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1.
Sci Total Environ ; 753: 142228, 2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33207473

RESUMO

This research examines the heterogeneous dynamic links among healthcare expenditures, land urbanization, and CO2 emissions across the development levels of China. To this end, data of 27 Chinese provinces are considered from 1999 to 2018. Theoretically, this research developed a healthcare expenditures-augmented Stochastic Impacts of Regression by Population, Affluence, and Technology (STIRPAT) model to incorporate healthcare expenditures as a determinant of affluence. Empirically, this research established a system of simultaneous equations based on the healthcare expenditures-augmented STIRPAT model to estimate the links among the variables. As a pre-analysis, second-generation Westerlund cointegration is applied and found the long-term equilibrium association among the variables. The long-run estimations and short-run causality are done by employing dynamic common correlated effects mean group method (DCCEMGM) and Dumitrescu-Hurlin causality. A heterogeneous long-run equilibrium linkage is confirmed to exist among the variables of interest. Concerning the long-run estimates, firstly, the healthcare expenditures growth and land urbanization exhibited a bilateral positive link. Secondly, CO2 emissions and healthcare expenditures growth manifested the existence of a bilateral positive link. And thirdly, a unilateral positive (negative) link is revealed to exist from a linear term (squared term) of land urbanization to CO2 emissions. Concerning the short-run results, firstly, a bilateral causal bond exists between the land urbanization and healthcare expenditures growth. Secondly, a bilateral causal bond prevails between CO2 emissions growth and healthcare expenditures growth. Finally, a unilateral causal bond is operational from land urbanization to CO2 emissions growth. In terms of the nature of the link, the long-run findings are consistent across the data samples. However, considering the degree of influence, heterogeneity is confirmed across the development levels for both long- and short-run. It infers that relatively more (less) developed regions showed relatively strong (weak) influence. Based on empirical findings, relevant policies are recommended.


Assuntos
Desenvolvimento Econômico , Urbanização , Dióxido de Carbono/análise , China , Gastos em Saúde
3.
BMJ Glob Health ; 5(11)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33184065

RESUMO

INTRODUCTION: The COVID-19 pandemic caused a healthcare crisis in China and continues to wreak havoc across the world. This paper evaluated COVID-19's impact on national and regional healthcare service utilisation and expenditure in China. METHODS: Using a big data approach, we collected data from 300 million bank card transactions to measure individual healthcare expenditure and utilisation in mainland China. Since the outbreak coincided with the 2020 Chinese Spring Festival holiday, a difference-in-difference (DID) method was employed to compare changes in healthcare utilisation before, during and after the Spring Festival in 2020 and 2019. We also tracked healthcare utilisation before, during and after the outbreak. RESULTS: Healthcare utilisation declined overall, especially during the post-festival period in 2020. Total healthcare expenditure and utilisation declined by 37.8% and 40.8%, respectively, while per capita expenditure increased by 3.3%. In a subgroup analysis, we found that the outbreak had a greater impact on healthcare utilisation in cities at higher risk of COVID-19, with stricter lockdown measures and those located in the western region. The DID results suggest that, compared with low-risk cities, the pandemic induced a 14.8%, 26.4% and 27.5% reduction in total healthcare expenditure in medium-risk and high-risk cities, and in cities located in Hubei province during the post-festival period in 2020 relative to 2019, an 8.6%, 15.9% and 24.4% reduction in utilisation services; and a 7.3% and 18.4% reduction in per capita expenditure in medium-risk and high-risk cities, respectively. By the last week of April 2020, as the outbreak came under control, healthcare utilisation gradually recovered, but only to 79.9%-89.3% of its pre-outbreak levels. CONCLUSION: The COVID-19 pandemic had a significantly negative effect on healthcare utilisation in China, evident by a dramatic decline in healthcare expenditure. While the utilisation level has gradually increased post-outbreak, it has yet to return to normal levels.


