Cost calculation and prediction in adult intensive care: A ground-up utilization study

Publisher's copy made available with the permission of the publisherThe ability of various proxy cost measures, including therapeutic activity scores (TISS and Omega) and cumulative daily severity of illness scores, to predict individual ICU patient costs was assessed in a prospective “ground-up” utilization costing study over a six month period in 1991. Daily activity (TISS and Omega scores) and utilization in consecutive admissions to three adult university associated ICUs was recorded by dedicated data collectors. Cost prediction used linear regression with determination (80%) and validation (20%) data sets. The cohort, 1333 patients, had a mean (SD) age 57.5 (19.4) years, (41% female) and admission APACHE III score of 58 (27). ICU length of stay and mortality were 3.9 (6.1) days and 17.6% respectively. Mean total TISS and Omega scores were 117 (157) and 72 (113) respectively. Mean patient costs per ICU episode (1991 $AUS) were$6801 ($10311), with median costs of$2534, range $106 to$95,602. Dominant cost fractions were nursing 43.3% and overheads 16.9%. Inflation adjusted year 2002 (mean) costs were $9343 ($ AUS). Total costs in survivors were predicted by Omega score, summed APACHE III score and ICU length of stay; determination R2, 0.91; validation 0.88. Omega was the preferred activity score. Without the Omega score, predictors were age, summed APACHE III score and ICU length of stay; determination R2, 0.73; validation 0.73. In non-survivors, predictors were age and ICU length of stay (plus interaction), and Omega score (determination R2, 0.97; validation 0.91). Patient costs may be predicted by a combination of ICU activity indices and severity scores.J. L. Moran, A. R. Peisach, P. J. Solomon, J. Martinhttp://www.aaic.net.au/Article.asp?D=200403

Provider payments and patient charges as policy tools for cost-containment: How successful are they in high-income countries?

In this paper, we focus on those policy instruments with monetary incentives that are used to contain public health expenditure in high-income countries. First, a schematic view of the main cost-containment methods and the variables in the health system they intend to influence is presented. Two types of instruments to control the level and growth of public health expenditure are considered: (i) provider payment methods that influence the price and quantity of health care, and (ii) cost-containment measures that influence the behaviour of patients. Belonging to the first type of instruments, we have: fee-for-service, per diem payment, case payment, capitation, salaries and budgets. The second type of instruments consists of patient charges and reference price systems for pharmaceuticals. Secondly, we provide an overview of experience in high-income countries that use or have used these particular instruments. Finally, the paper assesses the overall potential of these instruments in cost-containment policies

Corrosion of bone by solutions simulating raptor gastric juice

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The Mystery of Elin : Incorporating a City Cultural Program on History and Heritage into a Pervasive Game

This paper reports on the use of mobile terminals in historical spaces to play an adventure game, using a location-based platform to awaken the fantasy and curiosity of children about cultural heritage; the design of a mystery game as the medium to convey content along with features shared by pervasive games, such as mobile exploration, team work, and the combination of virtual and real worlds. It includes the process of adapting history to storytelling and the results of using a method to evaluate the experience

Managerialism and beyond: Discourses of civil society organization and their governance implications

Different disciplinary, theoretical, and empirical lenses have contributed to a kaleidoscopic picture of CSO governance. Most of the time, CSO governance is contrasted with corporate governance in business organizations; only rarely is the broad variety of CSOs taken into account. To widen this perspective, we develop an empirically grounded typology of five discourses of organization in CSOs: managerialist, domestic, professionalist, grassroots, and civic discourse. We argue that each of these discourses gives specific answers to the three core questions of governance: To whom is the CSO accountable, i.e., who are the key actors who need to be protected by governance mechanisms? For what kind of performance is the CSO accountable? And which structures and processes are appropriate to ensure accountability? The way in which different discourses answer these questions provides us with a deeper understanding of the reasons behind the manifold notions of governance in CSOs. (authors' abstract