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At least 1,621 records · Page 90Linked to original sources
PubMed1985

Controlling cephalosporin and aminoglycoside costs through pharmacy and therapeutics committee restrictions.

The cost-reducing effect of antibiotic restrictions imposed by a pharmacy and therapeutics (P & T) committee was evaluated. The pharmacy department developed guidelines restricting the use of second-generation cephalosporins and aminoglycosides in cooperation with the infectious disease division. The P & T committee approved the restrictions, and the pharmacy department disseminated information on the program to the hospital's physicians. Specific indications were developed for the use of amikacin, tobramycin, cefoxitin, and cefamandole. In order to prescribe a restricted antibiotic, physicians are required to write an approved indication on the physician's order form. Residents cannot prescribe restricted antibiotics for unapproved indications unless they acquire the signature of an attending physician. Pharmacy personnel closely monitor the restricted antibiotic use and enforce the established guidelines. The major impact of the restrictions was the reversal of a previous trend toward the use of more expensive second-generation cephalosporins and tobramycin to the use of first-generation cephalosporins and gentamicin. Injectable antibiotic expenses decreased by $193,172 in the first 12 months of the program. Antibiotic restrictions imposed by the P & T committee were effective in reducing the cost of antimicrobial therapy.

Aminoglycosides↗
PubMed1996

[Economic aspects of oncologic surgery: what do we know, are they relevant; must--may--we regard them?].

Economic aspects of medical care play an increasingly more important part in evaluation of diagnostics and therapeutics. Therefore it seems necessary to examine the present studies and their results carefully. In meta-analysis of cancer care, different techniques of economic analysis are used. Stage-specific analyses of direct costs in patients with colorectal neoplasms show a major influence of the stage at diagnosis on total costs of initial care. In contrast to this, increased age and increased comorbidity of patients did not function as a cost increasing factor in each stage of the disease. Net costs, that is attributable costs, are the difference between costs of the care of each subject and the average costs of controls. Net costs of continuing care decreased with age in patients with colorectal neoplasms. Cost-effectiveness analyses in patients with colon and breast cancers demonstrated lower medicare payments per year of survival for tumors diagnosed at earlier stages. From the date presented, no relevance of health economic aspects on individual planning of therapy can be deduced. Health economic aspects are appropriate in order to develop guidelines and are a basis of discussion at the level of macro-allocation. They can be used in the scope of a multi-dimensional evaluation of a new treatment and serve medical and therapeutic definitions of goals.

Colorectal Neoplasms↗
PubMed1984

The Canadian health care system: an overview.

Although health care is a provincial responsibility in Canada, universal hospital insurance was fully adopted by 1961; universal medical insurance followed 10 years later. Each province enacted universal insurance after the federal government offered to pay 50% of provincial hospital and medical care costs. Hospital insurance had wide public and provider support but universal medical care insurance was opposed by organized medicine. The federal government soon realized that it had no control over total expenditures and no mechanisms for controlling costs. In 1977 it enacted Bill C-37 which limited total federal contributions and made those contributions independent of provincial health care expenditures so that increased costs had to be met by the provinces. Since private health care insurance for universal benefits is prohibited by the federal terms of reference for health insurance, the provinces must raise the money by taxes and (in some provinces) premiums. Although prohibited by the terms of reference of the universal program, some provinces have adopted hospital user fees and are allowing their physicians to bill patients in excess of provincial fee schedules. The 1980s have seen increased confrontations between the federal and provincial governments and between the provinces and their providers. The issues are cost containment and control of the system. The provinces have two broad options. The first is more private funding through private insurance and user fees. The proposed new Canada Health Act will probably prohibit such charges. A second option involves greater control and management of the system by the provinces; this has already occurred in Quebec. Greater control is vigorously opposed by physicians and hospitals. The Canadian solution to health insurance problems in the past has been moderation. Extreme moves in either direction would represent a break with tradition, but they may prove to be unavoidable.

Canada↗
PubMed1998

Evaluation and additional recommendations for preparing a whole blood control material.

