ABSTRACT
BACKGROUND: In mid-2007, endovenous ablation (EVA) of the great saphenous vein was introduced into the publicly funded health care system in Saskatchewan, Canada. We hypothesize that the introduction of EVA resulted in a decrease in use of high ligation and stripping (HL/S), decreased costs to the health care system, and increased demand of patients for great saphenous vein ablative procedures. METHODS: We retrospectively reviewed administrative data to capture cases of HL/S between 2003 and 2014 and cases of EVA of the great saphenous vein (endovenous laser treatment and radiofrequency ablation) between 2007 and 2014. Accounting for the change in practice pattern that occurred slowly between 2007 and 2009, we divided our patients into the pre-EVA era (2003-2006) and the post-EVA era (2010-2014). Procedure costs were determined with models used by our health region for this purpose. RESULTS: Utilization rates for great saphenous vein intervention remained similar in the pre-EVA (90 procedures per year) and post-EVA (92 procedures per year; P = .83) eras. Case costs of HL/S ($1965.12/case) were higher than those of EVA (endovenous laser treatment, $1295.08/case; radiofrequency ablation, $1410.54/case). The total annual costs of great saphenous vein intervention decreased from $176,861 in the pre-EVA era to $134,525 (P = .02). CONCLUSIONS: Introduction of publicly funded EVA has reduced rates of HL/S and reduced costs to our health system by approximately $42,000 per year, without increasing great saphenous vein intervention rates.
Subject(s)
Catheter Ablation/economics , Delivery of Health Care/economics , Endovascular Procedures/economics , Health Care Costs , Hospital Planning/economics , Laser Therapy/economics , Process Assessment, Health Care/economics , Public Health/economics , Saphenous Vein/surgery , Varicose Veins/economics , Varicose Veins/surgery , Administrative Claims, Healthcare , Catheter Ablation/adverse effects , Cost Savings , Cost-Benefit Analysis , Databases, Factual , Endovascular Procedures/adverse effects , Health Services Needs and Demand/economics , Humans , Laser Therapy/adverse effects , Needs Assessment/economics , Program Evaluation , Retrospective Studies , Saphenous Vein/diagnostic imaging , Saphenous Vein/physiopathology , Saskatchewan , Time Factors , Treatment Outcome , Varicose Veins/diagnostic imaging , Varicose Veins/physiopathologyABSTRACT
BACKGROUND: Despite evidence on large variation in breast cancer expenditures across geographic regions, there is little understanding about the association between expenditures and patient outcomes. OBJECTIVES: To examine whether Medicare beneficiaries with nonmetastatic breast cancer living in regions with higher cancer-related expenditures had better survival. RESEARCH DESIGN: A retrospective cohort study of women with localized breast cancer from the Surveillance, Epidemiology, and End Results-Medicare linked database. Hospital referral regions (HRR) were categorized into quintiles based on risk-standardized per patient Medicare expenditures on initial phase of breast cancer care. Hierarchical generalized linear models were estimated to examine the association between patients' HRR quintile and survival. SUBJECTS: In total, 12,610 Medicare beneficiaries diagnosed with stage II-III breast cancer during 2005-2008 who underwent surgery. MEASURES: Outcome measures for our analysis were 3- and 5-year overall survival. RESULTS: Risk-standardized per patient Medicare expenditures on initial phase of breast cancer care ranged from $13,338 to $26,831 across the HRRs. Unadjusted 3- and 5-year survival varied from 66.7% to 92.2% and 50.0% to 84.0%, respectively, across the HRRs, but there was no significant association between HRR quintile and survival in bivariate analysis (P=0.08 and 0.28, respectively). After adjustment for sociodemographic and clinical characteristics, quintiles of regional cancer expenditures remained unassociated with patients' 3-year (P=0.35) and 5-year survival (P=0.20). Further analysis adjusting for treatment factors (surgery type and receipt of radiation and systemic therapy) and stratifying by cancer stage showed similar results. CONCLUSIONS: For Medicare beneficiaries with nonmetastatic breast cancer, residence in regions with higher breast cancer-related expenditures was not associated with better survival. More attention to value in breast cancer care is warranted.
