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2.
Waste Manag ; 118: 637-646, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33011541

RESUMO

Over the last two decades, Barcelona has implemented a far-reaching reform of the city's solid waste collection. In 2000, the city was divided in four zones, with four separate solid waste collection contracts being awarded to private firms, with none being allowed to obtain more than two zones, a rule that was revised in 2009 to just one contract per firm. This division of the market via exclusive territories sought to enhance competition in the expectation of the convergence of relative costs, efficiency and service quality throughout the city. This study analyzes and evaluates the creation of lots as a tool of competition with monthly observations of costs and outputs between 2015 and 2019. Main findings are that firms producing in larger zones report higher costs, that increased competition was not sufficient to lead to converging costs, and that none of the firms operate under increasing returns to scale. Based on our results, we recommend creating an additional zone. We further suggest that if a public firm managed one of the zones, the regulator would obtain more reliable information on the service costs and technical characteristics, thus increasing her capabilities as supervisor of the private firms delivering the service in other zones.


Assuntos
Resíduos Sólidos , Cidades , Custos e Análise de Custo , Resíduos Sólidos/análise
3.
Science ; 370(6513): 179-180, 2020 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-33033210
5.
Rev. SOBECC ; 25(3): 151-158, 30-09-2020.
Artigo em Português | LILACS | ID: biblio-1122702

RESUMO

Objetivo: Determinar o perfil de geração e mensurar os custos dos materiais utilizados no gerenciamento de resíduos de serviços de saúde em um centro cirúrgico. Método: Trata-se de pesquisa exploratória, descritiva, com abordagem quantitativa, na modalidade estudo de caso. O local foi o Centro Cirúrgico do Hospital Universitário da Universidade de São Paulo. A amostra estratificada foi de 1.120 cirurgias, e os resíduos foram pesados por 82 dias. Resultados: Os resíduos do Centro Cirúrgico representaram 6,38% do total hospitalar. O grupo mais representativo foi A-infectantes (50,62%). A média de geração foi de 3,72 kg por cirurgia. A sala de operação foi o local que mais gerou resíduos (55,93%), e as cirurgias buco-maxilares as que mais geraram resíduos, em termos de massa. O custo de um quilo foi: Grupo A (R$ 1,10), Grupo B (R$ 5,70), Grupo D Reciclado (R$ 0,96), Grupo D Não Reciclado (R$ 1,01) e Grupo E (R$ 3,23). Conclusão: O custo total médio por cirurgia foi de R$ 8,641, e sua redução depende da negociação de compra dos itens de consumo que tiveram maior representatividade nos custos.


Objective: To determine the waste generation profile and measure the costs of materials used in medical waste management in a surgical site. Method: This is an exploratory-descriptive survey, with a quantitative approach, in the case study modality. The site was the surgical site of the University Hospital of Universidade de São Paulo. The stratified sample was of 1,120 surgeries, and the waste was weighed for 82 days. Results: The surgical site waste accounted for 6.38% of the total hospital waste. The most representative group was A-infectious (50.62%). The mean generation was 3.72 kg per surgery. Most of the waste was generated in the operating room (55.93%), and oral maxillary surgeries generated most of the waste in terms of mass. The cost per kilo was: Group A (R$ 1.10), Group B (R$ 5.70), Group D Recycled (R$ 0.96), Group D Nonrecycled (R$ 1.01) and Group E (R$ 3.23). Conclusion: The mean total cost per surgery was R$ 8.641, and its reduction depends on strategies of purchasing consumable supplies that had greater impact on costs.


Objetivo: Determinar el perfil de generación y medir los costos de los materiales utilizados en la gestión de los Residuos De Los Servicios De Salud en un Centro Quirúrgico. Método: Esta es una investigación exploratoria, descriptiva, con un enfoque cuantitativo, en la modalidad de estudio de caso. El sitio fue el Centro Quirúrgico del Hospital Universitario de la Universidad de São Paulo. La muestra estratificada fue de 1.120 cirugías y los residuos se pesaron durante 82 días. Resultados: Los residuos del Centro Quirúrgico representaron el 6,38% del total del hospital. El grupo más representativo fue A-infeccioso (50,62%). La generación promedio fue de 3,72 kg por cirugía. El quirófano fue el lugar que generó la mayor cantidad de residuos (55,93%) y las cirugías orales-maxilares las que generaron la mayor cantidad de residuos, en términos de masa. El costo de un kilo fue: Grupo A (R$ 1,10), Grupo B (R$ 5,70), Grupo D Reciclado (R$ 0,96), Grupo D No Reciclado (R$ 1,01) y Grupo E (R$ 3,23). Conclusión: El costo total promedio por cirugía fue de R$ 8,641 y su reducción depende de la negociación de compra de los artículos de consumo que tuvieron mayor representatividad en los costos.


Assuntos
Humanos , Cirurgia Geral , Centros Cirúrgicos , Gerenciamento de Resíduos , Resíduos , Custos e Análise de Custo , Hospitais , Resíduos de Serviços de Saúde
6.
Pharm. pract. (Granada, Internet) ; 18(3): 0-0, jul.-sept. 2020. graf
Artigo em Inglês | IBECS | ID: ibc-194196

RESUMO

BACKGROUND: Type 2 diabetes mellitus is a chronic disease that is reaching epidemic proportions worldwide. It is imperative to adopt an integrated strategy, which involves a close collaboration between the patient and a multidisciplinary team of which pharmacists should be integral elements. OBJECTIVE: This work aims to identify and summarize the main effects of interventions carried out by clinical pharmacists in the management of patients with type 2 diabetes, considering clinical, humanistic and economic outcomes. METHODS: PubMed and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials assessing the effectiveness of such interventions compared with usual care that took place in hospitals or outpatient facilities. RESULTS: This review included 39 studies, involving a total of 5,474 participants. Beneficial effects were observed on various clinical outcomes such as glycemia, blood pressure, lipid profile, body mass index and coronary heart disease risk. For the following parameters, the range for the difference in change from baseline to final follow-up between the intervention and control groups was: HbA1c, -0.05% to -2.1%; systolic blood pressure, +3.45 mmHg to -10.6 mmHg; total cholesterol, +10.06 mg/dL to -32.48 mg/dL; body mass index, +0.6 kg/m2 to -1.94 kg/m2; and coronary heart disease risk, -3.0% and -12.0% (among the studies that used Framinghan prediction method). The effect on medication adherence and health-related quality of life was also positive. In the studies that performed an economic evaluation, the interventions proved to be economically viable. CONCLUSIONS: These findings support and encourage the integration of clinical pharmacists into multidisciplinary teams, underlining their role in improving the management of type 2 diabetes


No disponible


Assuntos
Humanos , Farmacêuticos/normas , Diabetes Mellitus Tipo 2/tratamento farmacológico , Competência Clínica , Assistência Farmacêutica/normas , Assistência Farmacêutica/organização & administração , Cooperação e Adesão ao Tratamento , Custos e Análise de Custo/métodos , Hemoglobina A Glicada/uso terapêutico , Qualidade de Vida
7.
Value Health ; 23(9): 1142-1148, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940231

RESUMO

OBJECTIVES: To inform allocation decisions in any healthcare system, robust cost data are indispensable. Nevertheless, recommendations on the most appropriate valuation approaches vary or are nonexistent, and no internationally accepted gold standard exists. This costing analysis exercise aims to assess the impact and implications of different calculation methods and sources based on the unit cost of general practitioner (GP) consultations in Austria. METHODS: Six costing methods for unit cost calculation were explored, following 3 Austrian methodological approaches (AT-1, AT-2, AT-3) and 3 approaches applied in 3 other European countries (Germany, The Netherlands, United Kingdom). Drawing on Austrian data, mean unit costs per GP consultation were calculated in euros for 2015. RESULTS: Mean unit costs ranged from €15.6 to €42.6 based on the German top-down costing approach (DE) and the Austrian Physicians' Chamber's price recommendations (AT-3), respectively. The mean unit cost was estimated at €18.9 based on Austrian economic evaluations (AT-1) and €17.9 based on health insurance payment tariffs (AT-2). The Dutch top-down (NL) and the UK bottom-up approaches (UK) yielded higher estimates (NL: €25.3, UK: €29.8). Overall variation reached 173%. CONCLUSIONS: Our study is the first to systematically investigate the impact of differing calculation methods on unit cost estimates. It shows large variations with potential impact on the conclusions in an economic evaluation. Although different methodological choices may be justified by the adopted study perspective, different costing approaches introduce variation in cross-study/cross-country cost estimates, leading to decreased confidence in data quality in economic evaluations.


