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1.
Artículo en Inglés | MEDLINE | ID: mdl-33807846

RESUMEN

With increasing constraints on resources and the environment, it is of great practical importance to discover and utilize the induced effect of green technology through market-based tools, in order to simultaneously realize economic development and ecological sustainability. Based on unique patent data from 1999 to 2013, this paper examines the induced effect of China's increasing-block electricity pricing scheme (IBP) on energy-efficient patents and checks whether the effect is neutral or biased. Furthermore, the quality of the induced patents is identified. The results reveal that increased green innovation is strongly related to the IBP scheme. In addition, the induced effect is biased towards green technology such that, apart from autonomous technological advances, the biased effect of IBP induced two more energy-efficient patents per hundred technological patents. However, the quality of the induced innovation is relatively low: compared to high-quality inventions, low-quality utility models showed greater and more significant growth due to the IBP. Our paper provides quantitative insight into the impact of the IBP and indicates that a reasonable pricing scheme can benefit both the environment and the economy.


Asunto(s)
Desarrollo Económico , Invenciones , China , Costos y Análisis de Costo , Tecnología
2.
Artículo en Inglés | MEDLINE | ID: mdl-33808724

RESUMEN

BACKGROUND: The study aimed to analyze the burden and territorial diversification of adolescent suicide and the link between suicide attempts and selected socioeconomic variables in Poland. METHODS: Rates of suicide by voivodeships for years 1999-2019 were obtained from the General Police Headquarters of Poland database. The burden of premature death was expressed in years of life lost (YLL) and costs of lost productivity, which were estimated using the human capital approach. The link between suicide rates and socioeconomic determinants has been analyzed with Pearson's correlation coefficient. RESULTS: Over the analyzed period, an increase in suicide attempt rates and a decrease in suicide death rates have been observed. Mean YLL and costs of lost productivity per year amounted to 11,982 and 153,172,415 PLN, respectively. Territorial diversification in suicide attempt rates corresponds to the living condition, poverty, association-based capital, and satisfaction with family situation in individual voivodeships. The number of deaths due to suicide is negatively correlated with an indicator of good living conditions. CONCLUSIONS: Our findings provide quantitative evidence of the national impact of suicide and suggest that addressing social capital and poverty may have a role in preventing adolescent mortality due to suicide.


Asunto(s)
Eficiencia , Mortalidad Prematura , Adolescente , Costos y Análisis de Costo , Humanos , Polonia/epidemiología , Factores Socioeconómicos
3.
MMWR Morb Mortal Wkly Rep ; 70(16): 577-582, 2021 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-33886534

RESUMEN

Overexertion is a leading cause of work-related musculoskeletal disorders (WMSDs) among construction workers. Nearly 90% of construction jobs require manual handling of materials for approximately one half of the worker's time (1). In 2015, overexertion from lifting and lowering materials caused 30% of WMSDs among construction workers; overexertion involving pushing, pulling, holding, carrying, and catching materials caused an additional 37% of WMSDs (1). This study examined the rate and cost of WMSD claims from overexertion among Ohio construction workers during 2007-2017. Workers' compensation claims related to overexertion that were submitted to the Ohio Bureau of Worker's Compensation (OHBWC) by workers in the construction industry for injuries and illnesses occurring during 2007-2017 were analyzed. Rates and costs of allowed claims were measured by age group. Workers aged 35-44 years experienced the highest claim rate: 63 per 10,000 full-time employees (FTEs) for WMSDs from overexertion. However, claims by workers aged 45-54 years and 55-64 years were more costly on average and resulted in more days away from work. Ergonomic design improvements and interventions are needed to ensure that the majority of construction workers can safely perform jobs throughout their careers. Age-specific WMSD prevention and risk communication efforts also might be helpful.


