Painless cost control as a central strategy for universal oral health coverage: A critical review with policy guide.

AIM: This study aimed to critically review the methods used to control the significantly increasing costs of dental care. METHODS: Through a comprehensive search of the available literature, the cost control (CC) mechanisms for health services were identified from a healthcare system perspective. The probable applicability of each CC method was evaluated mainly based on its potential contribution to oral health promotion. Each mechanism was then classified and discussed under any of the two headings of financing and service provision. An operational guide was finally presented for policy-making in each of the three main models of healthcare systems, including National Health Services, social/public health insurance and private insurance. RESULTS: From a total of 142 articles/reports retrieved in PubMed, 73 in Scopus and 791 in Google Scholar, 35 were included in the final review after eliminating the duplicates and screening process. Totally ten mechanisms were identified for CC of dental care. Seven were discussed under the financing function, including cost sharing, preauthorization, mixed payment method and an evidence-based approach to benefit package definition, among others. Three further methods were classified under the service provision function, including workforce skill mix with emphasis on primary oral healthcare providers, development of primary healthcare (PHC) network and an appropriate use of tele-dentistry. CONCLUSION: Painless control of dental expenditures requires a smart integration of prevention into the CC plans. The suggested policy guide emphasizes organizational factors; particularly including the development of PHC-based networks with midlevel providers (desirably extended-duty dental hygienists) as the frontline oral healthcare providers.

Predicting construction cost under uncertainty using grey-fuzzy earned value analysis.

Insufficient emphasis on planning and control is one of the major causes of several delayed and cost-overrun construction projects. To improve such performances, many studies have been conducted on project control techniques such as Earned Value Analysis (EVA) and its modifications: fuzzy EVA and grey EVA. Since there is no analytical model integrating fuzzy theory and grey theory simultaneously with EVA, this research aimed at predicting construction cost under uncertainty using grey-fuzzy EVA. Consequently, simple and valid project cost control grey-fuzzy EVA algorithms were developed to ensure continuous project cost performance improvement in the presence of imprecise data. In addition, an analysis result interpretation scheme was presented. Grey-fuzzy EVA was compared with fuzzy EVA and grey EVA to check its validity. Then, a case study of a road project in Addis Ababa, Ethiopia, was presented to demonstrate the application of grey-fuzzy EVA. This research contributes determinations of the lower limit, median, and upper limit of predicted costs and degree of greyness using grey-fuzzy EVA, which simplifies cost analysis, requires only a small number of data points (BAC, PV, AC, and Progress), needs no experts to create a membership function, and is comprehensible for practitioners as compared to fuzzy EVA and grey EVA used separately.

Cost awareness among intensivists in their daily clinical practice: a prospective multicentre study.

BACKGROUND: Better cost-awareness is a prerogative in achieving the best benefit/risk/cost ratio in the care. We aimed to assess the cost-awareness of intensivists in their daily clinical practice and to identify factors associated with accurate estimate of cost (50-150% of the real cost). METHODS: We performed a prospective observational study in seven French ICUs. We compared the estimate of intensivists of the daily costs of caring with the real costs on a given day. The estimates covered five categories (drugs, laboratory tests, imaging modalities, medical devices, and waste) whose sum represented the overall cost. RESULTS: Of the 234 estimates made by 65 intensivists, 70 (29.9%) were accurate. The median overall cost estimate (€330 [170; 620]) was significantly higher than the real cost (€178 [124; 239], p < 0.001). This overestimation was found in four categories, in particular for waste (€40 [15; 100] vs. €1.1 [0.6; 2.3], p < 0.001). Only the laboratory tests were underestimated (€65 [30; 120] vs. €106 [79; 138], p < 0.001). Being aware of the financial impact of prescriptions was factor associated with accurate estimate (OR: 5.05, 95%CI:1.47-17.4, p = 0.01). However, feeling able to accurately perform estimation was factor negatively associated with accurate estimate (OR: 0.11, 95%CI: 0.02-0.71, p = 0.02). CONCLUSION: French intensivists have a poor awareness of costs in their daily clinical practice. Raising awareness of the financial impact of prescriptions, and of the cost of laboratory tests and waste are the main areas for improvement that could help achieve the objective of the best care at the best cost.

Finite-time guarantee-cost H∞ consensus control of second-order multi-agent systems based on sampled-data event-triggered mechanisms.

