PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Development Planning--cost”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed1987

Today's stronger, tougher, smarter financial manager.

The average CFO is 40 years old and has been in his current position for six years. He (CFOs are still overwhelmingly male) earns $56,615 a year and has increasing responsibility for nontraditional finance functions such as loan administration and real estate management. Furthermore, the CFO is assuming responsibility for other areas such as medical records and contract negotiation. In his professional development, the CFO is becoming increasingly interested in strategic planning, cost accounting to determine pricing, management skills, new business development, and government reimbursement policies. In his personal development, the CFO in finding such personal traits as motivation, drive, the ability to achieve tangible benefits, and strong personal values as ingredients of a successful CFO.

Financial Management↗
PubMed1990

Shared-risk arrangement between employers and insurers.

Development of and initial experience with a shared-risk arrangement between an employer, Allied-Signal, Incorporated, and a health insurer, CIGNA Corporation, are discussed. Rapidly rising health-plan costs and projections for even greater increases in the next three years, coupled with other related considerations, spurred Allied-Signal to undertake a major re-evaluation of its employee health plan in 1987. After extensive discussions and consultation, Allied-Signal negotiated a shared-risk contract with CIGNA, a dual-option insurer, under which premium price increases are capped for a period of three years. CIGNA is at risk for any costs that exceed premium revenue; if costs are less than premium revenue, CIGNA will retain the surplus. Price and geographic accessibility to Allied-Signal beneficiaries were the two key factors in the choice of CIGNA Corporation. The company selected a point-of-service delivery model, which grants employees greater freedom of choice in the use of health-care providers; those who use network providers pay a fixed copayment while those who use nonnetwork providers pay a fixed copayment providers pay an annual deductible plus 20% of medical expenses incurred above the deductible. During the first year of the program, 75% of beneficiaries used network providers from 95% to 100% of the time. The actual costs for the first 18 months were less than projected and much less than increases experienced by fee-for-service plans during that same period. The shared-risk contract between Allied-Signal and CIGNA Corporation has been successful thus far.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost Control↗
PubMed1998

Design of a privileging program for diagnostic imaging: costs and implications for a large insurer in Massachusetts.

PURPOSE: To evaluate the results of a privileging program aimed to ensure that health care providers and facilities adhere to standards of care. MATERIALS AND METHODS: Technical and professional privileging applications were mailed to more than 1,800 diagnostic imaging facilities and more than 6,000 professional providers of services to members of a health care plan. Site inspections were used to determine whether facilities met standards of care. Specialty providers were assigned a range of current procedural terminology codes for which they had privileges to bill the payer. RESULTS: Of 1,004 imaging sites inspected, 197 (20%) failed with the ability to remedy the violation, 106 (10%) failed with fundamental and serious deficiencies, and 701 (70%) passed. Site inspection pass rates varied substantially by specialty. Chiropractors and podiatrists were more likely to fail than medical and surgical specialists. A strong correlation was found between refusal to participate in the inspection and failure rate. Results suggest that reduction of the number of professional claims billed led to a 2% decline in total imaging expenditures, or a more than 10:1 return on the cost of implementing technical and professional privileging programs. CONCLUSION: Health care plans can positively influence costs and quality by developing, monitoring, and enforcing their own quality standards for diagnostic imaging.

Blue Cross Blue Shield Insurance Plans↗
PubMed1986

The competitive effects of health maintenance organizations: another look at the evidence from Hawaii, Rochester, and Minneapolis/St. Paul.

There has been much discussion about the potential cost-containing impact of HMOs upon the local medical care market. Three areas have been identified by various observers as experiencing such beneficial effects: Hawaii, after the development of Kaiser in the late 1950s; Rochester, New York, which experienced rapid HMO growth and declining Blue Cross hospital use in the late 1970s; and Minneapolis/St. Paul, which has been the focus of vigorous HMO competition in the last decade. While comprehensive data on health care expenditures are not available, bits of evidence can be pieced together to develop case studies of each area. Careful review of the available data often identifies internal inconsistencies and contradictions, but in none of the three sites is there a reduction in hospital use that is most plausibly attributed to HMO competition. Instead, the reported reductions are in each case attributable to other factors--including biases in data, long-term trends predating HMOs, indirect effects of other policy changes, and other forms of competition.

Blue Cross Blue Shield Insurance Plans↗
PubMed1995

Technology assessment. Old, new, and needs-based.

Recent health reports, including the 1993 World Development Report, have emphasized the importance of integrating the needs of the population into technology assessment. This paper reviews previous approaches to technology assessment and identifies the missing link between technology and its impact on the physical, emotional, and social needs of the community, namely needs-based technology assessment. It stresses the key role played by issues of equity and community values in making technology decisions. A number of models for needs-based technology assessment are described.

Community Health Planning↗
PubMedDate not supplied

Non-governmental organizations in international health: past successes, future challenges.

Non-governmental organizations, or NGOs, are increasingly instrumental to the implementation of international health programs. Following an overview of current conditions in global health and the problems that could be targeted by NGOs, this article describes the activities and philosophies of several representative approaches in this sector. The attributes of NGOs that increase their potential effectiveness are discussed, including ability to reach areas of severe need, promotion of local involvement, low cost of operations, adaptiveness and innovation, independence, and sustainability. A summary is provided of major future challenges in international health that may be addressed by NGOs, with particular emphasis on tobacco-related disease, communicable diseases and the AIDS epidemic, maternal mortality and women's health, injury prevention and control, and the need to secure durable financial support.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Design of a fully integrated three-dimensional computed tomography simulator and preliminary clinical evaluation.

PURPOSE: We describe the conceptual structure and process of a fully integrated three-dimensional (3-D) computed tomography (CT) simulator and present a preliminary clinical and financial evaluation of our current system. METHODS AND MATERIALS: This is a preliminary report on 117 patients treated with external beam radiation therapy alone on whom a 3-D simulation and treatment plan and delivery were carried out from July 1, 1992, through June 30, 1993. The elements of a fully integrated 3-D CT simulator were identified: (a) volumetric definition of tumor volume and patient anatomy obtained with a CT scanner, (b) virtual simulation for beam setup and digitally reconstructed radiographs, (c) 3-D treatment planning for volumetric dose computation and plan evaluation, (d) patient-marking device to outline portal on patient's skin, and (e) verification (physical) simulation to verify portal placement on the patient. Actual time-motion (time and effort) recording was made by each professional involved in the various steps of the 3-D simulation and treatment planning on computer-compatible forms. Data were correlated with the anatomic site of the primary tumor being planned. Cost accounting of revenues and operation of the CT simulator and the 3-D planning was carried out, and projected costs per examination, depending on case load, were generated. RESULTS: Average time for CT volumetric simulation was 74 min without or 84 min with contrast material. Average times were 36 min for contouring of tumor/target volume and 44 min for normal anatomy, 78 min for treatment planning, 53 min for plan evaluation/optimization, and 58 min for verification simulation. There were significant variations in time and effort according to the specific anatomic location of the tumor. Portal marking of patient on the CT simulator was not consistently satisfactory, and this procedure was usually carried out on the physical simulator. Based on actual budgetary information, the cost of a volumetric CT simulation (separate from the 3-D treatment planning) showed that 1500 examinations per year (six per day in 250 working days) must be performed to make the operation of the device cost effective. The same financial projections for the entire 3-D planning process and verification yielded five plans per day. Some features were identified that will improve the use of the 3-D simulator, and solutions are offered to incorporate them in existing devices. CONCLUSIONS: Commercially available CT simulators lack some elements that we believe are critical in a fully integrated 3-D CT simulator. Sophisticated 3-D simulation and treatment planning can be carried out in a significant number of patients at a reasonable cost. Time and effort and therefore cost vary according to the anatomic site of the tumor being planned and the number of procedures performed. Further efforts are necessary, with collaboration of radiation oncologists, physicists, and manufacturers, to develop more versatile and efficient 3-D CT simulators, and additional clinical experience is required to make this technology cost effective in standard radiation therapy of patients with cancer.

