Improving the delivery of clinic care

There has been an increasingly widespread movement toward the delivery of health care in outpatient settings. Hospitals must start to prepare for the shift from inpatient to outpatient services. Reductions in reimbursement and increasing costs will force hospitals to collect and obtain more data on outpatient services. Projecting future demands and assessing current utilization rates are two of the key factors in maintaining stability. This article is a case study of a major urban medical center's outpatient clinic. It includes a summary of observations on the clinic's daily operations and several recommendations for improvement. While the original analysis was highly specific to the actual facility observed, this article has been structured so that it may be applied to other institutions.     

Is hospital competition wasteful?

Recent attention has been given to the hypothesis that local hospital competition takes the form of costly duplication of specialized services--the "medical arms race." This contrasts with the hypothesis that the supply of specialized services is determined solely by "the extent of the market." We develop a model predicting the provision of specialized services in local markets. Our analysis of California hospitals provides minimal support for the medical arms race hypothesis while suggesting substantial scale economies for many services. Our results emphasize the importance of properly specifying the extent of the market. Failure to do so leads one to overestimate the importance of competition.     

Into the twenty-first century with British households

"This paper takes [U.K.] General Household Survey (GHS) data at the micro level and ages these households by simulation to the year 2001. Differing scenarios are considered in order to accommodate high and low variants of each household type in the British household distribution."     

Population,labour force and unemployment in Andalusia: prospects for 1993

"This paper is concerned with forecasting population, employment, labour force and unemployment in Andalusia [Spain] to 1993. For this purpose, a block-recursive demoeconomic model is presented. The demographic submodel is based on the component-cohort method of forecasting population by age and sex. The economic submodel uses econometric and time series analysis to forecast employment both in the medium and short-term. In the labour market part, the labour force is forecasted taking into account the encouraged-discouraged worker effects of changes in the demand for labour."     

Protecting the ozone layer

Stratospheric ozone layer depletion has been recognized as a problem by the Vienna Convention for the Protection of the Ozone Layer and the 1987 Montreal Protocol (MP). The ozone layer shields the earth from harmful ultraviolet radiation (UV-B), which is more pronounced at the poles and around the equator. Industrialized countries have contributed significantly to the problem by releasing chlorofluorocarbons (CFCs) and halons into the atmosphere. The effect of these chemicals, which were known for their inertness, nonflammability, and nontoxicity, was discovered in 1874. Action to deal with the effects of CFCs and halons was initiated in 1985 in a 49-nation UN meeting. 21 nations signed a protocol limiting ozone depleting substances (ODS): CFCs and halons. Schedules were set based on each country's use in 1986; the target phaseout was set for the year 2000. The MP restricts trade in ODSs and weights the impact of substances to reflect the extent of damage; i.e., halons are 10 times more damaging than CFCs. ODS requirements for developing countries were eased to accommodate scarce resources and the small fraction of ODS emissions. An Interim Multilateral Fund under the Montreal Protocol (IMFMP) was established to provide loans to finance the costs to developing countries in meeting global environmental requirements. The IMFMP is administered by the World Bank, the UN Environmental Program, and the UN Development Program. Financing is available to eligible countries who use .3 kg of ODS/person/year. Rapid phaseout in developed countries has occurred due to strong support from industry and a lower than expected cost. Although there are clear advantages to rapid phaseout, there were no incentives included in the MP for rapid phaseout. Some of the difficulties occur because the schedules set minimum targets at the lowest possible cost. Also, costs cannot be minimized by a country-specific and ODS-specific process. The ways to improve implementation in scheduling and incremental costs are indicated.     

Second opinion programs: continued savings from nonconfirmed surgeries

A second opinion program for elective surgery was one of the first tools utilized by employers to "manage" health care costs. These authors argue that second opinion programs continue to demonstrate their usefulness as part of overall health care cost-management effort.     

How to implement competitive-cost benchmarking

Companies in the cost- and price-conscious commodity field can achieve clear bottom-line gains through a detailed assessment of competitive alternates for use in purchasing negotiations, price setting, and development priorities.