Economic evaluation of costs and effectiveness of the program aimed at early detection of lung di... more Economic evaluation of costs and effectiveness of the program aimed at early detection of lung diseases was the subject of the study. The scope of the study is related to the European tendency of creating information resources for public resources management. The study covered more than 14 000 people divided into three age groups, living in 11 localities in the Lódź region. The program aimed at lung diseases detection was conducted in three steps: first specialist examinations, X-ray examinations, second specialist examinations. Costs and effectiveness of the program were compared by cost/effectiveness and incremental ratios. The results of the study were formulated in the following areas: costs of the program by age groups and groups with suspected diseases, effects of the program, costs per one detected case and incremental ratios. The results of the study show that economic evaluation conducted from ex post perspective could be useful in building decision scenarios. Sensitivity a...
Economic analyses and evaluation of the effect of workers' health on the national economy have be... more Economic analyses and evaluation of the effect of workers' health on the national economy have begun to play a significant role in decision-making processes in terms of relations between health and safety in the work environment and the financial policy of enterprises. The economic dimension of consequences of occupational diseases and accidents at work is more frequently associated with the financial policy of enterprises understood as an element of costs involved. This gains particular significance when enterprises must maintain and improve economic effectiveness especially in the case of limited resources and permanent competition on the market. Therefore, the evaluation of economic interventions in the area of health and safety at workplace and its results are so important in the enterprise decision-making process. Several models of economic evaluation are used in assessing effectiveness of actions aimed at improving health and safety at workplace against a background of the overall economic situation of enterprises. The author presents the principles of six models, which have been used in the evaluation process. These models are based on information about costs of interventions/programs designed to reduce harmful effects of working conditions on workers' health and information concerning the results of individual ventures. They also take account of the influence of changes in working conditions on reduced sick absence, increased effectiveness of enterprises, production costs, and changes in productivity. The relationship between costs of intervention and its effects in financial terms based on cost-benefit analysis is the measure of effectiveness of health investments. The models presented show in practice a number of limitations, resulting mostly from the way the data are recorded in individual enterprises. Therefore, it is recommended that evaluation should be preceded by a precise definition of its aims, the range of the intervention and effects to be attained, which should provide the basis for defining the means and resources necessary for its implementation. This mainly applies to availability of data on costs and effects as well as to calculation methods, which can be used in view of collected numerical data.
In the countries of the European Union, several million workers meet with an accident every year.... more In the countries of the European Union, several million workers meet with an accident every year. In the national economy, the costs of accidents at work and occupational diseases are born by different institutions in different proportions, and they are estimated at several percent of the gross domestic product of each of these countries. The issue concerning economic consequences of occupational diseases and accidents at work has been emphasized in the section on health and safety at work of the Community Strategy for 2007-2012. Bearing this in mind, the need have arose to strengthen the efficiency of legal instruments and economic stimuli to motivate actions aimed at improving work conditions. Economic stimuli and legal instruments complement each other in the process of motivating various institutions. The following kinds of economic stimuli have been distinguished: subsidies, grants and financial assistance of the state and stimuli incorporated into tax and insurance systems. Economic evaluation at the information, allocation and educational levels, being an economic tool, may support policymakers who can use this tool to asses economic efficiency of decisions made in the area of health and safety of workers as well as to asses economic consequences of the functioning of legal instruments. The aim of the project, implemented under the Seventh Framework Program by the Nofer Institute of Occupational Medicine, is to promote the system of economic stimuli understood as an incentive to undertake actions for the improvement of work conditions. Owing to this project the discussion forum, addressed to relevant and interested social partners, will be established, and experts in the field will assist in determining directions of further actions aimed at advancing motivation systems.
