Hospital Costs: The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment, etc. Hospital costs are one of the factors which determine HOSPITAL CHARGES (the price the hospital sets for its services).Costs and Cost Analysis: Absolute, comparative, or differential costs pertaining to services, institutions, resources, etc., or the analysis and study of these costs.Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from HEALTH EXPENDITURES, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost.Economics, Hospital: Economic aspects related to the management and operation of a hospital.Length of Stay: The period of confinement of a patient to a hospital or other health facility.Cost Allocation: The assignment, to each of several particular cost-centers, of an equitable proportion of the costs of activities that serve all of them. Cost-center usually refers to institutional departments or services.Hospital Charges: The prices a hospital sets for its services. HOSPITAL COSTS (the direct and indirect expenses incurred by the hospital in providing the services) are one factor in the determination of hospital charges. Other factors may include, for example, profits, competition, and the necessity of recouping the costs of uncompensated care.Cost Control: The containment, regulation, or restraint of costs. Costs are said to be contained when the value of resources committed to an activity is not considered excessive. This determination is frequently subjective and dependent upon the specific geographic area of the activity being measured. (From Dictionary of Health Services Management, 2d ed)Hospitals, University: Hospitals maintained by a university for the teaching of medical students, postgraduate training programs, and clinical research.Cost of Illness: The personal cost of acute or chronic disease. The cost to the patient may be an economic, social, or psychological cost or personal loss to self, family, or immediate community. The cost of illness may be reflected in absenteeism, productivity, response to treatment, peace of mind, or QUALITY OF LIFE. It differs from HEALTH CARE COSTS, meaning the societal cost of providing services related to the delivery of health care, rather than personal impact on individuals.Hospitals, Teaching: Hospitals engaged in educational and research programs, as well as providing medical care to the patients.Drug Costs: The amount that a health care institution or organization pays for its drugs. It is one component of the final price that is charged to the consumer (FEES, PHARMACEUTICAL or PRESCRIPTION FEES).Cost-Benefit Analysis: A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors that are not measured ultimately in economic terms. Cost effectiveness compares alternative ways to achieve a specific set of results.Diagnosis-Related Groups: A system for classifying patient care by relating common characteristics such as diagnosis, treatment, and age to an expected consumption of hospital resources and length of stay. Its purpose is to provide a framework for specifying case mix and to reduce hospital costs and reimbursements and it forms the cornerstone of the prospective payment system.Hospital Bed Capacity, 500 and overHospital Bed Capacity: The number of beds which a hospital has been designed and constructed to contain. It may also refer to the number of beds set up and staffed for use.Hospital Planning: Areawide planning for hospitals or planning of a particular hospital unit on the basis of projected consumer need. This does not include hospital design and construction or architectural plans.Hospitalization: The confinement of a patient in a hospital.Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer.Insurance, Health, Reimbursement: Payment by a third-party payer in a sum equal to the amount expended by a health care provider or facility for health services rendered to an insured or program beneficiary. (From Facts on File Dictionary of Health Care Management, 1988)Hospitals, Urban: Hospitals located in metropolitan areas.Direct Service Costs: Costs which are directly identifiable with a particular service.Hospitals, General: Large hospitals with a resident medical staff which provides continuous care to maternity, surgical and medical patients.Financial Management, Hospital: The obtaining and management of funds for hospital needs and responsibility for fiscal affairs.Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.United StatesInsurance, Hospitalization: Health insurance providing benefits to cover or partly cover hospital expenses.Models, Economic: Statistical models of the production, distribution, and consumption of goods and services, as well as of financial considerations. For the application of statistics to the testing and quantifying of economic theories MODELS, ECONOMETRIC is available.Intermediate Care Facilities: Institutions which provide health-related care and services to individuals who do not require the degree of care which hospitals or skilled nursing facilities provide, but because of their physical or mental condition require care and services above the level of room and board.Hospitals, Proprietary: Hospitals owned and operated by a corporation or an individual that operate on a for-profit basis, also referred to as investor-owned hospitals.Medicare: Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976)Nursing Staff, Hospital: Personnel who provide nursing service to patients in a hospital.Accounting: System of recording financial transactions.Hospitalists: Physicians who are employed to work exclusively in hospital settings, primarily for managed care organizations. They are the attending or primary responsible physician for the patient during hospitalization.Patient Admission: The process of accepting patients. The concept includes patients accepted for medical and nursing care in a hospital or other health care institution.Ancillary Services, Hospital: Those support services other than room, board, and medical and nursing services that are provided to hospital patients in the course of care. They include such services as laboratory, radiology, pharmacy, and physical therapy services.Hospitals, Pediatric: Special hospitals which provide care for ill children.Economic Competition: The effort of two or more parties to secure the business of a third party by offering, usually under fair or equitable rules of business practice, the most favorable terms.Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.Hospitals, District: Government-controlled hospitals which represent the major health facility for a designated geographic area.Patient Readmission: Subsequent admissions of a patient to a hospital or other health care institution for treatment.Hospitals, Special: Hospitals which provide care for a single category of illness with facilities and staff directed toward a specific service.Multi-Institutional Systems: Institutional systems consisting of more than one health facility which have cooperative administrative arrangements through merger, affiliation, shared services, or other collective ventures.Critical Pathways: Schedules of medical and nursing procedures, including diagnostic tests, medications, and consultations designed to effect an efficient, coordinated program of treatment. (From Mosby's Medical, Nursing & Allied Health Dictionary, 4th ed)Recovery Room: Hospital unit providing continuous monitoring of the patient following anesthesia.Operating Rooms: Facilities equipped for performing surgery.Health Resources: Available manpower, facilities, revenue, equipment, and supplies to produce requisite health care and services.Inpatients: Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment.Ownership: The legal relation between an entity (individual, group, corporation, or-profit, secular, government) and an object. The object may be corporeal, such as equipment, or completely a creature of law, such as a patent; it may be movable, such as an animal, or immovable, such as a building.Economics, Medical: Economic aspects of the field of medicine, the medical profession, and health care. It includes the economic and financial impact of disease in general on the patient, the physician, society, or government.Bed Occupancy: A measure of inpatient health facility use based upon the average number or proportion of beds occupied for a given period of time.Surgical Procedures, Elective: Surgery which could be postponed or not done at all without danger to the patient. Elective surgery includes procedures to correct non-life-threatening medical problems as well as to alleviate conditions causing psychological stress or other potential risk to patients, e.g., cosmetic or contraceptive surgery.Health Facility Closure: The closing of any health facility, e.g., health centers, residential facilities, and hospitals.Hospitals, Private: A class of hospitals that includes profit or not-for-profit hospitals that are controlled by a legal entity other than a government agency. (Hospital Administration Terminology, AHA, 2d ed)Time Factors: Elements of limited time intervals, contributing to particular results or situations.Patient Discharge: The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities.Emergency Service, Hospital: Hospital department responsible for the administration and provision of immediate medical or surgical care to the emergency patient.Models, Econometric: The application of mathematical formulas and statistical techniques to the testing and quantifying of economic theories and the solution of economic problems.Prospective Payment System: A system wherein reimbursement rates are set, for a given period of time, prior to the circumstances giving rise to actual reimbursement claims.Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (HEALTH CARE COSTS) and may or may not be shared among the patient, insurers, and/or employers.Intensive Care Units: Hospital units providing continuous surveillance and care to acutely ill patients.Academic Medical Centers: Medical complexes consisting of medical school, hospitals, clinics, libraries, administrative facilities, etc.Outcome Assessment (Health Care): Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure).Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery.Hospitals, Community: Institutions with permanent facilities and organized medical staff which provide the full range of hospital services primarily to a neighborhood area.Cost Sharing: Provisions of an insurance policy that require the insured to pay some portion of covered expenses. Several forms of sharing are in use, e.g., deductibles, coinsurance, and copayments. Cost sharing does not refer to or include amounts paid in premiums for the coverage. (From Dictionary of Health Services Management, 2d ed)Utilization Review: An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use.Cross Infection: Any infection which a patient contracts in a health-care institution.Hospital Departments: Major administrative divisions of the hospital.Health Services Research: The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)Quality of Health Care: The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.Hospitals, Psychiatric: Special hospitals which provide care to the mentally ill patient.Ambulatory Surgical Procedures: Surgery performed on an outpatient basis. It may be hospital-based or performed in an office or surgicenter.Hospital Units: Those areas of the hospital organization not considered departments which provide specialized patient care. They include various hospital special care wards.Hospital Records: Compilations of data on hospital activities and programs; excludes patient medical records.Surgical Procedures, Operative: Operations carried out for the correction of deformities and defects, repair of injuries, and diagnosis and cure of certain diseases. (Taber, 18th ed.)Infant, Newborn: An infant during the first month after birth.Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see LINEAR MODELS) the relationship is constrained to be a straight line and LEAST-SQUARES ANALYSIS is used to determine the best fit. In logistic regression (see LOGISTIC MODELS) the dependent variable is qualitative rather than continuously variable and LIKELIHOOD FUNCTIONS are used to find the best relationship. In multiple regression, the dependent variable is considered to depend on more than a single independent variable.Risk Factors: An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.Laryngeal Diseases: Pathological processes involving any part of the LARYNX which coordinates many functions such as voice production, breathing, swallowing, and coughing.Quality-Adjusted Life Years: A measurement index derived from a modification of standard life-table procedures and designed to take account of the quality as well as the duration of survival. This index can be used in assessing the outcome of health care procedures or services. (BIOETHICS Thesaurus, 1994)Equipment and Supplies, Hospital: Any materials used in providing care specifically in the hospital.Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.Databases, Factual: Extensive collections, reputedly complete, of facts and data garnered from material of a specialized subject area and made available for analysis and application. The collection can be automated by various contemporary methods for retrieval. The concept should be differentiated from DATABASES, BIBLIOGRAPHIC which is restricted to collections of bibliographic references.Efficiency, Organizational: The capacity of an organization, institution, or business to produce desired results with a minimum expenditure of energy, time, money, personnel, materiel, etc.Libraries, Hospital: Information centers primarily serving the needs of hospital medical staff and sometimes also providing patient education and other services.Managed Care Programs: Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.Vascular Surgical Procedures: Operative procedures for the treatment of vascular disorders.Risk Adjustment: The use of severity-of-illness measures, such as age, to estimate the risk (measurable or predictable chance of loss, injury or death) to which a patient is subject before receiving some health care intervention. This adjustment allows comparison of performance and quality across organizations, practitioners, and communities. (from JCAHO, Lexikon, 1994)Outpatient Clinics, Hospital: Organized services in a hospital which provide medical care on an outpatient basis.Surgery Department, Hospital: Hospital department which administers all departmental functions and the provision of surgical diagnostic and therapeutic services.Ambulatory Care: Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility.Medicaid: Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons.Multivariate Analysis: A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables.Follow-Up Studies: Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease.Hospitals, County: Hospitals controlled by the county government.Hospitals: Institutions with an organized medical staff which provide medical care to patients.Insurance, Health: Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.MassachusettsIncidence: The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from PREVALENCE, which refers to all cases, new or old, in the population at a given time.New JerseyInfection Control: Programs of disease surveillance, generally within health care facilities, designed to investigate, prevent, and control the spread of infections and their causative microorganisms.Anti-Bacterial Agents: Substances that reduce the growth or reproduction of BACTERIA.Chi-Square Distribution: A distribution in which a variable is distributed like the sum of the squares of any given independent random variable, each of which has a normal distribution with mean of zero and variance of one. The chi-square test is a statistical test based on comparison of a test statistic to a chi-square distribution. The oldest of these tests are used to detect whether two or more population distributions differ from one another.Age Factors: Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time.Hospital Administration: Management of the internal organization of the hospital.American Hospital Association: A professional society in the United States whose membership is composed of hospitals.Hospital Information Systems: Integrated, computer-assisted systems designed to store, manipulate, and retrieve information concerned with the administrative and clinical aspects of providing medical services within the hospital.CaliforniaFood Service, Hospital: Hospital department that manages and supervises the dietary program in accordance with the patients' requirements.Hospitals, Municipal: Hospitals controlled by the city government.Databases as Topic: Organized collections of computer records, standardized in format and content, that are stored in any of a variety of computer-readable modes. They are the basic sets of data from which computer-readable files are created. (from ALA Glossary of Library and Information Science, 1983)Hospital Mortality: A vital statistic measuring or recording the rate of death from any cause in hospitalized populations.Severity of Illness Index: Levels within a diagnostic group which are established by various measurement criteria applied to the seriousness of a patient's disorder.Risk Assessment: The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988)New YorkPerioperative Period: The time periods immediately before, during and following a surgical operation.Obstetrics and Gynecology Department, Hospital: Hospital department responsible for the administration and management of services provided for obstetric and gynecologic patients.Patient Care Team: Care of patients by a multidisciplinary team usually organized under the leadership of a physician; each member of the team has specific responsibilities and the whole team contributes to the care of the patient.Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor.Surgical Wound Infection: Infection occurring at the site of a surgical incision.Outcome and Process Assessment (Health Care): Evaluation procedures that focus on both the outcome or status (OUTCOMES ASSESSMENT) of the patient at the end of an episode of care - presence of symptoms, level of activity, and mortality; and the process (ASSESSMENT, PROCESS) - what is done for the patient diagnostically and therapeutically.Cardiac Surgical Procedures: Surgery performed on the heart.Hospitals, Religious: Private hospitals that are owned or sponsored by religious organizations.Health Maintenance Organizations: Organized systems for providing comprehensive prepaid health care that have five basic attributes: (1) provide care in a defined geographic area; (2) provide or ensure delivery of an agreed-upon set of basic and supplemental health maintenance and treatment services; (3) provide care to a voluntarily enrolled group of persons; (4) require their enrollees to use the services of designated providers; and (5) receive reimbursement through a predetermined, fixed, periodic prepayment made by the enrollee without regard to the degree of services provided. (From Facts on File Dictionary of Health Care Management, 1988)EnglandLaryngectomy: Total or partial excision of the larynx.Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival.Hospitals, Maternity: Special hospitals which provide care to women during pregnancy and parturition.Nursing Service, Hospital: The hospital department which is responsible for the organization and administration of nursing activities.Laboratories, Hospital: Hospital facilities equipped to carry out investigative procedures.Colectomy: Excision of a portion of the colon or of the whole colon. (Dorland, 28th ed)Hospital Shared Services: Cooperation among hospitals for the purpose of sharing various departmental services, e.g., pharmacy, laundry, data processing, etc.Aortic Aneurysm, Abdominal: An abnormal balloon- or sac-like dilatation in the wall of the ABDOMINAL AORTA which gives rise to the visceral, the parietal, and the terminal (iliac) branches below the aortic hiatus at the diaphragm.Cardiology Service, Hospital: The hospital department responsible for the administration and provision of diagnostic and therapeutic services for the cardiac patient.Hospital Bed Capacity, under 100Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion.Hospital Bed Capacity, 100 to 299Statistics, Nonparametric: A class of statistical methods applicable to a large set of probability distributions used to test for correlation, location, independence, etc. In most nonparametric statistical tests, the original scores or observations are replaced by another variable containing less information. An important class of nonparametric tests employs the ordinal properties of the data. Another class of tests uses information about whether an observation is above or below some fixed value such as the median, and a third class is based on the frequency of the occurrence of runs in the data. (From McGraw-Hill Dictionary of Scientific and Technical Terms, 4th ed, p1284; Corsini, Concise Encyclopedia of Psychology, 1987, p764-5)Laparoscopy: A procedure in which a laparoscope (LAPAROSCOPES) is inserted through a small incision near the navel to examine the abdominal and pelvic organs in the PERITONEAL CAVITY. If appropriate, biopsy or surgery can be performed during laparoscopy.Questionnaires: Predetermined sets of questions used to collect data - clinical data, social status, occupational group, etc. The term is often applied to a self-completed survey instrument.Burns: Injuries to tissues caused by contact with heat, steam, chemicals (BURNS, CHEMICAL), electricity (BURNS, ELECTRIC), or the like.Stroke: A group of pathological conditions characterized by sudden, non-convulsive loss of neurological function due to BRAIN ISCHEMIA or INTRACRANIAL HEMORRHAGES. Stroke is classified by the type of tissue NECROSIS, such as the anatomic location, vasculature involved, etiology, age of the affected individual, and hemorrhagic vs. non-hemorrhagic nature. (From Adams et al., Principles of Neurology, 6th ed, pp777-810)Hospitals, Military: Hospitals which provide care for the military personnel and usually for their dependents.Hospitals, Veterans: Hospitals providing medical care to veterans of wars.Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression.Survival Analysis: A class of statistical procedures for estimating the survival function (function of time, starting with a population 100% well at a given time and providing the percentage of the population still well at later times). The survival analysis is then used for making inferences about the effects of treatments, prognostic factors, exposures, and other covariates on the function.Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment; the overall condition of a human life.Great BritainEmployer Health Costs: That portion of total HEALTH CARE COSTS borne by an individual's or group's employing organization.Health Facility Size: The physical space or dimensions of a facility. Size may be indicated by bed capacity.Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time.Health Care Surveys: Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.Medical Audit: A detailed review and evaluation of selected clinical records by qualified professional personnel for evaluating quality of medical care.Hospitals, AnimalCoronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion.Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures.Referral and Consultation: The practice of sending a patient to another program or practitioner for services or advice which the referring source is not prepared to provide.Patient Transfer: Interfacility or intrahospital transfer of patients. Intrahospital transfer is usually to obtain a specific kind of care and interfacility transfer is usually for economic reasons as well as for the type of care provided.Tertiary Care Centers: A medical facility which provides a high degree of subspecialty expertise for patients from centers where they received SECONDARY CARE.Purchasing, Hospital: Hospital department responsible for the purchasing of supplies and equipment.Nurseries, Hospital: Hospital facilities which provide care for newborn infants.Quality Indicators, Health Care: Norms, criteria, standards, and other direct qualitative and quantitative measures used in determining the quality of health care.Psychiatric Department, Hospital: Hospital department responsible for the organization and administration of psychiatric services.Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time.Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data.Emergency Medical Services: Services specifically designed, staffed, and equipped for the emergency care of patients.Formularies, Hospital: Formularies concerned with pharmaceuticals prescribed in hospitals.Quality Assurance, Health Care: Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps.Oncology Service, Hospital: The hospital department responsible for the administration and provision of diagnostic and therapeutic services for the cancer patient.Blood Vessel Prosthesis Implantation: Surgical insertion of BLOOD VESSEL PROSTHESES to repair injured or diseased blood vessels.Medical Records: Recording of pertinent information concerning patient's illness or illnesses.State Medicine: A system of medical care regulated, controlled and financed by the government, in which the government assumes responsibility for the health needs of the population.Housekeeping, Hospital: Hospital department which manages and provides the required housekeeping functions in all areas of the hospital.Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial.Health Facility Merger: The combining of administrative and organizational resources of two or more health care facilities.Catchment Area (Health): A geographic area defined and served by a health program or institution.

Practice patterns, case mix, Medicare payment policy, and dialysis facility costs. (1/1002)

OBJECTIVE: To evaluate the effects of case mix, practice patterns, features of the payment system, and facility characteristics on the cost of dialysis. DATA SOURCES/STUDY SETTING: The nationally representative sample of dialysis units in the 1991 U.S. Renal Data System's Case Mix Adequacy (CMA) Study. The CMA data were merged with data from Medicare Cost Reports, HCFA facility surveys, and HCFA's end-stage renal disease patient registry. STUDY DESIGN: We estimated a statistical cost function to examine the determinants of costs at the dialysis unit level. PRINCIPAL FINDINGS: The relationship between case mix and costs was generally weak. However, dialysis practices (type of dialysis membrane, membrane reuse policy, and treatment duration) did have a significant effect on costs. Further, facilities whose payment was constrained by HCFA's ceiling on the adjustment for area wage rates incurred higher costs than unconstrained facilities. The costs of hospital-based units were considerably higher than those of freestanding units. Among chain units, only members of one of the largest national chains exhibited significant cost savings relative to independent facilities. CONCLUSIONS: Little evidence showed that adjusting dialysis payment to account for differences in case mix across facilities would be necessary to ensure access to care for high-cost patients or to reimburse facilities equitably for their costs. However, current efforts to increase dose of dialysis may require higher payments. Longer treatments appear to be the most economical method of increasing the dose of dialysis. Switching to more expensive types of dialysis membranes was a more costly means of increasing dose and hence must be justified by benefits beyond those of higher dose. Reusing membranes saved money, but the savings were insufficient to offset the costs associated with using more expensive membranes. Most, but not all, of the higher costs observed in hospital-based units appear to reflect overhead cost allocation rather than a difference in real resources devoted to treatment. The economies experienced by the largest chains may provide an explanation for their recent growth in market share. The heterogeneity of results by chain size implies that characterizing units using a simple chain status indicator variable is inadequate. Cost differences by facility type and the effects of the ongoing growth of large chains are worthy of continued monitoring to inform both payment policy and antitrust enforcement.  (+info)

