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At least 19 recordsLinked to original sources
PubMed1998

Resource constraints and moral pressures: can we still afford ourselves?

We have reached a phase of diminishing returns in medicine. Increasing costs produce smaller and smaller incremental benefits in health status. Medical scientists continue to work within the ideology of the Enlightenment, whereby advances in knowledge will eventually lead to control of health and welfare. The enormous costs of this ideology have led to two new ideologies: those of economic rationalism and managerialism. At the public level, the Western liberal emphasis on the value of individual life is generally held to justify the amount of public money spent on health. Those who frame health policy are influenced to some extent by this ideal, but we cannot continue to develop costly interventions without constraint. To overcome this impasse, we might accept that economic rationalism provided a proper base for health care; or we might redefine disease so that more people were excluded from treatment programmes; or we might agree to limit medical research in costly areas; we might change our ethical thinking to emphasize classical utilitarianism; or we might undertake systematic studies of community values and opinions to find out what people really want from their health and welfare services. There are serious ethical problems with each of these solutions, except for the last: the idea of modifying services to take note of community values. Testing community values is difficult, but there are ways of doing it, and there have been some exercises in which the process has been undertaken with some success. The recent Constitutional convention suggests that it may even be possible in Australia.

Cost Control↗
PubMed1992

Cost-benefit analysis of a regional system for vaccination against pneumonia, meningitis type B, and typhoid fever.

In early 1989 PAHO began examining a proposal for a regional program that would develop and disseminate vaccines of particular interest to its Member Countries. As part of that examination, a cost-benefit analysis was performed. That general analysis, presented here, sought to point up key factors that would strongly influence whether or not the program's benefits outweighed its costs. The program's two fundamental components, vaccine development and vaccine administration, were evaluated separately. Using a discount rate (r) of 10%, 10-year vaccine development costs were estimated at US$80.3 million in constant dollars. It was felt that enough people (at least 19.5 million a year) would be vaccinated so that the program would benefit from economics of scale. The total discounted number of vaccinations administered over a 20-year period was expected to be in the range of 400 to 506 million. Using these figures, estimates were made of the maximum that could be spent on vaccine administration without exceeding anticipated benefits. Considering only treatment costs saved through vaccination, assuming all sick people were treated, the ceiling cost for vaccinating one person against one target disease would be in the range of US$0.52-0.58. Even if not all the sick were treated, however, the Regional Vaccine System (SIREVA) would still appear justified if the benefits per disease case prevented were found to average between US$1,000 and US$2,000. Even so, it should be noted that these estimates are subject to a good deal of additional variation because of uncertainties regarding the worth of many elements evaluated--including the costs of lost work time, disability, and mortality--and because some of the elements involved--such as pain, suffering, and death--fall outside the purely economic realm.

Cost Savings↗
PubMedDate not supplied

Can MHA graduates tackle financial management? Lessons from American corporate industry.

American industry, the major purchaser of medical services, is beginning to use its buying power to intervene in the healthcare system. Management committees hav been established to develop cost analysis and containment approaches to the utilization of medical services. With innovations by corporate industry, does the hospital CEO see an advocate or yet another adversary in addition to government regulation? Specifically, what preparation do master's degree graduates have, prior to their subsequent job experience, to make an informed contribution in financial decision making? Research was conducted to obtain data from health administration graduate programs in the United States and Canada to help find answers to these questions. This study addresses the strengths and weaknesses of the two major inputs to health financial management education--the proper mix and delivery of course presentations, and the student's motivation, maturity, and academic background. In some respects, both have been found wanting--not only from the findings of this investigation, but also by the AUPHA Task Force on Financial Management in the curriculum. About one-fourth of the entrants to master's degree programs have a business school background which includes courses in accounting, economics, and finance. However, the remaining 75% have other academic backgrounds, which suggests that teaching financially oriented courses to these graduate students is a major problem. The question of whether a health administration graduate with some finance training or a pure finance graduate is more desirable remains unanswered. This is especially true in meshing the immediate needs of the healthcare marketplace for financial management personnel and the long-range career goals of the graduate. This article presents the survey results and seven recommendations for action.