Background: A growing gap between the required and available funds forces relevant bodies to use ... more Background: A growing gap between the required and available funds forces relevant bodies to use more effectively available financial means without decreasing the health care efficiency. Health policy makers have to take decisions on the kind, timing, and standard of medical care as well as on the mode and place of health service delivery. Moreover, they have to decide who should be provided with medical care under the National Health Fund. The economic evaluation techniques, primarily cost-benefit and cost-effect analyses, are essential tools supporting decision-making processes. Materials and methods: Under the LEONARDO DA VINCI (2000-2003) EUROPHAMILI project, an economic evaluation method has been developed and used to evaluate the antismoking program. In developing the method, the guidelines of the World Health Organization (WHO) were applied. Actual data on the cost of the program carried out in Lódź were used, and the benefits attained due to its implementation were estimated adopting the study assumptions based on actual data on the program efficiency and the literature data. Results: In view of the expanded calculation model, only some examples of synthesized calculations are given. The results of the analysis show that the program financial profits exceed the costs incurred even if the assumed calculation parameters are changed. The performed calculations indicate that the shorter period of the prevention program implementation, the more advantageous cost-benefit relation. Conclusions: The performed economic evaluation helped to formulate prerequisites, which have to be met to facilitate the economic assessment of efficiency of the selected prevention programs.
The rational planning and financing of occupational health services at the national level have to... more The rational planning and financing of occupational health services at the national level have to be based on an appropriate system of information about individual units and their financial status that could illustrate their financial administration. This is required not only in view of the internal needs of public money management, but also in view of the national health accounts. The major task in this regard is to assess the level and structure of financing to individual units and to check the soundness of criteria used in the process of supplying financial means. The results of such an analysis can be a valuable source of information for planning carried out also by the institutions which provide funds to cover the cost of tasks performed by individual units. The aim of the project implemented by the Nofer Institute of Occupational Medicine was to collect, process and analyze data on the level and structure of financing of provincial occupational medicine centers. In this paper, the objectives, methodology and analytical tools are discussed. The results and structural data on the level and structure of financing of regional occupational health services centers covering a two-year period are presented. At the same time, the criteria for allocating funds were identified, which made it possible to evaluate the situation and to propose new solutions.
Background: The project entitled "An analysis of insurance models in the selected European Union ... more Background: The project entitled "An analysis of insurance models in the selected European Union (EU) member States" has recently been accomplished in the Nofer Institute of Occupational Medicine in the section concerning the health and safety of the working population. One of the aims of the project was to identify differences between EU and Polish models, which may provide the basis for a possible involvement of insurance providers (existing and/or created on purpose) in the implementation of tasks in the area of the workers' health protection in Poland. Material and methods: Documents and publications issued in Poland and elaborated by international organizations were used in the analysis. Of the existing models, those which differ in the solutions concerning the limitation of growing costs of insurance systems, the level of centralization of insurance system management, and the range of cooperation between public and private insurance providers were selected for the analysis. Results: The results of the analysis show that the functioning of insurance systems in the countries under study has been the subject of constant modifications and improvements. Their major aims are to limit the growth of costs of social insurance systems, to shape new qualitative relations between private and public insurance institutions, and to take account of new forms of work regarded as a factor contributing to changes in insurance systems. Discussion and conclusions: The conclusions arising from the analysis of European insurance systems in the area of workplace accidents and occupational diseases, as well as a possible direction of insurance system transformation in Poland address the following issues: the scope of centralization of insurance system management and the role of the state, the degree of independence of insurance institutions and their priority actions for prevention, motivation mechanisms targeted at employers, participation of employers in the consequences of occupational diseases and workplace accidents, as well as the role of additional voluntary workers' health insurance.
Occupational medicine and health affairs, Jun 8, 2013
The article raises a question of covering occupational health services (OHS) by private health in... more The article raises a question of covering occupational health services (OHS) by private health insurance. Such an idea has been recently promoted in Poland in order to diversify financing sources and strengthen market forces in relation to occupational medicine (OM). However, its implementation in a long-existing, highly regulated and comprehensive Polish OM system (characterized in a synthetic way by the Authors from the legal, organizational and macroeconomic points of view) brings about several issues to discuss and solve, including a scope of OHS insurance, the relations between private insurers and OHS providers, exchange of information, obligations of employers. Therefore, introduction of OHS insurance products requires adopting legal regulations concerning the definition of OM/OHS as well as the detailed range of insurance coverage (types of risks and benefits covered under standard and extended policies, such as preventive medical examinations, workplace health promotion programs, health care services provided in case of accidents and occupational diseases, etc.). Lack of precise regulations in this area may potentially result in certain unintended and negative consequences, including a significant and uncontrolled growth of OHS costs, applying different (unequal?) protection standards for employees working in the same sectors/ branches/ workplaces and the so-called “cream skimming” phenomenon limiting health insurance scope to the most financially effective insurance “products”. Finally it should be emphasized that successful implementation of OHS private insurance policies requires introducing fiscal incentives (tax reliefs for employers on OM insurance costs). Otherwise employers will be more likely to purchase OHS in the old ways - from medical firms (OHS as the core element of “medical packages”) or directly from OHS providers.
