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At least 163 records · Page 9Linked to original sources
PubMedDate not supplied

Organ procurement expenditures and the role of financial incentives.

OBJECTIVES: To evaluate the billed charges for organ procurement and to consider the role of financial incentives to encourage organ donation. DESIGN: Observational study. Data were obtained on donor organ acquisition charges from a random sample of kidney, heart, liver, heart-lung, and pancreas transplants. SETTING: The data were based on 28.7% of all transplants performed in the United States in 1988. MAIN OUTCOME MEASURE: Total charges for donor organ acquisition. RESULTS: The median charges (1988 dollars) for donor organs were as follows: kidney, $12,290; heart, $12,578; liver, $16,281; heart-lung, $12,028; and pancreas, $15,400. Since 1983, kidney acquisition charges have increased by 12.9%, heart charges by 64.1%, and liver charges by 61.8%, after adjusting for inflation. Between 9% and 31% of total transplant procedure-specific charges were associated with donor organ acquisition. CONCLUSIONS: There is wide unexplained variation in organ procurement charges. Data on actual costs are required to establish the appropriateness of current charges. Prevailing billing and payment methods should be reevaluated in an effort to address a variety of issues related to reimbursement. Current payment methods may actually contribute to cost inefficiency. Finally, while financial incentives may enhance the efficiency of organ procurement efforts, they will adversely affect the cost-effectiveness of transplantation.

Altruism↗
PubMed1987

Quality assurance in changing times: proposals for reform and research in the clinical laboratory field.

The U.S. Department of Health and Human Services recently commissioned a comprehensive analysis of the effectiveness and appropriateness of federal clinical regulations. The analysis found that many federal regulations are technically obsolescent and many may be operationally unnecessary as a result of changing laboratory technology and changed federal reimbursement policies. Among changes recommended by the HHS-funded analysis are: the regulatory classification system based upon physical location of laboratories is no longer appropriate and should be replaced with a classification system reflecting laboratory functions; a single, uniform set of federal regulations should be developed that covers all civilian laboratories receiving federal reimbursement or operating in interstate commerce; a revised federal regulatory system should emphasize measures of performance such as personnel and inspection requirements; and clinical laboratory regulations should be based upon objective data to the maximum extent possible.

Costs and Cost Analysis↗
PubMed1988

Federal regulation of clinical laboratories. A prospective public policy analysis.

The two-decade history of federal clinical laboratory standards is associated with improved laboratory performance. At present, there is limited empirical evidence explaining which regulatory requirements have contributed to this improvement. Some evidence suggests a cause-and-effect relationship for certain standards, eg, participation in proficiency testing, but not for others. Further improvements in performance and evolutionary changes in standards can be anticipated. The federal rule-making process properly emphasizes fairness and participation. As a result, the standard-setting process may not keep pace with rapid technological and utilization changes now in progress. A shared goal of laboratorians and policy makers is to "do no harm!" Empirical evidence is likely to play an ever increasing role in meeting this goal, which will require identifying effective and cost-efficient standards for laboratory performance.

Government Agencies↗
PubMedDate not supplied

[Hospital infection morbidity in the Russian Federation].

The epidemiological analysis of hospital infection morbidity in Russia at the period of 1990-1991 made it possible to establish the occurrence of hospital infections among hospitalized patients throughout the country. The data on the structure of registered hospital infections were obtained. These data indicate that the prevalent part of hospital infections were neonatal purulent septic infections and postoperative infections; among the former, ophthalmic infections and infections of the skin and subcutaneous fat prevailed. The outbreaks of total morbidity in hospital infections did not exceed 1%, while the total morbidity in enteric infections was 10% in the whole of Russia and 30% in the territories where outbreaks of enteric infections were registered.

Adolescent↗
PubMed2006

Federalism and regional health care expenditures: an empirical analysis for the Swiss cantons.

