Hugh Waters

Intensive care unit physician staffing: Financial modeling of the Leapfrog standard

Objective:To evaluate from a hospital’s perspective the costs and savings, over a 1-yr period, of implementing The Leapfrog Group’s Intensive Care Unit Physician Staffing (IPS) standard compared with the existing standard of nonintensivist staffing in adult intensive care units. Design:Using published data, we developed a financial model of costs and savings for 6-, 12- and 18-bed intensive care units using conservative estimates for all variables. Sensitivity analyses, including a best-case and worst-case scenario, were performed to evaluate the impact of changing assumptions on the outcome of the model. Setting:Nonrural hospitals in the United States. Patients:All adult intensive care unit patients. Interventions:The IPS standard requires that intensive care units have a dedicated intensivist present during daytime hours. Outside of these hours, an intensivist must be immediately available by pager, and a physician or “physician extender” must be in the hospital and able to immediately reach intensive care unit patients. Measurements and Main Results:Cost savings ranged from

Measuring equity in access to health care.

510,000 to

The Business Case for Quality Economic Analysis of the Michigan Keystone Patient Safety Program in ICUs

3.3 million for 6- to 18-bed intensive care units. The best-case scenario demonstrated savings of

Exploring the economics of motorcycle helmet laws - Implications for low and middle-income countries

4.2–13 million. Under the worst-case scenario, there was a net cost of

Impact of critical care physician workforce for intensive care unit physician staffing.

890,000 to

Economic evaluation of Mectizan distribution

1.3 million. Conclusions:Financial modeling of implementation of the IPS standard using conservative assumptions demonstrated cost savings to hospitals. Only under worst-case scenario assumptions did intensivist staffing result in additional cost to hospitals. These economic findings must be interpreted in the context of significant reductions in patient morbidity and mortality rates also associated with intensivist staffing. Given the magnitude of its clinical and financial impact, hospital leaders should be asking “how to” rather than “whether to” implement The Leapfrog Group’s ICU Physician Staffing standard.

Economic evaluation of interventions to reduce road traffic injuries--a review of the literature with applications to low and middle-income countries

This article develops and uses methodologies to: (1) measure equity in the distribution of access to health services; and (2) measure the impact of health insurance programs on equity. The article proposes two egalitarian-based indicators for measuring equity in terms of access to health care--a concentration coefficient derived from the Gini coefficient, and the Atkinson distributional measure and also employs a weighted Utilitarian social welfare function to measure overall levels of access. The article defines access as the use of health care by individuals with a need for care; need is measured as self-reported morbidity. The setting for the empirical application is the country of Ecuador. The Ecuador Social Security Institute runs a General Health Insurance (GHI) program, whose affiliates are primarily workers in the formal sector of the economy. The principal data source is the 1995 Ecuador Living Standards Measurement Survey. The study uses a microeconomic health care demand model and bivariate probit estimation techniques to measure the impact of insurance on health service use for each quintile of adjusted per-capita household expenditure. The study also predicts health care use and program impact for each quintile under a series of simulation scenarios corresponding to proposed expansion of eligibility for the GHI program. The GHI program increases overall access to health care, but has a negative impact on equity in the distribution of health services. The benefits of the program, calculated as its marginal impact on the probability of using of health care, have a strongly regressive distribution. Expanding eligibility to the self-employed makes the benefit more equitably distributed (but still inequitable), and increases overall social welfare considerably. Expanding eligibility to the dependents of the insured person has similar effects, although less important in magnitude.

Household surveillance of severe neonatal illness by community health workers in Mirzapur, Bangladesh: coverage and compliance with referral

Health care-associated infections affect an estimated 5% of hospitalized patients and represent one of the leading causes of illness and death in the United States. This study calculates the costs and benefits of a patient safety program in intensive care units in 6 hospitals that were part of the Michigan Keystone ICU Patient Safety Program. On average, 29.9 catheter-related bloodstream infections and 18.0 cases of ventilator-associated pneumonia were averted per hospital on an annual basis. The average cost of the intervention is

Self-reported price of cigarettes, consumption and compensatory behaviours in a cohort of Mexican smokers before and after a cigarette tax increase

3375 per infection averted, measured in 2007 dollars. The cost of the intervention is substantially less than estimates of the additional health care costs associated with these infections, which range from

User fees and health service utilization in Vietnam: How to protect the poor?

12 208 to