Determining resource intensity weights in ambulatory chemotherapy related to nursing workload.

Ontario cancer programs aim to deliver high-quality nursing care and treatment that is safe for patients and staff. The reality of health care is that financial constraints, inherent in the delivery of care, require that funding mechanisms count not only the cost of drugs, but factors such as pharmacy and nursing human resource costs. While some organizations have developed patient classification systems to measure nursing intensity and workload, these systems apply primarily to inpatient populations, and are fraught with numerous challenges, such as the need for nurses to document to justify the workload required for care.

Scale and scope efficiencies through hospital consolidations.

The hospital sector in the Province of Ontario has recently completed a large scale restructuring marked by wide ranging hospital closures, mergers and program transfers. Given a generally inconclusive economics literature, regulators used an accounting, as opposed to an economic, approach when predicting gains to consolidations. This paper uses an economic cost function to examine economies of scale and scope in the years preceding restructuring, where there was little doubt that economies were possible.

Coding response to a case-mix measurement system based on multiple diagnoses.

Objective: To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model.

Data Sources: Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002.

Study Design: Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses.