scholarly journals Development and application of tools to cost the delivery of environmental health services in healthcare facilities: a financial analysis in urban Malawi

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Darcy M. Anderson ◽  
Ryan Cronk ◽  
Emily Pak ◽  
Precious Malima ◽  
David Fuente ◽  
...  
Keyword(s):  
Health Services ◽  
Waste Management ◽  
Environmental Health ◽  
Financial Analysis ◽  
Electronic Records ◽  
Maintenance Costs ◽  
Healthcare Facilities ◽  
Capital Costs ◽  
Operations And Maintenance ◽  
The Cost

Abstract Background Environmental health services (EHS) in healthcare facilities (HCFs) are critical for providing a safe, functional healthcare environment, but little is known about their costs. Poor understanding of costs impedes progress towards universal access of EHS in HCFs. We developed frameworks of essential expenses required to provide EHS and conducted an ex-post financial analysis of EHS in a network of medical research and training facilities in Lilongwe, Malawi, serving an estimated 42,000 patients annually through seven outpatient buildings. Methods We estimated the cost of providing the following EHS: water, sanitation, hygiene, personal protective equipment use at the point of care, waste management, cleaning, laundry, and vector control. We developed frameworks of essential outputs and inputs for each EHS through review of international guidelines and standards, which we used to identify expenses required for EHS delivery and evaluate the completeness of costs data in our case study. For costing, we use a mixed-methods approach, applying qualitative interviews to understand facility context and review of electronic records to determine costs. We calculated initial costs to establish EHS and annual operations and maintenance. Results Available records contained little information on the upfront, capital costs associated with establishing EHS. Annual operations and maintenance totaled USD 220,427 for all EHS across all facilities (USD 5.21 per patient encounter), although costs of many essential inputs were missing from records. Annual operations and maintenance costs were highest for cleaning (USD 69,372) and waste management (USD 46,752). Discussion Missing expenses suggests that documented costs are substantial underestimates. Costs to establish services were missing predominantly because purchases pre-dated electronic records. Annual operations and maintenance costs were incomplete primarily because administrative records did not record sufficient detail to disaggregate and attribute expenses. Conclusions Electronic health information systems have potential to support efficient data collection. However, we found that existing records systems were decentralized and poorly suited to identify EHS costs. Our research suggests a need to better code and disaggregate EHS expenses to properly leverage records for costing. Frameworks developed in this study are a potential tool to develop more accurate estimates of the cost of providing EHS in HCFs.

scholarly journals Development and Application of Tools to Cost Delivery of Environmental Health Services in Healthcare Facilities: A Financial Analysis in Urban Malawi

2020 ◽  
Author(s):  
Darcy Anderson ◽  
Ryan Cronk ◽  
Emily Pak ◽  
David Fuente ◽  
J. Wren Tracy ◽  
...  
Keyword(s):  
Health Services ◽  
Waste Management ◽  
Environmental Health ◽  
Financial Analysis ◽  
Electronic Records ◽  
Maintenance Costs ◽  
Healthcare Facilities ◽  
Capital Costs ◽  
Operations And Maintenance ◽  
The Cost

Abstract Background Environmental health services (EHS) in healthcare facilities (HCFs) are critical for providing a safe, functional healthcare environment, but little is known about their costs. Poor understanding of costs impedes progress towards universal access of EHS in HCFs. We developed frameworks of essential expenses that provide EHS and conducted an ex-post financial analysis of EHS in a network of medical research and training facilities in Lilongwe, Malawi serving an estimated 42,000 patients annually. Methods We estimated the cost of providing the following EHS: water, sanitation, hygiene, personal protective equipment use at the point of care, waste management, cleaning, laundry, and vector control. We developed frameworks of essential outputs and inputs for each EHS through review of international guidelines and standards, which we used to identify required expenses for EHS delivery and evaluate the completeness of costs data in our case study. For costing, we use a mixed-methods approach, applying qualitative interviews to understand facility context and review of electronic records to determine costs. We calculated initial costs to establish services and annual operations and maintenance.Results Available records contained little information on the upfront, capital costs associated with establishing EHS. Annual operations and maintenance totaled USD 220,427 for all EHS, although costs of essential inputs were missing from records. Annual operations and maintenance costs were highest for cleaning (USD 69,372) and waste management (USD 46,752).Discussion Missing expenses suggests that documented costs are substantial underestimates. Costs to establish services were missing predominantly because purchases pre-dated electronic records systems. Annual operations and maintenance costs are incomplete primarily because administrative records did not record sufficient detail to disaggregate and attribute expenses. Conclusions Electronic health information systems have potential to support efficient data collection. However, we found that existing records systems were decentralized and poorly suited to identify EHS costs. Our research suggests a need to better code and disaggregate EHS expenses to properly leverage records for costing. Frameworks developed in this study are a potential tool to develop more accurate estimates of the cost of providing EHS in HCFs.