This study presents a solution to the challenges of tracking consensus and guarantee-cost H∞ control in a specific set of second-order multi-agent systems with external disturbances. A proposed event-triggered control method based on periodic sampling data is presented for second-order multi-agent systems that include external disturbances. In contrast to the real-time monitoring of system state information used in the previous event-triggered mechanism, this approach collects system state information through periodic sampling. This ensures that the interval between two consecutive triggering moments is at least one sampling cycle, thereby preventing the controller from triggering infinitely within a finite time frame. A finite-time controller based on the sampled-data event-triggered mechanism is designed, and sufficient conditions to ensure the finite-time stability of the closed-loop system at a specified attenuation level are established using theoretical methods such as matrix analysis. For the given sampled-data event-triggered control protocol with a finite-time controller, a quadratic guarantee-cost function is introduced, and by designing control inputs and determining the parameters such as the finite-time upper bound T∗ and the H∞ performance index γ , the exact value of the upper bound of the system's guarantee-cost function under the action of the designed controller is derived. Finally, the feasibility of the proposed control scheme is verified through numerical simulation.

Peripherally Inserted Central Catheter Versus Centrally Inserted Central Catheter for In-Hospital Infusion Therapy: A Cost-Effectiveness Analysis.

OBJECTIVES: To evaluate the comparative effectiveness and cost-effectiveness of peripherally inserted central catheters (PICCs) compared with centrally inserted central catheters (CICCs). METHODS: Prospective cohort study was followed by an economic analysis over a 30-day time horizon. Propensity score matching was used to select hospitalized adults with similar indications for PICC or CICC. The composite outcome was device removal or replacement because of complications before the end of treatment. The economic evaluation was based on a decision tree model for cost-effectiveness analysis, with calculation of the incremental cost-effectiveness ratio (ICER) per catheter removal avoided. All costs are presented in Brazilian reais (BRL) (1 BRL = 0.1870 US dollar). RESULTS: A total of 217 patients were followed in each group; 172 (79.3%) of those receiving a PICC and 135 (62.2%) of those receiving a CICC had no device-related complication, respectively. When comparing the events leading to device removal, the risk of composite endpoint was significantly higher in the CICC group (hazard ratio 0.20; 95% CI 0.11-0.35). The cost of PICC placement was BRL 1290.98 versus BRL 467.16 for a CICC. In the base case, the ICER for placing a PICC instead of a CICC was BRL 3349.91 per removal or replacement avoided. On univariate sensitivity analyses, the model proved to be robust within an ICER range of 2500.00 to 4800.00 BRL. CONCLUSIONS: PICC placement was associated with a lower risk of complications than CICC placement. Although the cost of a PICC is higher, its use avoided complications and need for catheter replacement before the end of treatment.

Carbon reduction and cost control of container shipping in response to the European Union Emission Trading System.

In response to the EU ETS, we propose a cost model considering carbon emissions for container shipping, calculating fuel consumption, carbon emissions, EUA cost, and total cost of container shipping. We take a container ship operating on a route from the Far East to Northwest Europe as a case study. Environmental and economic impacts of including maritime transport activities in the EU ETS on container shipping are assessed. Results show that carbon emissions from the selected container ship using methanol are the smallest, and total cost of the selected container ship using methanol is the lowest. Among MGO, HFO, LNG, and methanol, methanol is the most environmentally and cost-effective option. Using LNG has greater environmental benefit, while using HFO has greater economic benefit. Compared to MGO, carbon reduction effects of LNG and methanol are 14.2% and 57.1%, and their cost control effects are 7.8% and 26.5%. Compared to HFO, carbon reduction effects of LNG and methanol are 11.7% and 55.8%, and the cost control effect of methanol is 9.3%. Speed reduction is effective in achieving carbon reduction and cost control of container shipping only when the sailing speed of the selected container ship is greater than 8.36 knots. Once the sailing speed is less than this threshold, speed reduction will increase carbon emissions and total cost of container shipping. This model can assess the environmental and economic impacts of including maritime transport activities in the EU ETS on container shipping and explore the measures to achieve carbon reduction and cost control of container shipping in response to the EU ETS.

Adaptive guaranteed cost control for nonlinear systems with unknown parameters and time delays based on fully actuated system approaches.

