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Lima; Perú. Ministerio de Salud; 20191100. 45 p. ilus, tab.
Monografia em Espanhol | LILACS, LIPECS | ID: biblio-1024810


Contribuir con la mejora de la gestión en el uso eficiente de los recursos públicos que son utilizados por la IPRESS para brindar servicios de salud a la población usuaria

Atenção Primária à Saúde , Alocação de Custos , Instalações de Saúde , Serviços de Saúde
Farm. hosp ; 43(4): 121-127, jul.-ago. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-183898


Objective: There are differences between countries regarding data requirements for orphan drug evaluation and it is also unknown which criteria might determine the price and reimbursement decision. This study aimed to identify the key criteria for price and reimbursement of orphan drugs in Spain, approved by the European Commission, between January 2012 and June 2018. Method: A descriptive analysis of the orphan drugs and its characteristics was performed. Outcomes criteria assessed were: therapeutic area, existence of alternative treatment, rarity of the disease, clinical trial outcomes and therapeutic positioning report assessment. Hypotheses for each variable regarding Spanish pricing and reimbursement were made and tested with two regression analyses. Results: Out of 78 orphan drugs approved by the European Commission, 82.1% asked pricing and reimbursement in Spain. From this, 43.8% had pricing and reimbursement approved and 20.3% rejected. Mean time from Spanish marketing authorisation approval to pricing and reimbursement approval was 12.1 ± 5.1 months. Having a positive therapeutic positioning report and no therapeutic alternatives would be associated with a positive pricing and reimbursement in Spain. Conclusions: It remains challenging to establish which are the driving criteria for pricing and reimbursement approval of orphan drugs in Spain. Further research should be done including other variables that might influence the pricing and reimbursement final decision in Spain

Objetivo: Los requisitos para la evaluación de los medicamentos huérfanos difieren entre los países miembros de la Unión Europea y tampoco se sabe qué criterios influyen en la decisión final sobre precio y financiación. Este estudio ha tenido como objetivo identificar los criterios clave para establecer el precio y la financiación de los medicamentos huérfanos en España, una vez aprobados por la Comisión Europea, entre enero de 2012 hasta junio de 2018. Método: Se realizó un análisis descriptivo de los medicamentos huérfanos y sus características. Los criterios evaluados fueron: área terapéutica, existencia de tratamientos alternativos, rareza de la enfermedad, tipo de resultados de los ensayos clínicos e informe de posicionamiento terapéutico. Para cada variable se estableció una hipótesis con respecto a la aprobación de precio y financiación y se analizaron con dos análisis de regresión. Resultados: De las 78 aprobaciones de medicamentos huérfanos realizadas por la Comisión Europea, el 82,1% solicitaron precio y financiación en España. De estas, el 43,8% fueron aprobadas y el 20,3% fueron rechazadas. El tiempo medio desde la aprobación de la autorización de comercialización en España hasta la aprobación del precio y la financiación fue de 12,1 ± 5,1 meses. Un informe de posicionamiento positivo y la falta de alternativas terapéuticas se asociaría con una aprobación de precio y financiación. Conclusiones: Sigue siendo un reto establecer cuáles son los criterios clave para la aprobación de los medicamentos huérfanos en España. Los próximos estudios deberían incluir un mayor número de variables que puedan influir en el precio y la decisión de financiación

Produção de Droga sem Interesse Comercial/economia , Produção de Droga sem Interesse Comercial/normas , Tecnologia Biomédica/normas , Alocação de Custos/normas , Custos e Análise de Custo , Modelos Logísticos , Comercialização de Medicamentos
Manag Care ; 28(4): 27-29, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31188120


It is a heroic part of the American health system. Lives are saved, the dire consequences avoided. But the air ambulance industry is consolidating, prices are soaring, and insurers and providers continually fight over network issues. One consequence: Surprise billing that leaves patients owing tens of thousands of dollars.

Resgate Aéreo/economia , Ambulâncias , Alocação de Custos , Humanos , Estados Unidos
Kennedy Inst Ethics J ; 29(1): 1-31, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080175


Physicians' advocacy obligations are best understood as going beyond advocacy on behalf of individual patients, which I call the "individualistic view," to include advocacy for intelligent research-based allocation schemes that promote good outcomes and cost-effective care for all patients, which I call the "systemic view." This systemic view includes moving beyond self-interest to promote less-wasteful and more cost-conscious allocation decisions and the setting of priorities at all levels to expand health care access. It includes physician involvement in discussions with patients in the context of clinical care, involvement in the formulation and administration of benefit structures and other allocation policies, and, finally, involvement in promoting public dialogue about health care priorities. This involvement is based on a concept of a deliberative process that can result in "just enough" decisions within systems for the preservation and promotion of health care and other societal goods.

Alocação de Recursos para a Atenção à Saúde/ética , Acesso aos Serviços de Saúde/ética , Defesa do Paciente/ética , Papel do Médico , Alocação de Recursos/ética , Justiça Social/ética , Alocação de Custos/ética , Tomada de Decisões , Custos de Cuidados de Saúde/ética , Alocação de Recursos para a Atenção à Saúde/economia , Prioridades em Saúde/economia , Prioridades em Saúde/ética , Promoção da Saúde/economia , Promoção da Saúde/ética , Acesso aos Serviços de Saúde/economia , Humanos , Consentimento Livre e Esclarecido/ética , Benefícios do Seguro/economia , Benefícios do Seguro/ética , Reembolso de Seguro de Saúde/ética , Defesa do Paciente/economia , Alocação de Recursos/economia
Am J Public Health ; 109(6): 885-891, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30998407


Objectives. To assess states' provision of technical assistance and allocation of block grants for treatment, prevention, and outreach after the expansion of health insurance coverage for addiction treatment in the United States under the Affordable Care Act (ACA). Methods. We used 2 waves of survey data collected from Single State Agencies in 2014 and 2017 as part of the National Drug Abuse Treatment System Survey. Results. The percentage of states providing technical assistance for cross-sector collaboration and workforce development increased. States also shifted funds from outpatient to residential treatment services. However, resources for opioid use disorder medications changed little. Subanalyses indicated that technical assistance priorities and allocation of funds for treatment services differed between Medicaid expansion and nonexpansion states. Public Health Implications. The ACA's infusion of new public and private funds enabled states to reallocate funds to residential services, which are not as likely to be covered by health insurance. The limited allocation of block grant funds for effective opioid medications is concerning in light of the opioid crisis, especially in states that did not implement the ACA's Medicaid expansion.

Financiamento Governamental , Cobertura do Seguro/economia , Patient Protection and Affordable Care Act/economia , Governo Estadual , Transtornos Relacionados ao Uso de Substâncias/terapia , Alocação de Custos , Humanos , Medicaid/economia , Medicaid/organização & administração , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/terapia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Estados Unidos
J Laparoendosc Adv Surg Tech A ; 29(2): 136-140, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30222503


BACKGROUND: Since the late 1980s, minimally invasive surgery (MIS) has been one of the fastest growing approaches for surgical procedures. However, its development has reached a plateau. One of the reasons is the difficulty to operate on more complex cases, such as neonatal procedures. Some experts report outstanding outcomes for complex operations, but not all surgeons may be able to achieve the same results. Is robotic surgery (RS) a solution? METHODS: To answer this question, we reviewed the current indications of RS for the pediatric population and the steps needed to incorporate the robotic surgical system in a children's hospital. We reported our experience and presented our first results and the encountered problems. RESULTS: After a year and a half of experience with RS, several lessons were learned: (1) the current robotic surgical system cannot yet be considered a replacement to conventional MIS, (2) docking is less time consuming than expected, (3) postoperative pain is significantly decreased, (4) the absence of haptic feedback is still a matter of concern, and (5) costs can be afforded by sharing the RS with adult surgeons. CONCLUSIONS: Based on our experience, the advantages seem to outweigh the drawbacks as it encourages team building and increases overall comfort for the surgeon. However, the current literature fails to prove that RS gives better results for pediatric patients. New advances in technology will probably help to overcome the encountered difficulties and the high costs.

Custos Hospitalares , Hospitais Pediátricos/organização & administração , Procedimentos Cirúrgicos Robóticos , Alocação de Custos , Retroalimentação Sensorial , Hospitais Pediátricos/economia , Humanos , Laparoscopia/efeitos adversos , Dor Pós-Operatória/etiologia , Desenvolvimento de Programas , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/economia , Centro Cirúrgico Hospitalar/economia , Percepção do Tato
J Manag Care Spec Pharm ; 25(1): 66-71, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29927346


BACKGROUND: Developments in diagnostics, medical devices, procedures, and prescription drugs have increased life expectancy and quality of life after diagnosis for many diseases. Previous research has shown that, overall, increased investment in medical technology has led to increased health outcomes. In addition, the value of investment in specific innovations, particularly in new pharmaceuticals or biopharmaceuticals, has frequently been shown through an evaluation of the associated health outcomes and costs. Value assessments for all medical technologies and interventions are an important consideration in current debates on access and affordability of health care in the United States. OBJECTIVE: To identify practicing physician impressions of the historical effect of postdiagnosis innovations in medical technology on patient outcomes within the 8 health conditions that have the largest effect on health in the United States. METHODS: National statistics were used to identify the 8 conditions responsible for the most mortality and morbidity within the United States between 1990 and 2014. A physician survey was developed for each major condition to obtain physician opinion on the extent to which pharmaceuticals and biopharmaceuticals, medical devices, diagnostics, and surgical procedures contributed to improvements in postdiagnosis mortality and morbidity outcomes over the evaluated period. Respondents were provided with a fifth category, "cannot allocate," to account for postdiagnosis outcome gains resulting from other factors such as public health interventions. RESULTS: The conditions identified as having the greatest effect on morbidity and mortality since 1990 were breast cancer, ischemic heart disease, human immunodeficiency virus infection, diabetes, unipolar depression, chronic obstructive pulmonary disease, cerebrovascular disease, and lung cancer. After excluding other factors, physicians specializing in these conditions, with a mean of 21.4 years in practice, considered pharmaceuticals and biopharmaceuticals as having the greatest postdiagnosis effect across all 8 conditions, with 56% of outcome gains attributed to this innovation category. Diagnostics was the second biggest contributor at 20%. CONCLUSIONS: Physician perceptions indicated that attention should be paid to value assessments of innovative diagnostics, devices, and surgical procedures, as well as to pharmaceuticals and biopharmaceuticals, before goals for allocating health care expenditures among the different innovations are determined. DISCLOSURES: Funding for this study was provided by the National Pharmaceutical Council, a health policy research group that receives its funding from biopharmaceutical manufacturers. Wamble is employed by RTI Health Solutions, which received funding from the National Pharmaceutical Council to conduct this research. Ciarametaro and Dubois are employed by the National Pharmaceutical Council.

Tecnologia Biomédica/economia , Alocação de Custos , Invenções/economia , Médicos/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Técnicas e Procedimentos Diagnósticos/economia , Técnicas e Procedimentos Diagnósticos/instrumentação , Tratamento Farmacológico/economia , Tratamento Farmacológico/métodos , Gastos em Saúde/estatística & dados numéricos , Humanos , Morbidade , Mortalidade , Qualidade de Vida , Terapêutica/economia , Terapêutica/instrumentação , Terapêutica/métodos , Estados Unidos/epidemiologia
Rev. enferm. UFPE on line ; 13: [1-6], 2019. ilus, tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-1046247


Objetivo: avaliar o custo envolvido no preparo da nutrição parenteral em hospital universitário ao adquirido de uma empresa terceirizada. Método: trata-se de um estudo quantitativo, descritivo, exploratório com análise retrospectiva de dados. Obtiveram-se os dados por meio das prescrições médicas e notas fiscais das NP's. Calcularam-se, para a comparação de custos, os custos médios, em reais, das NP's por prescrição praticados pela empresa terceirizada, o valor estimado da produção no hospital comparado com o valor de ressarcimento pelo SUS, de acordo com a tabela Sistema de Gerenciamento da Tabela de Procedimento (SIGTAP) do SUS. Apresentaram-se os resultados em forma de tabelas. Resultados: analisaram-se 1818 prescrições, sendo 51,05% das prescrições de adultos; 22,71% de Pediatria e 26,24% de Neonatologia. Conclusão: conclui-se que os valores pagos pelo SUS são inferiores aos gastos pelos serviços de saúde, independentemente do tipo de produção da NP. Considera-se este estudo importante para auxiliar os gestores dos serviços hospitalares na tomada de decisões.(AU)

Objective: to evaluate the cost involved in the preparation of parenteral nutrition in a university hospital when acquired from a third party company. Method: this is a quantitative, descriptive, exploratory study with retrospective data analysis. The data was obtained through the medical prescriptions and fiscal notes of the PNs. The average costs, in reais, of the prescription PNs practiced by the outsourced company were calculated for the comparison of costs, the estimated value of the hospital production compared to the UHS compensation amount, according to the Management System table of the UHS Procedure Table (SIGTAP). Results were presented in the form of tables. Results: 1818 prescriptions were analyzed, being 51.05% of adult prescriptions; 22.71% of Pediatrics and 26.24% of Neonatology. Conclusion: it is concluded that the amounts paid by the UHS are lower than those spent by the health services, regardless of the type of PN production. This study is considered important to assist hospital managers in decisionmaking.(AU)

Objetivo: evaluar el costo involucrado en la preparación de la nutrición parenteral en un hospital universitario al adquirido de una empresa tercerizada. Método: se trata de un estudio cuantitativo, descriptivo, exploratorio con análisis retrospectivo de datos. Se obtuvieron los datos por medio de las prescripciones médicas y las notas fiscales de las NP's. Se calcularon, para la comparación de costos, los costos medianos, en reales, de las NP's por prescripción practicados por la empresa tercerizada, el valor estimado de la producción en el hospital comparado con el valor de resarcimiento por el SUS, de acuerdo con la tabla Sistema de Gestión de la Tabla de Procedimiento (SIGTAP) del SUS. Se presentaron los resultados en forma de tablas. Resultados: se analizaron 1818 prescripciones, siendo el 51,05% de las prescripciones de adultos; el 22,71% de Pediatría y el 26,24% de Neonatología. Conclusión: se concluye que los valores pagados por el SUS son inferiores a los gastos por los servicios de salud, independientemente del tipo de producción de la NP. Se considera este estudio importante para auxiliar a los gestores de los servicios hospitalarios en la toma de decisiones.(AU)

Humanos , Masculino , Feminino , Nutrição Parenteral , Custos Hospitalares , Custos e Análise de Custo , Soluções de Nutrição Parenteral , Administração Hospitalar , Estudos Retrospectivos , Alocação de Custos
In. Argentina. Ministerio de Salud y Desarrollo Social. Secretaria de Salud. Anuario 2015. Becas de Investigación. Ramón Carillo Arturo Oñativia. Ciudad Autónoma de Buenos Aires, Ministerio de Salud y Desarrollo Social. Secretaria de Salud, Diciembre 2018. p.50-50.
Monografia em Espanhol | BINACIS, ARGMSAL | ID: biblio-988175


Introducción En un contexto de crecimiento de la demanda de servicios asistenciales y cambios en los costos de los insumos, se ofrece un modelo de toma de decisiones y un ejemplo práctico de aplicación de la conformación de los laboratorios y un estudio de costos considerando una unidad de medida homogénea en términos de producción y costos, cuya finalidad es maximizar la racionalidad de la aplicación de recursos económicos en la compra de reactivos y equipos de laboratorios para dichos efectores. Objetivos Generar un marco de referencia teórico y práctico a fin de alcanzar una posición de mayor eficiencia en la aplicación de los recursos del Estado en salud, en particular para los laboratorios que funcionan en los centros asistenciales de referencia. Métodos Se realizó un estudio de costos cuantitativo, descriptivo, observacional y longitudinal, enfocado en el análisis de los gastos y producción de laboratorio. Resultados El estudio analiza la cantidad de turnos atendidos y, principalmente, las determinaciones realizadas, las cuales son transformadas en unidades de laboratorio de acuerdo con un sistema de coeficientes diseñados para tal fin. En este sentido, se computa también el gasto promedio mensual en reactivos incurrido por los hospitales bajo estudio y se observa la evolución del costo por unidad de laboratorio, tipo de determinación y turnos atendidos, tanto en la dimensión intertemporal como interhospitalaria. Conclusiones Mediante datos de costos unitarios concretos, se provee un marco de referencia para definir el set de equipos de laboratorio que mejor se ajusta a las necesidades asistenciales de los efectores sanitarios, de acuerdo con sus prestaciones y en pos de una eficiencia que permite disminuir el costo comparativo por unidad de laboratorio

Humanos , Redução de Custos , Análise Custo-Benefício , Alocação de Custos
Manag Care ; 27(9): 15, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30216152


With accumulators, the value of any copay assistance cards or coupons does not count toward out-of-pocket medicine costs that are applied toward deductibles. It's a cost-shifting tool that's facing pushback from patients, providers, and others saying that accumulators will hurt public health.