Cost-benefit analysis (CBA) as an economic tool for evaluating activities undertaken in different... more Cost-benefit analysis (CBA) as an economic tool for evaluating activities undertaken in different branches of the national economy may be also used in the field of occupational health and safety at workplaces. A growing economic approach to all actions concerning the work performance and the work environment increases the interest in this kind of analysis, what is reflected by numerous international conferences and seminars. A supporting role of CBA in the decision-making processes compels the development of methodology and empirical verification of its assumptions. International studies aimed at elaborating uniform guidelines for cost-benefit analyses apply mostly to interventions for prevention of accidents at work, health promotion, rehabilitation of workers and occupational disease prevention.
Introduction: One of the company's actions for strengthening human capital is the protection of h... more Introduction: One of the company's actions for strengthening human capital is the protection of health and safety of its employees. Its implementation needs financial resources, therefore, employers expect tangible effectiveness in terms of health and economics. Business plan as an element of company planning can be a helpful tool for new health interventions management. The aim of this work was to elaborate a business plan framework for occupational health interventions at the company level, combining occupational health practices with company management and economics. Materials and methods: The business plan of occupational health interventions was based on the literature review, the author's own research projects and meta-analysis of research reports on economic relations between occupational health status and company productivity. Results: The study resulted in the development of the business plan for occupational health interventions at the company level. It consists of summary and several sections that address such issues as the key elements of the intervention discussed against a background of the company economics and management, occupational health and safety status of the staff, employees' health care organization, organizational plan of providing the employees with health protection, marketing plan, including specificity of health interventions in the company marketing plan and financial plan, reflecting the economic effects of health care interventions on the overall financial management of the company. Conclusions: Business plan defines occupational health and safety interventions as a part of the company activities as a whole. Planning health care interventions without relating them to the statutory goals of the company may have the adverse impact on the financial balance and profitability of the company. Therefore, business plan by providing the opportunity of comparing different options of occupational health interventions to be implemented by employers is a key element of the management of employees' health.
Although advanced neonatal care technology has contributed to significant decline in mortality of... more Although advanced neonatal care technology has contributed to significant decline in mortality of premature infants, it has also resulted in rising costs of hospitalization. Premature infants constitute 4% to 6% of all newborns treated annually in Neonatal Intensive Care Units (NICUs) and that is why the cost of prematurity determines considerable financial burden on health care in each country. In Poland research concerning costs of neonatal intensive care have not been conducted so far. The object of this paper is to review world-wide literature on that subject, particularly taking into consideration methods of estimating costs and economic analysis, such as cost-benefit analysis, cost-effect analysis and cost-utility analysis. The results of studies undertaken in the United States of America, Canada and Australia have been presented. Results of review indicate the strong relationship between high costs and small gestational age or low birth-weight of newborns. As no research in this area has been conducted in Poland so far, it seems to be crucial to estimate costs of neonatal intensive care of premature infants in Poland. Precise analysis of main factors determining high costs may be helpful in searching for significant savings. It would be a useful decision-making tool both for the NICU and the hospital managers.
One of the most effective management systems is the so-called lean management (LM) aimed at loss ... more One of the most effective management systems is the so-called lean management (LM) aimed at loss minimization of institutions' activities while maximizing value and satisfaction to the clients. The system implementation comprises not only typical business areas but also health care sectors. The aim of the article is to present the concept and opportunity of improving the management of occupational health units. Due to its multi-profile nature of tasks and diverse relations with the environment occupational health could be a good institutional example of LM implementation. Operational perspective consists of five guidelines: describing values expected by final clients, setting value flow eliminating needless elements, creating the integrated, coherent and smooth sequence of valuable activities, offering the values to clients, and aiming at continuing improvement. LM could be implemented in occupational health units in the following areas: timing and tasks coordination, leaning some tasks and expanding others in order to maximize clients' value, cost rationalizing, improving the quality of services by eliminating mistakes, avoiding repetition of activities.
