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Activity-based costing in radiology. Application in a pediatric radiological unit.

https://arctichealth.org/en/permalink/ahliterature32870
Source
Acta Radiol. 2000 Mar;41(2):189-95
Publication Type
Article
Date
Mar-2000
Author
J. Laurila
I. Suramo
M. Brommels
E M Tolppanen
P. Koivukangas
P. Lanning
G. Standertskjöld-Nordenstam
Author Affiliation
Department of Radiology, Oulu University Hospital, Finland.
Source
Acta Radiol. 2000 Mar;41(2):189-95
Date
Mar-2000
Language
English
Publication Type
Article
Keywords
Child
Cost Savings
Costs and Cost Analysis
Health Care Rationing - economics
Hospital Costs - statistics & numerical data
Humans
Pediatrics - economics
Radiology Department, Hospital - economics
Time and Motion Studies
Abstract
PURPOSE: To get an informative and detailed picture of the resource utilization in a radiology department in order to support its pricing and management. MATERIAL AND METHODS: A system based mainly on the theoretical foundations of activity-based costing (ABC) was designed, tested and compared with conventional costing. The study was performed at the Pediatric Unit of the Department of Radiology, Oulu University Hospital. The material consisted of all the 7,452 radiological procedures done in the unit during the first half of 1994, when both methods of costing where in use. Detailed cost data were obtained from the hospital financial and personnel systems and then related to activity data captured in the radiology information system. RESULTS: The allocation of overhead costs was greatly reduced by the introduction of ABC compared to conventional costing. The overhead cost as a percentage of total costs dropped to one-fourth of total costs, from 57% to 16%. The change of unit costs of radiological procedures varied from -42% to +82%. CONCLUSION: Costing is much more detailed and precise, and the percentage of unspecified allocated overhead costs diminishes drastically when ABC is used. The new information enhances effective departmental management, as the whole process of radiological procedures is identifiable by single activities, amenable to corrective actions and process improvement.
PubMed ID
10741796 View in PubMed
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The added value of thorough economic evaluation of telemedicine networks.

https://arctichealth.org/en/permalink/ahliterature150016
Source
Eur J Health Econ. 2010 Feb;11(1):45-55
Publication Type
Article
Date
Feb-2010
Author
Myriam Le Goff-Pronost
Claude Sicotte
Author Affiliation
Telecom-Bretagne, Ecole Supérieure des Télécommunications de Bretagne, (LUSSI)/MARSOUIN/CREM, Département LUSSI, Logiques des Usages, Sciences Sociales et Sciences de l'Information, GET/ENST-Bretagne, Technopôle de Brest Iroise, CS 83818, 29238, Brest Cedex 3, France. myriam.legoff@telecom-bretagne.eu
Source
Eur J Health Econ. 2010 Feb;11(1):45-55
Date
Feb-2010
Language
English
Publication Type
Article
Keywords
Cardiology - economics - organization & administration
Child
Cost-Benefit Analysis
Hospitals, Community - economics
Hospitals, Teaching - economics
Humans
Models, Economic
Pediatrics - economics - organization & administration
Quebec
Retrospective Studies
Social Welfare
Telemedicine - economics - organization & administration
Abstract
This paper proposes a thorough framework for the economic evaluation of telemedicine networks. A standard cost analysis methodology was used as the initial base, similar to the evaluation method currently being applied to telemedicine, and to which we suggest adding subsequent stages that enhance the scope and sophistication of the analytical methodology. We completed the methodology with a longitudinal and stakeholder analysis, followed by the calculation of a break-even threshold, a calculation of the economic outcome based on net present value (NPV), an estimate of the social gain through external effects, and an assessment of the probability of social benefits. In order to illustrate the advantages, constraints and limitations of the proposed framework, we tested it in a paediatric cardiology tele-expertise network. The results demonstrate that the project threshold was not reached after the 4 years of the study. Also, the calculation of the project's NPV remained negative. However, the additional analytical steps of the proposed framework allowed us to highlight alternatives that can make this service economically viable. These included: use over an extended period of time, extending the network to other telemedicine specialties, or including it in the services offered by other community hospitals. In sum, the results presented here demonstrate the usefulness of an economic evaluation framework as a way of offering decision makers the tools they need to make comprehensive evaluations of telemedicine networks.
