Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 21.780
Filtrar
2.
Pediatr Clin North Am ; 67(4): 683-705, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32650867

RESUMO

Pediatric practice increasingly involves providing care for children with medical complexity. Telehealth offers a strategy for providers and health care systems to improve care for these patients and their families. However, lack of awareness related to the unintended negative consequences of telehealth on vulnerable populations--coupled with failure to intentional design best practices for telehealth initiatives--implies that these novel technologies may worsen health disparities in the long run. This article reviews the positive and negative implications of telehealth. In addition, to achieve optimal implementation of telehealth, it discusses 10 considerations to promote optimal care of children using these technologies.


Assuntos
Doença Crônica/terapia , Pediatria , Telemedicina/organização & administração , Populações Vulneráveis , Doença Crônica/epidemiologia , Controle de Custos , Equidade em Saúde , Acesso aos Serviços de Saúde , Humanos , Melhoria de Qualidade , Estados Unidos/epidemiologia
3.
Dermatol Online J ; 26(4)2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32621676

RESUMO

Drug expenditure in the United States has continued to increase unsustainably; the specialty of dermatology has been particularly affected. Resources are limited - someone has to make decisions about what treatments will be covered and how they will be reimbursed. Step therapy is a cost-control method used by insurers to encourage the use of the most cost-effective treatments before more expensive options are attempted. However, a rigid step therapy policy can be problematic when protocols are out of date, or delay necessary treatment leading to unnecessary suffering, increased morbidity, and overall cost. To address some of these concerns, the proposed Safe Step Act (S. 2546 and H.R. 2279) attempts to create a requirement that insurers provide a transparent, expeditious exceptions process for step therapy protocols. Increased flexibility in this process will allow for the unique circumstances of individual patients and improve access to expensive drugs for special cases. However, this bill may be exploited, further weakening insurers' ability to negotiate on cost. We should be cautious about measures that reduce the effectiveness of this tool, particularly if we, as a society, aim to expand access to basic care to all Americans.


Assuntos
Controle de Custos , Custos de Cuidados de Saúde , Seguro Saúde/legislação & jurisprudência , Controle de Custos/legislação & jurisprudência , Employee Retirement Income Security Act/legislação & jurisprudência , Gastos em Saúde , Seguro Saúde/economia , Estados Unidos
5.
Lancet ; 395(10232): 1305-1314, 2020 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-32247320

RESUMO

Fangcang shelter hospitals are a novel public health concept. They were implemented for the first time in China in February, 2020, to tackle the coronavirus disease 2019 (COVID-19) outbreak. The Fangcang shelter hospitals in China were large-scale, temporary hospitals, rapidly built by converting existing public venues, such as stadiums and exhibition centres, into health-care facilities. They served to isolate patients with mild to moderate COVID-19 from their families and communities, while providing medical care, disease monitoring, food, shelter, and social activities. We document the development of Fangcang shelter hospitals during the COVID-19 outbreak in China and explain their three key characteristics (rapid construction, massive scale, and low cost) and five essential functions (isolation, triage, basic medical care, frequent monitoring and rapid referral, and essential living and social engagement). Fangcang shelter hospitals could be powerful components of national responses to the COVID-19 pandemic, as well as future epidemics and public health emergencies.


Assuntos
Infecções por Coronavirus , Emergências , Arquitetura de Instituições de Saúde , Hospitais Especializados , Unidades Móveis de Saúde , Pandemias , Pneumonia Viral , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Controle de Custos , Surtos de Doenças , Hospitais Especializados/organização & administração , Hospitais Especializados/estatística & dados numéricos , Humanos , Controle de Infecções , Unidades Móveis de Saúde/organização & administração , Unidades Móveis de Saúde/estatística & dados numéricos , Isolamento de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia
6.
Lancet ; 395(10232): 1305-1314, 2020 04 18.
Artigo em Inglês | MEDLINE | ID: covidwho-27038

RESUMO

Fangcang shelter hospitals are a novel public health concept. They were implemented for the first time in China in February, 2020, to tackle the coronavirus disease 2019 (COVID-19) outbreak. The Fangcang shelter hospitals in China were large-scale, temporary hospitals, rapidly built by converting existing public venues, such as stadiums and exhibition centres, into health-care facilities. They served to isolate patients with mild to moderate COVID-19 from their families and communities, while providing medical care, disease monitoring, food, shelter, and social activities. We document the development of Fangcang shelter hospitals during the COVID-19 outbreak in China and explain their three key characteristics (rapid construction, massive scale, and low cost) and five essential functions (isolation, triage, basic medical care, frequent monitoring and rapid referral, and essential living and social engagement). Fangcang shelter hospitals could be powerful components of national responses to the COVID-19 pandemic, as well as future epidemics and public health emergencies.