Background: World trends and international organization recommendations point out the necessity o... more Background: World trends and international organization recommendations point out the necessity of OHS economic appraisal methods improvement in order to ensure effective resources management in companies. Materials and methods: Published world literature on economic appraisal results, recommendations of international organizations, results of the own studies on economic appraisal in the field of health and safety at work in the companies in Poland were the background of the economic appraisal model for Polish companies. Several project assumptions have been adopted. The model of the return of the investment, model based on the company participation and some elements of the net costs formula are recommended for Polish companies in order to appraise efficiency of the health investment. The basic ratio in economic evaluation should be cost/benefit ratio. The project of the economic evaluation algorithm has been elaborated. Results and conclusions: The economic analysis of the health protection and safety at work should include clear division between the internal and external costs. The proposed model could be used for the companies management needs in two directions: to microeconomic efficiency appraisal of investment in programs/intervensions in health and safety at workplace and to analyze the influence of the costs of accidents and occupational diseases and costs of preventive programs on finance management on the company level.
It is often pointed that hospitalizations of premature infants generate high costs. It is particu... more It is often pointed that hospitalizations of premature infants generate high costs. It is particularly bothering with reference to neonatal intensive care units (NICU). Objective: Since there is lack of desirable data in Poland, a study was launched in the city of Lódź in order to estimate exact costs of intensive care of premature infants. Methods: The study consisted in collecting data cocerning all resources (drugs, materials, medical equipment etc.) used during the hospitalizations of the neonates. It was constructed in a retrospective way, which means that data was collected from the first day of each patient's hospitalization till his or her discharge. The study lasted from 03.10.2004 to 06.04.2005. The study population were neonates borned before 37 week of gestation, who were treated in the Intensive Care Unit of Paediatric University Hospital, Medical University of Lodz. The population consisted of 30 patients borned between 23-36 week of gestation and birthweight between 600g and 3300g. Results: The structure of costs shows that the most expensive was medical care which constituted 51% of total costs. 90% of neonates costed no more than 30,000 zł and the average cost was 17,633,76 PLN. Conclusions: Total cost of hospitalization depends mainly on the length of stay. Among recovered patients hospitalizations lasted from 6 to 125 days. The longest stay costed 90,780 PLN. Detailed analysis is needed to consider if there is feasible possibility to limit time of hospitalizations in order to decrease costs.
In different health care systems, there are different schemes of organization and principles of f... more In different health care systems, there are different schemes of organization and principles of financing activities aimed at ensuring the working population health and safety. Regardless of the scheme and the range of health care provided, economists strive for rationalization of costs (including their reduction). This applies to both employers who include workers' health care costs into indirect costs of the market product manufacture and health care institutions, which provide health care services. In practice, new methods of setting costs of workers' health care facilitate regular cost control, acquisition of detailed information about costs, and better adjustment of information to planning and control needs in individual health care institutions. For economic institutions and institutions specialized in workers' health care, a traditional cost-effect calculation focused on setting costs of individual products (services) is useful only if costs are relatively low and the output of simple products is not very high. But when products form aggregates of numerous actions like those involved in occupational medicine services, the method of activity based costing (ABC), representing the process approach, is much more useful. According to this approach costs are attributed to the product according to resources used during different activities involved in its production. The calculation of costs proceeds through allocation of all direct costs for specific processes in a given institution. Indirect costs are settled on the basis of resources used during the implementation of individual tasks involved in the process of making a new product. In this method, so called map of processes/actions consisted in the manufactured product and their interrelations are of particular importance. Advancements in the cost-effect for the management of health care institutions depend on their managerial needs. Current trends in this regard primarily depend on treating all cost reference subjects as cost objects and taking account of all their interrelations. Final products, specific assignments, resources and activities may all be regarded as cost objects. The ABC method is characterized by a very high informative value in terms of setting prices of products in the area of workers' health care. It also facilitates the assessment of costs of individual activities under a multidisciplinary approach to health care and the setting costs of varied products. The ABC method provides precise data on the consumption of resources, such as human labor or various materials.
