Health as a consumption object: research notes and preliminary investigation

Through the processes of commodification and marketization, materials and human activities are brought within the domain of market exchange. The results of these accelerating processes are observed in the consumer culture centred on objects of consumption. We contend that, in addition to healthcare, health itself has become yet another object incorporated within consumption space. This contention is consistent with the perspective of consumption as the dominant social paradigm in the structuring of health and healthcare practices. In this paper we present the conceptual backdrop for our contentions, together with details of a heuristic study. Our findings support the view that people regard health as a consumption object. Furthermore, the evidence suggests a patterning of responses by social grade and gender. Given our wider interest in class‐based health inequalities, we use our results to comment on the broader policy debate concerning this phenomenon in relation to consumerism.     

Examining Public Hospital Service Failure: The Influence of Service Failure Type,Service Expectations,and Attribution on Consumer Response

This study investigates three independent variables; types of service failure, service expectations, and attribution on postfailure responses in healthcare. A between-subjects 3?×?2?×?2 experimental design using written scenarios was used. The findings demonstrate that customer responses to service failures in hospitals are extensively influenced by the type of service failure, the level of service expectation of the provider, and, to a lesser extent, the controllability of the cause of the failure. Core service failures lead to greater increases in negative responses for satisfaction, emotional, and behavioral responses than supplementary service failure with high service expectations protecting the provider against overall dissatisfaction, negative word-of-mouth, and switching behaviors. Interestingly, perceived high controllability leads to greater dissatisfaction but not to increased negative emotional or behavioral responses. The study applies attribution theory to explain the results. The article concludes with managerial implications.     

Measuring the Perceived Quality of Professional Business Services

Professional firms serving business clients are recognizing the need for improved quality services. Unfortunately, measures of professional service quality have proven difficult to develop. This paper reports on the use of SERVQUAL, an instrument commonly used to assess consumer perceptions of service quality. This instrument was employed with a sample of business owners who were asked to rate the quality of service received from their accounting firm. Although several dimensions of the scale proved useful, additional quality related factors emerged from the analysis.     

Impact of heart failure on hospital activity and healthcare costs in Belgium

Summary

Heart failure (HF) is a serious public health problem worldwide. It has a high prevalence, affects mainly the elderly and causes high mortality or disability with high economic costs. The aim of the present study was to calculate the number of admissions for HF, the total in-hospital stay, the mean length of in-hospital stay and the in-hospital costs due to HF in Belgium.

Retrospective analysis of data from the national hospital registration system provided the following results. In 2001, there were 19,398 admissions with HF as a primary diagnosis, with a total in-hospital stay of 286,938 days. The mean in-hospital stay for HF was 14.8 days. The total in-hospital cost of HF as a primary diagnosis was € 94,113,827, representing 1.8% of the total hospital expenditure.

The limitations of this study are its mere focus on admissions and their characteristics in 2001, and the use of a retrospective analysis. Nevertheless, it led to the conclusion that HF was responsible for a significant number of in-hospital days, with a significant impact on healthcare costs in Belgium.     

Evaluating the length of stay and value of time in a pediatric emergency department with two models by comparing two different albuterol delivery systems

Abstract

Objective:

Asthma is one of the most common childhood illnesses and accounts for a substantial amount of pediatric emergency department visits. Historically, acute exacerbations are treated with a beta agonist via nebulizer therapy (NEB). However, with the advent of the spacer, the medication can be delivered via a metered dose inhaler (MDI?+?S) with the same efficacy for mild-to-moderate asthma exacerbations. To date, no study has been done to evaluate emergency department (ED) length of stay (LOS) and opportunity cost between nebulized vs MDI?+?S. The objective of this study was to compare ED LOS and associated opportunity cost among children who present with a mild asthma exacerbation according to the delivery mode of albuterol: MDI?+?S vs NEB.

Methods:

A structured, retrospective cross-sectional study was conducted. Medical records were reviewed from children aged 1–18 years treated at an urban pediatric ED from July 2007 to June 2008 with a discharge diagnosis International Classification of Disease-9 of asthma. Length of stay was defined: time from initial triage until the time of the guardian signature on the discharge instructions. An operational definition was used to define a mild asthma exacerbation; those patients requiring only one standard weight based albuterol treatment. Emergency department throughput time points, demographic data, treatment course, and delivery method of albuterol were recorded.

Results:

Three hundred and four patients were analyzed: 94 in the MDI?+?S group and 209 in the NEB group. Mean age in years for the MDI?+?S group was 9.57 vs 5.07 for the NEB group (p?<?0.001). The percentage of patients that received oral corticosteroids was 39.4% in the MDI?+?S group vs 61.7% in the NEB group (p?<?0.001). There was no difference between groups in: race, insurance status, gender, or chest radiographs. The mean ED LOS for patients in the MDI?+?S group was 170 minutes compared to 205 minutes in the NEB group. On average, there was a 25.1 minute time savings per patient in ED treatment time (p?<?0.001; 95% CI?=?3.8–31.7). Significant predictors of outcome for treatment time were chest radiograph, steroids, and treatment mode. Opportunity cost analysis estimated a potential cost savings of $213,532 annually using MDI?+?S vs NEB.