scholarly journals Development and application of tools to cost the delivery of environmental health services in healthcare facilities: a financial analysis in urban Malawi

2021 ◽  
Author(s):  
Darcy Anderson ◽  
Ryan Cronk ◽  
Emily Pak ◽  
Precious Malima ◽  
David Fuente ◽  
...  
Keyword(s):  
Health Services ◽  
Waste Management ◽  
Environmental Health ◽  
Financial Analysis ◽  
Electronic Records ◽  
Maintenance Costs ◽  
Healthcare Facilities ◽  
Capital Costs ◽  
Operations And Maintenance ◽  
The Cost

Abstract Environmental health services (EHS) in healthcare facilities (HCFs) are critical for providing a safe, functional healthcare environment, but little is known about their costs. Poor understanding of costs impedes progress toward universal access of EHS in HCFs. We developed frameworks of essential expenses required to provide EHS and conducted an ex-post financial analysis of EHS in a network of medical research and training facilities in Lilongwe, Malawi, serving an estimated 42,000 patients annually through seven outpatient buildings. We estimated the cost of providing the following EHS: water, sanitation, hygiene, personal protective equipment use at the point of care, waste management, cleaning, laundry, and vector control. We developed frameworks of essential outputs and inputs for each EHS through review of international guidelines and standards, which we used to identify expenses required for EHS delivery and evaluate the completeness of costs data in our case study. For costing, we use a mixed-methods approach, applying qualitative interviews to understand facility context and review of electronic records to determine costs. We calculated initial costs to establish services and annual operations and maintenance. Available records contained little information on the upfront, capital costs associated with establishing EHS. Annual operations and maintenance totaled USD 220,427 for all EHS across all facilities (USD 5.21 per patient encounter), although costs of many essential inputs were missing from records. Annual operations and maintenance costs were highest for cleaning (USD 69,372) and waste management (USD 46,752). Missing expenses suggest that documented costs are substantial underestimates. Costs to establish services were missing predominantly, because purchases pre-dated electronic records. Annual operations and maintenance costs are incomplete primarily, because administrative records did not record sufficient details to disaggregate and attribute expenses. Electronic health information systems have potential to support efficient data collection. However, we found that existing record systems were decentralized and poorly suited to identify EHS costs. Our research suggests a need to better code and disaggregate EHS expenses to properly leverage records for costing. Frameworks developed in this study are a potential tool to develop more accurate estimates of the cost of providing EHS in HCFs.

scholarly journals Analysis of Annual Costs of Mobile Clinics in the Southern United States

2020 ◽  
Vol 11 ◽  
pp. 215013272098062
Author(s):  
Sharon Attipoe-Dorcoo ◽  
Rigoberto Delgado ◽  
Dejian Lai ◽  
Aditi Gupta ◽  
Stephen Linder
Keyword(s):  
Primary Care ◽  
Healthcare Services ◽  
Medicare Beneficiaries ◽  
Mobile Clinic ◽  
Efficient Manner ◽  
Healthcare Facilities ◽  
Capital Costs ◽  
At Risk Populations ◽  
Mobile Clinics ◽  
The Cost

Introduction Mobile clinics provide an efficient manner for delivering healthcare services to at-risk populations, and there is a need to understand their economics. This study analyzes the costs of operating selected mobile clinic programs representing service categories in dental, dental/preventive, preventive care, primary care/preventive, and mammography/primary care/preventive. Methods The methodology included a self-reported survey of 96 mobile clinic programs operating in Texas, North Carolina, Georgia, and Florida; these states did not expand Medicaid and have a large proportion of uninsured individuals. Data were collected over an 8-month period from November 2016 to July 2017. The cost analyses were conducted in 2018, and were analyzed from the provider perspective. The average annual estimated costs; as well the costs per patient in each mobile clinic program within different service delivery types were assessed. Costs reported in the study survey were classified into recurrent direct costs and capital costs. Results Results indicate that mean operating costs range from about $300 000 to $2.5 million with costs increasing from mammography/primary care/preventive delivery to dental/preventive. The majority of mobile clinics provided dental care followed by dental/preventive. The cost per patient visit for all mobile clinic service types ranged from $65 to $529, and appears to be considerably less than those reported in the literature for fixed clinic services. Conclusion The overall costs of all delivery types in mobile clinics were lower than the costs of providing care to Medicare beneficiaries in federally funded health centers, making mobile clinics a sound economic complement to stationary healthcare facilities.

scholarly journals Budgeting for Environmental Health Services in Healthcare Facilities: A Ten-Step Model for Planning and Costing

2020 ◽  
Vol 17 (6) ◽  
pp. 2075 ◽  
Author(s):  
Darcy M. Anderson ◽  
Ryan Cronk ◽  
Lucy Best ◽  
Mark Radin ◽  
Hayley Schram ◽  
...  
Keyword(s):  
Data Collection ◽  
Health Services ◽  
Environmental Health ◽  
Quality Data ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Good Practices ◽  
Middle Income Countries ◽  
Step Model ◽  
Adequate Provision

Environmental health services (EHS) in healthcare facilities (HCFs) are critical for safe care provision, yet their availability in low- and middle-income countries is low. A poor understanding of costs hinders progress towards adequate provision. Methods are inconsistent and poorly documented in costing literature, suggesting opportunities to improve evidence. The goal of this research was to develop a model to guide budgeting for EHS in HCFs. Based on 47 studies selected through a systematic review, we identified discrete budgeting steps, developed codes to define each step, and ordered steps into a model. We identified good practices based on a review of additional selected guidelines for costing EHS and HCFs. Our model comprises ten steps in three phases: planning, data collection, and synthesis. Costing-stakeholders define the costing purpose, relevant EHS, and cost scope; assess the EHS delivery context; develop a costing plan; and identify data sources (planning). Stakeholders then execute their costing plan and evaluate the data quality (data collection). Finally, stakeholders calculate costs and disseminate findings (synthesis). We present three hypothetical costing examples and discuss good practices, including using costing frameworks, selecting appropriate indicators to measure the quantity and quality of EHS, and iterating planning and data collection to select appropriate costing approaches and identify data gaps.

Costs: The Rest of the Economic Impact Story

2013 ◽  
Vol 27 (5) ◽  
pp. 379-392 ◽  
Author(s):  
John L. Crompton ◽  
Dennis R. Howard
Keyword(s):  
Economic Impact ◽  
Opportunity Cost ◽  
Return On Investment ◽  
Property Taxes ◽  
External Costs ◽  
Maintenance Costs ◽  
Capital Costs ◽  
Impact Studies ◽  
Operations And Maintenance ◽  
Economic Impact Studies

Economic impact studies are frequently commissioned to justify investments in sport projects. However, decisions also should include a consideration of a project’s costs since it is the net return on investment that should drive decisions. Whenever taxpayer funds are expended on a sports project there is an opportunity cost. Three types of opportunity cost are discussed. Explicit costs are those for which a government entity “writes a check.” They are comprised of event costs, land and infrastructure costs, and operations and maintenance costs. Implicit costs are those which remain “hidden” from most taxpayers: foregone property taxes, strategic underestimation of capital costs, displacement costs, and an inequitable nexus between payers and beneficiaries. External costs are those incurred by taxpayers beyond the boundaries of a local jurisdiction.

scholarly journals Safe Healthcare Facilities: A Systematic Review on the Costs of Establishing and Maintaining Environmental Health in Facilities in Low- and Middle-Income Countries

2021 ◽  
Vol 18 (2) ◽  
pp. 817
Author(s):  
Darcy M. Anderson ◽  
Ryan Cronk ◽  
Donald Fejfar ◽  
Emily Pak ◽  
Michelle Cawley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Waste Management ◽  
Vector Control ◽  
Environmental Health ◽  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Middle Income Countries ◽  
Low And Middle Income

A hygienic environment is essential to provide quality patient care and prevent healthcare-acquired infections. Understanding costs is important to budget for service delivery, but costs evidence for environmental health services (EHS) in healthcare facilities (HCFs) is lacking. We present the first systematic review to evaluate the costs of establishing, operating, and maintaining EHS in HCFs in low- and middle-income countries (LMICs). We systematically searched for studies costing water, sanitation, hygiene, cleaning, waste management, personal protective equipment, vector control, laundry, and lighting in LMICs. Our search yielded 36 studies that reported costs for 51 EHS. There were 3 studies that reported costs for water, 3 for sanitation, 4 for hygiene, 13 for waste management, 16 for cleaning, 2 for personal protective equipment, 10 for laundry, and none for lighting or vector control. Quality of evidence was low. Reported costs were rarely representative of the total costs of EHS provision. Unit costs were infrequently reported. This review identifies opportunities to improve costing research through efforts to categorize and disaggregate EHS costs, greater dissemination of existing unpublished data, improvements to indicators to monitor EHS demand and quality necessary to contextualize costs, and development of frameworks to define EHS needs and essential inputs to guide future costing.

Evaluation of Repowering Cycles

1993 ◽  
Author(s):  
Louis A. Riekert
Keyword(s):  
Energy Demand ◽  
Evaluation Method ◽  
Heat Rate ◽  
Capacity Factor ◽  
Primary Methods ◽  
Maintenance Costs ◽  
Capital Costs ◽  
Present Worth ◽  
The Cost

There are three primary methods by which an aging steam electric unit can be repowered by incorporating a gas turbine-generator. These are: heat recovery steam generator repowering, Feedwater Heater repowering, and Windbox repowering. Evaluation of these options can be very difficult due to the fact that the initial capital cost may be the smallest cost. The present worth of future fuel and maintenance costs can far outweigh the initial cost. An additional complexity is the fact that the repowered unit may have the best unit heat rate within the system. It will certainly be improved, which means the capacity factor will be increased. As the capacity factor increases, the cost of fuel becomes more significant. For a base loaded fossil unit, the cost of fuel is the largest single annual cost. Prediction of the future capacity factor is complex, involving many variables and uncertainties. Selection of the best method requires an evaluation of future energy demand and currently incurred capital costs as well as future fuel and maintenance costs. Determination of an optimum balance between present and future costs has always been the problem of the utility planner. The intent of this paper is to outline an evaluation method to determine the most suitable repowering option. Comments regarding each option will be made. In some cases, a selection can be made by intuition or by observing the obvious. In other cases, the selection will not be obvious. The utility will always benefit from the execution of a well thought out evaluation plan. Following an orderly procedure will enhance the thought process. In addition, a documented procedure will be available for re-evaluation when changes occur and will always provide documentation for future reference.

Combined-Cycle Power Plant Maintenance Costs

2008 ◽  
Author(s):  
Dale S. Grace
Keyword(s):  
Power Plants ◽  
Combined Cycle ◽  
Operating Conditions ◽  
Operating Life ◽  
Lost Generation ◽  
Maintenance Costs ◽  
Operations And Maintenance ◽  
Combined Cycle Plant ◽  
Cost Distribution ◽  
The Cost

This paper describes a methodology to quantify scheduled and unscheduled maintenance costs and a software framework for estimating operations and maintenance (O&M) costs of combined-cycle power plants over their operating life. Scheduled maintenance costs consist primarily of replacement and repair of hot section components of the combustion turbine that occur during planned inspections and overhaul events. Scheduled maintenance costs can be estimated based on anticipated parts life, operating conditions and parts costs. Some degree of uncertainty exists, but the range of costs is fairly well understood. Unscheduled maintenance costs are not as readily defined. Experiential data of unplanned events from a large sampling of plants over time can be used to estimate unscheduled costs. Because of the wide variation in experience from unit to unit, a range of costs are anticipated. This paper includes a description of a study of F-class combined-cycle plant data that provides the basis for defining a cost distribution of unscheduled maintenance costs. In addition, the reliability and availability statistics of these plants are used to estimate lost generation revenue due to unplanned outages, which can be significantly higher than the cost of performing the repairs to return the unit to service.

scholarly journals Costs and Benefits of Autonomous Shipping—A Literature Review

2021 ◽  
Vol 11 (10) ◽  
pp. 4553
Author(s):  
Ewelina Ziajka-Poznańska ◽  
Jakub Montewka
Keyword(s):  
Literature Review ◽  
Business Models ◽  
Financial Models ◽  
State Of The Art ◽  
Costs And Benefits ◽  
Capital Costs ◽  
Research Activities ◽  
Benefit Estimation ◽  
Autonomous Ship ◽  
The Cost

The development of autonomous ship technology is currently in focus worldwide and the literature on this topic is growing. However, an in-depth cost and benefit estimation of such endeavours is in its infancy. With this systematic literature review, we present the state-of-the-art system regarding costs and benefits of the operation of prospective autonomous merchant ships with an objective for identifying contemporary research activities concerning an estimation of operating, voyage, and capital costs in prospective, autonomous shipping and vessel platooning. Additionally, the paper outlines research gaps and the need for more detailed business models for operating autonomous ships. Results reveal that valid financial models of autonomous shipping are lacking and there is significant uncertainty affecting the cost estimates, rendering only a reliable evaluation of specific case studies. The findings of this paper may be found relevant not only by academia, but also organisations considering to undertake a challenge of implementing Maritime Autonomous Surface Ships in their operations.

scholarly journals “Just So You Know, It Has Been Hard”: Food Retailers’ Perspectives of Implementing a Food and Nutrition Policy in Public Healthcare Settings

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 2053
Author(s):  
Kristy Karying. Law ◽  
Claire Elizabeth. Pulker ◽  
Janelle Diann. Healy ◽  
Christina Mary. Pollard
Keyword(s):  
Nutrition Policy ◽  
Public Healthcare ◽  
Healthcare Facilities ◽  
Voluntary Standards ◽  
Policy Success ◽  
Healthcare Settings ◽  
Food Retailers ◽  
Food And Nutrition ◽  
The Cost ◽  
Public Health Practitioners

Mandated policies to improve food environments in public settings are an important strategy for governments. Most Australian governments have mandated policies or voluntary standards for healthy food procurement in healthcare facilities, however, implementation and compliance are poor. A better understanding of the support required to successfully implement such policies is needed. This research explored food retailers’ experiences in implementing a mandated food and nutrition policy (the Policy) in healthcare settings to identify barriers, enablers, and impacts of compliance. Three 90-min workshops facilitated by two public health practitioners were undertaken with 12 food retailers responsible for operating 44 outlets across four hospitals in Perth, Western Australia. Workshop discussions were transcribed non-verbatim and inductive thematic content was analyzed. Three main themes were identified: (1) food retailers had come to accept their role in implementing the Policy; (2) the Policy made it difficult for food retailers to operate successfully, and; (3) food retailers needed help and support to implement the Policy. Findings indicate the cost of implementation is borne by food retailers. Communications campaigns, centralized databases of classified products, reporting frameworks, recognition of achievements, and dedicated technical expertise would support achieving policy compliance. Feasibility assessments prior to policy implementation are recommended for policy success.

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