Commerce↗
PubMed2001

The cost of developing site-specific environmental regulations: evidence from EPA's project XL.

The flagship of the Environmental Protection Agency's regulatory reinvention initiative, Project XL has been touted as a regulatory blueprint for a site-specific, performance-based pollution-control system, but widespread complaints about the costs of the program beg the question of whether the costs of tailoring regulations to individual facilities are manageable. To address this question, this paper presents original survey data on a sample of 11 XL projects. We find that the fixed costs of putting in place XL agreements are substantial, averaging over $450,000 per firm. While stakeholder negotiations are widely cited as the principal source for these costs, we find that they actually arise mainly from interaction between participating facilities and the EPA. Moreover, EPA management problems are perceived by our survey respondents as having inflated project development costs. Finally, we find that the key factors that explains differences in costs across XL projects are the scope and complexity of the project proposal. These findings suggest that Project XL favors large firms that can afford to pay significant project development costs, that EPA management problems must be resolved to reduce costs, and that there may be a significant economic bias against complex and innovative proposals--precisely the type of proposals that Project XL was designed to foster in order to improve the efficiency of the regulatory system.

Commerce↗
PubMed2000

Comparison of methods for teaching clinical skills in assessing and managing drug-seeking patients.

AIMS: New medical graduates lack clinical skills in assessing and managing patients seeking drugs of dependence. This study compares the effectiveness of three different clinical skills training methods, with similar content, which were developed to teach these skills to senior medical students. METHODS: A preliminary survey indicated that common problems seen by primary care practitioners included both new and previously known patients seeking either benzodiazepines or opiates. The common content of the teaching was determined from this survey. A didactic small group tutorial (DT), a video-based tutorial (VBT) using professional actors, and a computer-aided instruction package using digitized video (CAI) were developed with this common content, and trialled with undergraduate medical students over 2 years in a parallel-group design. Outcome was assessed by student feedback, performance on a case-based written examination and by a structured evaluation of interviews with simulated patients requesting drugs. Comparison was also made between methods on the basis of knowledge tests. RESULTS: No difference was seen in written examination and simulated patient outcomes between the three groups. However, the VBT was thought by the students to be preferable to other methods. The estimated development costs of CAI were higher, but total costs over a 6-year period were lower than for the DT and VBT. The results suggest that clinical skills can be taught equally effectively through several different methods. Collaboration between institutions in the development of widely applicable CAI tools should be an efficient and economical mode of teaching with a wide range of applications.

Clinical Competence↗
PubMed1996

Do market components account for higher US prescription prices?

BACKGROUND: Although only 7-8% of US healthcare expenditures are spent on prescription drug products, the pharmaceutical industry's profitability and high cost of prescriptions to consumers make prescription drugs a visible target for reform. When compared with other products, it appears as if unfair pricing tactics are used. The pharmaceutical industry cites costs of research and development and a short patent life as justifiable grounds for high prices, but the reason why US drug prices appear to be so high has yet to be answered. OBJECTIVE: To examine identified components of the pharmaceutical industry that allow US prescription drugs to appear to be highly priced and to review the apparent factors that affect pricing policies for pharmaceuticals. DATA SOURCES: The literature was reviewed to identify current research regarding the pharmaceutical market. Sources included MEDLINE, Econolit, Business Periodical Index, International Pharmaceutical Abstracts, the Wall Street Journal, New York Times, and the F-D-C Pink Sheet. SUMMARY: Key factors account for the fact that US prescription drug prices are higher and that price discrimination occurs in the pharmaceutical industry within the US and among other countries. These factors include the unique market structure of the pharmaceutical industry, asymmetry of information, research and development costs, numerous channels of distribution and the differences among them, and government laws and regulations of prescription drugs. Pricing policies of pharmaceutical companies are based on manufacturing, promotion, and distribution costs; drug characteristics; and economic goals of the parent company.

Drug Costs↗
PubMed1995

Research and development costs for new drugs by therapeutic category. A study of the US pharmaceutical industry.

