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1.
Niger Postgrad Med J ; 27(2): 108-114, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32295941

RESUMO

Background: Although out-of-pocket (OOP) payment for health services is common, information on the experience in maternal health services especially caesarean delivery (CD) is limited. Aim: To compare the pregnancy events and financial transactions for CD among OOP and health-insured clients. Materials and Methods: A comparative (retrospective) study of 200 women who had CD as OOP (100 participants) or health-insured clients (100 participants) over 30 months at Anchormed Hospital, Ilorin, using multistage sampling was conducted. The data were analysed using Chi-square, t-test and regression analysis; P < 0.05 was considered statistically significant. Results: Of 1246 deliveries, 410 (32.9%) had CD; of these, 186 (45.4%) were health-insured and 224 (54.6%) were OOP payers. The health-insured were mostly civil servants (60.0% vs. 40.0%; P = 0.009) of high social class (48.0% vs. 29.0%; P = 0.001). The payment for CD was higher among OOP (P = 0.001), whereas duration from hospital discharge to payment of hospital bill was higher for the health-insured (P = 0.001). On regression, social class (odds ratio [OR]: 0.23, 95% confidence interval [CI]: -0.0891252-0.112799; P = 0.048), amount paid (OR: 48.52, 95% CI: -7.14-6.68; P = 0.001) and duration from discharge to payment (OR: 28.68, 95% CI: 51.7816-70.788; P = 0.001) were statistically significant among participants. The amount paid was lower (P = 0.001), whereas time interval before payment was longer (P = 0.001) for the public-insured compared to private-insured clients. Conclusion: OOP payers are prone to catastrophic spending on health. The waiting time before reimbursement to health-care providers was significantly prolonged; private insurers offered earlier and higher reimbursement compared to public insurers. The referral and transportation of health-insured clients during emergencies is suboptimal and deserve attention.


Assuntos
Cesárea/economia , Honorários e Preços/estatística & dados numéricos , Gastos em Saúde , Seguro Saúde , Adulto , Feminino , Humanos , Nigéria , Gravidez , Estudos Retrospectivos , Adulto Jovem
3.
Value Health ; 23(3): 300-308, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32197725

RESUMO

OBJECTIVES: The reduction and removal of user fees for essential care services have recently become a key instrument to advance universal health coverage in sub-Saharan Africa, but no evidence exists on its cost-effectiveness. We aimed to address this gap by estimating the cost-effectiveness of 2 user-fee exemption interventions in Burkina Faso between 2007 and 2015: the national 80% user-fee reduction policy for delivery care services and the user-fee removal pilot (ie, the complete [100%] user-fee removal for delivery care) in the Sahel region. METHODS: We built a single decision tree to evaluate the cost-effectiveness of the 2 study interventions and the baseline. The decision tree was populated with an own impact evaluation and the best available epidemiological evidence. RESULTS: Relative to the baseline, both the national 80% user-fee reduction policy and the user-fee removal pilot are highly cost-effective, with incremental cost-effectiveness ratios of $210.22 and $252.51 per disability-adjusted life-year averted, respectively. Relative to the national 80% user-fee reduction policy, the user-fee removal pilot entails an incremental cost-effectiveness ratio of $309.74 per disability-adjusted life-year averted. CONCLUSIONS: Our study suggests that it is worthwhile for Burkina Faso to move from an 80% reduction to the complete removal of user fees for delivery care. Local analyses should be done to identify whether it is worthwhile to implement user-fee exemptions in other sub-Saharan African countries.


