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1.
JAMA Netw Open ; 4(1): e2033967, 2021 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-33443581

RESUMEN

Importance: Telehealth has emerged as a means of improving access and reducing cost for medical oncology care; however, use by specialists prior to the coronavirus disease 2019 (COVID-19) pandemic still remained low. Medical oncology professionals' perceptions of telehealth for cancer care are largely unknown, but are critical to telehealth utilization and expansion efforts. Objective: To identify medical oncology health professionals' perceptions of the barriers to and benefits of telehealth video visits. Design, Setting, and Participants: This qualitative study used interviews conducted from October 30, 2019, to March 5, 2020, of medical oncology health professionals at the Thomas Jefferson University Hospital, an urban academic health system in the US with a cancer center. All medical oncology physicians, physicians assistants, and nurse practitioners at the hospital were eligible to participate. A combination of volunteer and convenience sampling was used, resulting in the participation of 29 medical oncology health professionals, including 20 physicians and 9 advanced practice professionals, in semistructured interviews. Main Outcomes and Measures: Medical oncology health professionals' perceptions of barriers to and benefits of telehealth video visits as experienced by patients receiving cancer treatment. Results: Of the 29 participants, 15 (52%) were women and 22 (76%) were White, with a mean (SD) age of 48.5 (12.0) years. Respondents' perceptions were organized using the 4 domains of the National Quality Forum framework: clinical effectiveness, patient experience, access to care, and financial impact. Respondents disagreed on the clinical effectiveness and potential limitations of the virtual physical examination, as well as on the financial impact on patients. Respondents also largely recognized the convenience and improved access to care enabled by telehealth for patients. However, many reported concern regarding the health professional-patient relationship and their limited ability to comfort patients in a virtual setting. Conclusions and Relevance: Medical oncology health professionals shared conflicting opinions regarding the barriers to and benefits of telehealth in regard to clinical effectiveness, patient experience, access to care, and financial impact. Understanding oncologists' perceptions of telehealth elucidates potential barriers that need to be further investigated or improved for telehealth expansion and continued utilization; further research is ongoing to assess current perceptions of health professionals and patients given the rapid expansion of telehealth during the COVID-19 pandemic.


Asunto(s)
Actitud del Personal de Salud , Oncólogos , Satisfacción del Paciente , Relaciones Médico-Paciente , Telemedicina , Comunicación por Videocoferencia , Adulto , Femenino , Gastos en Salud , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Oncología Médica , Persona de Mediana Edad , Enfermeras Practicantes , Percepción , Examen Físico , Asistentes Médicos , Relaciones Profesional-Paciente , Investigación Cualitativa , Revelación de la Verdad
2.
N C Med J ; 82(1): 14-20, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33397749

RESUMEN

BACKGROUND Patients with cancer are at risk for both objective and subjective financial distress. Financial distress during treatment is adversely associated with physical and mental well-being. Little is known about whether patients' subjective financial distress changes during the course of their treatment.method This is a cross-sectional study of insured adults with solid tumors on anti-cancer therapy for ≥1 month, surveyed at a referral center and three rural oncology clinics. The goal was to investigate how financial distress varies depending on where patients are in the course of cancer therapy. Financial distress (FD) was assessed via a validated measure; out-of-pocket (OOP) costs were estimated and medical records were reviewed for disease/treatment data. Logistic regression was used to evaluate the potential association between treatment length and financial distress.RESULTS Among 300 participants (86% response rate), median age was 60 years (range 27-91), 52.3% were male, 78.3% had stage IV cancer or metastatic recurrence, 36.7% were retired, and 56% had private insurance. Median income was $60,000/year and median OOP costs including insurance premiums were $592/month. Median FD score (7.4/10, SD 2.5) corresponded to low FD with 16.3% reporting high/overwhelming distress. Treatment duration was not associated with the odds of experiencing high/overwhelming FD in single-predictor (OR = 1.01, CI [.93, 1.09], P = .86) or multiple predictor regression models (OR = .98, CI [.86, 1.12], P = .79). Treatment duration was not correlated with FD as a continuous variable (P = .92).LIMITATIONS This study is limited by its cross-sectional design and generalizability to patients with early-stage cancer and those being treated outside of a major referral center.CONCLUSION Severity of cancer treatment-related financial distress did not correlate with time on treatment, indicating that patients are at risk for FD throughout the treatment continuum. Screening for and addressing financial distress should occur throughout the course of cancer therapy.


