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"Cost Control economics."
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The impact of repeated cost containment policies on pharmaceutical expenditure: experience in Spain
The growth in expenditure on the financing of Pharmaceuticals is a factor that accounts for a large part of the increase in public health spending in most developed countries. In an attempt to kerb this growth, many health authorities, particularly in Europe, have introduced numerous regulatory measures that have affected the market, especially on the supply side. These measures include the system of reference pricing, the reduction of wholesale distributors' and retailers' markups and compulsory reductions of ex-factory prices. We assess the impact of these cost containment measures on expenditure per capita, prescriptions per capita and the average price of Pharmaceuticals financed by the public sector in Catalonia (Spain), from 1995 to 2006. We apply an autoregressive integrated moving average (ARIMA) time series model using dummy variables to represent the various cost containment measures implemented. Twelve of the 16 interventions analysed that were intended to contain the overall pharmaceutical expenditure were not effective in reducing it even in the short term, and the four that were effective were not so in the long term, thus amounting to a moderate annual saving.
Journal Article
Stop spending, start managing : strategies to transform wasteful habits
\"Too often, managers spend money to solve problems at work, whether that means hiring outside consultants, investing in new software to fix communication issues, or bribing employees with cash to motivate them. But many managers are surprised when the problem they tried to solve reappears a few months, weeks, or even days later. The money is gone, but the problem is still there. These costs can add up, particularly when you consider the additional loss to your company in wasted time, energy, and resources when you don't solve problems effectively. Tanya Menon and Leigh Thompson, experts in how organizations work, have developed a framework to help you understand why you fall into this trap, and how to escape it. Five psychologies--each of which substitutes spending for your own powers of management--lead to wasteful spending: 1. Mindless spending: throwing money at a problem to avoid thinking about it; 2. Ego spending: squandering resources to make yourself look good; 3. Please-like-me spending: wasting time and money to avoid conflict; 4. Talk-to-me spending: buying expensive technologies to help people communicate; and 5. Follow-me spending: using financial incentives to motivate people To break these habits, Menon and Thompson show how you can use your smarts as a manager to find solutions. By consciously observing waste and identifying hidden value, widening your mind-set beyond ego, courageously negotiating with others, encouraging meaningful interaction, and transforming people with positive values and relationships rather than cash, you can overcome these psychological barriers and find the value that already exists in your organization and yourself--for free\"-- Provided by publisher.
Book
Understanding Why Patients Of Low Socioeconomic Status Prefer Hospitals Over Ambulatory Care
Patients with low socioeconomic status (SES) use more acute hospital care and less primary care than patients with high socioeconomic status. This low-value pattern of care use is harmful to these patients' health and costly to the health care system. Many current policy initiatives, such as the creation of accountable care organizations, aim to improve both health outcomes and the cost-effectiveness of health services. Achieving those goals requires understanding what drives low-value health care use. We conducted qualitative interviews with forty urban low-SES patients to explore why they prefer to use hospital care. They perceive it as less expensive, more accessible, and of higher quality than ambulatory care. Efforts that focus solely on improving the quality of hospital care to reduce readmissions could, paradoxically, increase hospital use. Two different profile types emerged from our research. Patients in Profile A (five or more acute care episodes in six months) reported social dysfunction and disability. Those in Profile B (fewer than five acute care episodes in six months) reported social stability but found accessing ambulatory care to be difficult. Interventions to improve outcomes and values need to take these differences into account. Adapted from the source document.
Journal Article
Survey Finds Few Orthopedic Surgeons Know The Costs Of The Devices They Implant
Orthopedic procedures represent a large expense to the Medicare program, and costs of implantable medical devices account for a large proportion of those procedures' costs. Physicians have been encouraged to consider cost in the selection of devices, but several factors make acquiring cost information difficult. To assess physicians' levels of knowledge about costs, we asked orthopedic attending physicians and residents at seven academic medical centers to estimate the costs of thirteen commonly used orthopedic devices between December 2012 and March 2013. The actual cost of each device was determined at each institution; estimates within 20 percent of the actual cost were considered correct. Among the 503 physicians who completed our survey, attending physicians correctly estimated the cost of the device 21 percent of the time, and residents did so 17 percent of the time. Thirty-six percent of physicians and 75 percent of residents rated their knowledge of device costs \"below average\" or \"poor.\" However, more than 80 percent of all respondents indicated that cost should be \"moderately,\" \"very,\" or \"extremely' important in the device selection process. Surgeons need increased access to information on the relative prices of devices and should be incentivized to participate in cost containment efforts. [PUBLICATION ABSTRACT]
Journal Article
Food & beverage cost control
\"In order for foodservice managers to control costs effectively, they must have a firm grasp of accounting, marketing, and legal issues, as well as an understanding of food and beverage sanitation, production, and service methods. This fully updated sixth edition of Food and Beverage Cost Control provides students and managers with a wealth of comprehensive resources and the specific tools they need to keep costs low and profit margins high\"-- Provided by publisher.
Book
The evolution of the Italian National Health Service
40 years ago, Italy saw the birth of a national, universal health-care system (Servizio Sanitario Nazionale [SSN]), which provides a full range of health-care services with a free choice of providers. The SSN is consistently rated within the Organisation for Economic Co-operation and Development among the highest countries for life expectancy and among the lowest in health-care spending as a proportion of gross domestic product. Italy appears to be in an envious position. However, a rapidly ageing population, increasing prevalence of chronic diseases, rising demand, and the COVID-19 pandemic have exposed weaknesses in the system. These weaknesses are linked to the often tumultuous history of the nation and the health-care system, in which innovation and initiative often lead to spiralling costs and difficulties, followed by austere cost-containment measures. We describe how the tenuous balance of centralised versus regional control has shifted over time to create not one, but 20 different health systems, exacerbating differences in access to care across regions. We explore how Italy can rise to the challenges ahead, providing recommendations for systemic change, with emphasis on data-driven planning, prevention, and research; integrated care and technology; and investments in personnel. The evolution of the SSN is characterised by an ongoing struggle to balance centralisation and decentralisation in a health-care system, a dilemma faced by many nations. If in times of emergency, planning, coordination, and control by the central government can guarantee uniformity of provider behaviour and access to care, during non-emergency times, we believe that a balance can be found provided that autonomy is paired with accountability in achieving certain objectives, and that the central government develops the skills and, therefore, the legitimacy, to formulate health policies of a national nature. These processes would provide local governments with the strategic means to develop local plans and programmes, and the knowledge and tools to coordinate local initiatives for eventual transfer to the larger system.
Journal Article
Cost-outcome description of clinical pharmacist interventions in a university teaching hospital
Background
Pharmacist interventions are one of the pivotal parts of a clinical pharmacy service within a hospital. This study estimates the cost avoidance generated by pharmacist interventions due to the prevention of adverse drug events (ADE). The types of interventions identified are also analysed.
Methods
Interventions recorded by a team of hospital pharmacists over a one year time period were included in the study. Interventions were assigned a rating score, determined by the probability that an ADE would have occurred in the absence of an intervention. These scores were then used to calculate cost avoidance. Net cost benefit and cost benefit ratio were the primary outcomes. Categories of interventions were also analysed.
Results
A total cost avoidance of €708,221 was generated. Input costs were calculated at €81,942. This resulted in a net cost benefit of €626,279 and a cost benefit ratio of 8.64: 1. The most common type of intervention was the identification of medication omissions, followed by dosage adjustments and requests to review therapies.
Conclusion
This study provides further evidence that pharmacist interventions provide substantial cost avoidance to the healthcare payer. There is a serious issue of patient’s regular medication being omitted on transfer to an inpatient setting in Irish hospitals.
Journal Article