Economic evaluation of costs and effectiveness of the program aimed at early detection of lung di... more Economic evaluation of costs and effectiveness of the program aimed at early detection of lung diseases was the subject of the study. The scope of the study is related to the European tendency of creating information resources for public resources management. The study covered more than 14 000 people divided into three age groups, living in 11 localities in the Lódź region. The program aimed at lung diseases detection was conducted in three steps: first specialist examinations, X-ray examinations, second specialist examinations. Costs and effectiveness of the program were compared by cost/effectiveness and incremental ratios. The results of the study were formulated in the following areas: costs of the program by age groups and groups with suspected diseases, effects of the program, costs per one detected case and incremental ratios. The results of the study show that economic evaluation conducted from ex post perspective could be useful in building decision scenarios. Sensitivity a...
Economic analyses and evaluation of the effect of workers' health on the national economy have be... more Economic analyses and evaluation of the effect of workers' health on the national economy have begun to play a significant role in decision-making processes in terms of relations between health and safety in the work environment and the financial policy of enterprises. The economic dimension of consequences of occupational diseases and accidents at work is more frequently associated with the financial policy of enterprises understood as an element of costs involved. This gains particular significance when enterprises must maintain and improve economic effectiveness especially in the case of limited resources and permanent competition on the market. Therefore, the evaluation of economic interventions in the area of health and safety at workplace and its results are so important in the enterprise decision-making process. Several models of economic evaluation are used in assessing effectiveness of actions aimed at improving health and safety at workplace against a background of the overall economic situation of enterprises. The author presents the principles of six models, which have been used in the evaluation process. These models are based on information about costs of interventions/programs designed to reduce harmful effects of working conditions on workers' health and information concerning the results of individual ventures. They also take account of the influence of changes in working conditions on reduced sick absence, increased effectiveness of enterprises, production costs, and changes in productivity. The relationship between costs of intervention and its effects in financial terms based on cost-benefit analysis is the measure of effectiveness of health investments. The models presented show in practice a number of limitations, resulting mostly from the way the data are recorded in individual enterprises. Therefore, it is recommended that evaluation should be preceded by a precise definition of its aims, the range of the intervention and effects to be attained, which should provide the basis for defining the means and resources necessary for its implementation. This mainly applies to availability of data on costs and effects as well as to calculation methods, which can be used in view of collected numerical data.
In the countries of the European Union, several million workers meet with an accident every year.... more In the countries of the European Union, several million workers meet with an accident every year. In the national economy, the costs of accidents at work and occupational diseases are born by different institutions in different proportions, and they are estimated at several percent of the gross domestic product of each of these countries. The issue concerning economic consequences of occupational diseases and accidents at work has been emphasized in the section on health and safety at work of the Community Strategy for 2007-2012. Bearing this in mind, the need have arose to strengthen the efficiency of legal instruments and economic stimuli to motivate actions aimed at improving work conditions. Economic stimuli and legal instruments complement each other in the process of motivating various institutions. The following kinds of economic stimuli have been distinguished: subsidies, grants and financial assistance of the state and stimuli incorporated into tax and insurance systems. Economic evaluation at the information, allocation and educational levels, being an economic tool, may support policymakers who can use this tool to asses economic efficiency of decisions made in the area of health and safety of workers as well as to asses economic consequences of the functioning of legal instruments. The aim of the project, implemented under the Seventh Framework Program by the Nofer Institute of Occupational Medicine, is to promote the system of economic stimuli understood as an incentive to undertake actions for the improvement of work conditions. Owing to this project the discussion forum, addressed to relevant and interested social partners, will be established, and experts in the field will assist in determining directions of further actions aimed at advancing motivation systems.
Background: A growing gap between the required and available funds forces relevant bodies to use ... more Background: A growing gap between the required and available funds forces relevant bodies to use more effectively available financial means without decreasing the health care efficiency. Health policy makers have to take decisions on the kind, timing, and standard of medical care as well as on the mode and place of health service delivery. Moreover, they have to decide who should be provided with medical care under the National Health Fund. The economic evaluation techniques, primarily cost-benefit and cost-effect analyses, are essential tools supporting decision-making processes. Materials and methods: Under the LEONARDO DA VINCI (2000-2003) EUROPHAMILI project, an economic evaluation method has been developed and used to evaluate the antismoking program. In developing the method, the guidelines of the World Health Organization (WHO) were applied. Actual data on the cost of the program carried out in Lódź were used, and the benefits attained due to its implementation were estimated adopting the study assumptions based on actual data on the program efficiency and the literature data. Results: In view of the expanded calculation model, only some examples of synthesized calculations are given. The results of the analysis show that the program financial profits exceed the costs incurred even if the assumed calculation parameters are changed. The performed calculations indicate that the shorter period of the prevention program implementation, the more advantageous cost-benefit relation. Conclusions: The performed economic evaluation helped to formulate prerequisites, which have to be met to facilitate the economic assessment of efficiency of the selected prevention programs.
The rational planning and financing of occupational health services at the national level have to... more The rational planning and financing of occupational health services at the national level have to be based on an appropriate system of information about individual units and their financial status that could illustrate their financial administration. This is required not only in view of the internal needs of public money management, but also in view of the national health accounts. The major task in this regard is to assess the level and structure of financing to individual units and to check the soundness of criteria used in the process of supplying financial means. The results of such an analysis can be a valuable source of information for planning carried out also by the institutions which provide funds to cover the cost of tasks performed by individual units. The aim of the project implemented by the Nofer Institute of Occupational Medicine was to collect, process and analyze data on the level and structure of financing of provincial occupational medicine centers. In this paper, the objectives, methodology and analytical tools are discussed. The results and structural data on the level and structure of financing of regional occupational health services centers covering a two-year period are presented. At the same time, the criteria for allocating funds were identified, which made it possible to evaluate the situation and to propose new solutions.
Background: The project entitled "An analysis of insurance models in the selected European Union ... more Background: The project entitled "An analysis of insurance models in the selected European Union (EU) member States" has recently been accomplished in the Nofer Institute of Occupational Medicine in the section concerning the health and safety of the working population. One of the aims of the project was to identify differences between EU and Polish models, which may provide the basis for a possible involvement of insurance providers (existing and/or created on purpose) in the implementation of tasks in the area of the workers' health protection in Poland. Material and methods: Documents and publications issued in Poland and elaborated by international organizations were used in the analysis. Of the existing models, those which differ in the solutions concerning the limitation of growing costs of insurance systems, the level of centralization of insurance system management, and the range of cooperation between public and private insurance providers were selected for the analysis. Results: The results of the analysis show that the functioning of insurance systems in the countries under study has been the subject of constant modifications and improvements. Their major aims are to limit the growth of costs of social insurance systems, to shape new qualitative relations between private and public insurance institutions, and to take account of new forms of work regarded as a factor contributing to changes in insurance systems. Discussion and conclusions: The conclusions arising from the analysis of European insurance systems in the area of workplace accidents and occupational diseases, as well as a possible direction of insurance system transformation in Poland address the following issues: the scope of centralization of insurance system management and the role of the state, the degree of independence of insurance institutions and their priority actions for prevention, motivation mechanisms targeted at employers, participation of employers in the consequences of occupational diseases and workplace accidents, as well as the role of additional voluntary workers' health insurance.
Occupational medicine and health affairs, Jun 8, 2013
The article raises a question of covering occupational health services (OHS) by private health in... more The article raises a question of covering occupational health services (OHS) by private health insurance. Such an idea has been recently promoted in Poland in order to diversify financing sources and strengthen market forces in relation to occupational medicine (OM). However, its implementation in a long-existing, highly regulated and comprehensive Polish OM system (characterized in a synthetic way by the Authors from the legal, organizational and macroeconomic points of view) brings about several issues to discuss and solve, including a scope of OHS insurance, the relations between private insurers and OHS providers, exchange of information, obligations of employers. Therefore, introduction of OHS insurance products requires adopting legal regulations concerning the definition of OM/OHS as well as the detailed range of insurance coverage (types of risks and benefits covered under standard and extended policies, such as preventive medical examinations, workplace health promotion programs, health care services provided in case of accidents and occupational diseases, etc.). Lack of precise regulations in this area may potentially result in certain unintended and negative consequences, including a significant and uncontrolled growth of OHS costs, applying different (unequal?) protection standards for employees working in the same sectors/ branches/ workplaces and the so-called “cream skimming” phenomenon limiting health insurance scope to the most financially effective insurance “products”. Finally it should be emphasized that successful implementation of OHS private insurance policies requires introducing fiscal incentives (tax reliefs for employers on OM insurance costs). Otherwise employers will be more likely to purchase OHS in the old ways - from medical firms (OHS as the core element of “medical packages”) or directly from OHS providers.