Switzerland (7.2 million inhabitants) is a federal state composed of 26 cantons. The autonomy of cantons and a particular health insurance system create strong heterogeneity in terms of regulation and organisation of health care services. In this study we use a single-equation approach to model the per capita cantonal expenditures on health care services and postulate that per capita health expenditures depend on some economic, demographic and structural factors. The empirical analysis demonstrates that a larger share of old people tends to increase health costs and that physicians paid on a fee-for-service basis swell expenditures, thus highlighting a possible phenomenon of supply-induced demand.

Delivery of Health Care↗
PubMed1979

Community mental health centers and the "seed money" concept: effects of terminating federal funds.

What happens to community mental health centers when federal funding ends? Analysis of the funding patterns of a cohort of "graduate" community mental health centers indicates that these centers remained fiscally viable subsequent to termination of basic federal grants. However, further analysis revealed two distinct funding patterns within the cohort. One group relied primarily on increased third-party reimbursements to offset the end of basic federal grants. The other sought more state funds and additional federal grants available through the Community Mental Health Center Amendments of 1975. As more centers "graduate," federal "floor funding" may be necessary to insure the survival of some of them.

Community Mental Health Centers↗
PubMed1988

Comparison of methods of analysis using data of the panel study of the Federal Institute for Population Research (BIB).

The author compares methods of analysis using data from a panel study of the Federal Republic of Germany's Institute for Population Research. "This does not only involve a comparison of the methods as such, but above all also a comparison of the results (of these methods), of their presentation and of the possibilities of interpreting them. The three programmes selected for this paper represent methods for...so-called multivariate analysis, in particular for the analysis of non-metric data as they are included in the panel study...." Data are for a sample of 1,868 women interviewed at least twice and concern women's educational status and the qualities of motherhood.

Developed Countries↗
PubMed1985

Analysis of the effects of applying federal diagnosis-related grouping (DRG) guidelines to a population of high-risk newborn infants.

Length of stay data collected for high-risk newborn infants admitted to a tertiary care children's hospital neonatal unit over a 6-year period were compared with mean and outlier lengths of stay published in the Federal Register as part of a proposed system for prospective payment of hospital cost by diagnosis-related groupings (DRGs). We found that the classification system for newborns markedly underestimated the number of days required for the treatment of these infants. The use of the geometric mean instead of the arithmetic mean as the measure of central tendency was a significant contributor to the discrepancy, especially in those subgroups with bimodal frequency distributions of lengths of stay. Another contributor to the discrepancy was the lack of inborn patients in the children's hospital cohort. The system of prospective payments, as outlined, does not take into account several factors that have a strong influence on length of stay such as birth weight (which requires more than three divisions to serve as an effective predictor), surgery, outborn status, and ventilation. Implementation of the system described in the Federal Register would severely discourage tertiary care referral hospitals from providing neonatal intensive care.

Birth Weight↗
PubMed1999

[Attitude toward smoking among smoking and non-smoking officials of the Federal University of Sao Paulo, Brazil: comparative analysis of smokers and non-smokers].

OBJECTIVE: To study the attitudes toward smoking of employees of the Federal University of Sao Paulo as a step toward implanting a consensualized anti-smoking program for the institution. METHOD: We designed and distributed anonymous, self-completed questionnaires with 51 multiple-choice questions, which were returned by 2,613 (48.6%) employees, professors, medical residents, nurses and students. RESULTS: Four hundred thirty-eight (16.8% of the population) of the respondents were smokers and 456 (17.5%) were non-smokers. For 84% smoking started between the ages of 11 and 20 years. Most smokers were between 31 and 40 years of age, and the prevalence of ex-smokers was highest in respondents over the age of 60. Seventy-eight percent of the smokers smoked at work. Both smokers and non-smokers reported some type of discomfort caused by cigarette smoke, mainly smell in clothes and hair (62.7% of smokers versus 59% of non-smokers, NS). The proportion who opted for a totally smoke-free environment was 37.5% among non-smokers and 10% among smokers (p < 0.05). Restrictions on smoking in specific places, on the other hand, met with the approval of 82.8% of smokers and 59% of non-smokers (p < 0.05). CONCLUSIONS: We believe that surveys such as this one should be carried out at all institutions, particularly in health care centers, in order to assure that smoking restriction policies are successful and receive the support of most employees, whether they smoke or not. Our data suggest the advisability of creating restricted-smoking zones in the early phase of an institutional anti-smoking campaign designed to lead to a totally smoke-free workplace environment.