This paper investigates the adaptive guaranteed cost stabilization (AGCS) problems for two classes of high-order nonlinear systems with unknown parameters (vector) and time delays. Firstly, based on the high-order fully actuated (HOFA) system approaches, the Lyapunov-Krasovskii functional (LKF) and the guaranteed cost control (GCC), a new AGCS strategy is proposed for HOFA nonlinear system with unknown parameter vector and time delays. Then, based on the above result, another AGCS controller for a class of strict-feedback systems (SFSs) with unknown parameters and time delays is obtained. Two designed controllers ensure that all of the states of two closed-loop systems are global boundedness, and preset arbitrarily the upper bound of cost functions (UBCFs) characterizing the output performance. More importantly, the UBCFs are independent of system initial values, unknown parameters (vector), and even time delays, which is difficult to achieve by using existing control methods. To do this, this paper introduces a local smooth nonlinear function (LSNF), and gives its corresponding lemma, which provide an important mathematical tool. Finally, three simulation examples, including an application in the electromechanical system, are given to prove the effectiveness and the practicability of our proposed control method.

Guaranteed cost control via dynamic output feedback for networked interval type-2 T-S fuzzy system with hybrid communication mechanism.

This paper aims to investigate the guaranteed cost control via dynamic output feedback for nonlinear networked control systems (NCSs) with consideration of hybrid communication mechanism, data dropout and bounded disturbance. Interval type-2 (IT2) Takagi-Sugeno (T-S) fuzzy model is utilized to describe the nonlinear system with parameter uncertainties. To enhance bandwidth utilization and improve control performance, a hybrid communication mechanism involving both event-triggered mechanism (ETM) and time-triggered mechanism (TTM) is proposed. Two Bernoulli processes are invoked to describe the switching between two triggering mechanisms, and the data dropout phenomenon in communication network, respectively. The quadratic boundedness (QB) technique is employed to specify the closed-loop stability of a bounded disturbance networked system. The sufficient conditions for the stability of the system and the presence of a dynamic output feedback guaranteed cost controller are presented. In addition, the problem of controller design is converted to a convex optimization problem that can be tackled by linear matrix inequalities (LMIs) technique. At last, simulation experiment is carried out to explicate the availability and usefulness of the designed controller.

Non-fragile guaranteed cost control of microbial fuel cells.

A microbial fuel cell (MFC), which is a new type of energy source, utilises electrogenic bacteria in sewage or soil to convert chemical energy into electrical energy. MFCs typically require an external controller to provide a stable output voltage to the external load. This study develops a non-fragile guaranteed cost (NFGC) controller to suppress the interference of the controller of an MFC and ensure that the quadratic cost function of the system satisfies certain performance indexes. First, for the convenience of controller design, a Takagi-Sugeno fuzzy model is established to approximate a single-chamber single-population MFC model. Subsequently, the linear matrix inequality method is used to design the NFGC controller. This control scheme can reduce the influence of controller disturbances on the system and ensure asymptotic stability of the closed-loop system under the specified upper bound of the provided cost function. The simulation results demonstrate that the developed control method has a shorter adjustment time and smaller steady-state error than traditional control methods such as sliding mode control (SMC), backstepping control, and fuzzy SMC.

Impacto del Aseguramiento en Salud en la Economía de los Hogares Peruanos, 2010-2019

Objetivo : Determinar el impacto del aseguramiento en salud en la economía de los hogares peruanos en el periodo 2010-2019. Materiales y Métodos : Estudio analítico transversal, que utilizó la base de datos de la Encuesta Nacional de Hogares de los años 2010, 2014 y 2019 para analizar el impacto del aseguramiento en salud en términos de gasto de bolsillo en salud, gasto catastrófico y empobrecimiento de los hogares peruanos, así como determinar qué otros factores se encuentran asociados. Resultados : Durante el periodo de estudio se observó que los hogares peruanos presentaron una disminución del gasto de bolsillo en salud promedio mensual (S/.119,9 en 2010 a S/.107,9 en 2019), así como del porcentaje de hogares con gasto catastrófico en salud (4,06 % en 2010 a 3,47 % en 2019) y del porcentaje de hogares que empobrecen por gastos de bolsillo en salud (1,78 % en 2010 a 1,51 % en 2019). Los factores asociados al gasto catastrófico en salud y al empobrecimiento fueron el menor nivel de escolaridad del jefe del hogar, la presencia de miembros con enfermedad crónica y el área de residencia rural. La ausencia de aseguramiento en salud se asoció significativamente a un mayor riesgo de gasto de bolsillo en salud catastrófico, mas no al empobrecimiento. Conclusiones : El aumento de la cobertura de aseguramiento en salud contribuye a la protección financiera de los hogares peruanos frente al gasto de bolsillo en salud; sin embargo, las barreras para el acceso efectivo a los servicios de salud y otros factores socioeconómicos pueden limitar significativamente su impacto.

