The role of esoteric reference laboratory as a partner for growth

Partnering with a reference lab can actually help grow a referring lab's own business. The reference lab provides a hospital's physicians with access to unique tests and clinical information and broadens the scope and depth of the referring lab's menu. As medicine moves toward prescribed treatments based on a patient's individual genotype or phenotype, the reference lab will play an even bigger role in helping the hospital to educate physicians and their patients to the most efficient testing strategies consistent with good patient management.     

Direct nucleic acid diagnostic tests for bacterial infectious diseases: streptococcal pharyngitis, pulmonary tuberculosis, vaginitis, chlamydial and gonococcal infections

Partnering with a reference lab can actually help grow a referring lab's own business. The reference lab provides a hospital's physicians with access to unique tests and clinical information and broadens the scope and depth of the referring lab's menu. As medicine moves toward prescribed treatments based on a patient's individual genotype or phenotype, the reference lab will play an even bigger role in helping the hospital to educate physicians and their patients to the most efficient testing strategies consistent with good patient management.     

Hospital developing powerful record system

In what probably sounds like an unusual arrangement, a Texas hospital is hooking up with a nuclear weapons lab as it develops an electronic medical records system. The hospital is tapping the lab's supercomputer to make its Macintosh-based system powerful as well as user-friendly. The facility hopes the result is a patient record that's as useful as traditional paper charts and also can be used for research purposes.     

The lab manager's role in assessing new technology

Without the benefit of the lab manager's experience, as well as the ability to solicit input from all necessary parties, a lab's short-term ?savings? due to new technology could amount to long-term disaster. Here are some common mistakes made by labs and how to avoid them.     

北京市二三级医院总额预付实施效果评价

目的:分析总额预付实施前后北京市二三级医院运行状况的变化,探讨总额预付对不同级别的医院影响的差异,从而评价总额预付的实施效果,发现存在的问题并提出建议。方法:使用"北京市卫生工作统计资料汇编"2007—2014年的数据,采用描述性统计和固定效应模型进行分析。结果:总额预付有效控制了二三级医院的药占比且对三级医院的次均费用控制效果优于二级医院,但是难以控制三级医院的服务量;固定效应模型显示总额预付能控制二级医院的业务收入,但是对三级医院业务收入没有影响。结论:总额预付取得一定效果,但是难以控制三级医院院均业务收入,应该切实推行分级诊疗并精细化测算总额预付基金数额。     

HIV抗体初筛实验室的管理

从实验室建设、人员配备与培训、仪器管理、文件管理、试剂管理、质量控制、安全防护等方面对HIV抗体初筛实验室的管理进行总结,指出,规范化的实验室管理是加强HIV抗体初筛实验室质量控制的有效手段.     

Automating clinical lab boosts quality and volume, allows more efficient use of labor

The clinical lab at the University of Nebraska Medical Center has a robot of its own. And it's on the cutting edge of robotics with the recent addition of an automated vehicle that transports patient specimens to the lab's testing sites. The result? Staffing has been reduced and quality has gone up. Learn how UNMC was used as a test site to develop a state-of-the-art system that's already being snapped up by other organizations.     

科研实验室相对集约化管理及其探讨

目前在大型综合性教学医院中还存在着分散的专科实验室,导致同一医院内重复购置仪器设备,浪费了物力,也是引起人才流失不安定的因素之一,这种分散管理的方式与当前新型科技体制改革不相适宜,这种局面迫使医院要适应市场经济的需要,结合自身的实际情况建立一种新型的实施室运行机制,即“相对集约化管理”的体制,加快实验室改革的步伐,加强科研管理力度,集中优势的人力、物力、财力,尽快地为科技人员提供较好的科研条件,创     

Smoke and mirrors: how Massachusetts diverted millions in tobacco tax revenues

OBJECTIVE: This study examines the politics of appropriating Question 1 tobacco tax revenues in the first budget year after Massachusetts voters passed the ballot initiative in 1992. The initiative increased the tobacco tax on cigarettes by 25 cents per pack and on smokeless tobacco by 25% of the wholesale price. METHODS: Data were collected from newspapers, letters, memoranda, budgets, press releases, legislative floor debates, government documents, legislative journals, personal interviews, and tobacco industry documents that were downloaded from the Tobacco Archives internet site. RESULTS: During the first budget year, programmes mentioned by the initiative that were not exclusively tobacco related accounted for 27% of total Question 1 expenditures, while 50% of the revenues were allocated for programmes that were neither mentioned by the initiative nor provided any tobacco education, prevention, and cessation services. Only 23% of Question 1 funds were appropriated for programmes that provided exclusively tobacco education, prevention, and cessation services. Question 1 revenues were also used to supplant funding for pre-existing programmes, which was explicitly prohibited by the initiative. The first budget year became the template for Question 1 appropriations in subsequent fiscal years. CONCLUSION: Politics did not end after voters passed Question 1. Public health advocates lacked a strategy and budget plan to influence the appropriation of Question 1 funds after the passage of this ballot initiative.     

