Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 12.966
Filtrar
3.
Expert Rev Pharmacoecon Outcomes Res ; 19(5): 517-528, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31401898

RESUMO

Background: Health-care systems in Asian countries are diverse. The economic evaluation provides information on how to make efficient use of the resources available to obtain the maximum benefits. In Asia, diseases such as cardiovascular diseases (CVDs), diabetes mellitus (DM), tuberculosis (TB) and epilepsy generate a heavy economic burden. The objective of this article is to provide a review of the economic burden of health to patients in Asian countries. Areas covered: All data were collected from already published research article and review papers. The databases searched were Science Direct, PubMed, MEDLINE and Google scholar. We found a total of 4456 articles on health economics. After reviewing the title, only 876 relevant articles were considered. Only 92 (n = 92) articles were considered on the basis of inclusion and exclusion criteria. Expert opinion: Available data give evidence that diseases are linked to the low socio-economic status of the Asian population. The cost per capita is high in Asian countries due to insufficient health-care facilities. The cost per capita in Asian countries ranges from $23 (Pakistan) to $1775 (Taiwan). The per capita cost of Malaysia, China, Singapore, and Thailand is $27 $83, $75, and $27, respectively.


Assuntos
Efeitos Psicossociais da Doença , Assistência à Saúde/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Ásia , Análise Custo-Benefício , Economia Médica , Humanos , Fatores Socioeconômicos
5.
Aust N Z J Public Health ; 43(5): 484-495, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31390112

RESUMO

OBJECTIVE: The aim of this literature review was to establish the economic burden of preventable disease in Australia in terms of attributable health care costs, other costs to government and reduced productivity. METHODS: A systematic review was conducted to establish the economic cost of preventable disease in Australia and ascertain the methods used to derive these estimates. Nine databases and the grey literature were searched, limited to the past 10 years, and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed to identify, screen and report on eligible studies. RESULTS: Eighteen studies were included. There were at least three studies examining the attributable costs and economic impact for each risk factor. The greatest costs were related to the productivity impacts of preventable risk factors. Estimates of the annual productivity loss that could be attributed to individual risk factors were between $840 million and $14.9 billion for obesity; up to $10.5 billion due to tobacco; between $1.1 billion and $6.8 billion for excess alcohol consumption; up to $15.6 billion due to physical inactivity and $561 million for individual dietary risk factors. Productivity impacts were included in 15 studies and the human capital approach was the method most often employed (14 studies) to calculate this. CONCLUSIONS: Substantial economic burden is caused by lifestyle-related risk factors. Implications for public health: The significant economic burden associated with preventable disease provides an economic rationale for action to reduce the prevalence of lifestyle-related risk factors. New analysis of the economic burden of multiple risk factors concurrently is needed.


Assuntos
Alcoolismo/economia , Doença Crônica/economia , Doença Crônica/prevenção & controle , Assistência à Saúde/economia , Custos de Cuidados de Saúde , Doenças não Transmissíveis/economia , Obesidade/economia , Obesidade/prevenção & controle , Comportamento Sedentário , Fumar/economia , Alcoolismo/terapia , Austrália/epidemiologia , Doença Crônica/epidemiologia , Efeitos Psicossociais da Doença , Custos e Análise de Custo , Humanos , Estilo de Vida , Doenças não Transmissíveis/terapia , Obesidade/epidemiologia , Fumar/efeitos adversos
6.
BMC Health Serv Res ; 19(1): 544, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375108