Objective : To determine the impact of health insurance in the economy of Peruvian households during the 2010-2019 period. Material and Methods : This is a cross-sectional analytical study that used the database of the National Peruvian Household Surveys from years 2010, 2014, and 2019, aiming to analyze the impact of health insurance in terms of pocket money spending for health issues, catastrophic healthcare spending, and impoverishment in Peruvian households, and also to determine the presence of other associated factors. Results : During the study period, it was observed that Peruvian households reduced their monthly average pocket money spending for health issues (119.9 PEN in 2010 and 107.9 PEN in 2029), as well as the percentage of household with catastrophic healthcare expenses (4.06% in 2010 to 3.47% in 2019), and the percentage of households who became impoverished because of pocket money expenses for health issues (1.78% in 2020 to 1.51% in 2019). Factors associated to catastrophic healthcare expenses and to impoverishment were lower educational level for the household leader, the presence of family members with chronic diseases, and living in a rural area. The absence of health insurance was significantly associated to a greater risk for catastrophic healthcare expenses, but not to impoverishment. Conclusions : Increased healthcare insurance coverage contributes to financial protection of Peruvian households against pocket money spending for health issues; however, barriers for effective access to healthcare services, and other socioeconomical factors may significantly limit this impact.

An innovative tool for cost control under fragmented scenarios: The container freight index microinsurance.

With the impact of the COVID-19 pandemic, global container freights have increased dramatically since the second half of 2020, which has significantly hampered the booking activities of fragmented transportation space for small and medium-sized import and export enterprises (SMIEEs). To provide SMIEEs with an effective tool for controlling shipping costs, we propose the design principles of index microinsurance under fragmented scenarios and design the container freight index microinsurance (CFIM) based on a comprehensive analysis of the term, compensation and share structures. We further establish the pricing model for the CFIM and selection procedure for product optimization, and illustrate the framework with a case study based on the data of the China Containerized Freight Index Europe Service, which demonstrates the good performance of the designed product even under extreme market conditions. The design principles proposed can shed light on the innovation of index microinsurance product that meets fragmented needs and the newly designed CFIM, along with the pricing and optimization procedure, provides practitioners with useful tools for cost control.

Approximation to the Consumption of Healthcare Resources and the Economic Cost of SARS-CoV-2 Patient Management: A Retrospective Study.

Spain has become one of the countries most affected by coronavirus disease 2019 (COVID-19), with the highest testing rates, and one of the worst-performing countries in the fight against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. There are no studies related to the consumption of health resources and the economic cost of the SARS-CoV-2 virus. We present a retrospective analysis of 9,811 (Primary Care and Hospital) patients which aimed to estimate public health expenditure by the consumption of health resources due to COVID-19. According to the results, the gender distribution of patients has a similar rate in both groups, with slightly higher rates in women. Similarly, age is the same in both groups, with a median of 62 years in the case of hospitalizations and 61 years in the case of primary care; using a weighted average of these rates and costs, we can estimate that the average cost of care per patient infected with the SARS-CoV-2 virus, regardless of the course is €2373.24. We conclude that a patient with COVID-19 without hospitalization costs €729.79, while the expenses of a hospitalized patient are between €4294.36 and €14440.68, if there is ICU admission.

Precision medicine and the fragmentation of solidarity (and justice).