Alocação de Custos/economia , Dedutíveis e Cosseguros/economia , Custos de Medicamentos/estatística & dados numéricos , Programas de Assistência Gerenciada/economia , Uso de Medicamentos/economia , Humanos , Política Pública , Estados Unidos
Artigo em Espanhol | PAHO-IRIS | ID: phr-49516


[RESUMEN]. Objetivo. Analizar el comportamiento de los costos médicos directos en relación al número de intentos de suicidio y comparar los costos de atención cognitivo-conductual respecto al tratamiento convencional. Métodos. Se cuantificaron los costos por prestación de servicios hospitalarios por intento de suicidio en 248 pacientes con diagnóstico de enfermedad mental atendidos en la empresa social del estado (E.S.E.) Hospital Mental de Antioquia y se implementó una evaluación de costo-consecuencia. Resultados. Se encontró que los costos directos promedio de la atención de pacientes con cuatro o más intentos de suicidio fueron equivalentes a 5 641 dólares estadounidenses (USD), con una diferencia de USD 5 490 respecto al grupo con un solo intento. Además, dichos costos aumentaron conforme se incrementó el número de intentos. Por último, el diagnóstico de enfermedad mental (p. ej., cronicidad), el método de intento y la necesidad de servicios especializados se relacionaron con el incremento en los costos directos. Conclusiones. La implementación de estrategias preventivas desde la salud pública que evalúen y hagan seguimiento a los factores psicosociales podría reducir la presentación de la problemática y de sus costos médicos directos.

[ABSTRACT]. Objective. Analyze the behavior of direct medical costs in relation to the number of suicide attempts and compare the costs of cognitive-behavioral therapy with those of conventional treatment. Methods. The cost of hospital services for attempted suicide was quantified for 248 patients with a diagnosis of mental illness treated at the Antioquia Mental Hospital, a state social enterprise (E.S.E.), and a cost-outcome analysis was performed. Results. It was found that the average direct cost of care for patients with four or more suicide attempts was equivalent to US$ 5,641, a US$ 5,490 difference vis-à-vis the group with a single attempt. Moreover, the cost increased with the number of attempts. Finally, the diagnosis of mental illness (e.g., chronicity), the method used in the suicide attempt, and the need for specialized services were associated with the increase in direct costs. Conclusions. The use of a public health approach involving preventive strategies that assess and monitor psychosocial factors could reduce the problem and its direct medical costs.

[RESUMO]. Objetivo. Examinar o comportamento dos custos médicos diretos em relação ao número de tentativas de suicídio e comparar o custo da terapia cognitivocomportamental e do tratamento convencional. Métodos. O custo por prestação de serviços hospitalares por tentativa de suicídio foi mensurado em 248 pacientes com diagnóstico de doença mental atendidos no Hospital Mental de Antioquia, um serviço da previdência social do Estado, e foi conduzida uma análise de custo-consequência. Resultados. Verificou-se que os custos diretos médios do atendimento de pacientes com quatro ou mais tentativas de suicídio foram equivalentes a US$ 5.641, com uma diferença de US$ 5.490 em relação aos custos para os pacientes com uma única tentativa de suicídio. Estes custos aumentaram conforme aumentou o número de tentativas. O diagnóstico de doença mental (por exemplo, doença crônica), o método de tentativa de suicídio e a necessidade de serviços especializados foram relacionados ao aumento dos custos diretos. Conclusões. A implementação de estratégias de prevenção de uma perspectiva de saúde pública para avaliar e monitorar os fatores psicossociais poderia contribuir para reduzir a ocorrência do problema e os custos médicos diretos correspondentes.

Saúde Mental , Alocação de Custos , Tentativa de Suicídio , Transtornos Mentais , Fatores de Risco , Colômbia , Saúde Mental , Alocação de Custos , Tentativa de Suicídio , Transtornos Mentais , Fatores de Risco , Saúde Mental , Alocação de Custos , Tentativa de Suicídio , Transtornos Mentais , Fatores de Risco , Colômbia
Soc Sci Med ; 211: 338-351, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30015243


BACKGROUND: Harsh funding cutbacks along with measures shifting cost to patients have been implemented in the Greek health system in recent years. Our objective was to investigate the evolution of financial protection of Greek households against out-of-pocket payments (OOPP) during the economic crisis. METHODS: National representative data of 33,091 households were derived from the Household Budget Surveys for the period 2008-2015. Financial protection was assessed by applying the approaches of catastrophic (CHE) and impoverishing OOPP. The determinants of CHE and impoverishment were examined using binary logistic regressions. RESULTS: OOPP dropped by 23.5% in real values between 2008 and 2015, though their share in households' budget rose from 6.9% to 7.8%, with an increasing trend since 2012. These outcomes were driven by significant increases in medical products (20.2%) and inpatient (63%) OOPP, while outpatient expenses decreased considerably (-62%). Both incidence and overshoot of CHE were significantly exacerbated. The additional burden was distributed progressively, hence, financial risk inequalities decreased. Food poverty increased, but its incidence still remains at very low levels. Both incidence and intensity of relative poverty increased considerably in real terms. The poverty impact of OOPP is aggravating following 2012, and 1.9% of individuals were impoverished due to OOPP in 2015. Households of higher size, lower expenditure quintile, in urban areas, without disabled, elderly or young children members, and with younger or retired, better-educated breadwinners were significantly less vulnerable to CHE. Households in the lower-middle expenditure quintile, in rural regions, and with elderly members were facing higher risk, while wealthier families exhibited a considerable lower likelihood of impoverishment. CONCLUSIONS: The expansion of reliance of healthcare funding on OOPP has increased the financial risk and hardship of Greek households, which may disrupt their living conditions and create barriers to healthcare access. Cost-sharing policies should recognise the different social protection needs of households.

Assistência à Saúde/economia , Recessão Econômica/tendências , Administração Financeira/métodos , Doença Catastrófica/economia , Alocação de Custos/estatística & dados numéricos , Alocação de Custos/tendências , Assistência à Saúde/estatística & dados numéricos , Recessão Econômica/estatística & dados numéricos , Características da Família , Administração Financeira/normas , Administração Financeira/estatística & dados numéricos , Grécia , Humanos , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/tendências
PLoS One ; 13(5): e0196990, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29768456


BACKGROUND: Acute gastrointestinal illness (AGI) incidence and per-capita healthcare expenditures are higher in some Inuit communities as compared to elsewhere in Canada. Consequently, there is a demand for strategies that will reduce the individual-level costs of AGI; this will require a comprehensive understanding of the economic costs of AGI. However, given Inuit communities' unique cultural, economic, and geographic contexts, there is a knowledge gap regarding the context-specific indirect costs of AGI borne by Inuit community members. This study aimed to identify the major indirect costs of AGI, and explore factors associated with these indirect costs, in the Inuit community of Rigolet, Canada, in order to develop a case-based context-specific study framework that can be used to evaluate these costs. METHODS: A mixed methods study design and community-based methods were used. Qualitative in-depth, group, and case interviews were analyzed using thematic analysis to identify and describe indirect costs of AGI specific to Rigolet. Data from two quantitative cross-sectional retrospective surveys were analyzed using univariable regression models to examine potential associations between predictor variables and the indirect costs. RESULTS/SIGNIFICANCE: The most notable indirect costs of AGI that should be incorporated into cost-of-illness evaluations were the tangible costs related to missing paid employment and subsistence activities, as well as the intangible costs associated with missing community and cultural events. Seasonal cost variations should also be considered. This study was intended to inform cost-of-illness studies conducted in Rigolet and other similar research settings. These results contribute to a better understanding of the economic impacts of AGI on Rigolet residents, which could be used to help identify priority areas and resource allocation for public health policies and programs.

Gastroenteropatias/economia , Inuítes , Programas Nacionais de Saúde/economia , Adolescente , Adulto , Canadá/epidemiologia , Canadá/etnologia , Criança , Pré-Escolar , Alocação de Custos , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/terapia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade
Int J Health Econ Manag ; 18(4): 395-408, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29611068


Maryland implemented one of the most aggressive payment innovations the nation has seen in several decades when it introduced global budgets in all its acute care hospitals in 2014. Prior to this, a pilot program, total patient revenue (TPR), was established for 8 rural hospitals in 2010. Using financial hospital report data from the Health Services Cost Review Commission from 2007 to 2013, we examined the hospitals' financial results including revenue, costs, and profit/loss margins to explore the impact of the adoption of the TPR pilot global budget program relative to the remaining hospitals in the state. We analyze financial results for both regulated (included in the global budget and subject to rate-setting) and unregulated services in order to capture a holistic image of the hospitals' actual revenue, cost and margin structures. Common size and difference-in-differences analyses of the data suggest that regulated profit ratios for treatment hospitals increased (from 5% in 2007 to 8% in 2013) and regulated expense-to-gross patient revenue ratios decreased (75% in 2007 and 68% in 2013) relative to the controls. Simultaneously, the profit margins for treatment hospitals' unregulated services decreased (- 12% in 2007 and - 17% in 2013), which reduced the overall margin significantly. This analysis therefore indicates cost shifting and less profit gain from the program than identified by solely focusing on the regulated margins.

Orçamentos/estatística & dados numéricos , Economia Hospitalar/organização & administração , Economia Hospitalar/estatística & dados numéricos , Mecanismo de Reembolso/legislação & jurisprudência , Mecanismo de Reembolso/estatística & dados numéricos , Alocação de Custos , Humanos , Maryland
Annu Rev Med ; 69: 41-52, 2018 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-29414261


The postelection efforts to repeal, replace, or modify the Affordable Care Act (ACA) suggest that the debate over healthcare coverage will remain contentious, particularly because of the high and rising cost of health care. Feasible, potentially bipartisan approaches to improving access to coverage should emphasize reforming health care to achieve higher quality at a lower cost. In the individual market, where many enrollees face limited options and rising premiums, a combination of high-risk pools, reinsurance, and risk adjustment could improve coverage options while encouraging innovations in care for the highest-risk patients. State Medicaid programs, which are increasingly important sources of coverage but are crowding out other important budget priorities that affect population health, could achieve better results through federal reforms that provide more flexibility for states alongside greater emphasis on achieving better outcomes. Accelerating payment reforms and other policy changes to encourage more innovative and efficient care delivery models, along with developing better evidence on successful models, can also improve the prospects for coverage reform.

Alocação de Custos , Patient Protection and Affordable Care Act , Mecanismo de Reembolso , Assistência à Saúde , Reforma dos Serviços de Saúde , Política de Saúde , Humanos , Seguro , Estados Unidos
Conserv Biol ; 32(4): 782-788, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29473220


Biodiversity offsetting aims to compensate for development-induced biodiversity loss through commensurate conservation gains and is gaining traction among governments and businesses. However, cost shifting (i.e., diversion of offset funds to other conservation programs) and other perverse incentives can undermine the effectiveness of biodiversity offsetting. Additionality-the requirement that biodiversity offsets result in conservation outcomes that would not have been achieved otherwise-is fundamental to biodiversity offsetting. Cost shifting and violation of additionality can go hand in hand. India's national offsetting program is a case in point. Recent legislation allows the diversion of offset funds to meet the country's preexisting commitments under the United Nations Framework Convention on Climate Change (UNFCCC) and United Nations Convention on Biological Diversity (CBD). With such diversions, no additional conservation takes place and development impacts remain uncompensated. Temporary additionality cannot be conceded in light of paucity of funds for preexisting commitments unless there is open acknowledgement that fulfillment of such commitments is contingent on offset funds. Two other examples of perverse incentives related to offsetting in India are the touting of inherently neutral offsetting outcomes as conservation gains, a tactic that breeds false complacency and results in reduced incentive for additional conservation efforts, and the clearing of native vegetation for commercial plantations in the name of compensatory afforestation, a practice that leads to biodiversity decline. The risks accompanying cost shifting and other perverse incentives, if not preempted and addressed, will result in net loss of forest cover in India. We recommend accurate baselines, transparent accounting, and open reporting of offset outcomes to ensure biodiversity offsetting achieves adequate and additional compensation for impacts of development.

Conservação dos Recursos Naturais , Motivação , Biodiversidade , Alocação de Custos , Índia