A cost-minimization study of cancer patients requiring a narcotic infusion in hospital and at home.

We conducted a retrospective, non-randomized, cost-minimization study, from the perspective of the Ministry of Health, to compare the cost of managing cancer patients who required narcotic infusions, in hospital and at home. Our medical costs averaged $369.72 per inpatient day and $150.24 per outpatient day (saving $219.48 per diem, 1988 Canadian dollars), while narcotic costs were the same for any given patient in both settings. Sensitivity analysis showed that no reasonable changes in the quantity and cost of services reduced our savings by more than 50%. During incremental analysis, savings increased as more outpatient days were managed by our centre, from $0.00 for 318 days, to more than $500,000 for over 2000 days per annum. As this program has been extremely cost effective and preferred by our patients, other hospitals and central funding agencies might consider establishing a regional outpatient narcotic infusion program to reduce their costs.

Product line management in oncology: a Canadian experience.

More competition for finite resources and increasing regulation have led many hospitals to consider a strategic reorganization. Recently, one common reorganization strategy has been"product line management." Product line management can be broadly defined in terms of centralized program management, planning, and marketing strategies. In Canada, while strategic driving forces may be different, a product line management alternative has arisen in one of the most potentially complex product lines, cancer services. This article compares and contrasts the theoretical model for product line management development, with special reference to cancer services, to the experience of one Canadian medical center and cancer center.

Re-evaluating the cost of outpatient cancer chemotherapy.

Chemotherapy for common malignant tumours has historically been considered relatively expensive. An examination of costs at the Toronto-Bayview Regional Cancer Centre and Sunnybrook Medical Centre, Toronto, suggests that this perception is not accurate. The cost of chemotherapeutic agents administered on an outpatient basis over 4 to 6 months in established drug protocols ranged from $260 to $5374 (mean $2224). The total cost of outpatient administration was estimated to be $152.53 per dose, compared with $185.39 for inpatient administration of the same protocol, a difference of 22%. The difference was predominantly due to a higher allocated per-diem charge at the medical centre. The results indicate that outpatient administration reduces the overall cost of chemotherapy.

The cost of radiation treatment at an Ontario regional cancer centre.

The cost of radiation treatment in 1985 at an Ontario regional cancer centre accruing 2500 new patients annually was examined. The radiation treatment department was equipped with three high-energy treatment machines, a treatment simulator and a treatment planning computer and was appropriately staffed. The total average annual cost of operating one high-energy treatment machine was $668,963. Salaries and employee benefits accounted for 78% of the costs. An average of 5439 radiation treatments were given annually with each treatment machine, at a cost $123 per treatment. The cost of a curative course of radiation treatment (average of 21 treatments) was $2583, and the cost of a palliative course (average of 7 treatments) was $861.

Cost analysis of the Kozak protocol as used in an Ontario hospital in the treatment of children with epidermolysis bullosa.

Conventional treatment of epidermolysis bullosa is often unsuccessful. The Kozak protocol is an alternative that has been given considerable public support in Ontario. The incremental cost of this treatment program at the Hospital for Sick Children, Toronto, was examined. The departments of nursing, pharmacy and food services each kept records of salaries and supply costs applicable to the care of nine patients with epidermolysis bullosa who were treated in the fiscal year 1982-83. The selected direct costs to the hospital were compared with the projected costs if these patients had been treated in Dr. Kozak's clinic in West Germany or under the financial arrangements offered to Dr. Kozak by the Ontario minister of health. At a total incremental cost of +255.92 per patient-day, care at the Hospital for Sick Children may not currently be the least expensive means of offering the Kozak protocol to Ontario children. However, the major expense of the program, the nurses' salaries, could be reduced if the patients' parents were to assume many of the nursing tasks; this would make the hospital's program the most cost-effective method of treating children with epidermolysis bullosa.

Protect yourself with effective security.

Hospitals have always been responsible for providing a "reasonably safe environment" for patients, visitors and staff. There are moral, legal, practical and profitability motives underlying this attitude. However, this responsibility has been reinforced by the increasing number of legal actions being brought against hospitals for breach of their duty. Hospitals are under pressure to increase existing security budgets to address the volume of complaints. The purpose of this article is to identify problems in existing hospital security systems and propose some potential solutions. Security has been defined as a "system of safeguards designed to protect the physical property of the facility and to achieve a relative ... (reduction in the probability of detrimental incidents) ... for all persons interacting within the organization and its environment". The goal of hospital security services is to reduce the institution's various vulnerabilities. These vulnerabilities have been divided into two major categories, personal safety and loss prevention.