Getting a return on investment from spending capital dollars on new beds

In assessing this bed-purchase process and the resulting return on investment, I identified the following critical success factors related to capital investments: Evaluation of capital equipment for return on investment from the expense side, particularly when looking at use of manpower for critical positions in the organization Evaluation of capital equipment for increasing nursing satisfaction, a factor in addressing the healthcare worker shortage in today's environment Involvement of a representative team to create personal ownership through individuals wanting to take care of something they are involved in purchasing Spin-off timesaving that can be realized through the adage "form follows function" The last factor was found not only in savings of nurse staff time but also in pharmacy time because the weight function on the new beds saved approximately one hour, allowing for speedier calculation of creatinine clearance in antibiotic dosing. Changing my position and perspective was rewarding. The persistence of the CNO and the involvement of the employees made the experience gratifying on a personal level as well.     

Getting what you pay for: public health spending and the performance of essential public health services.

Governmental spending in public health varies widely across communities, raising questions about how these differences may affect the availability of essential services and infrastructure. This study used data from local public health systems that participated in the National Public Health Performance Standards Program pilot tests between 1999 and 2001 to examine the association between public health spending and the performance of essential public health services. Results indicated that performance varies significantly with both local and federal spending levels, even after controlling for other system and community characteristics. Some public health services appear more sensitive to these expenditures than others, and all services appear more sensitive to local spending than to state or federal spending. These findings can assist public health decision makers in identifying public health financing priorities during periods of change in the resources available to support local public health infrastructure.     

Public spending and NHS finance

Reliability, the Chancellor's Autumn Statement on the country's economic prospects, and the Government's public spending plans seldom go hand in hand. Last year's statement, however, offers an insight into this year's discussions and negotiations and their effect on NHS resources. Tom Jones sets the scene.     

Fitting spending functions

Group sequential monitoring is used to provide guidance on stopping a clinical trial in progress based on interim evaluation of its efficacy objectives. A trial could stop because an experimental regimen (1) is efficacious, (2) lacks any sign of efficacy, or (3) is specifically less efficacious than a control. Group sequential methods using α‐ and β‐spending functions (Biometrika 1983; 70 :659–663) are often used to create stopping boundaries for test statistics for efficacy hypotheses computed at interim analyses. This paper explores fitting α‐ and β‐spending functions that have specific values at specific interim analyses. Commonly used one‐parameter families may not provide an adequate fit to more than one desired critical value. We define new one‐ and two‐parameter families to provide additional flexibility along with examples to demonstrate their usefulness. The logistic family is one of these two‐parameter families, which has been applied in several trials. Copyright © 2009 John Wiley & Sons, Ltd.     

Unintended pregnancy and taxpayer spending

CONTEXT: Nearly half of all pregnancies in the United States are unintended. These pregnancies likely represent a substantial cost to taxpayers, but national‐level estimates of these public costs have been lacking. METHODS: Taxpayer spending on unintended pregnancy is measured by multiplying estimates of the 2001 incidence of publicly financed unintended pregnancy outcomes (abortions, fetal losses, births and need for infant medical care) by average per‐incident costs. Public savings that would result from preventing unintended pregnancies are estimated by assuming that the prevention of an unwanted pregnancy would save the full cost of financing the pregnancy, while the prevention of a mistimed pregnancy would save the cost of financing the pregnancy today minus the present value of the cost of financing the pregnancy when it eventually occurs. RESULTS: Lower‐bound, mean and upper‐bound estimates of the annual cost of unintended pregnancy are, respectively, $9.6 billion, $11.3 billion and $12.6 billion. Corresponding estimates of the savings that would accrue to taxpayers by preventing unintended pregnancies are $4.7 billion, $5.6 billion and $6.2 billion. The mean estimate of the taxpayer cost per publicly subsidized unintended pregnancy is $9,000; the prevention of such a pregnancy would save taxpayers about half that amount. CONCLUSIONS: The prevention of unintended pregnancy represents an important opportunity for the public to reap substantial savings, especially given the current fiscal climate. The enactment or expansion of cost‐effective policies to prevent unintended pregnancies is therefore a timely and sensible strategy.     

Intergenerational equity and public spending

Concerns over public spending for elders and children are not new. Some of our previous work, combined with the analysis by Susmita Pati and colleagues in this volume of Health Affairs, documents a substantial divergence of social welfare spending for children and elders between 1965 and 2000. Looking to the future, our concern is that social welfare spending for children and elders will be driven more by political concerns and macroeconomic trends than by the needs of the two populations. We argue that the country needs to adopt a new fairness doctrine in allocating social welfare resources, whereby the needs of both groups are met.