Assuntos
Infecções por Coronavirus/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Betacoronavirus , China/epidemiologia , Humanos , Pandemias
4.
Artigo em Espanhol | PAHO-IRIS | ID: phr-52979

RESUMO

[RESUMEN]. Objetivo. Determinar existencia de desigualdad y gradiente en gastos de bolsillo, gasto público y gasto privado, entre países americanos estratificados según su densidad de recurso humano en salud (RHS). Métodos. Estudio analítico y transversal de desigualdades en salud para el gasto de bolsillo (porcentaje del gasto total en salud), el gasto público y el gasto privado (porcentaje del PIB), aplicando la densidad de recurso humano (medicina más enfermería) como estratificador. A partir de datos de la Organización Panamericana de la Salud y el Banco Mundial se categorizaron 32 países americanos según su densidad, se calcularon tasas ponderadas, descriptivos, diferencias, correlaciones, indicadores simples y complejos de desigualdad. Resultados. Hay alta variabilidad de densidad de RHS (3,8 a 171,3; media de 43,97, DS 37,08) con diferencias significativas entre las categorías de alta y baja densidad. El primer cuartil concentra el 9% de la población y 4,45% del RHS; los 3 primeros cuartiles concentran el 48,4% de la población y el 17% del RHS. Mediante estratificación, se evidenció un gradiente y desigualdades en indicadores de gastos, mayor en el gasto de bolsillo, con el cual también la densidad de RHS presentó una correlación negativa. Conclusiones. La densidad de RHS presenta alta variabilidad entre países y grupos categorizados; se concentra en forma desigual en la población, y es mayor en los países con mayor gasto público. Como estratificador de la muestra permitió evidenciar desigualdades y gradientes de gastos en salud; los estratos de menor densidad presentan mayor gasto de bolsillo, menor gasto público y mayor gasto privado.


[ABSTRACT]. Objective. To determine the existence of inequality and gradient in out-of-pocket expenses, public spending and private spending, among countries from the Americas stratified according to their human resources for health (HRH) density. Methods. Analytical and transversal study of health inequalities for out-of-pocket spending (percentage of total health spending), public spending and private spending (percentage of GDP), applying the human resource density (medicine and nursing) as a stratifier. Based on data from the Pan American Health Organization and the World Bank, 32 countries from the Americas were categorized according to their density, and weighted rates, descriptors, differences, correlations, and simple and complex indicators of inequality were calculated. Results. There is high variability in HRH density (3.8 to 171.3; mean 43.97, SD 37.08) with significant differences between high and low density categories. The first quartile concentrates 9% of the population and 4.45% of the HRH; the first 3 quartiles concentrate 48.4% of the population and 17% of the HRH. The stratification showed a gradient and inequalities in expenditure indicators, higher in the out-of-pocket expenditure, with which the HRH density presented a negative correlation. Conclusions. HRH density shows high variability among countries and categorized groups; it is unevenly concentrated in the population, and is greater in countries with higher public spending. As a stratifier of the sample, it showed inequalities and gradients in health spending; the strata with lower density showed higher out-of-pocket spending, lower public spending and higher private spending.


Assuntos
Avaliação de Recursos Humanos em Saúde , Gastos em Saúde , América , Avaliação de Recursos Humanos em Saúde , Gastos em Saúde , América
6.
Artigo em Alemão | MEDLINE | ID: mdl-33090245

RESUMO

In the German healthcare system, immunotherapies have been well established for years. Currently there are over 100 registrations of monoclonal antibodies (MABs). In recent years, new immunotherapeutic approaches became available, amongst them checkpoint inhibitors and CAR­T cells in oncology. Increasing expenditures of the German statutory health insurance (SHI) system are regarded with concerns. This article presents an overview of the development and status of prescriptions and sales of selected immunotherapeutics in Germany. Data from 2015-2019 were analyzed, primarily from the GKV-Arzneimittel-Schnellinformation (GAmSi) and the consultancy IQVIA.In the group of older MABs, such as immunosuppressive and antineoplastic agents, biosimilars led to a (temporary) increase of applications, but reimbursement amounts are decreasing. Instruments of the SHI system like drug agreements, reference prices, and individual discount contracts intervene as expenditure control. Checkpoint inhibitors clearly show increasing prescriptions and expenditures. Finally, the CAR­T cells are indeed very expensive treatments, but are currently not that important due to the limited number of applications. In addition, the exemption from VAT of 19% and the signed discount agreements between suppliers and sickness funds reduce the burden. In 2015 and 2019, the net expenditures on drugs and surgical dressings accounted for 17.2% of the total expenditures on benefits of the SHI system. Should the expenditures on drugs increase overproportionately in the future, the German SHI system will be able to counteract with already available or new instruments, supported by the legislator. Manufacturers and the SHI system should develop joint actions to achieve solutions for new treatment approaches.