Assuntos
Parto Obstétrico/economia , Honorários e Preços , Custos de Cuidados de Saúde , Gastos em Saúde , Acesso aos Serviços de Saúde/economia , Serviços de Saúde Materna/economia , Burkina Faso , Redução de Custos , Análise Custo-Benefício , Feminino , Humanos , Modelos Econômicos , Formulação de Políticas , Gravidez
4.
Am Surg ; 86(2): 140-145, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167057

RESUMO

Perception of physician reimbursement for surgical procedures is not well studied. The few existing studies illustrate that patients believe compensation to be higher than in reality. These studies focus on patient perceptions and have not assessed health-care workers' views. Our study examined health-care workers' perception of reimbursement for complex surgical oncology procedures. An anonymous online survey was distributed to employees at our cancer center with descriptions and illustrations of three oncology procedures-hepatectomy, gastrectomy, and pancreaticoduodenectomy. Participants estimated the Medicare fee and gave their perceived value of each procedure. Participants recorded their perception of surgeon compensation overall, both before and after revealing the Medicare fee schedule. Most of the 113 participants were physicians (33.6%) and nurses (28.3%). When blinded to the Medicare fee schedules, most felt that reimbursements were too low for all procedures (60-64%) and that surgeons were overall undercompensated (57%). Value predictions for each procedure were discordant from actual Medicare fee schedules, with overestimates up to 374 per cent. After revealing the Medicare fee schedules, 55 per cent of respondents felt that surgeons were undercompensated. Even among health-care workers, a large discrepancy exists between perceived and actual reimbursement. Revealing actual reimbursements did not alter perception on overall surgeon compensation.


Assuntos
Gastrectomia/economia , Pessoal de Saúde/psicologia , Hepatectomia/economia , Reembolso de Seguro de Saúde/economia , Medicare/economia , Pancreaticoduodenectomia/economia , Institutos de Câncer , Honorários e Preços , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Corpo Clínico/economia , Corpo Clínico/estatística & dados numéricos , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem/economia , Recursos Humanos de Enfermagem/estatística & dados numéricos , Estados Unidos
9.
Gen Dent ; 68(1): 56-60, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31859664

RESUMO

The purpose of this retrospective, observational study was to characterize the amounts and types of healthcare industry payments made to dental care providers in 2017. Data were collected from the Open Payments database of the US Centers for Medicare & Medicaid Services. Dentists were classified as providing general services or services in 1 of 9 specialties recognized by the American Dental Association (prior to the recognition of dental anesthesiology). The value and nature of each payment made to providers were recorded, and descriptive statistics were calculated. Distributions across dental specialties were compared with analyses of variance. In 2017, US dentists received a total of 321,627 industry payments totaling $110,750,601. The most money was spent on service fees ($37,333,870; 33.7%), followed by consulting fees ($12,983,013; 11.7%) and royalties and licenses ($11,426,776; 10.3%). Each provider received a median payment of $63.27 (range, $0.21-$22,931,027.12) spread over 2 payments (range, 1-285). Participation rates among dental specialists ranged from 19% to 62%, and the highest rates were found among orthodontists (61.8%), oral and maxillofacial surgeons (55.7%), and periodontists (54.6%). The greatest median payments per provider were made to specialists in oral and maxillofacial radiology ($187.52), periodontics ($127.31), and oral and maxillofacial surgery ($123.39). The mean number (P < 0.01) and amount of payments (P < 0.01) per provider differed significantly across all specialties. The majority of dentists in this study received less than $200; however, the distribution of payments was positively skewed by a few top earners. The effect of these payments on clinical practice remains to be determined.


Assuntos
Centers for Medicare and Medicaid Services, U.S. , Conflito de Interesses , Economia em Odontologia , Indústrias/economia , Idoso , Centers for Medicare and Medicaid Services, U.S./estatística & dados numéricos , Odontologia , Honorários e Preços , Setor de Assistência à Saúde , Humanos , Indústrias/ética , Medicare , Padrões de Prática Médica/economia , Estudos Retrospectivos , Estados Unidos
10.
BMC Health Serv Res ; 19(1): 928, 2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31796039

RESUMO

BACKGROUND: Telemedicine is the use of telecommunication technology to remotely provide healthcare services. Evaluation of telemedicine use often relies on administrative data, but the validity of identifying telemedicine encounters in administrative data is not known. The objective of this study was to assess the accuracy of billing codes for identifying telemedicine use. METHODS: In this retrospective study of encounters within a large integrated health system from January 2016 to December 2017, we examined the accuracy of billing codes for identifying live-interactive and store-and-forward telemedicine encounters compared to manual chart review. To further examine external validity, we applied these codes and assessed patient and visit characteristics for identified live-interactive telemedicine encounters and store-and-forward telemedicine encounters in a second data set. RESULTS: In manual review of 390 encounters, 75 encounters were live-interactive telemedicine and 158 were store-and-forward telemedicine. In weighted analysis, the presence of the GT modifier in the absence of the GQ modifier or CPT code 99444 yielded 100% sensitivity and 99.99% specificity for identification of live-interactive telemedicine encounters. The presence of either the GQ modifier or the CPT code 99444 had 100% sensitivity and 100% specificity for identification of store-and-forward telemedicine encounters. Applying these algorithms to a second data set (n = 5,917,555) identified telemedicine encounters with expected patient and visit characteristics. CONCLUSIONS: These findings provide support for use of CPT codes to perform telemedicine research in administrative data, aiding ongoing work to understand the role of non-face-to-face care in optimizing health care delivery.


Assuntos
Algoritmos , Current Procedural Terminology , Prestação Integrada de Cuidados de Saúde/economia , Telemedicina/estatística & dados numéricos , Honorários e Preços , Serviços de Saúde/economia , Humanos , Estudos Retrospectivos , Sensibilidade e Especificidade , Telemedicina/classificação , Telemedicina/economia
11.
Inquiry ; 56: 46958019894093, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31845597

RESUMO

Based on a large amount of data, the study aimed to analyze all expenses of outpatients in a southern China city from 2013 to 2015. It draws a conclusion that the total cost of outpatient has increased in the past 3 years, and various cost indexes either increased or decreased in different ways. Drug costs and treatment fees are the main influencing factors for the change in total outpatient cost. The structural change from 2013 to 2015 was 70.15%. Drug costs, laboratory fees, and inspection fees are the main indexes that account for the increasing total outpatient costs. This study puts emphasis on the cost of human resources, which eliminates the phenomenon of "Yi Yao Yang Yi" (support medical cost with medicine) and "Yi Xie Yang Yi" (support medical cost with medical device). This study also focuses on the balance of outpatient cost, as well as the compensation function of medical insurance, which encourages multiple participation and coordinated adjustment.


Assuntos
Assistência Ambulatorial/economia , Técnicas de Laboratório Clínico/economia , Custos de Medicamentos/tendências , Programas Nacionais de Saúde/economia , Assistência Ambulatorial/tendências , China , Técnicas de Laboratório Clínico/tendências , Honorários e Preços , Feminino , Custos de Cuidados de Saúde/tendências , Humanos , Masculino , Programas Nacionais de Saúde/tendências , Pacientes Ambulatoriais
12.
Aust J Rural Health ; 27(6): 514-519, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31713303

RESUMO

OBJECTIVE: To assess temporal trends in service provision by Accredited Exercise Physiologists based on remoteness classification using Australian Bureau of Statistics remoteness classifications of Major Cities, Inner Regional, Outer Regional, Remote and Very Remote. DESIGN AND PARTICIPANTS: Cross-sectional analysis of publicly available Medicare Benefits Schedule datasets, for Medicare item number 10953 from 2012-2013 to 2016-2017. MAIN OUTCOME MEASURE(S): Number of claims, benefits paid, fees charges and number of providers for Medicare item number 10953. RESULTS: Accredited Exercise Physiologist service delivery demonstrates growth across all areas of remoteness classification. Rebates and fees mirror service delivery trends. The rate of service growth was significantly greater in Major Cities compared with all other remoteness classifications. Provider numbers show a steady increase from 2012-2013 to 2016-2017 but number remains higher in Major Cities compared with all other remoteness locations. CONCLUSION: Given the high proportion of chronic and complex illness in rural and remote areas, and the limited access to allied health care services, we propose more needs to be done to position Accredited Exercise Physiologists in these regions of increasing need. These findings have implications for future development of the Accredited Exercise Physiologist profession.


Assuntos
Terapia por Exercício/economia , Terapia por Exercício/tendências , Serviços de Saúde Rural , Austrália , Estudos Transversais , Bases de Dados Factuais , Honorários e Preços/estatística & dados numéricos , Acesso aos Serviços de Saúde , Humanos , Cobertura do Seguro/economia , Seguro Saúde
13.
Tech Vasc Interv Radiol ; 22(3): 162-164, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31623757

RESUMO

A sound understanding of billing and coding is essential to start a successful interventional radiology endoscopy practice. While the codes utilized are similar to gastrointestinal and genitourinary endoscopy codes, physicians and institutional coders need to be familiar with the codes used for these types of procedures in the interventional radiology setting. The following manuscript gives a brief overview of aspects relating to credentialing, billing, and coding in interventional radiology endoscopy.


Assuntos
Credenciamento , Current Procedural Terminology , Endoscopia , Honorários e Preços , Custos de Cuidados de Saúde , Radiografia Intervencionista , Mecanismo de Reembolso , Competência Clínica , Credenciamento/normas , Endoscopia/classificação , Endoscopia/economia , Endoscopia/normas , Honorários e Preços/normas , Custos de Cuidados de Saúde/normas , Humanos , Radiografia Intervencionista/classificação , Radiografia Intervencionista/economia , Radiografia Intervencionista/normas , Mecanismo de Reembolso/economia , Mecanismo de Reembolso/normas
14.
PLoS One ; 14(9): e0222904, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31568536

RESUMO

PURPOSE: In 2013, the American Society for Radiation Oncology (ASTRO) issued a Choosing Wisely recommendation against the routine use of intensity modulated radiotherapy (IMRT) for whole breast irradiation. We evaluated IMRT use and subsequent impact on Medicare expenditure in the period immediately preceding this recommendation to provide a baseline measure of IMRT use and associated cost consequences. METHODS AND MATERIALS: SEER records for women ≥66 years with first primary diagnosis of Stage I/II breast cancer (2008-2011) were linked with Medicare claims (2007-2012). Eligibility criteria included lumpectomy within 6 months of diagnosis and radiotherapy within 6 months of lumpectomy. We evaluated IMRT versus conventional radiotherapy (cRT) use overall and by SEER registry (12 sites). We used generalized estimating equations logit models to explore adjusted odds ratios (OR) for associations between clinical, sociodemographic, and health services characteristics and IMRT use. Mean costs were calculated from Medicare allowable costs in the year after diagnosis. RESULTS: Among 13,037 women, mean age was 74.4, 50.5% had left-sided breast cancer, and 19.8% received IMRT. IMRT use varied from 0% to 52% across SEER registries. In multivariable analysis, left-sided breast cancer (OR 1.75), living in a big metropolitan area (OR 2.39), living in a census tract with ≤$90,000 median income (OR 1.75), neutral or favorable local coverage determination (OR 3.86, 1.72, respectively), and free-standing treatment facility (OR 3.49) were associated with receipt of IMRT (p<0.001). Mean expenditure in the year after diagnosis was $8,499 greater (p<0.001) among women receiving IMRT versus cRT. CONCLUSION: We found highly variable use of IMRT and higher expenditure in the year after diagnosis among women treated with IMRT (vs. cRT) with early-stage breast cancer and Medicare insurance. Our findings suggest a considerable opportunity to reduce treatment variation and cost of care while improving alignment between practice and clinical guidelines.


Assuntos
Neoplasias da Mama/economia , Honorários e Preços/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Mastectomia Segmentar/economia , Radioterapia de Intensidade Modulada/economia , Neoplasias Unilaterais da Mama/economia , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Neoplasias da Mama/terapia , Feminino , Humanos , Mastectomia Segmentar/métodos , Medicare/economia , Estadiamento de Neoplasias , Guias de Prática Clínica como Assunto , Radioterapia de Intensidade Modulada/métodos , Programa de SEER , Neoplasias Unilaterais da Mama/patologia , Neoplasias Unilaterais da Mama/cirurgia , Neoplasias Unilaterais da Mama/terapia , Estados Unidos
15.
Mar Pollut Bull ; 149: 110561, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31542600

RESUMO

This study investigates conditions under which differentiating port fees based on vessels' environmental performance could be an additional driver for cruise-ship owners to invest in green technologies. Our case study on liquefied natural gas (LNG) as fuel for a cruise ship shows that port-based incentives could help reduce emissions to air and drive uptake of green technologies. Assuming an average rebate of EUR 1500 per port visit, the accumulated rebates globally for our case study ship exceed EUR 400,000 per year. Applying a rebate of nearly EUR 4800 per visit as currently offered in Norwegian ports, and assuming 50% of ports globally adopt the scheme, gives a cost benefit of EUR 700,000 per year, reducing the LNG technology payback time up to one year. Our case study also shows that significantly reducing ship emissions in ports will bring social benefits through reduced risks of loss of life, health and wellbeing.


Assuntos
Conservação dos Recursos Naturais/economia , Conservação dos Recursos Naturais/métodos , Honorários e Preços/classificação , Navios/economia , Poluição do Ar/análise , Poluição do Ar/prevenção & controle , Análise Custo-Benefício , Gás Natural/análise , Emissões de Veículos/análise , Emissões de Veículos/prevenção & controle
16.
Int J Nurs Pract ; 25(6): e12782, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31512357

RESUMO

AIM: The aim of this study was to estimate the economic value of a family education and counselling service provided by critical care advanced practice nurses in South Korea utilizing a contingent valuation approach. METHODS: A double-bounded dichotomous choice contingent valuation method was utilized to estimate the public's willingness to pay value for an education and counselling service provided by critical care advanced practice nurses. A web-based self-administered survey was conducted. RESULTS: Median willingness to pay was 43 112 Korean won (35 US dollars). Higher income and younger age were associated with higher willingness to pay. CONCLUSION: This study captured the economic value of an education and counselling service provided by critical care advanced practice nurses that is not on the benefit list under the fee-for-service system of the Korean National Health System. Policy makers should consider including such services in the health care system.


Assuntos
Prática Avançada de Enfermagem , Aconselhamento/economia , Enfermagem de Cuidados Críticos , Honorários e Preços , Educação em Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Idoso , Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Inquéritos e Questionários , Adulto Jovem
17.
Spine (Phila Pa 1976) ; 44(16): 1162-1169, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31374001

RESUMO

STUDY DESIGN: A systematic review. OBJECTIVE: The aim of this study was to determine the association between study outcomes and the presence of a conflict of interest (COI) in the lumbar disc arthroplasty (LDA) literature. SUMMARY OF BACKGROUND DATA: Previous studies have evaluated the efficacy of LDA as a surgical alternative to arthrodesis. As investigators may have financial relationships with LDA device companies, it is important to consider the role of COI on study outcomes. METHODS: A systematic review was performed to identify articles reporting clinical outcomes of LDA. Any financial COIs disclosed were recorded and confirmed through Open Payments and ProPublica databases. Study outcomes were graded as favorable, unfavorable, or equivocal. Pearson Chi-squared analysis was used to determine an association between COI and study outcomes. Favorable outcomes were tested for an association with study characteristics using Poisson regression with robust error variance. RESULTS: Fifty-seven articles were included, 30 had a financial COI, while 27 did not. Ninety percent of the conflicted studies disclosed their COI in the article. Studies with United States authors were more likely to be conflicted (P = 0.019). A majority of studies reported favorable outcomes for LDA (n = 39). Conflicted studies were more likely to report favorable outcomes than nonconflicted studies (P = 0.020). Articles with COIs related to consultant fees (P = 0.003), research funding (P = 0.002), and stock ownership (P < 0.001) were more likely to report favorable outcomes. CONCLUSION: This study highlights the importance for authors to accurately report conflicting relationships with industry. As such, orthopedic surgeons should critically evaluate study outcomes with regard to potential conflicts before recommending LDA as a surgical option to their patients. LEVEL OF EVIDENCE: 3.


Assuntos
Artroplastia , Conflito de Interesses , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Bases de Dados Factuais , Revelação , Honorários e Preços , Humanos , Avaliação de Resultados em Cuidados de Saúde , Pesquisadores , Estados Unidos
19.
Proc Natl Acad Sci U S A ; 116(34): 16768-16772, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31387978

RESUMO

Citizenship can accelerate immigrant integration and result in benefits for both local communities and the foreign-born themselves. Yet the majority of naturalization-eligible immigrants in the United States do not apply for citizenship, and we lack systematic evidence on policies specifically designed to encourage take-up. In this study, we analyze the impact of the standardization of the fee-waiver process in 2010 by the US Citizenship and Immigration Service (USCIS). This reform allowed low-income immigrants eligible for citizenship to use a standardized form to have their application fee waived. We employ a difference-in-differences methodology, comparing naturalization behavior among eligible and ineligible immigrants before and after the policy change. We find that the fee-waiver reform increased the naturalization rate by 1.5 percentage points. This amounts to about 73,000 immigrants per year gaining citizenship who otherwise would not have applied. In contrast to previous research on the take-up of federal benefits programs, we find that the positive effect of the fee-waiver reform was concentrated among the subgroups of immigrants with lower incomes, language skills, and education levels, who typically face the steepest barriers to naturalization. Further evidence suggests that this pattern is driven by immigration service providers, who are well-positioned to help the most needy immigrants file their fee-waiver requests.


Assuntos
Emigrantes e Imigrantes , Honorários e Preços , Renda , Pobreza , Adolescente , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Adulto Jovem
20.
N Z Vet J ; 67(6): 306-314, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31319781

RESUMO

Aims: To describe the demographics of and predictors for pet ownership, reasons for visiting a veterinarian, and pet-related expenditure in pet owners in New Zealand. Methods: A cross-sectional online survey was conducted from 18-22 June 2015 using a permission-based panel of New Zealand residents aged ≥18 years. Questions included demographics of respondents, number of pets and reasons for owning or not owning pets, number of visits and reasons for visiting a veterinarian, and pet-related expenditure. Results: Of the 1,572 respondents who completed the survey, 1,013 (64.4%) owned ≥1 pet. Of these, 443 owned dogs, 696 cats, 32 horses, 103 birds, 55 rabbits, and 159 owned fish. Companionship was the most common reason for getting dogs, cats, and birds; horses were mostly owned as a hobby, rabbits to provide fun for children, and fish as a source of relaxation. The majority of dog, cat, and rabbit owners considered their pets to be family members; horse owners almost equally considered their horses a hobby or a family member. The odds of pet ownership increased for respondents from a rural region, having a higher household income, having children and being female. Overall, 711/1,013 (70.2%) pet-owning respondents had taken ≥1 animal to the veterinarian in the previous year, with the most common reasons being for vaccination or annual check-ups or health issues. Respondents who considered their pets trusted companions, had a higher income, and owned dogs or cats compared with other species, were most likely to have taken their pet to a veterinarian. The greatest pet-related expenditure for all species was food. The median yearly veterinary expenditure was $200-499 by dog owners, $100-199 by cat owners, and <$100 by horse, bird, rabbit, and fish owners. The best source of information for pet-related issues was considered to be veterinarians by 724/1,001 (72.3%) owners, and the internet by 509/1,001 (50.8%) owners. Conclusions: Among survey respondents, pet ownership was common and pets filled a variety of roles in the household. Pet owners reported spending considerable amounts of money on their pets each year, but some of them may be underutilising veterinary services despite veterinarians being considered as valuable sources of information about pet-related issues.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Propriedade , Animais de Estimação , Medicina Veterinária/economia , Bem-Estar do Animal , Animais , Custos e Análise de Custo , Estudos Transversais , Honorários e Preços , Humanos , Nova Zelândia , Médicos Veterinários , Medicina Veterinária/estatística & dados numéricos
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