WHICH DRUGS ARE BULLYING US FINANCIALLY? PRESCRIPTION COST ANALYSIS IN EX-SERVICEMAN POLYCLINIC DISPENSARY IN INDIA

Aims: To carry out prescription cost analysis in Ex-Serviceman Contributory Health Scheme (ECHS) Polyclinic dispensary in India Study Design: Retrospective Prescription Cost Analysis Place And Duration Of Study: ECHS Polyclinic Dispensary from 01 December 2019 to 31 December 2019 on all working days Methodology: A total of 8295 prescriptions were received at ECHS dispensary in the month of December 2019 at an average of 346 prescriptions per day and a maximum of 445 per day and minimum of 242 per day. On each working day data were collected for previous day and segregated in pre-dened format as per National List of Essential Medicines (NLEM) 2015. The cost toward each group of drugs were calculated on prescribed quantity of medicines and added to calculate unit prescription cost at ECHS Dispensary. Results: It is observed that the highest number of prescriptions 4599 (55.44%) were from General OPD. The total cost of prescribed medicines worked out to be INR 25,55,103.81 for the month of December 2019. Most of the cost was ascribed to amount of INR 13,03,489.31 (51.02%) by section 21 (Hormones, other endocrine medicines and contraceptives). The estimated unit cost of prescription was INR 308.03. Conclusion: Implementing change in prescribing behaviors remains a major challenge for administrators and an inclusive approach with integrated with non-coercive educational approach should be utilized to change the behavior in prescriptions writing. Inculcating the culture of cost awareness amongst the health care providers pays good dividends in the long run. As far as cost containment in the healthcare facility is concerned, the rst step forward can be cost awareness toward what and how much clinician are prescribing.

Cost awareness of radiological studies among doctors at Universitas Academic Hospital in Bloemfontein, South Africa

Background: South Africa has high healthcare expenses. Improving cost-consciousness could decrease government expenditure on healthcare.Objectives: To determine cost awareness of radiological studies among doctors at a tertiary hospital. The objective was met by assessing the accuracy of cost estimation according to the level of training and speciality, whether participants had received prior education/training related to cost awareness and if they had a desire to learn more about the cost of radiological imaging.Method: A cross-sectional survey was conducted in six clinical departments at Universitas Academic Hospital using an anonymous questionnaire that determined doctors’ cost awareness of five radiological studies. Each radiological study was answered using six different cost ranges, with one correct option. Costs were based on the Department of Health’s 2019 Uniform Patients Fee Schedule (UPFS).Results: In total, 131 (67.2%) of 195 questionnaires distributed to registrars and consultants were returned. Overall, low accuracy of cost estimation was observed, with 45.2% of the participants choosing only incorrect options. No participant estimated all five costs correctly. Only the Internal Medicine clinicians demonstrated a significant difference between registrars and consultants for the number of correct answers (median 0 and 1, respectively) (p = 0.04). No significant differences were found between specialities stratified by registrars/consultants. Most participants (88.6%) would like to learn about imaging costs. Only 2.3% of the participants had received prior education/training related to cost awareness of radiological studies.Conclusion: Doctors were consistently inaccurate in estimating the cost of radiological studies. Educating doctors about the cost of radiological imaging could have a positive effect on healthcare expenditure.

MULTI-CRITERIA ASSESSMENT AND PROCESS SELECTION MODEL FOR ADDITIVE MANUFACTURING IN THE CONCEPTUAL PHASE OF DESIGN

Additive manufacturing (AM), which was first applied for rapid prototyping, is now becoming a real option for small-batch production of final products. Further expansion of AM is closely correlated to production costs. AM can only become competitive to traditional manufacturing methods if a product is designed for AM already from the beginning as it is an expensive technology that should only be applied if it adds enough value to the product. The aim of this paper is to increase cost awareness in the conceptual design phase and to support product developers in doing AM cost estimation and process selection. The proposed model integrates design for AM and costs calculation. The input data to the process is preliminary design and design requirements. The main contribution of this paper is the multi-criteria AM function, which enables concurrent consideration of different technical and economical criteria. The multi-criteria AM function helps to compare how AM processing and product design parameters influence the product cost. The holistic overview of different options increases the solution space and enables product optimization in several iterations.

Impact of surgeon rhBMP-2 cost awareness on complication rates and health system costs for spinal arthrodesis

OBJECTIVE Recombinant human bone morphogenetic protein–2 (rhBMP-2) is used in spinal arthrodesis procedures to enhance bony fusion. Research has suggested that it is the most cost-effective fusion enhancer, but there are significant upfront costs for the healthcare system. The primary objective of this study was to determine whether intraoperative dosing and corresponding costs changed with surgeon cost awareness. The secondary objective was to describe surgical complications before and after surgeon awareness of rhBMP-2 cost. METHODS A retrospective medical record review was conducted to identify patients who underwent spinal arthrodesis procedures performed by a single surgeon, supplemented with rhBMP-2, from June 2016 to June 2018. Collected data included rhBMP-2 dosage, rhBMP-2 list price, and surgical complications. Expected Medicare reimbursement was calculated. Data were analyzed before and after surgeon awareness of rhBMP-2 cost. RESULTS Forty-eight procedures were performed using rhBMP-2, 16 before and 32 after surgeon cost awareness. Prior to cost awareness, the most frequent rhBMP-2 dosage level was x-small (38.9%, n = 7), followed by large (27.8%, n = 5) and small (22.2%, n = 4). After cost awareness, the most frequent rhBMP-2 dosage was xx-small (56.8%, n = 21), followed by x-small (21.6%, n = 8) and large (13.5%, n = 5). The rhBMP-2 average cost per surgery was $4116.56 prior to surgeon cost awareness versus $2268.38 after. Two complications were observed in the pre—cost awareness surgical group; 2 complications were observed in the post—cost awareness surgical group. CONCLUSIONS Surgeon awareness of rhBMP-2 cost resulted in use of smaller rhBMP-2 doses, decreased rhBMP-2 cost per surgery, and decreased overall hospital admission charges, without a detectable increase in surgical complications.

Curtailing Unnecessary Waste Among Operating Room Personnel: Evaluating the Cost Awareness of Commonly Used Surgical Items

Background Operating rooms (ORs) generate 70% of hospital waste, leading to increased costs for the hospital, patient, and the environment. The lack of cost awareness among physicians has been well documented; however, there is little information on anesthesiologists or ancillary OR staff. This study aimed to evaluate the cost awareness of commonly used items at an academic medical center among OR personnel. Methods Anonymous surveys were distributed to OR personnel (nurses, surgical technicians (STs), nurse anesthetists, anesthesiologists, surgeons, and residents), asking for the estimated costs of ten commonly used items. These costs were then compared against actual costs to evaluate the accuracy of participants’ estimates. Responders were clustered by job, highest level of education, and years of experience for comparison. Results 167 surveys were collected, and overall only 16.4% of estimates were accurate within 50% of actual price. No significant differences in accuracy between groups were identified overall ( P = .2), but both surgical and anesthesia attendings had significantly higher rates of correct responses than their respective residents. No difference was seen in accuracy when all attendings (surgeons and anesthesiologists) were compared with either nurses or STs. Linear regression demonstrated no correlation between number of years at current position or years at institution and number of correct responses ( R2 = .0025 and R2 = .005, respectively). Discussion Addressing the knowledge deficit around item costs via global education of all OR personnel (surgeons, anesthesia providers, and ancillary staff) could be a viable pathway to reduce waste, and thus cost, for our healthcare system.

Small Family Businesses: Innovation, Risk and Value

This article reviews the literature and applies principal-to-principal (PP) conflict theory to small family based businesses. The lack of accurate measurement and communication of risk leading to issues with innovation, is the primary cause of PP agency costs. Careful analysis of the risk levels reflected in the cost of debt and opportunity cost of equity provides a theoretically robust and empirically estimable process for ascertaining the true PP agency cost. Awareness of the constraining governance structures and the suggested method, based on the cost of capital, to assess small business risk can assist SME owners and financiers to SMEs to promote business efficiency and innovation.

Surgical Supply Cost Awareness Is Associated With Lower Costs: A Single-Center Experience

Surgeons are often unfamiliar with the costs of surgical instrumentation and supplies. We hypothesized that surgeon cost feedback would be associated with a reduction in cost. A multidisciplinary team evaluated surgical supply costs for laparoscopic appendectomies of 7 surgeons (surgeons A-G) at a single-center academic institution. In the intervention, each surgeon was debriefed with their average supply cost per case, their partner’s average supply cost per case, the cost of each surgical instrument/supply, and the cost of alternatives. In addition, the laparoscopic appendectomy tray was standardized to remove extraneous instruments. Pre-intervention (March 2017-February 2018) and post-intervention (March 2018-October 2018) costs were compared. Pre-intervention, the surgeons’ average supply cost per case ranged from $754-$1189; when ranked from most to least expensive, surgeon A > B > C > D > E > F > G. Post-intervention, the surgeons’ average supply cost per case ranged from $676 to $846, and ranked from surgeon G > D > F > C > E > B > A. Overall, the average cost per case was lower in the post-intervention group ($854.35 vs. $731.11, P < .001). This resulted in savings per case of $123.24 (14.4%), to a total annualized savings of $29 151.

Consumer Buying Behaviour towards E-Commerce during COVID-19

The job and effect of E-commerce business on Consumer behaviour are driving the business wide adoption of Consumer behaviour analysis for pulling in more shoppers and improving their shopping experience. There is a noteworthy change in buyer’s mentalities and shopping conduct, most of them are relied upon to remain post-pandemic. The lockdown has forced purchasers to question their shopping habits including cost awareness, preference inclination for neighbourhood items and the emotional move towards internet business. To what extend the pandemic changed the buying behaviour of consumer towards online purchases. Traditional or online practices, which one is most likely to be followed post pandemic. Are they satisfied with the e-commerce sites and their offerings?