Errors in health care management: what do they cost?
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BACKGROUND: Iatrogenic injuries are relatively common and a potentially avoidable source of morbidity. The economic evaluation of this area has been limited by the lack of good quality national data to provide an estimate of incidence, associated disability, and preventability of iatrogenic injuries. Two recent surveys, the Quality in Australian Health Care Study (QAHCS) and the Utah Colorado Study (UTCOS), have now made this feasible. AIMS: To determine the direct costs associated with iatrogenic injuries occurring in a hospital setting. METHODS: The QAHCS was used as a representative national source of information on the incidence, disability, and preventability of iatrogenic injuries. Costs were calculated using information from Australian disease related groups (AN-DRGs) relative to the injury categories. RESULTS: The cost of just 12 preventable iatrogenic injuries is significant (0.25 million US dollars) and accounts for 2-3% of the annual budget of a typical Australian community based hospital of 120 beds. Costing data provide additional useful information for policy and decision makers. CONCLUSION: Costing iatrogenic injuries is an important component of the impact of these events. An ongoing national database of iatrogenic injuries is necessary to assist in identifying the incidence of these injuries, monitoring trends, and providing data for cost estimates and economic evaluations. (+info)
Inadequate health insurance: costs and consequences.
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CONTEXT: Changes in the healthcare marketplace have begun to test the nature and adequacy of health insurance. The complex nature of insurance is driving us away from the notion that there are 2 distinct groups - the insured and the uninsured - toward an idea that insurance is best represented along a continuum, from the very well insured to the chronically uninsured, with a wide range of quality of coverage in between. OBJECTIVE: The objective of this study was to examine the experiences of insured adults as they try to get needed healthcare and balance the payment for these services against other basic needs. DESIGN: Using data from the Commonwealth Fund 1999 Survey of Workers' Health Insurance, the study analyzes the cost and access problems of insured adults by a number of different variables including income, plan satisfaction, health status, and insurance stability. RESULTS: Bivariate results indicate that insured adults with low incomes and those reporting fair or poor health are more likely to experience problems getting and paying for healthcare. These groups are also more likely to have problems paying for basic living expenses. CONCLUSIONS: The most essential notion of insurance is that it will provide protection against financial risk and assurance that we can get healthcare services when we are sick. Yet, we find substantial proportions of low- and modest-income, insured adults who struggle to afford insurance premiums; we also find that their insurance plans do not provide them with either access to care when needed or financial protection from the cost of that care. (+info)
The cost of integrating hepatitis B virus vaccine into national immunization programmes: a case study from Addis Ababa.
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National programmes of hepatitis B virus (HBV) vaccination are recommended by the World Health Organization for all countries. Countries suffering the highest burden of HBV disease are those most needy of universal vaccination, but are frequently of very low income and resources for health care are scarce. The introduction of HBV vaccination would inevitably stretch these resources further even with support of donor agencies. Thus an assessment of the cost-effectiveness of HBV vaccination is desirable to assist in decision making about resource allocation. We describe here a method for estimating the additional costs of introducing HBV vaccination into the Expanded Programme on Immunization (EPI) at a national level. Of fundamental importance is that this method enables costs to be assessed prior to the introduction of vaccination. We illustrate the method using a study carried out at the sub-national level, in the city of Addis Ababa, Ethiopia, but which can be expanded countrywide. The method, in brief, involved the use of a number of questionnaires which could be used to estimate the costs associated with the EPI programme from a large sample of the static clinics as well as from central sources. Since unit costs were collected along with the quantities of resources used and estimates of the capacity used for certain facilities (such as refrigerators), the additional cost of introducing HBV vaccine could be estimated largely by extrapolation of the resources used in vaccinating against diphtheria/pertussis/tetanus vaccine (which, similar to HBV vaccine, requires three doses). The estimation of costs is only part of the information required to make decisions on resource allocation, and should be used in association with measures of the burden of disease due to the infection in the community and effectiveness of the control programme at reducing this burden. The prediction of the latter, based upon a sound epidemiological understanding of the infection, is the subject of a forthcoming paper. (+info)
The costs of HIV/AIDS care at government hospitals in Zimbabwe.
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According to official figures, HIV infection in Zimbabwe stood at 700 000-1 000 000 in 1995, representing 7-10% of the population, with even higher expected numbers in 2000. Such high numbers will have far reaching effects on the economy and the health care sector. Information on costs of treatment and care of HIV/AIDS patients in health facilities is necessary in order to have an idea of the likely costs of the increasing number of HIV/AIDS patients. Therefore, the present study estimated the costs per in-patient day as well as per in-patient stay for patients in government health facilities in Zimbabwe with special emphasis on HIV/AIDS patients. Data collection and costing was done in seven hospitals representing various levels of the referral system. The costs per in-patient day and per in-patient stay were estimated through a combination of two methods: bottom-up costing methodology (through an in-patient note review) to identify the direct treatment and diagnostic costs such as medication, laboratory tests and X-rays, and the standard step-down costing methodology to capture all the remaining resources used such as hospital administration, meals, housekeeping, laundry, etc. The findings of the study indicate that hospital care for HIV/AIDS patients was considerably higher than for non-HIV/AIDS patients. In five of the seven hospitals visited, the average costs of an in-patient stay for an HIV/AIDS patient were found to be as much as twice as high as a non-HIV/AIDS patient. This difference could be attributed to higher direct costs per in-patient day (medication, laboratory tests and X-rays) as well as longer average lengths of stay in hospital for HIV/AIDS patients compared with non-infected patients. Therefore, the impact on hospital services of increasing number of HIV/AIDS patients will be enormous. (+info)
Complications of warfarin therapy: causes, costs, and the role of the anticoagulation clinic.
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CONTEXT: Anticoagulation with warfarin requires careful management to avoid hemorrhage or thrombosis. The anticoagulation clinic has been suggested as a mechanism to reduce complications related to anticoagulation. OBJECTIVE: To report our experience with anticoagulation complications, the cost of subsequent care, and the role of the anticoagulation clinic. DESIGN: Sequential patients who were receiving warfarin within a period of 4 months were followed to identify warfarin-related adverse events. An independent examiner reviewed medical records to determine whether events were preventable and to identify possible causes. Hospital-based accounting data were used to determine attributable costs. PATIENTS: 306 patients who received warfarin prescriptions at a rural Vermont university-affiliated VA hospital with an established anticoagulation clinic. RESULTS: 91% (278) of patients received follow-up at the anticoagulation clinic, and the remaining 9% (28) were followed by VA physicians without involving the anticoagulation clinic. A total of 12 patients had adverse events associated with either sub- or supratherapeutic international normalized ratios, with an attributable cost of approximately $90,000; 8 of these patients were not enrolled in the anticoagulation clinic. Thus, the estimated relative risk for adverse events for patients not at the clinic, compared with those who were, was almost 20 (95% CI, 6.4 to 61.8). Review of the remaining 4 patients revealed that their problems were attributable either to missed appointments or lack of coordination between other providers and the anticoagulation clinic. CONCLUSIONS: Establishing an anticoagulation clinic is only the first step toward reducing complications related to anticoagulation. The larger challenge is ensuring that patients use the anticoagulation clinic and that providers communicate with it. Our results suggest that our institution could invest considerable resources to meet this challenge and still save money. (+info)
Economic considerations in overactive bladder.
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Many costs are associated with overactive bladder (OAB). They include direct costs, such as those associated with treatment, diagnosis, routine care, and the consequences of the disease; indirect costs of lost wages and productivity; and intangible costs associated with pain, suffering, and decreased quality of life. Quantification of all these costs is essential for establishing the total economic burden of a disease on society. Currently, the total economic burden of OAB is unknown. However, various studies have determined that the economic burden of urinary incontinence, one of the symptoms of OAB, is substantial. It is also important to establish the economic impact of various interventions for OAB. Cost-minimization, cost-outcome, cost-utility, and cost-benefit models can be used for these analyses. The most difficult aspect of evaluating the economic impact of a treatment is estimating the intangible costs. (+info)
Modelling strategies for reducing pharmaceutical costs in hospital.
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OBJECTIVE: To describe drug utilization and cost in a large hospital and to compare the impact of different strategies on cost associated with drug prescribing. DESIGN: Retrospective data on drug utilization and cost, linked to patient clinical data and prescriber data from November 1998 were analyzed and modelled. MAIN OUTCOME MEASURES: Impact of different strategies for cost control. SETTING: A large hospital in Sydney, Australia. RESULTS: The mean cost of drugs per episode of care was 28 Australian dollars. Of all drug costs, 79% was incurred by medical units and 14% by surgical units. Oncology accounted for 42% and inpatients for 91% of drug costs. Although section-100 (S-100) drugs incurred a high cost (640 dollars) per episode of care, there were only 41 episodes where S-100 drugs (expensive, restricted drugs) were used, and the total cost of S-100 drugs was only 3.7% of the total cost to the hospital. Antibiotics were the most commonly prescribed drug category, prescribed in 14% of all hospital episodes, and accounting for 14% of total drug costs. Anti-ulcer drugs were the next most costly group, accounting for 7% of total drug costs. A 20% reduction in use of antibiotics would save four times that (233,832 dollars pa) of a 20% reduction in use of S-100 drugs (61,392 dollars pa). DISCUSSION: Our study suggests that reducing inappropriate use of high volume drugs such as antibiotics could be more effective in optimising health facility drug budgets than attempts concentrating solely on reducing use of high cost drugs alone. Moreover our study suggests that systematic measurement of drug utilisation patterns is a key element of drug cost control strategies. (+info)
Using costing as a district planning and management tool in Balochistan, Pakistan.
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This paper reports on two studies in the province of Balochistan, Pakistan, analyzing the costs of primary care facilities and district and divisional hospitals. There are no known previous cost studies within Balochistan and the information gained is a critical element in developing a more rational allocation of resources within the health sector. The results demonstrate both the high level of under-funding of primary care within the health sector and the current inefficiency of allocation towards primary care and, within budgets, between different line items. Medicines in particular are significantly under-funded at the expense of staffing costs. The results are of use in developing more bottom-up budgeting systems within a more rational resource allocation system that is being developed as an element of the more decentralized health system towards which the province is working. (+info)