Adult↗
PubMed1993

A specialized mental health plan for persons with severe mental illness under managed competition.

Many concerns have been raised about the special problems of providing care for severely mentally ill persons in a reformed health care system based on managed competition. The authors describe what will likely be basic features of the reformed system and discuss potential problems in serving this population. The authors recommend the development of special mental health maintenance organizations (MHMOs) that would serve only persons with severe mental illness. The MHMO would emphasize case management in the community and would provide a fixed point of responsibility for clinical care of these patients. Two methods of reimbursing MHMOs are proposed. Each region's health insurance purchasing cooperative (HIPC) could reimburse the MHMO on a capitated risk-adjusted basis. Alternatively, HIPCs could require the general health plan to operate or contract for MHMOs. In each case, the HIPC would provide quality-of-care oversight and assign a team to act as a gatekeeper for referrals to the MHMO.

Competitive Medical Plans↗
PubMed1995

A model for predicting transfusion requirements in head and neck surgery.

INTRODUCTION: Although allogeneic blood transfusions have allowed surgeons increased latitude in resecting advanced cancers, they can cause significant morbidity or even death in rare instances. Potential side effects may include transmission of infection and immunosuppression leading to an increased risk of cancer recurrence. Because patients have become more reluctant to receive transfusions, they frequently request preoperative autologous blood donation (PABD). In practice, however, only 50% or less of the donated blood is ultimately transfused while the remainder is discarded. PURPOSE: The purpose of this study was to develop a transfusion prediction and risk assessment (TPRA) model for predicting the need for perioperative blood transfusions in patients undergoing major head and neck oncologic surgical procedures. By knowing the probability for blood transfusion, the physician and patient can make an educated decision regarding the need for PABD. PATIENTS AND METHODS: Over a 4-year period, 436 patients underwent major head and neck surgical procedures for neoplasms of the upper aerodigestive tract, the thyroid gland, and the salivary glands. Data obtained prospectively on each patient included age and gender, the TNM stage, primary disease site, type of prior treatment, estimated intraoperative blood loss, duration of surgery, transfusion requirements, preoperative and postoperative hemoglobin and hematocrit levels, type of procedure and method of reconstruction. These variables were examined singly and in combination both for descriptive purposes and to evaluate their interrelationships. In order to develop the TPRA model, only the 12 variables available prior to the surgical procedure were examined. Variables associated with transfusion need were evaluated further in a multivariate analysis. The logistic regression model allowed a linear expression of patient characteristics to be related to a function of the probability of transfusion need. Analyses of association between categorical variables and transfusion status were based on chi-squared, Fisher's Exact, and Mann-Whitney U tests. RESULTS: Overall, 51 (11.7%) patients required blood transfusions. The median number of units transfused was 2.0 (range, 1 to 13 U). Univariate analysis demonstrated a higher probability for blood replacement in patients with oropharyngeal or hypopharyngeal primary tumor sites, a preoperative hemoglobin level below normal, prior chemotherapy, composite resection, flap reconstruction, between 50 and 59 years of age, and T3 or T4 tumor stage. Logistic regression analysis demonstrated that the need for flap reconstruction, a preoperative hemoglobin below the normal level, and T3 or T4 primary stage were the three factors most significantly associated with the need for transfusion (P < .03). Based on eight combinations of these three variables, transfusion risk predictions were obtained. The TPRA model predicted that patients with a normal hemoglobin level who did not require flap reconstruction and did not have either a T3 or T4 primary stage tumor had the lowest probability (.02) for requiring blood transfusion. Patients at highest risk (.65) were those with less than a normal hemoglobin level, who required flap reconstruction, and had T3 or T4 primary tumor stage. Based on the TPRA model, an algorithm was developed which could serve as a guideline for preoperative transfusion planning. CONCLUSION: By using the TPRA model to change guidelines for preoperative transfusion planning, costs can theoretically be reduced by 50% without significantly increasing the risk of exposing patients to allogeneic blood transfusion. If the TPRA model proves accurate in a follow-up study to test its validity, it may have clinical utility for aiding the surgeon in more cost-effective transfusion planning.

Adolescent↗
PubMed1995

New York City's 1993 child immunization day: planning, costs, and results.

OBJECTIVES: This study evaluates New York City's Child Immunization Day (1993), with emphasis on the cost and effects of a mass campaign and the use of strategies from developing nations in an inner-city context. METHODS: The methodology was designed to (1) document the planning and implementation process, (2) analyze the number and characteristics of children in the target group, and (3) estimate costs. RESULTS: Neither the social mobilization nor the political will that characterize successful campaigns in developing nations occurred in New York City's campaign. Despite substantial time and effort from both private and public agencies, turnout for the event was low. In total, 2647 families and 5237 children were assessed for health care and insurance needs, 2949 children were immunized at a cost of about $279 per immunized child, and 7236 vaccines were administered. CONCLUSIONS: The differences between inner cities and developing nations have a bearing on strategies used in planning and implementing mass campaigns. New strategies need to be forged from a blending of these contexts to create effective campaigns in industrialized inner cities.

Child Health Services↗
PubMed1995

Capitalizing strategic planning costs to recognize future value.

As healthcare organizations devote more resources to strategic planning, financial managers should consider capitalizing, rather than expensing, planning costs. Traditionally, healthcare organizations have absorbed these costs in the year a plan is developed. However, a strategic plan may be viewed as an intangible asset that provides the organization with future benefits. Therefore, its costs can be amortized over the plan's life.

Accounting↗
PubMed1996

Developing information systems for integrated systems.

As the structure of healthcare delivery systems changes, an increasing number of healthcare executives are rethinking their organizations' approaches to the delivery of care. At the same time, many executives are re-engineering their organizations' information systems to provide the infrastructure necessary to support changing requirements. Healthcare executives can take a number of steps to ensure that their organizations' information systems help reduce costs and improve quality of patient care.

Community Health Planning↗
PubMedDate not supplied

The impact of public-sector expenditures for contraceptive services in California.

A methodology previously used to calculate the number of unintended pregnancies averted nationally through publicly funded contraceptive services has been adapted for a state-level analysis in California. An estimated 136,800 unintended pregnancies--which would result in approximately 36,000 births, 85,100 abortions and 15,700 miscarriages--are averted each year because publicly funded contraceptive care is available from clinics and private physicians in California. Federal and state expenditures of $46 million for contraceptive services in California in FY 1989 resulted in an estimated savings of $232-$509 million in public costs for abortions, for prenatal and maternity care and for medical care, welfare and supplementary nutritional programs during the first two years after a birth. These savings represent an average of $7.70 saved for each dollar spent to provide contraceptive services. This savings/cost ratio is 75 percent higher than that previously estimated for the United States as a whole.

Abortion, Induced↗
PubMed1983

Hospice care: perspectives on a Blue Cross Plan's community pilot program.

A community approach to the provision of hospice care utilizing existing community institutions in the metropolitan Washington, DC, area was started as a pilot project among three entities: the Washington Home, a licensed, skilled nursing facility, which served as the hospice inpatient unit; Georgetown University Hospital and its home care program, which were to serve as the sole referral sources; and Group Hospitalization, Inc., the local Blue Cross Plan. Insufficient referrals resulted in expansion of referral sources to include other hospice home care providers and acute care hospitals in the general community. As other community hospices developed, the Blue Cross Plan expanded the pilot program and fostered the communitywide coordination of hospice services.

Blue Cross Blue Shield Insurance Plans↗
PubMed1993

Using claims data to monitor hospital utilization.

Controlling provider use is a continuing problem for health care insurers. This paper describes a Blue Cross and Blue Shield of Michigan system that places primary responsibility for inpatient admissions on participating hospitals and uses a dual monitoring approach. Expensive annual samples that review medical records against published criteria constitute the basic test of compliance. An inexpensive indicator is developed quarterly using automated universal claims review. Statistical methodology, costs, and savings for both monitors are described. The claims monitor uses diagnosis related group (DRG) characteristics to estimate the percentage of inappropriate utilization from historical values for the patient group.

Blue Cross Blue Shield Insurance Plans↗