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At least 19 recordsLinked to original sources
PubMed1990

Impact of a clinical pharmacokinetic service on patients treated with aminoglycosides: a cost-benefit analysis.

In a prospective, randomized study, 75 adults receiving aminoglycosides were followed by a clinical pharmacokinetic service and 70 followed as controls. The two groups were similar in age, gender, height, and APACHE II score. A cost-to-charge ratio was used to derive direct costs of hospitalization and calculate cost-benefit. Excluded from this comparison were patients with incomplete acceptance of pharmacokinetic service recommendations and patients followed by other clinical pharmacists. Pharmacokinetic service patients had shorter hospitalizations (322.67 +/- 270.28 h; controls 442.89 +/- 536.81, p = 0.087) and febrile periods (50.05 +/- 79.38 h; controls 92.23 +/- 122.50, p less than 0.05). More pharmacokinetic service patients had adequate peak levels. Pharmacokinetic service direct costs were lower ($7,102.56 +/- 9,898.19; controls $13,758.64 +/- 22,874.31, p less than 0.05). Calculated direct cost of the service was $85.00/patient. Annual savings for 500 patients is $2,220,540.00.

Amikacin↗
PubMed1991

Direct costs of emergency medical care: a diagnosis-based case-mix classification system.

STUDY OBJECTIVE: To develop a diagnosis-based case mix classification system for emergency department patient visits based on direct costs of care designed for an outpatient setting. DESIGN: Prospective provider time study with collection of financial data from each hospital's accounts receivable system and medical information, including discharge diagnosis, from hospital medical records. SETTING: Three community hospital EDs in Los Angeles County during selected times in 1984. MEASUREMENTS AND MAIN RESULTS: Only direct costs of care were included: health care provider time, ED management and clerical personnel excluding registration, nonlabor ED expense including supplies, and ancillary hospital services. Indirect costs for hospitals and physicians, including depreciation and amortization, debt service, utilities, malpractice insurance, administration, billing, registration, and medical records were not included. Costs were derived by valuing provider time based on a formula using annual income or salary and fringe benefits, productivity and direct care factors, and using hospital direct cost to charge ratios. Physician costs were based on a national study of emergency physician income and excluded practice costs. Patients were classified into one of 216 emergency department groups (EDGs) on the basis of the discharge diagnosis, patient disposition, age, and the presence of a limited number of physician procedures. Total mean direct costs ranged from $23 for follow-up visit to $936 for trauma, admitted, with critical care procedure. The mean total direct costs for the 16,771 nonadmitted patients was $69. Of this, 34% was for ED costs, 45% was for ancillary service costs, and 21% was for physician costs. The mean total direct costs for the 1,955 admitted patients was $259. Of this, 23% was for ED costs, 63% was for ancillary service costs, and 14% was for physician costs. Laboratory and radiographic services accounted for approximately 85% of all ancillary service costs and 38% of total direct costs for nonadmitted patients versus 80% of ancillary service costs and 51% of total direct costs for admitted patients. CONCLUSION: We have developed a diagnosis-based case mix classification system for ED patient visits based on direct costs of care designed for an outpatient setting which, unlike diagnosis-related groups, includes the measurement of time-based cost for physician and nonphysician services. This classification system helps to define direct costs of hospital and physician emergency services by type of patient.

Adult↗
PubMed1990

Case-mix classification for emergency departments.

This study developed a patient classification system for hospital emergency departments. Conducted at three Los Angeles area community hospitals, data collection included coding and abstracting medical records information, patient billing information detailing each patient's utilization of hospital services, and patient-specific provider time measuring each provider's time spent in direct patient care activities. A 20,000 patient sample was derived containing clinical and resource use variables, including physician, emergency department, and ancillary service direct costs. Patient visits were classified into 216 homogeneous groups, or patient clusters, using four types of variables: diagnoses, disposition, age, and physician procedures. The Emergency Department Groups (EDGs) appear to represent a clinically coherent system for classifying emergency department visits; moreover, the groups were found to explain 63% of the overall variance in resource use (total direct cost) suggesting that the EDGs may offer a useful tool for hospital cost control and reimbursement reform.

Accounts Payable and Receivable↗
PubMed1991

Cost-effectiveness of alternative approaches in treating severely mentally ill in California.

