1.An Empirical Analysis of Costs related to Nursing Practice.
Journal of Korean Academy of Nursing Administration 2017;23(2):139-150
PURPOSE: The purpose of this study was to identify nursing service costs associated with all health care costs incurred by the institution. METHODS: This study was an empirical case study research in which the nursing cost was separated from total medical cost. The nursing cost index was calculated through a cost allocation method after summarizing costs for personnel, raw materials and administration of each department in one public hospital. The 2014 budget plan, published in ‘Public Hospitals Alert’, was used as data and the data were analyzed using the Microsoft Office EXCEL 2013 program. RESULTS: When comparing total medical costs and nursing costs, the nursing cost were 27.14% of the total medical cost. The nursing cost per nurse per hour was calculated as ₩29,128 The nursing cost per inpatient per day was calculated as ₩157,970, and the administration cost per patient was calculated as ₩133,710. CONCLUSION: The results of the research present the process of cost allocation of specific cost elements in the hospital and evidence for administrative costs which in the past have been only vaguely formulated. These are the significant implications of this study.
Budgets
;
Cost Allocation
;
Costs and Cost Analysis
;
Health Care Costs
;
Hospital Costs
;
Hospitals, Public
;
Humans
;
Inpatients
;
Methods
;
Nursing Services
;
Nursing*
2.Cost of Tuberculosis Treatment: Evidence from Iran’s Health System.
Vahid BAY ; Payam TABARSI ; Aziz REZAPOUR ; Sima MARZBAN ; Ehsan ZAREI
Osong Public Health and Research Perspectives 2017;8(5):351-357
OBJECTIVES: This study aimed to estimate the cost of smear-positive drug-susceptible pulmonary tuberculosis (TB) treatment of the patients in the Azadshahr district, Golestan Province, Iran. METHODS: In this retrospective study, all new smear positive pulmonary TB patients who had been registered at the district’s health network between April, 2013 and December, 2015 and had successfully completed their treatment were entered into the study (45 patients). Treatment costs were estimated from the provider’s perspective using an activity-based costing (ABC) method. RESULTS: The cost of treating a new smear-positive pulmonary TB patient was US dollar (USD) 1,409.00 (Iranian Rial, 39,438,260), which can be divided into direct and indirect costs (USD 1,226.00 [87%] and USD 183.00 [13%], respectively). The highest cost (58.1%) was related to care and management of TB patients (including 46.1% human resources costs and 12% directly-observed treatment, short course implementation) and then respectively related to hospitalization (12.1%), supportive activity centers (11.4%), transportation (6.5%), medicines (5.3%), and laboratory tests and radiography (3.2%). CONCLUSION: Using disease-specific cost studies can help the healthcare system management to have correct insight into the financial burden created by the disease. This can subsequently be used in prioritization, planning, operational budgeting, economic evaluation of programs, interventions, and ultimately in disease management.
Budgets
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Cost-Benefit Analysis
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Costs and Cost Analysis
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Delivery of Health Care
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Disease Management
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Health Care Costs
;
Hospitalization
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Humans
;
Iran
;
Methods
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Public Health
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Radiography
;
Retrospective Studies
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Transportation
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Tuberculosis*
;
Tuberculosis, Pulmonary
3.Clinical outcomes and economic analysis of two ovulation induction protocols in patients undergoing repeated IVF/ICSI cycles.
Xiao CHEN ; Ling GENG ; Hong LI
Journal of Southern Medical University 2014;34(4):563-567
OBJECTIVETo compare the clinical outcomes and cost-effectiveness of luteal phase down-regulation with gonadotrophin-releasing hormone (GnRH) agonist protocol and GnRH antagonist protocol in patients undergoing repeated in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI) cycles.
METHODSA retrospective analysis of clinical outcomes and costs was conducted among 198 patients undergoing repeated IVF-ICSI cycles, including 109 receiving luteal phase down-regulation with GnRH agonist protocol (group A) and 89 receiving GnRH antagonist protocol (group B). The numbers of oocytes retrieved and good embryos, clinical pregnancy rate, abortion rate, the live birth rate, mean total cost, and the cost-effective ratio were compared between the two groups.
RESULTSIn patients undergoing repeated IVF-ICSI cycles, the two protocols produced no significant differences in the number of good embryos, clinical pregnancy rate, abortion rate, or twin pregnancy rate. Compared with group B, group A had better clinical outcomes though this difference was not statistically significant. The number of retrieved oocytes was significantly greater and live birth rate significantly higher in group A than in group B (9.13=4.98 vs 7.11=4.74, and 20.2% vs 9.0%, respectively). Compared with group B, group A had higher mean total cost per cycle but lower costs for each oocyte retrieved (2729.11 vs 3038.60 RMB yuan), each good embryo (8867.19 vs 9644.85 RMB yuan), each clinical pregnancy (77598.06 vs 96139.85 RMB yuan).
