scholarly journals Revenue of consultant physicians for private out-patient consultations

2019 ◽  
Vol 43 (2) ◽  
pp. 142
Author(s):  
Gary L. Freed ◽  
Amy R. Allen
Keyword(s):  
Government Expenditure ◽  
Unintended Consequences ◽  
Management Planning ◽  
Medical Specialties ◽  
Initial Management ◽  
Time Period ◽  
Initial Item ◽  
Consultant Physician ◽  
Changing Patterns ◽  
Multiple Morbidities

Objective The aim of this study was to determine the revenue to consultant physicians for private out-patient consultations. Specifically, the study determined changing patterns in revenue from 2011 to 2015 after accounting for bulk-billing rates, changes in gap fees and inflation. Methods An analysis was performed of consultant physician Medicare claims data from 2011 to 2015 for initial (Item 110) and subsequent (Item 116) consultations and, for patients with multiple morbidities, initial management planning (Item 132) and review consultations (Item 133). The analysis included 12 medical specialties representative of common adult non-surgical medical care. Revenue to consultant physicians was calculated for initial consultations (Item 110: standard; Item 132: complex) and subsequent consultations (Item 116: standard; Item 133: complex) accounting for bulk-billing rates, changes in gap fees and inflation. Results From 2011 to 2015, there was a decrease in inflation-adjusted revenue from standard initial and subsequent consultations (mean –$2.69 and –$1.03 respectively). Accounting for an increase in the use of item codes for complex consultations over the same time period, overall revenue from initial consultations increased (mean +$2.30) and overall revenue from subsequent consultations decreased slightly (mean –$0.28). All values reported are in Australian dollars. Conclusions The effect of the multiyear Medicare freeze on consultant physician revenue has been partially offset by changes in billing practices. What is known about the topic? There was a ‘freeze’ on Medicare schedule fees for consultations from November 2012 to July 2018. Concerns were expressed that the schedule has not kept pace with inflation and does not represent appropriate payments to physicians. What does this paper add? Accounting for bulk-billing, changes in gap fees and inflation, revenue from standard initial and subsequent consultations decreased from 2011 to 2015. Use of item codes for complex consultations (which have associated higher schedule fees) increased from 2011 to 2015. When standard and complex consultation codes are analysed together (and accounting for bulk-billing, changes in gap fees and inflation), revenue from initial consultations increased and revenue from subsequent consultations decreased slightly. What are the implications for practitioners? Efforts to control government expenditure through Medicare rebate payment freezes may result in unintended consequences. Although there were no overall decreases in bulk-billing rates, the shift to higher-rebate consultations was noticeable.

Changing Patterns of Addiction and Public Aid Receipt: Tracking the Unintended Consequences of Welfare Reform

2006 ◽  
Vol 31 (5) ◽  
pp. 945-980 ◽  
Author(s):  
Laura A. Schmidt ◽  
James Wiley ◽  
Daniel Dohan ◽  
Denise Zabkiewicz ◽  
Laurie M. Jacobs ◽  
...  
Keyword(s):  
Welfare Reform ◽  
Unintended Consequences ◽  
Public Aid ◽  
Changing Patterns

Nigeria: Does Terrorism Spring from Economic Conditions?

2018 ◽  
Vol 2 (1) ◽  
pp. 20-32
Author(s):  
Emmanuel O. Okon
Keyword(s):  
Government Expenditure ◽  
Primary Objective ◽  
Economic Resources ◽  
Policy Implications ◽  
Domestic Terrorism ◽  
Energy Market ◽  
Annual Data ◽  
Development Programs ◽  
Macroeconomic Policies ◽  
Time Period

Over the last half-century, Nigeria has become one of Africa’s three giants along with Egypt and South Africa, thereby gaining considerable clout on the regional and global arenas. It is Africa’s largest oil producer and recent finds ensure Nigeria’s significance in the energy market for the foreseeable future. But the country has an inability or an unwillingness to distribute economic resources and development programs equitably. The primary objective of this paper is to find out whether economic condition leads to domestic terrorism in the country, as the contemporary Nigeria society is engulfed by terrible acts of Terrorism. This paper uses annual data for the time period 1970-2016 and the multivariate regression results suggest that government expenditure hinders terrorism, whereas macroeconomic policies foster it. Possible reasons for the outcomes and the policy implications of the findings were discussed.

scholarly journals Exploring the Collateral Damage of the COVID-19 Pandemic on Stroke Care

Stroke ◽  
2021 ◽  
Author(s):  
Clotilde Balucani ◽  
J. Ricardo Carhuapoma ◽  
Joseph K. Canner ◽  
Roland Faigle ◽  
Brenda Johnson ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Unintended Consequences ◽  
Stroke Subtype ◽  
Hospital Arrival ◽  
Time Period ◽  
Ischemic Attack ◽  
The Impact ◽  
Emergency Measures

Background and Purpose: During the coronavirus disease 2019 (COVID-19) pandemic, the various emergency measures implemented to contain the spread of the virus and to overcome the volume of affected patients presenting to hospitals may have had unintended consequences. Several studies reported a decrease in the number of stroke admissions. There are no data on the impact of the COVID-19 pandemic on stroke admissions and stroke care in Maryland. Methods: A retrospective analysis of quality improvement data reported by stroke centers in the State of Maryland. The number of admissions for stroke, overall and by stroke subtype, between March 1 and September 30, 2020 (pandemic) were compared with the same time period in 2019 (prepandemic). Median last known well to hospital arrival time, the number of intravenous thrombolysis and thrombectomy were also compared. Results: During the initial 7 months of the pandemic, there were 6529 total admissions for stroke and transient ischemic attack, monthly mean 938 (95% CI, 837.1–1038.9) versus prepandemic 8003, monthly mean 1156.3 (CI, 1121.3–1191.2), P <0.001. A significant decrease was observed in intravenous thrombolysis treatments, pandemic 617, monthly mean 88.1 (80.7–95.6) versus prepandemic 805, monthly mean 115 (CI, 104.3–125.6), P <0.001; there was no significant decrease for thrombectomies. The pandemic decreased the probability of admissions for stroke and transient ischemic attack by 19%, for acute ischemic stroke by 20%, for the number of intravenous thrombolysis performed by 23%. There was no difference in the number of admissions for subarachnoid hemorrhage, pandemic 199, monthly mean 28.4 (CI, 22.5–34.3) versus prepandemic 217, monthly mean 31 (CI, 23.9–38.1), respectively, P =0.507. Conclusions: Our findings suggest that the COVID-19 pandemic adversely affected the acute care of unrelated cerebrovascular emergencies.

scholarly journals Changing Patterns in the Acute Pain Service: Epidural versus Patient-controlled Analgesia

2005 ◽  
Vol 33 (4) ◽  
pp. 501-505 ◽  
Author(s):  
G. E. Power ◽  
B. Warden ◽  
K. Cooke
Keyword(s):  
Acute Pain ◽  
Acute Pain Service ◽  
Evidence Based ◽  
Patient Controlled Analgesia ◽  
Princess Alexandra Hospital ◽  
Postoperative Pain Control ◽  
Time Period ◽  
Change In Practice ◽  
Changing Patterns ◽  
Based Medicine

This study involved an audit and a survey of the Acute Pain Service at Princess Alexandra Hospital. It was found in the audit that the relative choice of epidural analgesia had declined by 50% over the five-year time period of 1998–2003. The survey of consultants showed that 82% of them had changed their practice and that they were performing fewer epidural anaesthetics. Two of the most common reasons given for this change in practice related to fear of litigation (34%) and lack of evidence (21%). These results show that within this department approaches to postoperative pain control had changed and that this appears to have resulted from factors such as the medicolegal environment and the possible influence of evidence based medicine.

