Paying for Health Care, Today and Tomorrow

Before delving into the substance of this discussion, I must say that my personal beliefs are contradictory to many globalized health care efforts. Penner (2005) discusses some benefits of discussing and comparing health care economics between various nations. However, as we combine efforts to target specific health concerns across the globe, we lose the ability to innovate, promote evidence-based discussion, and promote the sovereignty of each country involved in the global effort. This globalization of health care deteriorates the ability to compare and contrast best practices of various countries. Unfortunately, most of the published works promote an insidious form of social justice and do not address how globalization efforts reduce the sovereignty of nations and people. Huynen, Martens, and Hilderdink (2005) support this deterioration by promoting a foundation for a global governance structure that would lead to better dissemination and control of globalization efforts.

Campbell and Gupta (2009) directly compare some claims that the U.K. National Health System (NHS) has worse health outcomes than the traditional U.S. model. Though Campbell and Gupta provide evidence disparaging many of these claims, they also seem to provide some insight as to the woes the NHS has recently faced and are working to correct. Under a system promoted by Huynen, Martens, and Hilderdink (2005), we would ultimately lose the comparison between nations as to best practices. The U.S. is currently debating the value of nationalizing health care, and similar arguments are arising based on the inability for interstate comparisons of effective and efficient delivery of health care among the various states.


Campbell, D. & Gupta, G. (2009, August 11). Is public healthcare in the UK as sick as rightwing America claims? The Guardian. Retrieved from

Huynen, M. M. T. E., Martens, P., & Hilderink, H. B. M. (2005). The health impacts of globalisation: a conceptual framework. Globalization and Health, 1, 1-14. doi:10.1186/1744-8603-1-14

Penner, S. J. (2004). Introduction to health care economics & financial management: fundamental concepts with practical applications. Philadelphia, PA: Lippincott Williams & Wilkins.

Discussing Cost-Effective Analysis

This week I was directed to provide insight to the cost-effective analysis (CEA) provided by Penner (2004) in A Cost-Effective Analysis for Proposed Alternative Interventions to Post-Procedure Surgical Pain Reduction. Within the CEA, three alternative treatments (guided imagery, hypnosis, and biofeedback) are proposed to reduce post-operative pain. The CEA is used to determine the efficiency that each intervention offers comparably to each of the other two alternatives.

I developed a PowerPoint™ presentation [click here] to provide a summation of the CEA and visually present the information for a quick rationalization of the chosen intervention. I will explain each slide of the PowerPoint™ as it pertains to the CEA.

The Cost-Effective Analysis

The CEA provided by Penner (2004) describes the various costs and benefits of using guided imagery, hypnosis, and biofeedback therapies to reduce post-operative pain (as defined on slide #3), which improves the overall healing process. The objective, as noted on slide #2, is the importance of effective pain control. The author of the CEA concedes that all three interventions similarly meet the therapeutic objective of limiting post-operative pain in a safe and low-risk manner; however, the cost differences are significant.


As provided in the CEA, the most significant tangible benefits, as mentioned above, are providing effective pain management in a safe, low-risk manner. Additionally, and as a result of reducing pain effectively, increased patient satisfaction, better patient compliance, and overall better healing leads to reduced costs associated with post-operative recovery, such as reduced length of stay and reduced need for post-surgical care (e.g. nursing care, physician care, rehospitalization, medications). Slide #4 of the presentation outlines these similar benefits.


The costs of each intervention are significant factors in deciding which intervention to promote. Once the annual cost for each intervention if figured, each of the identified costs are distributed across the expected patient volume of 197 and further distributed over the likelihood of each of three surgical procedures (spinal fusion, total hip replacement, and auto hema stem cell transplant) being performed. Though this is largely unnecessary, it does provide perspective for how the costs will be distributed and raise the overall cost for each surgical procedure performed, as shown on slide #8. The total annual cost for each intervention, as well as the per-patient cost, is outlined on slide #5 and graphed on slides #6 and #7.

The fixed costs for guided imagery include a psychology consultant, a surgery PA coordinator, wages for clerical staff, and training for the surgery PA.

The fixed costs for hypnosis includes a psychologist skilled in hypnotherapy and wages for clerical staff. The amount of resources for hypnosis are significantly less than for guided imagery; however, the intervention is more substantial requiring significantly more hours per week paid (12 for hypnosis vs. 2 for guided imagery).

The fixed costs for biofeedback are more equivalent to, though slightly more than, those of guided imagery. Biofeedback requires a psychology consultant, a surgery PA coordinator, wages for clerical staff, and training for the surgery PA, but the fixed costs for biofeedback also include specific equipment, including skin sensors, two video monitors, VCRs, and carts.