PubMed ID
19562393 View in PubMed
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Alternative funding plans: is there a place in academic medicine?

https://arctichealth.org/en/permalink/ahliterature221368
Source
CMAJ. 1993 Apr 1;148(7):1141-6
Publication Type
Article
Date
Apr-1-1993
Author
R H Haslam
N E Walker
Author Affiliation
Department of Paediatrics, University of Toronto, Ont.
Source
CMAJ. 1993 Apr 1;148(7):1141-6
Date
Apr-1-1993
Language
English
Publication Type
Article
Keywords
Academic Medical Centers - economics - organization & administration
Budgets
Child
Evaluation Studies as Topic
Faculty, Medical
Financing, Government - methods - trends
Hospital Departments - economics - organization & administration
Hospitals, Pediatric - economics
Humans
Medical Staff, Hospital - economics
Ontario
Organizational Innovation
Public Health Administration
Salaries and Fringe Benefits
Abstract
Because of shrinking resources and the resulting threat to its academic vitality the Department of Paediatrics, Hospital for Sick Children, University of Toronto, entered into an agreement on alternative funding with the Ontario Ministry of Health in 1990. The department developed a set of principles that guided the negotiations, which ultimately led to a budget that formed the basis of the agreement. The contract with the ministry provides a global budget to the department; this budget funds faculty members, administrative staff and the educational and research programs formerly supported by fee-for-service billing to the Ontario Health Insurance Plan. The alternative funding plan has provided financial stability to the department and affords an opportunity to develop innovative and cost-effective models of pediatric care.
Notes
Comment In: CMAJ. 1993 Sep 1;149(5):536-78364807
Comment In: CMAJ. 1993 Apr 1;148(7):1127-98457952
PubMed ID
8457954 View in PubMed
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An economic evaluation of home care for children with newly diagnosed diabetes: results from a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature205981
Source
Med Care. 1998 Apr;36(4):586-98
Publication Type
Article
Date
Apr-1998
Author
G E Dougherty
L. Soderstrom
A. Schiffrin
Author Affiliation
Intensive Ambulatory Care Service, Montreal Children's Hospital, and Department of Pediatrics, McGill University, Québec, Canada.
Source
Med Care. 1998 Apr;36(4):586-98
Date
Apr-1998
Language
English
Publication Type
Article
Keywords
Adolescent
Child
Child Health Services - economics
Child, Preschool
Cost of Illness
Diabetes Mellitus, Type 1 - diagnosis - economics - therapy
Female
Health Care Costs - statistics & numerical data
Home Care Services, Hospital-Based - economics
Hospitalization - economics
Hospitals, Pediatric - economics
Humans
Male
Program Evaluation
Quebec
Treatment Outcome
Abstract
This study was undertaken to determine the health and cost effects of using home care to treat newly diagnosed Type I diabetic children rather than traditional inpatient hospital care. There had been no well-designed evaluations of home care for such children, and very few for children with other health conditions.
Sixty-three children seen at the Montreal Children's Hospital were randomly assigned at diagnosis to home care or traditional inpatient care. The children in the former group were discharged once their metabolic condition stabilized; insulin adjustments and teaching were done in their homes by a trained nurse. The children in the latter group remained hospitalized for insulin adjustments and teaching. All were followed for 24 months. The cost effects were estimated using hospital and parental data.
Social costs were only $48 higher with home care. It had little effect on social costs, because the increased costs of health care services with home care ($768) were largely offset by parental cost savings ($720). Home care improved the children's metabolic outcomes without adversely affecting their psychosocial outcomes.
