Administrative costs in health care—A scoping review

BackgroundAdministrative costs (AC) are a relevant spending category in health care, and several approaches exist on how to define and measure them. Based on available AC studies, this paper aims to provide a map for this multifaceted research topic.MethodsA scoping review was conducted using the databases MEDLINE, EconLit, and Business Source Premier. Literature was screened focussing on the research question: What is known about the methodology of AC research from scientific publications?ResultsDefinition concepts mostly rely on national cost documentations. The international cost reporting framework of the Systems of Health Accounts was a critical reference point in six studies. Indications on how to operationalise AC independently from periodical cost reports were suggested by ten publications. In this context, time and full time equivalents are the most common cost measurements.ConclusionsThe results indicate a lack of evidence regarding patients’ perceptions of administrative issues in health care. Also, research on administrative impact on working conditions for health care employees beyond hospitals and physicians’ offices is underrepresented. A systematic approach to reporting AC studies is needed. Reporting should include the appointment of entities actually empowered to change administrative resource usage. This would help to promote principles of a balanced administration.     

Valuing the benefits and costs of health care programmes: where's the 'extra' in extra-welfarism?

The application of Sen's notion of capabilities to problems of the allocation of resources to health in the form of an extra-welfarist framework underlies the justification of quality adjusted life years (QALYs) as the method for valuing the benefits of health care. In this paper we critically appraise this application from both conceptual and empirical perspectives. We show that the alleged limitations of the welfarist approach are essentially limitations in its application, not in the capacity of the approach to accommodate the concerns of extra-welfarists. Moreover, the arguments used to justify the application of the extra-welfarist framework are essentially welfarist. We demonstrate that the methods used to measure QALYs share their basic theoretical roots with welfarist valuation methods, such as willingness to pay (WTP). Although QALYs and WTP share many challenges, we argue that WTP provides a method which performs better with respect to those challenges. In the context of evaluating alternative allocations of health care resources we are left asking what is 'extra' in extra-welfarism?     

Perceptions of postnatal depression and health care needs in a South African sample: the “mental” in maternal health care

Background

Maternal mental health care is a neglected area in low and middle income countries (LAMIC) such as South Africa, where maternal and child health care priorities are focused on reducing maternal and infant mortality and promoting infant physical health. In the context of a paucity of mental health specialists, the aim of this study was to understand the explanatory models of illness held by women with maternal depression with the view to informing the development of an appropriate counselling intervention using a task sharing approach.

Methods

Twenty semi-structured qualitative interviews were conducted with mothers from a poor socio-economic area who were diagnosed with depression at the time of attending a primary health care facility. Follow-up interviews were conducted with 10 participants in their homes.

Results

Dimensions of poverty, particularly food and financial insecurity and insecure accommodation; unwanted pregnancy; and interpersonal conflict, particularly partner rejection, infidelity and general lack of support were reported as the causes of depression. Exacerbating factors included negative thoughts and social isolation. Respondents embraced the notion of task sharing, indicating that counselling provided by general health care providers either individually or in groups could be helpful.

Conclusion

Counselling interventions drawing on techniques from cognitive behavioural therapy and problem solving therapy within a task sharing approach are recommended to build self-efficacy to address their material conditions and relationship problems in poorly resourced primary health care facilities in South Africa.

     

Is choice of care compatible with integrated health care? An exploratory study in Sweden

Competitive and integrative policy actions are simultaneously being promoted in Swedish primary care; citizens' choice of care is launched while primary care is expected to integrate its activities with other providers for the creation of 'local health care'. Competition tends, however, to fragment the provision of services. The aim of this study is, accordingly, to explore whether or not these policies are compatible in practice. For this purpose, strategically designed group interviews were conducted with citizens. When citizens make active choices, they are under the influence of self-perceived conditions: that is, the accessibility of the care, its continuity and the treatment offered by the care provider, conditions which, in turn, have a lot in common with the guiding principles of local health care. On the other hand, citizens who choose passively, because of not being in contact with primary care, have no difficulties in being disloyal to the chosen unit when becoming patients. In doing so, they also contribute to the fragmentation of local health care. Making entirely free choices when it comes to primary care seems to be incompatible with local health care. However, choice of care only partly equals the conditions of free choice. Choice of care and local health care would thus seem to be compatible, in practice, for the majority of patients.     

