Financial Arguments Research Articles

645 Does progress translate into outcome?

There is now ample evidence that there are wide divergences in the outcome of treatment of cancer in different countries, regions and hospitals. This would suggest that available knowledge and know-how is not always applied to its full extent and the available numbers would indicate that important progress in overall outcome for the global population could be made, if state of the art treatment would be asked and given at the right time. The analysis of the reasons of such differences complex. After treatment efficacy of a new biological or technological development has been proven in clinical research, a complex process is required for a novelty to reach the whole patient population. Even major improvements have been shown to take up to 10 years to be applied and, as in cancer most progresses have been achieved in small steps, their diffusion can be expected to be even slower. Three main steps can be assessed: a treatment has to be available, needs prescription at the right time and has to be given in the correct form. The availability is dependent on decisions by the structures governing the health care system and these are influenced by political and financial arguments. The adequate prescription pattern is dependent from training and educational aspects, as well from the public as from the general practitioner, the non oncological specialist and the oncologist. The rapidly expanding body of knowledge has created very specific requirements for continued medical education and structural support for diffusion of information. Finally, the correct execution of a treatment, monitored by quality control, is an aspect which has only in the very recent years been identified in its full importance. This is linked with the fact that the complexity of cancer treatment has been rapidly increasing with the involvement of growing numbers of people and the implementation of more sophisticated treatment schedules. The whole of these elements are covered in the process of “quality assurance”, which is the responsibility of all bodies involved. The importance of the different aspects of this process can be illustrated with a number of specific examples.

5.2.3 JUSTIFYING THE INVESTMENT IN SYSTEMS ENGINEERING TOOLS

Abstract“Automation Tools for Systems Engineers are good and the right thing to do…” has never been a good enough justification in most companies for purchasing tools for Systems Engineers. Arguments such as “Systems Engineering has been successfully done without automation over the last thousands of years” (the pyramid builders were Systems Engineers or we landed a man on the moon with my slide rule) always took the wind out of our justification sails. Of course the basic response to that argument is that computerized tools are needed to handle the complexity, communication, control, and myriad other issues that Systems Engineers are called upon to design/manage; but we could never quite pin it down financially. This article attempts to gather the appropriate cost/benefit financial justification arguments in one place and presents a framework for dealing with management unbelief.

Educational decentralization in Latin America: Lessons learned

This paper describes some of the financial, efficiency (wastage), quality, and equity changes which occurred during educational decentralization in Argentina, Chile, Colombia, and Mexico. The data show that there are obvious discrepancies between what educational policymakers preached and what was practiced through decentralization. Financial, efficiency, and power distribution arguments were the main thrust behind the reforms. Yet, for example, basic education financing continues, in general, to rely heavily on central government resources. The evidence suggests that management styles may not be key factors to increase sector productivity, but are appropriate fora to speed up efficiency. Quality of education did not improve during the decentralization process, and the gap between the better off and worst off schools actually widened.

Economic assessment of maternal serum screening for Down's syndrome using human chorionic gonadotropin.

The effectiveness and costs of prenatal screening programmes for Down's syndrome using maternal serum markers will vary significantly depending on the biological cut-off values chosen in order to select women, at each maternal age, who will be sent for amniocentesis. On the basis of the first French prospective study of human chorionic gonadotropin (hCG) measurement in maternal serum, this paper shows that the screening protocol currently used in France, where hCG cut-off values are defined in order to offer amniocentesis to women of all ages with a 1 per cent fetal risk of Down's syndrome, would detect 64.06 per cent of all cases of trisomy 21 at birth and would be highly profitable for the French social security system. On the basis of a representative sample of 100,000 pregnant women, the total costs of screening would reach $8,302,000 but would generate net potential savings of $32,186,000 in terms of life-long costs of care for trisomic 21 children which would be 'avoided' by termination of pregnancy following a positive diagnosis of Down's syndrome. Economic assessment shows that cost-benefit analysis would justify lower hCG cut-off values and a higher detection rate of fetal Down's syndrome (74.45 per cent) than the current French protocol. This paper concludes that it is ethical and value-laden issues, such as the consequences for women and couples of false positives and false negatives of screening, rather than economic and financial arguments that may set limits to the utilization of screening for Down's syndrome using maternal serum markers like hCG.

Factors affecting European privatisation and deregulation policies in local public transport: The evidence from Scandinavia

This paper concerns itself with the question of the forces behind privitisation and regulatory reform in local public transport in Europe. Two different approaches to the explanation of the changes are presented: the political and the economic. The paper gives a review of current discussions and sets forward the hypothesis that even though there is much evidence to support a process of privatization and deregulation (with a vague rationale), much can be seen as a political process; the real objectives of change can be found in policies in advocating the need for reduced public expenditure and subsidies. Thus, the ideological side of change is weaker than the financial arguments. The paper discusses the process in Europe on the basis of an all-European survey, and concludes that there is no general trend towards deregulation in local public transport in Europe, but a trend towards the use of franchising in certain countries such as Norway, Sweden, and Denmark. The Scandinavian experience is dealt with and the results of change of policies are analyzed. The wider implications of regulatory reform in Europe are seen in the context of the development of the single European market, and the need for transport policies to account for environmental problems. All these factors indicate that there will be some change, but more cautions ones, and this again indicates that a franchising solution may be more likely than full deregulation in the European bus industry.

