Technology assessment and equipment management: a practical approach to cost reduction

The Medical University of South Carolina (Charleston, SC) responded to the necessity of reducing costs in a competitive marketplace by developing a program called Technology Assessment and Equipment Management. The program uses a process that systematically evaluates clinical equipment acquisitions and provides over sight on equipment management within the 587-bed tertiary care center. This article reviews how equipment is evaluated and purchased emphasizing cost control.     

北京大学第三医院第二门诊部成本核算的问题解决式实践研究

"问题解决(Question solving)"属于认知心理学领域的一个概念,大致可分为形成问题的初步表征、制定问题解决的计划、重构问题表征、执行计划和检验结果等五阶段,是问题解决者对一系列算子进行加工、组合、运算使其从初始状态向目标状态转化的过程,最早被用于学科教学领域,现广泛应用于各种社会研究领域.     

National cost study versus hospital cost accounting for organ recovery cost assessment in a French hospital group

Background

The choice of cost data sources is crucial, because it influences the results of cost studies, decisions of hospital managers and ultimately national directives of policy makers. The main objective of this study was to compare a hospital cost accounting system in a French hospital group and the national cost study (ENC) considering the cost of organ recovery procedures. The secondary objective was to compare these approaches to the weighting method used in the ENC to assess organ recovery costs.

Methods

The resources consumed during the hospital stay and organ recovery procedure were identified and quantified retrospectively from hospital discharge abstracts and the national discharge abstract database. Identified items were valued using hospital cost accounting, followed by 2010–2011 ENC data, and then weighted using 2010–2011 ENC data. A Kruskal–Wallis test was used to determine whether at least two of the cost databases provided different results. Then, a Mann–Whitney test was used to compare the three cost databases.

Results

The costs assessed using hospital cost accounting differed significantly from those obtained using the ENC data (Mann–Whitney; P-value?<?0.001). In the ENC, the mean costs for hospital stays and organ recovery procedures were determined to be €4961 (SD €7295) and €862 (SD €887), respectively, versus €12,074 (SD €6956) and €4311 (SD €1738) for the hospital cost accounting assessment. The use of a weighted methodology reduced the differences observed between these two data sources.

Conclusions

Readers, hospital managers and decision makers must know the strengths and weaknesses of each database to interpret the results in an informed context.

     

高危儿早期干预模式的建立和评估

【目的】通过专科医院和区妇幼保健院分别对早产儿系统管理和干预,探索实施高危儿早期干预的有效模式。【方法】分别由复旦大学附属儿科医院和卢湾区妇幼保健院定期随访早产儿共90例。每次随访对早产儿行发育评估、给予家长针对性干预指导、记录家长的依从性。统计依从性和失访率,比较不同模式下早期干预参与率的差异。【结果】专科模式管理的早产儿失访率较高(39.4%),社区模式失访率较低(12.5%),两种模式失访率差异有统计学意义(P0.05)。早产儿失访和家长依从性、双亲文化程度呈显著负相关;而家长依从性和双亲文化程度呈显著正相关。失访原因以家长认为"没必要随访"最多,占总失访数的34.5%;其次为"居住距离远"、"去了外地"和"太忙没时间随访"。【结论】依托三级妇幼保健网络的社区早期干预模式更有效,失访率较低,管理更系统;但还存在参与率较低、家长不重视随访干预等问题。     

Dollars and sense: a practical guide to cost analysis for hospital epidemiology and infection control

This paper explains practical approaches for collecting inpatient cost data for cost-of-illness and cost-effectiveness analyses. The economic definition of cost of an item is the value of the resources that are consumed in its production. Cost analysis should collect the resources hypothesized to be affected by the illness or intervention. The dollar value of these resources can also be estimated. Diagnosis-related group (DRG) reimbursements are not helpful when all study patients have the same DRG or when no DRG exists (e.g., nosocomial infection). Hospital charges are not a good surrogate for costs. Hence, data needed include resources used, charges, and cost-to-charge ratios, so that cost can be estimated. Resources used can be obtained from hospital information systems. For some resource use (e.g., physician services, pharmacy, and intravenous fluids), charges or cost-to-charge ratios may not be available, and an external standard may be needed to estimate the dollar value. For many types of resources, hospital financial systems provide both charges and cost-to-charge ratios. This yields an estimate of average cost (total cost divided by patient days) when marginal cost (change in variable cost per day of patient stay) is a better estimate of the value of the resources consumed. However, cost-to-charge ratios remain the only practical way of estimating cost in many circumstances and are commonly used in economic studies. Cost-of-illness estimates vary among the various nonrandomized study designs used. "Real-world" randomized trials are potentially useful to obtain advantages of randomization but avoid the protocol-induced biases of traditional double-blind controlled trials.     

The hygienic assessment of D-51A rubber and the conditions for its practical use in household drinking water supply

Rubber D-51A under examination, treated by thiuram, following long-time contact with drinking water (static conditions of the experiment) discharges thiuram into it, which significantly worsens the water quality. Drinking of this water by animals leads to functional disturbances in their organisms. Short-time contact of rubber D-51A with drinking water does not cause deterioration of its quality. Therefore rubber D-51A can be recommended to be used as pump gaskets.     

Insurers' strategies for managing the use and cost of biopharmaceuticals

This paper examines strategies under development by health insurers to manage biopharmaceuticals, as their use spreads beyond rare diseases and academic sub-specialists to common conditions and community-based practices. Emphasis is placed on medical management (formulary placement and prior authorization), network design (physician contracting and drug distribution), and benefit design (coinsurance and annual payment limits). Contemporary initiatives are modest in ambition but potentially lay the foundation for a framework that balances access to innovation with affordability in this dynamic industry.     

Comprehensive cardiac rehabilitation: a cost assessment based on a randomized clinical trial

OBJECTIVES: The costs of comprehensive cardiac rehabilitation are established and compared to the corresponding costs of usual care. The effect on health-related quality of life is analyzed. METHODS: An unprecedented and very detailed cost assessment was carried out, as no guidelines existed for the situation at hand. Due to challenging circumstances, the cost assessment turned out to be ex-post and top-down. RESULTS: Cost per treatment sequence is estimated to be approximately euro 976, whereas the incremental cost (compared with usual care) is approximately euro 682. The cost estimate is uncertain and may be as high as euro 1.877. CONCLUSIONS: Comprehensive cardiac rehabilitation is more costly than usual care, and the higher costs are not outweighed by a quality of life gain. Comprehensive cardiac rehabilitation is, therefore, not cost-effective.     

Measures for low back pain: a proposal for clinical use

Low back pain represents a serious public health problem. Therefore, great efforts have been made in order to improve and assess the efficacy of its treatment. Reports in international literature have presented important studies concerning instruments to assess pain and functional incapacity in patients with low back pain. This study presents a clinical protocol which was developed by a multidisciplinary team. This protocol consists of the evaluation and distribution of pain, The Spitzer Quality of Life, The Oswestry Low Back Pain Disability Questionnaire, and The Center for Epidemiological Studies Depression Scale. Instruments must be urgently developed or adapted in order to be used according to the Brazilian reality.     

HealthScope: a model for a low cost health education program using commercial television.

HealthScope is a health education based on the Health Belief Model that uses television and print materials. It was designed for a number of agendas--(a) a desire by health educators to provide health information to a broad audience at a reasonable cost (b) a desire by the local medical association to promote its role in prevention and primary care, and (c) a desire by commercial television to expand its coverage of local health issues in a cost-effective way. In its summer series, HealthScope included 10 weekly television programs that focused on various aspects of disease prevention and health promotion and answered viewers'' questions on the air. Each program was followed by a bank of physicians answering questions on the telephone for 90 minutes. Corresponding fact sheets were distributed through a local pharmacy chain. A "healthy weekend" sweepstakes contest also was held. Intermediate outcome measures indicated that HealthScope had a broad reach and stimulated viewers to seek additional information about health. At the same time, the program generated revenue for the commercial television station.     

Willingness to pay for a public health checkup program: assessment by the travel cost method

OBJECTIVE: Whether the benefit of a public health program surpasses the cost of providing the program is an important question for public service providers. This study aimed to evaluate one health checkup program provided by a municipal government by measuring the public's willingness to pay (WTP) for maintaining the program. METHODS: A questionnaire-based study of a health checkup program targeting people joining the National Health Insurance system was conducted. The WTP was estimated from a demand curve for the program, which was constructed by a revealed preference method, that is, by the travel cost method. RESULTS: The WTP was calculated as 5410 yen per person, an amount substantially below the cost to the government of providing the service. The aggregate WTP was also estimated to be lower than the current expense of the municipal government. CONCLUSION: The amount users are willing to pay for a health checkup program provided by the municipal government appears to be less than the actual cost of the program. The travel cost method might reflect short-term private benefit produced by the health checkup program but cannot take into account long-term private benefit or overall social benefits which ensues.