Costs in Management of Health Services

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Direct medical costs associated with schizophrenia relapses in health care services in the city of São Paulo

Direct medical costs associated with schizophrenia relapses in health care services in the city of São Paulo

The component that most infl uenced direct medical costs was daily rate charged per patient, with signifi cant variations between services. One possible explanation for these differences would be the effi ciency of public versus private management. Another explanation would be the fact that SUS pays the CH for a package of services rather than per procedure, encouraging the CH to keep its costs down. CMHC human resources and general expenses were similar to those in the CH, though lengths of stay in the former were longer, probably because this is not an inpatient situation and therefore
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How Health Relationship Management Services (HRMS) Benefits  Corporate Wellness

How Health Relationship Management Services (HRMS) Benefits Corporate Wellness

Obesity and related diseases, have led to a signiicant increase in healthcare costs for many organizations. Zappos was aware that obesity is one of the largest contributors to health problems linked to diseases such as diabetes, hypertension, cardiovascular disease, and cancers. Moreover, these health problems resulted in lower employee productivity, higher absenteeism and an increase in employee turnover. Additional costs aside from medical claims occur when employees are not performing at optimal level. Technological systems can indicate patients’ adherence to medical protocols and acts as a warning sign in many cases such as hypertension, cardiac disease, and many other diseases, as patients are continuously monitored no matter where they are.
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Cost evaluation of reproductive and primary health care mobile service delivery for women in two rural districts in South Africa.

Cost evaluation of reproductive and primary health care mobile service delivery for women in two rural districts in South Africa.

The variable cost of providing a Pap smear was $6.94 in both districts; most of this cost was for the laboratory charge which included the collection supplies, test and transport of the speci- men and results. Marginal costs for providing additional, integrated services to the women, such as provision of contraceptives, management of STIs, HCT and TB screening were mini- mal in comparison. In addition, offering medical history screening, BP checks, TB and STI/ candidiasis symptoms screening and a breast exam required no additional costs as a result of no additional consumables or supplies being needed to provide these services. Thus, especially in remote areas where patient volumes do not exceed the capacity of the nurse offering services, incorporating multiple SRH and other primary care services within a program for cervical can- cer screening is one way to potentially expand access to a broader range of services without added costs.
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Clinical governance; How been understood, what is needed? Nurses' perspective

Clinical governance; How been understood, what is needed? Nurses' perspective

practitioners were unsure about the concept of CG and its activities (24). Murray study has shown that NHS staff had not has a uniform level of knowledge about CG (25). Also Currie mentioned that frontline clinical staffs in NHS required raising awareness in CG concept (15). Staff education and training was employed as a fundamental step toward CG development in Tabrizi study (26). Greenfield said that divergence in CG is referred to reflect the understandings about it (27). Also its successful implementation, in longer term, is required to changing the paradigm for health professionals (28). Lack of clarity about CG concept in hospitals, would be consequent the continuous confusion and resistance from clinicians and nurses (29-31). However, all quality improvement initiatives to be successful needs to board on some infrastructures. Jeffery studies results have showed that organizational infrastructures and financial support were significantly affect the quality improvement initiatives at hospital-level. They concluded that if the hospitals intent to successfully implement quality improvement activities, they must attend to the context in which the efforts will be placed (32). In addition, senior primary care managers of NHS considered cultural change as an important enabler to CG implementation (33). The same results was obtained in Saadati study about accreditation implementation in Iranian hospitals (34). However, Campbell had identified three major CG barriers including structural barriers, resource barriers (lack of staff or money) and cultural barriers (blame culture) (35). Nurses in our study have mentioned that cultural change, staff education and performance assessment could be as a three enablers to effective CG implementation. Also they regard that with a lack in staff and inadequate financial support, CG implementation would not be successful.
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Rev. Soc. Bras. Med. Trop.  vol.42 número4

Rev. Soc. Bras. Med. Trop. vol.42 número4

This study analyzed the approximate cost of treatment of patients hospitalized with a diagnosis of imported malaria in Slovakia. Between 2003 and 2007, 15 patients with imported malaria were hospitalized. The mean direct cost of the treatment was 970.75 euros and the mean indirect cost was 53.15 euros. For the patient with the highest cost of treatment, the use of mefloquine prophylaxis would have represented only 0.5% of the total direct cost of treating the disease. Despite the partial resistance of plasmodia, malaria chemoprophylaxis is unequivocally a cheaper choice than subsequent treatment of malaria.
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Extension of health services

Extension of health services

This document, together with the information on the evaluation of the Ten-Year Health Plan and the document on "Implications of the Global Goal 'Health for All[r]

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METHODOLOGICAL APPROACHES IN REALIZING AND APPLYING COST-BENEFIT ANALYSIS FOR THE INVESTMENT PROJECTS

METHODOLOGICAL APPROACHES IN REALIZING AND APPLYING COST-BENEFIT ANALYSIS FOR THE INVESTMENT PROJECTS

Cost-Benefit Analysis (CBA) estimates and totals up the equivalent money value of the benefits and costs to the community of projects to establish whether they are worthwhile. The idea of this economic accounting originated with Jules Dupuit, a French engineer. The British economist, Alfred Marshall, formulated some of the formal concepts that are at the foundation of CBA. But the practical development of CBA came as a result of the impetus provided by the Federal Navigation Act of 1936. This act required that the U.S. Corps of Engineers carry out projects for the improvement of the waterway system when the total benefits of a project to whomsoever they accrue exceed the costs of that project. Thus, the Corps of Engineers had created systematic methods for measuring such benefits and costs. The engineers of the Corps did this without much, if any, assistance from the economics profession. It wasn't until about twenty years later in the 1950's that economists tried to provide a rigorous, consistent set of methods for measuring benefits and costs and deciding whether a project is worthwhile. Some technical issues of CBA have not been wholly resolved even now but the fundamental presented in the following are well established (3). If until the '60, cost benefit analysis (CBA) was used to assess investment projects such as water management plant (using water as a resource or as a means of transport - to prevent flooding, hydroelectric works, water supply, sewers, hydro-transport, etc.), since the 1970s, the method has been translated and used in other projects with public funding (and not only), which generates an impact on the environment (1).
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Health services utilization, work absenteeism and costs of pandemic influenza A (H1N1) 2009 in Spain: a multicenter-longitudinal study.

Health services utilization, work absenteeism and costs of pandemic influenza A (H1N1) 2009 in Spain: a multicenter-longitudinal study.

The results of this study should be interpreted taking into account several limitations. First, the study population was a subsample of patients recruited for a case-control study. This is important for outpatients who were selected to be matched with inpatient rather than a representative sample of the outpatient Spanish population. Therefore, external validity could be compromised. However, patient’s were temporally representative of the pandemic surge in Spain [9], and the prevalence of comorbidities among our inpatient’s was similar to that reported before [10,41]. Also, although follow-up response was not 100%, demographic characteristics of lost patients and those who stayed in the study were not statistically different. Second, none of the patients included died during the influenza infection. Consequent- ly, our estimates underestimate the actual impact of the pandemic. Nevertheless, most patients who died during the pandemic were either old or had previous severe chronic conditions, thus not affecting much our estimation of indirect costs [10,41]. Third, we could only analyse flu cases that had contact with health services and were laboratory confirmed. This might have prevented us from overestimating costs due to over diagnosis of influenza. However, it could have lead us underestimate productivity costs among specific populations (housekeepers, or non-contracted individuals, for instance) [42]. Fourth, even though there is evidence regarding possible differences in mean cost by social class [12], comparisons stratifying by this variable could not be performed due to many missing values. Also, we need to indicate that the number of cases that were used to estimate the costs per ICU-inpatient was small (n = 20). Finally, the limitations related with the sources of data used in our study deserve a comment. Although some of the information was directly gathered from the patient during an interview (to patients or proxies) and in some cases several months after the flu, memory bias was probably minor due to the influenza pandemic’s important mass media repercussion [43]. We had to consider alternative sources of information for unit costs, as there is no accepted common information source for the Spanish national healthcare system. While the source of unit costs for hospital and day absenteeism were reliable, many ambulatory unit costs were probable overestimated because they were obtained from the list of prices of health services provision to third parties. It is worth mentioning that several of the limitations listed above were addressed by the sensitivity analyses performed, because variations in unit costs, hospitalization length of stay in each area and days of work absenteeism were introduced as inputs of the model. The resulting confidence intervals of estimates represent the degree of uncertainty introduced by these limitations.
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Templates for Calculating IT Services Costs

Templates for Calculating IT Services Costs

Having information such as this, the User Support Department can better know the true costs of its Service Desk, identifying possible inefficient activities as well as cost reduction opportunities, allowing more accurate decision making. The departments’ management staff found the model and results very useful, since it enables costing by each activity, incident category and, eventually, final client, which allows to make interesting comparisons and improvements. This demonstration raised awareness and interest in applying the same model to other ITIL processes executed in the department, progressively. It allowed us to apply in practice the proposed template with real process execution, helping to fine- tune and validate it.
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Braz. J. Pharm. Sci.  vol.47 número2

