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1.
Orthop Clin North Am ; 51(2): 161-168, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32138854

RESUMEN

Despite the increase in utilization of total joint arthroplasty (TJA) throughout high-income countries, there is a lack of access to basic surgical care, including TJA, in low- and middle-income countries (LMICs). Multiple strategies, including short-term surgical trips, establishment of local TJA centers, and education-based international academic collaborations, have been used to bridge the gap in access to quality TJA. The authors review the obstacles to providing TJA in LMICs, the outcomes of the 3 strategies in use to bridge gaps, and a framework for the establishment and maintenance of meaningful international collaborations.


Asunto(s)
Artroplastia de Reemplazo , Ortopedia , Osteoartritis/cirugía , Artroplastia de Reemplazo/economía , Artroplastia de Reemplazo/educación , Artroplastia de Reemplazo/ética , Artroplastia de Reemplazo/normas , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/ética , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/normas , Humanos , Cooperación Internacional , Internacionalidad , Ortopedia/economía , Ortopedia/educación , Ortopedia/organización & administración , Ortopedia/normas
5.
BMC Health Serv Res ; 20(1): 75, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32007089

RESUMEN

Value-Based Medicine (VBM) is imposing itself as 'a new paradigm in healthcare management and medical practice.In this perspective paper, we discuss the role of VBM in dealing with the large productivity issue of the healthcare industry and examine some of the worldwide industrial and technological trends linked with VBM introduction. To clarify the points, we discuss examples of VBM management of stroke patients.In our conclusions, we support the idea of VBM as a strategic aid to manage rising costs in healthcare, and we explore the idea that VBM, by establishing value-generating networks among different healthcare stakeholders, can serve as the long sought-after redistributive mechanism that compensate patients for the industrial exploitation of their personal medical records.


Asunto(s)
Prestación de Atención de Salud/economía , Costos de la Atención en Salud/estadística & datos numéricos , Accidente Cerebrovascular/terapia , Control de Costos/métodos , Humanos , Accidente Cerebrovascular/economía
6.
Med Care ; 58(3): 257-264, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32106167

RESUMEN

BACKGROUND: Medical care overuse is a significant source of patient harm and wasteful spending. Understanding the drivers of overuse is essential to the design of effective interventions. OBJECTIVE: We tested the association between structural factors of the health care delivery system and regional differences systemic overuse. RESEARCH DESIGN: We conducted a retrospective analysis of deidentified claims for 18- to 64-year-old adults from the IBM MarketScan Commercial Claims and Encounters Database. We calculated a semiannual Johns Hopkins Overuse Index for each of the 375 Metropolitan Statistical Areas in the United States, from January 2011 to June 2015. We fit an ordinary least squares regression to model the Johns Hopkins Overuse Index as a function of regional characteristics of the health care system, adjusted for confounders and time. RESULTS: The supply of regional health care resources was associated with systemic overuse in commercially insured beneficiaries. Regional characteristics associated with systemic overuse included number of physicians per 1000 residents (P=0.001) and higher Medicare malpractice geographic price cost index (P<0.001). Regions with a higher density of primary care physicians (P=0.008) and a higher proportion of hospital-based providers (P=0.016) had less systemic overuse. Differences in hospital and insurer market power were inversely associated with systemic overuse. CONCLUSIONS: Systemic overuse is associated with observable, structural characteristics of the regional health care system. These findings suggest that interventions that aim to improve care efficiency via reductions in overuse should focus on the structural drivers of this phenomenon, rather than on the eradication of individual overused procedures.


Asunto(s)
Geografía , Mal Uso de los Servicios de Salud , Beneficios del Seguro , Sector Privado , Adulto , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/tendencias , Femenino , Mal Uso de los Servicios de Salud/economía , Mal Uso de los Servicios de Salud/tendencias , Humanos , Beneficios del Seguro/economía , Beneficios del Seguro/tendencias , Masculino , Medicare/economía , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos , Adulto Joven
10.
Lancet ; 395(10223): 524-533, 2020 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-32061298

RESUMEN

Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Ahorro de Costo/métodos , Prestación de Atención de Salud/economía , Costos de los Medicamentos/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Medicare/economía , Patient Protection and Affordable Care Act , Pronóstico , Estados Unidos , Atención de Salud Universal
12.
PLoS One ; 15(1): e0227149, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31935218

RESUMEN

Racism is a neglected but relevant cause of health disparities within multi-ethnic societies. Different types of racism and other expressions of discrimination must be recognized, critically analyzed, and actively reverted. This paper is based on anthropological fieldwork conducted in three medical facilities in the indigenous region Sierra de Totonacapan in the highlands of Veracruz in Mexico and analyzes maternal health and identifies levels of racism as perceived by female indigenous patients. Applying a theoretical framework that defines racism at three levels, namely, institutionalized, personally mediated, and internalized racism. We empirically distinguish and acknowledge human rights omissions and violations and then analyze the sources of racism in close relation to an intersectional view on gender-, class-, and race-based forms of discrimination. Finally, in addition to investment in health goods and skilled birth attendants, we propose an intercultural competence approach to manage racism, among other ideologies. This approach targets health professionals as conscious, reflexive, and transformative actors of intercultural interactions with culturally diverse patients.


Asunto(s)
Prestación de Atención de Salud/etnología , Personal de Salud/psicología , Disparidades en Atención de Salud/etnología , Servicios de Salud Materna , Racismo/etnología , Adolescente , Adulto , Anciano , Barreras de Comunicación , Diversidad Cultural , Prestación de Atención de Salud/economía , Femenino , Humanos , Masculino , Salud Materna , México/etnología , Persona de Mediana Edad , Pobreza , Relaciones Profesional-Paciente , Estudios Retrospectivos , Encuestas y Cuestionarios , Adulto Joven
13.
Med Hist ; 64(1): 32-51, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31933501

RESUMEN

This paper addresses the relative scholarly oversight of the history of public health in Haiti through a close examination of the colonial public health system constructed and operated by the United States (US) during its occupation of Haiti from 1915 to 1934. More than simply documenting a neglected aspect of Caribbean history, the paper offers the US occupation of Haiti as a remarkably clear example of a failed attempt to use a free public health service to cultivate a health conscientiousness among the Haitian citizenry through the aggressive treatment of highly visible ailments such as cataracts and yaws. I argue that the US occupation viewed the success of the Haitian Public Health Service as critical to the generation of a taxable, compliant and trusting citizenry that the colonial state could enter into a contract with. This idealistic programme envisioned by the US occupation was marred by financial mismanagement, racism, delusions of grandeur and contempt for Haitian physicians that resulted in the production of a far more precarious public health service and administrative state than the US occupation had hoped. By the time the Great Depression arrived in 1930 the Haitian Public Health Service was gutted and privatised, having successfully provided the majority of Haitians with free healthcare, yet failed to have persuaded them of the value of being governed by a centralised administrative state.


Asunto(s)
Prestación de Atención de Salud/historia , Salud Pública/historia , Actitud del Personal de Salud , Colonialismo/historia , Prestación de Atención de Salud/economía , Haití , Historia del Siglo XX , Humanos , Médicos/historia , Administración en Salud Pública/historia , Práctica de Salud Pública/historia , Racismo/historia , Estados Unidos
14.
World Neurosurg ; 135: e716-e722, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31899389

RESUMEN

BACKGROUND: Anterior lumbar interbody fusion (ALIF) is a commonly performed surgical procedure for the management of degenerative lumbar spine pathologic entities. Despite an increasing number of ALIFs performed nationally, to the best of our knowledge, no study has evaluated the costs associated with the 90-day episode of care postoperatively. METHODS: The 2007-2016 Humana Administrative Claims data set, a national database of commercial and Medicare Advantage (MA) beneficiaries, was queried using Current Procedural Terminology code 22558 for patients who had undergone single-level ALIF. The 90-day costs were defined using the following categories: facility, surgeon, anesthesia, other hospitalization costs and services, radiology, office visits, physical therapy/rehabilitation, emergency department visits, and readmissions. RESULTS: A total of 365 ALIF procedures (MA, n = 244; commercial, n = 121) were included in the analysis. The average 90-day cost of single-level ALIF was $25,568 and $51,741 for the MA and commercial enrollees, respectively. The major proportion of 90-day costs was attributable to facility reimbursement (74%-76%), followed by surgeon costs (9%-11%). Postacute care (i.e., office visits and physical therapy/rehabilitation) was not a major driver of the 90-day costs, consisting of only 0.7%-1.3% of the total 90-day reimbursement. Of patients who had required readmission, the costs of the readmission increased the average 90-day costs by 65%-66%. CONCLUSIONS: Facility costs were the major drivers of a stipulated 90-day reimbursement for patients undergoing single-level ALIF. Health policy makers and providers can use these data to better understand the distribution of costs in a stipulated bundled-payment model for ALIFs and allow them to identify areas in which cost reduction strategies can be performed.


