Relation between physician characteristics and prescribing for elderly people in New Brunswick. (33/43)

OBJECTIVE: To determine whether there is a relation between physician characteristics and prescribing for elderly patients. DESIGN: Descriptive study linking two provincial databases. SETTING: New Brunswick. PARTICIPANTS: All general practitioners (GPs) in New Brunswick who ordered at least 200 prescriptions for elderly beneficiaries of the New Brunswick Prescription Drug Program between Apr. 1, 1990, and Mar. 31, 1991; eligible GPs accounted for 376 (40%) of all physicians with a general licence in New Brunswick. MAIN OUTCOME MEASURES: GPs' personal and professional characteristics (age, sex, family practice accreditation, country of training and number of years in practice), practice characteristics (number of practice days, number of patients seen and medical services provided per day, average amount of billing per patient, total number of patients seen and their average age, and total amount of billings) and number of prescriptions by category of drug. RESULTS: High prescribers and low prescribers did not differ significantly in age, number of years in practice, mean practice size or patient age. Compared with the low prescribers the high prescribers were more likely to be male, have been trained in Canada and be qualified by the Canadian College of Family Physicians. Also, they had more practice days, saw more patients per day, performed more services per day, billed more per patient and billed on average 30% more during the study period. Overall, the high prescribers ordered on average 45% more prescriptions than the low prescribers. CONCLUSION: There is a significant relation between certain physician characteristics and prescribing behaviour. Further study is required to examine the relation between these variables and patient outcomes.  (+info)

A clinical economics workstation for risk-adjusted health care cost management. (34/43)

This paper describes a healthcare cost accounting system which is under development at Duke University Medical Center. Our approach differs from current practice in that this system will dynamically adjust its resource usage estimates to compensate for variations in patient risk levels. This adjustment is made possible by introducing a new cost accounting concept, Risk-Adjusted Quantity (RQ). RQ divides case-level resource usage variances into their risk-based component (resource consumption differences attributable to differences in patient risk levels) and their non-risk-based component (resource consumption differences which cannot be attributed to differences in patient risk levels). Because patient risk level is a factor in estimating resource usage, this system is able to simultaneously address the financial and quality dimensions of case cost management. In effect, cost-effectiveness analysis is incorporated into health care cost management.  (+info)

Reducing demand for physician visits through public education: a look at the pilot cold-and-flu campaign in London, Ontario. (35/43)

OBJECTIVE: To estimate the effect of the Ontario Ministry of Health's pilot public-education campaign launched in London, Ont., on Jan. 15, 1994, to reduce the number of visits to physicians' offices because of cold and flu symptoms. DESIGN: Before-after comparison of claims to the Ontario Health Insurance Plan. OUTCOME MEASURES: Physician billings for visits because of cold and flu symptoms and total billings for all types of visits during the 2 months before and after the start of the campaign, and during the same two periods in the previous year, in London and in the rest of Ontario. RESULTS: By the time the campaign was started, much of the cold and flu season was already over for that winter. Still, the decrease in billings for visits because of cold and flu symptoms in the 2 months after the campaign was introduced was 6% greater in London than in the rest of Ontario. There was virtually no difference in total billings between London and the rest of the province during the same period. CONCLUSION: The modest relative reduction in physician billings for visits because of cold or flu symptoms in London following the introduction of the public-education campaign may have been due to the intervention as well as to other factors.  (+info)

The role of employee flexible spending accounts in health care financing. (36/43)

Employee flexible spending accounts for health care represent one component of the current health care financing system that merits serious reform. These accounts create a system of undesirable incentives, force employees and employers to take complicated gambles, reduce tax revenues, and fail to meet their purported policy objectives. This paper describes shortcomings in these accounts from both a theoretical and an empirical perspective. Some proposed alternatives; including medical spending accounts and zero balance accounts, resolve many of these concerns but not all of them.  (+info)

Desktop system for accounting, audit, and research in A&E. (37/43)

The development of a database for audit, research, and accounting in accident and emergency (A&E) is described. The system uses a desktop computer, an optical scanner, sophisticated optical mark reader software, and workload management data. The system is highly flexible, easy to use, and at a cost of around 16,000 pounds affordable for larger departments wishing to move towards accounting. For smaller departments, it may be an alternative to full computerisation.  (+info)

Budget management. (38/43)

Budgetary responsibility gives you more control. Take time to master the fine detail, ask questions of your management and finance colleagues about anything you do not understand (you will not lose face), and develop the skills of lateral thinking and creative accountancy. Even if your budget is repeatedly overspent do not take it personally, ensure that management are aware of it and have a good night's sleep. Do not worry about it.  (+info)

Use and abuse of the medical loss ratio to measure health plan performance. (39/43)

This paper examines the use and abuse of the medical loss ratio in the contemporary health care system and health policy debate. It begins with a survey of the ways in which the medical loss ratio has been interpreted to be something it is not, such as a measure of quality or efficiency. It then analyzes key organizational features of the emerging health care system that complicate measures of financial performance, including integration between payers and providers, diversification of payers across multiple products and distribution channels, and geographic expansion across metropolitan and state lines. These issues are illustrated using medical loss ratios from a range of nonprofit and for-profit health plans. The paper then sketches a strategy for improving the public's understanding of health plan performance as an alternative to continued reliance on the flawed medical loss ratio. This strategy incorporates data on structure and process, service quality, and financial performance.  (+info)

Cost advantages of an ad hoc angioplasty strategy. (40/43)

OBJECTIVES: We sought to determine the cost advantage of a strategy of same-sitting diagnostic catheterization and percutaneous transluminal coronary angioplasty (PTCA) (ad hoc) in comparison with staged PTCA. BACKGROUND: It is widely assumed that an ad hoc strategy lowers costs by reducing the length of hospital stay (LOS). However, this assumption has not been examined in a contemporary data set. METHODS: We studied 395 patients undergoing PTCA during 6 consecutive months. Cost analysis was performed using standard cost-accounting methods and a mature cost-accounting system. Costs were examined within three clinical strata based on the indication for PTCA (stable angina, unstable angina and after myocardial infarction [MI]). RESULTS: For the entire patient cohort, there was no significant cost advantage of an ad hoc approach within any of the strata, although there was a nonsignificant trend toward an ad hoc approach in patients with stable angina. For patients treated with conventional balloon PTCA alone, the lack of a significant difference between ad hoc and staged strategies persisted. For patients who received stents, there was a significant cost advantage of an ad hoc approach in all three clinical strata. An important cost driver was the occurrence of complications. Differences in the rates of complications did not reach statistical significance between ad hoc and staged strategies, but even a small trend toward greater complications in patients who had the ad hoc strategy negated cost and LOS advantages. Our study had the power to detect significant cost differences of $1,300 for patients with stable angina, $2,100 for patients with unstable angina and $2,500 for post-MI patients. It is possible that we failed to detect smaller cost advantages as significant. CONCLUSIONS: A cost savings with an ad hoc strategy of PTCA could not be consistently demonstrated. The cost advantage of an ad hoc approach may be most readily realized in clinical settings where the intrinsic risks are low (e.g., stable angina) or in which the device used carries a reduced risk of complications (e.g., stenting), because even a small increase in the complication rate will negate any financial advantage of an ad hoc approach.  (+info)