Solidarity is a fundamental social value in many European countries, though its precise practical and theoretical meaning is disputed. In a health care context, I agree with European writers who take solidarity normatively to mean roughly equal access to effective health care for all. That is, solidarity includes a sense of justice. Given that, I will argue that precision medicine represents a potential weakening of solidarity, albeit not a unique weakening. Precision medicine includes 150 targeted cancer therapies (mostly for metastatic cancer), all of which are extraordinarily expensive. Our critical question: Must a commitment to solidarity as defined mean that all these targeted cancer therapies should be guaranteed to all within each country in the European Union, no matter the cost, no matter the degree of effectiveness? Such a commitment would imply that cancer was ethically special, rightfully commandeering unlimited resources. That in itself would undermine solidarity. I offer multiple examples of how current and future dissemination of these targeted cancer drugs threaten a commitment to solidarity. An alternative is to fund more cancer prevention efforts. However, that too proves a threat to solidarity. Solidarity, with or without a sense of justice, is too abstract a notion to address these challenges. Further, we need to accept that we can only hope to achieve "rough justice" and "supple solidarity." The precise practical meaning of these notions needs to be worked out through a fair and inclusive process of rational democratic deliberation, which is the real and practical foundation of just solidarity.

Research on the influence of payment methods on the control of medical insurance expenses-Based on empirical analysis of double difference.

Background: The medical insurance system is constantly reformed and optimized. In order to control the cost of medical insurance funds, the medical insurance payment method has been reformed. The reform of the payment method can effectively control the medical insurance expenses. Method: In this paper, the annual data of 27 provinces from 2013 to 2017 were selected, and the cost control effect of the dual difference (DID) model of medical insurance payment method was analyzed. Results: The study found that the effect of the pilot reform of medical insurance payment mode was in line with the policy objectives and achieved the effect of cost control to a certain extent. Conclusion: The failure to significantly reduce the growth rate of the expenditure of medical insurance funds is not ideal to curb the excessive growth of health insurance funds. Therefore, strengthening the control of medical expenses, improving the control of medical insurance fund fees through the reform of payment methods are the effective ways to strengthen the control of medical insurance funds.

LMI-Based Delayed Output Feedback Controller Design for a Class of Fractional-Order Neutral-Type Delay Systems Using Guaranteed Cost Control Approach.

In this research work, we deal with the stabilization of uncertain fractional-order neutral systems with delayed input. To tackle this problem, the guaranteed cost control method is considered. The purpose is to design a proportional-differential output feedback controller to obtain a satisfactory performance. The stability of the overall system is described in terms of matrix inequalities, and the corresponding analysis is performed in the perspective of Lyapunov's theory. Two application examples verify the analytic findings.

Do indicators for the proportion of pharmaceutical spending alleviate the burden of medical expenditure? Evidence from provincial panel-data in China, 2010-2019.

BACKGROUND: The current study aims to empirically evaluate the direct relationship between the proportion of pharmaceutical spending and total medical expenditure in China in a recent decade period. METHODS: A two-way fixed-effect model was established to estimate the relationship between the proportion of pharmaceutical spending and total medical expenditure using the balanced panel data for thirty provincial-level administrative regions in mainland China from 2010 to 2019. RESULTS: The proportion of pharmaceutical spending was significantly positively related to inpatient and outpatient expenditure, with coefficients of 0.30 (p = 0.014) and 0.58 (p = 0.002), respectively. This positive correlation was not significant in the eastern regions, likely due to the unexpected supply-side coping behaviors brought about by the compulsory control of the proportion of pharmaceutical spending. We investigated the improvement of service efficiency could significantly alleviate the burden of medical expenses. CONCLUSION: Our research provided empirical evidence for the necessity of using the proportion of pharmaceutical spending as a cost control indicator and showed the factors that may affect the amount of medical expenditure, emphasizing the significance of improving the efficiency of resource utilization to compensate for the unintended behaviors and effects caused by single index assessment.

German Pharmaceutical Pricing: Lessons for the United States.

To control pharmaceutical spending and improve access, the United States could adopt strategies similar to those introduced in Germany by the 2011 German Pharmaceutical Market Reorganization Act. In Germany, manufacturers sell new drugs immediately upon receiving marketing approval. During the first year, the German Federal Joint Committee assesses new drugs to determine their added medical benefit. It assigns them a score indicating their added benefit. New drugs comparable to drugs in a reference price group are assigned to that group and receive the same reimbursement, unless they are therapeutically superior. The National Association of Statutory Health Insurance Funds then negotiates with manufacturers the maximum reimbursement starting the 13th month, consistent with the drug's added benefit assessment and price caps in other European countries. In the absence of agreement, an arbitration board sets the price. Manufacturers accept the price resolution or exit the market. Thereafter, prices generally are not increased, even for inflation. US public and private insurers control prices in diverse ways, but typically obtain discounts by designating certain drugs as preferred and by restricting patient access or charging high copayment for nonpreferred drugs. This article draws 10 lessons for drug pricing reform in US federal programs and private insurance.