Given the rising costs of health care and the decrease in public expenditures on mental health care, policy-makers and program managers must identify cost-effective approaches for treating severely mentally ill patients. During the last year, there have been two major cost-effectiveness studies implemented in California. One initiated by Santa Clara County and funded by the National Institute of Mental Health compares the cost-effectiveness of two existing community-based treatment and case-management approaches. The other study, which compares the cost-effectiveness of capitation funding of services for the severely mentally ill, was initiated by the State of California and is currently being implemented in two counties. This article describes the cost-effectiveness evaluations of these two programs and provides preliminary results of the case-management program.

California↗
PubMed1986

Cost-outcome analysis and service planning in a CMHC.

The outcome of outpatient treatment of 497 children and 396 adults at a large community mental health and mental retardation center was associated with cost of services and with clients' number of sessions, length of stay, and density of treatment. The cost of one hour of outpatient services averaged $53.15 for adults and $52.32 for children. Treatment outcome was not directly related to cost of treatment, but clients who regressed used more resources than did clients whose conditions remained the same. Adults who improved were in therapy for a shorter period than were adults who became worse, but they were treated more times per month. The cost-outcome analysis methodology described here can be useful in forecasting the effects of budget reductions on case mix and treatment outcome, in developing effective service models for various funding levels, and in identifying optimal caseloads.

Adolescent↗
PubMed1991

Cardiac rehabilitation--a cost analysis.

This economic evaluation is based on a 5-year follow-up study comparing a comprehensive cardiac rehabilitation programme with standard care after myocardial infarction (MI). The intervention group consisted of 147 non-selected MI patients aged less than 65 years, who were participating in a rehabilitation programme consisting of follow-up at a post-MI clinic, health education and physical training in out-patient groups. The control group consisted of a non-selected MI-population aged less than 65 years (n = 158), who were receiving standard care. The rehabilitation programme did not increase the health-care costs of post-MI care, as the increase in cost due to participation in the programme was balanced by a decrease in readmissions for cardiovascular diseases. On average, the rehabilitated patient returned to work more frequently, resulting in decreased costs due to loss of production. The mean patient total cost of a 5-year MI follow-up was SEK 73,500 lower in the rehabilitated group. The outstanding winner of the rehabilitation programme was the Swedish National Health Insurance System (NHIS). It must be concluded that the comprehensive cardiac rehabilitation programme is a major strategy that leads to both lowered costs and positive health effects. The cardiac rehabilitation programme is therefore highly cost-effective.

Cardiology Service, Hospital↗
PubMed1976

Time unit system of fee setting.

An efficient, accurate, and simple method was developed to determine charges for physical therapy services. Based on cost accounting, the charges were developed from the direct and indirect costs of operating the department. Methods to determine operating costs are outlined and the process used to establish a time unit system is presented. The charges to the patient were developed to reflect accurately the patient's use of resources in terms of time, supplies, and share of indirect costs. A differentiation was made between direct treatment time when the patient is in actual contact with a physical therapist or physical therapist assistant and nondirect time when the patient is practicing a skill on his own. Although developed for a medical center teaching hospital, this system can be adapted to any type of facility.

Cost-Benefit Analysis↗
PubMed1991

Costs, needs, and outcomes.

There is a tendency in discussions of mental health policy and psychiatric practice to talk of the cost of a treatment, facility, or policy and to ignore variations. These variations can be considerable, which alone suggests they should not be overlooked, and they can be explored and perhaps exploited to improve the delivery of services. This article describes a theoretical framework for the examination of cost differences, applies it to a particularly rich data base on people with long-term mental health problems moving from hospital to the community, and uses the empirical evidence to address four key policy questions. The study finds encouragingly strong positive associations between costs, needs, and outcomes. It also uncovers significant cost-effectiveness differences between the public and private sectors and between community accommodation types.

Adult↗
PubMed1991

Cost evaluation of chronic schizophrenic patients during the first 3 years after the first contact.

This study was performed in Italy, where mental health care is largely provided by the Government-financed Italian National Health Service (INHS). Since 1978, outpatient services and psychiatric beds in general hospitals have replaced psychiatric hospitals, which have not been permitted to admit new patients. The direct costs of three cohorts of 20 chronic schizophrenic patients were evaluated according to incidence data for a 3-year period. The analysis focused in particular on services provided by public institutions. The average cost per patient during this period following first contact-admission was $9,612 (1989 U.S. dollars), which is low compared to costs in other countries. The cost distribution between inpatient and outpatient services was different from other studies and showed that, in Italy, hospital expenses covered approximately 50 percent of total direct INHS costs. The length of time between onset and first contact-admission showed a significant association (p less than 0.01) with INHS costs during the 3 years. A significant association (p less than 0.05) also was found between the Scale for the Assessment of Positive Symptoms (SAPS) global symptom "delusions" evaluated after 5 to 7 years and the average INHS costs during the 3 years of the study.

Adult↗
PubMed1976

The cost of a general practitioner in the national health service.

This paper estimates the cost to the National Health Service of decisions made by a trainee general practitioner during two consecutive weeks. By extrapolation of the cost of these actions (issuing prescriptions, issuing National Insurance certificates, requesting investigations, and initiating hospital referrals), the annual cost of a general practitioner in the National Health Service is at least pound43,000.

Costs and Cost Analysis↗
PubMed1978

The AHA cost and intensity indexes: a rejoinder.

Conventional studies point to the spiraling cost of hospital services as the principal, if not the only, cause of escalating hospital expenditures; but using the AHA's Hospital Intensity Index to obtain a measure of the "real" volume of services provided by the industry opens up a whole new perspective--a perspective that gives attention to the role played by increased demand for services, as opposed to mere cost control.

American Hospital Association↗
PubMedDate not supplied

Estimates of economic costs of alcohol and drug abuse and mental illness, 1985 and 1988.

The high prevalence of alcohol and drug abuse and mental illness imposes a substantial financial burden on those affected and on society. The authors present estimates of the economic costs from these causes for 1985 and 1988, based on current and reliable data available from national surveys and the use of new costing methodology. The total losses to the economy related to alcohol and drug abuse and mental illness for 1988 are estimated at $273.3 billion. The estimate includes $85.8 billion for alcohol abuse, $58.3 billion for drug abuse, and $129.3 billion for mental illness. The total estimated costs for 1985, $218.1 billion, include $51.4 billion for direct treatment and support costs; $80.8 billion for morbidity costs, the value of reduced or lost productivity; $35.8 billion for mortality costs, the value of foregone future productivity for the 140,593 premature deaths associated with these disorders, based on a 6 percent discount rate and including an imputed value for housekeeping services; and $47.5 billion in other related costs, including the costs of crime, motor vehicle crashes, fire destruction, and the value of productivity losses for victims of crime, incarceration, crime careers, and caregiver services. The cost of acquired immunodeficiency syndrome associated with drug abuse is estimated at $1 billion, and the cost of fetal alcohol syndrome is estimated at $1.6 billion. The estimates may be considered lower limits of the true costs to society of alcohol and drug abuse and mental illness in the United States.

Age Factors↗
PubMed1990

Direct costs of stroke for a Swedish population.

Direct costs were estimated for the treatment, rehabilitation, and nursing of 125 patients with first stroke in the Lund and Orup health districts (population of 200,191). Patients were followed from the onset of stroke in 1983 until October 31, 1985. The data were used to calculate the present value of the expected lifetime direct costs for an individual contracting his or her first stroke at various ages. For example, at the age of 72, these costs were estimated at SEK 283,000 for a man and SEK 561,000 for a woman. Hospital care was the major cost component (75% for males and 89% for females) at this age of onset. The results could be used to estimate the economic benefits of preventing new strokes, hence, forming part of a cost-effectiveness or cost-utility analysis. Together with prognoses of the expected developments in the incidence of stroke, they could also serve as the basis of forecasts of future costs of the health care and social service sectors.

Adult↗
PubMed1979

Charging for hospital pharmaceutical services: product cost, per diem fees and fees for special clinical services.

A method of charging for pharmaceutical services is described which includes the cost of drug products, dispensing fees for intravenous drug admixtures, per diem fees for basic dispensing and clinical services (according to patient type), and fees for special clinical services. The basic per diem charge covers drug purchasing and inventory control, department management, drug information services, dose preparation, drug order interpretation, drug therapy monitoring, and the availability of pharmacists to answer the questions of nurses and physicians. The clinical services for which special fees are charged are: hemogram drug report, drug liver function report, aminoglycoside dosing guidelines, heparin i.v. infusion, oral anticoagulation, patient drug history, operant conditioning, parenteral nutrition guidelines, and pharmacokinetic drug level interpretations and consultations. The reasons for changing to the system, the services provided and experiences with the system are discussed. Implementation of the system is discussed in relation to the calculation of fees; comparisons with alternate charging methods; approval of special clinical service charges; computer billing; information about pharmacy charges for patients; and third-party payers.

California↗