Asunto(s)
Gastos en Salud , Neoplasias , Adulto , Anciano , Anciano de 80 o más Años , Costo de Enfermedad , Estudios Transversales , Femenino , Humanos , Renta , Masculino , Persona de Mediana Edad , Neoplasias/terapia
3.
Sci Total Environ ; 753: 142228, 2021 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-33207473

RESUMEN

This research examines the heterogeneous dynamic links among healthcare expenditures, land urbanization, and CO2 emissions across the development levels of China. To this end, data of 27 Chinese provinces are considered from 1999 to 2018. Theoretically, this research developed a healthcare expenditures-augmented Stochastic Impacts of Regression by Population, Affluence, and Technology (STIRPAT) model to incorporate healthcare expenditures as a determinant of affluence. Empirically, this research established a system of simultaneous equations based on the healthcare expenditures-augmented STIRPAT model to estimate the links among the variables. As a pre-analysis, second-generation Westerlund cointegration is applied and found the long-term equilibrium association among the variables. The long-run estimations and short-run causality are done by employing dynamic common correlated effects mean group method (DCCEMGM) and Dumitrescu-Hurlin causality. A heterogeneous long-run equilibrium linkage is confirmed to exist among the variables of interest. Concerning the long-run estimates, firstly, the healthcare expenditures growth and land urbanization exhibited a bilateral positive link. Secondly, CO2 emissions and healthcare expenditures growth manifested the existence of a bilateral positive link. And thirdly, a unilateral positive (negative) link is revealed to exist from a linear term (squared term) of land urbanization to CO2 emissions. Concerning the short-run results, firstly, a bilateral causal bond exists between the land urbanization and healthcare expenditures growth. Secondly, a bilateral causal bond prevails between CO2 emissions growth and healthcare expenditures growth. Finally, a unilateral causal bond is operational from land urbanization to CO2 emissions growth. In terms of the nature of the link, the long-run findings are consistent across the data samples. However, considering the degree of influence, heterogeneity is confirmed across the development levels for both long- and short-run. It infers that relatively more (less) developed regions showed relatively strong (weak) influence. Based on empirical findings, relevant policies are recommended.


Asunto(s)
Desarrollo Económico , Urbanización , Dióxido de Carbono/análisis , China , Gastos en Salud
5.
Support Care Cancer ; 29(1): 349-358, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32361832

RESUMEN

PURPOSE: Fighting cancer is a costly battle, and understanding the relationship between patient-reported financial toxicity (FT) and health outcomes can help inform interventions for post-treatment cancer survivors. METHODS: Stages I-III solid tumor, insured US cancer survivors (N = 103) completed a survey addressing FT (as measured by the standardized COST measure) and clinically relevant health outcomes (including health-related quality of life [HRQOL] and adherence to recommended survivorship health behaviors). Univariate and multivariate analyses were used to assess demographic and disease-specific correlates of FT, and to assess the predictive value of FT on HRQOL and adherence to survivorship health behaviors. RESULTS: Approximately 18% of respondents noted FT levels associated with significant financial burden. In univariate analyses, after correcting for multiple comparisons, greater FT was associated with unpartnered status, non-retirement, and lower level of educational attainment. Greater FT was also significantly associated with HRQOL components of anxiety, fatigue, pain, physical functioning, and social functioning. FT was not significantly associated with any measured survivorship health behaviors. In multivariate analyses, FT was found to be a meaningful predictor of patient-reported anxiety, fatigue, physical functioning, and social functioning above and beyond theoretically and statistically relevant demographic characteristics. CONCLUSIONS: Although overall levels of FT were lower among cancer survivors in this sample, as compared with active treatment patients assessed in previous studies, financial burden continued to be a concern for a significant minority of cancer survivors and was associated with components of reduced HRQOL. Further research is needed to understand FT among underinsured survivors and those treated in community oncology settings. IMPLICATIONS FOR CANCER SURVIVORS: Incorporation of FT assessment into survivorship care planning could enhance clinical assessment of survivors' FT vulnerability, help address the dynamic and persistent challenges of survivorship, and help identify those most in need of intervention across the cancer care continuum.


Asunto(s)
Supervivientes de Cáncer/psicología , Costo de Enfermedad , Gastos en Salud , Neoplasias/economía , Calidad de Vida/psicología , Adulto , Ansiedad/psicología , Fatiga/psicología , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Persona de Mediana Edad , Grupos Minoritarios , Neoplasias/terapia , Medición de Resultados Informados por el Paciente , Encuestas y Cuestionarios , Supervivencia
6.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 13: 50-56, jan.-dez. 2021. tab
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1146063

RESUMEN

Objetivo: descrever os casos de morbidade hospitalar e impactos financeiros por urolitíase no estado da Bahia, Brasil no período de 2012 a 2016. Métodos: trata-se de um estudo epidemiológico, descritivo e transversal baseado no banco de dados secundários do Departamento de Informática do Sistema Único de Saúde. As variáveis coletadas foram: sexo, faixa etária, custos e raça/cor notificados no período citado. Resultados: foram registrados 15.171 casos de morbidade hospitalar por urolitíase, o que corresponde a 0,46% do total das internações. A maior prevalência ocorreu na macrorregião leste (n=6.920), entre o sexo masculino (n=7.815), em idade entre 35 e 39 anos (n=1.877) e cor/raça ignorada (n=8.031). A urolitíase gerou um impacto financeiro superior a 5,5 milhões de reais ao Sistema Único de Saúde. Conclusão: de acordo com os resultados, observa-se a necessidade de tornar a macrorregião leste como prioritária para as ações de controle e prevenção da patologia


Objective: to describe the cases of hospital morbidity and financial impacts for urolithiasis in the state of Bahia, Brazil, 2012-2016. Methods: this was an epidemiological, cross-sectional and descriptive study based on secondary data from the Information Technology Department of the Unified Health System. The variables collected were: sex, age groups, costs and race notified in the cited period. Results: it were registered 15.171 cases of hospital morbidity for urolithiasis, which corresponds to 0,46% of all hospitalizations. The greatest prevalence occurred in the east macro region (n=6.920), among males (n=7.815), aged between 35 and 39 years old (n=1.877) and ignored color/ race (n=8.031). The urolithiasis generated a financial impact superior to 5,5 millions of reais to the Single Health System. Conclusion: according to the results, there is the need to make the east macro region as priority for actions of control and prevention of the pathology


Objetivo: describir los casos de morbilidad hospitalaria por urolitiasis en el estado de Bahía, Brasil, 2012-2016. Método: estudio epidemiológico, descriptivo y transversal, utilizando los datos obtenidos en lo Departamento de Informática del Sistema Único de Salud. Las variables recolectadas fueron: sexo, grupo de edad, gastos y raza notificados em el período citado. Resultados: se han registrados 15.171 casos de hospitalizaciones por urolitiasis, que corresponde a 0,46% del total de las hospitalizaciones. La mayor prevalencia ocurrió en la macrorregión leste (n=6.920), entre lo sexo masculino (n=7.815), de grupo etario entre 35 y 39 años (n=1.877) y color/raza ignorada (n=8.031). La urolitiasis ha generado un impacto financiero superior a 5,5 millones de reales al Sistema Único de Salud. Conclusión: de acuerdo con los resultados constata la necesidad de volver la macrorregión leste como prioritaria para las acciones de control y prevención de la patología


Asunto(s)
Humanos , Masculino , Femenino , Morbilidad , Gastos en Salud , Costos y Análisis de Costo , Urolitiasis/epidemiología , Hospitalización/estadística & datos numéricos , Sistema Único de Salud , Prevalencia , Prevención de Enfermedades
7.
Swiss Med Wkly ; 150: w20446, 2020 12 14.
Artículo en Inglés | MEDLINE | ID: mdl-33382449

RESUMEN

AIMS OF THE STUDY: Hydroxychloroquine and lopinavir/ritonavir have been used as experimental therapies to treat COVID-19 during the first wave of the pandemic. Randomised controlled trials have recently shown that there are no meaningful benefits of these two therapies in hospitalised patients. Uncertainty remains regarding the potential harmful impact of these therapies as very early treatments and their burden to the health care system. The present study investigated the length of hospital stay (LOS), mortality, and costs of hydroxychloroquine, lopinavir/ritonavir or their combination in comparison with standard of care among patients hospitalised for coronavirus disease 2019 (COVID-19). METHODS: This retrospective observational cohort study took place in the Geneva University Hospitals, Geneva, Switzerland (n = 840) between 26 February and 31 May 2020. Demographics, treatment regimens, comorbidities, the modified National Early Warning Score (mNEWS) on admission, and contraindications to COVID-19 treatment options were assessed. Outcomes included LOS, in-hospital mortality, and drug and LOS costs. RESULTS: After successful propensity score matching, patients treated with (1) hydroxychloroquine, (2) lopinavir/ritonavir or (3) their combination had on average 3.75 additional hospitalisation days (95% confidence interval [CI] 1.37–6.12, p = 0.002), 1.23 additional hospitalisation days (95% CI −1.24 – 3.51, p = 0.319), and 4.19 additional hospitalisation days (95% CI 1.52–5.31, p <0.001), respectively, compared with patients treated with the standard of care. Neither experimental therapy was significantly associated with mortality. These additional hospital days amounted to 1010.77 additional days for hydroxychloroquine and hydroxychloroquine combined with lopinavir/ritonavir, resulting in an additional cost of US$ 2,492,214 (95%CI US$ 916,839–3,450,619). CONCLUSIONS: Prescribing experimental therapies for COVID-19 was not associated with a reduced LOS and might have increased the pressure put on healthcare systems.