Average direct costs of outpatient, hospital, and home care provided to patients with chronic wounds / Costos directos promedios de la atención ambulatoria, hospitalaria y domiciliaria prestada a pacientes con heridas crónicas / Custos diretos médios da assistência ambulatorial, hospitalar e domiciliar prestada aos pacientes com feridas crônicas

ABSTRACT Objective: To analyze the average direct costs of outpatient, hospital, and home care provided to patients with chronic wounds. Method: Quantitative, exploratory-descriptive case study, carried out in a Comprehensive Wound Care Unit. Costs were obtained by multiplying the time spent by professionals by the unit cost of labor in the respective category, adding to the costs of materials and topical therapies. Results: Outpatient care costs corresponded to US$4.25 (SD ± 7.60), hospital care to US$3.87 (SD ± 17.27), and home care to US$3.47 (SD ± 5.73). In these three modalities, direct costs with dressings and medical consultations were the most representative: US$7.76 (SD ± 9.46) and US$6.61 (SD ± 6.54); US$7.06 (SD ± 24.16) and US$15.60 (SD ± 0.00); US$4.09 (SD ± 5.28) and US$15.60 (SD ± 0.00), respectively. Conclusion: Considering comprehensive care for patients with chronic wounds, the mean total direct cost was US$10.28 (SD ± 17.21), with the outpatient modality being the most representative in its composition. There was a statistically significant difference (p value = 0.000) between the costs of home and outpatient, home and hospital, and outpatient and hospital care.

RESUMEN Objetivo: Analizar los costos directos promedios de la atención ambulatoria, hospitalaria y domiciliaria prestada a pacientes con heridas crónicas. Método: Investigación cuantitativa, exploratoria-descriptiva, del tipo estudio de caso, realizada en una Unidad de Atención Integral de Heridas. Los costos se obtuvieron al multiplicar el tiempo dedicado por los profesionales por el costo unitario de la mano de obra en la respectiva categoría, sumado a los costos de materiales y terapias tópicas. Resultados: Los costos de atención ambulatoria correspondieron a US$ 4,25 (DE ± 7,60), hospitalaria a US$ 3,87 (DE ± 17,27) y atención domiciliaria a US$ 3,47 (DE ± 5,73). En estas tres modalidades, los costos directos con apósitos y consultas médicas fueron los más representativos: US$7,76 (DE ± 9,46) y US$6,61 (DE ± 6,54); US$7,06 (DE ± 24,16) y US$15,60 (DE ± 0,00); US$4,09 (DE ± 5,28) y US$15,60 (DE ± 0,00), respectivamente. Conclusión: Considerando la atención integral a pacientes con heridas crónicas, el costo directo promedio total fue de US$ 10,28 (DE ± 17,21), siendo la modalidad ambulatoria la más representativa en su composición. Hubo una diferencia estadísticamente significativa (p-valor = 0,000) entre los costos de atención domiciliaria y ambulatoria; domiciliaria y hospitalaria y, por fin, ambulatoria y hospitalaria.

RESUMO Objetivo: Analisar os custos diretos médios da assistência ambulatorial, hospitalar e domiciliar prestada aos pacientes com feridas crônicas. Método: Pesquisa quantitativa, exploratório-descritiva, do tipo estudo de caso, realizada numa Unidade de Tratamento Integral de Ferida. Obtiveram-se os custos multiplicando-se o tempo despendido pelos profissionais pelo custo unitário da mão de obra da respectiva categoria, somando-se aos custos dos materiais e terapias tópicas. Resultados: Os custos da assistência ambulatorial corresponderam a US$4,25 (DP ± 7,60), da hospitalar a US$3,87 (DP ± 17,27) e da domiciliar a US$3,47 (DP ± 5,73). Nessas três modalidades, os custos diretos com os curativos e consultas médicas foram os mais representativos: US$7,76 (DP ± 9,46) e US$6,61 (DP ± 6,54); US$7,06 (DP ± 24,16) e US$15,60 (DP ± 0,00); US$4,09 (DP ± 5,28) e US$15,60 (DP ± 0,00), respectivamente. Conclusão Considerando a assistência integral aos pacientes com feridas crônicas, o custo direto médio total foi de US$10,28 (DP ± 17,21), sendo a modalidade ambulatorial a mais representativa na sua composição. Constatou-se diferença estatística significante (valor p = 0,000) entre os custos da assistência domiciliar e ambulatorial, domiciliar e hospitalar e ambulatorial e hospitalar.

[Sustainable Development Goals: impact of lack of financial protection in health in Latin American and Caribbean countriesObjetivos de Desenvolvimento Sustentável: impacto da falta de proteção financeira em saúde nos países da América Latina e do Caribe]. / Objetivos de Desarrollo Sostenible: impacto de la falta de protección financiera en salud en países de América Latina y el Caribe.

OBJECTIVE: To determine the impact of household out-of-pocket health spending, financial protection levels, and their inequality according to relevant variables in the countries of the Region; to investigate their evolution and relationship with health system services utilization. METHODS: Comparative descriptive information was compiled on out-of-pocket spending, its incidence in the population, and its weight and contribution to household consumption. Financial protection indicators for the national level and their distribution by quintiles of total household consumption and by gender are presented, and compared to an indicator of service coverage. RESULTS: Out-of-pocket spending and financial protection indicators are deficient but demonstrate differences among countries. The composition of health expenditure is identified for a subset of countries and significant gradients are seen when inequalities are studied. Changes over time and possible associations with service coverage levels are shown for several cases. DISCUSSION: Lack of financial protection affects a large part of the population. Additionally, there are groups of countries with greater difficulties than others, where a preponderance of spending is on medicines, and there is greater exposure of groups in conditions of vulnerability, such as the poorest and women, indicating great inequity. Policies of some countries that can be associated with improvement in financial protection are identified. To replace out-of-pocket spending, which is a barrier to access, countries need to increase public spending by financing health systems undergoing transformation toward universal health.

OBJETIVO: Determinar o impacto dos gastos diretos em saúde nas famílias, os níveis de proteção financeira e sua desigualdade, de acordo com variáveis relevantes nos países da Região; investigar sua evolução e sua relação com a utilização dos serviços do sistema de saúde. MÉTODOS: Foram coletadas informações descritivas comparativas sobre gastos diretos em saúde, sua incidência na população e seu peso e composição no consumo familiar. Os indicadores de proteção financeira são apresentados em nível nacional, estratificados por quintis de consumo total das famílias e por gênero, e são comparados com um indicador de cobertura de serviço. RESULTADOS: Os indicadores de gastos diretos e proteção financeira são limitados, mas demonstram diferenças entre os países. Foi possível identificar a composição dos gastos com saúde para um subgrupo deles, observando-se gradientes significativos quando as desigualdades são estudadas. Em alguns casos, observam-se também mudanças ao longo do tempo e possíveis associações com os níveis de cobertura de serviço. DISCUSSÃO: A falta de proteção financeira atinge grande parte da população. Foram observados grupos de países com mais dificuldades do que outros, com preponderância de gastos com medicamentos e maior exposição de grupos em situação de vulnerabilidade, como os mais pobres e as mulheres, o que denota alto nível de iniquidade. Em alguns países foram identificadas políticas que podem estar associadas à evolução da proteção financeira. Para substituir os gastos diretos, que constituem uma barreira ao acesso, os países precisam aumentar o gasto público, financiando os sistemas de saúde numa transformação rumo à saúde universal.

A real world cost-minimization analysis comparing the use of different endoscopic staplers in video-assisted thoracic surgery lobectomy procedures.

Aim: China's cost-containment measures increasingly focus solely on the prices of consumable medical supplies without taking a broader perspective on differences in features and overall costs. This study compared two types of endoscopic staplers in video-assisted thoracoscopic surgery (VATS) lobectomy. Materials & methods: Electronic medical records for video-assisted thoracoscopic surgery from 2016 to 2017 were collected from a hospital in Anhui province. Two cohorts were retroactively defined based on stapler type. Total costs were compared using a cost-minimization analysis model. Probabilistic sensitivity analysis was performed. Results: In the base case, the group using more expensive staplers achieved overall cost savings of about $300 per procedure. Sensitivity analysis confirmed this result in 86.5% of cases. Conclusion: A price-only supply selection strategy may have unintended cost consequences.