Browsing by Subject "costs"

Now showing 1 - 3 of 3
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    The Effect of Charter Schools on Districts’ Student Composition, Costs, and Efficiency: The Case of New York State
    (Elsevier, 2019) Buerger, Christian; Bifulco, Robert; School of Public and Environmental Affairs
    Charter schools can influence a school district's costs by reducing economies of scale and by changing the share of high cost students a district serves, but might also increase the district's efficiency through competition. Utilizing data for New York State school districts from 1998/99 to 2013/14, we estimate difference-in-differences models to assess the effect of charter schools on enrollment and student composition. Then, we estimate an expenditure function, using data prior to the charter school program, to measure the costs associated with reaching a given performance standard for students in various need categories and different enrollments. Next, using the entire data set, we run a second expenditure function to determine changes in efficiency associated with charter school entry. We find that charter schools increase the cost of providing education, and that these cost increases are larger than short-run efficiency gains, but are offset by efficiency gains in the long term.
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    Hospice use among nursing home and non-nursing home patients
    (Springer, 2015-02) Unroe, Kathleen T.; Sachs, Greg A.; Dennis, M.E.; Hickman, Susan E.; Stump, Timothy E.; Tu, Wanzhu; Callahan, Christopher; Department of Medicine, IU School of Medicine
    BACKGROUND: For nursing home patients, hospice use and associated costs have grown dramatically. A better understanding of hospice in all care settings, especially how patients move across settings, is needed to inform debates about appropriateness of use and potential policy reform. OBJECTIVE: Our aim was to describe characteristics and utilization of hospice among nursing home and non-nursing home patients. DESIGN AND PARTICIPANTS: Medicare, Medicaid and Minimum Data Set data, 1999-2008, were merged for 3,771 hospice patients aged 65 years and above from a safety net health system. Patients were classified into four groups who received hospice: 1) only in nursing homes; 2) outside of nursing homes; 3) crossover patients utilizing hospice in both settings; and 4) "near-transition" patients who received hospice within 30 days of a nursing home stay. MAIN MEASURES: Differences in demographics, hospice diagnoses and length of stay, utilization and costs are presented with descriptive statistics. KEY RESULTS: Nursing home hospice patients were older, and more likely to be women and to have dementia (p < 0.0001). Nearly one-third (32.3 %) of crossover patients had hospice stays > 6 months, compared with the other groups (16 % of nursing home hospice only, 10.7 % of non-nursing home hospice and 7.6 % of those with near transitions) (p < 0.0001). Overall, 27.7 % of patients had a hospice stay <1 week, but there were marked differences between groups-48 % of near-transition patients vs. 7.4 % of crossover patients had these short hospice stays (p < 0.0001). Crossover and near-transition hospice patients had higher costs to Medicare compared to other groups (p < 0.05). CONCLUSIONS: Dichotomizing hospice users only into nursing home vs. non-nursing home patients is difficult, due to transitions across settings. Hospice patients with transitions accrue higher costs. The impact of changes to the hospice benefit on patients who live or move through nursing homes near the end of life should be carefully considered.
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    Time-driven Activity-based Costing Analysis in Total Knee Arthroplasty
    (2025-04-25) Ali, Iyad S; Smith, Reed; Sandberg, Rory
    Understanding the costs associated with total knee arthroplasty (TKA) is crucial for optimizing resource allocation and improving healthcare value. This pilot study employs time-driven activity-based costing (TDABC) to assess procedural costs for TKA in both hospital and outpatient surgery center settings. By mapping process steps and recording time spent on each phase, we calculated the associated personnel costs based on salary-derived cost per minute. Data from three TKA cases were analyzed, with a mean procedural time of 167.2 minutes. Personnel costs for attending surgeons, scrub technologists, circulating nurses, advanced practice providers, and anesthesiologists were computed, resulting in an average total indirect cost of $2,751.18 per procedure. Our findings demonstrate TDABC’s effectiveness in providing a granular and accurate assessment of TKA costs compared to traditional accounting methods. As healthcare reimbursement models shift and surgical costs rise, precise cost quantification is increasingly vital. This study highlights cost drivers within TKA procedures, offering insights for cost containment strategies without compromising patient outcomes. Future research should incorporate additional cost variables such as implant prices, facility expenses, and postoperative care to develop a comprehensive financial model for TKA. TDABC has the potential to enhance financial transparency and inform policy decisions in orthopedic surgery.