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Use of agency-employed supplemental nurses on nursing personnel costs was examined in 19 adult patient care units in a large academic medical center. Results indicated that the modest use of supplemental nurses was cost-efficient with regard to overall nursing personnel costs, but heavy reliance on supplemental nurses to meet staffing needs was not cost-efficient. In addition, there was no statistical difference in hourly personnel cost between the use of supplemental nurses and overtime worked by permanent nurses. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the long-term effects of Medicaid managed care (MMC) on obstetric service use and program costs in California, Data Sources/Study Setting. Longitudinal administrative data on Medical enrollment and claims and encounters related to pregnancy and delivery services were gathered from three counties-two long-standing MMC counties and one traditional fee-for-service Medicaid county in California between 1987 and 1992. Study Design. We studied Aid to Families with Dependent Children (AFDC) beneficiaries with live singleton vaginal deliveries with associated hospital stays of 14 days or less. Effects of managed care were examined with respect to prenatal visits, length of stay for delivery, maternal postpartum readmission rates, and total program expenditures. Multivariate analyses examined how the relative effect of managed care on service use and program expenditures in each MMC county evolves over time in comparison to fee-for-service. We controlled for length of Medical enrollment prior to delivery, data censoring, arid individual characteristics such as race and age. Principal Findings. Prenatal care use is consistently lower in the MMC counties, although all three counties' prenatal care provision is well below the national standard. Drastic increases in one-day-stay deliveries were found: up to almost 50 percent of deliveries in MMC counties were one-day stays. Program cost savings associated with MMC enrollment are unambiguous. Conclusions. MMC cost savings might have come at the expense of reduced provision of prenatal care and shorter delivery length of stay. Future studies should verify any possible causal link and the effects on maternal and infant health outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Subsidized rural clinics and providers, have long depended on the rural hospital for the care of some of their patients; the hospital has also been a source of revenue for these providers and programs. We studied a representative national sample of 116 subsidized rural clinics, focusing on the impact on rural clinic costs and revenues of the use of the hospital by the clinics' providers. Both clinic costs and revenue are reduced by the use of the hospital by rural practice providers, but costs are lowered to a greater extent than revenues, thereby enhancing the financial self sufficiency of the subsidized clinic. The cost savings affect all aspects of clinic operation, but especially laboratory costs, community services costs, and administrative costs. The dependence of these rural clinics on the hospital indicates that the condition of subsidized rural clinics would be worsened by decreased availability of hospital services. (Am J Public Health 1985; 75:749-753.) [ABSTRACT FROM AUTHOR]

The article reports that that with the exception of 9.2% of the population who remain uninsured, the U.S. citizens with health insurance have coverage for prescription drugs. Pharmaceutical expenditures are increasing more than overall healthcare expenditures, which is due to the opaque nature of the drug pricing process in the U.S.