Panel data comparative analysis on the influence of population age structure on the size of government expenditure in Africa and Asia

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Chukwuebuka Bernard Azolibe
Keyword(s):  
Cross Sections ◽  
Age Structure ◽  
Government Expenditure ◽  
Empirical Literature ◽  
Size Of Government ◽  
Population Age Structure ◽  
Content Type ◽  
Time Period ◽  
The World ◽  
Age Structures

PurposeAfrica and Asia are the two most populous continents in the world and are projected to increase further in the near future and this puts the governments under great stress in terms of increased public expenditure and dealing with a low revenue generation. Thus, the purpose of this study is to assess the influence of population age structure on the size of government expenditure in Africa and Asia covering the period 1990–2018.Design/methodology/approachThe study employed panel fully modified ordinary least squares (FMOLS) estimation in estimating the relevant relationship between the variables in the model.FindingsThe key findings revealed that the major population age structures that influence the size of government expenditure in Africa are population aged 0–14 years and population aged 15–64 years, while that of Asia are population aged 15–64 years and population aged 65 years and above. The findings provided strong support for the Population Reference Bureau report (2019) that countries in Africa are home to some of the world's youngest population, that is, those aged 15 years or below, while Asia is home to some of the world's oldest population, that is, those aged 65 years and above.Research limitations/implicationsWhile generalized method of moments (GMM) estimation is beneficial in the presence of endogeneity, it is only designed for situations with a small time period (T) and a large number of cross sections (N). Hence, the estimation technique was limited only to FMOLS as the number of the cross sections or countries which is ten for Africa and ten for Asia is lower than the time period which is 29 years (1990–2018).Originality/valueEmpirical literature investigating the influence of population age structure on the size of government expenditure has focussed mainly on one aspect of the population age structure and government expenditure, which is the influence of ageing population on government expenditure on health. Hence, this study focussed on assessing the influence of population age structure on the size of government expenditure. The study is unique as it compared the two most populous continents in the world, which are Africa and Asia to determine which of the population age structures have the most significant influence on the size of government expenditure.

An examination of changing patterns in Lean Six Sigma research

2019 ◽  
Vol 27 (7) ◽  
pp. 23-25
Keyword(s):  
Six Sigma ◽  
Keyword Search ◽  
Fixed Time ◽  
Lean Six Sigma ◽  
Integrated System ◽  
Content Type ◽  
Time Period ◽  
Changing Patterns ◽  
Six Sigma Methodology ◽  
Six Sigma Approach

Purpose The purpose of this study was to examine patterns in the research contributions from individuals in the field to detect whether they reflect the evolution of academic discussion concerning integration of Lean and Six Sigma methodology over a fixed time period. Design/methodology/approach Data was gathered from a keyword search of articles in the SCOBUS data base to determine the most frequent contributors in the areas of Lean, Six Sigma and Lean Six Sigma research. Searches were carried out over five-yearly intervals from 2000 to 2015 and the twenty-one top contributors in each time period were identified. Findings The findings show that research contributions have moved away from looking at the single methodologies of Lean and Six Sigma and towards research based on the integrated Lean Six Sigma approach. The analysis also suggested that researchers may be publishing papers using different methodologies in response to different challenges in selecting the most appropriate tools to meet the needs of the specific issues they are addressing rather than advocating a particular approach. Practical implications For organizations to optimize performance a flexible approach would be beneficial with consideration being given to the specific issue and the correct tools and methodology selected from an integrated system or from Lean or Six Sigma systems alone. Originality/value This paper has originality in its’ consideration of the patterns of research contributions over a fixed time period as a reflection of the shift in debate from exclusive Lean or Six Sigma approaches to a more integrated Lean Six Sigma system.

