Correcting India's Chronic Shortage of Drug Inspectors to Ensure the Production and Distribution of Safe, High-Quality Medicines.

BACKGROUND: Good drug regulation requires an effective system for monitoring and inspection of manufacturing and sales units. In India, despite widespread agreement on this principle, ongoing shortages of drug inspectors have been identified by national committees since 1975. The growth of India's pharmaceutical industry and its large export market makes the problem more acute. METHODS: The focus of this study is a case study of Maharashtra, which has 29% of India's manufacturing units and 38% of its medicines exports. India's regulations were reviewed, comparing international, national and state inspection norms with the actual number of inspectors and inspections. Twenty-six key informant interviews were conducted to ascertain the causes of the shortfall. RESULTS: In 2009-2010, 55% of the sanctioned posts of drug inspectors in Maharashtra were vacant. This resulted in a shortfall of 83%, based on the Mashelkar Committee's recommendations. Less than a quarter of the required inspections of manufacturing and sales units were undertaken. The Indian Drugs and Cosmetics Act and its Rules and Regulations make no provisions for drug inspectors and workforce planning norms, despite the growth and increasing complexity of India's pharmaceutical industry. CONCLUSION: The Maharashtra Food and Drug Administration (FDA) falls short of the Mashelkar Committee's recommended workforce planning norms. Legislation and political and operational support are required to produce needed changes.

Measuring shared inefficiency between hospital cost centers.

In this article, a combination of data envelopment analysis, spreadsheet modeling and regression techniques is applied to a panel of nonprofit Washington State hospitals in an effort to determine whether (and if so, to what extent) inefficiency in one hospital cost center is shared with inefficiency in other cost centers. The findings suggest that a significant amount of inefficiency is shared across hospital cost centers. The authors further determine that certain cost centers contribute more to the overall performance of a given hospital than others. As such, managerial decisions and government policies designed to enhance hospital efficiency should be implemented differently, depending on the characteristics of the hospital in question.

Factor analysis of financial and operational performance measures of non-profit hospitals.

OBJECTIVE: To understand the important dimensions of the financial and operational performance of non-profit hospitals. DATA SOURCE: Secondary data for non-profit US hospitals between 1996 and 2004. STUDY DESIGN: I use iterative principal factor analysis of hospitals' financial and operational ratios for each year of the study. For factor interpretation, I use oblique rotation. DATA COLLECTION/EXTRACTION METHODS: Financial ratios were created using cost report data from HCRIS 2552-96 available from the Centers for Medicaid & Medicare Services (CMS). PRINCIPAL FINDING: I identify five factors--capital structure, profitability, activity, liquidity, and an operational factor--that explain most of the variation in the performance of non-profit hospitals. I also find that capital structure is more important than profitability in determining the performance of these hospitals. CONCLUSION: The importance of capital structure highlights a significant shift in the organization of the non-profit hospitals' finances.

Speculating to accumulate: reducing the cost of wound care by appropriate dressing selection.

The key determinants of wound-care costs are well known. When undertaking local audits, practitioners are advised to collect data against each of these determinants and then use them to formulate cost-effective dressing formularies.

Breathing easy: auditing your anesthesia practice revenue cycle.

The following steps should be part of any anesthesia revenue cycle auditing program: scrutinize documentation; verify compliance; check coding; examine billing and collections; solve identified problems.

Is hospital performance related to expenditure on management?

OBJECTIVES: Reducing the costs of management appears an easy target for those seeking to generate savings or to promote better spending in the National Health Service (NHS). However, an assessment of the appropriate amount of spending on management requires an evaluation of how much management contributes to organizational performance. METHODS: Using routinely available NHS acute hospital data, an econometric analysis was undertaken to test the hypothesis that there is a relationship between the proportion of a hospital's income spent on management and the performance of the hospital measured along three dimensions: the achievement of financial targets; performance against waiting time standards defined in the Patient's Charter; and costs of service provision. RESULTS: No general relationship was found between management costs and hospital performance. However, there was some evidence of a quadratic relationship between management spending and the amount of operating surplus generated and performance against the three-month waiting time standard for an inpatient admission specified in the Patient's Charter. These results suggest that performance returns reach an optimum when management expenditure is around 5-6% of hospital income. CONCLUSIONS: The evidence is not yet strong enough to draw a general conclusion that management costs in NHS acute hospitals are too high or that an undiscriminating reduction in management costs would have no detrimental effects on hospital performance. However, the findings should prompt managers to identify ways in which their activities are productive and how these can be measured, and what distinguishes effective from ineffective management.

