Simulation model for planning renal services in a district health authority.
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OBJECTIVE: To investigate the use of a computer simulation model in planning and budgeting for renal replacement services. SETTING: Regional renal unit. RESULTS: The simulation provided projections that accurately reflected the actual numbers of people maintained on different forms of renal replacement therapy in previous years. Projections up to the end of the century showed that with no change in the demand for the service the total number of people on the renal replacement programme would increase by 40%. Increasing the uptake of new patients from 40 per million to 55 per million would mean an increase of 66% in patient numbers over the same period. Similarly, at present day prices the cost of providing the service would rise by 31% with no change in demand and by twice this with the greater uptake of new patients. Increasing the number of transplant operations was shown to offer little prospect of a reduction in these costs. CONCLUSION: The simulation program could be used by individual renal units to evaluate different treatment policies and to budget for resource use. Even at current demand levels resource requirements for renal replacement therapy will continue to grow until after the end of the century. (+info)
On the abolishment of the case manager.
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Stabilizing clients in the midst of a psychotic episode in the hospital can be a difficult task that requires a multidisciplinary team. The task of helping those persons to live stable lives of decent quality after they leave the hospital is at least as difficult, and much more complex. Thus, it is not surprising that the case management model, which is not multidisciplinary and is available only on weekdays, is inadequate to deliver well-integrated, constantly available services to difficult clients. The effect on clients is that few are receiving adequate rehabilitation, and many are unstable and frequently rehospitalized. The effect on the system is that a large portion of the mental health budget goes to hospital care, frustrating attempts to reallocate dollars to develop comprehensive services in the community. (+info)
Should public policy seek to control the growth of health care spending?
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Debate about whether to restrain health care spending is intensifying. Much of the debate revolves around efficient research allocation. The possible impact of cost control on the advance of medical technology merits more attention. Public and private efforts to slow growth of health spending have not enjoyed much success. Most recently, managed care failed because administrators lacked political legitimacy. Politically established budget limits can hold down spending, but the United States seems unwilling to adopt them; even if it were, the technology to administer them rationally does not exist. In this situation, efforts to hold down cost growth carry grave risks. (+info)
AHCPR and the changing politics of health services research.
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The Agency for Health Care Policy and Research has had a turbulent history. Created with little opposition in 1989, it narrowly escaped being eliminated in 1995, only to be reauthorized (with a new mandate and name--the Agency for Healthcare Research and Quality, or AHRQ) with overwhelming support in 1999. In focusing on budgetary history, this paper sheds light on why health services research (HSR) has difficulty obtaining funding from a government that is willing to spend vast sums on basic biomedical research. The paper argues that three strategies--bureaucratic, marketing, and constituency building--that advocates adopted in the late 1980s made HSR more visible and consequential and were responsible for AHCPR's budgetary successes as well as its near-demise. (+info)
An insider's perspective on the near-death experience of AHCPR.
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The story of AHCPR's struggle with Congress to remain a federal agency is an example of the longer struggle health services research (HSR) has had to hold a priority in the federal budget. But from another perspective, the growth of HSR has been substantial, albeit an up-and-down experience. Its survival during the turbulent years of 1995-1996 is attributed to a fundamental restructuring of its program priorities and building a new base of support from major health care associations and leaders. A fortunate sequence of events also contributed to the reversal of what could have been a cataclysmic occurrence for the field of HSR. (+info)
European food availability databank based on household budget surveys: the Data Food Networking initiative.