Assuntos
Infecções por Coronavirus , Emergências , Arquitetura de Instituições de Saúde , Hospitais Especializados , Unidades Móveis de Saúde , Pandemias , Pneumonia Viral , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Controle de Custos , Surtos de Doenças , Hospitais Especializados/organização & administração , Hospitais Especializados/estatística & dados numéricos , Humanos , Controle de Infecções , Unidades Móveis de Saúde/organização & administração , Unidades Móveis de Saúde/estatística & dados numéricos , Isolamento de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia
7.
Value Health ; 23(4): 418-420, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32327157

RESUMO

In response to rising healthcare costs, value-based arrangements (VBAs) have emerged as a mechanism for transforming how we pay for high-cost therapies. As we think about how VBAs fit into the larger effort of the United States healthcare system to transition to value-based payment, it is important to consider the strengths and limitations associated with this model and to set appropriate expectations for what VBAs can realistically achieve. For example, for VBAs to meaningfully affect overall healthcare spending, there needs to be a sufficient number of products that meet the ideal criteria for a value-based contract. These products also need to represent a meaningful share of healthcare spending, and the VBA contracts need to be designed with enough financial risk to actually influence spending. Although there are limited data about the components of current contracts (eg, how much financial risk is involved, product and class specifications), VBAs will likely not be a singular solution for improving healthcare cost containment. Instead, VBAs offer an opportunity for the US healthcare system to achieve higher value for dollars spent when implemented in combination with other value-based payment mechanisms and policies that disincentivize low-value care.


Assuntos
Contratos/economia , Assistência à Saúde/economia , Custos de Cuidados de Saúde , Aquisição Baseada em Valor/economia , Controle de Custos , Humanos , Estados Unidos
8.
Value Health ; 23(4): 425-433, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32327159

RESUMO

BACKGROUND: Mounting pressures on the healthcare system, such as budget constraints and new, costly health technologies reaching the market, have pushed payers and manufacturers to engage in managed entry agreements (MEAs) to address uncertainty and facilitate market access. OBJECTIVES: This study was conducted to illustrate the current landscape of MEAs in Europe and to analyze the main hurdles they face in implementation, providing a policy perspective. METHODS: We conducted a health policy analysis based on a literature review and described the emergence, classification, current use, and implementation obstacles of MEAs in Europe. RESULTS: Throughout Europe, uncertainty and high prices of health technologies have pushed stakeholders towards MEAs. Two main types of MEAs were applied heavily, finance-based agreements (FBAs) and performance-based agreements, including individual performance-based agreements and coverage with evidence development (CED). Service-based agreements have not been as heavily considered so far, yet are increasingly used. Many European countries are turning to CEDs to address uncertainty and facilitate market access while negotiating the pricing and reimbursement rates of products. Despite the interest in CEDs, European countries have moved toward FBAs due to the complexities and burdens associated with PBAs. CONCLUSIONS: Ultimately, in Europe, with the exception of Italy, where MEAs have proven to be inefficient, MEAs are predominantly FBAs dedicated to addressing cost containment from payers' perspective and external reference pricing from the manufacturers' perspective. It has been speculated that MEAs will disappear in the medium-term as they are counterproductive for extending patient access and emergence of innovation. To inform value-based decision making and allow early access to innovative medicines, CEDs should be revisited.


Assuntos
Tecnologia Biomédica/economia , Assistência à Saúde/economia , Política de Saúde , Controle de Custos , Indústria Farmacêutica/economia , Europa (Continente) , Humanos , Formulação de Políticas , Avaliação da Tecnologia Biomédica/economia
9.
N C Med J ; 81(2): 95-99, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32132248

RESUMO

BACKGROUND Health care costs are on the rise and causing financial burden for many patients. Price transparency has been proposed as a tool to control health care costs. New federal legislation requires all hospitals to publish their chargemasters, or price lists, on their websites as of January 1, 2019.METHOD All general acute care hospitals in North Carolina were contacted in 2017 to request price information. After mandatory chargemaster publication was in effect in 2019, all hospitals previously contacted had their websites evaluated for chargemaster availability. Price information collected in 2019 was compared to information collected in 2017.RESULTS Zero percent of hospitals provided access to chargemasters in 2017, and 72% provided access in 2019. Average price per queried item decreased from 2017 to 2019. Price variability also decreased. However, there was no statistical significance when comparing price means.LIMITATIONS In 2017, price data was limited due to low hospital participation when queried for prices. In 2019, this study's definition of "access to chargemaster" inadvertently excluded some North Carolina hospitals from qualifying as providing price access.CONCLUSION After mandated chargemaster publication, consumer access to hospital price lists greatly increased in North Carolina. Price data, although limited, reveals decreased mean prices and decreased price variability for queried procedures after chargemaster publication was required.


