The Role of Unions in Hospital Cost Inflation

ILR Review ◽  
1984 ◽  
Vol 37 (2) ◽  
pp. 252-262 ◽  
Author(s):  
Frank A. Sloan ◽  
Killard W. Adamache
Keyword(s):  
Health Insurance ◽  
Hospital Cost ◽  
Hospital Costs ◽  
Hospital Workers ◽  
Worker Productivity ◽  
Worker Compensation ◽  
The Mean ◽  
The Impact

This study examines the impact of unions on worker compensation and total costs in hospitals, both in specific departments and in the hospital as a whole. An analysis of data for 367 hospitals for the years 1974 and 1977 shows that unions raised the mean compensation of hospital workers by 8.8 percent without producing offsetting increases in worker productivity. Thus, unions do increase hospital costs, although far less than health insurance and other factors do.

scholarly journals PRE- and POST-STORM LiDAR SURVEYS FOR ASSESSMENT OF IMPACT ON COASTAL EROSION

2019 ◽  
Vol XLII-3/W8 ◽  
pp. 261-266
Author(s):  
A.-L. Montreuil ◽  
M. Chen ◽  
A. Esquerré ◽  
R. Houthuys ◽  
R. Moelans ◽  
...  
Keyword(s):  
Management Practices ◽  
Morphological Changes ◽  
Storm Surges ◽  
High Water ◽  
Water Levels ◽  
Airborne Lidar ◽  
Coastline Change ◽  
The Mean ◽  
The Impact

<p><strong>Abstract.</strong> Sustainable management of the coastal resources requires a better understanding of the processes that drive coastline change. The coastline is a highly dynamic sea-terrestrial interface. It is affected by forcing factors such as water levels, waves, winds, and the highest and most severe changes occur during storm surges. Extreme storms are drivers responsible for rapid and sometimes dramatic changes of the coastline. The consequences of the impacts from these events entail a broad range of social, economic and natural resource considerations from threats to humans, infrastructure and habitats. This study investigates the impact of a severe storm on coastline response on a sandy multi-barred beach at the Belgian coast. Airborne LiDAR surveys acquired pre- and post-storm covering an area larger than 1 km<sup>2</sup> were analyzed and reproducible monitoring solutions adapted to assess beach morphological changes were applied. Results indicated that the coast retreated by a maximum of 14.7 m where the embryo dunes in front of the fixed dunes were vanished and the foredune undercut. Storm surge and wave attacks were probably the most energetic there. However, the response of the coastline proxies associated with the mean high water line (MHW) and dunetoe (DuneT) was spatially variable. Based on the extracted beach features, good correlations (r>0.73) were found between coastline, berm and inner intertidal bar morphology, while it was weak with the most seaward bars covered in the surveys. This highlights the role of the upper features on the beach to protect the coastline from storm erosion by reducing wave energy. The findings are of critical importance in improving our knowledge and forecasting of coastline response to storms, and also in its translation into management practices.</p>

scholarly journals THE LUCK IN “TALENT VERSUS LUCK” MODELING

2020 ◽  
Vol 23 (03) ◽  
pp. 2050007
Author(s):  
SEAN ELVIDGE
Keyword(s):  
Mean Value ◽  
Maximum Amount ◽  
Random Numbers ◽  
Individual Parameter ◽  
Input Parameters ◽  
The Mean ◽  
Model Variability ◽  
The Impact ◽  
The Relationship

This paper further investigates the Talent versus Luck (TvL) model described by [Pluchino et al. Talent versus luck: The role of randomness in success and failure, Adv. Complex Syst. 21 (2018) 1850014] which models the relationship between ‘talent’ and ‘luck’ on the impact of an individuals career. It is shown that the model is very sensitive to both random sampling and the choice of value for the input parameters. Running the model repeatedly with the same set of input parameters gives a range of output values of over 50% of the mean value. The sensitivity of the inputs of the model is analyzed using a variance-based approach based upon generating Sobol sequences of quasi-random numbers. When using the model to look at the talent associated with an individual who has the maximum capital over a model run it has been shown that the choice for the standard deviation of the talent distribution contributes to 67% of the model variability. When investigating the maximum amount of capital returned by the model the probability of a lucky event at any given epoch has the largest impact on the model, almost three times more than any other individual parameter. Consequently, during the analysis of the model results one must keep in mind the impact that only small changes in the input parameters can have on the model output.

Cardiovascular Risk After Sepsis: Understanding the Role of Statin Indications and the Impact of Clinical Inertia on Prescribing Patterns

2020 ◽  
Vol 25 (6) ◽  
pp. 541-547
Author(s):  
Vedant A. Gupta ◽  
Talal S. Alnabelsi ◽  
Sandipan Shringi ◽  
Steve W. Leung ◽  
Vincent L. Sorrell
Keyword(s):  
Cohort Analysis ◽  
Prescribing Patterns ◽  
Clinical Inertia ◽  
Major Adverse Cardiovascular Events ◽  
Prescribing Practices ◽  
Retrospective Cohort Analysis ◽  
The Mean ◽  
The Impact ◽  
Statin Use

Introduction: Patients with sepsis have high rates of major adverse cardiovascular events (MACE) in the literature, but the stratification of those at risk has been limited. Statin indicated groups provides clear criteria for therapy, but the risk of MACE after sepsis based on these groups has never been assessed. Materials and Methods: This was a retrospective cohort analysis conducted on adult patients admitted from January 1, 2013, to December 31, 2013, with suspected or confirmed sepsis and data available on statin use. Patients’ past medical history; statin use prior, during, or at time of discharge; and occurrence of MACE were recorded from electronic health records. Result: A total of 321 patients were screened and 265 were found to have data available on statin use. The mean age of the patients was 59 ± 15 years and 47% were female. Overall, 9% were observed to have a MACE at 1 year, with significantly higher rates in those in a statin indicated group (12.2%). On admission, 174 patients were not taking a statin out of whom 52% were in a statin indicated group. Among those in a statin indicated group who survived to hospital discharge, only 10% not on a statin on admission received a statin on discharge, whereas 89% on a statin on admission received a statin on discharge. Conclusion: There is a high risk of MACE after sepsis especially among those in statin indicated groups with significant clinical inertia in prescribing practices.

Drivers of biases in the extratropical storm tracks in CMIP6

2020 ◽  
Author(s):  
Matthew Priestley ◽  
Duncan Ackerley ◽  
Jennifer Catto ◽  
Kevin Hodges ◽  
Ruth McDonald ◽  
...  
Keyword(s):  
Large Scale ◽  
Climate Models ◽  
Storm Track ◽  
Storm Tracks ◽  
Extratropical Cyclones ◽  
Ocean Coupling ◽  
Coupled Climate Models ◽  
The Mean ◽  
The Impact

&lt;p&gt;Extratropical cyclones are the leading driver of the day-to-day weather variability and wintertime losses for Europe. In the latest generation of coupled climate models, CMIP6, it is hoped that with improved modelling capabilities come improvements in the structure of the storm track and the associated cyclones. Using an objective cyclone identification and tracking algorithm the mean state of the storm tracks in the CMIP6 models is assessed as well as the representation of explosively deepening cyclones. Any developments and improvements since the previous generation of models in CMIP5 are discussed, with focus on the impact of model resolution on storm track representation. Furthermore, large-scale drivers of any biases are investigated, with particular focus on the role of atmosphere-ocean coupling via associated AMIP simulations and also the influence of large-scale dynamical and thermodynamical features.&lt;/p&gt;

The impact of duration of drainage on the seed banks of northern prairie wetlands

1989 ◽  
Vol 67 (6) ◽  
pp. 1878-1884 ◽  
Author(s):  
Carol E. Wienhold ◽  
A. G. van der Valk
Keyword(s):  
Seed Bank ◽  
Seed Banks ◽  
Seed Density ◽  
Prairie Wetlands ◽  
Vegetation Surveys ◽  
The Mean ◽  
Wetland Species ◽  
Total Seed ◽  
The Impact