Assuntos
Honorários e Preços , Medicina Geral/economia , Custos e Análise de Custo , Economia Médica/estatística & dados numéricos , Europa (Continente) , Humanos
8.
Bone Joint J ; 102-B(10): 1354-1358, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993329

RESUMO

AIMS: In the UK, fasciectomy for Dupuytren's contracture is generally performed under general or regional anaesthetic, with an arm tourniquet and in a hospital setting. We have changed our practice to use local anaesthetic with adrenaline, no arm tourniquet, and perform the surgery in a community setting. We present the outcome of a consecutive series of 30 patients. METHODS: Prospective data were collected for 30 patients undergoing open fasciectomy on 36 digits (six having two digits affected), over a one-year period and under the care of two surgeons. In total, 10 ml to 20 ml volume of 1% lidocaine with 1:100,000 adrenaline was used. A standard postoperative rehabilitation regime was used. Preoperative health scores, goniometer measurements of metacarpophalangeal (MCP), proximal interphalangeal (PIP) contractures, and Unité Rheumatologique des Affections de la Main (URAM) scores were measured pre- and postoperatively at six and 12 weeks. RESULTS: The mean preoperative contractures were 35.3° (0° to 90°) at the metacarpophalangeal joint (MCPJ), 32.5° (0° to 90°) at proximal interphalangeal joint (PIPJ) (a combined deformity of 67.8°). The mean correction was 33.6° (0° to 90°) for the MCPJ and 18.2° (0° to 70°) for the PIPJ leading to a combined correction of 51.8°. There was a complete deformity correction in 21 fingers (59.5%) and partial correction in 14 digits (37.8%) with no correction in one finger. The mean residual deformities for the partial/uncorrected group were MCP 4.2° (0° to 30°), and PIP 26.1° (0° to 85°). For those achieving a full correction the mean preoperative contracture was less particularly at the PIP joint (15.45° (0° to 60°) vs 55.33° (0° to 90°)). Mean preoperative URAM scores were higher in the fully corrected group (17.4 (4 to 31) vs 14.0 (0 to 28)), but lower at three months post-surgery (0.5 (0 to 3) vs 4.40 (0 to 18)), with both groups showing improvements. Infections occurred in two patients (three digits) and both were successfully treated with oral antibiotics. No other complications were noted. The estimated cost of a fasciectomy under local anaesthetic in the community was £184.82 per patient. The estimated hospital theatre costs for a fasciectomy was £1,146.62 under general anaesthetic (GA), and £1,085.30 under an axillary block. CONCLUSION: This study suggests that a fasciectomy performed under local anaesthetic with adrenaline and without an arm tourniquet and in a community setting is safe, and results in favourable outcomes regarding the degree of correction of contracture achieved, functional scores, and short-term complications. Local anaesthetic fasciectomy in a community setting achieves a saving of £961.80 for a GA and £900.48 for an axillary block per case. Cite this article: Bone Joint J 2020;102-B(10):1354-1358.


Assuntos
Anestesia Local/economia , Anestesia Local/métodos , Contratura de Dupuytren/cirurgia , Fasciotomia/economia , Fasciotomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Custos e Análise de Custo , Epinefrina/administração & dosagem , Feminino , Humanos , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reino Unido
9.
J Environ Manage ; 275: 111221, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-32956918

RESUMO

Accurately assessing the effectiveness of industrial carbon emission reduction in each province and optimizing the emission reduction path have important practical significance for China's Nationally Determined Contribution (NDC) emission reduction achievement targets. This study first evaluates the industry's emission reduction effects across 30 provinces of China. Then, the emission reduction paths of "lagging regions," which fail to meet the 2030 industrial carbon emission reduction target, are optimized based on the two-dimensional perspective of carbon emission efficiency and emission reduction cost. This study found that (1) China has exceeded its 2020 industrial carbon emission reduction target. There are 9 potential "lagging regions" that failed to meet their 2020 targets, (2) if the current emission reduction rate is maintained, China is capable of exceeding its 2030 industrial carbon emission reduction target, but there are still 11 "lagging regions," (3) there are clear differences in carbon emission efficiency and shadow price among the "lagging regions," and (4) under the premise of ensuring feasibility and fairness, the three provinces of Liaoning, Guangxi, and Shaanxi can set strict emission reduction targets, while other "lagging regions" can set flexible targets.


