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1.
IEEE Pulse ; 11(5): 24-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33064641

RESUMO

Citizens' dissatisfaction with the scope of the United States health care system has been a hot topic for many years. In a country where patient to nurse ratios remain 6:1, even universal health care coverage cannot guarantee adequate patient care. These issues were further highlighted by the COVID-19 pandemic, where inadequate hospital funding and lack of attention to patients led to challenging situations in hotspot areas. Although this pandemic will shape us for many years to come with far reaching impacts, social distancing norms have accelerated technologies that enable services to be delivered remotely, a capability even more necessary in our health care system. By providing care that can be delivered remotely, we can focus in-person care in our hospitals to only the ones who really need it. This allows us to scale our systems, protect lives, and safeguard economic activity.


Assuntos
Assistência à Saúde , Internet das Coisas , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Redução de Custos , Assistência à Saúde/economia , Equipamentos e Provisões , Humanos , Monitorização Fisiológica/métodos , Monitorização Fisiológica/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Tecnologia de Sensoriamento Remoto , Transportes , Estados Unidos/epidemiologia , Gerenciamento de Resíduos
3.
Lancet ; 396(10258): 1135-1159, 2020 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-33069324

RESUMO

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3·5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.


Assuntos
Assistência à Saúde/economia , Carga Global da Doença/economia , Saúde Global/tendências , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Coeficiente de Natalidade , Assistência à Saúde/estatística & dados numéricos , Feminino , Carga Global da Doença/tendências , Humanos , Masculino , Doenças não Transmissíveis/epidemiologia , Avaliação de Resultados em Cuidados de Saúde/tendências , Fatores de Risco , Fatores Socioeconômicos , Ferimentos e Lesões/epidemiologia
6.
J Nurs Adm ; 50(11): 584-589, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33105335

RESUMO

The US healthcare system is moving into a new era of value-based care, which focuses on delivering safer and higher quality care while reducing costs. Health information exchange (HIE) has been a vital component in this process; however, there has been a lack of awareness and use of HIE among nurse leaders, clinicians, and researchers. The purpose of this article is to provide nurses and administrators with a brief overview of HIE and its impact on care delivery, as well as practical applications using specific case examples.


Assuntos
Troca de Informação em Saúde , Processo de Enfermagem , Recursos Humanos de Enfermagem , Controle de Custos , Assistência à Saúde/economia , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Humanos , Qualidade da Assistência à Saúde
9.
PLoS One ; 15(9): e0236255, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881867

RESUMO

Community Health Workers (CHWs) play a vital role delivering health services to vulnerable populations in low resource settings. In Rwanda, CHWs provide village-level care focused on maternal/child health, control of infectious diseases, and health education, but do not receive salaries for these services. CHWs make up the largest single group involved in health delivery in the country; however, limited information is available regarding the socio-economic circumstances and satisfaction levels of this workforce. Such information can support governments aiming to control infectious diseases and alleviate poverty through enhanced healthcare delivery. The objectives of this study were to (1) evaluate CHW opportunity costs, (2) identify drivers for CHW motivation, job satisfaction and care provision, and (3) report CHW ideas for improving retention and service delivery. In this mixed-methods study, our team conducted in-depth interviews with 145 CHWs from three districts (Kirehe, Kayonza, Burera) to collect information on household economics and experiences in delivering healthcare. Across the three districts, CHWs contributed approximately four hours of volunteer work per day (range: 0-12 hrs/day), which translated to 127 684 RWF per year (range: 2 359-2 247 807 RWF/yr) in lost personal income. CHW out-of-pocket expenditures (e.g. patient transportation) were estimated at 36 228 RWF per year (range: 3 600-364 800 RWF/yr). Participants identified many benefits to being CHWs, including free healthcare training, improved social status, and the satisfaction of helping others. They also identified challenges, such as aging equipment, discrepancies in financial reimbursements, poverty, and lack of formal workspaces or working hours. Lastly, CHWs provided perspectives on reasonable and feasible improvements to village-level health programming that could improve conditions and equity for those providing and using the CHW system.


Assuntos
Agentes Comunitários de Saúde , Adulto , Agentes Comunitários de Saúde/economia , Agentes Comunitários de Saúde/educação , Agentes Comunitários de Saúde/psicologia , Estudos Transversais , Assistência à Saúde/economia , Feminino , Humanos , Renda , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Motivação , Ruanda , Adulto Jovem
11.
PLoS One ; 15(9): e0238565, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915826

RESUMO

BACKGROUND: Ageing populations and rising prevalence of non-communicable diseases (NCDs) increasingly contribute to the growing cost burden facing European healthcare systems. Few studies have attempted to quantify the future magnitude of this burden at the European level, and none of them consider the impact of potential changes in risk factor trajectories on future health expenditures. METHODS: The new microsimulation model forecasts the impact of behavioural and metabolic risk factors on NCDs, longevity and direct healthcare costs, and shows how changes in epidemiological trends can modify those impacts. Economic burden of NCDs is modelled under three scenarios based on assumed future risk factors trends: business as usual (BAU); best case and worst case predictions (BCP and WCP). FINDINGS: The direct costs of NCDs in the EU 27 countries and the UK (in constant 2014 prices) will grow under all scenarios. Between 2014 and 2050, the overall healthcare spending is expected to increase by 0.8% annually under BAU. In the all the countries, 605 billion Euros can be saved by 2050 if BCP is realized compared to the BAU, while excess spending under the WCP is forecast to be around 350 billion. Interpretation: Although the savings realised under the BCP can be substantial, population ageing is a stronger driver of rising total healthcare expenditures in Europe compared to scenario-based changes in risk factor prevalence.


Assuntos
Efeitos Psicossociais da Doença , Assistência à Saúde/economia , Assistência à Saúde/tendências , Custos de Cuidados de Saúde , Adulto , Idoso , Índice de Massa Corporal , Europa (Continente) , Feminino , Gastos em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
12.
Proc Natl Acad Sci U S A ; 117(39): 24008-24009, 2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-32958640
13.
Stud Health Technol Inform ; 274: 68-81, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32990666

RESUMO

This chapter deals with financial management in healthcare institutions. Topics which will be covered in this chapter include the function of financial management in a company and elements of financial management. We also discuss types of ownership and related organizational forms of healthcare institutions, which influence financial functions. We are trying to identify the general role and objectives of financial management in healthcare institutions. Having in mind the fact that financial management is based on the information provided through company's accounting we will give an overview of basic accounting concepts. They influence financial reporting, which is also covered in the chapter through a presentation of different types of financial statements and their content.


Assuntos
Contabilidade , Assistência à Saúde , Administração Financeira , Assistência à Saúde/economia
14.
PLoS One ; 15(9): e0238843, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915863

RESUMO

OBJECTIVE: The economic burden of commercially insured patients in the United States with treatment-resistant depression and patients with non-treatment-resistant major depressive disorder was compared using data from the Optum Clinformatics™ claims database. METHODS: Patients 18-63 years on antidepressant treatment between 1/1/13 and 9/30/13, who had no treatment claims for depression 6 months before the index date (first antidepressant dispensing), and who had a major depressive disorder or depression diagnosis within 30 days of the index date, were included. Treatment-resistant depression was defined as receiving 3 antidepressant regimens during 1 major depressive disorder episode. Patients with treatment-resistant depression were matched with patients with non-treatment-resistant major depressive disorder at a 1:4 ratio using propensity score matching. The study consisted of 1-year baseline (pre-index) and 2-year follow-up (post index) periods. Cost outcomes were compared using a generalized linear model. RESULTS: 2,370 treatment-resistant depression and 9,289 non-treatment-resistant major depressive disorder patients were included. In year 1 of the follow-up period, compared with non-treatment-resistant major depressive disorder, patients with treatment-resistant depression had: more emergency department visits (odds ratio = 1.39, 95% confidence interval = 1.24-1.56); more inpatient hospitalizations (odds ratio = 1.73, 95% confidence interval = 1.46-2.05); longer hospital stays (mean difference vs non-treatment-resistant major depressive disorder = 2.86, 95% confidence interval = 0.86-4.86 days); and more total healthcare costs (mean difference vs non-treatment-resistant major depressive disorder = US$3,846, 95% confidence interval = $2,855-$4,928). These patterns remained consistent in year 2 of the follow-up period. CONCLUSION: Treatment-resistant depression was associated with higher healthcare resource utilization and costs versus non-treatment-resistant major depressive disorder in this commercially insured cohort of patients in the United States.