The economic impact of Staphylococcus aureus infection in New York City hospitals. (2/1002)

We modeled estimates of the incidence, deaths, and direct medical costs of Staphylococcus aureus infections in hospitalized patients in the New York City metropolitan area in 1995 by using hospital discharge data collected by the New York State Department of Health and standard sources for the costs of health care. We also examined the relative impact of methicillin-resistant versus -sensitive strains of S. aureus and of community-acquired versus nosocomial infections. S. aureus-associated hospitalizations resulted in approximately twice the length of stay, deaths, and medical costs of typical hospitalizations; methicillin-resistant and -sensitive infections had similar direct medical costs, but resistant infections caused more deaths (21% versus 8%). Community-acquired and nosocomial infections had similar death rates, but community-acquired infections appeared to have increased direct medical costs per patient ($35,300 versus $28,800). The results of our study indicate that reducing the incidence of methicillin-resistant and -sensitive nosocomial infections would reduce the societal costs of S. aureus infection.  (+info)

Total joint replacement: implication of cancelled operations for hospital costs and waiting list management. (3/1002)

OBJECTIVE: To identify aspects of provision of total joint replacements which could be improved. DESIGN: 10 month prospective study of hospital admissions and hospital costs for patients whose total joint replacement was cancelled. SETTING: Information and Waiting List Unit, Musgrave Park Regional Orthopaedic Service, Belfast. PATIENTS: 284 consecutive patients called for admission for total joint replacement. MAIN MEASURES: Costs of cancellation of operation after admission in terms of hotel and opportunity costs. RESULTS: 28(10%) planned operations were cancelled, 27 of which were avoidable cancellations. Five replacement patients were substituted on the theatre list, leaving 22(8%) of 232 operating theatre opportunities unused. Patients seen at assessment clinics within two months before admission had a significantly higher operation rate than those admitted from a routine waiting list (224/232(97%) v 32/52(62%), x2 = 58.6, df = 1; p < 0.005). Mean duration of hospital stay in 28 patients with cancelled operations was 1.92 days. Operating theatre opportunity costs were 73% of the total costs of cancelled total joint replacements. CONCLUSION: Patients on long waiting lists for surgery should be reassessed before admission to avoid wasting theatre opportunities, whose cost is the largest component of the total costs of cancelled operations.  (+info)

Resource allocation for public hospitals in Andhra Pradesh, India. (4/1002)

The composition of the hospital sector has important implications for cost effectiveness accessibility and coverage. The classification of acute general hospitals is reviewed here with particular reference to India and Andhra Pradesh. Approaches to arrive at a norm for allocation of hospital expenditure among secondary and tertiary hospitals are discussed. The actual allocation of public sector hospital expenditures is analyzed with data from Andhra Pradesh. The shift in allocative emphasis away from hospitals and in favour of primary health care during the 1980s was found to have been equally shared by secondary and tertiary hospitals. The shares of recurrent (non-plan) expenditure to secondary and tertiary hospitals were 51% and 49% respectively. This can be compared to a derived norm of 66% and 33%. The opportunity that new investment funds (plan schemes) could have provided to rectify the expenditure bias against secondary level hospitals was missed as two-thirds of plan expenditure were also spent on tertiary level hospitals. The share of secondary hospital bed capacity was 45.5% against India's Planning Commission norm of 70%. Public spending strategies should explicitly consider what mix of hospital services is being financed as well as the balance between hospital and primary health care expenditures.  (+info)

The influence of day of life in predicting the inpatient costs for providing care to very low birth weight infants. (5/1002)

The purpose of this study was to test, refine, and extend a statistical model that adjusts neonatal intensive care costs for a very low birth weight infant's day of life and birth weight category. Subjects were 62 infants with birth weights below 1,501 g who were born and cared for in a university hospital until discharged home alive. Subjects were stratified into 250-g birth weight categories. Clinical and actual daily room and ancillary-resource costs for each day of care of each infant were tabulated. Data were analyzed by using a nonlinear regression procedure specifying two separate for modeling. The modeling was performed with data sets that both included and excluded room costs. The former set of data were used for generating a model applicable for comparing interhospital performances and the latter for comparing interphysician performances. The results confirm the existence of a strong statistical relationship between an infant's day of life and both total hospital costs and the isolated costs for ancillary-resource alone (P < 0.0001). A refined series of statistical models have been generated that are applicable to the assessment of either interhospital or interphysician costs associated with providing inpatient care to very low birth weight infants.  (+info)

Short-term continuous infusion thrombolytic therapy for occluded central nervous venous dialysis catheters. (6/1002)

