John E. Schneider

Tobacco Outlet Density and Demographics at the Tract Level of Analysis in Iowa: Implications for Environmentally Based Prevention Initiatives

This study assessed the geographic association between tobacco outlet density and three demographic correlates—income, race, and ethnicity—at the tract level of analysis for one county in the Midwestern United States. Data for residential census tracts in a Midwestern U.S. county were derived from year 2003 licenses for 474 tobacco outlets. Demographic variables were based on 2000 census data. Census tracts with lower median household income, higher percent of African American residents, and higher percent of Latinos residents had greater density of tobacco selling retail outlets. Areas characterized by lower income and disproportionately more African Americans and Latinos have greater physical access to tobacco products. Physical access to tobacco is a critical public-health issue because, given that smokers have been shown to be price sensitive, lowering access costs (e.g., reduced travel time) is likely to increase consumption. Findings also suggest the need for structural or environmental interventions, i.e., tobacco outlet zoning laws, to mitigate the health consequences associated with tobacco use in certain populations and geographic regions.

The Economics of Specialty Hospitals

Specialty hospitals, particularly those specializing in surgery and owned by physicians, have generated a relatively high degree of policy attention over the past several years. The main focus of policy debates has been in two areas: the extent to which specialty hospitals might compete unfairly with incumbent general hospitals and the extent to which physician ownership might be associated with higher usage. Largely absent from the debates, however, has been a discussion of the basic economic model of specialty hospitals. This article reviews existing literature, reports, and findings from site visits to explore the economic rationale for specialty hospitals. The discussion focuses on six factors associated with specialization: consumer demand, procedural operating margins, clinical efficiencies, procedural economies of scale, economies (and diseconomies) of scope, and competencies and learning. A better understanding of the economics of specialization will help policy makers evaluate the full spectrum of advantages and disadvantages of specialty hospitals.

Cost Effectiveness of a Point-of-Care Test for Adenoviral Conjunctivitis

Background:Conjunctivitis is a relatively common condition of the eye that can be caused by a number of different pathogens including bacteria and viruses. Clinical differentiation between adenoviral and bacterial conjunctivitis is difficult, often resulting in misdiagnosis and the provision of inappropriate treatment. Methods:A cost-effectiveness analysis was performed from a societal perspective using primary, secondary, published literature, and expert opinion data sources. The incremental costs and effects (cases of unnecessary antibiotic treatment avoided) for a rapid point-of-care test for adenoviral conjunctivitis (RPS Adeno Detector) were modeled. Results:Using base case values, the incremental cost of using no point-of-care test compared with the point-of-care test is

The effect of physician and health plan market concentration on prices in commercial health insurance markets

71.30 with 0.1786 cases of unnecessary antibiotic treatment. Extrapolating these costs to the entire U.S. population per annum, society could potentially save nearly

Implementation of hospital computerized physician order entry systems in a rural state: Feasibility and financial impact

430 million currently spent on unnecessary medical care and avoid over 1 million cases of unnecessary antibiotic treatment. The no-point-of-care test strategy is both more costly and less effective; indicating that the point-of-care test strategy is the most cost-effective option. The results were robust to variation in key model parameters. Conclusions:Through the use of a rapid point-of-care test for adenovirus, much of the cost to society caused by acute conjunctivitis can be avoided through more timely and accurate diagnosis.

Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a US health system perspective

The objective of this paper is to describe the market structure of health plans (HPs) and physician organizations (POs) in California, a state with high levels of managed care penetration and selective contracting. First we calculate Herfindahl–Hirschman (HHI) concentration indices for HPs and POs in 42 California counties. We then estimate a multivariable regression model to examine the relationship between concentration measures and the prices paid by HPs to POs. Price data is from Medstat MarketScan databases. The findings show that any California counties exhibit what the Department of Justice would consider high HHI concentration measures, in excess of 1,800. More than three quarters of California counties exhibit HP concentration indices over 1,800, and 83% of counties have PO concentration levels in excess of 1,800. Half of the study counties exhibited PO concentration levels in excess of 3,600, compared to only 24% for plans. Multivariate price models suggest that PO concentration is associated with higher physician prices (p ≤0.05), whereas HP concentration does not appear to be significantly associated with higher outpatient commercial payer prices.

Converting to critical access status: how does it affect rural hospitals' financial performance?

OBJECTIVE The aim of this study was to estimate the costs of implementing computerized physician order entry (CPOE) systems in hospitals in a rural state and to evaluate the financial implications of statewide CPOE implementation. METHODS A simulation model was constructed using estimates of initial and ongoing CPOE costs mapped onto all general hospitals in Iowa by bed quantity and current clinical information system (CIS) status. CPOE cost estimates were obtained from a leading CPOE vendor. Current CIS status was determined through mail survey of Iowa hospitals. Patient care revenue and operating cost data published by the Iowa Hospital Association were used to simulate the financial impact of CPOE adoption on hospitals. RESULTS CPOE implementation would dramatically increase operating costs for rural and critical access hospitals in the absence of substantial costs savings associated with improved efficiency or improved patient safety. For urban and rural referral hospitals, the cost impact is less dramatic but still substantial. However, relatively modest benefits in the form of patient care cost savings or revenue enhancement would be sufficient to offset CPOE costs for these larger hospitals. CONCLUSION Implementation of CPOE in rural or critical access hospitals may depend on net increase in operating costs. Adoption of CPOE may be financially infeasible for these small hospitals in the absence of increases in hospital payments or ongoing subsidies from third parties.

Tobacco litter costs and public policy: a framework and methodology for considering the use of fees to offset abatement costs

Abstract Background: Whether or not antibiotic stewardship protocols based on procalcitonin levels results in cost savings remains unclear. Herein, our objective was to assess the economic impact of adopting procalcitonin testing among patients with suspected acute respiratory tract infection (ARI) from the perspective of a typical US integrated delivery network (IDN) with a 1,000,000 member catchment area or enrollment. Methods: To conduct an economic evaluation of procalcitonin testing versus usual care we built a cost-impact model based on patient-level meta-analysis data of randomized trials. The meta-analytic data was adapted to the US setting by applying the meta-analytic results to US lengths of stay, costs, and practice patterns. We estimated the annual ARI visit rate for the one million member cohort, by setting (inpatient, ICU, outpatient) and ARI diagnosis. Results: In the inpatient setting, the costs of procalcitonin-guided compared to usual care for the one million member cohort was

Tobacco outlet density and demographics at the tract level of analysis in New Jersey: A statewide analysis

2,083,545, compared to

Clinical practice guidelines and organizational adaptation: A framework for analyzing economic effects

2,780,322, resulting in net savings of nearly