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PubMed2003

Rough set-based hybrid fuzzy-neural controller design for industrial wastewater treatment.

Recent advances in control engineering suggest that hybrid control strategies, integrating some ideas and paradigms existing in different soft computing techniques, such as fuzzy logic, genetic algorithms, rough set theory, and neural networks, may provide improved control performance in wastewater treatment processes. This paper presents an innovative hybrid control algorithm leading to integrate the distinct aspects of indiscernibility capability of rough set theory and search capability of genetic algorithms with conventional neural-fuzzy controller design. The methodology proposed in this study employs a three-stage analysis that is designed in series for generating a representative state function, searching for a set of multi-objective control strategies, and performing a rough set-based autotuning for the neural-fuzzy logic controller to make it applicable for controlling an industrial wastewater treatment process. Research findings in the case study clearly indicate that the use of rough set theory to aid in the neural-fuzzy logic controller design can produce relatively better plant performance in terms of operating cost, control stability, and response time simultaneously, which is effective at least in the selected industrial wastewater treatment plant. Such a methodology is anticipated to be capable of dealing with many other types of process control problems in waste treatment processes by making only minor modifications.

Artificial Intelligence↗
PubMed1980

High-cost users of medical care.

Cost characteristics of hospital patients were analyzed in 2238 medical records randomly selected from 42,880 dicharges in six contrasting hospital populations in the year 1976. Total hospital billings were concentrated on a few patients. On average, the high-cost 13% of patients consumed as many resources as the low-cost 87%. Repeated hospitalizations for the same disease were more characteristic of the expensive patients than were single cost-intensive stays, "intensive care," or prolonged single hospitalizations. Potentially harmful personal habits (e.g., drinking and smoking) were indicated in the records of high-cost patients substantially more often than in those of low-cost patients. Unexpected complications during treatment were five times more frequent in the high-cost group. Public policy programs for health insurance or cost control should include provisions based on the special characteristics of high-cost patients.

Accounts Payable and Receivable↗
PubMed1990

A model for reducing the cost of care in VA medical centers that offer adult day health care.

One approach to providing cost-effective adult day health care (ADHC) services is to guide both the inputs to ADHC services and the provision of other services so that substitution for institutional services can realistically take place. This approach has been used in a randomized clinical trial to evaluate the medical efficacy and cost of ADHC in the Department of Veterans Affairs (DVA). This article describes the strategies that were used to improve the cost effectiveness of ADHC during the evaluation. Cost and use estimates were developed based on the best data available from the DVA and previous research on the cost for patients' use of ADHC, nursing home, hospital, and ambulatory care. A cost workshop was attended by the ADHC managers to develop plans for controlling costs. Plans were identified that increase the likelihood that ADHC can be shown to be less costly than customary care.

Adult↗
PubMed2005

Medicaid waiver programs for traumatic brain and spinal cord injury.

With policy makers facing the competing challenges of budget crises and pressures to expand Medicaid home and community- based service programs to populations including those with traumatic brain and spinal cord injuries (TBI/SCI), this paper addresses the need for information about the development of waiver programs for this target population. This study draws from the most recent and comprehensive available dataset to present national participation and expenditure trends for all TBI/SCI waivers for the period 1995-2002, it reports findings from a national survey of policies (e.g., eligibility criteria and cost controls) used on these waiver programs in 2002, and compares the Medicaid cost of serving this target group through institutional care and waiver programs.

Brain Injuries↗
PubMed2000

Economic injury levels for western flower thrips (Thysanoptera: Thripidae) on greenhouse cucumber.