Asunto(s)
Antivirales/uso terapéutico , /epidemiología , Hidroxicloroquina/uso terapéutico , Lopinavir/uso terapéutico , Ritonavir/uso terapéutico , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antivirales/administración & dosificación , Antivirales/efectos adversos , Niño , Preescolar , Comorbilidad , Combinación de Medicamentos , Quimioterapia Combinada , Gastos en Salud , Mortalidad Hospitalaria/tendencias , Humanos , Hidroxicloroquina/administración & dosificación , Hidroxicloroquina/efectos adversos , Lactante , Tiempo de Internación/estadística & datos numéricos , Lopinavir/administración & dosificación , Lopinavir/efectos adversos , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos , Ritonavir/administración & dosificación , Ritonavir/efectos adversos , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores Socioeconómicos , Terapias en Investigación/métodos , Adulto Joven
8.
Artículo en Inglés | MEDLINE | ID: mdl-33322428

RESUMEN

The COVID-19 epidemic has crashed on the social and economic stability of China and even the world, and raised the question: how has the Chinese government done with public health in recent years? The purpose of this paper is to clarify the definition and items of Chinese public-health expenditure, then to objectively evaluate the Chinese government's performance, so as to help the government to perform better in public health. To achieve this goal, we measure the Chinese public-health expenditure at national and provincial levels based on our definition, and then compare it with the expenditures of other countries. The results show that: (1) the level of public-health expenditure in China is relatively low and far lower than that in developed countries; (2) Chinese governments have not paid enough attention to the prevention and control of major public-health emergencies, which may be an important reason for the outbreak of COVID-19; (3) Chinese public-health expenditure shows a fluctuating growth trend, but the growth rate is so slow that it is lower than that of GDP and fiscal expenditure; (4) although the Chinese government inclines the public-health expenditure to the poor provinces in central and western regions, the imbalance and inequity of public-health resource allocation are still expanding among provinces; (5) there is a lot of waste of resources in the public-health system, which seriously reduces the efficiency of public-health expenditure in China. Therefore, the Chinese government should improve the quantity and quality of public-health expenditure in the above aspects.


Asunto(s)
Gobierno , Gastos en Salud , Salud Pública/economía , China , Humanos
9.
Rev Saude Publica ; 54: 125, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33331522

RESUMEN

OBJECTIVE: To estimate the relation between catastrophic health expenditure (CHE) and multimorbidity in a national representative sample of the Brazilian population aged 50 year or older. METHODS: This study used data from 8,347 participants of the Estudo Longitudinal de Saúde dos Idosos Brasileiros (ELSI - Brazilian Longitudinal Study of Aging) conducted in 2015-2016. The dependent variable was CHE, defined by the ratio between the health expenses of the adult aged 50 years or older and the household income. The variable of interest was multimorbidity (two or more chronic diseases) and the variable used for stratification was the wealth score. The main analyses were based on multivariate logistic regression. RESULTS: The prevalence of CHE was 17.9% and 7.5%, for expenditures corresponding to 10 and 25% of the household income, respectively. The prevalence of multimorbidity was 63.2%. Multimorbidity showed positive and independent associations with CHE (OR = 1.95, 95%CI 1.67-2.28, and OR = 1.40, 95%CI 1.11-1.76 for expenditures corresponding to 10% and 25%, respectively). Expenditures associated with multimorbidity were higher among those with lower wealth scores. CONCLUSIONS: The results draw attention to the need for an integrated approach of multimorbidity in health services, in order to avoid CHE, particularly among older adults with worse socioeconomic conditions.