Assuntos
Carbono , Indústrias , Carbono/análise , Dióxido de Carbono/análise , China , Custos e Análise de Custo
10.
Stud Health Technol Inform ; 274: 82-98, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32990667

RESUMO

Healthcare institutions are business systems that provide different medical products and services to improve the health and quality of life of users of products and services. First of all, this is reflected in the differing complexities of the business, but also of the products and services they offer, as well as the different costs they cause. Thus, some products or services cause high indirect costs, while others require higher direct costs. For health care managers to make the right business decisions, they must continually have timely, quality and truthful information at their disposal. This information is provided by the management accounting of the institutions. This paper aims to present management accounting activities that enable the acquisition of information necessary for decision making.


Assuntos
Contabilidade , Qualidade de Vida , Custos e Análise de Custo , Assistência à Saúde
11.
Rev Soc Bras Med Trop ; 53: e20200314, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32997053

RESUMO

INTRODUCTION: Rapid and accurate tuberculosis detection is critical for improving patient diagnosis and decreasing tuberculosis transmission. Molecular assays can significantly increase laboratory costs; therefore, the average time and economic impact should be evaluated before implementing a new technology. The aim of this study was to evaluate the cost and average turnaround time of smear microscopy and Xpert assay at a university hospital. METHODS: The turnaround time and cost of the laboratory diagnosis of tuberculosis were calculated based on the mean cost and activity based costing (ABC). RESULTS: The average turnaround time for smear microscopy was 16.6 hours while that for Xpert was 24.1 hours. The Xpert had a mean cost of USD 17.37 with an ABC of USD 10.86, while smear microscopy had a mean cost of USD 13.31 with an ABC of USD 6.01. The sensitivity of smear microscopy was 42.9% and its specificity was 99.1%, while the Xpert assay had a sensitivity of 100% and a specificity of 96.7%. CONCLUSIONS: The Xpert assay has high accuracy; however, the turnaround time and cost of smear microscopy were lower than those of Xpert.


Assuntos
Bioensaio/economia , Patologia Molecular/economia , Tuberculose Pulmonar/diagnóstico , Bioensaio/métodos , Custos e Análise de Custo , Humanos , Microscopia , Mycobacterium tuberculosis , Patologia Molecular/métodos , Sensibilidade e Especificidade , Tuberculose , Tuberculose Pulmonar/economia
12.
S Afr Med J ; 110(7): 605-606, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32880330

RESUMO

In the South African public healthcare sector, patient medical records are still written on paper and stored in filing rooms. There has been an attempt to move towards a paperless electronic system in many public healthcare facilities, but owing to lack of funding, this has been a challenge to achieve. During the current COVID-19 pandemic, the virus could be transmitted through the physical manipulation of patient records by various categories of staff who handle the records with or without gloves for protection. We discuss a digital option that has been partially used at Tygerberg Hospital (TBH), Cape Town, to avoid SARS-CoV-2 patient hard-copy record manipulation. It includes assignment of a QR code to every patient admitted as a person under investigation or confirmed COVID-19 case. The QR code is synced to one of the many free online medical notes smartphone applications (apps), which are password-protected with patient information privacy regulations (Trello is used at TBH), for daily medical notes review and editing. Upon discharge, all notes made during the patient's hospital stay, together with the discharge summary, are printed to generate a hard copy of notes for filing to avoid violation of the current national and provincial patient records policy. Doing this means that a patient will have a virtual online file through the designated app until discharge, when a physical file will be made for storage and safekeeping. It will keep physical manipulation of patient records to the minimum, and potentially assist in reducing transmission of the SARS-CoV-2 virus among healthcare workers.