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BACKGROUND: There is a need in Europe for sources of dietary data that would provide a regular flow of comparable nutrition information. In this context, the Data Food Networking (DAFNE) project has been developing a cost-effective food databank that allows monitoring of food availability within and between countries. METHODS: The DAFNE project has developed a common classification system for the food and socio-demographic variables recorded in the national household budget surveys. Daily individual food availability was estimated for each participating country and basic descriptive statistics were used to depict the nutritional habits of the populations. RESULTS: The DAFNE databank is freely accessible through DafneSoft (www.nut.uoa.gr). Three figures, based on Greek, Norwegian and UK data respectively, were selected to indicatively present the potential of the DAFNE data in order to monitor changes in the availability of 12 food groups over time; to study the effect of education in the total added lipid availability; and to follow time changes in fresh vegetable availability between manual and non-manual households. CONCLUSION: The HBS data allows the highlighting of issues related to nutrition surveillance. The application of the DAFNE methodology in developing a databank of standardized dietary data offers a realistic option for monitoring dietary habits in Europe. Benefiting from this potential, the European Union may additionally consider the undertaking of a pan-European individual dietary survey, in a sub-sample of the household budget population. (+info)
Pharmacy benefit forecast for a new interferon Beta-1a for the treatment of multiple sclerosis: development of a first-line decision tool for pharmacy-budget planning using administrative claims data.
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OBJECTIVE: To estimate the incremental change in pharmacy per-member-permonth (PMPM) costs, according to various formulary designs, for a new interferon beta-1a product (IB1a2) using administrative claims data. METHODS: Cross-sectional sex- and age-specific disease prevalence and treatment rates for relapsing, remitting multiple sclerosis (RRMS) patients were measured using integrated medical and pharmacy claims data from a 500,000- member employer group in the southern United States. Migration to IB1a2 from other drugs in the class was based on market-share data for new and existing RRMS patients. Duration of therapy was estimated by analyzing claims for current RRMS therapies. Daily therapy cost was provided by the manufacturer of IB1a2, adjusted for migration from other therapies, and multiplied by estimated volume to predict incremental and total PMPM cost impact. Market-share estimates were used to develop a PMPM cost forecast for the next 2 years. PMPM cost estimates were calculated for preferred (copayment tier 2) and nonpreferred (copayment tier 3) formulary designs with and without prior authorization (PA). One-way sensitivity analysis was performed to assess the influence of product pricing, duration of therapy, and other market factors. RESULTS: Annual incremental PMPM change was $0.047 for the scenario of third copayment tier with PA. The incremental change was greatest for those aged 55 to 65 years ($0.056 PMPM) and did not vary greatly by benefit design. Duration of therapy had the greatest impact on the PMPM estimate across benefit designs. CONCLUSION: IB1a2 will not cause a significant change in managed care pharmacy budgets under a variety of formulary conditions, according to this crosssectional analysis of current care-seeking behavior by RRMS patients. Economic impact may differ if IB1a2 expands RRMS patients. treatment-seeking behavior. (+info)
Decentralization in Zambia: resource allocation and district performance.
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Zambia implemented an ambitious process of health sector decentralization in the mid 1990s. This article presents an assessment of the degree of decentralization, called 'decision space', that was allowed to districts in Zambia, and an analysis of data on districts available at the national level to assess allocation choices made by local authorities and some indicators of the performance of the health systems under decentralization. The Zambian officials in health districts had a moderate range of choice over expenditures, user fees, contracting, targeting and governance. Their choices were quite limited over salaries and allowances and they did not have control over additional major sources of revenue, like local taxes. The study found that the formula for allocation of government funding which was based on population size and hospital beds resulted in relatively equal per capita expenditures among districts. Decentralization allowed the districts to make decisions on internal allocation of resources and on user fee levels and expenditures. General guidelines for the allocation of resources established a maximum and minimum percentage to be allocated to district offices, hospitals, health centres and communities. Districts tended to exceed the maximum for district offices, but the large urban districts and those without public district hospitals were not even reaching the minimum for hospital allocations. Wealthier and urban districts were more successful in raising revenue through user fees, although the proportion of total expenditures that came from user fees was low. An analysis of available indicators of performance, such as the utilization of health services, immunization coverage and family planning activities, found little variation during the period 1995-98 except for a decline in immunization coverage, which may have also been affected by changes in donor funding. These findings suggest that decentralization may not have had either a positive or negative impact on services. (+info)