Asunto(s)
Enfermedad Catastrófica/economía , Enfermedad Crónica/economía , Gastos en Salud/estadística & datos numéricos , Multimorbilidad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Enfermedad Catastrófica/epidemiología , Enfermedad Crónica/epidemiología , Costo de Enfermedad , Estudios Transversales , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores Socioeconómicos
10.
Rev Saude Publica ; 54: 127, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33331523

RESUMEN

OBJECTIVE: To examine the financing of the Unified Health System (SUS) from 2010 to 2019 and analyze the recent trends in the allocation of federal resources to large areas of operation of the system, as well as the possibility of achieving the Sustainable Development Goal (SDG) 3 of the 2030 Agenda. METHODS: Data from the budgetary and financial execution of the federation entities were obtained. Transfers from the Brazilian Ministry of Health (MH) to the municipal and state departments and their direct applications were identified according to large final areas of SUS and middle areas. Basic descriptive statistics, graphs and tables were used to analyze the execution of expenses by these areas. RESULTS: Public spending per capita on health increased between 2010 and 2018. However, compared to 2014, it reduced 3% in 2018. There was a displacement of the allocation of federal resources to the detriment of transfers to the states (-21%). There are also losses of health surveillance in favor of primary care and pharmaceuticals. In the case of primary care, the increase in spending was tied to changes in policy and the expansion of resources allocated by parliamentary amendments. In the case of pharmaceuticals, the increase was due to the incorporation of new drugs, including vaccines, judicialization, increased spending on blood products and centralization, in the MH, of the purchase of items of high budgetary impact. CONCLUSION: If there is no change in the current SUS financing framework, something unlikely under Constitutional Amendment No. 95, associated with the redefinition of health policy priorities, the risk of non-compliance with the SDG 3 of the Agenda 2030 is very high.


Asunto(s)
Financiación Gubernamental , Gastos en Salud , Financiación de la Atención de la Salud , Programas Nacionales de Salud , Brasil , Objetivos , Humanos
11.
Artículo en Español | PAHO-IRIS | ID: phr-52979

RESUMEN

[RESUMEN]. Objetivo. Determinar existencia de desigualdad y gradiente en gastos de bolsillo, gasto público y gasto privado, entre países americanos estratificados según su densidad de recurso humano en salud (RHS). Métodos. Estudio analítico y transversal de desigualdades en salud para el gasto de bolsillo (porcentaje del gasto total en salud), el gasto público y el gasto privado (porcentaje del PIB), aplicando la densidad de recurso humano (medicina más enfermería) como estratificador. A partir de datos de la Organización Panamericana de la Salud y el Banco Mundial se categorizaron 32 países americanos según su densidad, se calcularon tasas ponderadas, descriptivos, diferencias, correlaciones, indicadores simples y complejos de desigualdad. Resultados. Hay alta variabilidad de densidad de RHS (3,8 a 171,3; media de 43,97, DS 37,08) con diferencias significativas entre las categorías de alta y baja densidad. El primer cuartil concentra el 9% de la población y 4,45% del RHS; los 3 primeros cuartiles concentran el 48,4% de la población y el 17% del RHS. Mediante estratificación, se evidenció un gradiente y desigualdades en indicadores de gastos, mayor en el gasto de bolsillo, con el cual también la densidad de RHS presentó una correlación negativa. Conclusiones. La densidad de RHS presenta alta variabilidad entre países y grupos categorizados; se concentra en forma desigual en la población, y es mayor en los países con mayor gasto público. Como estratificador de la muestra permitió evidenciar desigualdades y gradientes de gastos en salud; los estratos de menor densidad presentan mayor gasto de bolsillo, menor gasto público y mayor gasto privado.


[ABSTRACT]. Objective. To determine the existence of inequality and gradient in out-of-pocket expenses, public spending and private spending, among countries from the Americas stratified according to their human resources for health (HRH) density. Methods. Analytical and transversal study of health inequalities for out-of-pocket spending (percentage of total health spending), public spending and private spending (percentage of GDP), applying the human resource density (medicine and nursing) as a stratifier. Based on data from the Pan American Health Organization and the World Bank, 32 countries from the Americas were categorized according to their density, and weighted rates, descriptors, differences, correlations, and simple and complex indicators of inequality were calculated. Results. There is high variability in HRH density (3.8 to 171.3; mean 43.97, SD 37.08) with significant differences between high and low density categories. The first quartile concentrates 9% of the population and 4.45% of the HRH; the first 3 quartiles concentrate 48.4% of the population and 17% of the HRH. The stratification showed a gradient and inequalities in expenditure indicators, higher in the out-of-pocket expenditure, with which the HRH density presented a negative correlation. Conclusions. HRH density shows high variability among countries and categorized groups; it is unevenly concentrated in the population, and is greater in countries with higher public spending. As a stratifier of the sample, it showed inequalities and gradients in health spending; the strata with lower density showed higher out-of-pocket spending, lower public spending and higher private spending.


