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5.
Med Care ; 57(8): 648-653, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31299026

RESUMO

OBJECTIVE: The objective of this study was to evaluate the impacts of the implementation of patient cost-sharing for an outpatient visit and prescription drugs for poor and nonable bodied Koreans in 2007. DATA SOURCES/STUDY SETTINGS: Nationally-representative longitudinal data sets (Korea Welfare Panel Study and the Korean Longitudinal Study of Ageing) in 2006, 2008, and 2010. RESEARCH DESIGN: Propensity score matching with difference-in-differences framework exploiting within-person variation in cost-sharing. RESULTS: Decreases in the probability of outpatient visit are offset by increases in the likelihood of hospitalization after the policy change. Cost-sharing also decreases drug adherence by 20%, particularly among chronically-ill persons. CONCLUSION: Because the costs of increased hospitalization among Medical Aid enrollees accrue to the government, the introduction of outpatient cost-sharing does not achieve the goal of cost control.


Assuntos
Assistência Ambulatorial/economia , Custo Compartilhado de Seguro , Pobreza , Idoso , Assistência Ambulatorial/organização & administração , Controle de Custos/economia , Controle de Custos/métodos , Controle de Custos/organização & administração , Custo Compartilhado de Seguro/economia , Custo Compartilhado de Seguro/métodos , Custos de Medicamentos/estatística & dados numéricos , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Adesão à Medicação/estatística & dados numéricos , Medicamentos sob Prescrição/economia , Pontuação de Propensão , República da Coreia
7.
J Health Organ Manag ; 33(3): 304-322, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31122116

RESUMO

PURPOSE: The purpose of this paper is to identify the lean production (LP) practices applied in healthcare supply chain and the existing barriers related to their implementation. DESIGN/METHODOLOGY/APPROACH: To achieve that, a scoping review was carried out in order to consolidate the main practices and barriers, and also to evidence research gaps and directions according to different theoretical lenses. FINDINGS: The findings show that there is a consensus on the potential of LP practices implementation in healthcare supply chain, but most studies still report such implementation restricted to specific unit or value stream within a hospital. ORIGINALITY/VALUE: Healthcare organizations are under constant pressure to reduce costs and wastes, while improving services and patient safety. Further, its supply chain usually presents great opportunities for improvement, both in terms of cost reduction and quality of care increase. In this sense, the adaptation of LP practices and principles has been widely accepted in healthcare. However, studies show that most implementations fall far short from their goals because they are done in a fragmented way, and not from a system-wide perspective.


Assuntos
Controle de Custos/métodos , Assistência à Saúde/organização & administração , Eficiência Organizacional , Controle de Custos/organização & administração , Assistência à Saúde/economia , Assistência à Saúde/métodos , Humanos , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/organização & administração
8.
Geriatr Gerontol Int ; 19(7): 667-672, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30968552

RESUMO

AIM: The present study aimed to evaluate drug costs per resident at Japanese intermediate care facilities for older adults (called Roken) in relation to drug utilization after admission to these facilities. The payment, including coverage of drugs, is mainly determined by the resident's long-term care needs. METHODS: A nationwide drug utilization survey was carried out. The participants were 1324 residents of 350 Roken (up to five individuals per facility) who were admitted in 2015 and agreed to participate in this study. Drug costs per resident per month at admission and 2 months later were calculated for drugs prescribed for regular use. Associations between characteristics of the residents and drug costs were examined. RESULTS: A wide variation in drug costs with a long right tail was observed. Median drug costs were $77 (interquartile range $34-147) at admission, and $46 (interquartile range $19-98) in month 2. There was no apparent association between the level of long-term care needs and drug costs, adjusting for sex, age and main place of residence before admission. Anti-dementia drugs accounted for the largest portion of total drug costs at admission (15.4%) and in month 2 (12.4%). The average drug cost per user was also the highest for anti-dementia drugs ($90.2 per user per month), followed by drugs for Parkinson's disease ($70.3). The proportion of generic drugs across all drug classes examined increased after admission. CONCLUSIONS: These findings might suggest that implementation of the bundled payment scheme would be effective for the reduction of medication costs in institutional long-term care. Geriatr Gerontol Int 2019; 19: 667-672.


