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1.
Inquiry ; 59: 469580221143631, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36510414

RESUMO

Medicare's Hospital Trust Fund is projected to become insolvent sometime during 2028 and there will be insufficient funds to cover the costs of beneficiaries' care if reforms are not made before then. Many options have been proposed on ways to extend the trust fund's solvency. Some proposals focus on controlling costs and other proposals include options for raising revenues. A fresh perspective on this policy dilemma may arise by considering Japan's statutory health insurance (SHI) and its financing mechanisms. Japan could be a useful model because it has an older population and it is facing similar fiscal challenges before Medicare. Japan could offer some useful perspectives from its cost containment efforts to extend Medicare's solvency.


Assuntos
Administração Financeira , Medicare , Estados Unidos , Idoso , Humanos , Controle de Custos , Programas Nacionais de Saúde , Confiança
2.
Front Public Health ; 10: 1011928, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36438231

RESUMO

Central and Eastern European countries (CEEC) have among the highest rates of increase in healthcare expenditure. External reference pricing, generics and biologics price capping, regressive scale for price setting, health technology assessment (HTA), and positive drug lists for reimbursed medicines are among the variety of implemented cost-containment measures aimed at reducing and controlling the rising cost for pharmaceuticals. The aim of our study was to analyze the influence of a recently introduced measure in Bulgaria-budget capping in terms of overall budget expenditure. A secondary goal was to analyze current and extrapolate future trends in the healthcare and pharmaceutical budget based on data from 2016 to 2021. The study is a retrospective, observational and prognostic, macroeconomic analysis of the National Health Insurance Fund's (NHIF) budget before (2016-2018) and after (2019-2021) the introduction of the new budget cap model. Subgroups analysis for each of the three new budget groups of medicines (group A: medicines for outpatient treatment, prescribed after approval by a committee of 3 specialists; group B: all other medicines out of group A; and group C: oncology and life-saving medicines out of group A) was also performed, and the data were extrapolated for the next 3 years. The Kruskal-Wallis test was applied to establish statistically significant differences between the groups. During 2016-2021, healthcare services and pharmaceutical spending increased permanently, observing a growth of 82 and 80%, respectively. The overall healthcare budget increased from European €1.8 billion to 3.3 billion. The subgroup analysis showed a similar trend for all three groups, with similar growth between them. The highest spending was observed in group C, which outpaced the others mainly due to the particular antineoplastic (chemotherapy) medicines included in it. The rising overall healthcare cost in Bulgaria (from European €1.8 billion to 3.3 billion) reveals that implementation of a mechanism for budget predictability and sustainability is needed. The introduced budget cap is a relatively effective measure, but the high level of overspending and pay-back amount (from European €34 billion to 59 billion during 2019-2021) reveals that the market environmental risk factors are not well foreseen and practically implemented.


Assuntos
Custos de Medicamentos , Bulgária , Estudos Retrospectivos , Controle de Custos , Preparações Farmacêuticas
3.
Farm. hosp ; 46(6): 327-334, diciembre 2022. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-212420

RESUMO

Objetivo: Estimar el uso de recursos y costes asociados al seguimientode pacientes con infección por el virus de la inmunodeficiencia humanatras discontinuación del tratamiento antirretroviral actual debido a faltade efectividad o toxicidad inaceptable y cambio a un nuevo tratamientoantirretroviral, comparado con el seguimiento habitual de los pacientescon tratamiento antirretroviral, desde la perspectiva del Sistema Nacionalde Salud español.Método: Se identificó el uso de recursos (pruebas clínicas, visitasmédicas, visitas a la farmacia hospitalaria) asociado al seguimiento depacientes con infección por el virus de la inmunodeficiencia humana entres perfiles de pacientes (estable, discontinuación y cambio por faltade efectividad, discontinuación y cambio por toxicidad inaceptable), apartir de las guías de práctica clínica y un panel de expertos multidisciplinar (n = 5). Los expertos consensuaron los principales eventos adversos que conducían a la discontinuación, agrupándolos en: alteracionesgastrointestinales, renales, óseas, musculoesqueléticas, dermatológicas,hepáticas y del perfil lipídico, trastornos neuropsiquiátricos y sexuales.Los costes unitarios se identificaron a partir de bases de datos oficiales de costes sanitarios y de la literatura. Se estimó el coste (€, 2020) delseguimiento en cada perfil de paciente, sin incluir el coste derivado deltratamiento antirretroviral, en un horizonte temporal de dos años.Resultados: El coste por paciente a dos años se estimó en 4.148 €(pruebas: 2.293 €; visitas: 1.855 €) para el seguimiento del pacienteestable. (AU)


Objective: To assess the use of resources and the costs associatedwith following up patients infected with the human immunodeficiency virusafter discontinuation of an antiretroviral treatment and initiation of a newone due to a lack of effectiveness or unacceptable toxicity, as comparedto the costs involved in the routine follow-up of patients on antiretroviraltreatment, from the Spanish National Health System perspective.Method: The use of resources (clinical tests, medical visits, and hospitalpharmacy visits) associated with following three profiles of patients infected with the human immunodeficiency virus (stable ones, those discontinuing an existing antiretroviral treatment and being switched to a newone due to a lack of effectiveness, and those discontinuing an existingantiretroviral treatment and being switched to a new one due to unacceptable toxicity) was identified, based on clinical practice guidelinesand the findings of a multidisciplinary expert panel (n = 5). The expertsagreed on the main adverse events leading to discontinuation, classifyingthem into gastrointestinal, renal, osseous, musculoskeletal, dermatological,hepatic, lipid profile-related, neuropsychiatric and sexual alterations. Unitcosts were identified from official healthcare costs databases. The cost (€, 2020) of following up each patient profile was estimated, excludingthe cost of the antiretroviral treatment itself, with a time horizon of twoyears.Results: The per-patient cost of following up stable patients over twoyears was estimated at €4,148 (tests: €2,293; visits: €1,855). Patientfollow-up after discontinuation of an existing antiretroviral treatment andinitiation of a different one due to a lack of effectiveness was estimatedat €5,434 (tests: €2,777; visits: €2,657). (AU)


Assuntos
Humanos , Farmácia , Assistência ao Convalescente , Serviço de Farmácia Hospitalar , Toxicidade , Custos de Cuidados de Saúde , Controle de Custos , Terapêutica , Espanha
4.
Comput Intell Neurosci ; 2022: 1721157, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36210986

RESUMO

Under the background of the Internet of things (IoT), the problems between the actual production and the environment are also prominent. The environmental cost control in the production process of manufacturing enterprises are discussed to reduce the environmental cost and promote the improvement of production efficiency. First, the environmental cost under the background of IoT is analyzed. Also, the environmental cost control methods in the production process of traditional manufacturing enterprises are investigated. Second, based on the principle of traditional genetic algorithm, the fast-nondominated sorting genetic algorithm (NSGA-II) of multiobjective genetic algorithm is introduced to complete the optimization of BP neural network (BPNN) algorithm in deep learning (DL), and the multiobjective GA optimization BPNN model is established. Finally, the multiobjective GA algorithm is used to empirically analyze the environmental cost control capability of a paper-making enterprise. It is compared with enterprises with excellent and poor environmental cost control capabilities in the same industry to find out secondary indexes. The results show that environmental costs have long-term and economic characteristics. The global search ability of BPNN optimized by multiobjective GA is improved, and the local optimal dilemma is avoided. Through empirical analysis, it is found that the comprehensive capability of the environmental cost control of the enterprise is better, scored 79 or more, and the indexes of insufficient development and advantages are obtained. As IoT rapidly develops, it is necessary to further improve the ability of enterprises in environmental cost management, which is very important to promote the development of enterprises and enhance their core competitiveness. It is hoped that this investigation can provide certain reference significance for improving the environmental cost management capability of enterprises, increasing production efficiency, and reducing environmental costs.


Assuntos
Aprendizado Profundo , Internet das Coisas , Algoritmos , Controle de Custos , Redes Neurais de Computação
5.
Fam Med ; 54(9): 688-693, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36219424

RESUMO

Disparities and inequities based on ethnic and racial differences have been a part of health care in America from the time of its founding. These disparities have persisted through recurrent efforts to reform our health care system. This article brings historical perspective to what has become a systemic part of US health care; examines the extent of disparities today as they impact access, quality, and outcomes of care; and considers what can be done within our polarized political environment to eliminate them. It is hoped that this can help to spark dialogue within our discipline on these matters of critical importance. A single-payer national health insurance program, whereby all Americans can access affordable care based on medical need instead of ability to pay, can help to move our current nonsystem toward health equity. This change can bring improved health care to all Americans with simplified administration, cost containment, and less bureaucracy. It can be financed through a progressive tax system whereby 95% of Americans pay less than they do now and receive more in return. The past is never dead. It's not even past.1-William Faulkner.


Assuntos
Etnicidade , Acesso aos Serviços de Saúde , Controle de Custos , Disparidades em Assistência à Saúde , Humanos , Estados Unidos
6.
Asian Pac J Cancer Prev ; 23(8): 2835-2842, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-36037141

RESUMO

OBJECTIVES: This study aims to identify the role of adopting lean management in the quality of service, cost containment, and time management and to identify factors affecting lean management adoption, quality of service, cost containment, and time management in oncology settings. METHODS: A cross-sectional design was adopted in this study at the King Hussein Cancer Center (KHCC), a private institution in Amman, Jordan. A convenience sampling technique was used to select 360 participants. A self-administered questionnaire (58 items) was used to collect the data.  Results: The mean value for the quality of services was 3.84±0.56. These values for adoption of lean, time management, and cost containment were 3.82±0.74, 3.73±0.75, and 3.40±0.76 respectively. The results showed that the impacts of lean management adoption on the quality of service, cost containment, and time management were significant (p-value<0.001). The results showed substantial effects of all factors (organizational, departmental, and individual factors) on lean adoption, quality of service, cost containment, and time management (p value<.001). CONCLUSION: Lean management adoption had a significant impact on quality of service, cost containment, and time management in oncology settings.


Assuntos
Oncologia , Gerenciamento do Tempo , Controle de Custos , Estudos Transversais , Humanos , Inquéritos e Questionários
7.
Comput Math Methods Med ; 2022: 3425873, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35844453

RESUMO

The purpose of this study is to strengthen the procurement management of public hospitals and ensure the quality of medical equipment. In this paper, combined with the procurement process of medical equipment in public hospitals, on the basis of RFID technology, a JRP model of random demand for medical equipment procurement in public hospitals is established. At the same time, according to the type and quantity of decision variables, the DE solution algorithm is redesigned, and based on the support of the algorithm, a mathematical model for cost control of medical equipment procurement in public hospitals is established. It can be seen from the analysis results that the cost control system for medical equipment procurement in public hospitals based on the mathematical model proposed in this paper can play an important role in public hospital equipment procurement and promote the standardized operation of public hospital procurement management.


Assuntos
Hospitais Públicos , Modelos Teóricos , Controle de Custos , Humanos
8.
Respir Med Res ; 82: 100930, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35905555

RESUMO

BACKGROUND: Home respiratory equipment (HRE) designed for the management of chronic respiratory failure includes oxygen therapy (O2), noninvasive ventilation (NIV) and mechanical insufflation-exsufflation (MI-E). The growth of the number of patients treated by HRE, the prevalence and the associated costs in France have not been determined. METHODS: The French open access national health insurance aggregated data was used to estimate the evolution of theses parameters from 2006 to 2019. RESULTS: The number of patients treated by HRE increased by 117% between 2006 and 2019, reaching a total of 245,896 patients (367/100,000). Prescriptions for O2, NIV, and MI-E increased by 88%, 189% and 162%, respectively. In 2019, 139,323 patients received long-term home O2 alone (208/100,000) with a 13% decrease for liquid O2 compared to a 44% increase for O2 concentrator. The number of patients treated by portable oxygen concentrator increased by 509% over the last 5 years. In 2019, 96,126 patients received NIV (144/100,000) and 97% of these patients were treated by NIV for less than 12 h/day. A total of 9,158 patients were treated by MI-E in 2019 (13.6/100,000). Despite the global increase in the number of patients, health costs decreased from 9% to 8% of total medical device spending in 2019 due to adjustment of health policies, such as a reduction of reimbursement rates. CONCLUSION: Our results highlighted the high rate of HRE prescription, but with cost control as a result of adapted health policies.


Assuntos
Ventilação não Invasiva , Insuficiência Respiratória , Humanos , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/terapia , Ventilação não Invasiva/métodos , Oxigênio , Controle de Custos , Política de Saúde
9.
BMC Health Serv Res ; 22(1): 752, 2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35668425

RESUMO

BACKGROUND: Rapidly increasing health care costs are a widespread problem in the world. The cost-consciousness among Chinese medical staff is an important topic that needs further investigation. Our study aimed to focus on the cost-consciousness of Chinese medical staff and explore the factors related to their cost-consciousness. Differences regarding cost-consciousness between doctors and nurses were also reported. METHODS: Eight hospitals in Liaoning Province, China, were surveyed using a self-reporting questionnaire. A total of 1043 respondents, including 635 doctors and 408 nurses, participated in the study. A revised Chinese Cost-consciousness Scale was used to estimate cost-consciousness. RESULTS: The mean score of the Cost-consciousness Scale was 27.60 and 28.18 among doctors and nurses, respectively, and there were no significant differences in any personal characteristics. Most Chinese medical staff were aware of the treatment costs and considered cost control as their responsibility. Chinese doctors disliked adhering to guidelines more and preferred to remain independent in making or denying a treatment decision; thus, they like autonomously balancing the treatment and cost. Chinese nurses have similar attitudes, but nurses tended to deny costly services and interventions and were more sensitive to the health care costs by rationing decisions and uncertainty in their medical practice. CONCLUSION: We reveal the attitudes regarding cost-consciousness among Chinese medical staff. Chinese medical staff was aware of their responsibility in health cost control. Chinese doctors and nurses had different tendencies with regard to health care cost containment. Our study highlights the importance of education and professional training on cost-consciousness.


Assuntos
Atitude do Pessoal de Saúde , Custos de Cuidados de Saúde , Médicos , Conscientização , China , Controle de Custos , Estudos Transversais , Humanos , Corpo Clínico , Inquéritos e Questionários
10.
Stud Health Technol Inform ; 290: 1050-1051, 2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35673200

RESUMO

There is a gap between medical resources and patient needs, Managers need to obtain productivity information to optimize resources allocation. The value of this research is that the information provided by the dashboard allows hospital managers problems respond to it quickly. We recommend the research could integrate more data (such as temperature data, national death population data record), so as to be closed to hospital operating cost control and to estimate patients' needs.


Assuntos
Instituições de Assistência Ambulatorial , Hospitais , Controle de Custos , Humanos , Inteligência , Alocação de Recursos
11.
Inquiry ; 59: 469580221093171, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35586944

RESUMO

BACKGROUND: A rise in pharmaceutical expenses in Portugal led to the introduction of policy measures aimed at controlling outpatient public costs. This research examines and categorizes the most common pharmaceutical measures implemented during the Troika intervention, as well as comparing this period of time to prior ones. METHODS: A hierarchical structure of descriptors was built to classify and group measures over a 20-year period, including whether they might be deemed austerity measures. The nature, relative weight, and frequency of measures, along with the evolution of public drug expenditure, were assessed. RESULTS: Although there were fluctuations, frequency tended to increase. The highest number of policy changes per year was in 2010, a year before the financial assistance. The Troika intervention was characterized by a strong emphasis on pricing and prescription-related initiatives. Generic medicines played a significant role in the effort to reduce public drug expenditure. CONCLUSIONS: During the Troika intervention, outpatient public drug expenditure was consistently reduced through a comprehensive "package of measures" aimed at both the demand and supply sides. The effectiveness of some previous independent measures, if any, was temporary.


Assuntos
Controle de Medicamentos e Entorpecentes , Gastos em Saúde , Controle de Custos , Medicamentos Genéricos , Humanos , Portugal
12.
Health Econ Policy Law ; 17(3): 348-365, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35382921

RESUMO

This paper explores policy mechanisms behind New Zealand's remarkable track record of cost containment in public pharmaceutical spending, contrasting with most other advanced economies. We drew on a review of official policy documents and 28 semi-structured expert interviews. We found that decision making in pricing and reimbursement policy was dominated by a small group of managers at the Pharmaceutical Management Agency (PHARMAC), the country's drug reimbursement and Health Technology Assessment Agency, who negotiated pharmaceutical prices on behalf of the public payer. In formal negotiation over patented pharmaceutical prices these managers applied an array of pricing strategies, most notably, 'bundling' consisting of discounted package deals for multiple pharmaceuticals, and 'play-off tenders', whereby two or more pharmaceutical companies bid for exclusive contracts. The key pricing strategy for generic drugs, in contrast, was 'blind-tenders' taking the form of an annual bidding process for supply contracts. An additional contextual condition on bargaining over pharmaceutical prices was an indirect strategy that involved the cultivation of the PHARMAC's 'negotiation leverage'. We derived two cost containment mechanisms consisting in the relationship between pricing strategy options and various reimbursement actors. Our findings shed light on aspects of the institutional design of drug reimbursement that may promote the effective use of competitive negotiations of pharmaceutical prices, including specific pricing strategies, by specialist public payer institutions. On this basis, we formulate recommendations for countries seeking to develop or reform policy frameworks to better meet the budgetary challenge posed by pharmaceutical expenditure.


Assuntos
Custos de Medicamentos , Negociação , Controle de Custos , Medicamentos Genéricos , Humanos , Nova Zelândia
13.
BMC Health Serv Res ; 22(1): 495, 2022 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-35418090

RESUMO

BACKGROUND: Cost containment is a major issue for health policy, in many countries. Policymakers have used various measures to deal with this problem. In Switzerland, the national parliament and subnational (cantonal) governments have used moratoriums to limit the admission of specialist doctors and general practitioners. METHODS: We analyze the impact of these regulations on the number of doctors billing in free practice and on the health costs created by medical practice based on records from the data pool of Swiss health insurers (SASIS) from 2007 to 2018 using interrupted time series and difference-in-differences models. RESULTS: We demonstrate that the removal of the national moratorium in 2012 increased the number of doctors, but did not augment significantly the direct health costs produced by independent doctors. Furthermore, the reintroduction of regulations at the cantonal level in 2013 and 2014 decreased the number of doctors billing in free practice but, again, did not affect direct health costs. CONCLUSIONS: Our findings suggest that regulating healthcare supply through a moratorium on doctors' admissions does not directly contribute to limiting the increase in health expenditures.


Assuntos
Clínicos Gerais , Gastos em Saúde , Controle de Custos , Custos de Cuidados de Saúde , Humanos , Suíça
14.
Artigo em Inglês | MEDLINE | ID: mdl-35409966

RESUMO

Volume-based drug purchasing by China's health insurance system currently represents the largest group purchasing organization worldwide. After exchanging the market that accounted for nearly half of the volume of the healthcare system for the ultra-low-price supply of limited drugs, what are the effects on patient and funding burdens, drug accessibility, and clinical efficacy? We aimed to verify the effectiveness of the policy, explore the reasons behind the problem and identify regulatory priorities and collaborative measures. We used literature and reported data from 2019 to 2021 to conduct a stakeholder analysis and health impact assessment, presenting the benefit and risk share for various dimensions. The analysis method was a multidimensional scaling model, which visualized problematic associations. Seventy-nine papers (61 publications and 18 other resources) were included in the study, with 22 effects and 36 problems identified. The results indicated favorable affordability and poor accessibility of drugs, as well as high risk of reduced drug quality and drug-use rationality. The drug-use demand of patients was guaranteed; the prescription rights of doctors regarding clinical drug use were limited; unreasonable evaluation indicators limited the transformation of public hospitals to value- and service-oriented organizations; the sustainability of health insurance funds and policy promotion were at risk; and innovation by pharmaceutical companies was accelerated. The problems associated with high co-occurrence frequencies were divided into the following clusters: cost control, drug accessibility, system rationality, policy fairness, drug quality, and moral hazards. These findings suggested that China has achieved short-term success in reducing the burden on patients and reducing fund expenditure. However, there were still deficiencies in guaranteed supply, quality control, and efficacy tracking. The study offers critical lessons for China and other low- and middle-income countries.


Assuntos
Comportamento do Consumidor , Gastos em Saúde , China , Controle de Custos , Humanos , Seguro Saúde
15.
Cytotherapy ; 24(7): 750-753, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35304076

RESUMO

Over the last decade, cancer immunotherapy has progressed from an academically interesting field to one of the most promising forms of new treatments in which not the cancer but the immune system is treated. In particular, genetic modification for purposeful redirection of autologous T cells is providing hope to many treatment-resistant patients. This personalized form of medicine is radically different from more traditional oncologic drugs. With these evolving medical advancements and more cellular therapies becoming available, some regulatory agencies have created new regulatory requirements to manage the production of these types of products. The regulations are specifically suited for the manufacture of gene and cell therapy products, as they use a risk-based approach towards product development and manufacturing, when there is limited characterization available. The correct interpretation of how and when requirements apply is crucial, since theoretical approaches to implementing GMP can easily lead to disproportionate and unwarranted restrictions that may not address the specific risks that regulators were intending to control. This is especially relevant for cell collection and biopreservation preceding the manufacturing process for products manufactured from autologous T cells. Both the fresh and cryopreserved apheresis materials can be filed as minimally manipulated starting materials to the authorities. The preservation of such cellular material can then routinely be managed using the available regulations for tissues and cells, allowing for a more fit-for-purpose approach to the control measures implemented.


Assuntos
Criopreservação , Neoplasias , Terapia Baseada em Transplante de Células e Tecidos , Controle de Custos , Humanos , Neoplasias/terapia
16.
Comput Intell Neurosci ; 2022: 9932603, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35047037

RESUMO

The sublevel caving method without sill pillar is used to improve the cost of mining. The analysis is performed according to unique geographical environment and the current mining technology of the mine. The wireless communication network is used to budget and control the work cost of mining. Simulation operation about unit explosive dosage, fan-shaped deep hole interval, hole bottom distance, and collapse step distance is performed. Experiments have shown that budget and control of the cost of mining workers with wireless communication technology can manage mining data and guide the design of mining data.


Assuntos
Pesquisa Operacional , Tecnologia sem Fio , Simulação por Computador , Controle de Custos , Humanos
17.
J Manag Care Spec Pharm ; 28(2): 275-277, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35098750

RESUMO

DISCLOSURES: The thoughts and opinions expressed in this article are those of the author only and are not the thoughts and opinions of any current or former employer of the author. Nor is this publication made by, on behalf of, or endorsed or approved by any current or former employer of the author.


Assuntos
Custo Compartilhado de Seguro/economia , Custos de Medicamentos , Seguro de Serviços Farmacêuticos/economia , Controle de Custos , Letramento em Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Estados Unidos
18.
Health Policy ; 126(2): 112-121, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35000803

RESUMO

BACKGROUND: Various forms of value-based pricing policies for new medicines have recently been introduced in OECD countries. While these initiatives are expected to have a positive impact on societal outcomes such as availability, affordability and value for money, scientific evidence on this impact is scarce due to confidential agreements. OBJECTIVE: We aimed to assess the impact of value-based policy interventions in price negotiations on patient benefit in an experimental setting. METHODS: An online experiment was conducted (n = 269). Participants were randomly assigned into the active role of either a buyer or seller in two intervention groups (cost-benefit, risk-sharing) and one control group. Decisions had real monetary consequences on other participants and through donations to a patient association. RESULTS: Patient access, benefit and value for money were higher in the cost-benefit group than in the risk-sharing group. An available alternative to the agreement led to higher price offers. This effect was weaker in the cost-benefit group. CONCLUSIONS: Outcomes of price negotiations on patient benefit depend on the alternatives available for failed or delayed negotiations. A shared but voluntary valuation framework might increase patient access, benefit, and value for money. The cost containment effect of risk-sharing agreements may be offset by the negative impact on overall patient benefit. Further development of the approach could provide support for policy design of pharmaceutical pricing regulations.


Assuntos
Custos de Medicamentos , Negociação , Comércio , Controle de Custos , Humanos , Políticas
19.
Int J Health Plann Manage ; 37(3): 1252-1298, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34981855

RESUMO

INTRODUCTION: Vertical integration models involve integrating services from different levels of care (e.g., primary care, acute care, post-acute care). Therefore, one of their main objectives is to increase continuity of care, potentially improving outcomes like efficiency, quality, and access or even enabling cost containment. OBJECTIVES: This study conducts a literature review and aims at contributing to the contentious discussion regarding the effects of vertical integration reforms in terms of efficiency, costs containment, quality, and access. METHODS: We performed a systematic search of the literature published until February 2020. The articles respecting the conceptual framework were included in an exhaustive analysis to study the impact of vertical integration on costs, prices of care, efficiency, quality, and access. RESULTS: A sample of 64 papers resulted from the screening process. The impact of vertical integration on costs and prices of care appears to be negative. Decreases in technical efficiency upon vertical integration are practically out of the question. Nevertheless, there is no substantial inclination to visualise a positive influence. The same happens with the quality of care. Regarding access, the lack of available articles on this outcome limits conjectures. CONCLUSIONS: In summary, it is not clear yet whether vertically integrated healthcare providers positively impact the overall delivery care system. Nevertheless, the recent growing trend in the number of studies suggests a promising future on the analysis of this topic.


Assuntos
Atenção à Saúde , Instalações de Saúde , Controle de Custos , Pessoal de Saúde , Humanos
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