Asunto(s)
Industria de la Construcción , Enfermedades Musculoesqueléticas/economía , Enfermedades Profesionales/economía , Traumatismos Ocupacionales/economía , Indemnización para Trabajadores/estadística & datos numéricos , Adolescente , Adulto , Costos y Análisis de Costo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/epidemiología , Enfermedades Profesionales/epidemiología , Traumatismos Ocupacionales/epidemiología , Ohio/epidemiología , Esfuerzo Físico , Adulto Joven
4.
Artículo en Inglés | MEDLINE | ID: mdl-33806044

RESUMEN

In reverse green supply chain, the mixed collection channel strategy of green remanufacturer is analyzed by building a dynamic game model in which we consider that the green remanufacturer undertakes the environmental responsibility and the green collector shows strong fairness concern for the profit. We analyze the impact of the environmental responsibility level of the green remanufacturer, the preference coefficient of the green remanufacturer, the fairness concern coefficient of the green collector, and the coefficient of cross collection price on optimal decision and profit of the green remanufacturer. The result shows that (1) the green remanufacturer can further improve the collection price, so that it makes many more customers participate in the collection activity; (2) the green remanufacturer pays more attention to fulfill the environmental responsibility, which will increase the intensity of collection of the waste green product, and improve the collection price, as the old green product's remanufacturing cost is lower than the production cost of the new product, and it can improve the green remanufacturer's profits; (3) the green remanufacturer's profit in the mixed collection channel is higher than those in online or offline collection channels.


Asunto(s)
Comercio , Reciclaje , Costos y Análisis de Costo , Toma de Decisiones
5.
Klin Lab Diagn ; 66(3): 187-192, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33793120

RESUMEN

The basis for calculating the cost price of any product, including laboratory tests, is based on an estimate of direct costs of the production. At present, there are no systematic ideas about the structure of such costs, and approaches to their analysis have not been defined, in the management practice of medical laboratories. The purpose of this work was developing and testing a method for analyzing the structure of direct costs and their allocation bases when calculating the cost of a laboratory test. We analyzed data on the volume of laboratory tests performed in the clinical diagnostic laboratory of the National Medical Research Center of Cardiology, prices for purchased reagents and consumables, depreciation and maintenance costs of equipment, staff salaries. As a result, we proposed a typical component structure of direct costs, established the allocation bases of fixed costs, and determined the ratio of some variable cost components to onе product unit cost. On the basis of these concepts, an algorithm for calculating the total direct laboratory (technological) cost per test has been developed, which makes it possible to simulate the cost structure under conditions of arbitrarily specified variables. During the testing of the algorithm, the values of direct costs and the technological cost per test were calculated for billable (ordered) laboratory tests. Comparison of the economic efficiency of various methods, as well as modeling of changes in the cost depending on the volume of testing and the turn-around time (TAT) has been performed. It can be concluded that the approach to creating the tables of the technological cost per test based on dividing direct costs into variable and fixed costs and structuring them by components and allocation bases is an effective tool for medical laboratory management.


Asunto(s)
Laboratorios , Costos y Análisis de Costo , Humanos
6.
An. Fac. Cienc. Méd. (Asunción) ; 54(1): 51-60, 20210000.
Artículo en Español | LILACS | ID: biblio-1178618

RESUMEN

Introducción: Actualmente el tabaquismo es una de las mayores amenazas para la salud pública a nivel mundial. La muerte atribuida al tabaco en Paraguay representa el 12,2% de todas las muertes y el costo de la enfermedad asociada al consumo de tabaco en el sistema de salud es elevado. Objetivos: El objetivo de este estudio es describir las características del consumo de tabaco en jóvenes en Paraguay. Materiales y métodos: Se realizó un estudio descriptivo transversal no probabilístico de muestreo estandarizado con representatividad nacional en estudiantes matriculados del 7° al 9° grado de la educación escolar básica, de 13 a 15 años de ambos sexos que incluyo a 6.518 estudiantes, correspondiente a 25 escuelas de la capital y 25 escuelas en el resto del país. Resultados: La prevalencia actual de consumo de productos de tabaco fue del 7%, fumadores actuales de 3,9% y fumadores de cigarrillos electrónicos de 3,7%. La prevalencia de fumadores de segunda mano fue más del 20% en todos los escenarios estudiados. Alto porcentaje de adolescentes con acceso fácil a la compra de cigarrillos sin verificación de la edad. Más del 50% con acceso a mensajes publicitarios sobre tabaco. Casi un 30% tenían conocimiento del efecto dañino del tabaco y más del 80% se manifiestan favorables a la prohibición de fumar en espacios cerrados y abiertos. Conclusión: Aunque la prevalencia de fumadores en adolescentes no es muy elevada, es un problema de salud pública creciente. Se requiere fortalecer las medidas de prevención y control.