RESUMO

BACKGROUND: In most developing countries, healthcare cost is mainly paid at the time of sickness and out-of-pocket at the point of service delivery which potentially could inhibit access. The total economic cost of illness for households is also estimated to be frequently above 10% of household income which is categorized as catastrophic. The purpose of this study was to assess factors that determine decisions to join the community based health insurance in West Gojjam zone. METHODS: A community based cross sectional survey was conducted to collect data from 690 household heads using a multistage sampling technique. A binary logistic regression was used to identify the determinants of household decisions for CBHI enrollment. RESULTS: Out of the participants, 58% were CBHI members. Besides, family size (AOR = 1.17; CI = 1.02-1.35), average health status (AOR = .380; CI = .179-.805), chronic disease (AOR = 3.42; CI = 1.89-6.19); scheme benefit package adequacy (AOR = 2.17; CI = 1.20-3.93), perceived health service quality (AOR = 3.69; CI = 1.77-7.69), CBHI awareness (AOR = 4.90; CI = 1.65-14.4); community solidarity (AOR = 3.77; CI = 2.05-6.92) and wealth (AOR = 3.62; CI = 1.67-7.83) were significant determinant factors for enrolment in the community based health insurance scheme. CONCLUSION: CBHI awareness, family health status, community solidarity, quality of service of health institutions, and wealth were major factors that most determine the household decisions to enroll in the system. Therefore, in-depth and sustainable awareness creation programs on the scheme; stratified premium- based on economic status of households; incorporation of social capital factors, particularly building community solidarity in the scheme implementation are vital to enhance sustainable enrollment. As perceived family health status and the existence of chronic disease were also found significant determinants of enrollment, the Government might have to look for options to make the scheme mandatory.


Assuntos
Seguro Saúde/estatística & dados numéricos , Saúde Pública , Adulto , Comportamento do Consumidor/estatística & dados numéricos , Estudos Transversais , Assistência à Saúde/economia , Etiópia , Feminino , Humanos , Seguro Saúde/economia , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto Jovem
7.
Artigo em Russo | MEDLINE | ID: mdl-31465651

RESUMO

The article based on the analysis of foreign experience of commercialization of health care and introducing management methods typical for business into the work of medical organizations, shows the difficult conflict of interests within the medical community itself, as well as the clash of organizational cultures of doctors and managers. As a result, the population suffers as it either cut of from medical care or pays for imposed medical services. And the doctors suffer because of the pursuit of their leadership for economic efficiency and productivity without taking into account the specifics of the medical profession, and this leads to overwork, stress and early professional burnout. Based on a survey of Russian experts, the authors show that while in the West they come to a conclusion about the need for a management revolution that returns doctors to their priority role and prioritizes not patient's profits, but patient interests, Russia is rapidly moving along the path of unrestrained health care commercialization and fetishization indicators in the medical industry. The article describes a system of economic and organizational-legal factors that provoke a conflict of interest that arise management and staff, and also reveals the absence of mechanisms that are designed to contain its negative consequences and to some extent operate in countries whose approaches to organization Russia is rapidly adopting in health care. In addition, the opinions and arguments of the experts are given in relation to the new question for Russia as to whether the head of the medical organization should be a clinician or a manager.


Assuntos
Esgotamento Profissional , Assistência à Saúde/economia , Médicos , Conflito de Interesses , Humanos , Federação Russa
9.
Georgian Med News ; (291): 126-130, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31418745