The clinical period (i.e. clinical trial and long term animal testing) development costs of a random sample of new chemical entities (NCEs) were examined for differences in average cost. All of the NCEs studied were first tested in humans between 1970 and 1982, and were classified for the purposes of the study by therapeutic class. The costs of unsuccessful projects were included with those of projects that resulted in US marketing approval. Including income forgone from expending funds before returns are earned ('time costs'), the capitalised (i.e. out-of-pocket plus time) clinical period costs per approved NCE were $US70, $US98, $US103 and $US163 million (1993 dollars) for anti-infective, cardiovascular, neuropharmacological and nonsteroidal anti-inflammatory drugs, respectively. Combining the data for all therapeutic categories, the mean clinical period cost per approved NCE was $US93 million. Omitting costs associated with unsuccessful projects, the mean capitalised clinical period costs for approved NCEs ranged from $US7.1 million (for topical steroids) to $US66.7 million (for cardiovascular agents) [1993 dollars]. The estimates of total clinical period costs per approved NCE depend on average out-of-pocket clinical phase costs, attrition rates across phases (i.e. the rates at which compounds drop out of active testing), the probability of marketing approval, and development and regulatory review times. Phase attrition and approval rates are the most important sources of variability in total clinical period costs between therapeutic categories. Development cost estimates by therapeutic category did not correlate strongly with US sales in the fifth year of marketing. Cardiovascular NCEs had much higher than average sales revenues, but clinical development costs for these drugs were only slightly above average. Conversely, nonsteroidal anti-inflammatory drugs attained average sales revenues, but had much higher than average development costs.

Clinical Trials as Topic↗
PubMed1999

Pharmacoeconomic considerations in treating patients with acute leukaemia.

Whereas individual cost-effectiveness analyses of new agents for acute leukaemia should be performed in target populations, any meaningful pharmacoeconomic evaluation of treatment options for this condition should include the many types of costs and outcomes in unselected, representative groups of patients. Both direct costs (e.g. costs for medication and hospitalisation) and indirect costs (e.g. lost productivity costs and reduced quality of life) are important parameters to assess, as are the costs of chronic adverse effects, research and development costs for new agents, and costs of procedure-related deaths. Complete remission, cure and survival are the 'success' response criteria for acute leukaemia treatments, in addition to prolonged life with acceptable quality of life for patients with incurable acute leukaemia. Death is 'failure', caused either by resistant disease (relapse and progressive disease) inspite of optimal chemotherapy or, sometimes, by insufficient treatment. All of these parameters should be taken into account when a pharmacoeconomic evaluation is performed (either for administrative or scientific purposes) in order to ensure a comprehensive and reliable background for the evaluation in question. Treatment of acute leukaemia is expensive with a total cost of about $US3000 per patient per day during the induction. Although 80% of children with acute leukaemia are cured, only less than 50% of adults are cured. Thus, a great cost is associated with death during treatment and only optimal medical treatment with full-scale combination chemotherapy and full supportive treatment can keep the number of deaths to a minimum.

Acute Disease↗
PubMed2000

Age of calf at weaning of spring-calving beef cows and the effect on cow and calf performance and production economics.

Over a 5-yr period, spring-calving cows were used in a carry-over design experiment to evaluate effects of calf age at weaning on cow and calf performance and production economics. Weaning management groups were early (n = 60, calf age 150 d, EW), traditional (n = 60, calf age 210 d, NW), and late (n = 60, calf age 270 d, LW). Cow body condition score (BCS) and weights at the last weaning date were different (P < .05) for EW (5.8, 583 kg), NW (5.5, 560 kg), and LW (5.2, 541 kg) management groups. Pregnancy rates among groups were similar. Days on feed for groups differed (P = .001) and was 247 for EW, 204 for NW, and 164 d for LW steers. Average daily gain in the feedlot differed (P = .01) among groups and averaged 1.5 kg for LW, 1.4 kg for NW, and 1.3 kg for EW steers. Dry matter intake while steers were in the feedlot was greater (P = .001) for LW than for NW and EW calves. Hot carcass weight was greater (P = .01) for EW (328 kg) and NW (332 kg) calves than for LW (321 kg) steers, and fat depth was greater (P = .05) for EW and NW steers than for LW steers. When carcass data for the NW and LW steers were adjusted to the fat depth of EW steers, carcass characteristics among groups were similar. Net income per steer at slaughter for the feedlot phase was greater (P < .001) for the EW ($75.36) and NW ($62.16) steers than for the LW ($10.09) steers. Again, when carcass data for the NW and LW steers were adjusted to the same fat depth of the EW steers, net income differences among groups were reduced. Replacement heifers were developed in a drylot and costs were higher (P < .001) for the EW than for NW and LW heifers. Annual cow costs were greater (P < .10) for the LW ($443.45) than for the EW ($410.09) and NW ($421.35) groups. Break-even for each system on a steer financial basis was not different between the NW and LW groups, and both the NW and LW groups had lower (P = .08) break-evens than the EW group. Age of the calf at weaning affects cow weight and BCS. Net income in each system is influenced by cow costs, month of the year that steer calves are purchased into the feedlot and finished steers are sold, month of the year cull cows are marketed, and replacement heifer development costs.

Aging↗
PubMed1987

Economic evaluation of alternative crossbreeding systems involving four breeds of swine. I. The simulation model.

A static, deterministic computer model, programmed in Microsoft Basic for IBM PC and Apple Macintosh computers, was developed to calculate production efficiency (cost per kg of product) for nine alternative types of crossbreeding system involving four breeds of swine. The model simulates efficiencies for four purebred and 60 alternative two-, three- and four-breed rotation, rotaterminal, backcross and static cross systems. Crossbreeding systems were defined as including all purebred, crossbred and commercial matings necessary to maintain a total of 10,000 farrowings. Driving variables for the model are mean conception rate at first service and for an 8-wk breeding season, litter size born, preweaning survival rate, postweaning average daily gain, feed-to-gain ratio and carcass backfat. Predictions are computed using breed direct genetic and maternal effects for the four breeds, plus individual, maternal and paternal specific heterosis values, input by the user. Inputs required to calculate the number of females farrowing in each sub-system include the proportion of males and females replaced each breeding cycle in purebred and crossbred populations, the proportion of male and female offspring in seedstock herds that become breeding animals, and the number of females per boar. Inputs required to calculate the efficiency of terminal production (cost-to-product ratio) for each sub-system include breeding herd feed intake, gilt development costs, feed costs and labor and overhead costs. Crossbreeding system efficiency is calculated as the weighted average of sub-system cost-to-product ratio values, weighting by the number of females farrowing in each sub-system.

Animal Husbandry↗
PubMed1979

Specialty groups give cost containment support, advice.

A number of medical and health care specialty organizations have either given direct support to the Voluntary Effort or have sanctioned cost containment as a principle. Some have drawn upon their professional expertise and developed cost containment recommendations for their constituencies. A sampling of these recommendations is included.

Anesthesiology↗
PubMed1991

Cost-effectiveness of environmental management for vector control in resource development projects.

Vector control methods are traditionally divided in chemical, biological and environmental management approaches, and this distinction also reflected in certain financial and economic aspects. This is particularly true for environmental modification, usually engineering or other structural works. It is highly capital intensive, as opposed to chemical and biological control which require recurrent expenditures, and discount rates are therefore a prominent consideration in deciding for one or the other approach. Environmental manipulation requires recurrent action, but can often be carried out with the community participation, which raises the issue of opportunity costs. The incorporation of environmental management in resource projects is generally impeded by economic considerations. The Internal Rate of Return continues to be a crucial criterion for funding agencies and development banks to support new projects; at the same time Governments of debt-riden countries in the Third World will do their best to avoid additional loans on such frills as environmental and health safeguards. Two approaches can be recommended to nevertheless ensure the incorporation of environmental management measures in resource projects in an affordable way. First, there are several examples of cases where environmental management measures either have a dual benefit (increasing both agricultural production and reducing vector-borne disease transmission) or can be implemented at zero costs. Second, the additional costs involved in structural modifications can be separated from the project development costs considered in the calculations of the Internal Rate of Return, and financial support can be sought from bilateral technical cooperation agencies particularly interested in environmental and health issues. There is a dearth of information in the cost-effectiveness of alternative vector control strategies in the developing country context. The process of integrating vector control in the general health services will make it even more difficult to gain a clear insight in the matter.

Animals↗