Unintended outcomes effects of the European Union and the International Monetary Fund on Hungary's public sector and administrative reforms

2019 ◽  
Vol 35 (2) ◽  
pp. 158-178
Author(s):  
Zoltán Török
Keyword(s):  
European Union ◽  
Public Sector ◽  
International Monetary Fund ◽  
Policy Transfer ◽  
Unintended Consequences ◽  
The European Union ◽  
Administrative Reforms ◽  
Public Sector Reforms ◽  
Time Period ◽  
Depth Analysis

This article investigates European Union and International Monetary Fund influence on Hungary's public sector reforms in the period 2004–2013, that is, a time period that saw the initiation of the European Union's Excessive Deficit Procedure (the whole period) and an International Monetary Fund bailout programme (2008–2010). In this case, public sector reforms became derailed from the externally proposed trajectory and took the opposite direction: instead of fostering decentralization of the state administration and deepening the Europeanization process, Hungary's restructuring of the public sector delivered centralization and a ‘power grab’ that eventually impinged on some core values of the European Union ‘constitution’ (the acquis communautaire). This study aims to explain this empirical puzzle by in-depth analysis of how external influence was exerted and became interwoven with dynamically changing domestic factors in circumstances of conditionality. The research is framed by existing policy transfer and public sector reform theories. The article argues that the Hungarian case provides evidence of the unintended consequences of European Union-driven public sector reforms.

Imaging Evaluation in the Early Management of Severely Injured Patients.

2021 ◽  
Author(s):  
Christopher Spering ◽  
Soehren Dirk Brauns ◽  
Bertil Bouillon ◽  
Mark-Tilmann Seitz ◽  
Katharina Jaeckle ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Thoracic Trauma ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Initial Management ◽  
Trauma Centres ◽  
Therapeutic Consequences ◽  
Time Period ◽  
Injured Patients

Abstract Introduction: The plain film chest x-ray in supine position (CXR) during the initial management of severely injured patients has almost lost its clinical relevance, since it has been challenged by extended focused assessment with sonography in trauma (eFAST) in early trauma management, due to its superiority in detecting a pneumo-/hematothorax. One of the last diagnostic fields in such setting of CXR is the mediastinal vascular injury. These injuries are rare yet life-threatening events. The most easily accessible diagnostic tool to identify these patients would be CXR as it is still one of the standard diagnostic tools in the early assessment of severely injured patients with significant thoracic trauma (Abbreviated Injury Scale, AIS ≥3). This study evaluates the role of early CXR in the Trauma Resuscitation Unit (TRU) in the last diagnostic field where eFAST cannot provide an answer: detecting mediastinal vascular injury in severely injured patients.Method: This retrospective, observational, single-centre study included all primary blunt trauma patients of a 24 months time period, that had been admitted to the TRU. Mediastinal/chest (M/C) ratio measurements were taken from CXRs at three defined levels of the mediastinum. The accuracy of the CXR findings were compared to whole-body computed tomography scans (WBCT) and therapeutic consequences were observed. Additionally a 15 years (2005–2019) time period out of the TraumaRegister DGU® was evaluated regarding usage of eFAST, CXR und WBCT in Level-1, -2, and − 3 Trauma Centres in Germany.Results: A total of 267 patients showed a significant blunt thoracic trauma (27 with mediastinal vascular injury (VThx)). The initial CXR in a supine position was unreliable for detecting mediastinal vascular injury. The sensitivity and specificity at different thresholds of maximum M/C ratio (2.0–3.0) were not clinically acceptable. The aortic contour and haemato- and pneumothorax were not reliably detected in the initial CXRs. No significant differences in the cardiac silhouette were observed between patients with or without mediastinal vascular injury (mean cardiac width, 136.5 mm, p = 0.44). No therapeutic consequences were drawn after CXR in the study period. The data from the TR-DGU (N = 251,095) showed a continuous reduction of CXR from 75% (2005) to 25% (2019), while WBCT raised from 35% to a steady level of about 80%. This development was seen in all trauma hospitals almost simultaneously.Conclusion: In present guidelines, CXR remains an integral diagnostic element during early TRU management, although several prior publications show the superior role of eFAST. Our data support that in most cases, CXR is time consuming and provides no benefit during initial management of severely injured patients and might delay the use of WBCT. The trauma centres in Germany have already significantly reduced the usage of CXR in the TRU. We therefore recommend to revise current guidelines and emphasise eFAST and rapid diagnostic through WBCT if rapidly available.