Adult↗
PubMed1986

Epidemiological analysis of Neisseria gonorrhoeae in the Federal Republic of Germany by auxotyping and serological classification using monoclonal antibodies.

We evaluated a new serological classification system for Neisseria gonorrhoeae based on monoclonal antibodies directed against epitopes on the outer membrane protein I, in conjunction with auxotyping, to analyse gonococci from two cities in the Federal Republic of Germany. Isolates of N gonorrhoeae were collected during 1976-8 and 1980-2 in Lübeck, and during 1980-2 in Heidelberg. Between the two study periods in Lübeck, we observed an appreciable decrease in strains of the auxotype that requires arginine, hypoxanthine, and uracil (AHU-) and with serovar class PrIA-1 and the emergence of strains with the proline requiring auxotype and PrIB-1 serovar class. Serovar PrIA-1 accounted for 89 (97%) of 92 strains with the AHU- auxotype as opposed to 12 (4%) of 297 strains with other auxotypes (p less than 0.0001). Disseminated gonococcal infection was associated with AHU-/PrIA-1 strains. Penicillinase producing N gonorrhoeae (PPNG) strains belonged to eight different auxotype and serovar classes, which indicated that different strains had been imported. Classification of strains of N gonorrhoeae by auxotype and serovar class permits analysis of temporal changes in gonococcal populations, and of migrations of gonococci between different geographical areas. Typing N gonorrhoeae, together with assessing antibiotic susceptibilities, may prove useful for further studies of the epidemiology and control of gonorrhoea.

Antibodies, Monoclonal↗
PubMed2001

The effects of gender role orientation on team schema: a multivariate analysis of indicators in a US Federal health care organization.

In this empirical study of 649 employees at a federally supported health care facility in the United States, the authors investigated the effects of individual gender role orientation on team schema. The results indicated (a) that nontraditional male and female employees perceived the greatest amount of group cohesion in their team schemas and (b) that both traditional and nontraditional male employees perceived greater problem-solving potential in their team schemas. Meaningful implications for team composition are discussed.

Adult↗
PubMed2001

[Hospital mortality in cardiology. Analysis of deaths occurring in the Federation of Cardiology of a university hospital center].

The aim of this study was to examine the nature of cardiovascular deaths occurring in a University Hospital. All the hospital files of 1999 of the Federation of Cardiology of Henri Mondor Hospital, Creteil, of patients who died in the department or after transfer to the intensive care unit or cardiac surgery department, were analysed. Myocardial ischaemia was the leading cause of death, occurring either in the acute phase of transmural infarction or in patients with chronic cardiac failure. Deaths occurring during acute myocardial infarction were associated with late treatment and/or non-reperfusion of the culprit artery. The delay of diagnosis seemed to be secondary to late consultation or difficulty in diagnosis. This resulted in severe left ventricular dysfunction and, in a quarter of cases, mechanical complications. They led to the early death of the patients (2.9 +/- 3.5 days after admission). Campaigns of patient information and education of doctors who see these patients would seem to be the most appropriate approach to reduce the delay before hospital admission in order to reduce mortality related to myocardial infarction. Cardiac failure is a common cause of death in cardiology departments. The deaths of patients occurred after a long follow-up and several days after hospital admission (11 +/- 10 days). Optimisation of the treatment of cardiac failure, the investigation of ischaemic heart disease, the search for new therapeutic strategies of acute cardiac failure and information of patients about their disease, seem to be the principal measures to take to improve the poor prognosis of this disease.

Aged↗
PubMedDate not supplied

[The advances in the health care management in the Russian Federation on the basis of the analysis of the health personnel].

Present the purpose, tasks, methods and programs of a comprehensive study of medical personnel organization and management. The activities of staff departments are proposed to be singled out as a specific service. Some findings of the study are presented, as are the results attained with the introduction into practice of a model of staff service in number of regions and the experience gained with training of specialists for personnel departments.

Health Personnel↗