Future health care costs--do health care costs during the last year of life matter?

While some studies have shown a considerable effect of ageing upon future health care costs, others indicate small or no effects. Moreover, studies have shown that age-related increases in health care costs in part can be explained by high costs in the last year of life. The aim of this study was to project future costs of hospital in-patient care and primary health care services in Denmark on the basis of demographic changes, both with and without account for the high costs in the last year of life. Costs were projected on the basis of a random 19% sample of the Danish population using the cohort-component method. The traditional projection method does not account for the high costs in the last year of life while the 'improved' method does. The Danish population was projected to increase by 8.2% during the period 1995-2020, and health care costs by 18.5% according to the traditional projection method and 15.1% according to the improved one. These results suggest that the high costs in the last year of life does matter in projections of future health care costs and should be taken into account. Furthermore, ageing per se seems to have considerable impact on future health care costs.     

Nutrition—an essential component of health and health care.

Nutrition and medicine interface in a variety of ways and combine to serve as a dynamic force in health as well as in disease. A conceptual understanding of this interrelationship is critical to the continued and effective development of clinical nutrition in medical education. The physician may play an important role in critical-care medicine, long-term health care, research, education, and preventive medicine. While there is great potential for the physician to impact on nutrition status in both health and disease, there is clear evidence that greater emphasis needs to be placed on providing adequate nutrition training for every physician.     

Cost of HIV and determinants of health care costs in HIV-positive patients in Germany: results of the DAGNÄ K3A Study

Objectives

The aims of this study were to estimate the expenditure for HIV-care in Germany and to identify variables associated with resource use.

Design/setting

We performed an 18-month prospective multi-center study in an HIV specialized ambulatory care setting from 2006 to 2009.

Subjects, participants

Patients were eligible for study participation if they (1) were HIV-positive, (2) were ≥18 years of age, (3) provided written consent and (4) were not enrolled in another clinical study; 518 patients from 17 centers were included.

Main outcome measures

Health care costs were estimated following a micro-costing approach from two perspectives: (1) costs incurred to society in general, and (2) costs incurred to statutory health insurance. Data were obtained using questionnaires. Several empirical models for identifying the relationship between health care costs and independent variables, including age, gender, route of transmission and CD4 cell count at baseline, were developed.

Results

Average annual health care costs were €23,298 per patient from the societal perspective and €19,103 from the statutory health insurance perspective. Most expenses are caused by antiretroviral medication (80 % of the total and 89 % of direct costs), while hospital costs represented 7 % of total expenditure. A statistically significant association was found between health care costs and clinical variables, with higher CD4 count and female gender generating lower costs, while increased antiretroviral experience and injection drug use led to higher expenditures (P < 0.05).

Conclusions

Expenditures for HIV-infection are driven mainly by drug costs. We identified several clinical variables influencing the costs of HIV-treatment. This information could assist policymakers when allocating limited health care resources to HIV care.     

Ageing of population and health care expenditure: a red herring?

This paper studies the relationship between health care expenditure (HCE) and age, using longitudinal rather than cross-sectional data. The econometric analysis of HCE in the last eight quarters of life of individuals who died during the period 1983-1992 indicates that HCE depends on remaining lifetime but not on calendar age, at least beyond 65+. The positive relationship between age and HCE observed in cross-sectional data may be caused by the simple fact that at age 80, for example, there are many more individuals living in their last 2 years than at age 65. The limited impact of age on HCE suggests that population ageing may contribute much less to future growth of the health care sector than claimed by most observers.     

Cost of unintended pregnancy in Sweden — a possibility to lower costs by increasing LARC usage

Objectives

The objective of this study was to determine the cost of unintended pregnancy (UP) in Sweden and savings generated by a switch of 5% of women from short-acting reversible contraception (SARC) and other methods to long-acting reversible contraceptives (LARCs).

The ability of managed care to control health care costs: how much is enough?

This article argues that moral hazard is the main source of market failure in the health care sector. Cost sharing and managed care both are designed to control the extra costs of moral hazard. Managed care organizations (MCOs) have the potential to control costs by changing provider incentives away from excessive utilization of resources toward less costly and more effective treatments. However, MCOs have been given the wrong instructions by short-sighted employers who have overemphasized cost control. The solution is to give consumers more information and a choice of plans that emphasize different types and levels of cost control.     

Complaints against nurses: a reflection of 'the new managerialism' and consumerism in health care?

This paper discusses the effects of restructuring on nursing as a profession through an examination of the issue of complaints in Ontario. It argues that new managerialist techniques and associated changes in the nature of work are reducing the autonomy of nurses and making it difficult for them to meet the standards of their profession. Simultaneously, the Ontario government has increased the power of the public in the disciplinary process and the College of Nurses of Ontario is encouraging patients to register their complaints. The growth of consumerism in health care, coupled with the disciplinary process, individualizes complaints and deemphasizes their relationship to restructuring. Moreover, in response to the increasing number of complaints - complaints which more often come from the public - nursing organizations have encouraged the legalization of the disciplinary process, thus fostering the individualization of the issues.     

The impact of team-based primary care on health care services utilization and costs: Quebec’s family medicine groups

We investigate the effects on health care costs and utilization of team-based primary care delivery: Quebec’s Family Medicine Groups (FMGs). FMGs include extended hours, patient enrolment and multidisciplinary teams, but they maintain the same remuneration scheme (fee-for-service) as outside FMGs. In contrast to previous studies, we examine the impacts of organizational changes in primary care settings in the absence of changes to provider payment and outside integrated care systems. We built a panel of administrative data of the population of elderly and chronically ill patients, characterizing all individuals as FMG enrollees or not. Participation in FMGs is voluntary and we address potential selection bias by matching on GP propensity scores, using inverse probability of treatment weights at the patient level, and then estimating difference-in-differences models. We also use appropriate modelling strategies to account for the distributions of health care cost and utilization data. We find that FMGs significantly decrease patients’ health care services utilization and costs in outpatient settings relative to patients not in FMGs. The number of primary care visits decreased by 11% per patient per year among FMG enrolees and specialist visits declined by 6%. The declines in costs were of roughly equal magnitude. We found no evidence of an effect on hospitalizations, their associated costs, or the costs of ED visits. These results provide support for the idea that primary care organizational reforms can have impacts on the health care system in the absence of changes to physician payment mechanisms. The extent to which the decline in GP visits represents substitution with other primary care providers warrants further investigation.     

Price: a market signal of quality in health care insurance policies?

Choosing a good quality health insurance policy is important for most individuals in this country. The choice task is however, made quite complicated by the existence of many alternative policies which are each characterized by multiple attributes. This paper examines whether the price (i.e., premium) of a health insurance plan can give a reliable signal about the objective quality level of the plan. Empirical analysis of real-world data shows that overall, price is positively correlated with such quality. Statistical significance tests are conducted to separately evaluate such correlations for different categories of health insurances. Finally, the empirical results are used to indicate implications for consumer decision making.     

Anticoagulant treatment in primary health care in Sweden – prevalence,incidence and treatment diagnosis: a retrospective study on electronic patient records in a registered population

Background  

The indications for warfarin treatment in primary health care are increasing. An undertreatment with warfarin is reported in the prevention of embolic stroke in patients with chronic atrial fibrillation, and can be suspected for other indications. Information on the prevalence and incidence of diseases treated with warfarin would reveal useful data for audits concerning management of anticoagulant treatment. We aimed to assess warfarin treatment in primary health care with regard to prevalence, incidence, treatment diagnosis and patient characteristics.