RESUMO

The article examines the issue of public procurement in the healthcare sector through the prism of the Association Agreement with the EU. The emphasis is on the ensuring mutual access to the markets of public procurement of the EU and Ukraine on the basis of planned and consistent approximation of Ukrainian legislation in the field of public procurement to the EU acquis in the field of public procurement. The purpose of this article is to identify the peculiarities of the reform in the field of public procurement in Ukraine, to search for drawbacks in the administrative legislation of Ukraine, which is governing public procurement in the healthcare sector in the context of Ukraine's implementation of the Association Agreement with the EU, and to justify its improvement. The subject of research is the social relations that arise in the implementation of public procurement in the field of health. The methodological basis of the conducted research is the general methods of scientific cognitivism as well as concerning those used in legal science: methods of analysis and synthesis, formal logic, comparative law, statistical methods etc The following main directions of reforming the system of public procurement were established. It has been proved that CPO functioning on the national level of government in the form of a state-owned enterprise under the control of one of the relevant ministries is non-feasibility. The advantages of the ProZorro electronic procurement system and the state of implementation of the provisions of the EU Directives on 2014/23/ EU, 2014/24/ EU, 2014/25/EU, 2014/55/EU into the administrative legislation of Ukraine have been identified. It has been found that in March, 2015 centralized procurement system for medicines and medical products was changed in Ukraine to use the funds of the State Budget of Ukraine for the purchase of medicines and medical products with the involvement of international specialized organizations. On December 21, 2018 the Verkhovna Rada (Supreme Council) of Ukraine put amendments into the Law of Ukraine "On Public Procurement". The attention is paid to the novelties of this Law. It has been found that the legislation of Ukraine has such shortcomings: 1) in Ukraine the issue of clear distribution of functions of the authorities authorized to carry out control in the field of public procurements remains unresolved; 2) the norms of the Law contradict each other; 3) the problems of creating effective mechanisms for the formation of the nomenclature of medicines still remain, as well as their supplies to healthcare institutions.


Assuntos
Assistência à Saúde/legislação & jurisprudência , União Europeia , Setor de Assistência à Saúde/legislação & jurisprudência , Assistência à Saúde/economia , Setor de Assistência à Saúde/economia , Humanos , Ucrânia
10.
Georgian Med News ; (291): 130-136, 2019 Jun.
Artigo em Russo | MEDLINE | ID: mdl-31418746

RESUMO

The objective of the article is a comparative and legal study of the models for the organization of public procurements in the healthcare field in the EU and Ukraine. Theoretical and empirical methods of cognition were used to achieve this goal, namely, methods of analysis, synthesis, generalization, as well as comparative and legal method in analyzing the experience of the EU countries in organizing public procurements. The conducted study suggests that the public procurement mechanism in the healthcare sector exists in most states. However, the legal regulation in this area differs significantly in different states. It has been established that a significant part of the states use centralized procurements. The shortcomings of the legal regulation of public procurements in Ukraine have been revealed and the ways to solve them have been offered. The authors have indicated the necessity of using international experience in organizing public procurements in the healthcare sector, in particular, with respect to: centralized procurements with the introduction of procurement groups or consortia (Great Britain, France, Germany, Italy); activities of specially created centralized organizations (Austria, Belgium, Spain, Hungary, Portugal) decentralized procurements (Sweden). In order to improve the legal regulation of public procurements in the healthcare field, the authors have proved the necessity of making amendments to the Law of Ukraine "On Public Procurements".


Assuntos
Assistência à Saúde/economia , Assistência à Saúde/legislação & jurisprudência , União Europeia , Humanos , Ucrânia
11.
Medicine (Baltimore) ; 98(33): e16808, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415394

RESUMO

Evidence-based studies have revealed outcomes in patients with chronic kidney disease that differed depending on the design of care delivery. This study compared the effects of 3 types of nephrology care: multidisciplinary care (MDC), nephrology care, and non-nephrology care. We studied their effects on the risks of requiring dialysis and the differences between these methods had on long-term medical resource utilization and costs.We conducted a retrospective cohort study involving patients with an estimated glomerular filtration rate of (eGFR) ≤45 mL/min/1.73 m from 2005 to 2007. Patients were divided into MDC, non-MDC, and non-nephrology referral groups. Between-group differences with regard to the risk of requiring dialysis and annual medical utilization and costs were evaluated using a 5-year follow-up period.In total, 661 patients were included. After other covariates and the competing risk of death were taken into account, we observed a significant (56%) reduction in the incidence of dialysis in both the MDC and non-MDC groups relative to the non-nephrology referral group. Costs were markedly lower in the MDC group relative to the other groups (average savings: US$ 830 per year; 95% confidence interval: 367-1295; P < .001).For patients without nephrology referrals, MDC can substantially reduce their risk of developing end-stage renal disease and lower their medical costs. We therefore strongly advocate that all patients with an eGFR of ≤45 mL/min/1.73 m should be referred to a nephrologist and receive MDC.