Conclusion:

In mild asthma exacerbations, administering albuterol via MDI?+?S decreases ED treatment time when compared to administering nebulized albuterol. A metered dose inhaler with spacer utilization may enhance opportunity cost savings and decrease the left without being seen population with improved throughput.

Limitations:

The key limitations of this study include its retrospective design, the proxy non-standard definition of mild asthma exacerbation, and the opportunity cost calculation, which may over-estimate the value of ED time saved based on ED volume.     

Prevalence and cost of hospital medical errors in the general and elderly United States populations

Abstract

Objective:

The primary objective of this study was to quantify the differences in the prevalence rate and costs of hospital medical errors between the general population and an elderly population aged ≥65 years.

Methods:

Methods from an actuarial study of medical errors were modified to identify medical errors in the Premier Hospital Database using data from 2009. Visits with more than four medical errors were removed from the population to avoid over-estimation of cost. Prevalence rates were calculated based on the total number of inpatient visits.

Results:

There were 3,466,596 total inpatient visits in 2009. Of these, 1,230,836 (36%) occurred in people aged ≥ 65. The prevalence rate was 49 medical errors per 1000 inpatient visits in the general cohort and 79 medical errors per 1000 inpatient visits for the elderly cohort. The top 10 medical errors accounted for more than 80% of the total in the general cohort and the 65+ cohort. The most costly medical error for the general population was postoperative infection ($569,287,000). Pressure ulcers were most costly ($347,166,257) in the elderly population.

Limitations:

This study was conducted with a hospital administrative database, and assumptions were necessary to identify medical errors in the database. Further, there was no method to identify errors of omission or misdiagnoses within the database.

Conclusions:

This study indicates that prevalence of hospital medical errors for the elderly is greater than the general population and the associated cost of medical errors in the elderly population is quite substantial. Hospitals which further focus their attention on medical errors in the elderly population may see a significant reduction in costs due to medical errors as a disproportionate percentage of medical errors occur in this age group.     

A real-world analysis of healthcare costs and relative risk of hyperprolactinemia associated with antipsychotic treatments in the United States

Abstract

Aims: Antipsychotic medications are associated with an increased risk of hyperprolactinemia, but differ in their propensity to cause this complication. This study aimed to assess the economic burden of hyperprolactinemia, and to compare its risk among adult patients using atypical antipsychotics (AAs) with a mechanism of action associated with no/low vs high/moderate prolactin elevation.

Methods: This retrospective cohort study was based on US Commercial and Medicaid claims databases. Healthcare costs were compared between matched hyperprolactinemia and hyperprolactinemia-free cohorts using a two-part model. Risk of hyperprolactinemia was compared between patients receiving AAs with a mechanism of action associated with no/low (no/low prolactin elevation cohort) vs high/moderate prolactin elevation (high/moderate prolactin cohort) using logistic regression.

Results: In the commercially insured sample, compared to the hyperprolactinemia-free cohort (n?=?499), the hyperprolactinemia cohort (n?=?499) was associated with incremental total healthcare costs of $5,732 ($20,081 vs $14,349; p?=?.004), and incremental medical costs of $3,861 ($13,218 vs $9,357; p?=?.040), mainly driven by hyperprolactinemia-related costs. In the Medicaid-insured sample, compared to the hyperprolactinemia-free cohort, the hyperprolactinemia cohort was associated with incremental total healthcare costs of $10,773 ($30,763 vs $19,990; p?=?.004), and incremental medical costs of $9,246 ($20,859 vs $11,613; p?=?.004), mainly driven by hyperprolactinemia-related and mental health-related costs. The odds of hyperprolactinemia in the no/low prolactin elevation cohort were 4–5-times lower than that in the high/moderate prolactin elevation cohort (odds ratio =0.21; p?<?.001).

Limitations: Hyperprolactinemia may be under-reported in claims data.

Conclusions: Hyperprolactinemia is associated with substantial healthcare costs. AAs associated with no/low prolactin elevation reduce the risk of hyperprolactinemia by 4–5-times compared to AAs associated with moderate/high prolactin elevation. Treatment options with minimal impact on prolactin levels may contribute to reducing hyperprolactinemia burden in AA-treated patients.     

Assessing performance and value-creation capabilities in Lean healthcare: insights from a case study

ABSTRACT

Lean thinking is increasingly being applied worldwide. Yet its actual impact is still a puzzle, particularly when a ‘full-implementation approach’—which entails the adoption of a strategic approach to Lean dissemination on policy deployment procedures—is used. Focusing on the healthcare sector, this paper presents and tests a comprehensive measurement framework for Lean interventions. The paper explains how Lean testing can help decision-makers to solve managerial issues related to Lean initiatives.     

商业健康保险推行社区健康保障服务模式可行性探讨

本文从分析社区医疗保障现状、其面对的主要问题及其主要原因出发,认为社区医疗体系的发展需要商业健康保险介入,并有针对性地分析了商业健康保险介入社区医疗体系发展的意义、保障模式选择、多方面作用和多角度可行性,详细阐述了商业健康保险介入社区医疗领域的主要思路。