Facility Revenue Research Articles

Factors Affecting the Availability of Essential Health Commodities in Tanzania with a Special Focus on the Tracer Commodities

Background: Access to essential health commodities is fundamental to healthcare system efficacy. These commodities are vital in delivering health services and form integral elements within the World Health Organization's strengthening framework, encompassing the six foundational building blocks. Regrettably, there has been a global increase in shortages and stockouts of essential health commodities in recent years. Objective: The study aimed to identify factors influencing the availability of essential health commodities throughout all levels of the supply chain in Tanzania. Methods: A cross-sectional that employed qualitative and quantitative data collection techniques. Quantitative data were analyzed using STATA version 16, while Qualitative data were thematically analyzed. Results: Factors contributing to stockouts of essential commodities at the national level include increased demand, delayed shipments from donors, decreased funding commitments, delayed disbursement of funds, global shortages, inadequate governance, debt within the Medical Stores Department, donor dependency for vertical program commodities, and long lead times by Medical Stores Department suppliers. At the Regional and District levels, such factors include a shortage of human resources, lack of Electronic Medical Records, limited interoperability of information systems, poor quality of logistics data, inadequate use of data for decision-making, and poor inventory management. At the healthcare facility level, they include an overwhelming number of exempted clients, which reduces facility revenues. Conclusion: More efforts are still needed to address both the upstream and downstream challenges needed to ensure sustainable access and availability of essential health commodities at service delivery points as a pathway for improving health sector performance.

How an Automated Patient Education Module Improves Patient Outcomes and Informs Quality-of-Care Measures for Providers Within a Minimally Invasive Aesthetic Practice.

I conducted a quality improvement project to determine whether providing patient education before consultation and treatment would help meet the needs of aesthetic patients and providers. The project objective was to create an automated patient education module that provided consistent, accurate information to each patient who viewed it and would give the providers additional time to treat the patient and generate revenue. Before and during the 6-week study period, I administered three surveys and reviewed electronic health records metrics indicating patient check-in and check-out times and facility revenue. I used descriptive statistics to examine the demographics of the patients included in the study. I analyzed check-in and check-out times and facility revenue by conducting two-tailed Mann-Whitney U tests. There were a total of 201 patient visits in the 6-week period before the study and a total of 316 patient visits during the study period. Most patients were White, married women, 50- to 59-years-old, with at least some college education. The most common treatments administered were neurotoxin and dermal filler injections. After implementing the preappointment education, I found a significant reduction in the length of patient appointments (p < .001) and a significant increase in facility revenue (p < .037). I concluded that after implementing the education program, patient understanding about the intended treatment was improved. To better correlate how preappointment automated education impacts the amount of time the provider spends with patients and influences practice revenue, I recommend conducting a longer study with a greater number of patients.

The US Supreme Court and Future of Financing Dialysis Care.

The US Supreme Court and Future of Financing Dialysis Care.

Factors and Solutions Addressing Overcrowding in Emergency Department

Overcrowding in emergency departments is a significant challenge in the world of medicine. Approximately 90% of the emergency departments face the issue of overcrowding. The causes of the phenomena are intensely contested, which makes it challenging to come up with effective, focused solutions. Individual patients, healthcare systems, and entire communities are all impacted by emergency department overcrowding. Crowding's detrimental effects on the delivery of healthcare services lead to delays, subpar care, and inefficiency, all of which have an adverse impact on the health outcomes of emergency patients. The purpose of this research is to review the available information about factors and solutions addressing overcrowding in emergency departments. Increased number of patients arriving in the emergency department, lack of resources, and the number of admitted patients waiting for transfer from the emergency department to a hospital ward are all contributing factors to the problem of overcrowding in the emergency department. The quality of medical care is directly impacted by emergency department overcrowding, which causes medication to be administered later than intended and raises the risk of morbidity and mortality among hospitalized patients. It also contributes to a number of unintended issues, including increased duration of waiting times, a decline in patient satisfaction, and a loss of revenue for medical facilities. Additional staff, observation units, hospital bed access, non-urgent referrals, ambulance diversion, destination control, congestion controls, and queuing theory are some of the possible solutions to overcrowding. Effective implementation of the strategies managing overcrowding at emergency department is needed.