Assuntos
Assistência à Saúde/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Nefrologia/economia , Diálise Renal/economia , Insuficiência Renal Crônica/economia , Idoso , Assistência à Saúde/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nefrologia/métodos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Equipe de Assistência ao Paciente/economia , Encaminhamento e Consulta/economia , Estudos Retrospectivos
12.
Artigo em Alemão | MEDLINE | ID: mdl-31410523

RESUMO

BACKGROUND: For various psychiatric and somatic disorders, there is evidence of an association between patients' socioeconomic status (SES), healthcare utilisation, and the resulting costs. In the field of child and adolescent psychiatric disorders, studies on this topic are lacking. OBJECTIVES: To exploratively analyse the association of healthcare expenditures for children and adolescents with conduct disorder (including oppositional-defiant disorder) - one of the most prevalent child and adolescent psychiatric disorders - and SES. MATERIALS AND METHODS: The analysis is based on routine data from the German statutory health insurance company AOK Nordost for the calendar year 2011, covering 6461 children and adolescents (age 5-18 years) with an ICD-10 diagnosis of conduct disorder. The insureds' SES was estimated indirectly, based on the social structure of the postcode area, using the German Index of Multiple Deprivation (Mecklenburg-Vorpommern, Brandenburg), and the Berliner Sozialindex I (Berlin), respectively. From the two indices, quintiles were derived. Based on these quintiles, average costs per case for the following cost types were analysed: inpatient healthcare, outpatient healthcare (general practitioners, paediatricians, child and adolescent psychiatrists, child and adolescent psychotherapists), and prescribed medication. RESULTS: There was no significant functional association between SES and healthcare costs for any of the analysed cost types. CONCLUSIONS: In contrast to findings in adults, this study on children and adolescents with conduct disorders did not reveal an association between SES and healthcare costs. Within this group of patients, social inequality does not seem to have a significant influence on healthcare utilisation in Germany.


Assuntos
Transtorno da Conduta/economia , Transtorno da Conduta/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Seguro Saúde , Classe Social , Adolescente , Criança , Assistência à Saúde/economia , Alemanha , Humanos
13.
BMC Public Health ; 19(1): 1020, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31362727

RESUMO

BACKGROUND: Rising health spending is associated with high out-of-pocket expenditure (OOPE), catastrophic health spending (CHS), increasing poverty, and impoverishment. Though studies have examined poverty and impoverishment effect of health spending in India, there is limited research on the regional patterns of health spending by type of health centers. This paper tests the hypothesis that the poor people from the poorer states of India pay significantly more for hospitalization in public health centers than those in the richer states of India. METHODS: Data from the Social Consumption of Health Survey (71st round, 2014), carried out by the National Sample Survey (NSS) is used in the analyses. Descriptive statistics, log-linear regression model and tobit model were used to examine the determinants and variations in health spending. RESULTS: Inter-state variations in the utilization of public health services and the OOPE on hospitalization are high in India. States with high levels of poverty make higher use of the public health centers and yet incur high OOPE. In 2014, the mean OOPE per episode of hospitalization in public health centers in India was ₹5688 and ₹4264 for the economically poor households. It was lowest in the economically developed state of Tamil Nadu and highest in the economically poorer state of Bihar. The OOPE per episode of hospitalization in public health centers among the poor in the poorer states was at least twice that in Tamil Nadu. Among the poor using public health centers, the share of direct cost account 24% in Tamil Nadu compared to over 80% in Bihar, Odisha and other poorer states. Adjusting for socio-economic correlates, the cost of hospitalization per episode (CHPE) among the poor using public health centers was 51% lower than for the non-poor using private health centers in India. CONCLUSION: The poor people in the poorer states in India pay significantly more to avail hospitalization in public health centers than those in the developed states. Provision of free medicines, surgery and free diagnostic tests in public health centers may reduce the high OOPE and medical poverty in India.