To determine the potential role of seed banks in the restoration of drained wetlands, the seed banks of 30 extant and 52 drained and cultivated prairie potholes were sampled in Iowa, Minnesota, and North Dakota; the potholes had been drained between 5 and 70 years ago. The midsummer vegetation of most of these potholes was also sampled. The number of species in the seed bank of a pothole declined from a mean of 12.3 in extant potholes to 7.5, 5.4, 5.0, 7.4, 3.2, and 2.1 in potholes drained up to 5, 10, 20, 30, 40, and 70 years ago, respectively. The mean total seed density of extant potholes was 3600 seeds/m2. It increased to 7000 seeds/m2 up to 5 years after drainage, but then declined rapidly to 1400, 1200, 600, 300, and 160 after up to 10, 20, 30, 40, and 70 years after drainage. Changes in both species richness and seed density with increasing duration of drainage varied from state to state. About 60% of the species present in the seed banks of extant or recently drained wetlands were not detected in wetlands that had been drained for more than 20 years. Vegetation surveys of extant and drained wetlands indicated that as many or more wetland species not detected in the seed bank were present in the vegetation, as there were wetland species in the seed bank.

scholarly journals In hospital cost assessment and prevalence of Total Hip Arthroplasty in China: A 10-years real-world study

2020 ◽  
Author(s):  
Mingcheng Yuan ◽  
Hirose Shakya ◽  
Hao-Yang Wang ◽  
Zhenyu Luo ◽  
Ke Xiao ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Hospital Cost ◽  
Hospital Costs ◽  
Labor Cost ◽  
Total Charge ◽  
Strongly Correlated ◽  
Total Hip ◽  
The Mean

Abstract Background: The rising costs of total hip arthroplasty (THA) have resulted in a substantial economic burden to the people of China and Chinese health-care system. The objective of this study was to assess the in-hospital costs associated with primary total hip arthroplasty and efforts to contain these costs by ascertaining factors responsible for the rise in cost.Methods: In-hospital costs of 8111 patients (3878 male and 42337female) who underwent elective primary unilateral hip arthroplasty were extracted from our institution between January 2009 and December 2018 and reviewed. The number of yearly procedures was recorded. All hospital related charges were categorized into 9 groups based on hospital-based supplies and services. The correlation between total in hospital cost and 9 groups were assessed using Pearson’s coefficient. The same method was used for correlating hospital stay and bed charge.Results: The substantial rise in yearly procedure volume was observed. The number of procedures had risen from 306 in 2009 to 1024 in 2018, an incidence increased by more than threefold. The average cost for THAs procedure was ¥53468.03 ± 4833 in 2009 that rose by approximately 10% in 2018 (¥58593.62 ± 4801). The mean cost observed over the study period was ¥62980.21 ± 6314.673. The charges analyzed in all categories expect the hospital bed cost increased during the study period. The joint implant was the most expensive supply item contributing ~ 75% of the total in-hospital cost. Labor cost covered only ~ 10% and bed charge 0.93% of the total charge. The rise in total in-hospital cost strongly correlated with increase in implant cost (Pearson’s correlation (r) = 0.908, α > 0.05). The mean total hospital stays declined from 16.11 ± 8.19 days in 2009 to 6.13 ± 2.65 days in 2018. The mean post-operative stay had also reduced from 9.12 ± 4.88 to a third (3.01 ± 1.80) during the same period. The hospital cost and bed charge also strongly correlated (r = 0.931, α > 0.05)Conclusions: The number of hip arthroplasty procedures performed annually in China is growing rapidly. An incidence rose by threefold over 10-year period in the present study and we predict an unprecedented rise in the incidence in coming years due to an aging population and improving economic conditions in China. The hospital stay was significantly reduced and early discharge within 3 days postoperatively was a noteworthy outcome. Implant cost remained the largest single expense. As a result, some patients who are medical candidates for total joint arthroplasty, may not have access to care due to relatively high financial barrier. Hence it is important to note that significant patient benefits may be realized by efforts to reduce the cost of the prosthesis in China.

scholarly journals Streamlining Medicaid Enrollment: The Role of the Health Insurance Marketplaces and the Impact of State Policies

