Master-Arbeit Univ. St. Gallen, 2006.

The Affordable Care Act (ACA) was passed by Congress in 2010 as a health policy initiative to improve the effectiveness of the United States healthcare system. Policies and regulations under the ACA include provisions to improve the quality and cost-effectiveness of medical services which has resulted in a transition of payment systems from fee-for-service (FFS) reimbursement models to value-based reimbursement (VBR) models. Policies under the ACA also encouraged the formation of affordable care organizations (ACOs) which endorse new models of healthcare delivery, specifically team-based care models, to increase the efficiency, quality and accessibility of medical care while at the same time controlling costs. Although physician assistants (PAs) have been a proposed method for addressing the growing demand for high quality, cost-effective healthcare, research that explores the economic value and financial impact of physician assistants is limited. Currently, productivity metrics are used to determine the economic value of physicians and PAs. Current methods of measuring productivity include volume-based metrics and claim based data. Although these methods may be sufficient for measuring physician productivity, they fail to account for PA practices. Current productivity metrics also fail to account for a vast majority of PA productivity due to current billing policies that do not capture all services provided by PAs. In this study, we will explore the financial impact associated with the addition of PAs to ten different physician-owned family medicine practices by measuring the percent increase in net annual practice revenue one year after the employment of a PA. Net practice revenue is defined as the total revenue generated per provider per year minus overhead costs associated with provider employment.

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FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / The economic values for traits of a meet sheep production system were calculated using Morada Nova hair sheep, raised under the conditions of native pasture in the Brazilian semi-arid region, as model. These economic weights were estimated using the equation of profit, profit = revenue â costs, after increase by one unit and 1% for each trait, evaluated on the average of the others. Whereas 1% increase in the trait, the economic values for lambing percentage (LP), litter size (LS), lambs mortality (LM), yearling mortality (YM), ewes and rams mortality (AM), female slaughter weight (FSW), male slaughter weight (MSW), ewe adult weight (EAW), ram adult weight (RW), carcass yield (CY), number of lambings per year (NLY), age at first lambing (AFL) and number of anthelminthic doses used per year (AC) were 1,439, 1,439, -0,254, -0,110, -0,054, 0,487, 0,767, -0,172, 0,005, 1,523, 1,439, -0,258 and -0,025, respectively, expressed in Brazilian currency (R$) per ewe per year. The traits that showed greater economic importance were CY, NLY, LP and LS. The traits that showed lower economic values were: RW, AC and AM. The production system with Morada Nova sheep grazing native âcaatingaâ pasture in Brazilian Northeast, exclusively for meat production, is profitable when taking into account all costs of production, including that of family labour. Carcass yield was shown to be an important selection objective. As it is expressed when the animal is slaughtered, further studies need to be carried out with this population to aid in the choice of appropriate selection criteria for the improvement of this trait. / Os valores econÃmicos para caracterÃsticas de produÃÃo de carne de ovinos foram calculados considerando-se como modelo o sistema de produÃÃo com a raÃa Morada Nova, criada sob as condiÃÃes de pastagem nativa do semi-Ãrido brasileiro. Os ponderadores econÃmicos foram estimados utilizando a equaÃÃo de lucro, lucro = receita - custos, para aumento de uma unidade e de 1 % em cada caracterÃstica, avaliada no valor mÃdio das demais. Com o aumento de 1% nas caracterÃsticas (R$ por ovelha ano) os valores econÃmicos para fertilidade ao parto (FP), prolificidade (PRO), mortalidade de cordeiros (MC), mortalidade de borregos (MB), mortalidade de ovelhas e carneiros (MA), peso de fÃmeas ao abate (PAF), peso de machos ao abate (PAM), peso maduro das matrizes (PM), peso dos reprodutores (PR), nÃmero de partos/ano (NPA), idade ao primeiro parto (IPP), rendimento de carcaÃa (RC) e nÃmero de tratamentos parasitÃrios/ano (TP) foram 1,439, 1,439, -0,254, -0,110, -0,054, 0,487, 0,767, -0,172, 0,005, 1,523, 1,439, -0,258 e -0,025, respectivamente. As caracterÃsticas que apresentaram maior importÃncia econÃmica foram RC, NPA, FP e PRO. As caracterÃsticas que apresentaram menor peso econÃmico foram: PR, TP e MA. O sistema de produÃÃo com ovinos Morados Nova em pastagem nativa (caatinga) no Nordeste brasileiro, exclusivamente para a produÃÃo de carne, à rentÃvel quando se toma em conta todos os custos de produÃÃo, incluindo o de mÃo de obra familiar. O rendimento de carcaÃa foi mostrado a ser um objetivo importante seleÃÃo. Como ela se expressa quando o animal for abatido, estudos adicionais necessitam de ser realizadas com esta populaÃÃo para ajudar na escolha adequada de critÃrios de seleÃÃo para a melhoria desta caracterÃstica.