Introduction: Currently, smoking is one of the greatest threats to public health worldwide. Death attributed to tobacco in Paraguay represents 12.2% of all deaths and the cost of the disease associated with tobacco consumption in the health system is high. Objectives: The objective of this study is to describe the characteristics of tobacco consumption in young people in Paraguay. Materials and methods: A non-probabilistic descriptive cross-sectional study of standardized sampling was carried out with national representativeness in students enrolled from 7th to 9th grade of basic school education, from 13 to 15 years old of both sexes that included 6,518 students, corresponding to 25 schools in the capital and 25 schools in the rest of the country. Results: The current prevalence of tobacco product use was 7%, current smokers 3.9%, and electronic cigarette smokers 3.7%. The prevalence of second-hand smokers was more than 20% in all the scenarios studied. High percentage of adolescents with easy access to the purchase of cigarettes without age verification. More than 50% with access to advertising messages about tobacco. Almost 30% were aware of the harmful effect of tobacco and more than 80% are in favor of the prohibition of smoking in closed and open spaces. Conclusion: Although the prevalence of smoking in adolescents is not very high, it is a growing public health problem. It is necessary to strengthen prevention and control measures.


Asunto(s)
Tabaco , Tabaquismo , Uso de Tabaco , Estudiantes , Enfermedad , Prevalencia , Costos y Análisis de Costo , Control
7.
Farm Hosp ; 45(2): 66-72, 2021 02 05.
Artículo en Inglés | MEDLINE | ID: mdl-33709888

RESUMEN

OBJECTIVE: The main purpose of this study was to analyze and compare three different medication delivery methods used by the outpatient care unit of a hospital pharmacy, namely health center collection, community pharmacy collection and home delivery. The secondary purpose was to compare the economic cost of those methods for the Spanish health service. METHOD: A failure mode and effects analysis was carried out to attain the primary objective. For the secondary objective, an in-depth analysis  was performed of the economic costs associated with each program using  a cost-minimization analysis. RESULTS: The failure mode and effects analysis resulted in scores of 184, 170 and 126 points for the health center collection, home delivery and community pharmacy collection programs, respectively. The economic evaluation, for its part, rendered estimated costs of €18,434.52, €11,417.08 and €7,986.52 for home delivery, health center collection and community pharmacy collection services, respectively. CONCLUSIONS: The results of the study indicated that collection at the community pharmacy was the program associated to the lowest risk, most likely due to the crucial role of the pharmacist regarding the custody and preservation of medicines. As regards cost, dispensation at the community pharmacy was also associated with the lowest cost. Nevertheless, this finding was biased by the fact that, given the generous collaboration of pharmaceutical distributors during the COVID-19 pandemic, the cost of transport and delivery to the pharmacy during the study period was zero. Further economic analyses are required to evaluate the costs of community pharmacy delivery and determine their impact on the public health system in cases where transport costs are different from zero.


Asunto(s)
Costos y Análisis de Costo , Análisis de Modo y Efecto de Fallas en la Atención de la Salud , Servicios Farmacéuticos/economía , Servicio de Farmacia en Hospital/economía , Análisis Costo-Beneficio , Humanos , España
8.
Artículo en Inglés | MEDLINE | ID: mdl-33673412

RESUMEN

The reduction in carbon emissions by industrial enterprises is an important means for promoting environmental protection and achieving sustainable development. To determine the impact of carbon emissions reduction on supply chain operation and financing decision-making, in this study we designed three financing strategies, i.e., bank loan financing, equity financing, and hybrid financing (a combination of bank loan financing and equity financing), for a manufacturer (leader) and a low-carbon supply chain composed of a capital-constrained retailer, constructed Stackelberg game models, solved the equilibrium results under each financing strategy using the reverse recursion method, and revealed the financing preference of the supply chain member companies through comparative analysis. The results showed that the increase in the consumers' low-carbon preference and equity financing ratio have positive impacts on supply chain equilibrium, a result that is opposite that for the impact of the interest rate of bank loan financing; additionally, the abovementioned three factors jointly determine the profit of the manufacturer of the low-carbon supply chain, while the retailer's profit is affected by the equity dividend ratio. Finally, we present the conditions for the financing preference of the manufacturer and the retailer. The findings of this study can provide references for low-carbon supply chain companies to make appropriate management decisions.


