country.

The cost of schistosomiasis control in Mali was calculated on the assumption that the programme is fully nationalized and organized using the experience gained during the past seven years. In order to expand the model and to extrapolate from actual cost that arose, activities have been standardized into preparatory, baseline and follow-up sample surveys for monitoring purposes and into blanket and case mass chemotherapy for interventions. Health education is contained in them as a component, sanitation is seen as a standard item linked at a fixed cost to the duration of the intervention phase. These activities were divided into months of action and their unit cost was calculated on the basis of requirements of field allowances, transport, drugs, expendable materials, and equipment. Fixed operational costs were calculated on a yearly basis for salaries, data processing and administrative overheads. Using these unit costs, and on the basis of present knowledge of the prevalence, epidemiology and efficiency of control, the need and quantity of activities and the probable duration of a programme to achieve the goals set in the national health plan were estimated. If a population of 180,000 persons in about 300 villages is to be included in a programme that has as target to diminish the prevalence of both, Schistosoma haematobium and S. mansoni to less than 20% and that plans to diminish the prevalence of intensive infections of both parasites to less than 5%, a total amount of DM 6.9 to 7.5 million over a period of seven to nine years are required.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗
PubMed1991

Capitation in dentistry: original concepts and current reality.

Modern dental capitation was conceived as being based on staff model group practice, receiving regular periodic payments to provide comprehensive care with few exclusions, limitations and copayments, to a given population. High utilization, completion and recall rates were expected. Examples are presented. The dominant form of capitation has become a network of solo and small group practices, usually with a for-profit intermediary. Premiums are low and administrative costs are high. There are many exclusions and limitations. Low utilization and under-treatment are endemic. Specific examples are presented. The reasons for this development include competition among dentists concerned about busyness, and predominance of cost control concerns over quality concerns on the part of purchasers.

Capitation Fee↗
PubMed1987

Economic impact of oral ciprofloxacin. A pharmacist's perspective.

With increasing numbers of patients covered under diagnostic-related group or prospective payment systems, there is mounting pressure to reduce the costs associated with caring for patients while maintaining the quality of care. New, broad-spectrum, parenteral antimicrobial agents are a prime target for cost control. The availability of an orally administered drug that is effective in a variety of serious infections would have a significant impact on cost reduction in hospitals. A significant proportion of the cost of parenteral drug therapy is associated with labor, supplies, and equipment. An orally administered drug would obviate these costs. Additionally, iatrogenic problems associated with parenteral therapy (e.g., phlebitis) would be avoided, the quantities of expensive parenteral drugs purchased might be reduced, and the duration of hospitalization for selected diseases such as osteomyelitis would probably decrease. Finally, the ease of oral administration may allow longer courses of therapy for resistant infections than have heretofore been possible. Oral ciprofloxacin and similar compounds present both opportunities and challenges for pharmacists. The fiscal impact may be beneficial for the hospital in terms of cost reductions for drug purchases and in expediting discharge for prolonged courses of outpatient therapy. The magnitude of cost reductions will vary substantially depending upon the types of patients and infections managed in a given institution. The challenge for pharmacists is to assure that these valuable compounds, as well as all antimicrobial agents, are appropriately utilized to avoid the offsetting costs of adverse effects, superinfection, unnecessary use, and the development of resistance.

Administration, Oral↗