OBJECTIVE: The assessment of an easy to prepare and low cost control material for Hematology, available for manual and automated methods. MATERIAL AND METHOD: Aliquots of stabilized whole blood were prepared by partial fixation with aldehydes; the stability at different temperatures (4.20 and 37 degrees C) during periods of up to 8-9 weeks and aliquot variability with both methods were controlled. RESULTS: Aliquot variability with automated methods at day 1, expressed as CV% (coefficient of variation) was: white blood cells (WBC) 2.7, red blood cells (RBC) 0.7, hemoglobin (Hb) 0.6, hematocrit (Hct) 0.7, mean cell volume (MCV) 0.3, mean cell hemoglobin (MCH) 0.6, mean cell hemoglobin concentration (MCHC) 0.7, and platelets (PLT) 4.6. The CV (coefficient of variation) percentages obtained with manual methods in one of the batches were: WBC 23, Hct 2.8, Hb 4.5, MCHC 5.9, PLT 41. Samples stored at 4 degrees C and 20 degrees C showed stability, only a very low initial hemolysis being observed, whereas those stored at 37 degrees C deteriobed a rapidly (metahemoglobin formation, aggregation of WBC and platelets, as well as alteration of erythrocyte indexes). CONCLUSIONS: It was confirmed that, as long as there is no exposure to high temperatures during distribution, this material is stable, allowing assessment, both external and internal, for control purposes, with acceptable reproductivity, both for manual and automatic methods.

Hematology↗
PubMed2003

[The American health care system: origins and developments of managed care organizations].

The first Health Maintenance Organizations (HMOs) appeared in the 70's in the context of care rationing. These organizations have rapidly become responsible for delivering care to the general population. Cost/effectiveness studies and other quality control programs rapidly appeared, followed by other sophisticated cost-control devices. The following article gives information on the current difficulties encountered by HMOs. Other aspects of the care given by the HMOs are also addressed. The economical and legal difficulties to which these companies were confronted have prompted them to withdraw from some market segments. Patients have become more vulnerable, despite limited attempts of reforms.

Costs and Cost Analysis↗
PubMed1988

Cost of nosocomial infection: relative contributions of laboratory, antibiotic, and per diem costs in serious Staphylococcus aureus infections.

This study reports an analysis of the relative importance of laboratory antibiotic, and per diem costs of caring for 58 patients with serious Staphylococcus aureus nosocomial infections. Laboratory costs accounted for 2%, antibiotics for 21%, and per diem costs for 77% of total infection-related costs. Only 45% of patients were hospitalized for additional days specifically because of infection, but these patients stayed an average of 18 extra days. Nosocomial infections with S. aureus resistant to penicillinase-resistant penicillins (PRP) were more frequently associated with additional infection-related days of hospitalization than were PRP-susceptible infections. The cost of PRP-resistant infections was also significantly greater than PRP-susceptible infections, primarily because of the costs of additional days of hospitalization. Rational strategies to control costs of nosocomial infection should focus on two approaches: (1) prevention and (2) reduction of acute hospital days attributable to infections.

Adult↗
PubMed2002

Helium-oxygen ventilation.

Because of its low density, the He/O2 mixture markedly affects the dynamics of gas-flow, increasing inspiratory and expiratory flows, reducing WOB and respiratory acidosis, and relieving dyspnea in various clinical situations associated with obstructive airway disease. The magnitude of these changes varies according to the proportion of turbulent, transitional, and laminar flow conditions. These effects, however, last only as long as the patient breathes the He/O2 mixture, because it has no curative effect on the cause of airway obstruction. Thus, He/O2 ventilation is mostly useful while awaiting the effects of more definitive treatment. Evidence shows that He/O2 ventilation can improve pathophysiologic and clinical parameters in spontaneously breathing patients with upper airway obstruction, asthma. COPD, bronchopulmonary dysplasia. and bronchiolitis. Furthermore. He/O2 ventilation may prove to be a valuable adjunct in decompensated COPD patients, during both NIV and conventional mechanical ventilation. Despite promising results, however, there are two primary pitfalls to He/O2 ventilation. First, the consequences of the physical properties of the He/O2 mixture on various ventilator functions, the major differences between machines, and the correction factors to apply (if necessary) should be known. Second, in this age of cost control, particular attention should be paid to the cost-benefit ratio of He/O2 ventilation. Indeed, despite clinical evidence that the pathophysiologic principles on which He/O2 ventilation rests can be translated into favorable short-term physiologic and subjective effects, there is presently no evidence of a significant effect on patient outcome. Hence, before He/O2 ventilation can be recommended for widespread use, prospective outcome studies should be conducted in patients who suffer from the conditions discussed in this article to identify which, if any, are most likely to receive a benefit. Meanwhile, the authors recommend that He/O2 ventilation be reserved for patients who have a severe condition and who do not respond to the classic validated treatment modalities.