Asunto(s)
Carbono , Comercio , Financiación del Capital , Comportamiento del Consumidor , Costos y Análisis de Costo
9.
Food Chem ; 352: 129415, 2021 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-33711728

RESUMEN

Furazolidone (FZD) and its metabolite called 3-amino-2-oxazolidinone (AOZ) would induce carcinogenic and mutagenic effects to human. In this work, to develop a novel, stable, and simple point of care testing (POCT) with a potential to social applied for FZD detection, we utilized the aspect of protein staining of coomassie brilliant blue (CBB) to exploit a new CBB-LFIA strategy free of NPs. Only one mixing step is needed during the probe manufacturing process, which requires just 2 h and is a great time saving strategy compared with other methods (requiring 4-33 h for probe preparation). Besides, the cost of CBB-LFIA is 300 times lesser than other LFIA with respect to obtaining the label. The developed CBB-LFIA was successfully applied to detect AOZ with a detection limit of 2 ng mL-1, without any influence from other potential interfering compounds. The proposed CBB-LFIA exhibited prominent practical application, and possesses considerable utilization potential in the related field.


Asunto(s)
Costos y Análisis de Costo , Furazolidona/análisis , Furazolidona/química , Inmunoensayo/economía , Inmunoensayo/métodos , Sistemas de Atención de Punto/economía , Colorantes de Rosanilina/química , Humanos , Límite de Detección , Factores de Tiempo
10.
Milbank Q ; 99(1): 273-327, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33751662

RESUMEN

Policy Points In two respects, quality of care tends to be higher at major teaching hospitals: process of care and long-term survival of cancer patients following initial diagnosis. There is also evidence that short-term (30-day) mortality is lower on average at such hospitals, although the quality of evidence is somewhat lower. Quality of care is mulitdimensional. Empirical evidence by teaching status on dimensions other than survival is mixed. Higher Medicare payments for care provided by major teaching hospitals are partially offset by lower payments to nonhospital providers. Nevertheless, the payment differences between major teaching and nonteaching hospitals for hospital stays, especially for complex cases, potentially increase prices other insurers pay for hospital care. CONTEXT: The relative performance of teaching hospitals has been discussed for decades. For private and public insurers with provider networks, an issue is whether having a major teaching hospital in the network is a "must." For traditional fee-for-service Medicare, there is an issue of adequacy of payment of hospitals with various attributes, including graduate medical education (GME) provision. Much empirical evidence on relative quality and cost has been published. This paper aims to (1) evaluate empirical evidence on relative quality and cost of teaching hospitals and (2) assess what the findings indicate for public and private insurer policy. METHODS: Complementary approaches were used to select studies for review. (1) Relevant studies highly cited in Web of Science were selected. (2) This search led to studies cited by these studies as well as studies that cited these studies. (3) Several literature reviews were helpful in locating pertinent studies. Some policy-oriented papers were found in Google under topics to which the policy applied. (4) Several papers were added based on suggestions of reviewers. FINDINGS: Quality of care as measured in process of care studies and in longitudinal studies of long-term survival of cancer patients tends to be higher at major teaching hospitals. Evidence on survival at 30 days post admission for common conditions and procedures also tends to favor such hospitals. Findings on other dimensions of relative quality are mixed. Hospitals with a substantial commitment to graduate medical education, major teaching hospitals, are about 10% to 20% more costly than nonteaching hospitals. Private insurers pay a differential to major teaching hospitals at this range's lower end. Inclusive of subsidies, Medicare pays major teaching hospitals substantially more than 20% extra, especially for complex surgical procedures. CONCLUSIONS: Based on the evidence on quality, there is reason for patients to be willing to pay more for inclusion of major teaching hospitals in private insurer networks at least for some services. Medicare payment for GME has long been a controversial policy issue. The actual indirect cost of GME is likely to be far less than the amount Medicare is currently paying hospitals.