The total identified costs for guided imagery is 32.18% less than biofeedback and 64.56% less than hypnosis.


Based on the CEA, the most cost-effective intervention for impacting and controlling post-operative pain on patients undergoing one of the three surgical procedures outlined is guided imagery. This result is stated on slide #10.


The appropriate management of pain is crucial to patient care. Assuming that the three interventions investigated are equally effective towards the objective of reducing and controlling pain, the cost of each intervention is the deciding factor when considering which of the three interventions to employ. In this case, guided imagery is the most cost-effective intervention and is the recommended intervention, per the CEA.

It is important to understand that these costs will be borne by not one but three different departments – the pain clinic, the orthopedic surgery department, and the patient education department. This cost-sharing removes the burden of providing the intervention from a single department and disperses the burden over the budgets of three different departments.


Penner, S. J. (2004). Introduction to health care economics & financial management: fundamental concepts with practical applications. Philadelphia, PA: Lippincott Williams & Wilkins.

Grant Sources: Proposing a New Treatment Program

As grant funding is one of the largest sources of state revenue, it would be remiss for any program administrator facing financial difficulty to not leverage these available funds towards their program (Menifield, 2009). With this in mind, I will create a fictional program and discuss many of the points worthy of mention when completing a grant proposal for such a program, as presented by Markin (2006). The fictional program will provide an opportunity for the criminal justice system to intervene with young offenders during enrollment in the probation program to prevent recidivism.

The Proposal

Statement of the Problem

The juvenile recidivism rate in the State of Connecticut is approximately 33-36% (University of New Haven, 2010). Though the recidivism rate is not counted through the transition from juvenile to adult, it is widely believed that most adult offenders have committed offenses as juveniles (Burnette, 2004). According to Stone (2010), interdicting juvenile offenders at the time of first offense reduces the overall risk of recidivism.

Goals, Objectives, and Performance Measures

Goals of this program should be directly measurable. For one, the immediately obvious goal for this program would be a measurable reduction in juvenile recidivism. Objectives could be relative to benchmarks within the program to show periodic compliance, such as the absence of drug use by participants and evaluation of test scores. Another goal of this program could reduce first adult offenses by juvenile offenders.

Program Design

The development of this juvenile offender outreach program takes into consideration three different evidence-based programs that show promising reductions in juvenile recidivism. The first program is a 12-step program, called Moral Reconation Therapy ® (MRT). According to Burnette et al. (2004), MRT involves reprogramming of the participants’ sense of self, sense of others, attitudes towards risk-taking, and provides a foundation of support and improved moral reasoning. MRT is credited at reducing relative recidivism by 39-60%.

The second program is a mentor program that can be easily integrated with MRT. The mentor component focuses on the importance of vocation and work ethic (Stone, 2009). The vocational mentor program has shown to reduce recidivism by 50-65%.

The third program, a restorative justice mediation program that allows “offenders … to brainstorm with the mediator and the victim on how best to make reparations” (University of New Haven, 2010, para. 3). UNH Associate Professor and Director of the Legal Studies Program Donna Decker Morris (as cited in University of New Haven, 2010) advocates this program and credits the program with 40-45% reductions in recidivism rates.
By integrating all three programs into a single cohesive approach, recidivism rates could be reduced by as much as 90-95%; however, this is an estimate and requires close and frequent assessment.

Organization & Management

Though it is beyond the scope of this fictional presentation, Markin (2006) shows the importance of providing the names and credentials of the professionals who will be working within the program.


The primary source of funding for programs such as this is grant funding (Menifield, 2009). One grant opportunity, Serving Juvenile Offenders in High-Poverty, High-Crime Communities (SGA-DFA-PY-11-09; U.S. Department of Labor, 2012), focuses on improving the long-term labor market prospects for youths aged 14 and above. This grant is focused towards high-crime, high-poverty areas and, therefore, provides for the opportunity for high impact.

As the program focuses on impacting juveniles and increasing their focus towards vocational contributions towards society and their community, this grant opportunity is appropriate to fund this program.


Whether in hard times or easy times, we live in communities and want to contribute to the improvement of society, though most of us do this passively. A program such as the one outlined above can have significant effects at improving society by reducing crime, removing first-time offenders from the criminal justice system, and increasing employability of those offenders thereby decreasing the overall unemployment rate. Programs such as these can have far reaching and immeasurable effects on each member of the community.

