Browsing by Subject "kustannusanalyysi"
Now showing items 1-4 of 4
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(2017)The incidence of wet age-related macular degeneration (AMD) is increasing with ageing. AMD leads to blindness if it is not treated properly. Common treatment is to administrate intravitreal growth factor inhibitors. An ageing population increases the number of patients which overloads the public health services and expands costs. Traditionally, injections have been administered by physicians but because of the limited recourses nurses have been trained to administer injections. In addition, injections can be administered as physician's clinical extra work to alleviate the queue and as an outsourcing service from the private sector. As the resources of the public health service are limited, it is important to evaluate used methods reliably. The target of this research was to investigate the administration costs of intravitreal injections which are administered by physicians, nurses, a physician or a nurse working extra to alleviate the queue or by a private sector. The used method was cost analysis because the effectiveness of the care is the same regardless of the administer of the injection. The source of costs was Ecomed database of HUS, the data of cost accounting and catalogue of billing from the outsourcing service. The costs were examined in perspective of the producer of the service. Based on the cost analysis, the administration costs per injection are following: administered by physicians 51,39 €, nurse-administered 51,19 €, administered by a physician to alleviate the queue 100,46 €, nurse-administered to alleviate the queue 72,87 €, administered by a physician in outsourcing service 276,19 and nurse-administered in outsourcing service 269,85 €. The annual total costs of the producer of the service were 4 563 726 €. By increasing the number of injections administered by a nurse of HUS the need for an outsourcing service can be decreased which may decrease the annual total costs by two million euro. It is important to find cost-effective solutions because the number of patients are increasing. Based on this research it is more profitable to increase the number of injections administered by a nurse of HUS than to train more nurses to administrate injections to alleviate the queue or to work in outsourcing services. The result of this research can be adapted in planning of the public health services.
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(2016)Rheumatoid arthritis (RA) is a chronic autoimmune disease with prevalence around 0.8 % in Finland. Joint inflammation causes pain, tenderness and swelling in joint as well as loss of functional and work capacity. Patients need healthcare resources and medical treatments cause substantial costs to patient and society. Severity of RA can be measured by Disease Activity Score (DAS28) and Health Assessment Questionnaire (HAQ). Previous studies suggest these measures are related to higher direct and indirect cost. The aims of this study are to determine cost of RA in Finland and analyse cost by disease activity and functional disability. Literature review was performed by using some methods from systematic reviews to identify previous studies examining cost of RA by DAS28 and HAQ scores. Secondly in this master thesis was made a quantitative cost analysis which study population was identified from the National register for Biologics in Finland (ROB-FIN) and patient records of the Central Finland Central Hospital. The cost data for direct and productivity costs was received from Finnish national registries. Costs were determined from the followed six months after patients' (N=2285) first routine outpatient visit to specialized healthcare. Distribution of costs was examined by DAS28 and HAQ score based classification. Additionally cost related to RA was determined separately between biologic and non-biologic drug users. Total average costs of the study population were 11 720 € biannually. Direct costs, productivity costs and total costs were higher for patients with higher DAS28 and HAQ scores. Increase in average total costs between best and worst DAS28 and HAQ classifications were 7817 -15 838 € and 8545 - 16 718 €, respectively. In the cost categories changes in both directions were detected between different DAS28 and HAQ score classifications. Drug costs comprised largest part of direct costs (56 %). RA related average total costs increased from best to worst DAS28 and HAQ class for both biologic and non-biologic drug users (p<0,01). Similar study based real life register data is not previous made in Finland. Studies in other countries can`t be directly adapted to Finnish healthcare system, treatment traditions and productivity costs. This study provides information for real-life cots of RA and how they are related to disease activity and functional disability. This information can be used in modelling of cost-effectiveness.
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(2017)The wood procurement companies and the forest industry are linked in both economical and operational perspective. Therefore, the success of one is dependent on another. In Finland, the procurement volumes are to increase, so efficient performance of procurement operations is vital. In this study, the operational environment and operative practices of the chosen 12 procurement companies were studied by analyzing procurement data of three years’ period, by interviewing the entrepreneurs and by assessing their operative practices with a cost analysis model. The results point out considerable variation in the procured volume and productive machine hours. Common problems were related to timber reception at mills and difficulties in resource utilization planning due to varying amount of harvesting work. Entrepreneurs hoped for larger forest stand inventory and more systematic planning in acquisition of stands to optimize logistics and harvesting. Variation in the worksite preparation performance of the employees of the customers requires improvement and entrepreneurs have development to do in performance monitoring and attitudes towards it. Variation in tools used for monitoring and resources dedicated to it was notable. Limitations of management resources appeared in middle-size companies and hiring supervisor-level personnel is a high threshold. Unit costs for harvesting varied considerably, but in general higher productive machine hours decrease the unit cost. Decrease of the annual standstill-time and transit distances and adequate worksite volume and machinery utilization rate are key factors, that can affect the unit cost by up to several per cent. On national scale, the cost decrement can be from millions of euros to tens of millions only by small improvements Notable variation in productive machine hours and harvested volumes tells about possibilities for improvements. These can be found by developing the operational environment together with customers and by assessing own practices and attitudes openly and critically. Wood procurement companies in general have the will to improve and develop and together with the forest industry’s increasing need for timber, this provides improvement possibilities for the whole chain of wood procurement.
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(2017)The wood procurement companies and the forest industry are linked in both economical and operational perspective. Therefore, the success of one is dependent on another. In Finland, the procurement volumes are to increase, so efficient performance of procurement operations is vital. In this study, the operational environment and operative practices of the chosen 12 procurement companies were studied by analyzing procurement data of three years’ period, by interviewing the entrepreneurs and by assessing their operative practices with a cost analysis model. The results point out considerable variation in the procured volume and productive machine hours. Common problems were related to timber reception at mills and difficulties in resource utilization planning due to varying amount of harvesting work. Entrepreneurs hoped for larger forest stand inventory and more systematic planning in acquisition of stands to optimize logistics and harvesting. Variation in the worksite preparation performance of the employees of the customers requires improvement and entrepreneurs have development to do in performance monitoring and attitudes towards it. Variation in tools used for monitoring and resources dedicated to it was notable. Limitations of management resources appeared in middle-size companies and hiring supervisor-level personnel is a high threshold. Unit costs for harvesting varied considerably, but in general higher productive machine hours decrease the unit cost. Decrease of the annual standstill-time and transit distances and adequate worksite volume and machinery utilization rate are key factors, that can affect the unit cost by up to several per cent. On national scale, the cost decrement can be from millions of euros to tens of millions only by small improvements Notable variation in productive machine hours and harvested volumes tells about possibilities for improvements. These can be found by developing the operational environment together with customers and by assessing own practices and attitudes openly and critically. Wood procurement companies in general have the will to improve and develop and together with the forest industry’s increasing need for timber, this provides improvement possibilities for the whole chain of wood procurement.
Now showing items 1-4 of 4