Asunto(s)
Educación de Postgrado en Medicina/economía , Costos de Hospital , Hospitales de Enseñanza , Calidad de la Atención de Salud , Costos y Análisis de Costo , Mortalidad Hospitalaria , Hospitales de Enseñanza/economía , Hospitales de Enseñanza/normas , Seguro de Salud , Estados Unidos
11.
Milbank Q ; 99(1): 240-272, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33751664

RESUMEN

Policy Points  Spending on prescription drugs is much higher per capita in the United States than in most other industrialized nations, including France.  Lower prescription drug spending in France is due to different approaches to managing drug prices, volume of prescribing, and global health budgets.  Linking a drug's price to value both at the launch of the drug and over its lifetime is key to controlling spending. Regulations on prescription volume and global spending complement the interventions on prices.  If the United States adopted the French approach to regulating drug pricing, Medicare could potentially save billions of dollars annually on prescription drug spending. CONTEXT: Prescription drug spending per capita in the United States is higher than in most other industrialized countries. Policymakers seeking to lower drug spending often suggest benchmarking prices against other countries, including France, which spends half as much as the United States per capita on prescription drugs. Because differences in drug prices may result from how markets are organized in each nation, we sought to directly compare drug prices and pricing regulations between the United States and France. METHODS: For the six brand-name drugs with the highest gross expenditures in Medicare Part D in 2017, we compared the price dynamics in France and the United States between 2010 and 2018 and analyzed associations between price changes in each country and key regulatory events. We also comprehensively reviewed US and French laws and regulations related to drug pricing. FINDINGS: Prices for the six drugs studied were higher in the United States than in France. In 2018, if Medicare had paid French prices for the brand-name drugs in our cohort, the agency would have saved $5.1 billion. We identified 12 factors that explain why the United States spends more than France on drugs, including variations in unit prices and the volume of prescriptions, driven by use of health technology assessment and value-based pricing in France. CONCLUSIONS: Key drivers of lower drug spending in France compared to the United States are that the French government regulates drug prices when products are launched and prohibits substantial price increases after launch. The regulation of prescription drugs in France is governed by rules that can inform discussions of US prescription drug policy and potential Medicare price negotiations.


Asunto(s)
Ahorro de Costo , Regulación Gubernamental , Medicare Part D/economía , Medicamentos bajo Prescripción/economía , Costos y Análisis de Costo , Costos de los Medicamentos/legislación & jurisprudencia , Francia , Cobertura del Seguro , Legislación de Medicamentos , Estados Unidos
12.
Int J Technol Assess Health Care ; 37: e43, 2021 Mar 09.
Artículo en Inglés | MEDLINE | ID: mdl-33686927

RESUMEN

AbstractThe rapid spread of the current COVID-19 pandemic has affected societies worldwide, leading to excess mortality, long-lasting health consequences, strained healthcare systems, and additional strains and spillover effects on other sectors outside health (i.e., intersectoral costs and benefits). In this perspective piece, we demonstrate the broader societal impacts of COVID-19 on other sectors outside the health sector and the growing importance of capturing these in health economic analyses. These broader impacts include, for instance, the effects on the labor market and productivity, education, criminal justice, housing, consumption, and environment. The current pandemic highlights the importance of adopting a societal perspective to consider these broader impacts of public health issues and interventions and only omit these where it can be clearly justified as appropriate to do so. Furthermore, we explain how the COVID-19 pandemic exposed and exacerbated existing deep-rooted structural inequalities that contribute to the wider societal impacts of the pandemic.


Asunto(s)
/economía , Costo de Enfermedad , Economía Médica/organización & administración , Costos y Análisis de Costo , Educación/economía , Eficiencia , Humanos , Modelos Económicos , Pandemias , Recursos Humanos/economía
13.
Medicine (Baltimore) ; 100(10): e24867, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725842

RESUMEN

ABSTRACT: As access to human immunodeficiency virus treatment expands in Low to Middle Income Countries, it becomes critical to develop and test strategies to improve adherence and ensure efficacy. Text messaging improves adherence to antiretroviral treatment antiretroviral treatment in some patient populations, but data surrounding the use of these tools is sparse in pediatric and adolescent patients in low to middle income countries. We evaluated if a text message intervention can improve antiretroviral treatment adherence while accounting for cell phone access, patterns of use, and willingness to receive text messages.We carried out a cross sectional study to understand willingness of receiving text message reminders, followed by a randomized controlled trial to assess effectiveness of text message intervention.Enrolled participants were randomized to receive standard care with regular clinic visits, or standard care plus short message service reminders. Adherence was measured 3 times during the study period using a 4-day Recall Questionnaire. Outcome was measured based on differences in the average adherence between the intervention and control group at each time point (baseline, 3 months, 6 months).Most respondents were willing to receive text message adherence reminders (81.1%, n = 53). Respondent literacy, travel time to clinic, cell phone access, and patterns of use were significantly associated with willingness. In the randomized trial the intervention group (n = 50) experienced a small but significant mean improvement in adherence over the six-month period (4%, P < .01) whereas the control group (n = 50) did not (mean improvement: 0.8%, P = .64).Text message interventions effectively support antiretroviral adherence in pediatric patients living with human immunodeficiency virus. Studies designed to assess the impact of text messaging interventions must examine local context for cellular phone infrastructure and use and must account for potential loss to follow up when patients miss appointments and study assessments.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Seropositividad para VIH/tratamiento farmacológico , Cumplimiento de la Medicación , Envío de Mensajes de Texto , Adolescente , Niño , Costos y Análisis de Costo , Estudios Transversales , Países en Desarrollo , Guatemala , Humanos , Envío de Mensajes de Texto/economía , Adulto Joven
14.
Water Sci Technol ; 83(5): 1108-1117, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33724940

RESUMEN

It is difficult to adjust the pH of oil acidized wastewater rich in Ca2+, thus hindering the polyacrylamide (PAM) flocculation. This study aims at accelerating the flocculation process by introducing CO2 into the water to induce the formation of CaCO3 nuclei. The order in which CO2 and NaOH were added affected the floc structures. Compared with CO2-NaOH-PAM, the flocs of NaOH-CO2-PAM were more compact and more CaCO3 crystals were formed. The aqueous Ca2+ involved in the reaction reached 20%, and CO2 utilization was enhanced. The settling time was shortened by half (from 20 to 3 min), and NaOH consumption was reduced by one-tenth (from 0.03 to 0.003 mol), hence significantly reducing the costs. Due to the higher settling rate and shorter contact time, the NaOH-CO2-PAM flocs adsorbed less so that the residual oil was 124 mg·L-1, while in the case of CO2-NaOH-PAM it was 88 mg·L-1. As a promising coagulation aid, CO2 can also be used to mineralize pollutants in wastewater.


Asunto(s)
Contaminantes Ambientales , Purificación del Agua , Dióxido de Carbono , Costos y Análisis de Costo , Floculación , Aguas Residuales
15.
Water Res ; 195: 116957, 2021 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-33711745

RESUMEN

To fully understand the economic viability and implementation strategy of the emerging algae-based desalination technology, this study investigates the economic aspects of algae-based desalination system by comparing the life-cycle costs of three different scenarios: (1) a multi-stage microalgae based desalination system; (2) a hybrid desalination system based on the combination of microalgae and low pressure reverse osmosis (LPRO) system; and (3) a seawater reverse osmosis (SWRO) desalination system. It is identified that the capital expenditure (CAPEX) and operational expenditure (OPEX) of scenario 1 are significantly higher than those of scenarios 2 and 3, when algal biomass reuse is not taken into consideration. If the revenues obtained from the algal biomass reuse are taken into account, the OPEX of scenario 1 will decrease significantly, and scenarios 2 and 3 will have the highest and lowest OPEX, respectively. However, due to the high CAPEX of scenario 1, the total expenditure (TOTEX) of scenario 1 is still 27% and 33% higher than those of scenarios 2 and 3, respectively. A sensitivity study is undertaken to understand the effects of six key parameters on water total cost for different scenarios. It is suggested that the electricity unit price plays the most important role in determining the water total cost for different scenarios. An uncertainty analysis is also conducted to investigate the effects and limitations of the key assumptions made in this study. It is suggested that the assumption of total dissolved solids (TDS) removal efficiency of microalgae results in a high uncertainty of life-cycle cost analysis (LCCA). Additionally, it is estimated that 1.58 megaton and 0.30 megaton CO2 can be captured by the algae-based desalination process for scenarios 1 and 2, respectively, over 20 years service period, which could result in approximately AU $18 million and AU $3 million indirect financial benefits for scenarios 1 and 2, respectively. When algal biomass reuse, CO2 bio-fixation and land availability are all taken into account, scenario 2 with hybrid desalination system is considered as the most economical and environmentally friendly option.