Assuntos
Medicamentos Biossimilares , Medicamentos Biossimilares/uso terapêutico , Assistência à Saúde , Alemanha , Gastos em Saúde , Imunoterapia , Programas Nacionais de Saúde
7.
J Manag Care Spec Pharm ; 26(11): 1468-1474, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33119445

RESUMO

The COVID-19 pandemic and the social unrest pervading U.S. cities in response to the killings of George Floyd and other Black citizens at the hands of police are historically significant. These events exemplify dismaying truths about race and equality in the United States. Racial health disparities are an inexcusable lesion on the U.S. health care system. Many health disparities involve medications, including antidepressants, anticoagulants, diabetes medications, drugs for dementia, and statins, to name a few. Managed care pharmacy has a role in perpetuating racial disparities in medication use. For example, pharmacy benefit designs are increasingly shifting costs of expensive medications to patients, creating affordability crises for lower income workers, who are disproportionally persons of color. In addition, the quest to maximize rebates serves to inflate list prices paid by the uninsured, among which Black and Hispanic people are overrepresented. While medication cost is a foremost barrier for many patients, other factors also propagate racial disparities in medication use. Even when cost sharing is minimal or zero, medication adherence rates have been documented to be lower among Blacks as compared with Whites. Deeper understandings are needed about how racial disparities in medication use are influenced by factors such as culture, provider bias, and patient trust in medical advice. Managed care pharmacy can address racial disparities in medication use in several ways. First, it should be acknowledged that racial disparities in medication use are pervasive and must be resolved urgently. We must not believe that entrenched health system, societal, and political structures are impermeable to change. Second, the voices of community members and their advocates must be amplified. Coverage policies, program designs, and quality initiatives should be developed in consultation with those directly affected by racial disparities. Third, the industry should commit to dramatically reducing patient cost sharing for essential medication therapies. Federal and state efforts to limit annual out-of-pocket pharmacy spending should be supported, even though increased premiums may be an undesirable (yet more equitable) consequence. Finally, information about race should be incorporated into all internal and external reporting and quality improvement activities. DISCLOSURES: No funding was received for the development of this manuscript. Kogut is partially supported by Institutional Development Award Numbers U54GM115677 and P20GM125507 from the National Institute of General Medical Sciences of the National Institutes of Health, which funds Advance Clinical and Translational Research (Advance-CTR), and the RI Lifespan Center of Biomedical Research Excellence (COBRE) on Opioids and Overdose, respectively. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Disparidades nos Níveis de Saúde , Programas de Assistência Gerenciada/organização & administração , Assistência Farmacêutica/organização & administração , Pneumonia Viral/epidemiologia , Afro-Americanos , Betacoronavirus , Custo Compartilhado de Seguro , Indústria Farmacêutica , Grupo com Ancestrais do Continente Europeu , Honorários Farmacêuticos , Feminino , Gastos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde , Hispano-Americanos , Humanos , Masculino , Programas de Assistência Gerenciada/economia , Adesão à Medicação , Pandemias , Assistência Farmacêutica/economia , Estudos Retrospectivos , Fatores Socioeconômicos , Estados Unidos/epidemiologia
9.
PLoS One ; 15(10): e0239576, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33113548