Asunto(s)
Evaluación de Recursos Humanos en Salud , Gastos en Salud , Américas , Evaluación de Recursos Humanos en Salud , Gastos en Salud , Américas
12.
BMJ Glob Health ; 5(11)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33184065

RESUMEN

INTRODUCTION: The COVID-19 pandemic caused a healthcare crisis in China and continues to wreak havoc across the world. This paper evaluated COVID-19's impact on national and regional healthcare service utilisation and expenditure in China. METHODS: Using a big data approach, we collected data from 300 million bank card transactions to measure individual healthcare expenditure and utilisation in mainland China. Since the outbreak coincided with the 2020 Chinese Spring Festival holiday, a difference-in-difference (DID) method was employed to compare changes in healthcare utilisation before, during and after the Spring Festival in 2020 and 2019. We also tracked healthcare utilisation before, during and after the outbreak. RESULTS: Healthcare utilisation declined overall, especially during the post-festival period in 2020. Total healthcare expenditure and utilisation declined by 37.8% and 40.8%, respectively, while per capita expenditure increased by 3.3%. In a subgroup analysis, we found that the outbreak had a greater impact on healthcare utilisation in cities at higher risk of COVID-19, with stricter lockdown measures and those located in the western region. The DID results suggest that, compared with low-risk cities, the pandemic induced a 14.8%, 26.4% and 27.5% reduction in total healthcare expenditure in medium-risk and high-risk cities, and in cities located in Hubei province during the post-festival period in 2020 relative to 2019, an 8.6%, 15.9% and 24.4% reduction in utilisation services; and a 7.3% and 18.4% reduction in per capita expenditure in medium-risk and high-risk cities, respectively. By the last week of April 2020, as the outbreak came under control, healthcare utilisation gradually recovered, but only to 79.9%-89.3% of its pre-outbreak levels. CONCLUSION: The COVID-19 pandemic had a significantly negative effect on healthcare utilisation in China, evident by a dramatic decline in healthcare expenditure. While the utilisation level has gradually increased post-outbreak, it has yet to return to normal levels.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Gastos en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Aceptación de la Atención de Salud/estadística & datos numéricos , Neumonía Viral/epidemiología , Betacoronavirus , China/epidemiología , Humanos , Pandemias
14.
PLoS One ; 15(10): e0238720, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33031440

RESUMEN

BACKGROUND: Global HIV funding cutbacks have been accompanied by the adoption of user fees to address funding gaps in treatment programs. Our objective was to assess the impact of user fees on HIV care utilization and medication adherence in Nigeria. METHODS: We conducted a retrospective analysis of patients enrolled in care before (October 2012-September 2013) and after (October 2014-September 2015) the introduction of user fees in a Nigerian clinic. We assessed pre- vs. post-user fee patient characteristics and enrollment trends, and determined risk of care interruption, loss to follow-up, and optimal medication adherence. RESULTS: After fees were instituted, there was a 66% decline in patient enrollment and 75% decline in number of ART doses dispensed. There was no difference in the proportion of female clients (64% vs 63%, p = 0.46), average age (36 vs. 37 years, p = 0.15), or median baseline CD4 (220/ul vs. 222/uL, p = 0.24) in pre- and post-fee cohorts. There was an increase in clients employed and/or had tertiary education (24% vs. 32%, p<0.001). Compared to pre-fee patients, the post-fee period had a 48% decreased risk of care interruption (aRR = 0.52, 95%CI:0.39-0.69), 22% decreased LTFU risk (aRR = 0.64, 95%CI:0.96), and 27% decreased odds of optimal medication adherence (aOR = 0.7, 3 95%CI 0.59-0.89). CONCLUSIONS: Patients enrolled in care after introduction of user fees in Nigeria were more likely to be educated or employed, and effectively retained in care after starting ART. However, fees were accompanied by a drastic reduction in new patient enrollment, suggesting that many patients may have been marginalized from HIV care.


Asunto(s)
Fármacos Anti-VIH/economía , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/economía , Cumplimiento de la Medicación , Adulto , Instituciones de Atención Ambulatoria/economía , Estudios de Cohortes , Honorarios y Precios , Femenino , Gastos en Salud , Humanos , Perdida de Seguimiento , Masculino , Nigeria , Pacientes Desistentes del Tratamiento , Estudios Retrospectivos
15.
BMJ ; 371: m4040, 2020 10 23.
Artículo en Inglés | MEDLINE | ID: mdl-33097492

RESUMEN

OBJECTIVE: To assess the relation between autocratisation-substantial decreases in democratic traits (free and fair elections, freedom of civil and political association, and freedom of expression)-and countries' population health outcomes and progress toward universal health coverage (UHC). DESIGN: Synthetic control analysis. SETTING AND COUNTRY SELECTION: Global sample of countries for all years from 1989 to 2019, split into two categories: 17 treatment countries that started autocratising during 2000 to 2010, and 119 control countries that never autocratised from 1989 to 2019. The treatment countries comprised low and middle income nations and represent all world regions except North America and western Europe. A weighted combination of control countries was used to construct synthetic controls for each treatment country. This statistical method is especially well suited to population level studies when random assignment is infeasible and sufficiently similar comparators are not available. The method was originally developed in economics and political science to assess the impact of policies and events, and it is now increasingly used in epidemiology. MAIN OUTCOME MEASURES: HIV-free life expectancy at age 5 years, UHC effective coverage index (0-100 point scale), and out-of-pocket spending on health per capita. All outcome variables are for the period 1989 to 2019. RESULTS: Autocratising countries underperformed for all three outcome variables in the 10 years after the onset of autocratisation, despite some improvements in life expectancy, UHC effective coverage index, and out-of-pocket spending on health. On average, HIV-free life expectancy at age 5 years increased by 2.2% (from 64.7 to 66.1 years) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 3.5% (95% confidence interval 3.3% to 3.6%, P<0.001) (from 64.7 to 66.9 years) in the absence of autocratisation. On average, the UHC effective coverage index increased by 11.9% (from 42.5 to 47.6 points) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 20.2% (95% confidence interval 19.6% to 21.2%, P<0.001) (from 42.5 to 51.1 points) in the absence of autocratisation. Finally, on average, out-of-pocket spending on health per capita increased by 10.0% (from $4.00 (£3.1; €3.4) to $4.4, log transformed) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by only 4.4% (95% confidence interval 3.9% to 4.6%, P<0.001) (from $4.0 to $4.2, log transformed) in the absence of autocratisation. CONCLUSIONS: Autocratising countries had worse than estimated life expectancy, effective health service coverage, and levels of out-of-pocket spending on health. These results suggest that the noticeable increase in the number of countries that are experiencing democratic erosion in recent years is hindering population health gains and progress toward UHC. Global health institutions will need to adjust their policy recommendations and activities to obtain the best possible results in those countries with a diminishing democratic incentive to provide quality healthcare to populations.


Asunto(s)
Democracia , Atención de Salud Universal , Anciano , Salud Global/legislación & jurisprudencia , Gastos en Salud , Humanos , Esperanza de Vida , Persona de Mediana Edad , Política
17.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(9): 1482-1486, 2020 Sep 10.
Artículo en Chino | MEDLINE | ID: mdl-33076603

RESUMEN

Objective: To investigate the relationship between smoking status and the onset age of stomach cancer patients and estimate the patients' direct medical cost burden of stomach cancer due to smoking in Anhui province. Methods: The information about the primary stomach cancer patients and their direct treatment expenditures in 10 cancer-registered areas in Anhui were collected in 2017. The association between smoking status and the age of onset of stomach cancer patients was analyzed by univariate regression and multivariate logistic regression models. The median and smoking-attributed risk method was used to describe the direct treatment expenditure of stomach cancer patients in Anhui due to smoking. Results: A total of 736 patients with stomach cancer were analyzed in this study. Univariate regression analysis showed that rural household registration (t=2.091, P=0.037), smoking (t=-2.357, P=0.001 9) and alcohol consumption (t=-2.036, P=0.042) were related to the age of onset of stomach cancer. After adjusting for gender, alcohol consumption, body mass index and household registration type, the risk of early stomach cancer in people who quitted smoking cessation was lower than that in smokers (OR=0.36, 95%CI: 0.17-0.75). The total direct medical cost burden of 736 newly diagnosed stomach cancer patients was 6.939 6 million RMB. The direct medical expenditure in stomach cancer patients who had smoking behavior was higher than that in stomach cancer patients who quitted smoking and never smoked. Conclusions: Smoking is one of the risk factors for the earlier onset of stomach cancer in Anhui. It is necessary to strengthen tobacco control to reduce the economic burden of patients with stomach cancer.


Asunto(s)
Fumar , Neoplasias Gástricas , Edad de Inicio , China/epidemiología , Gastos en Salud , Humanos , Fumar/epidemiología , Neoplasias Gástricas/economía , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/terapia
19.
Artículo en Alemán | MEDLINE | ID: mdl-33090245

RESUMEN

In the German healthcare system, immunotherapies have been well established for years. Currently there are over 100 registrations of monoclonal antibodies (MABs). In recent years, new immunotherapeutic approaches became available, amongst them checkpoint inhibitors and CAR­T cells in oncology. Increasing expenditures of the German statutory health insurance (SHI) system are regarded with concerns. This article presents an overview of the development and status of prescriptions and sales of selected immunotherapeutics in Germany. Data from 2015-2019 were analyzed, primarily from the GKV-Arzneimittel-Schnellinformation (GAmSi) and the consultancy IQVIA.In the group of older MABs, such as immunosuppressive and antineoplastic agents, biosimilars led to a (temporary) increase of applications, but reimbursement amounts are decreasing. Instruments of the SHI system like drug agreements, reference prices, and individual discount contracts intervene as expenditure control. Checkpoint inhibitors clearly show increasing prescriptions and expenditures. Finally, the CAR­T cells are indeed very expensive treatments, but are currently not that important due to the limited number of applications. In addition, the exemption from VAT of 19% and the signed discount agreements between suppliers and sickness funds reduce the burden. In 2015 and 2019, the net expenditures on drugs and surgical dressings accounted for 17.2% of the total expenditures on benefits of the SHI system. Should the expenditures on drugs increase overproportionately in the future, the German SHI system will be able to counteract with already available or new instruments, supported by the legislator. Manufacturers and the SHI system should develop joint actions to achieve solutions for new treatment approaches.


Asunto(s)
Biosimilares Farmacéuticos , Biosimilares Farmacéuticos/uso terapéutico , Prestación de Atención de Salud , Alemania , Gastos en Salud , Inmunoterapia , Programas Nacionales de Salud
20.
PLoS One ; 15(10): e0239576, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33113548

RESUMEN

In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the differences in the level of income and expenditure between chronically-ill people and non-chronic population. Data were gathered from a national level survey conducted namely, the Household Income and Expenditure Survey (HIES) by the Department of Census and Statistics (DCS) of Sri Lanka. These data were statistically analysed with one-way and two-way ANOVA, to identify the factors that cause the differences among different groups. For the first time, this study makes an attempt using survey data, to examine the differences in the level of income and expenditure among chronically-ill people in Sri Lanka. Accordingly, the study discovered that married females who do not engage in any type of economic activity (being unemployed due to the disability associated with the respective chronic illness), in the age category of 40-65, having an educational level of tertiary education or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. If workforce population is compelled to lose jobs, it can lead to income insecurity and impair their quality of lives. Under above findings, it is reasonable to assume that most health care expenses are out of pocket. Furthermore, the study infers that chronic illnesses have a statistically proven significant differences towards the income and expenditure level. This has caused due to the interaction of demographic and socio-economic characteristics associated with chronic illnesses. Considering private-public sector partnerships that enable affordable access to health care services for all as well as implementation of commercial insurance and community-based mutual services that help ease burden to the public, are vital when formulating effective policies and strategies related to the healthcare sector. Sri Lanka is making strong efforts to support its healthcare sector and public, which was affected by the coronavirus (COVID-19) in early 2020. Therefore, findings of this paper will be useful to gain insights on the differences of chronic illnesses towards the income and expenditure of chronically-ill patients in Sri Lanka.


Asunto(s)
Betacoronavirus , Enfermedad Crónica/epidemiología , Infecciones por Coronavirus/epidemiología , Gastos en Salud/estadística & datos numéricos , Renta/estadística & datos numéricos , Pandemias , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Análisis de Varianza , Niño , Preescolar , Enfermedad Crónica/economía , Comorbilidad , Infecciones por Coronavirus/economía , Países en Desarrollo/economía , Personas con Discapacidad/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Composición Familiar , Femenino , Alimentos/economía , Humanos , Lactante , Recién Nacido , Masculino , Indigencia Médica/estadística & datos numéricos , Persona de Mediana Edad , Pandemias/economía , Neumonía Viral/economía , Pobreza , Factores Socioeconómicos , Sri Lanka/epidemiología , Encuestas y Cuestionarios , Adulto Joven
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