Analisis Perubahan Kebijakan Pajak di Negara GCC dalam Perspektif Ekonomi Islam

G.C.C. countries use oil as a significant source of state revenue because the G.C.C. region is a collection of world oil-producing countries. However, since the world oil price slumped from 2005-2008, governments have changed course by imposing taxes on their citizens. The point of this study is to argue the G.C.C. countries that have changed their tax-free system in their economy into countries that apply taxes today. Then, the views of some Muslim scientists related to taxation are related to changes in tax policy in G.C.C. countries. The qualitative method is used in this paper with a critical approach and analysis of several kinds of literature and financial reports relating to changes in tax policy in the G.C.C. area. The results of this study explain that the G.C.C. countries compile a value-added tax of 5%, which is applied to several basic needs such as food, clothing, water, and electricity bills. Later, some Muslim scientists agreed on the existence of taxes for the common good, a source of revenue for public facilities and services.

Formulations for automatic optimization of decommissioning timing in offshore oil and gas field development planning

A mathematical programming formulation has been developed to optimize the drilling program, the production allocation, and the decommissioning time in early-stage field development planning. Various abandonment constraints are considered in the optimization model when searching for the best decommissioning time for the long-term field development strategy. The model is tested on a real field development planning consisting of two reservoirs produced with subsea wells to an offshore facility. The novelty of this work is the utilization of mathematical programming to formulate and solve early-stage field development planning considering the variable decommissioning time. The results show that considering a variable decommissioning time in early-stage field development planning yields improved economic margins. Further, it provides operators a decision-support tool with enhanced capabilities of forecasting the best decommissioning time, improving the forecasts for processing and production planning, expected revenue and lifetime of facilities, and anticipating and preparing for field abandonment in advance. The optimization model is capable of determining the drilling and production schedules, and the optimal decommissioning time that yielded the maximum net present value for the project.

Efficiency of malaria service delivery in selected district-level hospitals in Ghana

ABSTRACT Malaria remains an important public health concern. Sub-Saharan African countries carry over 95% of the global burden. Unfortunately, there are also major resource constraints that have limited efforts to reduce the burden. Our study sought to estimate efficiency in the use of malaria resources and to identify potential determinants. We used primary data collected from district-level health facilities in three administrative regions in Ghana from 2014 to 2016. The Data Envelopment Analysis technique was used to estimate efficiency. The Malmquist productivity index was estimated and disaggregated to reflect the sources of productivity change. The findings show an average technical efficiency score of 0.61 with private facilities being more efficient. Productivity changes were driven by changes in technology/innovation advancements. Facility revenue mix and ownership type were important determinants of efficiency. The findings highlight the need to improve resource use in the delivery of specific services such as malaria.

Examining the implementation of the Linda Mama free maternity program in Kenya.

BackgroundIn 2013, Kenya introduced a free maternity policy in all public healthcare facilities. In 2016, the Ministry of Health shifted responsibility for the program, now called Linda Mama, to the National Hospital Insurance Fund (NHIF) and expanded access beyond public sector. This study aimed to examine the implementation of the Linda Mama program.MethodsWe conducted a mixed‐methods cross‐sectional study at the national level and in 20 purposively sampled facilities across five counties in Kenya. We collected data using in‐depth interviews (n = 104), administered patient‐exit questionnaires (n = 108), and carried out document reviews. Qualitative data were analysed using a framework approach while quantitative data were analysed descriptively.Results Linda Mama was designed and resulted in improved accountability and expand benefits. In practice however, beneficiaries did not access some services that were part of the revised benefit package. Second, out of pocket payments were still being incurred by beneficiaries. Health facilities in most counties had lost financial autonomy and had no access to reimbursements from NHIF for services provided; but those with financial autonomy were able to boost facility revenue and enhance service delivery. Further, fund disbursements from NHIF were characterised by delays and unpredictability. Implementation experiences reveal that there was inadequate communication, claim processing challenges and reimbursement rates were deemed insufficient.ConclusionsOur findings show that there are challenges associated with the implementation of the Linda Mama program and highlights the need for process evaluations for programs to track implementation, ensure continuous learning, and provide opportunities for course correcting programs' implementation.

Accuracy of Hemodialysis Bloodstream Infection Pathogen Reporting to the National Healthcare Safety Network: Results of an Academic Dialysis Program Audit

Patients with dialysis-dependent end-stage kidney disease experience high rates of infections.1 Bloodstream infections (BSIs) are the major cause of fatal infection and third leading cause of death.1 Since 1999, the Centers for Disease Control and Prevention has tracked dialysis infections by facility self-reporting to the National Healthcare Safety Network (NHSN).2 Maintaining accurate BSI data is necessary to inform infection prevention efforts. BSI rates also affect the Patient Safety domain of the Quality Incentive Program, negatively affecting facility revenue.

Emergency Department Psychiatric Observation Units: Good Care and Good Money?

The boarding of Psychiatric Emergency Department patients continues to be a crisis across our country. As healthcare leaders navigate the challenges of COVID -19 there is an amplified urgency for novel solutions to this complex problem. Congested waiting rooms and hallways, the unfortunate byproduct of boarding, result in emergency departments becoming a potential focal point for disease transmission. Given the financial losses that many health care institutions have incurred due to the pandemic, understanding the fiscal implications of any intervention is paramount.

The Effect of Ethiopia's Community-Based Health Insurance Scheme on Revenues and Quality of Care.

Ethiopia’s Community-Based Health Insurance (CBHI) scheme was established with the objectives of enhancing access to health care, reducing out-of-pocket expenditure (OOP), mobilizing financial resources and enhancing the quality of health care. Previous analyses have shown that the scheme has enhanced health care access and led to reductions in OOP. This paper examines the impact of the scheme on health facility revenues and quality of care. This paper relies on a difference-in-differences approach applied to both panel and cross-section data. We find that CBHI-affiliated facilities experience a 111% increase in annual outpatient visits and annual revenues increase by 47%. Increased revenues are used to ameliorate drug shortages. These increases have translated into enhanced patient satisfaction. Patient satisfaction increased by 11 percentage points. Despite the increase in patient volume, there is no discernible increase in waiting time to see medical professionals. These results and the relatively high levels of CBHI enrollment suggest that the Ethiopian CBHI has been able to successfully negotiate the main stumbling block—that is, the poor quality of care—which has plagued similar CBHI schemes in Sub-Saharan Africa.

Decision time: Cost estimations and policy implications to advance Universal Health Coverage in Cambodia

Cambodia aims to expand social health protection to move toward Universal Health Coverage. We developed a modeling tool to facilitate the simple, interactive estimation of cost and coverage for three policy alternatives, enabling decision-makers to simultaneously adjust for scenario options currently under consideration. Assuming the adoption of all scenario options, the projected cost of expanding social health protection to all is US$42 million, to vulnerable individuals is US$32.1 million, and to uncovered 1st–3rd wealth quintile people is US$30.4 million. These policy alternatives are projected to increase population coverage to 100%, 89.1%, and 92.5% by 2025, respectively. The results have multiple policy implications. First, given the similar costs and coverage estimates for the targeted approaches, and other considerations, expansion to the 1st–3rd wealth quintiles is recommended. Second, the model quantifies the potential impacts for policy changes relating to each scenario option. The inclusion of dependents under the contributory schemes significantly shifts costs; reversing the policy of non-payment for priority public health services increases public health facility revenue; and, alignment of reimbursement rates leverages demand-side financing which can increase value for money. Finally, the cost estimates provide a basis for economic planning. Revenue raising options include increasing the contribution ceiling for the private employees’ scheme and the progressive adoption of strategic purchasing.

The effect of political control on financial performance, structure, and outcomes of US nursing homes.

ObjectiveTo evaluate the effect of partisan political control on financial performance, structure, and outcomes of for‐profit and not‐for‐profit US nursing homes.Data Sources/Study SettingNineteen‐year panel (1996‐2014) of state election outcomes, financial performance data from nursing home cost reports, operational and aggregate resident characteristics from OSCAR of 13 737 nursing homes.Study DesignA linear panel model was estimated to identify the effect of Democratic and Republican political control on next year's outcomes. Nursing home outcomes were defined as yearly facility revenues, expenses, and profits; the number of Medicaid, Medicare, and private‐pay residents; staffing levels; and selected resident outcomes.Principal FindingsDemocratic political control leads to an increase in financial flows to for‐profit nursing homes, boosting profits without producing observable improvements in resident outcomes. Republican political control leads to lower revenues and profits of for‐profit nursing homes. A shift from Medicaid to more profitable private‐pay residents following Republican political control is observed for all nursing homes. Financial performance of not‐for‐profit nursing homes is not significantly affected by changes in political control.ConclusionPolitical control of the two legislative chambers—but not of the governorship—shapes the structure of the nursing home industry as seen in provider behavior.

Commentaries on health services research

Commentaries on health services research

Assessment of the Meetings, Incentives, Conventions and Exhibitions (MICE) Industry in the Philippines

Assessment of the Meetings, Incentives, Conventions and Exhibitions (MICE) Industry in the Philippines

Implementing demand side targeting mechanisms for maternal and child health-experiences from national health insurance fund program in Rungwe District, Tanzania.

BackgroundLow and middle income countries have adopted targeting mechanisms as a means of increasing program efficiency in reaching marginalized people in the community given the available resources. Design of targeting mechanisms has been changing over time and it is important to understand implementers’ experience with such targeting mechanisms since such mechanisms impact equity in access and use of maternal health care services.MethodsThe case study approach was considered as appropriate method for exploring implementers’ and decision-makers’ experiences with the two targeting mechanisms. In-depth interviews in order to explore implementer experience with the two targeting mechanisms. A total of 10 in-depth interviews (IDI) and 4 group discussions (GDs) were conducted with implementers at national level, regional, district and health care facility level. A thematic analysis approach was adopted during data analysis.ResultsThe whole process of screening and identifying poor pregnant women resulted in delay in implementation of the intervention. Individual targeting was perceived to have some form of stigmatization; hence beneficiaries did not like to be termed as poor. Geographical targeting had a few cons as health care providers experienced an increase in workload while staff remained the same and poor quality of information in the claim forms. However geographical targeting increase in the number of women going to higher level of care (district/regional referral hospital), increase in facility revenue and insurance coverage.ConclusionInterventions which are using targeting mechanisms to reach poor people are useful in increasing access and use of health care services for marginalized communities so long as they are well designed and beneficiaries as well as all implementers and decision makers are involved from the very beginning. Implementation of demand side financing strategies using targeting mechanisms should go together with supply side interventions in order to achieve project objectives.

A PROPOSED MODEL FOR MEASURING COST AND BENEFIT IN WATER INSTITUTIONS TO EVALUATE THE ENVIRONMENTAL PERFORMANCE AN APPLIED STUDY ON TOSHKA PROJECT

The environment kept its miraculous balance due to God's power till man, intentionally or non-intentionally, started to corrupt God's creation. This led to a huge problem, namely damaging the environment. Hence, the researcher decided to study and analyze costs, environmental returns of water industrial facilities of Toshka project of agricultural expansion under the title A proposed Model to Measure Cost & Return in Water Facilities with the aim of Assessing Environmental Performance- Applied Study on Toshka Project . This is due to the importance quality of accounting information for decision-making and conducting a research study of the opinions of a sample of those responsible for industrial facilities of Toshka Project. For the theoretical part of the studyk, light was shed on care of these facilities of environmental issues and nature of environmental costs borne by these facilities. The researcher also examined concept and nature of environmental costs and means of approaching them. As for the applied part, it is the research study and building a measurement model of cost & return. Through a questionnaire form distributed on those working at industrial facilities at Toshka Project, results and recommendations to achieve goals of the research were attained, the most important of which are: Firstly, Results: There is no moral relationship of statistically significance between rationalizing costs in water facilities and the results of the environmental performance of these facilities. There is no moral- relationship of statistically significance between cost rationalization, revenue of water facilities & the amount of environmental pollution. There is no moral relationship of statistically significance among the results of suggested model for measuring the cost & revenue of water facilities & rationalizing environmental performance of Toshka Project. Secondly: Recommendations: Paying attention to laying out qualified cadres in the accountant units & operational ones related to environment. Activating the laws that make the facilities conform to their responsibilities towards the environment & paying attention to research & study for indicating the role of environmental legislations & their effects on environmental costs. Paying attention to evaluation as a tool for improving the facilities performance periodically as well as research and study of accountancy information in evaluating environmental performance .

Paying for Infrastructure in an Urban Environment

This study examines public preferences for two revenue options—fuel taxes and tolls—to finance transportation infrastructure in an urban area with the use of the results of a survey of residents of the Hampton Roads region of southeastern Virginia. Specifically, the study addresses two related research questions: (a) To what extent do residents support instituting tolls, increasing the fuel tax, or both? (b) What roles do self-interest and ideological beliefs play in support of increasing the fuel tax, imposing tolls, or doing both? The study finds that 50% of respondents expressed a willingness to support fuel taxes or tolls for infrastructure, 29% for increasing fuel taxes, and 28% for tolls, with 7% supporting both revenue options. The study also finds that the support for each funding source is associated with a different set of ideological beliefs and self-interest factors. Implications for generating public support for increases in revenue and funding for transportation facilities are discussed.

Increasing access to specialty surgical care: application of a new resource allocation model to bariatric surgery.

To calculate the public health impact and economic benefit of using ancillary health care professionals for routine postoperative care. The need for specialty surgical care far exceeds its supply, particularly in weight loss surgery. Bariatric surgery is cost-effective and the only effective long-term weight loss strategy for morbidly obese patients. Without clinically appropriate task shifting, surgeons, hospitals, and untreated patients incur a high opportunity cost. Visit schedules, time per visit, and revenues were obtained from bariatric centers of excellence. Case-specific surgeon fees were derived from published Current Procedural Terminology data. The novel Microsoft Excel model was allowed to run until a steady state was evident (status quo). This model was compared with one in which the surgeon participates in follow-up visits beyond 3 months only if there is a complication (task shifting). Changes in operative capacity and national quality-adjusted life years (QALYs) were calculated. In the status quo model, per capita surgical volume capacity equilibrates at 7 surgical procedures per week, with 27% of the surgeon's time dedicated to routine long-term follow-up visits. Task shifting increases operative capacity by 38%, resulting in 143,000 to 882,000 QALYs gained annually. Per surgeon, task shifting achieves an annual increase of 95 to 588 QALYs, $5 million in facility revenue, 48 cases of cure of obstructive sleep apnea, 44 cases of remission of type 2 diabetes mellitus, and 35 cases of cure of hypertension. Optimal resource allocation through task shifting is economically appealing and can achieve dramatic public health benefit by increasing access to specialty surgery.

The differential impact of plastic surgery subspecialties on the financial performance of an academic clinical practice.

In an academic center, plastic surgery provides multiple important and distinct services. Limited data exist on how each service affects a department clinically and financially. All new patient consultations and surgical cases between 2004 and 2012 were reviewed. Conversion rates from consultation to surgery and relative value units were calculated. Professional and facility revenues, costs, and net income were ascertained. These measures were compared between different subspecialties. A total of 12,020 new patient consultations and 5741 surgical cases were reviewed. Total growth in consultations was greatest for breast reconstruction (396.8 percent), followed by aesthetic (83.8 percent), oncology (12.9 percent), general (-16.9 percent), and burn/trauma (-75.0 percent). The conversion rate from consultation to surgery was highest in breast reconstruction (57.0 ± 3.1 percent) and oncology (56.9 ± 6.6 percent), followed by burn/trauma (47.0 ± 6.8 percent), general (46.1 ± 3.5 percent), and aesthetic (37.0 ± 4.8 percent). Total growth in professional net income was greatest for breast reconstruction (1241.4 percent), followed by oncology (378.4 percent), general (159.7 percent), aesthetic (130.5 percent), and burn/trauma (-20.9 percent). Total growth in facility net income was greatest for breast reconstruction (7619.5 percent), followed by oncology (2648.0 percent), aesthetic (432.3 percent), general (283.3 percent), and burn/trauma (108.7 percent). Breast reconstruction exhibited the greatest growth in consultations, and oncologic consultations demonstrated the highest consultation-to-surgery conversion rate. The higher consultation volume and conversion rate associated with breast reconstruction resulted in greater financial gains for both the department and the hospital. These findings may be of utility in the development of academic plastic surgery programs.