Clinical Trials as Topic↗
PubMed1994

Current spine surgery in North America: progress or violation?

We physicians are the drivers, the people who select the patients, the people who do the operations, and the people who encourage the instrument companies; it is our responsibility to oversee both the effectiveness of treatment and its cost. The resources available to neurosurgery for improving care, controlling cost, and promoting research include the following. 1. The outstanding spinal neurosurgeons actively participating in excellent clinical care and research, neurosurgeons in training, and neurosurgeons committed to excellence. 2. A commitment by neurosurgery to improve the plight of the patients with spinal disorders. 3. Support from instrument and drug companies and national funding. 4. A medical wave of support for outcome studies and clinical trials. 5. A proven track record in doing clinical trials and a clear indication that others are in process. 6. The knowledge, abilities, and energies of neurosurgeons. Our liabilities include the following. 1. Irresponsible behavior by a few professionals. 2. The negative effects of competition with non-neurosurgical spinal surgeons. We must obtain their support in many of these clinical trials. 3. Inertia. It is much easier to take the path of least resistance, much easier to choose the course of economic incentive. Perhaps, out of all of this, spinal neurosurgery will lead the way to developing a better understanding of the natural history of degenerative diseases of the spine and the way to selecting patients properly on the basis of studies of the efficacy of appropriate surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Education, Medical↗
PubMedDate not supplied

The feasibility of case costing.

The rising cost of health care has resulted in the imposition of cash limits on the distribution of services. This article explores the concept of patient-orientated information, called case costing, as a means of making comparisons between hospitals, controlling cost, and charging for treatment. Five forms of case costing are identified and the desirability and problems of implementation are discussed.

Diagnosis-Related Groups↗
PubMedDate not supplied

Health and the welfare of U.S. business.

Business leaders continue to blame the skyrocketing cost of health care for jeopardizing the global competitiveness of U.S. industries, and they continue to turn to Washington for the solution. Yet after a study of 16 countries, Wharton researchers David Brailer and R. Lawrence Van Horn have discovered that health care costs do not directly hinder U.S. competitiveness. Their conclusion: there is indeed a health care crisis in the United States as well as a competitiveness crisis. But the two are unrelated, and confusing them makes it difficult to solve either one. The real problem, according to the authors, is the hands-off approach that employers typically adopt when it comes to health care. No matter how Washington responds to the health care crisis, employers must explore their own role in ensuring the health of their work force. And they must realize that their role can be a strategic one. Instead of containing costs by fine-tuning benefits packages, companies can control costs and improve health care delivery by treating health care like any other crucial component of production. Brailer and Van Horn propose three strategies for managing health care delivery: First, companies must intervene in the supply side of the health care market. This may mean creating a clinic alone or with other companies, or joining with other companies to procure health care. Second, companies need to translate corporate health benefits into the most cost-effective set of services at the local level. Finally, companies must encourage and educate employees to participate in decisions regarding health care delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗
PubMedDate not supplied

The impact of mergers/alliances on hospice care.

Since its inception, hospice care in the U.S. has transcended from a "movement" into the mainstream of healthcare. Hospice care consumes about $1.8 billion of the federal healthcare pie, making it one of the smallest providers. Yet hospice has been one of the most successful providers in terms of patient satisfaction and cost control. The Hospice Model as structured by Medicare provides cost savings primarily due to the substation of homecare for hospital stays in the last months of life.

Delivery of Health Care, Integrated↗