Cost-benefit analysis (CBA) as an economic tool for evaluating activities undertaken in different... more Cost-benefit analysis (CBA) as an economic tool for evaluating activities undertaken in different branches of the national economy may be also used in the field of occupational health and safety at workplaces. A growing economic approach to all actions concerning the work performance and the work environment increases the interest in this kind of analysis, what is reflected by numerous international conferences and seminars. A supporting role of CBA in the decision-making processes compels the development of methodology and empirical verification of its assumptions. International studies aimed at elaborating uniform guidelines for cost-benefit analyses apply mostly to interventions for prevention of accidents at work, health promotion, rehabilitation of workers and occupational disease prevention.
Introduction: One of the company's actions for strengthening human capital is the protection of h... more Introduction: One of the company's actions for strengthening human capital is the protection of health and safety of its employees. Its implementation needs financial resources, therefore, employers expect tangible effectiveness in terms of health and economics. Business plan as an element of company planning can be a helpful tool for new health interventions management. The aim of this work was to elaborate a business plan framework for occupational health interventions at the company level, combining occupational health practices with company management and economics. Materials and methods: The business plan of occupational health interventions was based on the literature review, the author's own research projects and meta-analysis of research reports on economic relations between occupational health status and company productivity. Results: The study resulted in the development of the business plan for occupational health interventions at the company level. It consists of summary and several sections that address such issues as the key elements of the intervention discussed against a background of the company economics and management, occupational health and safety status of the staff, employees' health care organization, organizational plan of providing the employees with health protection, marketing plan, including specificity of health interventions in the company marketing plan and financial plan, reflecting the economic effects of health care interventions on the overall financial management of the company. Conclusions: Business plan defines occupational health and safety interventions as a part of the company activities as a whole. Planning health care interventions without relating them to the statutory goals of the company may have the adverse impact on the financial balance and profitability of the company. Therefore, business plan by providing the opportunity of comparing different options of occupational health interventions to be implemented by employers is a key element of the management of employees' health.
Although advanced neonatal care technology has contributed to significant decline in mortality of... more Although advanced neonatal care technology has contributed to significant decline in mortality of premature infants, it has also resulted in rising costs of hospitalization. Premature infants constitute 4% to 6% of all newborns treated annually in Neonatal Intensive Care Units (NICUs) and that is why the cost of prematurity determines considerable financial burden on health care in each country. In Poland research concerning costs of neonatal intensive care have not been conducted so far. The object of this paper is to review world-wide literature on that subject, particularly taking into consideration methods of estimating costs and economic analysis, such as cost-benefit analysis, cost-effect analysis and cost-utility analysis. The results of studies undertaken in the United States of America, Canada and Australia have been presented. Results of review indicate the strong relationship between high costs and small gestational age or low birth-weight of newborns. As no research in this area has been conducted in Poland so far, it seems to be crucial to estimate costs of neonatal intensive care of premature infants in Poland. Precise analysis of main factors determining high costs may be helpful in searching for significant savings. It would be a useful decision-making tool both for the NICU and the hospital managers.
One of the most effective management systems is the so-called lean management (LM) aimed at loss ... more One of the most effective management systems is the so-called lean management (LM) aimed at loss minimization of institutions' activities while maximizing value and satisfaction to the clients. The system implementation comprises not only typical business areas but also health care sectors. The aim of the article is to present the concept and opportunity of improving the management of occupational health units. Due to its multi-profile nature of tasks and diverse relations with the environment occupational health could be a good institutional example of LM implementation. Operational perspective consists of five guidelines: describing values expected by final clients, setting value flow eliminating needless elements, creating the integrated, coherent and smooth sequence of valuable activities, offering the values to clients, and aiming at continuing improvement. LM could be implemented in occupational health units in the following areas: timing and tasks coordination, leaning some tasks and expanding others in order to maximize clients' value, cost rationalizing, improving the quality of services by eliminating mistakes, avoiding repetition of activities.