Justifying the picture archiving and communication system: General considerations based on the trieste experience

W E PRESENT SOME general ideas about the reasons for introduction of a picture archiving and communications system (PACS) into a radiology department. Merits, benefits, and costs of PACS, in their widest meaning, are evaluated both in general and with respect to our actual experience. Traditional approaches for justification, based mainly on economic and financial arguments, are widely considered to be more and more inadequate. This is even more evident in medicine, in which practice all benefits are hardly quantifiable in terms of profits. We propose a multiattribute approach to the problem of justifying PACS. Attfibutes are parameters apt to describe the performance of a system with respect to some definite viewpoints. Different attributes may refer to different entities and be evaluated in different ways (qualitative, quantitative). No comparison or tradeoff among attributes is required. Rather, the same attribute is compared for different systems or different situations. This implies an analytical attitude toward the justification problem rather than a normative one. We believe that such an approach is more appropriate in view of the present state of the art and of the actual diffusion of PACS. We classify attributes to justify PACS into three broad classes: clinical, economic, and operational. Before we proceed to analyze such attributes, we summarize the conditions under which our experience with PACS is occurring.

Costs of bone marrow transplants using unrelated donors

Bone marrow transplantation is an expensive treatment, rationed primarily by the availability of donors. Recruiting potential unrelated bone marrow donors to a register would add not only to the cost, but also to the volume, of transplantation. Proposals to establish such registries have thus been subject to rigorous financial scrutiny. In Australia, 3 alternative estimates suggest that approximately 200 patients, otherwise suitable for bone marrow transplantation, do not receive transplants because they have no suitable related donor. The population of Australia is approximately 16 million. The alternatives for these patients are thus chemotherapy or unrelated bone marrow transplantation. The costs of chemotherapy and transplantation have been directly compared in 1 trial of treatment for acute nonlymphoblastic leukaemia. The cost per year of life saved was approximately the same for the 2 treatments, with better patient survival from transplantation. The estimated cost difference in both the United States and Australia, between the policy extremes of no patients transplanted, and all transplanted, was between 1.3–2.4% of the total costs of managing these patients. The cost of searching existing registers for unrelated donors for Australian patients, averages A$24 000–28 000 to the point of a successful donor procedure. The cost of establishing and maintaining an Australian Register of a size predicted to find donors for half of the potential recipients, has been estimated at A$ 10 000 per donor procedure. The decision to proceed with unrelated bone marrow transplantation commits resources that are currently used by the alternative therapies. It is thus important to monitor both the costs and effects of the new approach. The medical efficacy of bone marrow transplantation from matched but unrelated donors has been under discussion in Australia for the past 5 years. It is not the subject of this review to outline the progress of that debate. On the basis of both local and international experience, the conclusion has been to propose that matched unrelated bone marrow transplants should no longer be considered experimental. In Australia, as in many other countries making a similar decision, the cost of both establishing this therapy and of recruiting potential donors to a register has come under scrutiny. While therapies of uncertain efficacy and indeterminate but large financial cost have become established by tradition in hospitals throughout the world, modern therapy, where it is perceived to be expensive, must account not only to the yardstick of efficacy but also to that of the budget. It is appropriate to analyse medical management in terms of its cost to the community, since the community must forgo some other expenditure to pay for it. This paper thus reviews the financial arguments that have followed from the these policy decisions.

Financial arguments and university education for nurses: a Canadian perspective

Published information concerning costs of the various university disciplines is scanty, and Deans of Nursing have to rely on information that is transmitted to them by their university administrators. This paper provides some hard facts of comparative costs at one university, where, after an examination of the various factors involved, it was found that when judged by a) the cost of producing a section of a course, Nursing ranked 21 out of 28; b) the cost/student/section, regardless of level, Nursing ranked 19 out of 28; and c) the cost/student/section of the highest level undergraduate courses, Nursing ranked one out of 28. It was therefore concluded that financial arguments cannot be used to deprive nurses of the university education received by all other professionals.

Stress and Unemployment in Rural Nonfarm Couples: A Study of Hardships and Coping Resources

This study was designed to explore effects of unemployment on stress with rural nonfarm families. Specifically, relationships were analyzed among increases in financial management, increases in financial arguments, and coping resources on stress. Eighty-eight husbands and wives (44 couples) participated in the study. The study determined that increases in financial arguments are more predictive of stress than actual changes in financial management, especially for wives. Avoidance coping was predictive of stress and mediated the relationship between financial arguments and stress for both husbands and wives. Implications for counselors and educators are discussed.

Implementing the unrelated product strategy

AbstractThere has been considerable debate over the viability of the unrelated product, or conglomerate strategy. The financial arguments for and against its viability are well known. However, the administrative imperatives for its successful implementation have not been well investigated. The paper argues that there are a number of critical administrative contingencies for successful implementation of this strategy which only a few unrelated product firms have recognized. These concern policies dealing with acquisition, divestment, portfolio structure, management and organization. The paper discusses each in turn, describing specific instances of success and failure to illustrate the major points of the argument.