Government realizes that it is highly ineffective at controlling local programs and provides grants to states and localities, as well as not-for-profit organizations, to help administer programs that it feels would be beneficial to society as a whole. This process assists states and localities by positively impacting directly the lives of those living within the community.


Burnette, K. D., Swan, E. S., Robinson, K. D., Woods-Robinson, M., Robinson, K. D., & Little, G. L. (2004). Treating youthful offenders with Moral Reconation Therapy®: a recidivism and pre- posttest analysis. Cognitive Behavioral Treatment Review, 3, 14-15. Retrieved from

Markin, K. (2006, September). How to write a proposal for an outreach grant. The Chronicle of Higher Education, 53(4), C1, C4.

Menifield, C. E. (2009). The basics of public budgeting and financial management: a handbook for academics and practitioners. Lanham, MD: University Press of America.

Stone, K. (2009). Vocational mentoring program for youth [Grant proposal]. Retrieved from

University of New Haven. (2010, January 12). Breaking the cycle of juvenile crime: UNH study shows mediation effective in reducing juvenile recidivism. Retrieved from

U. S. Department of Labor, Employment and Training Administration. (2012, April 4). ETA grants. Retrieved from

Financial Statements:

What to Use, When to Use It

Accounting in health care is very important in order to understand the economic health of the organization. Without understanding the financial status of the organization, directionality of growth and prosperity is certainly in question; however, with financial statements as a guide, one can make informed and logical decisions to develop a strategic plan to direct organizational growth in a fiscally responsible nature.

Ittelson (2009) and Penner (2004) outline the various financial statements and how they are used. I will review three financial statements (the balance sheet, the income statement, and the cash flow statement) and the means to use the values on these statements to provide meaning, through the use of ratio analysis, of the fiscal health of the organization.

Financial Statements

Balance Sheet

The balance sheet is one of two main organizational financial statements. Ittelson (2009) outlines the balance sheet as showing assets = liabilities + worth, in that the value of an organization’s assets (or, what an organization has) is the sum of the organization’s liabilities (or, what is owed) and worth (or, the value of the organization to the owners).

Assets are usually listed on the balance sheet in order of liquidity and include everything valuable within an organization, including cash, accounts receivable, any inventory (included at depreciated value, if applicable), expenses that were prepaid, and any other intangibles that offer intrinsic value to the organization (Ittelson, 2009; Penner, 2004).

Liabilities, according to Ittelson (2009), are listed on the balance sheet as groupings of term (short- and long-term) and include current liabilities (accounts payable, expenses, portions of contracted debt currently payable, and taxes), long-term debt (or, contracted debt payable outside of the bounds of the current statement), and shareholder equity (or, the sum of capital stock value and the amount of retained earnings). The shareholder equity is also the worth of the organization.

By definition, the balance sheet must be balanced in the end with the value of the assets being the total liabilities and equities offset by the shareholder equity. The balance sheet, with this comparison, provides the fixed financial picture of the organization at any particular date.

Income Statement

The income statement, which describes an organization’s profitability, is the other main financial statement of an organization (Ittelson, 2009). The income statement details the value of inputs and expenses required to develop a specific income for a defined period of time; however, according to Ittelson (2009), it does not provide timing on payments or an assessment of how much cash the organization has on hand.

The income statement accounts for the gross margin (net sales vs. cost of goods sold), operating expenses (e.g. sales and marketing, research and development, and general and administrative expenses), interest income, and income taxes to derive net income (Ittelson, 2009; Penner, 2004).

As the organization’s net income increases, reflections of increased assets or decreased liabilities will be seen on the balance sheet. Likewise, this link will also show the reverse to be true as decreased assets or increased liabilities (Ittelson, 2009).

Cash Flow Statement

The cash flow statement, as noted by Ittelson (2009) and Penner (2004), simply describes the movement, or flow, of cash within the organization. Starting with the amount of cash on hand at the beginning of the reporting period, the cash flow statement tracks how cash is paid and received, such as cash receipts and disbursements, purchases of fixed assets, money borrowed, stock sales, and taxes paid, ending with the amount of cash on hand at the end of the reporting period. However, this statement does not account for receiving inventory or delivering finished products to customers as these would account for non-cash transactions. Only when the organization pays for the inventory or the customer pays for the product would it affect the cash flow statement.

According to Ittelson (2009), the cash flow statement describes the velocity of cash, exclusively, within an organization, and accounts for a portion of the organization’s assets as well as some new liabilities (such as a new mortgage or loan) and old liabilities (debt being paid).

Ratio Analysis

Although the financial statements described above describe the general financial health of an organization, the relationships of particular items within those reports can provide more specific indicators of financial condition (Ittelson, 2009; Penner, 2004). The use of these relationships is called ratio analysis.

Ratio analysis can help to determine factors, such as profitability, liquidity, asset management, and leverage. Ratio analysis can also help to compare various organizations among various industries by using a statement conversion to “common size” (Ittelson, 2009, p. 194), which represents items as percentages of the largest item on each statement.

Profitability, according to Ittelson (2009), is the ability of an organization to generate a return of profit on equity, sales, and assets. The gross margin, as a percentage, is also a profitability ratio analysis.

Liquidity, as opposed to the measure of returning a profit, is a measure of an organization’s ability to maintain a financial cushion and show financial strength.

Asset management ratios are measures of the efficient or inefficient use of assets and the time generally taken from using inputs to receiving payment. According to Ittelson (2009), “asset management ratios provide a tool to investigate how effective in generating profits the [organization’s] investment in accounts receivables, inventory [sic] and fixed assets is” (p. 198).

Leverage, much like liquidity, is a safety measure that describes the organization’s ability to absorb loss and meet obligations. The leverage safety cushion is also referred by Ittleson (2009) as the “equity cushion” (p. 202). Too much leverage is risky, but too little leverage decreases the ability to maximize profit and growth. Leverage is the use of other people’s money to augment the owner’s investment in order to maximize profits.


By using strict accounting guidelines and keeping accurate records, financial statements can be prepared that will provide insight into the financial health of an organization. These statements can help to compare the financial status of the organization at different times or to compare the organization with other organizations. Also, accurate financial statements will help to draw investors, secure lending opportunities, and comply with legal requirements.


Ittelson, T. R. (2009). Financial statements: A step-by-step guide to understanding and creating financial reports (Revised and expanded ed.). Pompton Plains, NJ: Career Press.

Penner, S. J. (2004). Introduction to health care economics & financial management: fundamental concepts with practical applications. Philadelphia, PA: Lippincott Williams & Wilkins.

Budget Forecasting Models

Forecasting, according to Menifield (2009), is an important component of budget preparation and analysis. Using the Putnam police department (Putnam, CT) as an example, I will show how forecasting can benefit the budget process.

The Putnam police department is a small local department that relies heavily on public support. In order to forecast the economic condition that provide insight to the budgetary needs of the department, I would normally suggest using simple time-series forecast model. Due to the wavering economy over the last few years, however, I would start to consider using a multiple regression model that could take into account decreases in property taxes, real inflation, and the poor business environment for many of the small businesses that contribute a sizable portion of the tax base (Spencer, 2009). Menifield (2009) suggests that many localities can get by using the simpler, non-multivariate analysis, though as I point out, economic trends should be considered, lately.

The Putnam police department has annual purchases very typical of other similar sized departments and the single capital program (for the K-9 division) is being paid for by grants and donations. It is these donations that promote the need for additional fiscal responsibility; the public may be less willing in the future to offset major purchases through donations if property taxes rise significantly.


Menifield, C. E. (2009). The basics of public budgeting and financial management: a handbook for academics and practitioners. Lanham, MD: University Press of America.

Spencer, M. (2009, January 5). Current economic situation vs. the Great Depression: Striking comparisons with the current economic situation to the Great Depression. Retrieved from

Government Budgets

Every line item of a government budget must be an expenditure necessary to achieving the goals of the organization (Menifield, 2009). The governmental budgetary process provides transparency to the economic demands of the organization allowing for oversight by the people directly and by committees of elected officials dedicated to fiscal responsibility. It is this fiscal responsibility that ensures government spending is controlled and necessary for the purposes of government.

As Menifield (2009) points out, there are four dominant areas of concern, typically, when addressing governmental impact: political, tax, demographic, and administrative. Within each of these areas of concerns, aspects of efficiency, effectiveness, and equity must be addressed. While political concerns are more about the soundness of the overall plan, other concerns are more focused on specific aspects of the plan, such as who will be impacted and how

The budget process is the government’s means of allocating funds to departments within its jurisdiction in order to perform efficiently and effectively. The transparency of this process allows the people to offer criticism and promote their values and views on the process. This is important to ensure that people understand the necessity of each expenditure.

Though there are few people that pay attention to every aspect of the budget process, there are programs, usually expensive ones, that empassion people towards action in the way of participation in the process. Politicians should envision and anticipate many of the questions and concerns that the public might have for any program that they are seeking to funding. By being prepared, politicians will serve their constituency well by allaying fears and providing information.


Menifield, C. E. (2009). The basics of public budgeting and financial management: A handbook for academics and practitioners. Lanham, MD: University Press of America.