Braz. J. Pharm. Sci. vol.47 número2

Cost Minimization Analysis (CMA), one of the simplest economic evaluations, is utilized when the result of two or more interventions are the same in terms of their clinical consequences. In CMA, only costs are submitted for comparison, because the eficacy or effectiveness of comparable alternatives are equal. (Eisenberg, 1989; Joli- coeur, Jones-Grizzle, Boyer, 1992; Sacristan Del Castillo, 1995; Bootman, Townsend, Mcghan, 1996; Drummond et al., 1997). This approach is justiied when alternatives of comparable programs or therapies produce clinically equivalent results, as in decision taking of pharmothera- peutic guides (Carreira-Hueso, 1998; Drummond, 1991). Thus, the irst critical step prior to conducting a CMA is to determine the therapeutic equivalence of the interventions (Robertson, Lang, Hill, 2003). When intervention results differ, it is not possible to proceed to cost minimization analysis. An example of CMA is the analysis of adminis- tration costs of the same medicine given using different routes of administration (Przybylski et al., 1997).
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en 1415 790X rbepid 16 02 00338

en 1415 790X rbepid 16 02 00338

O objetivo deste estudo foi avaliar o perfil sociodemográfico de risco para infecção do trato urinário e para inadequação do pré-natal, segundo índice de Kotelchuck, e avaliar o manejo da infecção do trato urinário durante o pré-natal segundo o profissional de saúde, o serviço de saúde e a mulher, em gestantes no município do Rio de Janeiro. Um estudo seccional foi realizado com 1.091 gestantes, 501 com in- fecção do trato urinário, na rede do SUS do Rio de Janeiro em 2007/2008. Informações demográficas, socioeconômicas, história obstétrica e adequação do pré-natal foram coletadas através de entrevistas e do cartão do pré-natal. O manejo inadequado da in- fecção do trato urinário foi avaliado pelas dimensões: profissional de saúde, serviços de saúde e mulher. Utilizou-se o teste χ² e regressão logística multivariada para com- paração entre os grupos e identificação dos fatores associados ao manejo inadequado da infecção do trato urinário. As gestan- tes adolescentes, anêmicas, diabéticas e com qualidade do pré-natal parcialmente adequado ou inadequado apresentaram maior chance de infecção do trato urinário. Na avaliação global, 72% tiveram manejo inadequado da infecção do trato urinário. O manejo inadequado da infecção do trato urinário foi associado à cor parda em com- paração com a cor branca. Na avaliação do profissional de saúde, o manejo inadequado para infecção do trato urinário foi menos comum nas gestantes com baixo peso e com sobrepeso e obesidade e, na avaliação da gestante, as primíparas tiveram menor chance de manejo inadequado para infec- ção do trato urinário em relação àquelas com um ou mais filhos.
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Rev. Saúde Pública  vol.43 número6

Rev. Saúde Pública vol.43 número6

place in two phases: the irst, pre-pathogenic (health promotion and speciic protection), in which the host, pathogenic agent and environment are in balance, and the second, pathogenic (diagnosis and early treatment, damage limitation and rehabilitation), when the disease is already present. At irst, the reports do not focus on health promotion in the pre-pathogenic phase. “Prevention is being aware of things you can avoid before they happen, like dealing with this before and after. Back home we do everything to prevent dengue fever, but if it happens we already know the symptoms, what it is and the drugs you can’t take.” (E16) In some reports the word prevention was synonymous with preventive gynecological examination. This interpretation may be due to the orthographic similarity between the words “prevention” and “preventive” and also because some users associate prevention with the use of medical technology and the gynecological examination represents their main reference point of a diagnostic examination carried out in the basic health unit.
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The high costs of health care in Brazil

The high costs of health care in Brazil

Most of Brazil’s medical and hospital services are delivered through the private sector but are paid for by the government through the National Insti- tute of Medica[r]

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Premature birth: An Enigma for the Society?

Premature birth: An Enigma for the Society?

Infants born preterm are at greater risk than infants born at term for mortality and a variety of health and developmental problems. Complications include acute respiratory, gastrointestinal, immunologic, central nervous system, hearing, and vision problems, as well as longer-term motor, cognitive, visual, hearing, behavioral, social-emotional, health, and growth problems. The birth of a preterm infant can also bring considerable emotional and economic costs to families and have implications for public-sector services, such as health insurance, educational, and other social support systems. The greatest risk of mortality and morbidity is for those infants born at the earliest gestational ages. However, those infants born nearer to term represent the greatest number of infants born preterm and also experience more complications than infants born at term. Preterm birth is a complex cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, neighborhood characteristics, environmental exposures, medical conditions, infertility treatments, biological factors and genetics. Many of these factors occur in combination, particularly in those who are socioeconomically disadvantaged or who are members of racial and ethnic minority groups. The empirical investigation was carried out to draw correlation between preterm birth and eventuality. This paper deals with various issues related to the premature deliveries from socio-biological perspectives.
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Morality and Values in Support of Universal Healthcare Must be Enshrined in Law; Comment on “Morality and Markets in the NHS”

Morality and Values in Support of Universal Healthcare Must be Enshrined in Law; Comment on “Morality and Markets in the NHS”

And, at the same time the government is doing all it can to shake our faith in the NHS, that it will be there when we need it. It uses the constant cry of an aging population, lack of affordability or blames the public for inappropriate use of services and rising expectations. All of these are in their own way shibboleths. It is proximity to death not age that determines cost. It is the market that increases the transaction costs and makes healthcare unaffordable. It is services that are contracting, while needs may well be staying constant. And as for inappropriate use of services, NHS England recently claimed that 40% of all admissions to A and E in England were unnecessary – on the basis that people had been discharged without treatment. The claim was used to justify closure of A and E units and reorganization. The president of the Royal College of Emergency Medicine investigated those figures and a subsequent report suggested the figures were incorrect and that fewer than 15% of these could be seen elsewhere, i.e. in general practice.
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Acute upper gastrointestinal bleeding: using quality data for operational and clinical improvement

Acute upper gastrointestinal bleeding: using quality data for operational and clinical improvement

determines the level of anesthetic support. After the procedure, the patients are admitted or transferred back to their institution. Our practice is to perform EGD before discharge on all patients who have AUGIB and then, decide to, admit, discharge or transfer. In order to identify whether interventions might improve quality of care, the authors prospectively collected data, to investigate the outcomes of these patients and correlate them to the all process of care. We took several important steps: the first retrospective clinical audit, twelve months after the model's implementation, demonstrated weak adherence to important aspects of care and highlighted the areas that required improvement. In 2010, clinical guidelines, including safe transfer practice, for AUGIB were implemented and spread among all the northern institutions, whatever their level of care. They were reviewed and approved by the directors of all gastroenterology departments and published (I Pedroto and F Magro. Gestão Clínica da Hemorragia Digestiva Alta: Normas de Orientação Clínica. Conselho Diretivo da ARS-Norte, 2010). Also, check sheets have been updated; the pilot test showed that the first was too long, with a large number of items; now a simple check sheet, that separates the process into sub steps, is fulfilled for all the bleeding patients: time of contact, time of arrival, hemodynamics, risk stratification, medication, time of endoscopy, time of discharge; nurses do part of this job. Data are filled out by the attending physician. The URGES' coordinator is responsible for checking the standardized-item list. The complete 30 days follow-up was ensured by analysis of the electronic database or by direct telephone contact.
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Use of performance indicators to assess the solid waste management of health services

Use of performance indicators to assess the solid waste management of health services

Modern society faces serious challenges, among them, the complexity of environmental problems. Thus, there are several possible sources of environmental degradation, however, the waste produced by health services have an important peculiarity due to its toxic or pathogenic characteristics, since when managed improperly provide also health risk public. The involvement of solid waste from healthcare services environmental impact integrates matters a little more complex, because in addition to environmental health, they also interfere with the healthiness of environments that generate, with the consequences of nosocomial infections, occupational health and public. Thus, the management has become an urgent need, especially when we see no use of performance indicators management in healthcare environments in the city of São Mateus, ES. For this, we used the Analytic Hierarchy Process Method to prioritize such indicators as the potential improvement in health services waste management process - WHS and thus environmental analysis was performed with the use of a template for SWOT analysis. The results showed that the performance indicator training strategies developed with employees has the greatest potential to assist in improvements in WHS (Health Services Waste) management process followed indicator knowledge of the regulations associated with procedures performed by employees and importance of biosafety regulations.
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Assessment of Information Technology and Data Communication and Management within Community Health Services in Jakarta

Assessment of Information Technology and Data Communication and Management within Community Health Services in Jakarta

The computer world is growing with a new approach in software development. Software patent has been recognized and implemented in the United States, while in Indonesia the protection of IPR (Intellectual Property Rights) still encounter problems because of the high rate of piracy of software product. Another approach is the Free Software Foundation, which support the GNU Public License (for software or tools known as GNU), as well as other groups who pioneered copyleft, copywrong, public domain, and the like. Currently, one popular approach is the open source approach, in which the source code of an application or software package may be obtained or viewed by the public, even though the source code is not necessarily public domain. The example of well-known open source software such as the Linux (operating system), Apache (web server), PERL, Java, PHP (application tools), MySQL (database server) and many others.
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Health services system in Dominica

Health services system in Dominica

The Ministry of Health in Dominica ment of an increasingly decentralized four- has made significant progress, particu- tier health system and community involve- la[r]

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The impact of drugs on health costs: national and international problems

The impact of drugs on health costs: national and international problems

designed to control drug costs and their impact upon total health costs in.. any nation of the Region.[r]

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