Subject(s)
Breast Neoplasms/economics , Health Expenditures/statistics & numerical data , Hospital Planning/economics , Medicare/statistics & numerical data , Aged , Aged, 80 and over , Breast Neoplasms/epidemiology , Cohort Studies , Female , Humans , Neoplasm Staging , Referral and Consultation/statistics & numerical data , Residence Characteristics , Retrospective Studies , Socioeconomic Factors , United StatesABSTRACT
The aim of this study is to explore the application of Boston matrix combined with SWOT analysis on operational development and evaluations of hospital departments. We selected 73 clinical and medical technology departments of our hospital from 2011 to 2013, and evaluated our hospital by Boston matrix combined with SWOT analysis according to the volume of services, medical quality, work efficiency, patients' evaluations, development capacity, operational capability, economic benefits, comprehensive evaluation of hospital achievement, innovation ability of hospital, influence of hospital, human resources of hospital, health insurance costs, etc. It was found that among clinical departments, there were 11 in Stars (22.4%), 17 in cash cow (34.7%), 15 in question marks (31.2%), 6 Dogs (12.2%), 16 in the youth stage of life cycle assessment (27.6%), 14 in the prime stage (24.1%), 12 in the stationary stage (20.7%), 9 in the aristocracy stage (15.5%) and 7 in the recession stage (12.1%). Among medical technology departments, there were 5 in Stars (20.8%), 1 in Cash cow (4.2%), 10 in question marks (41.6%), 8 Dogs (29.1%), 9 in the youth stage of life cycle assessment (37.5%), 4 in the prime stage (16.7%), 4 in the stable stage (16.7%), 1 in the aristocracy stage (4.2%) and 6 in the recession stage (25%). In conclusion, Boston matrix combined with SWOT analysis is suitable for operational development and comprehensive evaluations of hospital development, and it plays an important role in providing hospitals with development strategies.
Subject(s)
Hospital Planning , Hospitals , Costs and Cost Analysis , Hospital Departments , Hospital Planning/economicsABSTRACT
O gerenciamento de uma organização hospitalar exige provisionar seus custos/gastos com ferramentas que a aproximam da realidade. A tarefa de aferição da produtividade pode ser complexa e duvidosa, diversos métodos são experimentados e a utilização do DRG tem se mostrado eficiente, sendo utilizado na avaliação da produtividade através de desfechos assistenciais. Estudo transversal, avaliou 145.710 internações, no período de 2012-2014, utilizando a metodologia do DRG para medição de sua produtividade a partir da mediana do tempo de internação. Ao agruparmos todas as internações em clínicos (37,6%) e cirúrgicos (62,4%), várias análises puderam ser feitas de acordo com esse critério.O DRG como ferramenta para predição de dias de internação é uma alternativa eficiente, colaborando assim para o controle da produtividade que influencia diretamente nos gastos e custos dos produtos hospitalares e qualidade dos serviços.
The management requires a hospital organization to provision their costs/expenses with tools that approximate reality. The task of measuring productivity can be complex and uncertain, several methods are tested and the use of the DRG has been efficient, being used to assess the productivity through clinical outcomes. Cross-sectional study evaluated 145.710 hospitalizations in the period 2012-2014, using the DRG methodology for measuring productivity from the median length of hospitalization. When we group all hospitalizations in clinical (37.6%) and surgical (62.4%), multiple analyzes could be made according to this criterion. The DRG as a tool for prediction of hospital days is an effective alternative, thereby contributing tothe control of productivity that directly influences the costs of hospital expenses and product and service quality.
Subject(s)
Humans , Male , Female , Adult , International Classification of Diseases , Diagnosis-Related Groups/economics , Efficiency, Organizational/economics , Efficiency , Hospitalization/economics , Retrospective Studies , Congresses as Topic , Health Services Research/methods , Hospital Planning/economicsSubject(s)
Conservation of Energy Resources/methods , Hospital Design and Construction/standards , Hospital Planning/organization & administration , Conservation of Energy Resources/economics , Hospital Design and Construction/economics , Hospital Design and Construction/methods , Hospital Planning/economics , Hospital Planning/methods , Humans , TexasSubject(s)
Health Facility Closure/economics , Hospital Planning/economics , Hospitals, General/economics , Hospitals, Special/economics , State Medicine/economics , Catchment Area, Health/economics , Cost Control/methods , Health Facility Size/economics , Health Facility Size/standards , Health Facility Size/trends , Hospitals, General/organization & administration , Hospitals, General/trends , Hospitals, Special/organization & administration , Hospitals, Special/standards , Humans , Models, Organizational , Program Evaluation/economics , State Medicine/organization & administration , State Medicine/trends , United KingdomABSTRACT
Markets with too many hospital beds could see trouble as providers seek to control spending and avoid expensive hospitalizations. "You'll need a lot fewer hospitals and hospital beds" because providers will do more to keep patients healthy enough not to need them, says Frank Trembulak, of Geisinger Health System.
Subject(s)
Ambulatory Care/economics , Economics, Hospital/trends , Hospitalization/economics , Ambulatory Care/trends , Cost Control/methods , Cost Control/trends , Health Promotion/economics , Health Promotion/trends , Hospital Bed Capacity/economics , Hospital Bed Capacity/statistics & numerical data , Hospital Planning/economics , Hospital Planning/trends , Hospitalization/trends , Humans , Insurance Coverage/legislation & jurisprudence , Medicaid/economics , Medicaid/legislation & jurisprudence , Needs Assessment , Patient Protection and Affordable Care Act/economics , Patient Protection and Affordable Care Act/standards , United StatesABSTRACT
In medical systems, economic issues and means of action are in the course of dwindling human (physicians and nurses) and financial resources are more important. For this reason, physicians must understand basic economic principles. Only in this way, there may be medical autonomy from social systems and hospital administrators. The current work is an approach to present a model for strategic planning of an anesthesia department. For this, a "strengths", "weaknesses", "opportunities", and "threats" (SWOT) analysis is used. This display is an example of an exemplary anaesthetic department.
Subject(s)
Anesthesia Department, Hospital/economics , Delivery of Health Care/economics , Health Care Costs , Hospital Planning/economics , Income , Models, Organizational , Organizational Objectives/economics , Germany , Hospital Planning/methodsSubject(s)
Bipolar Disorder/economics , Bipolar Disorder/nursing , Evidence-Based Medicine/economics , Financing, Government/economics , Hospital Planning/economics , Hospitals, Psychiatric/economics , National Health Programs/economics , Cooperative Behavior , Cost-Benefit Analysis/legislation & jurisprudence , Financing, Government/legislation & jurisprudence , France , Health Services Needs and Demand/economics , Hospital Planning/legislation & jurisprudence , Humans , Interdisciplinary Communication , Secondary PreventionABSTRACT
Expanding hospital capacity by developing an observation unit may be an important strategy in congested hospitals. Understanding the principles for evaluating the potential impact and appropriate sizing of an observation unit is important. The objective of this paper is to contrast two approaches to determining observation unit sizing and profitability, real options, and a flow analysis based on Little's Law. Both methods have validity and use similar data sets. The Little's Law approach has the advantage of providing an estimate of appropriate size for the unit and a natural internal consistency check on data. The benefits of an observation unit can depend critically on assumptions regarding backfill patients, and minor changes in data or assumptions can translate into significant changes in annual financial consequences. Using both the real options and the Little's Law approaches provides some internal consistency checks on data and assumptions. Both are sufficiently simple to be easily mastered and conducted. Using these two simple and accessible methods in parallel for computing the size and financial consequences for an observation unit is recommended.
Subject(s)
Emergency Service, Hospital , Health Care Rationing/methods , Hospital Planning/methods , Patient Admission , Crowding , Decision Making, Organizational , Emergency Service, Hospital/economics , Health Care Rationing/economics , Hospital Planning/economics , Humans , Outpatient Clinics, Hospital , Patient Admission/economicsSubject(s)
Budgets/legislation & jurisprudence , Cost-Benefit Analysis/legislation & jurisprudence , Health Care Reform/economics , Hospital Planning/economics , Hospitalization/economics , Hospitals, Psychiatric/economics , National Health Programs/economics , Psychosomatic Medicine/economics , Psychotherapy/economics , Reimbursement Mechanisms/economics , Germany , Health Care Rationing/economics , Health Care Rationing/legislation & jurisprudence , Health Care Reform/legislation & jurisprudence , Hospital Planning/legislation & jurisprudence , Hospitalization/legislation & jurisprudence , Hospitals, Psychiatric/legislation & jurisprudence , Humans , Length of Stay/economics , Length of Stay/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Psychosomatic Medicine/legislation & jurisprudence , Psychotherapy/legislation & jurisprudence , Quality Assurance, Health Care/economics , Quality Assurance, Health Care/legislation & jurisprudence , Reimbursement Mechanisms/legislation & jurisprudenceSubject(s)
Capital Financing/trends , Hospital Planning/economics , Investments/economics , Multi-Institutional Systems/economics , Decision Making, Organizational , Financing, Construction/trends , Health Services Needs and Demand , Hospital Planning/trends , Multi-Institutional Systems/organization & administration , Practice Valuation and Purchase/economics , United StatesABSTRACT
The crisis in the financial markets is having a major impact on hospitals' ability to access capital. Providers are seeking longer-term fixed-rate debt rather than shortterm debt. Hospital management teams and their boards need to understand the upside and downside of variable-rate debt and interest rate derivatives.
Subject(s)
Capital Financing/trends , Financial Management, Hospital/trends , Hospital Planning/trends , Governing Board , Government , Hospital Planning/economics , Humans , Income/trends , Insurance, Hospitalization , Investments/trends , Leadership , Risk Management , United StatesABSTRACT
Among the steps to take in conducting a focused analysis of your competitors: Assess your market clout and understand who your competition is. Determine how important your core service area is to your competitors. Tap intelligence networks within your own organization.