Low, medium and high densities of western flower thrips, Frankliniella occidentalis (Pergande), were established in three greenhouses at the Greenhouse and Processing Crops Research Centre, Ontario, Canada, in 1996 and 1998 to develop economic injury levels for thrips on greenhouse cucumber. Thrips densities were monitored weekly using yellow sticky traps and flower counts. Fruit was harvested twice a week, graded for size, weighed, and rated for thrips damage using three damage categories. Significant yield reduction was detected 4 wk after severe fruit damage was observed in the high and medium thrips density treatments in 1996 and 7 wk in 1998. Percentage of severe damaged fruit (P(F3)) has significant linear relationships with the adult thrips density (x) that was sampled by sticky traps 1 wk before harvest (P(F3) = -0.2533 + 0.0828x) and that was sampled by flower counts 2 wk before harvest (P(F3) = -0.2025 + 0.5490x). Based on the regression equations, economic injury levels, expressed as adult thrips per sticky trap per day or adult thrips per flower, were calculated for various combinations of control costs, yield potential and fruit prices. The economic injury levels for F. occidentalis ranged from 20 to 50 adults per sticky trap per day or 3 to 7.5 per flower as determined under average greenhouse production conditions in Ontario, Canada.

Animals↗
PubMed1991

Social health maintenance organizations' service use and costs, 1985-89.

Presented in this article are aggregate utilization and financial data from the four social health maintenance organization (S/HMO) demonstrations that were collected and analyzed as a part of the national evaluation of the S/HMO demonstration project conducted for the Health Care Financing Administration. The S/HMOs, in offering a $6,500 to $12,000 chronic care benefit in addition to the basic HMO benefit package, had higher start up costs and financial losses over the first 5 years than expected, and controlling costs continues to be a challenge to the sites and their sponsors.

Aged↗
PubMedDate not supplied

Lessons from the first to the latest nation to enact national health insurance.

In 1989, South Korea became the latest country to enact a national health insurance plan. In 1989-91, South Korea experienced a 22 percent increase in health care spending despite instituting the world's highest level of cost-sharing and coinsurance. Now, taking a page from the lesson book of Germany--the first country to adopt a national insurance strategy--South Korea is applying a system of global budgeting that should produce an optimal amount of cost control while preserving consumer choice.

Costs and Cost Analysis↗
PubMed1983

Financial management of hospital pharmacies.

This paper launches a 12-part series of articles on financial management of hospital pharmacies. This series is designed to help hospital pharmacists develop expertise in financial management so that they can keep pace with changing reimbursement structures and shrinking departmental budgets. The objectives, responsibilities, and capabilities of the hospital financial department will be reviewed, and the need for pharmacy directors to develop departmental financial management systems will be stressed. Methods of collecting financial information and preparing financial reports will be reviewed, as well as how those reports can be used in managing the pharmacy. Budgeting techniques will be demonstrated, methods for analyzing expenses and revenues will be illustrated, and possible cost-containment activities will be identified. Methods used by hospital administration to control costs of all departments will be reviewed.

Costs and Cost Analysis↗
PubMed1978

Sponsor of Texas health laws brings expertise to Congress.

An opponent of government regulation of hospital costs, Rep. Bob Gammage of Texas thinks that Congress should have the right to veto the triggering of mandatory cost controls. It makes no sense, he says, to single out a particular industry for what, in effect, would be wage and price controls, especially because hospitals don't control what they buy, in terms of goods and services.

Costs and Cost Analysis↗
PubMed2006

Cost-effectiveness analysis of screening for abdominal aortic aneurysms based on five year results from a randomised hospital based mass screening trial.

BACKGROUND: The aim of this study was to estimate the cost effectiveness of screening for abdominal aortic aneurysm (AAA). MATERIAL AND METHODS: All 12,639 men born in the years 1921-1933 (aged 64-73) living in Viborg County, Denmark, were randomly allocated either to receive an invitation to abdominal ultrasound scanning for AAA or to be controls. Costs for screening and surveillance were assessed prospectively. Diagnosis Related Group (DRG) costs from 1999 were used concerning admissions with uncomplicated and complicated operations. Admissions for AAA surgery were retrospectively classified according to complications in patient records. RESULTS: Mean follow-up time was 52 months. 76.6% of invited men attended screening, and 191 (4.0%) had an AAA. As previously reported, the cumulative 5-year AAA-specific mortality in the invited group was significantly reduced by 67% compared to the control group (P = 0.003). The costs were estimated to be Euro 11.23 per scan. The costs per life-year saved were Euro 9057 (Euro 5872-20,063) after 5 years, and were expected to decrease to Euro 2708 (Euro 1758-6031) after 10 years and to Euro 1825 (Euro 1185-4063) after 15 years. CONCLUSION: Screening of 64-73 years old males in Denmark seems cost effective.

