Showing papers in "Inquiry : a journal of medical care organization, provision and financing in 1978"

Simulation-based occupancy recommendations for adult medical/surgical units using admissions scheduling systems.

Abstract: Minimum cost operation of a hospital requires the correct number of beds to meet the de? mand placed on the facility. An excess of beds results in inflated operating and construction costs, while a bed shortage is unacceptable for a variety of reasons, such as the lack of quality care to the community. Several models have been developed and used to assist planners in finding the correct bed size to meet a given demand. These models are inadequate in an environment where stringent cost containment is second only in importance to quality of care. The pre? vious models, such as the Hill-Burton formu? las and the Poisson approximation, are inad? equate because they are incompatible with contemporary admissions scheduling systems. These systems alter the behavior of the census so that analytical models based upon the Pois? son assumption do not fit the results and, along with normative models such as the Hill Burton program, allow too many beds. The implications of the Poisson assumption will be discussed at length here because the contention in the remainder of the paper is that almost any hospital medical/surgical (M/ S) unit should operate well in excess of that model's widely used occupancy recommen? dations. In most cases this also leads to op? eration in excess of the state Hill-Burton rec? ommendations for medical/surgical units, thus Hill-Burton is rejected as a consequence.1 The Poisson assumption for hospital census was first used in the 1940s,2 and has been ap? plied worldwide to determine the size of hos? pital facilities.3 An appealing feature of the Poisson assumption is the simplicity of the parameters; the census mean is equal to the census variance. The factor which has varied from application to application has been the amount of that variance to allow in sizing a particular facility. The first models used from three to four standard deviations which cor? responded to at least the 99.9 percentage point of the Poisson distribution. Later model build? ers reduced this coefficient. One low value used is 2.06 standard deviations, correspond? ing to the 98 percentage point of the normal approximation to the Poisson distribution:

Disenrollment from a prepaid group practice: an actuarial and demographic description.

Abstract: Increases in health care costs during recent years have generated increasing concern over the best method to contain these costs. Focus has developed on the structure and financing of the health delivery system itself. One expression of this focus was the passage of the Health Maintenance Organization Act (P.L. 93-222). An assumption underlying this legis? lation was that reorganization of delivery of health care would contain costs, as well as improve quality. In this context, enrollment in prepaid group practices is of concern in health care planning, both at the community level and among administrators at individual pre? paid group practices. Among these prepaid practices, with several million enrollees, are smaller numbers of groups that have enrolled less than 500,000 Medicaid recipients, mostly in California and New York.1 Enrollment in prepaid plans has been stud? ied for several years. One focus of research has been on reasons why individuals enroll. Most important among the reasons for enroll? ment have been assurance of no out-of-pocket costs,2 recommendations from friends or rel? atives,3 and a large range of available ser? vices.4 The financial benefits of prepaid prac? tice have been particulary attractive to large families and older adults, both of whom have greater concern about costs of health care.5 Reviews of enrollment rates and reasons for joining prepaid groups have been made by Donabedian5 and Roemer and Shonick.6 A re?

Hospital information systems: a current perspective.

Abstract: Management processes in hospitals rely heav? ily upon information. For example, planning, resource allocation, productivity analysis, medical quality control, and program evalua? tion are activities that require relevant, sen? sitive, and timely information. Effective com? munity health planning requires uniform data reporting for purposes of interhospital com? parison. Unfortunately, information systems in hos? pitals have not yet met their potential in pro? viding effective information for management control. Despite considerable investments of time and money, hospital information systems lag well behind their counterparts in the profit oriented sector.1 While there appear to be several factors that cause this lag, the main one seems to be hos? pital managers themselves. Many hospital ad? ministrators simply do not possess the tech? nical knowledge and skills required to understand control processes. As a result, they are not sufficiently involved in the design of information systems for their organizations, particularly the important tasks of setting sys? tem objectives and defining system require? ments. This lack of involvement ultimately leads to lack of use by top management, the final death knell for any system. An information system used regularly by top management for making such key deci? sions as budget allocation will eventually overcome any initial flaws of design and in? stallation.2

Classification of short-term general hospitals for control and equity.

Abstract: The need for classifying the nation's hospitals into homogenous groups has been renewed with the 1972 amendment to the Medicare and Medicaid law. At the same time, new systems have been developed for classifying hospitals. Katherine Bauer1 has prepared a comprehen? sive review and critique of five existing hos? pital classification systems which are of major importance. For classifying hospitals nation? wide, the method used by the Social Security Administration and the cluster analysis ap? proach recently proposed by the American Hospital Association are most prominent.

Elective hysterectomy: a cost-benefit analysis.

Abstract: Data were collected from the Seattle Washington Prepaid Health Care Project in order to analyze the direct costs and direct benefits of elective simple hysterectomy. Within the age range of 30-65 years 1129 women were enrolled with King County Medical/Blue Shield under the Prepaid Health Care Project Plan. The charge data collected over a period from July 1971 through January 1975 were used to compute the annualized age-specific average expenditure per woman for the selected diagnoses. Data on charges for hysterectomies were collected by assessing patient files to obtain hospital charges and by selecting outpatient hysterectomy-specific charges from surgeons anesthesiologists and consultants. The calculations of age-specific costs for outpatient and inpatient treatment of uterine-related ambulatory care ranged from a low of $9 after age 60 to a high of $44 for women age 45-49. For women between the ages of 30 and 55 the costs were stable at approximately $40 per year. The range of inpatient average annual per capita costs was larger. The peak of $88 occurred for women in the 45-49 age group. Women younger than 45 years old incurred costs that ranged from $40-59 whereas women who were older than age 49 incurred costs of $25-$35. The net direct benefit as a result of a hysterectomy was found to be $2735 undiscounted. When discounted at a 3% interest rate the value of the benefit is reduced to $1822. By discounting at a rate of 6.5% the present value becomes $1240. The study findings suggest that very little if any financial benefit would be expected to accrue from the purchase of an elective hysterectomy by or for an asymptomatic woman at 30 years of age.

The economic feasibility of pharmacy patient medication profiles.

Abstract: The product provided by the pharmacist con? sists of services offered and drugs dispensed. In the past, the physical product was empha? sized because most prescriptions required the pharmacist's unique knowledge of how best to combine drug ingredients. However, the ad? vent of prefabrication in the pharmaceutical industry resulted in a steady decline in de? mand for extemporaneously compounded me dicinals,1 and in a reappraisal of the pharma? cist's role in delivering health care. The main thrust of this reappraisal has been to empha? size the pharmacist's convenience and profes? sional services. This paper studies one of the latter class of services. An important professional service rendered by the pharmacist is drug-use monitoring. To deliver this service successfully, the pharma? cist must maintain a record of information rel? evant to the patient's drug therapy.2 Called a "patient medication profile," this record con? tains the patient's name, address, telephone number, birth date, weight, drug allergies, dis? ease states, and other idiosyncracies that might account for untoward drug reactions. It also contains drug-related information such as prescription number, date dispensed, dispens ing pharmacist, prescribing physician, drug name, drug strength, quantity dispensed, price, and over-the-counter drugs used.2 The major reasons for establishing this ser? vice are: 1) The rise in drug interactions; 2) the prevalence of allergic conditions or dis? ease states that may alter drug actions; 3) the rise in patient self-medication. These fac? tors have been cited as leading to injury or death.3-11 When properly used, patient medica? tion profiles have been claimed to involve many costs and benefits. Among the benefits cited are:12"19