不同试点地区收支两条线投入政策比较

通过分析了不同试点地区在实行收支两条线改革过程中，政府财政预算的测算方式和投入标准、投入方式和收支两条线资金的管理模式，并比较分析了各地实践与各部委文件之间的异同点，说明各地可以根据本地区实际情况，因地适宜，制定有关收支两条线的投入政策和管理模式。     

Linking the laboratory with future techs

How do you further staff development, boost recruitment efforts, enhance public awareness of the lab, and provide an educational resource for teachers all on a micro budget? Introduce the lab to your school system.     

Functional evaluation in patients with chronic obstructive pulmonary disease: pulmonary function test versus cardiopulmonary exercise test.

The pulmonary function test (PFT) alone may be inadequate for predicting work-related exercise capacity in patients who file workers' compensation claims for respiratory limitation and compensation. Two hundred sixteen ambulatory patients with chronic obstructive pulmonary disease (forced expiratory volume in 1 second = 54.1 +/- 16.8% predicted) were administered the PFT and cardiopulmonary exercise test, and the results were analyzed by categorical statistical comparison, based on standard medical impairment classifications. Sixty-five patients (30.1%) were similarly classified by the two methods. Of the remaining patients, 132 (61.1%) were found to be less impaired according to the cardiopulmonary exercise test than according to the PFT, and 19 (8.8%) were more impaired according to the PFT. The results favor the use of the cardiopulmonary exercise test for the routine evaluation of respiratory impairment in patients with chronic obstructive pulmonary disease, particularly for patients with mild or moderate impairment revealed by the PFT. The large discrepancy between the two procedures emphasizes the need for a novel approach.     

Budget crisis, entitlement crisis, health care financing problem--which is it?

Many budget analysts allege that growing expenditures on entitlements will necessitate a reexamination of all public spending and taxes. In fact, anticipated budget problems are fully explained by projected growth of Medicare and Medicaid. But the same forces driving public-sector health care spending are also driving private spending. Sensible reforms of publicly financed health care require a systemwide approach. Apart from health care, currently legislated federal revenues suffice to cover all currently projected spending, including all Social Security and other entitlements. The United States confronts a public and private health care spending problem, not an entitlement crisis.     

Penalizing patients and rewarding providers: user charges and health care utilization in Vietnam

The introduction of a comprehensive system of user charges in 1995 provided public health facilities in Vietnam, especially hospitals, with a growing source of revenue. By 1998 revenues from user charges accounted for 30% of public hospital revenues. Increasingly, provider incomes have relied on fee revenues and provision-based bonuses, the effect of which is that a poorly regulated fee-for-service system has replaced a salary system based upon a centrally determined global budget. This paper examines the potential influence of providers' on the use of publicly provided health services. Using facility-based data over the period 1996-98, the relative contribution of treatment intensity is compared and contrasted under the two sources of hospital revenues from patients, namely a user charge system and a third party payment system based on fee-for-services. The primary focus of the comparison is on the treatment intensity for all hospital contacts, hospital admissions and the length of hospital stays, decisions normally taken by the providers and over which patients have little or no influence. The results indicate that growth in patient revenues was associated with large increases in intensity. The growth in intensity was more pronounced in the case of inpatient contacts. Moreover, both the admission rate and the length of hospital stay were far higher for better off individuals than for the poor, and greater for the insured than the uninsured. The increase in the intensity of hospital care for both health insurance enrollees and the uninsured can be seen as, among other things, an attempt on the part of providers to increase revenue from health insurance premiums and user charges in the face of a shrinking share of public resources allocated to hospitals, and low wages and salaries.     

Time for a change in how new antibiotics are reimbursed: Development of an insurance framework for funding new antibiotics based on a policy of risk mitigation

Healthcare systems depend on the availability of new antibiotics. However, there is a lack of treatments for infections caused by multidrug resistant (MDR) pathogens and a weak development pipeline of new therapies. One core challenge to the development of new antibiotics targeting MDR pathogens is that expected revenues are insufficient to drive long-term investment. In the USA and Europe, financial incentives have focussed on supporting R&D, reducing regulatory burden, and extending market exclusivity. Using resistance data to estimate global revenues, we demonstrate that the combined effects of these incentives are unlikely to rekindle investment in antibiotics. We analyse two supplemental approaches: a commercial incentive (a premium price model) and a new business model (an insurance model). A premium price model is familiar and readily implemented but the required price and local budget impact is highly uncertain and sensitive to cross-sectional and longitudinal variation in prevalence of antibiotic resistance. An insurance model delivering risk mitigation for payers, providers and manufacturers would provide an incentive to drive investment in the development of new antibiotics while also facilitating antibiotic conservation. We suggest significant efforts should be made to test the insurance model as one route to stimulate investment in novel antibiotics.     

A strategy for supply cost savings

A collaborative team effort and a new software program helped this hospital lab to come in $47,500 under budget on supply expenses.     

Early retirement and the influence on healthcare budgets and insurance premiums in a diabetes population

Objectives

To contribute to current discussions about budget impact modeling, two different approaches for the impact of a new pharmaceutical product were analyzed: firstly considering the impact on annual healthcare expenditures only, and secondly additional inclusion of lost insurance premiums due to possible early retirement in patients with chronic diseases.

Methods

The dynamic model calculates the budget impact from two different perspectives: (a) the impact on healthcare expenditures and (b) on expenditures as well as on health insurance revenues due to premiums. The latter approach could especially be useful for patients with chronic diseases who have higher probabilities of early retirement. Early retirement rates and indirect costs were derived from published data. Healthcare premiums were calculated based on an average premium and a mean income. Epidemiological input data were obtained from the literature. Time horizon was 10 years.

Results

Results in terms of reimbursement decisions of the budget impact analysis varied depending on the assumptions made for the insurance premiums, costs, and early retirement rate. Sensitivity analyses revealed that in extreme cases the decision for accepting a new pharmaceutical product would probably be negative using approach (a), but positive using approach (b).

Conclusions

Depending on the disease and population of interest in a budget impact analysis, not only the healthcare expenditures for a health insurance have to be considered but also the revenue side for an insurance due to retirement should be included.     

On ecological fallacy, assessment errors stemming from misguided variable selection, and the effect of aggregation on the outcome of epidemiological study

In social and environmental sciences, ecological fallacy is an incorrect assumption about an individual based on aggregate data for a group. In the present study, the validity of this assumption was tested using both individual estimates of exposure to air pollution and aggregate data for 1,492 schoolchildren living in the in vicinity of a major coal-fired power station in the Hadera region of Israel. In 1996 and 1999, the children underwent subsequent pulmonary function tests (PFT), and their parents completed a detailed questionnaire on their health status and housing conditions. The association between children's PFT results and their exposure to air pollution was investigated in two phases. During the first phase, PFT averages were compared with average levels of air pollution detected in townships, and small census areas in which the children reside. During the second phase, individual pollution estimates were compared with individual PFT results, and pattern detection techniques (Getis-Ord statistic) were used to investigate the spatial data structure. While different levels of areal data aggregation changed the results only marginally, the choice of indices measuring the children's PFT performance had a significant influence on the outcome of the analysis. As argued, differences between individual-level and group-level effects of exposure (i.e., ecological or cross-level bias) are not necessary outcomes of data aggregation, and that seemingly unexpected results may often stem from a misguided selection of variables chosen to measure health effects. The implications of the results of the analysis for epidemiological studies are discussed, and recommendations for public health policy are formulated.     

Impact of a community-based exercise program on children and adolescents with disabilities

The purpose of this study was to determine if participation in a community-based fitness program improves: a) strength and endurance, b) self-concept and quality of life, and c) positive social interactions among participants with disabilities. Nineteen children completed the study (10 experimental group, 9 control group). Pre/post testing included body mass index (BMI), energy expenditure index (EEI), Presidential Fitness Test (PFT), strength testing using a handheld dynamometer, PedsQL, and the Piers-Harris 2 Self-Concept Scale (PH-2). The experimental group participated in an 8-week exercise program two times per week and were given a home exercise program (HEP). No statistically significant differences were observed in BMI, EEI, PFT, strength, quality of life, or self-concept. A statistically significant difference in social interactions was found between the first and second half of the exercise program while the children performed group activities and ran track based on repeated measures MANOVA at p<0.05. While changes in fitness may not be observed following an 8-week exercise program, improvements in social interactions may be possible.     

典型国家公立医院财务治理经验及其对我国的启示

指出目前我国部分公立医院内部管理粗放,运行成本上升,需要建立科学规范的财务治理框架。通过对各国公立医院财务治理经验的分析,提出公立医院内部财务治理重在重大经济事项集体决策;财务收支合规合法;内部控制及预算绩效等方面,外部治理关键在于监管报告建立及信息透明等。