2016 ◽  
Author(s):  
Sara Rosenbaum Rosenbaum ◽  
Sara Schmucker Schmucker ◽  
Sara Rothenberg Rothenberg ◽  
Rachel Gunsalus Gunsalus
Keyword(s):  
Health Insurance ◽  
State Policies ◽  
Medicaid Enrollment ◽  
The Impact

Capturing the Financial Impact of Heparin-Induced Thrombocytopenia.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3127-3127 ◽  
Author(s):  
Maureen A. Smythe ◽  
John M. Koerber ◽  
Joan C. Mattson
Keyword(s):  
Control Patient ◽  
Hospital Cost ◽  
Financial Impact ◽  
Case Patient ◽  
Heparin Induced Thrombocytopenia ◽  
The Mean ◽  
Cost Calculations ◽  
The Cost ◽  
And Control ◽  
The Impact

Abstract Data evaluating the financial impact of heparin-induced thrombocytopenia (HIT) (a severe adverse drug reaction which can result in life threatening thrombosis) is lacking. The goal of this case-control study was to evaluate the financial impact of HIT. Case patients were those with a new diagnosis of HIT from April 2003 to March 2004 for whom matched controls were available. Controls for each case patient were matched for the DRG under which the hospital was reimbursed, the patient’s primary diagnosis code and their primary procedure code. Case patients required identification of &gt;1 control for inclusion. The hospital’s financial database was queried for length of stay (LOS), total cost, and reimbursement. For each case patient, the cost and reimbursement were compared to the cost and reimbursement for each group of matched controls. In an effort to eliminate the impact of variable reimbursement, a subset of only Medicare case and control patients was also evaluated. Of 72 new HIT patients, matched controls were identified for 31. The mean LOS for the case and control patients was 22.8 and 11.6 days respectively (p=0.006). The mean hospital cost of case and control patients was $55,440 and $26,505 respectively. From reimbursement minus cost calculations, our institution lost an average of $13,429 per HIT patient compared to an average of $393 per control patient (p=0.005). The mean LOS for Medicare cases (n=21) and matched Medicare controls was 26 and 14.6 days respectively (p=0.041). The mean hospital cost of Medicare case and control patients was $58,842 and $30,210 respectively. From reimbursement minus cost calculations for the Medicare subset, our institution lost an average of $20,229 per HIT case compared to $1844 per control patient (p&lt;0.0001). Assuming 72 new cases of HIT per year, our institution incurs a projected annual financial loss of $980,000 from HIT. The use of alternate anticoagulants, although having a higher acquisition cost, may offset this loss through HIT avoidance.

scholarly journals Think globally, act locally: the role of local demographics and vaccination coverage in the dynamic response of measles infection to control

2013 ◽  
Vol 368 (1623) ◽  
pp. 20120141 ◽  
Author(s):  
M. J. Ferrari ◽  
B. T. Grenfell ◽  
P. M. Strebel
Keyword(s):  
Dynamic Models ◽  
Vaccine Coverage ◽  
National Level ◽  
Age Distribution ◽  
Local Variation ◽  
Comparative Approach ◽  
Age Of Infection ◽  
The Mean ◽  
The Impact

The global reduction of the burden of morbidity and mortality owing to measles has been a major triumph of public health. However, the continued persistence of measles infection probably not only reflects local variation in progress towards vaccination target goals, but may also reflect local variation in dynamic processes of transmission, susceptible replenishment through births and stochastic local extinction. Dynamic models predict that vaccination should increase the mean age of infection and increase inter-annual variability in incidence. Through a comparative approach, we assess national-level patterns in the mean age of infection and measles persistence. We find that while the classic predictions do hold in general, the impact of vaccination on the age distribution of cases and stochastic fadeout are mediated by local birth rate. Thus, broad-scale vaccine coverage goals are unlikely to have the same impact on the interruption of measles transmission in all demographic settings. Indeed, these results suggest that the achievement of further measles reduction or elimination goals is likely to require programmatic and vaccine coverage goals that are tailored to local demographic conditions.

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