Assuntos
Custos de Medicamentos/estatística & dados numéricos , Revisão de Uso de Medicamentos/métodos , Assistência de Longa Duração , Nootrópicos/uso terapêutico , Instituições de Cuidados Especializados de Enfermagem , Idoso , Controle de Custos/métodos , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Japão , Assistência de Longa Duração/economia , Assistência de Longa Duração/métodos , Masculino , Instituições de Cuidados Especializados de Enfermagem/economia , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos
9.
Expert Rev Pharmacoecon Outcomes Res ; 19(6): 733-742, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30900482

RESUMO

Objectives: The current study aims to analyze, from a historical perspective, the regulatory framework of prices and reimbursement in Bulgaria with emphasis on the introduction of economic evaluation.Methods: The study explores all regulatory changes during the period 1995-2016 combining the macroeconomic and regulatory analysis on medicines pricing and reimbursement. A roadmap summarizing the current regulatory requirements for the medicinal product entrance on national market and access to public funding was elaborated.Results: Demographic processes in the country have been negative for the past decade. On the other hand, health care and pharmaceutical expenditures experienced a growth up to 8.6% and 3% of total GDP, respectively. The total pharmaceutical market permanently grew from 309 to 1409 million of Euro. During the last 20 years, the pricing and reimbursement legislation of medicines in Bulgaria was changed extensively.Conclusion: Pricing policy remains oriented toward the lowest European prices and reimbursement policy impose cost containment measures. Appraisal of the obligatory Health Technology Assessment Dossiers and pharmacoeconomic analysis is in accordance with world recommendations. Main regulatory issues that still remain to be tackled are the slower entrance of medicines on the national market and lower national prices that often lead to parallel import.


Assuntos
Custos e Análise de Custo/legislação & jurisprudência , Custos de Medicamentos/legislação & jurisprudência , Farmacoeconomia , Mecanismo de Reembolso/legislação & jurisprudência , Bulgária , Controle de Custos/métodos , Custos e Análise de Custo/tendências , Custos de Medicamentos/tendências , Gastos em Saúde/legislação & jurisprudência , Humanos , Mecanismo de Reembolso/tendências , Avaliação da Tecnologia Biomédica/legislação & jurisprudência
10.
Health Policy ; 123(1): 71-79, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30429060

RESUMO

Unsustainable growth in healthcare expenditure demands effective cost-containment policies. We review policy effectiveness using total payer expenditure as primary outcome measure. We included all OECD member states from 1970 onward. After a rigorous quality appraisal, we included 43 original studies and 18 systematic reviews that cover 341 studies. Policies most often evaluated were payment reforms (10 studies), managed care (8 studies) and cost sharing (6 studies). Despite the importance of this topic, for many widely-used policies very limited evidence is available on their effectiveness in containing healthcare costs. We found no evidence for 21 of 41 major groups of cost-containment policies. Furthermore, many evaluations displayed a high risk of bias. Therefore, policies should be more routinely and rigorously evaluated after implementation. The available high-quality evidence suggests that the cost curve may best be bent using a combination of cost sharing, managed care competition, reference pricing, generic substitution and tort reform.


Assuntos
Controle de Custos/métodos , Custos de Cuidados de Saúde/estatística & dados numéricos , Política de Saúde , Humanos
11.
Health Care Manag Sci ; 22(1): 121-139, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29177758

RESUMO

This paper introduces a case study at a community hospital to develop a predictive model to quantify readmission risks for patients with chronic obstructive pulmonary disease (COPD), and use it to support decision making for appropriate incentive-based interventions. Data collected from the community hospital's database are analyzed to identify risk factors and a logistic regression model is developed to predict the readmission risk within 30 days post-discharge of an individual COPD patient. By targeting on the high-risk patients, we investigate the implementability of the incentive policy which encourages patients to take interventions and helps them to overcome the compliance barrier. Specifically, the conditions and scenarios are identified for either achieving the desired readmission rate while minimizing the total cost, or reaching the lowest readmission rate under incentive budget constraint. Currently, such models are under consideration for a pilot study at the community hospital.