Assuntos
Antidepressivos/economia , Assistência à Saúde/estatística & dados numéricos , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Custos de Cuidados de Saúde , Recursos em Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Antidepressivos/uso terapêutico , Bases de Dados Factuais , Assistência à Saúde/economia , Transtorno Depressivo Maior/economia , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Resistente a Tratamento/economia , Transtorno Depressivo Resistente a Tratamento/epidemiologia , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
18.
Malawi Med J ; 32(1): 37-44, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32733658

RESUMO

Background: The report from the World Health Organization (WHO) reveals that health spending worldwide remains highly unequal as more than 80% of the world's population live in low and middle-income countries but only account for about 20% of global health expenditure. Another report by the WHO on the state of health financing in Africa published in 2013 intimates that countries that are part of their member states are still on the average level in meeting set goals in financing key health projects. Objective: The study set out to investigate the association between public and private spending and health status for eight selected African countries, namely Burundi, Eritrea, Ethiopia, Kenya, Rwanda, Sudan, Tanzania and Uganda. Health status indicators include the incidence of tuberculosis, mortality rates, maternal deaths and prevalence of HIV. Methods: Descriptive statistics and pairwise correlation are used to assess the relationship between healthcare spending and health status. Random and fixed effect models are further employed to provide insights into the association between descriptive statistics and pairwise correlation. We used annual data from the year 2000 to 2014 obtained from world development indicators. Results: The relationship between healthcare spending (public and private) and health status is statistically significant. Public healthcare expenditure has a higher association than private expenditure in reducing the mortality rate, tuberculosis and HIV for the average country in our sample. For example, an increase in public healthcare spending is negatively associated and statistically significant at 5% or better in reducing female mortality, male mortality, tuberculosis and HIV. Private healthcare spending is more impactful in the area of maternal deaths, where it is associated negatively and statistically significant at 1%. An increase in private healthcare spending is linked to a reduction in maternal deaths. We also compared the association between an increase in healthcare spending on males versus females and observed that public health expenditure impacts the health status of both sexes equally, however, private health expenditure provides a greater positive benefit to males. It is worth remembering that two goals of the United Nations agenda on sustainable development are gender equality and ensuring healthcare for all. Conclusion: The findings of this research call for the selected African countries to pay more attention to public healthcare expenditure in order to improve health status, especially since private healthcare which provides access to healthcare facilities for some poor people leads to costs that are a burden. So, future research should focus on analyzing components of private healthcare spending such as direct household out-of-pocket spending, private insurance and direct service payments by private corporations as dependent variables to understand what form of private investment should be encouraged.


Assuntos
Assistência à Saúde/economia , Gastos em Saúde , Indicadores Básicos de Saúde , Nível de Saúde , Financiamento da Assistência à Saúde , Saúde Pública/economia , Tuberculose/epidemiologia , África Oriental , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Humanos , Incidência , Morte Materna , Mortalidade , Prevalência
19.
J Int AIDS Soc ; 23(8): e25587, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32767707

RESUMO

INTRODUCTION: The COVID-19 pandemic reached the African continent in less than three months from when the first cases were reported from mainland China. As COVID-19 preparedness and response plans were rapidly instituted across sub-Saharan Africa, many governments and donor organizations braced themselves for the unknown impact the COVID-19 pandemic would have in under-resourced settings with high burdens of PLHIV. The potential negative impact of COVID-19 in these countries is uncertain, but is estimated to contribute both directly and indirectly to the morbidity and mortality of PLHIV, requiring countries to leverage existing HIV care systems to propel COVID-19 responses, while safeguarding PLHIV and HIV programme gains. In anticipation of COVID-19-related disruptions, PEPFAR promptly established guidance to rapidly adapt HIV programmes to maintain essential HIV services while protecting recipients of care and staff from COVID-19. This commentary reviews PEPFAR's COVID-19 technical guidance and provides country-specific examples of programme adaptions in sub-Saharan Africa. DISCUSSION: The COVID-19 pandemic may pose significant risks to the continuity of HIV services, especially in countries with high HIV prevalence and weak and over-burdened health systems. Although there is currently limited understanding of how COVID-19 affects PLHIV, it is imperative that public health systems and academic centres monitor the impact of COVID-19 on PLHIV. The general principles of the HIV programme adaptation guidance from PEPFAR prioritize protecting the gains in the HIV response while minimizing in-person home and facility visits and other direct contact when COVID-19 control measures are in effect. PEPFAR-supported clinical, laboratory, supply chain, community and data reporting systems can play an important role in mitigating the impact of COVID-19 in sub-Saharan Africa. CONCLUSIONS: As community transmission of COVID-19 continues and the number of country cases rise, fragile health systems may be strained. Utilizing the adaptive, data-driven programme approaches in facilities and communities established and supported by PEPFAR provides the opportunity to strengthen the COVID-19 response while protecting the immense gains spanning HIV prevention, testing and treatment reached thus far.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Assistência à Saúde , Infecções por HIV/complicações , Pneumonia Viral/complicações , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/mortalidade , África ao Sul do Saara/epidemiologia , China , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Efeitos Psicossociais da Doença , Assistência à Saúde/economia , Assistência à Saúde/normas , Assistência à Saúde/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/mortalidade , Humanos , Cooperação Internacional , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Prevalência
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