Do managers pay their way? The impact of management input on hospital productivity in the NHS internal market.

INTRODUCTION: Levels of management staffing in the UK National Health Service (NHS) have received considerable political and media attention in the last four years or so. Both the previous and current governments committed themselves to reducing management expenditure in the health service, and significant cuts appear to have been made in this area in the last year or so. Few systematic evaluations have been undertaken of the value of general management input, however, and policy changes appear to have been largely determined by popular opinion. This study attempts to quantify the effect of management input on hospital productivity for the first three years of the NHS internal market (1991/2-1993/4). METHODS: An average cost function was used to model the effect of management inputs on hospital costs after adjustment for the levels of outputs produced, input costs, and internal and external exogenous constraints on hospital functioning. Two measures of management input were used: the proportion of total spending consumed by top level management, and the proportion consumed by all administrative activities. Cross-sectional and longitudinal models with contemporaneous and lagged management input effects were estimated. RESULTS: Higher spending on top level management was associated with poorer productivity levels in most instances. Total administrative inputs had a weaker, but still generally negative, association with productivity. CONCLUSIONS: No evidence was found that increasing management inputs was associated with improved productivity. On the contrary, spending more on top level managers appeared in fact to be associated with lower productivity levels. Results would thus appear to be in line with decisions to reduce the level of expenditure on management in NHS hospitals. Quality differences could not be measured, however, and it is possible that management input is associated with quality improvements which might reduce or reverse observed productivity losses.

Administrative benchmarks for Medicare, Medicaid HMOs.

Plus, check out benchmark data on Medicare and Medicaid administrative costs. Every provider knows that HMOs take a slice of the Medicare or Medicaid premium for their administrative costs before they determine provider capitation. But how much does administration really cost? Here's some PMPM data from a study by the Sherlock Company.

The cost of poor quality: an opportunity of enormous proportions.

In all organizations, the state of finance is routinely reported in sublime detail for study and action. And yet, anywhere from 20 to 50 percent of the monies involved in that report are never identified as unnecessary and nonproductive. These monies, referred to as the Cost of Waste (COW), are the result of actions that have been taken or must be taken because quality is not served--inappropriate actions are being performed or appropriate actions are not being performed right the first time, every time. Proactively determining, reporting, and monitoring the COW brings a degree of objectivity to the quality management process and provides a powerful internal driver for performance improvement. A 10 step Cost of Waste system is proposed.

Reviewing practice procedure can improve bottom line.

Anecdotal and statistical sources attest that many hospital-owned physician practices are either losing money or breaking even. This is alarming for not only hospital-owned practices, but stand-alone practices, too. However, careful review of standard billing and coding practice procedures and policies, among other things, can help reverse that trend.

Value-based cost management: the foundation of a balanced performance measurement system.

Healthcare organizations need critical performance measures if they are to lead, manage, and operate effectively. Traditional financial measures or report cards on patient satisfaction and clinical outcomes are insufficient, however. Value-based cost management directly links cost accounting, processes, clinical outcomes, and patient and employee satisfaction through organizational, work environment, and financial relations measures. These measures address three levels of performance: strategic, diagnostic, and operational. Their linkages identify value in three areas: business-related financial and operational measures; employee-related measures such as those related to satisfaction and well-being; and learning and patient-related measures linked to clinical outcomes, satisfaction, and population.

Audit: an exploration of two models from outside the health care environment.

Whilst there has been exponential growth in auditing health care services and a proliferation of the instruments involved, there seems to have been less cross-fertilization of audit systems and instruments between health care environments and other environments. This paper identifies and explores two audit systems and instruments outside the health care environment. The objective is to seek to improve the level of common understanding, communication and collaboration amongst those who are interested or involved in audit in any sector of the economy. This exercise offers an opportunity and incentive for cross-fertilization of ideas with respect to audit concepts, systems, instruments, results and experiences. Yet there is a more fundamental question to be considered: why bother with audit? This paper identifies core reasons for performing audit which, although they have been mentioned elsewhere, are worth recalling once again. The two non-health care audit systems and instruments are then identified and explored. On the one hand it is seen that the two audit systems and instruments outside health care have common features with audits in health care. On the other hand, it is also suggested that there are some significant differences in the two audit systems and instruments when compared to health care audits. This paper identifies and discusses similarities and differences. Finally, if we fail to learn from the mixture of experiences and insights of various audit exercises, not only will be doing our professions and our customers a disservice but we will lower the chances of continuous improvement in knowledge and understanding.