Assuntos
Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Registros Eletrônicos de Saúde/economia , Controle de Infecções/métodos , Saúde do Trabalhador , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Custos e Análise de Custo , Países em Desenvolvimento , Registros Eletrônicos de Saúde/organização & administração , Feminino , Controle de Formulários e Registros , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Registros Médicos/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , África do Sul
13.
Nat Commun ; 11(1): 4295, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32908130

RESUMO

Recent expansion of croplands in the United States has caused widespread conversion of grasslands and other ecosystems with largely unknown consequences for agricultural production and the environment. Here we assess annual land use change 2008-16 and its impacts on crop yields and wildlife habitat. We find that croplands have expanded at a rate of over one million acres per year, and that 69.5% of new cropland areas produced yields below the national average, with a mean yield deficit of 6.5%. Observed conversion infringed upon high-quality habitat that, relative to unconverted land, had provided over three times higher milkweed stem densities in the Monarch butterfly Midwest summer breeding range and 37% more nesting opportunities per acre for waterfowl in the Prairie Pothole Region of the Northern Great Plains. Our findings demonstrate a pervasive pattern of encroachment into areas that are increasingly marginal for production, but highly significant for wildlife, and suggest that such tradeoffs may be further amplified by future cropland expansion.


Assuntos
Animais Selvagens , Conservação dos Recursos Naturais , Custos e Análise de Custo/estatística & dados numéricos , Produção Agrícola/tendências , Produtos Agrícolas/economia , Animais , Biodiversidade , Borboletas , Produção Agrícola/economia , Produção Agrícola/estatística & dados numéricos , Dispersão Vegetal , Análise Espaço-Temporal , Estados Unidos
14.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-47798

RESUMO

Traz informações acerca de estudos sobre análises comparativas de estratégias em termos de custos e desfechos em saúde num determinado horizonte temporal.


Assuntos
Economia da Saúde , Avaliação da Tecnologia Biomédica , Custos e Análise de Custo , Avaliação em Saúde
15.
J Emerg Manag ; 18(4): 349-354, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804402

RESUMO

This work is a companion paper to "Quantifying the Relationship Between Predisaster Mitigation Spending and Major Disaster Declarations for US States and Territories." Mitigation is a relatively new undertaking, especially for local jurisdictions, within the United States disaster policy. The Disaster Mitigation Act of 2000 (DMA 2000) requires local jurisdictions to plan for and implement mitigative strategies in order to access federal grant funding options for emergency management. After DMA 2000 went into effect in the mid-2000s, a supporting study by the Multi-Hazard Mitigation Council (MMC 2005) found that on average, mitigation projects yielded a benefit-cost ratio of 4:1 at the local level.1 This paper evaluates and compares predisaster mitigation spending and postdisaster assistance spend-ing at the state and FEMA Regional levels, hypothesizing that as mitigation spending increases, postdisaster spend-ing should decrease. The results however indicate the opposite, with most states showing increasing in both types of spending over time.


Assuntos
Planejamento em Desastres/economia , Desastres/economia , Organização do Financiamento/estatística & dados numéricos , Custos e Análise de Custo , Humanos , Governo Local , Estados Unidos
17.
Value Health ; 23(8): 1072-1078, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828220

RESUMO

Although it is generally accepted that human tissue biobanks are important to facilitate progress in health and medical research, many academic biobanks face sustainability challenges. We propose that biobank sustainability is challenged by a lack of available data describing the outputs and benefits that are produced by biobanks, as reflected by a dearth of publications that enumerate biobank outputs. We further propose that boosting the available information on biobank outputs and using a broader range of output metrics will permit economic analyses such as cost-consequence analyses of biobank activity. Output metrics and cost-consequence analyses can allow biobanks to achieve efficiencies, and improve the quality and/or quantity of their outputs. In turn, biobank output measures provide all stakeholders with explicit and accountable data on biobank value, which could contribute to the evolution of biobank operations to best match research needs, and mitigate some threats to biobank sustainability.


Assuntos
Bancos de Espécimes Biológicos/organização & administração , Pesquisa Biomédica/organização & administração , Modelos Econométricos , Bancos de Espécimes Biológicos/economia , Pesquisa Biomédica/economia , Custos e Análise de Custo , Humanos
18.
Nephrol Nurs J ; 47(4): 343-346, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32830940

RESUMO

Peritoneal dialysis transfer sets (extension lines) are replaced every six to nine months to minimize peritoneal dialysis catheter complications. The aim of this study was to compare a revised non-bag transfer set exchange procedure with the standard bag exchange procedure on nursing time, costs, and safety. Thirty-three people were randomized to two groups - a standard bag exchange procedure group (n = 16) and a non-bag transfer set exchange procedure group (n = 17). The standard bag exchange procedure took a median of 32 minutes (interquartile range [IQR] 25 to 38 minutes) compared to the non-bag transfer set exchange procedure of 6 minutes (IQR 4 to 8 minutes) (p Ò 0.0001). There was one episode of peritonitis in each group within the 72-hour follow-up period. The average cost of the non-bag transfer set exchange procedure was $24.54 lower, a 37% cost reduction. This study has shown the revised non-bag transfer set replacement procedure appears to be safe, consume less participant and staff time, and decreases costs.