Asunto(s)
Degeneración del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Fusión Vertebral/métodos , Costos y Análisis de Costo , Prestación de Atención de Salud/economía , Episodio de Atención , Instituciones de Salud/economía , Costos de Hospital , Humanos , Degeneración del Disco Intervertebral/economía , Medicare/economía , Readmisión del Paciente/economía , Sector Privado/economía , Estudios Retrospectivos , Fusión Vertebral/economía , Cirujanos/economía , Estados Unidos
15.
Plast Reconstr Surg ; 145(2): 471-481, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985644

RESUMEN

BACKGROUND: Hand surgeons can alleviate the burden associated with various congenital anomalies, burn sequelae, and trauma that debilitate individuals in low- and middle-income countries. Because few surgeons in these areas have the necessary resources to perform complex hand surgery, surgical trips provide essential surgical care. The authors aimed to determine the economic benefit of hand surgical trips to low- and middle-income countries to comprehensively determine the economic implications of hand surgery trips in low-resource settings. METHODS: The authors collected data from two major global hand surgery organizations to analyze the economic benefit of hand surgery trips in low- and middle-income countries. The authors used both the human capital approach and the value of a statistical life-year approach to conduct this cost-benefit analysis. To demonstrate the economic gain, the authors subtracted the budgeted cost of each trip from the economic benefit. RESULTS: The authors analyzed a total of 15 trips to low- and middle-income countries. The costs of the trips ranged from $3453 to $87,434 (average, $24,869). The total cost for all the surgical trips was $373,040. The authors calculated a net economic benefit of $3,576,845 using the human capital approach and $8,650,745 using the value of a statistical life-year approach. CONCLUSIONS: The authors found a substantial return on investment using both the human capital approach and the value of a statistical life-year approach. In addition, the authors found that trips emphasizing education had a net economic benefit. Cost-benefit analyses have substantial financial implications and will aid policy makers in developing cost-reduction strategies to promote surgery in low- and middle-income countries.


Asunto(s)
Países en Desarrollo/economía , Deformidades Congénitas de la Mano/economía , Traumatismos de la Mano/economía , Mano/cirugía , Adolescente , Adulto , Anciano , Niño , Preescolar , Análisis Costo-Beneficio , Prestación de Atención de Salud/economía , Femenino , Deformidades Congénitas de la Mano/cirugía , Traumatismos de la Mano/cirugía , Humanos , Masculino , Turismo Médico/economía , Área sin Atención Médica , Persona de Mediana Edad , Embarazo , Años de Vida Ajustados por Calidad de Vida , Estudios Retrospectivos , Viaje/economía , Viaje/estadística & datos numéricos , Adulto Joven
18.
Rev Saude Publica ; 53: 110, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31826176

RESUMEN

OBJECTIVE: To evaluate the influence of the Mais Médicos (More Doctors) Program on the performance of primary health care by quantifying health services access and use in Northeast Brazil, based on the population size of the municipalities, on the financial investment in health, and on the number of physicians in the family health teams. METHOD: Evaluative research of quantitative nature. Access was evaluated by the population coverage ratio of the Family Health Strategy and use of health services, which were measured by medical appointments conducted between April 2013 and September 2015. We defined processes for database selection, adjustment, and validation, including explanatory variables for a sample of 896 municipalities. The analysis was based on the time periods before and after the implementation of the program. The Wilcoxon signed-rank test and non-parametric alternatives constituted statistical tests in the comparative analysis of the data. RESULTS: A 19.2% increase was observed in the number of medical appointments between the first six months and the final six months of the data series. In this period, the median appointments in municipalities with up to 5,000 inhabitants increased from 701.0 to 768.0; while in those with more than 100,000 inhabitants it decreased from 285.5 to 280.0 (p < 0.05). Between April 2013 and September 2015, the median coverage ratio of the family health teams increased from 89.2% to 95.3%, approaching 100% in the municipalities with up to 20,000 inhabitants. CONCLUSIONS: The study highlights the expansion of access and use of primary health care services in the northeast region after the implementation of the Mais Médicos (More Doctors) Program. Between April 2013 and September 2015, the coverage of family health teams and the production of medical appointments increased, constituting important achievements for SUS.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Programas de Gobierno , Médicos/provisión & distribución , Atención Primaria de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Brasil , Prestación de Atención de Salud/economía , Salud de la Familia , Asignación de Recursos para la Atención de Salud , Humanos , Atención Primaria de Salud/economía , Evaluación de Programas y Proyectos de Salud , Recursos Humanos
19.
PLoS One ; 14(12): e0226510, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31856192