Assuntos
Revelação/legislação & jurisprudência , Preços Hospitalares , Controle de Custos/métodos , Custos de Cuidados de Saúde , Preços Hospitalares/estatística & dados numéricos , Humanos , North Carolina
11.
J Surg Oncol ; 121(8): 1175-1178, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32207151

RESUMO

BACKGROUND AND OBJECTIVES: Prophylactic lymphovenous anastomosis (LVA) has been shown to decrease the incidence of postoperative lymphedema among patients receiving mastectomy with axillary lymph node dissection (ALND). However, the economic impact of this intervention on overall healthcare costs has not been adequately studied and insurance reimbursement for lymphedema treatment is limited resulting in substantial out-of-pocket patient expenses. METHODS: We performed a cost-minimization decision analysis from the societal perspective to assess two different patient scenarios: (a) mastectomy with ALND alone, (b) mastectomy with ALND and prophylactic LVA. RESULTS: The annual cost of lymphedema-related care is estimated to be $5,691.88 ($3,160.52 direct, $2,531.36 indirect). If all patients undergoing mastectomy with ALND undergo prophylactic LVA, the average expected lifetime cost per patient in the entire population (whether or not they develop lymphedema) is approximately $6,295.61, compared to $13,942.26 if no patients in the same population receive prophylactic LVA. CONCLUSIONS: Prophylactic LVA is economically preferred over mastectomy and ALND alone from a cost minimization perspective, and results in an average of $7,646.65 (45.2%) cost saving per patient over the course of their lifetime.


Assuntos
Anastomose Cirúrgica/economia , Linfedema Relacionado a Câncer de Mama/prevenção & controle , Neoplasias da Mama/economia , Neoplasias da Mama/cirurgia , Anastomose Cirúrgica/métodos , Linfedema Relacionado a Câncer de Mama/economia , Controle de Custos , Tomada de Decisões , Árvores de Decisões , Feminino , Custos de Cuidados de Saúde , Humanos , Reembolso de Seguro de Saúde , Excisão de Linfonodo/economia , Vasos Linfáticos/cirurgia , Mastectomia/efeitos adversos , Mastectomia/economia , Microcirurgia/economia , Microcirurgia/métodos , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Programa de SEER , Estados Unidos
12.
BMC Health Serv Res ; 20(1): 75, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32007089

RESUMO

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


Assuntos
Assistência à Saúde/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Acidente Vascular Cerebral/terapia , Controle de Custos/métodos , Humanos , Acidente Vascular Cerebral/economia
19.
Curr Diab Rep ; 20(1): 2, 2020 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-31997036

RESUMO

PURPOSE OF REVIEW: High insulin prices and cost-related insulin underuse are increasingly common and vexing problems for healthcare providers. This review highlights several factors that contribute to high prices and limited generic competition in the US insulin market. RECENT FINDINGS: An opaque and complex pricing and reimbursement system for insulin, allegations of collusive practices by insulin manufacturers, and a lack of generic competition drive and sustain high insulin prices. When combined with increasing insurance deductibles and cost sharing, these factors contribute to cost-related insulin underuse and are associated with adverse clinical outcomes. Healthcare providers facing patients with type 2 diabetes who struggle to afford insulin should consider initiating or switching from analogue to human insulin as one way to help address the challenges of access and affordability. However, it is also important to support initiatives to advocate for affordable pricing for insulin for patients who can benefit from the flexibility offered by many of the newer insulin preparations.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Custos de Medicamentos , Mau Uso de Serviços de Saúde/economia , Hipoglicemiantes/economia , Insulina/economia , Controle de Custos/legislação & jurisprudência , Custos e Análise de Custo , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/epidemiologia , Custos de Medicamentos/legislação & jurisprudência , Medicamentos Genéricos/economia , Medicamentos Genéricos/uso terapêutico , Competição Econômica , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico
20.
Ann Intern Med ; 172(2 Suppl): S33-S49, 2020 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-31958802

RESUMO

The American College of Physicians (ACP) has long advocated for universal access to high-quality health care in the United States. Yet, it is essential that the U.S. health system goes beyond ensuring coverage, efficient delivery systems, and affordability. Fundamental restructuring of payment policies and delivery systems is required to achieve a health care system that puts patients' interests first and supports physicians and their care teams to deliver high-value, patient- and family-centered care. The ACP calls for reform of U.S. payment, delivery, and information technology systems to achieve this vision. The ACP's recommendations include increased investment in primary care; alignment of financial incentives to achieve better patient outcomes, lower costs, reduce inequities in health care, and facilitate team-based care; freeing patients and physicians of inefficient administrative and billing tasks and documentation requirements; and development of health information technologies that enhance the patient-physician relationship.


Assuntos
Assistência à Saúde/economia , Reforma dos Serviços de Saúde/economia , Política de Saúde/economia , Acesso aos Serviços de Saúde/economia , Assistência Centrada no Paciente/economia , Controle de Custos , Necessidades e Demandas de Serviços de Saúde , Disparidades em Assistência à Saúde/economia , Humanos , Informática Médica/economia , Relações Médico-Paciente , Qualidade da Assistência à Saúde/economia , Sociedades Médicas , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA