The aim of this work was to carry out a cost evaluation of the home care programme for terminally ill cancer patients run by the Istituto Oncologico Romagnolo (I.O.R.) in the areas of Forlì, Cesena, Ravenna and Rimini (Romagna, Italy). To determine effective home care direct costs, we first selected 1 week of care as an observation unit. We then proceeded to assess the medical and nursing care units together with the clinical protocols administered for each patient. The Karnofsky Performance Status (KPS) was also assessed weekly. In this way, we calculated care costs for each patient and for each week as the sum of medical costs, nursing costs, treatment costs and other costs. A consecutive series of 574 patients were involved in the study from 1 April 1994 to 31 March 1995. A total of 5164 patient-weeks of care was provided, with an average cost per week of 177.6 Ecu. This weekly cost increased in the last 100 days of life (week -15 = 179.5 Ecu; week -8 = 188.3 Ecu; week -2 = 221.0 Ecu; P < 0.001). When single components were analysed in relation to total cost (treatment protocols, physician and nursing care) the increased global cost was found to be mainly attributable to the intensification in nursing care (21.8% of costs in week -15 vs 27.3% of costs in week -2). Examination of the relation between the cost of 1 week of care and KPS values clearly shows that healthcare costs increased as KPS decreased (from 152.2 Ecu with KPS > or = 60 to 292.6 Ecu with KPS < or = 20; P < 0.001). Home care costs were also seen to vary with some clinical characteristics and symptoms present when patients entered the study: asthenia, anorexia, nausea/vomiting, bedsores. Given the good results of home care for cancer patients in terms of quality of life, this method of cost accounting for home-care providers can help to monitor the rising cost of assistance and confirm the cost effectiveness of this type of care.
This research investigates what happens to sustainability disclosure in the light of an industrial disaster. Drawing from legitimacy theory, the disaster is treated as a moment of crisis, in which the relationship of trust between the company and its stakeholders suffers and has to be reconstructed to legitimise the company's operations once more. While past studies revealed an increase in corporate disclosure after a disaster, the authors' results highlight a different behaviour. The analysis focuses on six companies involved in industrial disasters with a global media coverage, before and after the event. The sample includes, among others, Tepco for the leakage of nuclear material from the Fukushima power plant and Carnival Cruise Corporation in relation to the sinking of the Costa Concordia. Findings obtained using text mining techniques suggest that there is a tendency to reduce the quantity of information provided in the year of the disaster, which represents a precise managerial strategy aiming to avoid further drops in corporate legitimacy.
The generaTion and re-generaTion of soCial CapiTal and enTerprises in mulTi-sTakeholders soCial CooperaTive enTerprises: a sysTem dynamiC approaCh
Abstract:Social Enterprise is increasingly becoming a pressing area of study in European faculties, and likewise, a broad range of literature has been produced on the various, relating arguments.One of the aspects least focused upon, however, regards the issue of governance; which is a fundamental aspect when defining a type of governing system that could lead to an improvement in the efficiency and effectiveness of social enterprises. The need to combine both social and economic aims in the decision making process also emphasizes the importance of stakeholder participation.Furthermore, seeing as how social enterprises work in an environment of high public involvement, whether it be with public entities or with the community as a whole, issues such as business administration and activity supervision, come to be of high importance. The production of social utility goods and/or services is directed toward a plurality of local actors, which are to be furthermore guaranteed a high level of accountability and transparency. This paper explores governance through an in-depth analysis and comparison of the legislation of eleven countries on social enterprise or social cooperatives
Direct mental health costs are concentrated among a small fraction of patients who receive intensive socio-rehabilitation in community services. One limitation includes the unavailability of hospital costs. Our methodology is replicable and useful for national and cross-national benchmarking.
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