RESUMEN

BACKGROUND: Person-centered care demands the evaluation of needs and preferences of the patients. In this study, we conducted a segmentation analysis of a large sample of older people based on their bio-psycho-social-needs and functioning. The aim of this study was to clarify differences in health care use and costs of the elderly in Germany. METHODS: Data was derived from the 8-year follow-up of the ESTHER study-a German epidemiological study of the elderly population. Trained medical doctors visited n = 3124 participants aged 57 to 84 years in their home. Bio-psycho-social health care needs were assessed using the INTERMED for the Elderly (IM-E) interview. Further information was measured using questionnaires or assessment scales (Barthel index, Patients Health Questionnaire (PHQ) etc.). The segmentation analysis applied a factor mixture model (FMM) that combined both a confirmatory factor analysis and a latent class analysis. RESULTS: In total, n = 3017 persons were included in the study. Results of the latent class analysis indicated that a five-cluster-model best fit the data. The largest cluster (48%) can be described as healthy, one cluster (13.9%) shows minor physical complaints and higher social support, while the third cluster (24.3%) includes persons with only a few physical and psychological difficulties ("minor physical and psychological complaints"). One of the profiles (10.5%) showed high and complex bio-psycho-social health care needs ("complex needs") while another profile (2.5%) can be labelled as "frail". Mean values of all psychosomatic variables-including the variable health care costs-gradually increased over the five clusters. Use of mental health care was comparatively low in the more burdened clusters. In the profiles "minor physical and psychological complaints" and "complex needs", only half of the persons suffering from a mental disorder were treated by a mental health professional; in the frail cluster, only a third of those with a depression or anxiety disorder received mental health care. CONCLUSIONS: The segmentation of the older people of this study sample led to five different clusters that vary profoundly regarding their bio-psycho-social needs. Results indicate that elderly persons with complex bio-psycho-social needs do not receive appropriate mental health care.


Asunto(s)
Costos y Análisis de Costo , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/estadística & datos numéricos , Salud Mental/estadística & datos numéricos , Evaluación de Necesidades , Anciano , Anciano de 80 o más Años , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad
20.
PLoS One ; 14(12): e0226686, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31860656

RESUMEN

Online crowdfunding platforms such as GoFundMe are used to raise funds for health-related expenses associated with medical conditions such as organ transplantation. By investigating crowdfunding in Canadian organ transplantation, this study aimed to increase understanding of the motivations and outcomes of organ transplantation crowdfunding. Canadian liver and kidney transplantation campaigns posted to GoFundMe between May 30 & 31 2018 were identified and after exclusion, 258 kidney and 171 liver campaigns were included in study. These campaigns were coded for: worthiness of the campaign recipient, requested financial and non-monetary contributions, how monetary donations would be spent, and comments on the Canadian health system, among others. Results suggest Canadian organ donors, transplant candidates, recipients, and their families and caregivers experience significant financial difficulties not addressed by the public health system. Living and medication costs, transportation and relocation expenses, and income loss were the expenses most commonly highlighted by campaigners. Liver campaigns raised nearly half their goal while kidney campaigns received 11.5% of their requested amount. Findings highlight disease burden and the use of crowdfunding as a response to the extraordinary costs associated with organ transplantation. Although crowdfunding reduces some financial burden, it does not do so equitably and raises ethical concerns.


Asunto(s)
Obtención de Fondos/métodos , Costos de la Atención en Salud , Trasplante de Riñón/economía , Trasplante de Hígado/economía , Adulto , Canadá , Cuidadores/economía , Niño , Prestación de Atención de Salud/economía , Familia , Obtención de Fondos/ética , Financiación de la Atención de la Salud , Humanos , Donantes de Tejidos , Receptores de Trasplantes
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