The necessity of maintaining a strict schedule of dialysis treatments in patients with chronic renal failure dictates that occluded access catheters be restored to full function in a timely and cost-effective manner. The records of 22 consecutive patients receiving outpatient treatment for occluded hemodialysis catheters at Osteopathic Medical Center of Texas were reviewed by the authors. Each patient had 100,000 units of urokinase in 50 ml normal saline instilled over 30 minutes through the occluded catheter. In most instances the dose was divided to allow 35 ml to the proximal port and 15 ml to the distal port. The maximum sustained blood flow rate on dialysis was recorded for each patient. The mean maximum sustained blood flow rate improved from 150 ml/min +/- 79 ml to 261 ml/min +/- 62 ml. Following infusion, improvement was obtained in 19 of 22 patients, with 14 catheters delivering blood flow greater than 250 ml/min. The total cost per treatment was $316. No adverse events were experienced. Thrombotic occlusion of extended use hemodialysis catheters can be rapidly and safely relieved in a cost-effective manner with little delay in scheduled dialysis treatments.  (+info)

Effects of a computerised protocol management system on ordering of clinical tests. (7/1002)

OBJECTIVE: To assess the effects of a computerised protocol management system on the number, cost, and appropriateness of laboratory investigations requested. DESIGN: A before and after intervention. SETTING: A supraregional liver unit in a teaching hospital. PATIENTS: 1487 consecutive patients admitted during 1990 and 1991 (one year before and one year after introduction of the system). INTERVENTION: Introduction of a computerised protocol management system on 1 January 1991. MAIN MEASURES: The number and cost of clinical chemistry tests requested per patient day. RESULTS: The total number of clinical chemistry tests requested per patient day by the unit declined 17% (p < 0.001, Student's t test) and of out of hours tests requested per patient day from 0.31 to 0.16, 48% (p < 0.001; Mann-Whitney U test), resulting in a 28% reduction (p < 0.001) in direct laboratory expenditure per patient-day. Overall, the number of tests per admission decreased by 24% (p < 0.001; Mann-Whitney U test). CONCLUSION: Use of the computerised protocol management system resulted in closer compliance with the protocols and a significant reduction in the overall level of requesting. IMPLICATIONS: Although similar systems need to be tested in other clinical settings, computerised protocol management systems may be important in providing appropriate and cost effective health care.  (+info)

Developments in total quality management in the United States: the Intermountain Health Care perspective. (8/1002)

In summary our purpose has been to evaluate quality in the following terms. Best process of care--narrowing the variation of care decisions, working towards the best method. Best clinical outcome--decreased morbidity ond mortality. Best patient satisfaction--both for clinical outcome and the process of care. Best value--best value at the lowest cost. At Intermountain Health Care we believe that the best way to achieve the best quality improvement in a health care system is to involve all of the participants--patients, providers, and systems--in employing the principles of total quality management. Patient involvement--in prevention; participating in best care process through education and utilisation; in evaluating functional status before, during, and after intervention; in satisfaction; in clinical outcome and follow up with providers. Provider involvement--in planning, implementing, analysing, and educating; in defining guidelines; in reassessing and defining guidelines; in reassessing and continually modifying the care map, always striving for "best care." System involvement--in providing structure and mechanisms, support staff, and information systems and being willing to focus on quality as a part of its mission. An American philosopher, George Santayana, once said: "What we call the contagious force of an idea is really the force of the people who have embraced it." It will be up to all of us collectively to become the force behind moving quality management principles into the forefront of patient care methodology and ensuring that quality remains as the guiding principle of health care delivery in the future.  (+info)

