Reduce Service Costs Research Articles

HELIPLAT: A high altitude very-long endurance solar powered platform for border patrol and forest fire detection

Research is being carried out, aimed at the design of a Very-Long Endurance Solar Powered Autonomous Aircraft (VESPAA) and the manufacture of a solar powered prototype. It could play the role of a pseudo satellite, with the advantage of being closer to the ground, more flexible and at a cost much less than a real satellite. An integrated multi-sensor interoperable system based on the use of remote means of surveillance should be used to manage who and what enters the European homeland in order to prevent the admission of terrorists and the instruments of terror through borders, coastline and harbors. UAVs are less expansive than other manned aircraft used for border surveillance drastically reducing service costs and tedious work. By UAV based fire remote sensing tools, highest performances should be available and it should be possible to detect a flame length of the order of a few square meters from installation on the WESPAA stratospheric platform of proper IR and LIDAR sensors. A first configuration of HELIPLAT® was worked out, as a result of the preliminary design study by using the most advanced tools (wing span 73m). A scaled size prototype (wing span 24 m, length 7 m) was built in order to show the technological feasibility. Static tests on the whole scaled-size prototype have been performed in our laboratory, finding a very good correlation with the numerical analysis. Design, payload sensors, aerodynamic and structural analysis and testing shall be reported.

MASSIHN: a multi-agent architecture for intelligent home network service

The major design challenge in developing intelligent home network services is to organize effectively distributed and heterogeneous home devices. This article considers a mobile agent space based multi-agent architecture to meet this challenge. MASSIHN is a home network system that links consumer electronics and computing devices. The proposed Java based MASSIHN with mobile agents, may change the management functionality and the type of information collected to control various home network devices. MASSIHN supports TCP/IP, and can obtain data from MASS (mobile agent space system), encode the data into an XML document and then transfer the XML document to the server at the monitoring and management center. The end-users of MASSIHN can modify the parameters that govern their home appliances, and monitor their most recent home service states via the Internet from anywhere at any time. The business partners of MASSIHN can provide their customers with Internet services without constructing the backbone of a network, greatly reducing service cost. The proposed approach can execute MASSIHN applications from several commonly used devices such as PDAs and laptops.

The strategic support of telemedicine and telecare

The modern development of telemedicine and telecare dates from the early 1990s when a combination of technological and service drivers created new opportunities. These drivers include advances in information and communications technologies, the need to extend healthcare access to remote and disadvantaged communities, military applications and perceived cost reduction. Governments and healthcare providers have shown considerable interest in the potential of telemedicine for reducing service costs but have been slow to provide the strategic context in which the approach can move into the mainstream. Only in the last five years or so have we seen an awareness of the strategic underpinning needed to produce this context. This paper identifies the roles of government, healthcare professionals and equipment suppliers in policy development and strategy setting and reviews the experience of several countries. The analysis seeks to determine the key principles that facilitate the mainstream development of telemedicine, and the critical success factors for the design and delivery of telemedicine and telecare services.

Mental health costs and outcomes under alternative capitation systems in Colorado: early results.

BACKGROUND: This study presents preliminary findings for the first nine months of the State of Colorado USA Medicaid capitation Pilot Project. Two different models of capitation (model I and model II) are compared with fee for service (FFS) in providing services to severely and persistently mentally ill adults. In model I the state's mental health authority contracts with community mental health centers (CMHCs) who both manage the care and deliver mental health services, while in model II the state contracted with a joint venture between a for-profit managed care firm who manage the care with either a single CMHC or an alliance of CMHCs who deliver the mental health services. AIMS: Our objective is to examine utilization, cost and outcomes of inpatient and outpatient (including community based) services before and after the implementation of a capitated payment system for Colorado's Medicaid mental health services compared to services that remained under FFS reimbursement. METHODS: The stratified, random sample includes 513 consumers (188 for model I, 179 for model II, and 146 for FFS). Consumer outcomes were collected by trained interviewers and include 17 measures of symptoms, health status, functioning, quality of life and consumer satisfaction. Utilization and cost of services are from the Medicaid claims data and a shadow billing data system (post-capitation) designed by Colorado. The first step of the two-step regression procedure adjusts for the presence of individuals with use or no service use during the specified time while the second step, ordinary least-squares regression, is applied to the sample who utilized services. RESULTS: These preliminary findings indicate consistent reductions in inpatient user costs and probability of outpatient use under capitation. Combining all services, there are consistent reductions in the probability of use in both models: model I had significantly higher initial probability of use for any service. Only model II showed a statistically significant decrease in post-capitation overall user costs, but they were initially higher than model I or FFS. Estimated total cost per person for model I suggests virtually no change from the pre- to post-capitation period. Model II had the highest pre-capitation and the lowest post-capitation estimated cost per person. Examination of pre measures of outcomes across capitated areas suggest that samples drawn from the FFS, model I and model II areas were comparable in severity of psychiatric symptoms, functioning, health status and quality of life. No changes were found in outcomes. DISCUSSION: These early findings are consistent with the limited literature on capitation. Both studies of capitation integrated with medical care and those specific to mental health settings did not find adverse changes in outcomes compared to FFS. Limitations include the short follow-up period, lack of detail and possible under-reporting of outpatient services provided by the shadow billing data system. CONCLUSIONS: For the short term, it is concluded that capitation can reduce service cost per person without significant change in clinical status. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Implications are unclear until we can determine whether (i) reductions in the numbers receiving service indicates favorable consumer outcomes or reductions in access and (ii) lack of change in consumer outcomes is due to the benefits of capitation or the lack of sensitivity of the outcome measures. IMPLICATIONS FOR HEALTH CARE POLICY FORMULATION: Implications are premature for these early findings. IMPLICATIONS FOR FUTURE RESEARCH: Future research should include longer follow-up as well as analysis of long-term consequences for both cost savings and clinical outcomes.

Privatization of Municipal Services in America's Largest Cities

Thanks in large part to three nationwide surveys sponsored by the International City/ County Management Association in 1982, 1988, and 1992, we know a great deal about the extent of municipal privatization in the United States. These surveys, however, were not designed to explore the various nuances of municipal privatization, such as the extent of their satisfaction with privatization, why cities choose to privatize services, the extent to which privatization reduces service costs and improves service delivery, how privatization affects employee's compensation packages, how cities monitor the quality and effectiveness of privatized services, and what lessons city officials have learned from their privatization experiences. The authors fill this void in the literature by asking these questions and more of city officials in America's largest cities. Among their many findings, they discovered that while privatization is now an accepted, alternative means of delivering municipal services throughout the United States, it is by no means viewed as a panacea. Faced with increased demands for public services and strong resistance to further tax increases, city officials across the country have been forced to reexamine the way they provide city services in an attempt to save money and find ways to more with less. Echoing the themes raised in Osborne and Gaebler's now famous book, Reinventing Government (1993), city officials are shifting away from a focus on what government should do toward a focus on how government can get things done more efficiently and effectively. This new focus has contributed to the increased use of strategic planning initiatives that use citizen surveys, public hearings, and town meetings to help city officials define their cities' long-term objectives and develop a strategy to achieve those objectives (Below, Morrisey, and Acomb, 1987; Streib, 1990; Wheeland, 1993). This focus has also contributed to the privatization of city services and, in a recent development, the increased use of competitive bidding practices that pit the private sector against existing city agencies (Uchitelle, 1988). In this article, we enhance the knowledge of the privatization movement in the United States by reporting the results of a survey of the privatization experiences of America's largest cities. We compare and contrast this surveys results with the results of surveys on municipal privatization experiences conducted by the International City/County Management Association (ICMA) in 1982, 1988, and 1992. The ICMA's surveys asked respondents to indicate the extent of privatization within their cities, and they remain the most comprehensive sources of information on municipal privatization activities. They did not, however, attempt, as this survey does, to determine the cities, level of satisfaction with their privatization experiences, nor did they attempt to explore some of the nuances of the cities' privatization experiences, such as why they chose to privatize specific services and what privatizations impact has been on service delivery costs and the quality of services. Also, the ICMA surveys did not focus on the privatization activities of America's largest cities. Instead, they included cities of various population sizes as well as county governments. The Survey A three-page survey was mailed during the summer of 1995 to the office of the mayor, or to the city manager when appropriate, of the 100 American cities with the largest populations. The survey was designed to determine the extent of privatization within these cities, the level of satisfaction with their privatization experiences, the reasons they privatized services, the extent to which privatization reduced service costs and improved service delivery, the effect of privatization on employees' compensation packages, the way cities monitored the quality and effectiveness of privatized services, and the lessons they had learned from their privatization experiences. …

Technology to ease team‐based quality assessments

AbstractCompanies such as IBM have found that periodic, team‐based quality assessments can reduce service costs and defects while increasing customer satisfaction and revenue per employee. Whereas in the past such assessments were conducted by high‐priced consultants, today team‐based assessment software offers a highly cost‐effective alternative. By averaging scores and merging comments from many assessors, team‐based software increases the validity of a self‐assessment while increasing involvement and understanding. Combined with appropriate leadership and other widely available technologies, team‐based assessment software has helped organizations ranging from the U.S. Air Force to AT&T address seven major challenges to quality assessment efforts.

Nuclear medicine instrumentation maintenance costs: the financial and service advantages of in-house service engineers

In the current era of cost containment in the health industry, increasing attention is being given to methods by which rising costs can be contained. Due to the high cost of the technology involved in diagnostic imaging, health care providers are coming under considerable pressure to reduce the operating and maintenance costs of imaging equipment. While the initial capital costs of such equipment are often carefully considered, the long term maintenance costs generally receive little consideration, even though they may eventually exceed the capital costs over the lifetime of the equipment. In the United States, the estimated sales of nuclear medicine instrumentation for 1991, totalled approximately $330 million [ 11. Assuming an average lifespan of 7-8 years for equipment, and an average vendor service cost of 10% of the purchase price, then equipment service costs run at approximately $250 million per year. Hence any reduction in service costs can have a significant effect on the overall operating costs of a diagnostic imaging department. One of the most obvious ways of reducing maintenance costs, is through the use of in-house service engineers. The purpose of this study was to evaluate the effectiveness of an in-house service program over a 2.5 year period in a nuclear medicine department.

The validity of the General Health Questionnaire for first-stage screening for mental illness in pain clinic patients

The validity of the 28-item version of the General Health Questionnaire (GHQ-28) was determined by comparison with the Clinical Interview Schedule (CIS) in 56 pain clinic patients. Despite some limitations, the GHQ can be used effectively and cheaply as the first stage of an assessment to identify potential “cases” of mental disorder which must then be verified using a second-stage clinical interview such as the CIS. This process can result in a considerable reduction in the proportion of patients requiring a psychiatric interview and, therefore, in reduced service costs. Factors associated with lower validity coefficients include female sex, age above 60 years and pain with a duration of less than 2 years.

Testing Small System Customer Set-Up

Customer Set-Up is a proven approach to reducing service costs and providing products at lower prices to customers. To ensure the effectiveness of Customer Set-Up instructions and procedures, these instructions and procedures must be studied before being shipped with their associated product. This paper will address several points to consider when planning a study of a Customer Set-Up system, such as procedure, appropriateness of subjects, number of subjects, the iterative procedure, studies vs. test, and development of test criteria.

Public Service Delivery in Rural Areas: Problems and Decisions

P UBLIC SERVICE QUALITY AND AVAILABILITY in rural areas of the United States remains low relative to urban areas [9, 20, 29]. Efforts to improve public service delivery in rural areas have resulted in only limited improvements in service availability and little or no reduction in service costs. Professional workers, elected officials, and voters find service delivery problems to be frustrating and not readily amenable to solution.