Assuntos
Readmissão do Paciente , Doença Pulmonar Obstrutiva Crônica/prevenção & controle , Controle de Custos/métodos , Técnicas de Apoio para a Decisão , Hospitais Comunitários/economia , Hospitais Comunitários/organização & administração , Humanos , Modelos Estatísticos , Motivação , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Probabilidade , Doença Pulmonar Obstrutiva Crônica/economia , Doença Pulmonar Obstrutiva Crônica/terapia , Fatores de Risco
12.
Eur J Health Econ ; 20(2): 271-280, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30051152

RESUMO

BACKGROUND: Vaccine price is one of the most influential parameters in economic evaluations of HPV vaccination programmes. Vaccine tendering is a cost-containment method widely used by national or regional health authorities, but information on tender-based HPV vaccine prices is scarce. METHODS: Procurement notices and awards for the HPV vaccines, published from January 2007 until January 2018, were systematically retrieved from the online platform for public procurement in Europe. Information was collected from national or regional tenders organized for publicly funded preadolescent vaccination programmes against HPV. The influence of variables on the vaccine price was estimated by means of a mixed-effects model. FINDINGS: Prices were collected from 178 procurements announced in 15 European countries. The average price per dose for the first-generation HPV vaccines decreased from €101.8 (95% CI 91.3-114) in 2007 to €28.4 (22.6-33.5) in 2017, whereas the average dose price of the 9-valent vaccine in 2016-2017 was €49.1 (38.0-66.8). Unit prices were, respectively, €7.5 (4.4-10.6) and €34.4 (27.4-41.4) higher for the 4-valent and 9-valent vaccines than for the 2-valent vaccine. Contract volume and duration, level of procurement (region or country), per capita GDP and number of offers received had a significant effect on vaccine price. INTERPRETATION: HPV vaccine procurement is widely used across Europe. The fourfold decrease in the average tender-based prices compared to list prices confirms the potential of tendering as an efficient cost-containment strategy, thereby expanding the indications for cost-effective HPV vaccination to previously ineligible target groups.


Assuntos
Controle de Custos/economia , Custos de Medicamentos/estatística & dados numéricos , Vacinas contra Papillomavirus/economia , Comércio/estatística & dados numéricos , Controle de Custos/métodos , Análise Custo-Benefício , Bases de Dados Factuais , Uso de Medicamentos , Europa (Continente) , Feminino , Humanos , Programas de Imunização , Neoplasias do Colo do Útero/prevenção & controle
13.
Int J Qual Health Care ; 31(2): 96-102, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29788203

RESUMO

OBJECTIVE: We evaluate the effects of drug price reduction policy on pharmaceutical expenditure and prescription patterns in diabetes medication. DESIGN: An interrupted time series study design using generalized estimating equations. SETTING: This study used National Health Insurance claim data from 2010 to 2013. PARTICIPANTS: A total of 68 127 diabetes patients and 12 465 hospitals. INTERVENTION(S): The drug price reduction policy. MAIN OUTCOME MEASURES: The primary outcome is pharmaceutical expenditure and prescription rate. To evaluate changes in prescription rate, we measured prescription rates such a brand-name drug and drug price reduction rate. RESULTS: Although the drug price reduction policy associated with decreased pharmaceutical expenditure (-13.22%, P < 0.0001), the trend (-0.01%, P = 0.9201) did not change significantly compared with the pre-intervention period. In addition, the trends in the monthly prescription rate of brand-name drugs decreased (-0.14%, P = 0.0091), while the immediate change was an increase (5.72%, P < 0.0001). Regardless of the drug reduction rate, the prescription rate after the introduction of the drug price reduction policy decreased compared with the pre-intervention period, and this decline was significant for reduction rates of 0% (-2.74%, P < 0.0001) and 10% (-0.13%, P = 0.0018). CONCLUSIONS: Our results provide evidence of the effects of the drug price reduction policy on pharmaceutical expenditure and prescription patterns. This policy did not affect the prescribing behavior of healthcare providers and did not increase the use of drugs not subject to this policy. Although this study did not observe changes in the cost of pharmaceuticals after the introduction of the drug price reduction policy, further research is needed on the long-term changes in such costs.


Assuntos
Controle de Custos/economia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Médicos/psicologia , Padrões de Prática Médica/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Controle de Custos/métodos , Humanos , Hipoglicemiantes/economia , Análise de Séries Temporais Interrompida , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Políticas , República da Coreia
15.
Am J Manag Care ; 24(12): e386-e392, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30586487

RESUMO

OBJECTIVES: Medicare Advantage (MA) plans have strong incentives to control costs, including postacute spending; however, to our knowledge, no research has examined the methods that MA plans use to control or reduce postacute costs. This study aimed to understand such MA plan efforts and the possible unintended consequences. STUDY DESIGN: A multiple case study method was used. METHODS: We conducted 154 interviews with administrative and clinical staff working in 10 MA plans, 16 hospitals, and 25 skilled nursing facilities (SNFs) in 8 geographically diverse markets across the United States. RESULTS: Participants discussed how MA plans attempted to reduce postacute care spending by controlling the SNF to which patients are discharged and SNF length of stay (LOS). Plans typically influenced SNF selection by providing patients with a list of facilities in which their care would be covered. To influence LOS, MA plans most commonly authorized patient stays in SNFs for a certain number of days and required that SNFs adhere to this limitation, but they did not provide guidance or assistance in ensuring that the LOS goals were met. Hospital and SNF responses to the largely authorization-based system were frequently negative, and participants expressed concerns about potential unintended consequences. CONCLUSIONS: In their interactions with hospitals and SNFs, MA plans attempted to influence the choice of SNF and LOS to control postacute spending. However, exerting too much influence over hospitals and SNFs, as these results seem to indicate, may have the negative consequences of delayed hospital discharge and SNFs' avoidance of burdensome plans.


Assuntos
Controle de Custos/métodos , Medicare Part C/economia , Cuidados Semi-Intensivos/economia , Custos de Cuidados de Saúde , Humanos , Entrevistas como Assunto , Tempo de Internação/economia , Pesquisa Qualitativa , Instituições de Cuidados Especializados de Enfermagem/economia , Estados Unidos
16.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 62(6): 408-414, nov.-dic. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-177664

RESUMO

Introducción: La enfermedad traumática continúa representando un importante problema socio-sanitario. El objetivo del estudio es valorar predictores clínicos del gasto total, así como analizar que componentes del coste se modifican con cada parámetro clínico del politraumatizado. Material y métodos: Estudio retrospectivo de 131 politraumatizados registrados prospectivamente. Se llevó a cabo un análisis estadístico para valorar la relación entre parámetros clínicos, el coste total y el coste de los principales componentes del tratamiento. Resultados: El coste total del ingreso hospitalario fue de 3.791.879 euros. El gasto medio por paciente fue de 28.945 Euros. La edad y el género no fueron predictores del coste. Las escalas ISS, NISS y PS fueron predictores del coste total y del coste de diferentes facetas del tratamiento. El AIS de cráneo y tórax predijo un mayor coste de ingreso en UCI y de coste total. El AIS de miembros inferiores se asoció exclusivamente a un mayor gasto en las facetas de tratamiento relacionadas con la actividad quirúrgica. Discusión: Existen parámetros clínicos que son predictores del coste de tratamiento del paciente politraumatizado. En el estudio se describe como el tipo de traumatismo que presenta el paciente modifica el tipo de gastos que presentará en su ingreso hospitalario. Conclusiones: Los pacientes politraumatizados que presentan lesión multisistémica grave presentan incremento del gasto en múltiples componentes del coste de tratamiento. Los pacientes donde predomina el TCE o traumatismo torácico presentan un mayor coste por ingreso en la UCI y los que predomina el traumatismo ortopédico asocian un mayor gasto en actividad quirúrgica


Introduction: Traumatic pathology continues to represent an important socio-health problem. The aim of the study was to assess the clinical predictors of total expenditure, as well as to analyze which components of the cost are modified with each clinical parameter of the polytraumatized patient. Material and methods: Retrospective study of 131 polytrauma patients registered prospectively. A statistical analysis was carried out to assess the relationship between clinical parameters, the total cost and the cost of various treatment components. Results: The total cost of hospital admission was 3,791,879 euros. The average cost per patient was Euros 28,945. Age and gender were not predictors of cost. The scales ISS, NISS and PS were predictors of the total cost and of multiple treatment components. The AIS of Skull and Thorax predicted a higher cost of admission to ICU and Total Cost. The AIS of lower limbs was associated with greater spending on facets of treatment related to surgical activity. Discussion: There are clinical parameters that are predictors of the treatment cost of the polytraumatized patient. The study describes how the type of trauma that the patient suffers modifies the type of expenses that will present in their hospital admission. Conclusions: Polytraumatized patients with severe multisystem injury present increased costs in multiple components of the treatment cost. Patients with TBI or chest trauma present a higher cost for admission to ICU and those with orthopaedic trauma are associated with greater expenditure on surgical activity