Background: World trends and international organization recommendations point out the necessity o... more Background: World trends and international organization recommendations point out the necessity of OHS economic appraisal methods improvement in order to ensure effective resources management in companies. Materials and methods: Published world literature on economic appraisal results, recommendations of international organizations, results of the own studies on economic appraisal in the field of health and safety at work in the companies in Poland were the background of the economic appraisal model for Polish companies. Several project assumptions have been adopted. The model of the return of the investment, model based on the company participation and some elements of the net costs formula are recommended for Polish companies in order to appraise efficiency of the health investment. The basic ratio in economic evaluation should be cost/benefit ratio. The project of the economic evaluation algorithm has been elaborated. Results and conclusions: The economic analysis of the health protection and safety at work should include clear division between the internal and external costs. The proposed model could be used for the companies management needs in two directions: to microeconomic efficiency appraisal of investment in programs/intervensions in health and safety at workplace and to analyze the influence of the costs of accidents and occupational diseases and costs of preventive programs on finance management on the company level.
It is often pointed that hospitalizations of premature infants generate high costs. It is particu... more It is often pointed that hospitalizations of premature infants generate high costs. It is particularly bothering with reference to neonatal intensive care units (NICU). Objective: Since there is lack of desirable data in Poland, a study was launched in the city of Lódź in order to estimate exact costs of intensive care of premature infants. Methods: The study consisted in collecting data cocerning all resources (drugs, materials, medical equipment etc.) used during the hospitalizations of the neonates. It was constructed in a retrospective way, which means that data was collected from the first day of each patient's hospitalization till his or her discharge. The study lasted from 03.10.2004 to 06.04.2005. The study population were neonates borned before 37 week of gestation, who were treated in the Intensive Care Unit of Paediatric University Hospital, Medical University of Lodz. The population consisted of 30 patients borned between 23-36 week of gestation and birthweight between 600g and 3300g. Results: The structure of costs shows that the most expensive was medical care which constituted 51% of total costs. 90% of neonates costed no more than 30,000 zł and the average cost was 17,633,76 PLN. Conclusions: Total cost of hospitalization depends mainly on the length of stay. Among recovered patients hospitalizations lasted from 6 to 125 days. The longest stay costed 90,780 PLN. Detailed analysis is needed to consider if there is feasible possibility to limit time of hospitalizations in order to decrease costs.
In different health care systems, there are different schemes of organization and principles of f... more In different health care systems, there are different schemes of organization and principles of financing activities aimed at ensuring the working population health and safety. Regardless of the scheme and the range of health care provided, economists strive for rationalization of costs (including their reduction). This applies to both employers who include workers' health care costs into indirect costs of the market product manufacture and health care institutions, which provide health care services. In practice, new methods of setting costs of workers' health care facilitate regular cost control, acquisition of detailed information about costs, and better adjustment of information to planning and control needs in individual health care institutions. For economic institutions and institutions specialized in workers' health care, a traditional cost-effect calculation focused on setting costs of individual products (services) is useful only if costs are relatively low and the output of simple products is not very high. But when products form aggregates of numerous actions like those involved in occupational medicine services, the method of activity based costing (ABC), representing the process approach, is much more useful. According to this approach costs are attributed to the product according to resources used during different activities involved in its production. The calculation of costs proceeds through allocation of all direct costs for specific processes in a given institution. Indirect costs are settled on the basis of resources used during the implementation of individual tasks involved in the process of making a new product. In this method, so called map of processes/actions consisted in the manufactured product and their interrelations are of particular importance. Advancements in the cost-effect for the management of health care institutions depend on their managerial needs. Current trends in this regard primarily depend on treating all cost reference subjects as cost objects and taking account of all their interrelations. Final products, specific assignments, resources and activities may all be regarded as cost objects. The ABC method is characterized by a very high informative value in terms of setting prices of products in the area of workers' health care. It also facilitates the assessment of costs of individual activities under a multidisciplinary approach to health care and the setting costs of varied products. The ABC method provides precise data on the consumption of resources, such as human labor or various materials.
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Papers by Izabela Rydlewska-Liszkowska