THE CHANGING FACE OF ACUTE NEUROLOGY: EXPERIENCE FROM TWO DECADES OF THE CAMBRIDGE NEUROLOGY EMERGENCY CLINIC

2015 ◽  
Vol 86 (11) ◽  
pp. e4.131-e4
Author(s):  
Laura Axinte ◽  
Stephen Sawcer ◽  
Sybil Stacpoole
Keyword(s):  
Neurological Diseases ◽  
Number Of Patients ◽  
Neurology Clinic ◽  
Consultant Physician ◽  
Changing Patterns ◽  
Day Of The Week ◽  
Increasing Demand ◽  
Specialist Nurses ◽  
The Uk ◽  
Emergency Neurology

Acute neurological presentations are a common problem, accounting for around 17% of GP consultations, 10% of A&E visits and around 20% of the medical take. There is an increasing appreciation of the need to reconfigure neurological services to meet this need, but the challenge is to provide a service for those who most need it with an under-resourced specialty. The Royal College of Physicians 2012 Consultant Physician Survey reported that there were 716 neurology consultants in the UK, resulting in 1 per 90,000 population, significantly lower than the recommended RCP minimum of 1 consultant per 70,000, every day of the week. One solution to the evident need is providing rapid access ambulatory pathways. Here we report on the Cambridge experience of nearly two decades provision of an emergency neurology clinic at Addenbrooke's Hospital. We show how the service has evolved and the changing patterns of presentation, management and outcomes of the patients seen. Annualised attendance data demonstrates increasing demand, whilst the proportion of patients presenting with headaches (now 40%) has escalated dramatically. By contrast, the number of patients referred with problems related to established chronic neurological diseases has fallen considerably, no doubt related to the development of specialist nurses and clinics.

scholarly journals Government Expenditure Data Exploration & Analysis Using Python

2021 ◽  
Vol 8 (2) ◽  
pp. 123-146
Author(s):  
Pedro Mena ◽  
Leslie Kerby ◽  
Derick Nielson ◽  
Katherine Wilsdon ◽  
Paul Gilbreath ◽  
...  
Keyword(s):  
Health Care ◽  
Public Perception ◽  
Data Science ◽  
Government Expenditure ◽  
Data Exploration ◽  
State Agencies ◽  
Budget Analysis ◽  
Cost Efficiencies ◽  
Time Period ◽  
State Expenditures

The goal of improving cost efficiencies is a constant endeavor of all organizations. This is especially true for governments, where public perception often has the ability to affect budget allocations. The data used in this analysis consisted of publically available state expenditures from 2018 and 2019 for the state of Idaho. The dataset contains the record of over 2 million state expenditures across all state agencies. The data analysis was performed using Python and the Pandas library. Visualizations were created using the Matplotlib package. The data exploration showed that Idaho’s Departments of Health and Welfare, Education and Transportation spent the most in this time period. The analysis also determined which Summary Objects, Sub-Object and Vendors experienced the greatest changes between the two years. Comparisons were also done using publicly available data on reported budget allocations by the states of Arkansas, California, Texas and Montana to see how spending differs between Idaho and these states based on percentage and per capita. Finally, suggestions for improvement in the areas of health care and employee transportation were given. These include methods of improving competition in health care, reducing travel through expanded teleconferencing and providing incentives to employees for reduced travel cost. Keywords: data science, budget analysis, python, pandas, government spending

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