Aged↗
PubMed1998

Cost-effective treatment of the infertile couple.

OBJECTIVE: To review the published literature on the cost-effective approach to infertility treatment. DESIGN: The literature on the economics and cost-effectiveness of infertility treatments was reviewed. Studies related to this topic were identified through MEDLINE. RESULT(S): Few cost-effectiveness studies about infertility treatment have been published. In the absence of tubal blockage and severe male factor, use of IUI and hMG-IUI is more cost-effective than IVF. In vitro fertilization is at least as cost-effective as tubal surgery. Although IVF costs are high, they fall well within the range of other accepted medical treatments and are below the general public's willingness to pay for these treatments. CONCLUSION(S): Cost-effectiveness analysis is an important means of improving quality of care while controlling costs. Further work regarding cost-effectiveness of treatments among different diagnostic groups is needed.

Cost-Benefit Analysis↗
PubMed2004

Pharmacoeconomics of atrial fibrillation and stroke prevention.

Atrial fibrillation (AF) is a common arrhythmia that significantly increases the risk of stroke by the formation and embolism of left-atrial appendage thrombi. This risk can be substantially reduced with antithrombotic therapies such as aspirin or warfarin. Those with the highest risk receive the most benefit from adjusted-dose warfarin compared with aspirin or low-dose warfarin. Because of its efficacy in reducing strokes, adjusted-dose warfarin has been shown to be cost-effective in several different settings, but mostly for AF patients with at least 1 additional risk factor. Warfarin must be adjusted to international normalized ratios (INRs) within the target range of 2.0 to 3.0 to minimize the risk--as well as the cost--of stroke and bleeding. Subtherapeutic INR values occur commonly, but the consequences are increased risk of stroke and therefore increased costs. Of the several strategies available for managing anticoagulation, the key element to controlling costs is avoiding out-of-range values.

Anticoagulants↗
PubMed2005

[Record optimization and control of medical property stocks].

To conduct the adequate control of medical property coming to the medical provision institution the software was developed where the special attention was paid to the functions of control-and-operational department. It is conditioned by the fact that together with cost control it is necessary to record the medical property in natural values. The use of the created program in local net system allowed organizing the operative control of material stocks at all stages of its movement.

Military Medicine↗
PubMed1997

[Analysis of compound prescriptions by practicing dermatologists. A study of 72,615 prescriptions for patients insured by the North Rhine-Westphalia BKK].

Over 72,000 prescriptions from practicing dermatologists were reviewed to obtain an overview of current prescribing trends including both medical and economic aspects. One main point of concern was the quality of compounded prescriptions, which play an important role in dermatology, comprising 39.5% of the total and 47.8% of the topical prescriptions. Mixtures containing corticosteroids play a central role, being present in 45.2% of topical preparations, and comprising 35.9% of the standard preparations. While most mixtures were totally acceptable, some seemed questionable, either because of the number of active ingredients (as many as 7), the combinations (corticosteroid, antibiotics and antifungals) or the selected concentrations. The increased number of prescriptions and the use of compounding both appear fertile areas for cost-control measures.

Cost-Benefit Analysis↗
PubMed1991

Realizing information technology benefits.

The Regional Medical Center at Memphis--the oldest hospital in Tennessee--acknowledged that information technology is a critical key to the pursuit of medical and managerial excellence. By outsourcing much of the center's computing and telecommunications needs, the MED's CEO, Lucy Shaw, feels she has maximized information technology benefits to her institution with maximum cost control.

Computer Communication Networks↗