Asunto(s)
Purificación del Agua , Animales , Costos y Análisis de Costo , Filtración , Ósmosis , Agua de Mar
16.
JAMA Netw Open ; 4(3): e212618, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33755167

RESUMEN

Importance: This study assesses the role of telehealth in the delivery of care at the start of the COVID-19 pandemic. Objectives: To document patterns and costs of ambulatory care in the US before and during the initial stage of the pandemic and to assess how patient, practitioner, community, and COVID-19-related factors are associated with telehealth adoption. Design, Setting, and Participants: This is a cohort study of working-age persons continuously enrolled in private health plans from March 2019 through June 2020. The comparison periods were March to June in 2019 and 2020. Claims data files were provided by Blue Health Intelligence, an independent licensee of the Blue Cross and Blue Shield Association. Data analysis was performed from June to October 2020. Main Outcomes and Measures: Ambulatory encounters (in-person and telehealth) and allowed charges, stratified by characteristics derived from enrollment files, practitioner claims, and community characteristics linked to the enrollee's zip code. Results: A total of 36 568 010 individuals (mean [SD] age, 35.71 [18.77] years; 18 466 557 female individuals [50.5%]) were included in the analysis. In-person contacts decreased by 37% (from 1.63 to 1.02 contacts per enrollee) from 2019 to 2020. During 2020, telehealth visits (0.32 visit per person) accounted for 23.6% of all interactions compared with 0.3% of contacts in 2019. When these virtual contacts were added, the overall COVID-19 era patient and practitioner visit rate was 18% lower than that in 2019 (1.34 vs 1.64 visits per person). Behavioral health encounters were far more likely than medical contacts to take place virtually (46.1% vs 22.1%). COVID-19 prevalence in an area was associated with higher use of telehealth; patients from areas within the top quintile of COVID-19 prevalence during the week of their encounter were 1.34 times more likely to have a telehealth visit compared with those in the lowest quintile (the reference category). Persons living in areas with limited social resources were less likely to use telehealth (most vs least socially advantaged neighborhoods, 27.4% vs 19.9% usage rates). Per enrollee medical care costs decreased by 15% between 2019 and 2020 (from $358.32 to $306.04 per person per month). During 2020, those with 1 or more COVID-19-related service (1 470 721 members) had more than 3 times the medical costs ($1701 vs $544 per member per month) than those without COVID-19-related services. Persons with 1 or more telehealth visits in 2020 had considerably higher costs than persons having only in-person ambulatory contacts ($2214.10 vs $1337.78 for the COVID-19-related subgroup and $735.87 vs $456.41 for the non-COVID-19 subgroup). Conclusions and Relevance: This study of a large cohort of patients enrolled in US health plans documented patterns of care at the onset of COVID-19. The findings are relevant to policy makers, payers, and practitioners as they manage the use of telehealth during the pandemic and afterward.


Asunto(s)
Atención Ambulatoria , Pautas de la Práctica en Medicina , Telemedicina , Adulto , Atención Ambulatoria/economía , Atención Ambulatoria/métodos , Atención Ambulatoria/estadística & datos numéricos , /prevención & control , Estudios de Cohortes , Costos y Análisis de Costo , Femenino , Humanos , Control de Infecciones/métodos , Seguro de Salud/estadística & datos numéricos , Masculino , Innovación Organizacional/economía , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/organización & administración , Pautas de la Práctica en Medicina/estadística & datos numéricos , Telemedicina/economía , Telemedicina/organización & administración , Telemedicina/estadística & datos numéricos , Estados Unidos/epidemiología
17.
Br J Oral Maxillofac Surg ; 59(4): 439-444, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33714625

RESUMEN

Personal and shared stand-up electronic scooters (e-scooters) have rapidly increased in popularity, leading to an increase in the number of patients with e-scooter-related trauma presenting to hospital Emergency departments. This study aimed to assess the patterns of oral and maxillofacial trauma directly related to e-scooter use and provide a cost-analysis related to the management of these patients. A retrospective, controlled interval study was conducted to examine all patients referred to the oral and maxillofacial surgical service at Christchurch Hospital, New Zealand, who sustained facial injury as a result of e-scooter accidents between 15 October 2018 and 15 April 2020. A total of 30 patients with e-scooter-related facial injuries were referred to the maxillofacial service and required a total of 23 operative procedures. The majority of patients (70%) were aged between 20-39 years and 63.3% were male. Two-thirds reported having consumed alcohol before the e-scooter accident. The total estimated cost for the treatment of patients was $298,054 NZD. E-scooter-related maxillofacial trauma represents an emerging mechanism of injury that is associated with significant facial trauma and results in a treatment cost that adds significant burden on the health care system.