Assuntos
Assistência à Saúde/economia , Gastos em Saúde/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Adolescente , Adulto , Feminino , Instalações de Saúde/economia , Hospitalização/economia , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Saúde Pública , Adulto Jovem
15.
Health Syst Transit ; 21(1): 1-234, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31333192

RESUMO

This analysis of the Polish health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. In late 2017, the Polish government committed to increase the share of public expenditures on health to 6% of GDP by 2024. If the GDP continues to grow in the years to come, this will present an opportunity to tackle mounting health challenges such as socioeconomic inequalities in health, high rates of obesity, rising burden of mental disorders and population ageing that put strain on health care resources. It is also an opportunity to tackle certain longstanding imbalances in the health sector, including overreliance on acute hospital care compared with other types of care, including ambulatory care and long-term care; shortages of human resources; the negligible role of health promotion and disease prevention vis-a-vis curative care; and poor financial situation in the hospital sector. Finally, the additional resources are much needed to implement important ongoing reforms, including the reform of primary care. The resources have to be spent wisely and waste should be minimized. The introduction, in 2016, of a special system (IOWISZ) of assessing investments in the health sector that require public financing (including from the EU funds) as well as the work undertaken by the Polish health technology assessment (HTA) agency (AOTMiT), which evaluates health technologies and publicly-financed health policy programmes as well as sets prices of goods and services, should help ensure that these goals are achieved. Recent reforms, such as the ongoing reform of primary care that seeks to improve coordination of care and the introduction of the hospital network, go in the right direction; however, a number of longstanding unresolved problems, such as hospital indebtedness, need to be tackled.


Assuntos
Assistência à Saúde/organização & administração , Gastos em Saúde/estatística & dados numéricos , Política de Saúde , Assistência à Saúde/economia , Economia Hospitalar/organização & administração , Reforma dos Serviços de Saúde/organização & administração , Hospitais/estatística & dados numéricos , Humanos , Polônia , Atenção Primária à Saúde/organização & administração
16.
Medicine (Baltimore) ; 98(29): e16500, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335718

RESUMO

BACKGROUND: In the 1980s, North Korea established a socialist health care system. However, following the food crisis and the economic sanctions, it is estimated that North Korea's health care system has experienced continuous deterioration. Thus, in the present study, we estimated the current medical research trends of North Korea through an analysis of the medical journal Korean Medicine, published in North Korea. METHODS: We analyzed the studies in Korean Medicine, which is the only North Korean medical journal accessible to foreigners with more than 30 years of data available, based on PRISMA guidelines. We analyzed the issues of the journal published for a total of 7 years, from 1985 onwards at 5-year intervals until 2015. To evaluate changes in the North Korean medical research trends, we compared and analyzed the issues published before and after the implementation of economic sanctions against North Korea. RESULTS: In this study, we analyzed 775 articles of Korean Medicine. Following economic sanctions, the number of publications on approved services (conventional therapy and diagnosis)-related articles was decreased. In contrast, the articles related to non-conventional therapy increased sharply in number. This showed a similar pattern to North Korean medical research trends seen during the food crisis of 1995 to 1997. CONCLUSIONS: After placement of economic sanctions on North Korea, North Korean medical research trends changed significantly. These could be indirectly estimated results suggesting that recently, the North Korean health care system had deteriorated, similarly to in the food crisis of 1995 to 1997.


Assuntos
Pesquisa Biomédica/economia , Pesquisa Biomédica/tendências , Política , Assistência à Saúde/economia , Assistência à Saúde/tendências , República Democrática Popular da Coreia , Humanos , Publicações Periódicas como Assunto/tendências , Socialismo/economia , Socialismo/tendências
17.
Georgian Med News ; (290): 107-116, 2019 May.
Artigo em Russo | MEDLINE | ID: mdl-31322525