Assuntos
Humanos , Traumatismo Múltiplo/epidemiologia , Índices de Gravidade do Trauma , Procedimentos Ortopédicos/economia , Traumatismo Múltiplo/economia , Controle de Custos/métodos , Custos Diretos de Serviços/estatística & dados numéricos , Estudos Retrospectivos , Efeito Idade
18.
Int J Clin Pharm ; 40(6): 1474-1481, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30367375

RESUMO

Background A significant number of clinical pharmacy services have shown to improve in-hospital medication safety and patient outcome. Prescription review and pharmacist interventions are a fundamental part of hospital clinical pharmacy activities. In a context of restricted financial resources, proving the economic and clinical impact of this activity seems necessary. Objective The aim of this study was to assess the clinical impact on patient outcomes and economic benefit of prescription review by pharmacists. Setting 1624-bed tertiary French university teaching hospital. Method Prospective single center study evaluating prescriptions for which a pharmacist intervention was issued over a 6-month period. The clinical impact of every pharmacist intervention was evaluated by a multidisciplinary experts committee. Economic benefit was evaluated from the public health care system spending standpoint. Main outcome measures Number of avoided hospitalization days and associated public health care system cost-avoidance. Results Prescription review and interventions by pharmacists prevented 73 intensive care unit hospitalization days, 74 continuous monitoring unit hospitalization days and 66 days of conventional hospitalization. €252,294.00 in public health expenditure were thus prevented. For every Euro invested in the prescription review activity, €5.09 of public health spending were potentially saved. Conclusion Our study shows that prescription review and clinical pharmacists' interventions had an impact on clinical outcomes which translated into prevented hospitalization days. Prescription optimization through pharmacist interventions allows significant health care cost savings which makes this service highly efficient.


Assuntos
Controle de Custos/métodos , Hospitais de Ensino/economia , Hospitais Universitários/economia , Farmacêuticos , Resultado do Tratamento , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Redução de Custos , Prescrições de Medicamentos/economia , Prescrições de Medicamentos/normas , Feminino , Hospitalização/economia , Humanos , Lactente , Unidades de Terapia Intensiva/economia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Saúde Pública/economia , Suíça , Adulto Jovem
19.
Health Aff (Millwood) ; 37(9): 1503-1508, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30179546

RESUMO

The California drug transparency bill (SB-17), signed into law in October 2017, seeks to promote transparency in pharmaceutical pricing, enhance understanding about pharmaceutical pricing trends, and assist in managing pharmaceutical costs. This article examines the legal and regulatory aspects of SB-17, explores legal challenges to the law, compares it to other state efforts to address rising drug prices, and discusses how California can maximize the impact of SB-17 by coupling the law with other incentives. While SB-17 might not significantly reduce drug prices, the new law represents a meaningful step for one state seeking to negotiate the political and legal boundaries of state action to rein in drug prices.


Assuntos
Controle de Custos/métodos , Custos de Medicamentos/legislação & jurisprudência , Farmacoeconomia , Legislação de Medicamentos , Medicamentos sob Prescrição/economia , California , Humanos
20.
J Health Econ ; 61: 27-46, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30053710

RESUMO

We examine the effects of a "per-episode fee limit" that was recently implemented as a cost-control policy in China's health care system. Using hospital administrative data on a rural public health insurance program in China, we find that hospital departments dynamically adjust episode fees in response to the level of stress under fee limits. We also document anomalous cycles in the fees and length of stay of discharged episodes, which are consistent with the dynamically optimizing behavior to comply with the fee limit. We find qualitatively similar results in administrative data from an urban public health insurance program.


Assuntos
Controle de Custos , Seguro Saúde/economia , China , Controle de Custos/métodos , Controle de Custos/organização & administração , Assistência à Saúde/economia , Assistência à Saúde/organização & administração , Economia Hospitalar , Honorários Médicos , Humanos , Seguro Saúde/organização & administração , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Serviços de Saúde Rural/economia , Serviços de Saúde Rural/organização & administração
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