Asunto(s)
Accidentes , Traumatismos Maxilofaciales , Adulto , Costos y Análisis de Costo , Femenino , Hospitales , Humanos , Masculino , Traumatismos Maxilofaciales/epidemiología , Traumatismos Maxilofaciales/cirugía , Nueva Zelanda , Estudios Retrospectivos , Adulto Joven
18.
Medicine (Baltimore) ; 100(12): e25231, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761713

RESUMEN

ABSTRACT: Physician-hospital integration among accountable care organizations (ACOs) has raised concern over impacts on prices and spending. However, characteristics of ACOs with greater integration between physicians and hospitals are unknown. We examined whether ACOs systematically differ by physician-hospital integration among 16 commercial ACOs operating in Massachusetts.Using claims data linked to information on physician affiliation, we measured hospital integration with primary care physicians for each ACO and categorized them into high-, medium-, and low-integrated ACOs. We conducted cross-sectional descriptive analysis to compare differences in patient population, organizational characteristics, and healthcare spending between the three groups. In addition, using multivariate generalized linear models, we compared ACO spending by integration level, adjusting for organization and patient characteristics. We identified non-elderly adults (aged 18-64) served by 16 Massachusetts ACOs over the period 2009 to 2013.High- and medium-integrated ACOs were more likely to be an integrated delivery system or an organization with a large number of providers. Compared to low-integrated ACOs, higher-integrated ACOs had larger inpatient care capacity, smaller composition of primary care physicians, and were more likely to employ physicians directly or through an affiliated hospital or physician group. A greater proportion of high-/medium-integrated ACO patients lived in affluent neighborhoods or areas with a larger minority population. Healthcare spending per enrollee in high-integrated ACOs was higher, which was mainly driven by a higher spending on outpatient facility services.This study shows that higher-integrated ACOs differ from their counterparts with low integration in many respects including higher healthcare spending, which persisted after adjusting for organizational characteristics and patient mix. Further investigation into the effects of integration on expenditures will inform the ongoing development of ACOs.


Asunto(s)
Organizaciones Responsables por la Atención/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Convenios Médico-Hospital , Costos y Análisis de Costo , Convenios Médico-Hospital/economía , Convenios Médico-Hospital/métodos , Relaciones Médico-Hospital , Humanos , Estados Unidos
19.
Cien Saude Colet ; 26(3): 1001-1012, 2021 Mar.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-33729354

RESUMEN

The American response to the pandemic involves a prominent volume of federal resources, especially for developing and acquiring products for internal use, such as diagnostics or vaccines. Investment mechanisms and historical aspects justify this expenditure. Thus, the social construction of nationalism in American society hinders access to health technologies. The review of such aspects shows how the United States (U.S.) secured a large number of potential products, ensuring excessive local production. This unilateral foreign policy has influenced other countries or regional blocs and undermined global cooperation and solidarity, affecting the collective health of several nations.


Asunto(s)
/epidemiología , Salud Global , Cooperación Internacional , Pandemias , /diagnóstico , /estadística & datos numéricos , Costos y Análisis de Costo , Países en Desarrollo , Difusión de Innovaciones , Economía , Recursos en Salud/economía , Recursos en Salud/provisión & distribución , Accesibilidad a los Servicios de Salud , Humanos , Sistemas Políticos , Asignación de Recursos/economía , Asignación de Recursos/métodos , Estados Unidos/epidemiología , United States Dept. of Health and Human Services/economía
20.
Br J Community Nurs ; 26(3): 110-115, 2021 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-33719559

RESUMEN

The purpose of this article is critical analysis, reflection and discussion in regards to the uses and impacts technology has had in community settings, specifically care homes during the COVID-19 pandemic. This will be investigated and supported with special emphasis on virtual assessment platforms and their use within the care homes settings, furthermore reviewing specific data collected in relation to the usage within community care homes. The article will outline the positive attributes and critically reflect upon the benefits of using audio and video conferencing when assessing patients and the beneficial impacts this has had on patients and the wider health community. While conversely addressing the obstacles and threats faced by clinicians in the use of assessment software.


Asunto(s)
/epidemiología , Enfermería en Salud Comunitaria/organización & administración , Pandemias , Consulta Remota/métodos , Costos y Análisis de Costo , Humanos , Consulta Remota/economía , Teléfono , Triaje/métodos
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