RESUMO

In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the differences in the level of income and expenditure between chronically-ill people and non-chronic population. Data were gathered from a national level survey conducted namely, the Household Income and Expenditure Survey (HIES) by the Department of Census and Statistics (DCS) of Sri Lanka. These data were statistically analysed with one-way and two-way ANOVA, to identify the factors that cause the differences among different groups. For the first time, this study makes an attempt using survey data, to examine the differences in the level of income and expenditure among chronically-ill people in Sri Lanka. Accordingly, the study discovered that married females who do not engage in any type of economic activity (being unemployed due to the disability associated with the respective chronic illness), in the age category of 40-65, having an educational level of tertiary education or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. If workforce population is compelled to lose jobs, it can lead to income insecurity and impair their quality of lives. Under above findings, it is reasonable to assume that most health care expenses are out of pocket. Furthermore, the study infers that chronic illnesses have a statistically proven significant differences towards the income and expenditure level. This has caused due to the interaction of demographic and socio-economic characteristics associated with chronic illnesses. Considering private-public sector partnerships that enable affordable access to health care services for all as well as implementation of commercial insurance and community-based mutual services that help ease burden to the public, are vital when formulating effective policies and strategies related to the healthcare sector. Sri Lanka is making strong efforts to support its healthcare sector and public, which was affected by the coronavirus (COVID-19) in early 2020. Therefore, findings of this paper will be useful to gain insights on the differences of chronic illnesses towards the income and expenditure of chronically-ill patients in Sri Lanka.


Assuntos
Betacoronavirus , Doença Crônica/epidemiologia , Infecções por Coronavirus/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Renda/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Análise de Variância , Criança , Pré-Escolar , Doença Crônica/economia , Comorbidade , Infecções por Coronavirus/economia , Países em Desenvolvimento/economia , Pessoas com Deficiência/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Características da Família , Feminino , Alimentos/economia , Humanos , Lactente , Recém-Nascido , Masculino , Indigência Médica/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias/economia , Pneumonia Viral/economia , Pobreza , Fatores Socioeconômicos , Sri Lanka/epidemiologia , Inquéritos e Questionários , Adulto Jovem
10.
PLoS One ; 15(10): e0238720, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031440

RESUMO

BACKGROUND: Global HIV funding cutbacks have been accompanied by the adoption of user fees to address funding gaps in treatment programs. Our objective was to assess the impact of user fees on HIV care utilization and medication adherence in Nigeria. METHODS: We conducted a retrospective analysis of patients enrolled in care before (October 2012-September 2013) and after (October 2014-September 2015) the introduction of user fees in a Nigerian clinic. We assessed pre- vs. post-user fee patient characteristics and enrollment trends, and determined risk of care interruption, loss to follow-up, and optimal medication adherence. RESULTS: After fees were instituted, there was a 66% decline in patient enrollment and 75% decline in number of ART doses dispensed. There was no difference in the proportion of female clients (64% vs 63%, p = 0.46), average age (36 vs. 37 years, p = 0.15), or median baseline CD4 (220/ul vs. 222/uL, p = 0.24) in pre- and post-fee cohorts. There was an increase in clients employed and/or had tertiary education (24% vs. 32%, p<0.001). Compared to pre-fee patients, the post-fee period had a 48% decreased risk of care interruption (aRR = 0.52, 95%CI:0.39-0.69), 22% decreased LTFU risk (aRR = 0.64, 95%CI:0.96), and 27% decreased odds of optimal medication adherence (aOR = 0.7, 3 95%CI 0.59-0.89). CONCLUSIONS: Patients enrolled in care after introduction of user fees in Nigeria were more likely to be educated or employed, and effectively retained in care after starting ART. However, fees were accompanied by a drastic reduction in new patient enrollment, suggesting that many patients may have been marginalized from HIV care.


Assuntos
Fármacos Anti-HIV/economia , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/economia , Adesão à Medicação , Adulto , Instituições de Assistência Ambulatorial/economia , Estudos de Coortes , Honorários e Preços , Feminino , Gastos em Saúde , Humanos , Perda de Seguimento , Masculino , Nigéria , Pacientes Desistentes do Tratamento , Estudos Retrospectivos
11.
BMJ ; 371: m4040, 2020 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-33097492

RESUMO

OBJECTIVE: To assess the relation between autocratisation-substantial decreases in democratic traits (free and fair elections, freedom of civil and political association, and freedom of expression)-and countries' population health outcomes and progress toward universal health coverage (UHC). DESIGN: Synthetic control analysis. SETTING AND COUNTRY SELECTION: Global sample of countries for all years from 1989 to 2019, split into two categories: 17 treatment countries that started autocratising during 2000 to 2010, and 119 control countries that never autocratised from 1989 to 2019. The treatment countries comprised low and middle income nations and represent all world regions except North America and western Europe. A weighted combination of control countries was used to construct synthetic controls for each treatment country. This statistical method is especially well suited to population level studies when random assignment is infeasible and sufficiently similar comparators are not available. The method was originally developed in economics and political science to assess the impact of policies and events, and it is now increasingly used in epidemiology. MAIN OUTCOME MEASURES: HIV-free life expectancy at age 5 years, UHC effective coverage index (0-100 point scale), and out-of-pocket spending on health per capita. All outcome variables are for the period 1989 to 2019. RESULTS: Autocratising countries underperformed for all three outcome variables in the 10 years after the onset of autocratisation, despite some improvements in life expectancy, UHC effective coverage index, and out-of-pocket spending on health. On average, HIV-free life expectancy at age 5 years increased by 2.2% (from 64.7 to 66.1 years) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 3.5% (95% confidence interval 3.3% to 3.6%, P<0.001) (from 64.7 to 66.9 years) in the absence of autocratisation. On average, the UHC effective coverage index increased by 11.9% (from 42.5 to 47.6 points) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 20.2% (95% confidence interval 19.6% to 21.2%, P<0.001) (from 42.5 to 51.1 points) in the absence of autocratisation. Finally, on average, out-of-pocket spending on health per capita increased by 10.0% (from $4.00 (£3.1; €3.4) to $4.4, log transformed) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by only 4.4% (95% confidence interval 3.9% to 4.6%, P<0.001) (from $4.0 to $4.2, log transformed) in the absence of autocratisation. CONCLUSIONS: Autocratising countries had worse than estimated life expectancy, effective health service coverage, and levels of out-of-pocket spending on health. These results suggest that the noticeable increase in the number of countries that are experiencing democratic erosion in recent years is hindering population health gains and progress toward UHC. Global health institutions will need to adjust their policy recommendations and activities to obtain the best possible results in those countries with a diminishing democratic incentive to provide quality healthcare to populations.


Assuntos
Democracia , Assistência de Saúde Universal , Idoso , Saúde Global/legislação & jurisprudência , Gastos em Saúde , Humanos , Expectativa de Vida , Pessoa de Meia-Idade , Política
13.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(9): 1482-1486, 2020 Sep 10.
Artigo em Chinês | MEDLINE | ID: mdl-33076603

RESUMO

Objective: To investigate the relationship between smoking status and the onset age of stomach cancer patients and estimate the patients' direct medical cost burden of stomach cancer due to smoking in Anhui province. Methods: The information about the primary stomach cancer patients and their direct treatment expenditures in 10 cancer-registered areas in Anhui were collected in 2017. The association between smoking status and the age of onset of stomach cancer patients was analyzed by univariate regression and multivariate logistic regression models. The median and smoking-attributed risk method was used to describe the direct treatment expenditure of stomach cancer patients in Anhui due to smoking. Results: A total of 736 patients with stomach cancer were analyzed in this study. Univariate regression analysis showed that rural household registration (t=2.091, P=0.037), smoking (t=-2.357, P=0.001 9) and alcohol consumption (t=-2.036, P=0.042) were related to the age of onset of stomach cancer. After adjusting for gender, alcohol consumption, body mass index and household registration type, the risk of early stomach cancer in people who quitted smoking cessation was lower than that in smokers (OR=0.36, 95%CI: 0.17-0.75). The total direct medical cost burden of 736 newly diagnosed stomach cancer patients was 6.939 6 million RMB. The direct medical expenditure in stomach cancer patients who had smoking behavior was higher than that in stomach cancer patients who quitted smoking and never smoked. Conclusions: Smoking is one of the risk factors for the earlier onset of stomach cancer in Anhui. It is necessary to strengthen tobacco control to reduce the economic burden of patients with stomach cancer.


Assuntos
Fumar , Neoplasias Gástricas , Idade de Início , China/epidemiologia , Gastos em Saúde , Humanos , Fumar/epidemiologia , Neoplasias Gástricas/economia , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/terapia
14.
PLoS One ; 15(9): e0239461, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970740

RESUMO

OBJECTIVE: To examine the association of health insurances on catastrophic health expenditure (CHE), and compares that among different health insurances in the last two decades in China. METHODS: The systematic review was conducted according to the Cochrane Handbook and reported according to PRISMA. We searched English and Chinese literature databases including PubMed, EM base, web of science, CNKI, Wan fang, VIP and CBM (Sino Med) for empirical studies on the association between health insurance and CHE from January 2000 to June 2020. Study selection, data extraction and quality appraisal were conducted by two reviewers. The secular trend of CHE rate and comparisons between population with different health insurances were conducted using meta-analysis, subgroup analysis and meta-regression. RESULTS: A total of 4874 citations were obtained, and finally 30 eligible studies with 633917 participants were included. The overall CHE rate was 13.6% (95% CI: 13.1% - 14.0%) from Jan 2000 to June 2020, 12.8% (95% CI: 12.2% - 13.3%) for people with health insurance compared with 16.2% (95% CI:15.4% - 16.9%) for people without health insurance. For types of insurance, the CHE rate was 13.0% (95% CI: 12.4% - 13.6%) for people with new rural cooperative medical scheme (NCMS), 11.9% (95% CI: 9.3% - 14.5%) for urban employees health insurance (UEBMI), 12.0% (95% CI: 8.3% - 15.6%) for urban residents health insurance (URBMI), and 18.0% (95% CI: - 4.5% - 31.5%) for commercial insurance. However, the CHE rate in China has increased in the past 20 years, even adjusted for other factors. The CHE rate of people with NCMS has increased significantly more than people with UEBMI and URBMI. CONCLUSION: In the past 20 years, the basic health insurance plan has reduce the rate of CHE to a certain extent, but due to the rapid increase in medical costs and the release of health needs in recent years, it masks the role of health insurance. More efforts are needed to control unreasonable medical demand and rising costs.


Assuntos
Gastos em Saúde/tendências , Disparidades em Assistência à Saúde/economia , Seguro Saúde/tendências , China/epidemiologia , Feminino , História do Século XXI , Humanos , Renda , Seguro Saúde/economia , Masculino , Serviços de Saúde Rural/economia , População Rural , Serviços Urbanos de Saúde/economia , População Urbana
15.
J Adv Nurs ; 76(12): 3218-3227, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32914471

RESUMO

AIM: To examine the UK pandemic preparedness in light of health expenditure, nursing workforce, and mortality rates in and relation to nursing leadership. BACKGROUND: The Global Health Security Index categorized the preparedness of 195 countries to face a biological threat on a variety of measures, producing an overall score. The United States of America and the United Kingdom were ranked 1st and 2nd most prepared in 2019. METHOD: A cross-nation comparison of the top 36 countries ranked by Global Health Security Index score using a variety of online sources, including key data about each nation's expenditure on health and the nursing workforce, and compared these with mortality data for COVID-19. RESULTS: The extent of a country's pandemic preparedness, expenditure on healthcare and magnitude of the nursing workforce does not appear to impact mortality rates at this stage of the pandemic which is something of a paradox. CONCLUSION: It is important that arrangements for dealing with future global pandemics involve a range of agencies and experts in the field, including nurse leaders. IMPLICATIONS FOR NURSING: To achieve the best outcomes for patients, nurse leaders should be involved in policy forums at all levels of government to ensure nurses can influence health policy.


Assuntos
Infecções por Coronavirus/mortalidade , Gastos em Saúde , Recursos Humanos de Enfermagem , Pandemias , Pneumonia Viral/mortalidade , Recursos Humanos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Reino Unido/epidemiologia
16.
Int J Equity Health ; 19(1): 152, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32887629

RESUMO

BACKGROUND: General Government Health Expenditure (GGHE) in Mauritius accounted for only 10% of General Government Expenditure for the fiscal year 2018. This is less than the pledge taken under the Abuja 2001 Declaration to allocate at least 15% of national budget to the health sector. The latest National Health Accounts also urged for an expansion in the fiscal space for health. As public hospitals in Mauritius absorb 70% of GGHE, maximising returns of hospitals is essential to achieve Universal Health Coverage. More so, as Mauritius is bracing for its worst recession in 40 years in the aftermath of the COVID-19 pandemic public health financing will be heavily impacted. A thorough assessment of hospital efficiency and its implications on effective public health financing and fiscal space creation is, therefore, vital to inform ongoing health reform agenda. OBJECTIVES: This paper aims to examine the trend in hospital technical efficiency over the period 2001-2017, to measure the elasticity of hospital output to changes in inputs variables and to assess the impact of improved hospital technical efficiency in terms of fiscal space creation. METHODS: Annual health statistics released by the Ministry of Health and Wellness and national budget of the Ministry of Finance, Economic Planning and Development were the principal sources of data. Applying Stochastic Frontier Analysis, technical efficiency of public regional hospitals was estimated under Cobb-Douglas, Translog and Multi-output distance functions, using STATA 11. Hospital beds, doctors, nurses and non-medical staff were used as input variables. Output variable combined inpatients and outpatients seen at Accident Emergency, Sorted and Unsorted departments. Efficiency scores were used to determine potential efficiency savings and fiscal space creation. FINDINGS: Mean technical efficiency scores, using the Cobb Douglas, Translog and Multi-output functions, were estimated at 0.83, 0.84 and 0.89, respectively. Nurses and beds are the most important factors in hospital production, as a 1% increase in the number of beds and nurses, result in an increase in hospital outputs by 0.73 and 0.51%, respectively. If hospitals are to increase their inputs by 1%, their outputs will increase by 1.16%. Hospital output process has an increasing return to scale. With technical efficiencies improving to scores of 0.95 and 1.0 in 2021-2022, potential savings and fiscal space creation at hospital level, would amount to MUR 633 million (US$ 16.2 million) and MUR 1161 million (US$ 29.6 million), respectively. CONCLUSION: Fiscal space creation through full technical efficiency, is estimated to represent 8.9 and 9.2% of GGHE in fiscal year 2021-2022 and 2022-2023, respectively. This will allow without any restrictions the funding of the national response for HIV, vaccine preventable diseases as well as building a resilient health system to mitigate impact of emerging infectious diseases as experienced with COVID-19.


Assuntos
Eficiência Organizacional/estatística & dados numéricos , Financiamento Governamental/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Hospitais Públicos/economia , Hospitais Públicos/organização & administração , Infecções por Coronavirus/epidemiologia , Reforma dos Serviços de Saúde , Humanos , Maurício , Pandemias , Pneumonia Viral/epidemiologia , Cobertura Universal do Seguro de Saúde
19.
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
20.
PLoS One ; 15(9): e0238980, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915916

RESUMO

Hypertension remains the leading risk factor for death and disability in China, and the ability of hypertensive patients to pay for outpatient care and medication has become a critical issue. To report the effect of an outpatient copayment scheme on health outcomes of hypertensive adults in a community-managed population in Xinjiang, we compared changes in outcomes between insured and uninsured groups from baseline to the first follow-up appointment in a community-managed hypertensive population and evaluated these changes based on propensity score matching and the difference-in-difference method. A total of 1,095 individuals in a community-managed hypertension population were selected for investigation at baseline, among which 805 (73.5%) had follow-up data and 749 (68.4%) were included in our analysis. After accounting for the self-reported severity of hypertension and individual characteristics, there were statistically significant improvements in drug treatment of hypertension and self-reported health. We also found increases in drug treatment for hypertension between groups, after correcting for confounding variables (Odds Ratio, OR 8.05, 95% Confidence interval, CI, 1.31-49.35), and in self-reported health between groups after correcting confounders (OR 1.96, 95% CI, 1.12 to 3.42). Adjusted estimates (confounding variables) were corrected for age, sex, income, marital status, education level, employment, family size, self-reported severity of hypertension, course of hypertension, and number of medications. As a result, decreased outpatient copayment was associated with an increase in antihypertensive treatment coverage, and an improvement in self-reported health among community-managed hypertensive populations in Xinjiang, China.


Assuntos
Assistência Ambulatorial/economia , Gastos em Saúde , Hipertensão/tratamento farmacológico , Hipertensão/economia , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , China , Serviços de Saúde Comunitária/economia , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pontuação de Propensão , Qualidade de Vida , Autorrelato , Inquéritos e Questionários , Resultado do Tratamento
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