Assuntos
Diálise Peritoneal/métodos , Diálise Peritoneal/enfermagem , Cateterismo/efeitos adversos , Custos e Análise de Custo , Humanos , Pesquisa em Avaliação de Enfermagem , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/economia , Peritonite/etiologia , Peritonite/prevenção & controle , Resultado do Tratamento , Carga de Trabalho/estatística & dados numéricos
19.
PLoS One ; 15(8): e0237159, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760101

RESUMO

BACKGROUND: Computerized Clinical Decision Support Systems (CCDSS) have become increasingly important in ensuring patient safety and supporting all phases of clinical decision making. The aim of this study is to evaluate, through a CCDSS, the rate of the laboratory tests overuse and to estimate the cost of the inappropriate requests in a large university hospital. METHOD: In this observational study, hospital physicians submitted the examination requests for the inpatients through a Computerized Physician Order Entry. Violations of the rules in tests requests were intercepted and counted by a CCDSS, over a period of 20 months. Descriptive and inferential statistics (Student's t-test and ANOVA) were made. Finally, the monthly comprehensive cost of the laboratory tests was calculated. RESULTS: During the observation period a total of 5,716,370 requests were analyzed and 809,245 violations were counted. The global rate of overuse was 14.2% ± 3.0%. The most inappropriate exams were Alpha Fetoprotein (85.8% ± 30.5%), Chlamydia trachomatis Nucleic Acid Amplification (48.7% ± 8.8%) and Alkaline Phosphatase (20.3% ± 6.5%). The monthly cost of over-utilization was 56,534€ for basic panel, 14,421€ for coagulation, 4,758€ for microbiology, 432€ for immunology exams. All the exams, generated an estimated avoidable cost of 1,719,337€ (85,967€ per month) for the hospital. CONCLUSIONS: The study confirms the wide variability in over-utilization rates of laboratory tests. For these reasons, the real impact of inappropriateness is difficult to assess, but the generated costs for patients, hospitals and health systems are certainly high and not negligible. It would be desirable for international medical communities to produce a complete panel of prescriptive rules for all the most common laboratory exams that is useful not only to reduce costs, but also to ensure standardization and high-quality care.


Assuntos
Técnicas de Laboratório Clínico/economia , Custos e Análise de Custo , Sistemas de Apoio a Decisões Clínicas/economia , Utilização de Instalações e Serviços/estatística & dados numéricos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Sistemas de Apoio a Decisões Clínicas/estatística & dados numéricos , Utilização de Instalações e Serviços/economia , Hospitais Universitários/economia , Hospitais Universitários/estatística & dados numéricos
20.
PLoS One ; 15(8): e0237082, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32776954

RESUMO

To understand the cost burden of medical care it is essential to partition medical spending into conditions. Two broad strategies have been used to measure disease-specific spending. The first attributes each medical claim to the condition that physicians list as its cause. The second decomposes total spending for a person over a year to their cumulative set of health conditions. Traditionally, this has been done through regression analysis. This paper has two contributions. First, we develop a new cost attribution method to attribute spending to conditions using a more flexible attribution approach, based on propensity score analysis. Second, we compare the propensity score approach to the claims-based approach and the regression approach in a common set of beneficiaries age 65 and older in the 2009 Medicare Current Beneficiary Survey. Our estimates show that the three methods have important differences in spending allocation and that the propensity score model likely offers the best theoretical and empirical combination.


Assuntos
Efeitos Psicossociais da Doença , Custos e Análise de Custo/métodos , Idoso , Feminino , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Medicare/estatística & dados numéricos , Pontuação de Propensão , Análise de Regressão , Estados Unidos
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