CONCLUSIONFor patients undergoing repeated IVF/ICSI cycle, luteal phase down-regulation with GnRH agonist protocol produces good clinical outcomes with also good cost-effectiveness in spite an unsatisfactory ovarian reserve.
Adult ; Costs and Cost Analysis ; Female ; Humans ; Ovulation Induction ; economics ; methods ; Pregnancy ; Pregnancy Rate ; Retrospective Studies
4.Development and Application of Cost Management Program for Visiting Nursing Centers Using Time-Driven Activity-Based Costing
Journal of Korean Academy of Nursing 2019;49(5):586-600
PURPOSE: This study aimed to develop a web-based cost management program for visiting nursing centers (CMP-VNC), using time-driven activity-based costing (TD-ABC), and to analyze effects of the program. METHODS: The CMP-VNC was developed using the combined prototyping approach and system developing life cycle method following four stages: need analysis with comprehensive literature reviews and focus group interviews, design and development of program algorithm, evaluation of the developed program validity using experts and users group, and application and effects analysis. The non-equivalent control group pretest-posttest design was used to analyze the effects of the program. The program demonstration was conducted for four weeks with 60 visiting nurses in 35 visiting centers. RESULTS: The web-based program was developed. It has five interfaces with basic and special functions using TD-ABC, namely, input, visiting nursing activity, visiting nursing activity cost, cost efficiency, and cost calculation report. The experimental group showed significantly higher cost perception and cost confidence than control group. CONCLUSION: We found that the CMP-VNC can be an effective tool to increase visiting nurses' competency of costing and enhance efficiencies of visiting nursing centers.
Costs and Cost Analysis
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Focus Groups
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Internet
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Life Cycle Stages
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Methods
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Nurses, Community Health
;
Nursing
5.Cost Comparison between Surgical Treatments and Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer in Korea.
Younhee KIM ; Young Woo KIM ; Il Ju CHOI ; Joo Young CHO ; Jong Hee KIM ; Jin Won KWON ; Ja Youn LEE ; Na Rae LEE ; Sang Yong SEOL
Gut and Liver 2015;9(2):174-180
BACKGROUND/AIMS: This study was conducted to evaluate whether medical costs can be reduced using endoscopic submucosal dissection (ESD) instead of conventional surgeries in patients with early gastric cancer (EGC). METHODS: Patients who underwent open gastrectomy (OG), laparoscopy-assisted gastrectomy (LAG), and ESD for EGC were recruited from three medical institutions in 2009. For macro-costing, the medical costs for each patient were derived from the expenses incurred during the patient's hospital stay and 1-year follow-up. The overall costs in micro-costing were determined by multiplying the unit cost with the resources used during the patients' hospitalization. RESULTS: A total of 194 patients were included in this study. The hospital stay for ESD was 5 to 8 days and was significantly shorter than the 12-day hospital stay for OG or the 11- to 17-day stay for LAG. Using macro-costing, the average medical costs for ESD during the hospital stay ranged from 2.1 to 3.4 million Korean Won (KRW) per patient, and the medical costs for conventional surgeries were estimated to be between 5.1 million and 8.2 million KRW. There were no significant differences in the 1-year follow-up costs between ESD and conventional surgeries. CONCLUSIONS: ESD patients had lower medical costs than those patients who had conventional surgeries for EGC with conservative indications.
*Costs and Cost Analysis
;
Dissection/*economics/methods
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Gastrectomy/*economics/methods
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Gastric Mucosa/surgery
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Gastroscopy/*economics/methods
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Humans
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Laparoscopy
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Length of Stay/statistics & numerical data
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Republic of Korea
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Stomach Neoplasms/pathology/*surgery
6.Cost Comparison between Surgical Treatments and Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer in Korea.
Younhee KIM ; Young Woo KIM ; Il Ju CHOI ; Joo Young CHO ; Jong Hee KIM ; Jin Won KWON ; Ja Youn LEE ; Na Rae LEE ; Sang Yong SEOL
Gut and Liver 2015;9(2):174-180
BACKGROUND/AIMS: This study was conducted to evaluate whether medical costs can be reduced using endoscopic submucosal dissection (ESD) instead of conventional surgeries in patients with early gastric cancer (EGC). METHODS: Patients who underwent open gastrectomy (OG), laparoscopy-assisted gastrectomy (LAG), and ESD for EGC were recruited from three medical institutions in 2009. For macro-costing, the medical costs for each patient were derived from the expenses incurred during the patient's hospital stay and 1-year follow-up. The overall costs in micro-costing were determined by multiplying the unit cost with the resources used during the patients' hospitalization. RESULTS: A total of 194 patients were included in this study. The hospital stay for ESD was 5 to 8 days and was significantly shorter than the 12-day hospital stay for OG or the 11- to 17-day stay for LAG. Using macro-costing, the average medical costs for ESD during the hospital stay ranged from 2.1 to 3.4 million Korean Won (KRW) per patient, and the medical costs for conventional surgeries were estimated to be between 5.1 million and 8.2 million KRW. There were no significant differences in the 1-year follow-up costs between ESD and conventional surgeries. CONCLUSIONS: ESD patients had lower medical costs than those patients who had conventional surgeries for EGC with conservative indications.
*Costs and Cost Analysis
;
Dissection/*economics/methods
;
Gastrectomy/*economics/methods
;
Gastric Mucosa/surgery
;
Gastroscopy/*economics/methods
;
Humans
;
Laparoscopy
;
Length of Stay/statistics & numerical data
;
Republic of Korea
;
Stomach Neoplasms/pathology/*surgery
7.Standardized Approaches to Syncope Evaluation for Reducing Hospital Admissions and Costs in Overcrowded Emergency Departments.
Tae Gun SHIN ; June Soo KIM ; Hyoung Gon SONG ; Ik Joon JO ; Min Seob SIM ; Seung Jung PARK
Yonsei Medical Journal 2013;54(5):1110-1118
PURPOSE: The evaluation of syncope is often disorganized and ineffective. The objective of this study was to examine whether implementation of a standardized emergency department (ED) protocol improves the quality of syncope evaluation. MATERIALS AND METHODS: This study was a prospective, non-randomized study conducted at a 1900-bed, tertiary teaching hospital in South Korea. We compared two specific periods, including a 12-month observation period (control group, January-December 2009) and a 10-month intervention period after the implementation of standardized approaches, comprising risk stratification, hospital order sets and establishment of a syncope observational unit (intervention group, March-December 2010). Primary end points were hospital admission rates and medical costs related to syncope evaluation. RESULTS: A total of 244 patients were enrolled in this study (116 patients in the control group and 128 patients in the intervention group). The admission rate decreased by 8.3% in the intervention group (adjusted odds ratio 0.31, 95% confidence interval 0.13-0.70, p=0.005). There was a cost reduction of about 30% during the intervention period [369000 Korean won (KRW), interquartile range (IQR) 240000-602000 KRW], compared with the control period (542000 KRW, IQR 316000-1185000 KRW). The length of stay in the ED was also reduced in the intervention group (median: 4.6 hours vs. 3.4 hours). CONCLUSION: Standardized approaches to syncope evaluation reduced hospital admissions, medical costs and length of stay in the overcrowded emergency department of a tertiary teaching hospital in South Korea.
Adult
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Aged
;
Costs and Cost Analysis
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Crowding
;
Emergency Medical Services/methods/*standards
;
*Emergency Service, Hospital
;
Female
;
*Hospitalization
;
Humans
;
Male
;
Middle Aged
;
Observation
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Prospective Studies
;
Syncope/*diagnosis
8.Operative approaches, indications, and medical economics evaluation of 4180 cases of hysterectomy.
Xian-jie TAN ; Jing-he LANG ; Keng SHEN ; Zhu-feng LIU ; Da-wei SUN ; Jin-hua LENG ; Lan ZHU
Acta Academiae Medicinae Sinicae 2003;25(4):406-409
OBJECTIVETo examine the operative approaches, major indications, and medical economic parameters of the hysterectomy.
METHODSData on hysterectomy performed due to benign gynecological disorders in Peking Union Medical College Hospital (PUMCH) from 1996 to 2001 were reviewed. The cases were classified into three groups according to the operative approaches: total abdominal hysterectomy (TAH), vaginal hysterectomy (VH), and laparoscopic assisted vaginal hysterectomy (LAVH). The major indications, length of hospital stay, operative cost, and total medical cost were analyzed.
RESULTSRecords of 4,180 women who had hysterectomies in PUMCH were examined. Operations included TAH (78.4%), LAVH (13.0%), and VH (8.6%). The use of LAVH increased from 2.4% in 1996 to 17.3% in 2001. The common indications for surgery included uterine leiomyoma (56.2%), adenomyosis (12.2%), benign ovarian tumor (9.2%), genital prolapse (7.7%), endometriosis (6.9%), atypical endometrial hyperplasia (3.0%), and cervical intraepithelial neoplasm (2.0%). The most common indications for TAH and LAVH were uterine leiomyomas and adenomyosis, whereas the most common indication for VH was genital prolapse, followed by uterine leiomyoma. The lengths of hospital stay in TAH, VH, and LAVH were (11.0 +/- 4.9) d, (10.9 +/- 3.9) d, and (8.9 +/- 3.7) d respectively. The total medical cost was (5,666.6 +/- 1,709.4) RMB Yuan for TAH, (5,027.6 +/- 1,067.0) RMB Yuan for VH, and (7,473.8 +/- 1,464.8) RMB Yuan for LAVH.
CONCLUSIONSThe use of LAVH has been increasing. Although the direct medical cost for LAVH is higher than that for TAH, its indirect benefit appeares superior to TAH. The major indications for LAVH and TAH are similar, whereas the indications for VH are different from those for TAH and LAVH.
Costs and Cost Analysis ; Evaluation Studies as Topic ; Female ; Gynecologic Surgical Procedures ; economics ; Humans ; Hysterectomy ; economics ; methods ; Hysterectomy, Vaginal ; Laparoscopy ; Leiomyoma ; surgery ; Uterine Neoplasms ; surgery
9.Fractional Flow Reserve Guided Percutaneous Coronary Intervention Improves Clinical Outcome with Reduced Cost in Contemporary Clinical Practice.
Po HU ; Meng-Yao TANG ; Wen-Chao SONG ; Jun JIANG ; Yong SUN ; Xian-Bao LIU ; Chang-Ling LI ; Xin-Yang HU ; Jian-An WANG ;
Chinese Medical Journal 2015;128(15):2000-2005
BACKGROUNDFractional flow reserve (FFR) is currently considered as the gold standard for evaluating the functional significance of coronary stenosis. However, its potential benefits in real-world practice remain unknown in China. This study aimed to test the hypothesis that the use of FFR is associated with improved outcome and reduced cost in Chinese real-world clinical practice.
METHODSA retrospective cohort study was carried out using the database of Second Affiliated Hospital of Zhejiang University, a tertiary and high-volume center in China. Clinical events were compared using the Cox proportional hazards model during a median follow-up of 13 months.
RESULTSThe study cohort consisted of 366 consecutive patients referred for coronary revascularization with adjunct FFR and 366 matched controls, from 2010 to 2014. Major adverse cardiac events (MACEs) (death, myocardial infarction, repeated revascularization, or hospitalization for angina) at 4 years were found in 12.0% of angiography-guided patients and 4.9% in the FFR-guided group (P < 0.001). The mean number of implanted stents was significantly lower in FFR treated subjects (0.52 ± 0.82 stents) compared with the angiography-guided group (0.93 ± 0.96 stents) (P < 0.001). No difference in overall costs at initial hospitalization was observed between angiography-guided percutaneous coronary intervention (PCI) compared with FFR-guided PCI (RMB 33,000 Yuan, range: RMB 7393-44,700 Yuan) versus RMB 21,200 Yuan (RMB 19,100-47,100 Yuan) (P = 0.54). However, costs for MACEs during follow-up were significantly reduced in the FFR-guided arm (P < 0.001).
CONCLUSIONSIn the contemporary clinical practice, FFR-guided PCI is associated with decreased use of stents, improved clinical outcome, and reduced costs, compared with angiography-guided PCI.
Aged ; China ; Costs and Cost Analysis ; Female ; Fractional Flow Reserve, Myocardial ; physiology ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; economics ; methods ; Retrospective Studies
10.Clinical outcome and cost comparison between laparoscopic and open appendicectomy.
Winson J H TAN ; Wansze PEK ; Tousif KABIR ; Weng Hoong CHAN ; Wai Keong WONG ; Hock Soo ONG
Annals of the Academy of Medicine, Singapore 2014;43(9):464-468
INTRODUCTIONLocal data comparing laparoscopic appendicectomy (LA) and open appendicectomy (OA) is lacking. We perform a cost and outcome comparison between LA and OA.
MATERIALS AND METHODSA retrospective review of all appendicectomies performed for suspected appendicitis from July 2010 to December 2010 was conducted. Patient demographics, duration of surgery, complication rates, total cost of stay (COS) and length of stay (LOS) were compared between LA and OA.
RESULTSA total of 198 patients underwent appendicectomy during the duration of study; 82 LA and 116 OA. There were 115 males (58.1%) and 83 females (41.9%). Median age was 33 years. Patients who underwent LA were significantly younger (P <0.001) with a greater proportion of females (P <0.0001) and were more likely to be negative appendicectomies (18.3% vs. 6.9%, P = 0.023). Duration of surgery was significantly longer in LA patients (86 min vs. 74 min, P = 0.003). LOS in the LA group was shorter by 1.3 days compared to OA (2.0 days vs. 3.3 days, P <0.0001). The differences in operative duration and LOS between LA and OA remained significant on multivariate analysis (P = 0.001 and P = 0.008, respectively). The COS (P = 0.359), wound infection rates (P = 0.528) and complication rates (P = 0.131) were not significantly different between the 2 groups.
CONCLUSIONLA is associated with a shorter LOS while its cost is equivalent to OA. From the perspective of utilisation of healthcare resources, LA appears to be superior.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Appendectomy ; economics ; methods ; Costs and Cost Analysis ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult