RESUMEN
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.
Asunto(s)
Ablación por Catéter/economía , Atención a la Salud/economía , Procedimientos Endovasculares/economía , Costos de la Atención en Salud , Planificación Hospitalaria/economía , Terapia por Láser/economía , Evaluación de Procesos, Atención de Salud/economía , Salud Pública/economía , Vena Safena/cirugía , Várices/economía , Várices/cirugía , Reclamos Administrativos en el Cuidado de la Salud , Ablación por Catéter/efectos adversos , Ahorro de Costo , Análisis Costo-Beneficio , Bases de Datos Factuales , Procedimientos Endovasculares/efectos adversos , Necesidades y Demandas de Servicios de Salud/economía , Humanos , Terapia por Láser/efectos adversos , Evaluación de Necesidades/economía , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Vena Safena/diagnóstico por imagen , Vena Safena/fisiopatología , Saskatchewan , Factores de Tiempo , Resultado del Tratamiento , Várices/diagnóstico por imagen , Várices/fisiopatologíaRESUMEN
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.
Asunto(s)
Neoplasias de la Mama/economía , Gastos en Salud/estadística & datos numéricos , Planificación Hospitalaria/economía , Medicare/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/epidemiología , Estudios de Cohortes , Femenino , Humanos , Estadificación de Neoplasias , Derivación y Consulta/estadística & datos numéricos , Características de la Residencia , Estudios Retrospectivos , Factores Socioeconómicos , Estados UnidosRESUMEN
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.
Asunto(s)
Planificación Hospitalaria , Hospitales , Costos y Análisis de Costo , Departamentos de Hospitales , Planificación Hospitalaria/economíaRESUMEN
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.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Clasificación Internacional de Enfermedades , Grupos Diagnósticos Relacionados/economía , Eficiencia Organizacional/economía , Eficiencia , Hospitalización/economía , Estudios Retrospectivos , Congresos como Asunto , Investigación sobre Servicios de Salud/métodos , Planificación Hospitalaria/economíaAsunto(s)
Conservación de los Recursos Energéticos/métodos , Arquitectura y Construcción de Hospitales/normas , Planificación Hospitalaria/organización & administración , Conservación de los Recursos Energéticos/economía , Arquitectura y Construcción de Hospitales/economía , Arquitectura y Construcción de Hospitales/métodos , Planificación Hospitalaria/economía , Planificación Hospitalaria/métodos , Humanos , TexasAsunto(s)
Clausura de las Instituciones de Salud/economía , Planificación Hospitalaria/economía , Hospitales Generales/economía , Hospitales Especializados/economía , Medicina Estatal/economía , Áreas de Influencia de Salud/economía , Control de Costos/métodos , Tamaño de las Instituciones de Salud/economía , Tamaño de las Instituciones de Salud/normas , Tamaño de las Instituciones de Salud/tendencias , Hospitales Generales/organización & administración , Hospitales Generales/tendencias , Hospitales Especializados/organización & administración , Hospitales Especializados/normas , Humanos , Modelos Organizacionales , Evaluación de Programas y Proyectos de Salud/economía , Medicina Estatal/organización & administración , Medicina Estatal/tendencias , Reino UnidoRESUMEN
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.
Asunto(s)
Atención Ambulatoria/economía , Economía Hospitalaria/tendencias , Hospitalización/economía , Atención Ambulatoria/tendencias , Control de Costos/métodos , Control de Costos/tendencias , Promoción de la Salud/economía , Promoción de la Salud/tendencias , Capacidad de Camas en Hospitales/economía , Capacidad de Camas en Hospitales/estadística & datos numéricos , Planificación Hospitalaria/economía , Planificación Hospitalaria/tendencias , Hospitalización/tendencias , Humanos , Cobertura del Seguro/legislación & jurisprudencia , Medicaid/economía , Medicaid/legislación & jurisprudencia , Evaluación de Necesidades , Patient Protection and Affordable Care Act/economía , Patient Protection and Affordable Care Act/normas , Estados UnidosRESUMEN
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.
Asunto(s)
Servicio de Anestesia en Hospital/economía , Atención a la Salud/economía , Costos de la Atención en Salud , Planificación Hospitalaria/economía , Renta , Modelos Organizacionales , Objetivos Organizacionales/economía , Alemania , Planificación Hospitalaria/métodosAsunto(s)
Trastorno Bipolar/economía , Trastorno Bipolar/enfermería , Medicina Basada en la Evidencia/economía , Financiación Gubernamental/economía , Planificación Hospitalaria/economía , Hospitales Psiquiátricos/economía , Programas Nacionales de Salud/economía , Conducta Cooperativa , Análisis Costo-Beneficio/legislación & jurisprudencia , Financiación Gubernamental/legislación & jurisprudencia , Francia , Necesidades y Demandas de Servicios de Salud/economía , Planificación Hospitalaria/legislación & jurisprudencia , Humanos , Comunicación Interdisciplinaria , Prevención SecundariaRESUMEN
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.
Asunto(s)
Servicio de Urgencia en Hospital , Asignación de Recursos para la Atención de Salud/métodos , Planificación Hospitalaria/métodos , Admisión del Paciente , Aglomeración , Toma de Decisiones en la Organización , Servicio de Urgencia en Hospital/economía , Asignación de Recursos para la Atención de Salud/economía , Planificación Hospitalaria/economía , Humanos , Servicio Ambulatorio en Hospital , Admisión del Paciente/economíaAsunto(s)
Presupuestos/legislación & jurisprudencia , Análisis Costo-Beneficio/legislación & jurisprudencia , Reforma de la Atención de Salud/economía , Planificación Hospitalaria/economía , Hospitalización/economía , Hospitales Psiquiátricos/economía , Programas Nacionales de Salud/economía , Medicina Psicosomática/economía , Psicoterapia/economía , Mecanismo de Reembolso/economía , Alemania , Asignación de Recursos para la Atención de Salud/economía , Asignación de Recursos para la Atención de Salud/legislación & jurisprudencia , Reforma de la Atención de Salud/legislación & jurisprudencia , Planificación Hospitalaria/legislación & jurisprudencia , Hospitalización/legislación & jurisprudencia , Hospitales Psiquiátricos/legislación & jurisprudencia , Humanos , Tiempo de Internación/economía , Tiempo de Internación/legislación & jurisprudencia , Programas Nacionales de Salud/legislación & jurisprudencia , Medicina Psicosomática/legislación & jurisprudencia , Psicoterapia/legislación & jurisprudencia , Garantía de la Calidad de Atención de Salud/economía , Garantía de la Calidad de Atención de Salud/legislación & jurisprudencia , Mecanismo de Reembolso/legislación & jurisprudenciaAsunto(s)
Financiación del Capital/tendencias , Planificación Hospitalaria/economía , Inversiones en Salud/economía , Sistemas Multiinstitucionales/economía , Toma de Decisiones en la Organización , Financiación de la Construcción de Edificios/tendencias , Necesidades y Demandas de Servicios de Salud , Planificación Hospitalaria/tendencias , Sistemas Multiinstitucionales/organización & administración , Valorización y Adquisición Práctica/economía , Estados UnidosRESUMEN
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.
Asunto(s)
Financiación del Capital/tendencias , Administración Financiera de Hospitales/tendencias , Planificación Hospitalaria/tendencias , Consejo Directivo , Gobierno , Planificación Hospitalaria/economía , Humanos , Renta/tendencias , Seguro de Hospitalización , Inversiones en Salud/tendencias , Liderazgo , Gestión de Riesgos , Estados UnidosRESUMEN
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.