  • President Donald Trump signed an executive order on Monday afternoon that calls for hospitals to tell patients how much they charge for surgeries and other services. (yahoo.com)
  • The administration hopes to force hospitals and insurers to reveal the prices that they negotiate for services - information that is a closely guarded secret - and to estimate out-of-pocket costs for patients. (yahoo.com)
  • The AHRQ Confidentiality Statute prohibits the use of AHRQ HCUP data to identify any person (including, but not limited to, patients, physicians, and other health care providers) or establishment (including, but not limited to, hospitals). (ahrq.gov)
  • CONCLUSIONS: Early care in agreement with key guidelines recommendations for the management of patients with stroke may be associated with hospital savings. (au.dk)
  • By developing a payer-specific case mix index (CMI) for third-party patients, this paper examined the effect of hospital case mix on hospital cost and revenue for third-party patients in California using the hospital financial and utilization data covering 1986-1998. (ucf.edu)
  • Over time, the differences in coefficients for CMIs in hospital revenue and cost models for third-party patients have become smaller and smaller although those differences are statistically insignificant. (ucf.edu)
  • The rest of the hospital and medical fees are charged to you. (vic.gov.au)
  • Most private health insurance funds offer plans that provide a combination of hospital, general medical and extras cover, depending on what you prefer. (vic.gov.au)
  • According to the article, the three hospitals involved in the ongoing litigation-CentraState Medical Center, Holy Name Medical Center and Valley Hospital-are losing millions of dollars a year and are at risk of having to cut services or merge to stay afloat. (daypitney.com)
  • The longevity and reliability of medical devices is a critical consideration for hospitals to remain profitable and provide the best possible patient care. (devicelongevity.com)
  • Even if your treatment is considered an emergency, the hospital will expect payment for treatment costs, including surgeries, medicines, medical supplies, ambulance transportation, and anything else used to treat you and make you well again. (okmydoc.com)
  • Michael Furey was quoted in an article, " An inside look at how Horizon used hospital costs - and quality - in plan to change N.J. health care ," which was published on NJ.com and also appeared in the July 29 edition of The Star-Ledger under the headline, "Reports: Horizon Skewed Quality, Costs on New Plan. (daypitney.com)
  • Recent studies indicate that approaching death, rather than age, may be the main demographic driver of health care costs. (ox.ac.uk)
  • Compared to the US system, the Canadian system has lower costs, more services, universal access to health care without financial barriers, and superior health status. (okmydoc.com)
  • Introduction: the hospital as the largest health care center of the society allocates a bulk of the sources and credits assigned to the health sector of the country. (uliege.be)
  • Horizon, however, rejected the recommendation and requested McKinsey not consider a hospital's cost of care in making recommendations. (daypitney.com)
  • You are accessing a healthcare data-related website that provides information on use of hospital care. (ahrq.gov)
  • A random effects panel data two-part model shows that approaching death affects costs up to 15 years prior to death. (ox.ac.uk)
  • Note that there is no such thing as free hospital treatment in the U.S. All fees have to be paid for either by you or your insurance company, even in the case of an emergency. (okmydoc.com)
  • Therefore, this research has been carried out for reducing the hospital costs to minimum through the optimization of the nursing force allocation using the Linear programming model in the hospital emergency department. (uliege.be)
  • BACKGROUND: The relationship between processes of early stroke care and hospital costs remains unclear. (au.dk)
  • The relationship between receiving more relevant processes of early stroke care and lower hospital costs followed a dose-response relationship. (au.dk)
  • They are at present taxing the minds of those responsible for administering the hospitals as they try to contain hospital expenditure within the limits of funds made available by the Government. (ohe.org)
  • A senior official, indeed the chief procurement officer of the Department of Public Expenditure and Reform, was both on the development board of the hospital and the finance and procurement subcommittees, with intimate knowledge of the overruns as and when they happened. (sinnfein.ie)
  • Rising hospital costs have caused concern to the public, Government, and Members of Parliament ever since the start of the National Health Service. (ohe.org)
  • Abbas Sheikh Aboumasoudi & Ali Sheikh Aboumasoudi , «Minimizing an important part of hospital costs through the optimal allocation of the number of nursing force to different days of the week using linear programming model», Bulletin de la Société Royale des Sciences de Liège [En ligne], Volume 85 - Année 2016, Actes de colloques, Special edition, 1195 - 1203 URL : https://popups.uliege.be:443/0037-9565/index.php?id=5963. (uliege.be)
  • Conclusion: the Linear programming model can be used as a useful tool for timing and determining the optimal number of employees needed by the various departments of a hospital and reduce costs to minimum. (uliege.be)
  • however, when excluding the costs incurred during the birth admission period, hospital costs of multiples and singletons were comparable. (maastrichtuniversity.nl)
  • Among multiples and singletons, respectively, 90.8 and 76.2% of the total hospital costs were caused by hospital admission days and 8.9 and 25.2% of the total hospital costs during the first 5 years of life occurred after the first year of life. (maastrichtuniversity.nl)
  • Americans get coverage from a profusion of different private and public health plans, which contributes to price variation and reduces negotiating power.That's truer when it comes to hospitals and specialists than anything else because health-plan administrators often have to bargain with highly consolidated hospital systems in any given market. (yahoo.com)