RESUMO

The aim of the study was to carry out a comparative economic analysis of the costs of therapeutic and surgical treatment of liver echinococcosis based on the developed methodological approaches and principles for calculating the cost of complex medical services in accordance with the «step-down¼ methodology. The model for calculating the cost of complex medical services for the treatment of echinococcosis was justified. The sum of costs of outpatient and inpatient units that directly provide medical care (direct costs) to the costs of support centers (indirect costs) was adjusted, which among simple medical services based on the chosen criterion were distributed. Calculation of costing items out on the basis of the direct-cost costing method was carried. Based on the proposed model, a comparative analysis of the cost of treatment of liver echinococcosis using therapeutic and surgical methods was carried out. As a result of the study, it was proved that the therapeutic method is less expensive than the surgical method. This is the basis to recommend it for wider use in medical practice, especially in cases when there is a problem of choosing the method of treatment of echinococcosis. Cost optimization is facilitated by a combination of surgical intervention and therapeutic treatment.


Assuntos
Assistência à Saúde/economia , Equinococose/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Custos e Análise de Custo , Assistência à Saúde/organização & administração , Equinococose/terapia , Gastos em Saúde/estatística & dados numéricos , Humanos , Pacientes Internados , Pacientes Ambulatoriais
18.
Soins Pediatr Pueric ; 40(309): 14-15, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31331595

RESUMO

The last decade has witnessed an increasing number of reforms of the French healthcare system. The main objectives are to control healthcare costs by reducing spending and pooling resources. This is not achieved without difficulties, the economic criteria sometimes overshadowing humanist and altruistic values. These changes influence the organisation of care, even in paediatrics.


Assuntos
Assistência à Saúde/organização & administração , Reforma dos Serviços de Saúde , Administração Hospitalar , Criança , Assistência à Saúde/economia , França , Humanos , Pediatria/organização & administração
20.
Implement Sci ; 14(1): 72, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307489

RESUMO

BACKGROUND: Economic evaluation can inform whether strategies designed to improve the quality of health care delivery and the uptake of evidence-based practices represent a cost-effective use of limited resources. We report a systematic review and critical appraisal of the application of health economic methods in improvement/implementation research. METHOD: A systematic literature search identified 1668 papers across the Agris, Embase, Global Health, HMIC, PsycINFO, Social Policy and Practice, MEDLINE and EconLit databases between 2004 and 2016. Abstracts were screened in Rayyan database, and key data extracted into Microsoft Excel. Evidence was critically appraised using the Quality of Health Economic Studies (QHES) framework. RESULTS: Thirty studies were included-all health economic studies that included implementation or improvement as a part of the evaluation. Studies were conducted mostly in Europe (62%) or North America (23%) and were largely hospital-based (70%). The field was split between improvement (N = 16) and implementation (N = 14) studies. The most common intervention evaluated (43%) was staffing reconfiguration, specifically changing from physician-led to nurse-led care delivery. Most studies (N = 19) were ex-post economic evaluations carried out empirically-of those, 17 were cost effectiveness analyses. We found four cost utility analyses that used economic modelling rather than empirical methods. Two cost-consequence analyses were also found. Specific implementation costs considered included costs associated with staff training in new care delivery pathways, the impacts of new processes on patient and carer costs and the costs of developing new care processes/pathways. Over half (55%) of the included studies were rated 'good' on QHES. Study quality was boosted through inclusion of appropriate comparators and reporting of incremental analysis (where relevant); and diminished through use of post-hoc subgroup analysis, limited reporting of the handling of uncertainty and justification for choice of discount rates. CONCLUSIONS: The quantity of published economic evaluations applied to the field of improvement and implementation research remains modest; however, quality is overall good. Implementation and improvement scientists should work closely with health economists to consider costs associated with improvement interventions and their associated implementation strategies. We offer a set of concrete recommendations to facilitate this endeavour.


Assuntos
Assistência à Saúde/economia , Prática Clínica Baseada em Evidências/economia , Ciência da Implementação , Modelos Econômicos , Melhoria de Qualidade/economia , Análise Custo-Benefício , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA