Evaluating emergency medical services: controlling the rising cost of saving lives

A combination of recent changes in the way Emergency Medical Services are reimbursed by Medicare for ambulance services and escalating costs have prompted many EMS providers to seek new ways to meet the needs of the communities they serve in a more cost-effective manner. This article reports one such study of a county in the Southeastern United States with a population of over 100,000 distributed over an area of 600 square miles. The study used industrial techniques, including a combination of historical data analysis and time studies, to recommend ways to cut costs without adversely affecting either the emergency coverage or patient case provided. Based on usage data, reducing the number of service units during time of least demand was suggested. The time studies indicated that it might be possible to combine some jobs (e.g. billing personnel and dispatchers), The usage data also showed that the existing geographical distribution of the units matched demand. The study demonstrated that industrial engineering techniques can be usefully employed in the evaluation of the efficiency and effectiveness of public services.     

Limited availability and higher cost of gluten‐free foods

Background: A gluten‐free diet is the only treatment for patients with coeliac disease, although it can be burdensome to follow and result in inadequate nutrient intake. The cost and availability of a gluten‐free diet has been cited as a cause of incomplete dietary compliance; however, this has not been extensively investigated. The aim was to investigate the availability and cost of gluten‐free foods across a wide range of stores. Methods: The availability and cost of 20 foods (both wheat‐based and everyday foods) was surveyed at 30 different stores across five different store categories. For each of the 20 foods, four products were selected (branded gluten‐free, cheapest gluten‐free, branded standard, cheapest standard) resulting in sampling of up to 80 products in each of the 30 stores. Results: In general, there was limited availability of gluten‐free foods, with an average of 8.2 of the 20 (41%) foods being available in a gluten‐free version per store. Regular supermarkets had a greater availability (18.0/20, 90%), whereas budget supermarkets (1.8/20, 9%) and corner shops (1.8/20, 9%) had almost no gluten‐free versions (P < 0.001). All 10 gluten‐free versions of wheat‐based foods were more costly than their standard counterparts (76–518% more expensive; P < 0.001). Some gluten‐free versions of everyday foods were also more costly than standard counterparts (2–124%). Conclusions: There is limited availability of gluten‐free foods and they are generally more expensive than their standard counterparts. This may impact on compliance to a gluten‐free diet, with potential nutritional and clinical consequences, together with an increased risk of complications.     

The growth in cost per case explains far more of US health spending increases than rising disease prevalence

Some prior research has suggested that health spending for many diseases has been driven more by increases in so-called treated prevalence-the number of people receiving treatment for a given condition-than by increases in cost per case. Our study reached a different conclusion. We examined treated prevalence, clinical prevalence-the number of people with a given disease, treated or not-and cost per case across all medical conditions between 1996 and 2006. Over this period, three-fourths of the increase in real per capita health spending was attributable to growth in cost per case, while treated prevalence accounted for about one-fourth of spending growth. Our evidence suggests that most of the treated-prevalence effect is due to an increase in the share of eligible people being treated rather than an increase in clinical prevalence of diseases. We conclude that efforts to curb health spending should focus more on reining in cost per case.     

The rising risk tide

Hospitals have a tricky course to navigate as health care reimbursement moves from volume- to value-based. Move to accountable care too soon and you leave volume-based money on the table. Move too late and you risk losing the market to better-prepared competitors. "How do you keep standing with your feet in two boats, one tied to the dock and the other pulling away?" a hospital executive wonders.     

Development of low cost supplementary foods for infants and children from locally available foods in Punjab (India)

Supplementary foods suited for weaning and feeding of infants were developed, using locally available foods in Punjab. Methods of cooking employed were those used commonly by low and middle income families. Cereal-pulse combinations along with some sesame seed and groundnuts were used to enhance the protein quality. The ratio used was such that the preparation did not deviate much from the accepted tastes of the population. Fresh green vegetables were also used. Fifteen recipes were standardized and acceptability trials carried out with mothers and infants of the different socio-economic groups. The preparations were highly accepted by all. Analysis of these were done for protein, calories, vitamin C and iron to see their contribution to the diet. The cost per serving of each recipe for various age groups was worked out and it was observed that at a very low cost a substantial amount of the above nutrients could be given to the infants by including these preparations in their diets. Education of mothers in making these recipes will go a long way towards popularizing such formulations.     

Consumers trail other groups in concern over healthcare cost, but interest is rising

A recent survey cited healthcare costs as the nation's No. 1 problem as judged by physicians, hospital administrators and employers. But only a third of consumers felt the same way, and only 1 in 5 consumers said healthcare costs were their greatest personal concern.