PubMed · 14839541
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M KENNISH. 1951. Reducing cost through efficiency, II.. https://pubmed.ncbi.nlm.nih.gov/14839541/
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The quality-adjusted life year (QALY) assumes that the value of a health state is linearly related to the time spent in it, which implies that the value of a health state is independent of the states which precede or follow it. Irritable bowel syndrome (IBS) is a suitable condition to test this assumption since it is subject to considerable fluctuations over time. Forty-nine IBS patients were asked to rate their own health using generic measures of health and a condition specific classification. They were then asked to value five IBS states and four profiles using a self-completed version of the standard gamble technique. The implied value of each profile was estimated using the QALY assumption of linearity over time and compared with the direct profile valuations. The directly elicited profile values suggest that reductions in the duration of IBS symptoms has less of an impact on the value of quality of life than would be implied by the QALY assumption of linearity over time, though the differences were small. There are a number of competing explanations for this finding, including possible sequence effects, quantity effects or time preference, or it might be due to gestalt effects resulting in a neglect of time spent in symptomatic states of health.
Ongoing instability in the nursing workforce is raising questions globally about the issue of nurse turnover. A comprehensive literature review was undertaken to examine the current state of knowledge about the scope of the nurse turnover problem, definitions of turnover, factors considered to be determinants of nurse turnover, turnover costs and the impact of turnover on patient, and nurse and system outcomes. Much of the research to date has focused on turnover determinants, and recent studies have provided cost estimations at the organizational level. Further research is needed to examine the impact of turnover on health system cost, and how nurse turnover influences patient and nurse outcomes.
Uncontrolled growth of the urban population in developing countries in recent years has made solid waste management an important issue. Very often, a substantial amount of total expenditures is spent on the collection of solid waste by city authorities. Optimization of the routing system for collection and transport of solid waste thus constitutes an important component of an effective solid waste management system. This paper describes an attempt to design and develop an appropriate storage, collection and disposal plan for the Asansol Municipality Corporation (AMC) of West Bengal State (India). A GIS optimal routing model is proposed to determine the minimum cost/distance efficient collection paths for transporting the solid wastes to the landfill. The model uses information on population density, waste generation capacity, road network and the types of road, storage bins and collection vehicles, etc. The proposed model can be used as a decision support tool by municipal authorities for efficient management of the daily operations for transporting solid wastes, load balancing within vehicles, managing fuel consumption and generating work schedules for the workers and vehicles. The total cost of the proposed collection systems is estimated to be around 80 million rupees for the fixed cost of storage bins, collection vehicles and a sanitary landfill and around 8.4 million rupees for the annual operating cost of crews, vehicles and landfill maintenance. A substantial amount (25 million rupees/yr) is currently being spent by AMC on waste collection alone without any proper storage/collection system and sanitary landfill. Over a projected period of 15 yr, the overall savings is thus very significant.