Using home care to reduce hospital stays for children with newly diagnosed Type I diabetes improved the children's health outcomes without significantly increasing social costs.
PubMed ID
9544598 View in PubMed
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Are children's hospitals an idea whose time has come and gone?

https://arctichealth.org/en/permalink/ahliterature221045
Source
CMAJ. 1993 May 15;148(10):1774-8
Publication Type
Article
Date
May-15-1993
Author
P P Morgan
L. Cohen
Source
CMAJ. 1993 May 15;148(10):1774-8
Date
May-15-1993
Language
English
Publication Type
Article
Keywords
Adolescent
Canada
Child
Hospital Planning
Hospitals, Pediatric - economics - organization & administration
Humans
Notes
Comment In: CMAJ. 1993 Sep 15;149(6):788-9; author reply 7928374833
Comment In: CMAJ. 1993 Sep 15;149(6):787-8; author reply 7928374832
Comment In: CMAJ. 1993 Sep 15;149(6):789, 7928374835
Comment In: CMAJ. 1993 Sep 15;149(6):789; author reply 7928374834
Comment In: CMAJ. 1993 Sep 15;149(6):787; author reply 7928374831
Comment In: CMAJ. 1993 Sep 15;149(6):7928374836
PubMed ID
8485681 View in PubMed
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Baseline status of paediatric oncology care in ten low-income or mid-income countries receiving My Child Matters support: a descriptive study.

https://arctichealth.org/en/permalink/ahliterature92673
Source
Lancet Oncol. 2008 Aug;9(8):721-9
Publication Type
Article
Date
Aug-2008
Author
Ribeiro Raul C
Steliarova-Foucher Eva
Magrath Ian
Lemerle Jean
Eden Tim
Forget Caty
Mortara Isabel
Tabah-Fisch Isabelle
Divino Jose Julio
Miklavec Thomas
Howard Scott C
Cavalli Franco
Author Affiliation
Department of Oncology and International Outreach Program, St Jude Children's Research Hospital, Memphis, TN 38105, USA. raul.ribeiro@stjude.org
Source
Lancet Oncol. 2008 Aug;9(8):721-9
Date
Aug-2008
Language
English
Publication Type
Article
Keywords
Child
Child Health Services - economics - standards
Child Welfare - economics
Child, Preschool
Cross-Sectional Studies
Developing Countries
Female
Financial Support
Health Care Surveys
Health Expenditures
Humans
Income
Infant
Male
Medical Oncology - economics - organization & administration - standards
Neoplasms - mortality - therapy
Pediatrics - economics - standards
Program Evaluation
Risk assessment
Socioeconomic Factors
Survival Analysis
Abstract
BACKGROUND: Childhood-cancer survival is dismal in most low-income countries, but initiatives for treating paediatric cancer have substantially improved care in some of these countries. The My Child Matters programme was launched to fund projects aimed at controlling paediatric cancer in low-income and mid-income countries. We aimed to assess baseline status of paediatric cancer care in ten countries that were receiving support (Bangladesh, Egypt, Honduras, Morocco, the Philippines, Senegal, Tanzania, Ukraine, Venezuela, and Vietnam). METHODS: Between Sept 5, 2005, and May 26, 2006, qualitative face-to-face interviews with clinicians, hospital managers, health officials, and other health-care professionals were done by a multidisciplinary public-health research company as a field survey. Estimates of expected numbers of patients with paediatric cancer from population-based data were used to project the number of current and future patients for comparison with survey-based data. 5-year survival was postulated on the basis of the findings of the interviews. Data from the field survey were statistically compared with demographic, health, and socioeconomic data from global health organisations. The main outcomes were to assess baseline status of paediatric cancer care in the countries and postulated 5-year survival. FINDINGS: The baseline status of paediatric oncology care varied substantially between the surveyed countries. The number of patients reportedly receiving medical care (obtained from survey data) differed markedly from that predicted by population-based incidence data. Management of paediatric cancer and access to care were poor or deficient (ie, nonexistent, unavailable, or inconsistent access for most children with cancer) in seven of the ten countries surveyed, and accurate baseline data on incidence and outcome were very sparse. Postulated 5-year survival were: 5-10% in Bangladesh, the Philippines, Senegal, Tanzania, and Vietnam; 30% in Morocco; and 40-60% in Egypt, Honduras, Ukraine, and Venezuela. Postulated 5-year survival was directly proportional to several health indicators (per capita annual total health-care expenditure [Pearson's r(2)=0.760, p=0.001], per capita gross domestic product [r(2)=0.603, p=0.008], per capita gross national income [r(2)=0.572, p=0.011], number of physicians [r(2)=0.560, p=0.013] and nurses [r(2)=0.506, p=0.032] per 1000 population, and most significantly, annual government health-care expenditure per capita [r(2)=0.882, p
Notes
Comment In: Lancet Oncol. 2008 Aug;9(8):703-418672209
PubMed ID
18672210 View in PubMed
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Characteristics and quality of pediatric cost-utility analyses.

https://arctichealth.org/en/permalink/ahliterature130061
Source
Qual Life Res. 2012 Oct;21(8):1315-25
Publication Type
Article
Date
Oct-2012
Author
Seija K Kromm
Jennifer Bethell
Ferne Kraglund
Sarah A Edwards
Audrey Laporte
Peter C Coyte
Wendy J Ungar
Author Affiliation
Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
Source
Qual Life Res. 2012 Oct;21(8):1315-25
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Canada
Child
Child Welfare - economics - psychology
Child, Preschool
Cost-Benefit Analysis
Decision Support Techniques
Female
Humans
Infant
Infant, Newborn
Linear Models
Male
Pediatrics - economics
Quality of Health Care - economics
Questionnaires
Registries
Time Factors
Abstract
Measuring utility for cost-utility analysis (CUA) is challenging in children. The objectives were to characterize pediatric CUAs, appraise their quality, and identify determinants of higher quality.
Descriptive data were imported from the PEDE database for 305 pediatric CUAs published from 1997 to 2009, and quality was rated using the Pediatric Quality Appraisal Questionnaire (PQAQ) in 213 studies. The impact on quality of publication year, journal type, and whether utility was measured was analyzed using multiple regression.
CUAs increased over time and the largest proportion was from North America (38%). Children aged 1-12 years (39%) and preventative interventions (51%) were studied most frequently. Whereas a societal perspective was most common in papers published before 2007 (49%), a third-party payer perspective was subsequently most frequent (63%). Utility was measured prospectively in 8% of studies. Domains that demonstrated the poorest quality were Perspective, Costs and resource use, Outcomes, Analysis, Incremental analysis and Conflict of interest. Quality increased significantly over time for most domains and was greater in studies published in methods/health economic journals.
The quality of pediatric CUAs is increasing. Few studies ascertain utility prospectively, suggesting the need for better instruments for pediatric health state valuation and measurement.
PubMed ID
22038397 View in PubMed
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Children in need of Pharmacare: medication funding requests at the Toronto Hospital for Sick Children.

https://arctichealth.org/en/permalink/ahliterature186005
Source
Can J Public Health. 2003 Mar-Apr;94(2):121-6
Publication Type
Article
Author
Wendy J Ungar
Carolyn Daniels
Ted McNeill
Mahdie Seyed
Author Affiliation
Division of Population Health Sciences, Hospital for Sick Children, Toronto, ON. wendy.ungar@sickkids.ca
Source
Can J Public Health. 2003 Mar-Apr;94(2):121-6
Language
English
Publication Type
Article
Keywords
Child
Financing, Organized
Health Services Accessibility - economics
Health services needs and demand
Health Services Research
Hospitals, Pediatric - economics
Humans
Insurance, Pharmaceutical Services - economics
Medical Assistance
Medically Uninsured
National Health Programs
Ontario
Pharmacy Service, Hospital - economics - utilization
Program Evaluation
Public Sector
Retrospective Studies
Social Class
Abstract
Although a national Pharmacare program ensuring access to and affordability of needed medications has repeatedly been cited as a priority to policymakers, 20% of families remain either uninsured or under-insured. The Hospital for Sick Children's Patient Amenities Fund (PAF) covers out-of-pocket medication expenses for inpatient and outpatient children. The research objectives were to 1) examine family demographics and socio-economic status (SES), the types of medications requested and government program process issues of PAF applicants in 1998 and 1999, and 2) describe trends in PAF requests from 1998 to 2000.
Data were extracted retrospectively from fund requests, charts and social work and discharge planning reports. Descriptive statistics were used to summarize the data and to examine time trends.
Eighty-six applicants submitted 112 requests from 1998-1999. Most were for children with cancer, neurological disorders and transplant patients. Medication expenditures were 22,408 dollars in 1999, a 39% increase over 1998. Most requests came from two-parent nuclear families where one or both parents were employed. High deductibles, waiting time, application form complexity and request denials were cited as problems encountered with government drug plans.
The findings suggest that for provinces that do not provide universal drug insurance programs, relying on a patchwork of government plans and community agencies may not be effective in ensuring easy and timely access to necessary medications for children.
PubMed ID
12675168 View in PubMed
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Comparative cost analysis of myringotomy with insertion of ventilation tubes in Ontario and British Columbia.

https://arctichealth.org/en/permalink/ahliterature205786
Source
J Otolaryngol. 1998 Apr;27(2):69-75
Publication Type
Article
Date
Apr-1998
Author
P C Coyte
C V Asche
E. Ho
T. Brassard
J. Friedberg
Author Affiliation
Department of Health Administration, Institute for Policy Analysis, University of Toronto, Ontario.
Source
J Otolaryngol. 1998 Apr;27(2):69-75
Date
Apr-1998
Language
English
Publication Type
Article
Keywords
British Columbia
Child, Preschool
Clinical Protocols
Cost-Benefit Analysis
Direct Service Costs - statistics & numerical data
Hospital Costs - statistics & numerical data
Hospitals, Pediatric - economics
Humans
Middle Ear Ventilation - economics - methods
Ontario
Otitis Media - surgery
Residence Characteristics
Abstract
The purpose of this study was to conduct a comparative cost analysis of myringotomy with insertion of ventilation tube (MVT) for children performed at two regional paediatric centres: The Hospital for Sick Children, and the British Columbia Children's Hospital.
Comparative cost analysis.
The Hospital for Sick Children (HSC), Toronto, and the British Columbia Children's Hospital (BCCH), Vancouver.
The cost analysis was performed from a health system perspective using a treatment protocol developed through a review of the literature and input from staff from each of the study hospitals. MVT cost estimates were derived, including direct treatment costs and overhead costs.
Total costs per MVT case (in 1994 Canadian dollars: Cdn$ 1.00 approximately US$ 0.75) varied from $390.81 at BCCH to $455.63 at HSC. Regional variations in physician costs accounted for almost 70% of the difference in MVT case costs. The distribution of nonphysician MVT case costs were similar in each study hospital, with direct (nonphysician) surgical costs, preoperative assessment and recovery room costs, and administration accounting for 30%, 26%, and 44% of total nonphysician costs, respectively.
This study identified the magnitude and determinants of regional variations in the cost of MVT surgery. Such cost estimates serve as an important (but not the sole) ingredient in service cost-effectiveness deliberations and in the formulation of evidence-based care when health care resources are scarce.
PubMed ID
9572455 View in PubMed
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48 records – page 1 of 5.