Technical efficiency of blood component preparation in blood centres of 10 European countries

Various reasons, such as ethical issues in maintaining blood resources, growing costs, and strict requirements for safe blood, have increased the pressure for efficient use of resources in blood banking. The competence of blood establishments can be characterized by their ability to predict the volume of blood collection to be able to provide cellular blood components in a timely manner as dictated by hospital demand. The stochastically varying clinical need for platelets (PLTs) sets a specific challenge for balancing supply with requests. Labour has been proven a primary cost-driver and should be managed efficiently. International comparisons of blood banking could recognize inefficiencies and allow reallocation of resources. Seventeen blood centres from 10 countries in continental Europe, Great Britain, and Scandinavia participated in this study. The centres were national institutes (5), parts of the local Red Cross organisation (5), or integrated into university hospitals (7). This study focused on the departments of blood component preparation of the centres. The data were obtained retrospectively by computerized questionnaires completed via Internet for the years 2000-2002. The data were used in four original articles (numbered I through IV) that form the basis of this thesis. Non-parametric data envelopment analysis (DEA, II-IV) was applied to evaluate and compare the relative efficiency of blood component preparation. Several models were created using different input and output combinations. The focus of comparisons was on the technical efficiency (II-III) and the labour efficiency (I, IV). An empirical cost model was tested to evaluate the cost efficiency (IV). Purchasing power parities (PPP, IV) were used to adjust the costs of the working hours and to make the costs comparable among countries. The total annual number of whole blood (WB) collections varied from 8,880 to 290,352 in the centres (I). Significant variation was also observed in the annual volume of produced red blood cells (RBCs) and PLTs. The annual number of PLTs produced by any method varied from 2,788 to 104,622 units. In 2002, 73% of all PLTs were produced by the buffy coat (BC) method, 23% by aphaeresis and 4% by the platelet-rich plasma (PRP) method. The annual discard rate of PLTs varied from 3.9% to 31%. The mean discard rate (13%) remained in the same range throughout the study period and demonstrated similar levels and variation in 2003-2004 according to a specific follow-up question (14%, range 3.8%-24%). The annual PLT discard rates were, to some extent, associated with production volumes. The mean RBC discard rate was 4.5% (range 0.2%-7.7%). Technical efficiency showed marked variation (median 60%, range 41%-100%) among the centres (II). Compared to the efficient departments, the inefficient departments used excess labour resources (and probably) production equipment to produce RBCs and PLTs. Technical efficiency tended to be higher when the (theoretical) proportion of lost WB collections (total RBC+PLT loss) from all collections was low (III). The labour efficiency varied remarkably, from 25% to 100% (median 47%) when working hours were the only input (IV). Using the estimated total costs as the input (cost efficiency) revealed an even greater variation (13%-100%) and overall lower efficiency level compared to labour only as the input. In cost efficiency only, the savings potential (observed inefficiency) was more than 50% in 10 departments, whereas labour and cost savings potentials were both more than 50% in six departments. The association between department size and efficiency (scale efficiency) could not be verified statistically in the small sample. In conclusion, international evaluation of the technical efficiency in component preparation departments revealed remarkable variation. A suboptimal combination of manpower and production output levels was the major cause of inefficiency, and the efficiency did not directly relate to production volume. Evaluation of the reasons for discarding components may offer a novel approach to study efficiency. DEA was proven applicable in analyses including various factors as inputs and outputs. This study suggests that analytical models can be developed to serve as indicators of technical efficiency and promote improvements in the management of limited resources. The work also demonstrates the importance of integrating efficiency analysis into international comparisons of blood banking.

Spam – Spim – Spit. En marknadsrättslig undersökning av marknadsföring via nya kommunikationstekniker

I boken behandlas nya kommunikationstekniker och olika marknadsföringsmetoder som har uppkommit till följd av den tekniska utvecklingen. Marknadsföring via de nya kommunikationskanalerna har givit upphov till vissa olägenheter för mottagarna. Olägenheterna som mottagarna förorsakas vid marknadsföring via de nya teknikerna kan delas in i tre kategorier; 1) meddelandet förorsakar kostnader för mottagaren, 2) meddelandet hindrar mottagaren samt 3) meddelandet upplevs vara påträngande och utgöra ett intrång i mottagarens privatliv. Under de senaste åren har det förekommit hektiska lagstiftningsåtgärder på många håll i världen. Såväl enskilda stater, nationella myndigheter samt internationella organisationer har utarbetat regler om marknadsföring via de nya teknikerna. En av kärnfrågorna i regleringen är huruvida man skall ha ett system med ”opt-in” eller ”opt-out”. En opt-in-lösning innebär att marknadsföraren måste inhämta mottagarens samtycke på förhand, medan en opt-out-lösning innebär att det är tillåtet att sända marknadsföring om inte mottagaren motsatt sig detta. Enligt gällande lagstiftning faller marknadsföring via följande tre tekniker under opt-in: automatiserade uppringningssystem, telefax samt e-post. Det huvudsakliga syftet med avhandlingen är att utreda om nuvarande opt-in-lista är tillräckligt omfattande med beaktande av de olägenheter som marknadsföring via de nya teknikerna förorsakar, eller om den bör utvidgas. I genomgången av marknadsföring via nya tekniker har marknadsföring via bl.a. följande tekniker undersökts: Internet (www-sidor), reklamfönster, reklambanner, e-post, mobiltelefon, telefax, bloggar, RSS, Instant Messaging samt Internettelefoni. Vid sidan av nya tekniker har även vissa ”traditionella” marknadsföringsmetoder undersökts, i syfte att utreda huruvida även de bör falla in under en opt-in-lösning. De traditionella marknadsföringsmetoder som ingår i avhandlingen är hemförsäljning, telemarketing, TV- och radioreklam samt adresserad och oadresserad direktreklam. En annan central del i avhandlingen är frågan hur påföljdssystemet vid överträdelser av opt-in-bestämmelserna bör utformas. Hur skall de enskilda mottagarna få ersättning för de kostnader de åsamkats av marknadsföringen? Är det dags att införa straffskadestånd i Finland? Hög tid att även Finland får grupptalan? Kan tvisterna avgöras virtuellt via domstolar on-line eller ODR?