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2.
Medicine (Baltimore) ; 99(3): e16635, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011430

RESUMO

OBJECTIVE: This study aimed to explore the cost-effectiveness of etanercept plus methotrexate (ETN+MTX) compared to triple disease-modifying anti-rheumatic drugs (DMARDs) in treating Chinese rheumatoid arthritis (RA) patients. METHODS: The 134 Chinese RA patients who were about to initiate ETN+MTX or triple DMARDs therapy based on treat-to-target strategy were consecutively recruited and categorized into ETN+MTX group (N = 49) or triple DMARDs group (N = 85). Treatment efficacy was assessed at month 3 (M3)/M6/M9/M12 after initiation of treatment. Also, 1-year treatment cost was evaluated, and cost-effectiveness analysis and sensitivity analysis were conducted. RESULTS: RA patients in ETN+MTX group exhibited similar disease activity and quality of life at each time point while elevated 28-joint disease activity score based on erythrocyte sedimentation rate (DAS28-ESR) change (M0-M12) and low disease activity rate compared with triple DMARDs group. For 1-year treatment cost, ETN+MTX required increased drug cost, decreased other medical cost, and finally elevated total cost compared with triple DMARDs. Meanwhile, compared to triple DMARDs, ETN+MTX produced an additional quality-adjusted life year (QALY) of 0.015, resulting in an incremental cost-effectiveness ratio (ICER) of ¥2,939,506.7 per QALY that was 53.1 folds of gross domestic product (GDP) per capita in China. More interestingly, sensitivity analysis revealed that the ETN price had to be reduced at least by 71.3% before ETN+MTX became cost-effectiveness compared to triple DMARDs. CONCLUSION: ETN+MTX is less cost-effective in treating Chinese RA patients compared with triple DMARDs.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Etanercepte/uso terapêutico , Metotrexato/uso terapêutico , Adulto , Idoso , Antirreumáticos/administração & dosagem , Antirreumáticos/economia , Sedimentação Sanguínea , China , Análise Custo-Benefício , Quimioterapia Combinada , Etanercepte/administração & dosagem , Etanercepte/economia , Feminino , Gastos em Saúde , Humanos , Masculino , Metotrexato/administração & dosagem , Metotrexato/economia , Pessoa de Meia-Idade , Qualidade de Vida , Indução de Remissão , Índice de Gravidade de Doença
3.
BMJ ; 368: m327, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32024652
4.
Medicine (Baltimore) ; 99(2): e18625, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914043

RESUMO

BACKGROUND: Inequality in health and health care remains a rather challenging issue in China, existing both in rural and urban area, and between rural and urban. This study used nationally representative data to assess inequality in both rural and urban China separately and to identify socioeconomic factors that may contribute to this inequality. METHODS: This study used 2008 National Health Services Survey data. Demographic characteristics, income, health status, medical service utilization, and medical expenses were collected. Horizontal inequality analysis was performed using nonlinear regression method. RESULTS: Positive inequity in outpatient services and inpatient service was evident in both rural and urban area of China. Greater inequity of outpatient service use in urban than that in rural areas was evident (horizontal inequity index [HI] = 0.085 vs 0.029). In contrast, rural areas had greater inequity of inpatient service use compared to urban areas (HI = 0.21 vs 0.16). The decomposition analysis found that the household income made the greatest pro-rich contribution in both rural and urban China. However, chronic diseases and aging were also important contributors to the inequality in rural area. CONCLUSION: The inequality in health service in both rural and urban China was mainly attributed to the household income. In addition, chronic disease and aging were associated with inequality in rural population. Those findings provide evidences for policymaker to develop a sustainable social welfare system in China.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , China , Feminino , Gastos em Saúde/estatística & dados numéricos , Nível de Saúde , Humanos , Renda/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto Jovem
6.
JAMA ; 322(21): 2115-2124, 2019 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-31794624

RESUMO

Importance: Although neighborhoods are thought to be an important health determinant, evidence for the relationship between neighborhood poverty and health care use is limited, as prior studies have largely used observational data without an experimental design. Objective: To examine whether housing policies that reduce exposure to high-poverty neighborhoods were associated with differences in long-term hospital use among adults and children. Design, Setting, and Participants: Exploratory analysis of the Moving to Opportunity for Fair Housing Demonstration Program, a randomized social experiment conducted in 5 US cities. From 1994 to 1998, 4604 families in public housing were randomized to 1 of 3 groups: a control condition, a traditional Section 8 voucher toward rental costs in the private market, or a voucher that could only be used in low-poverty neighborhoods. Participants were linked to all-payer hospital discharge data (1995 through 2014 or 2015) and Medicaid data (1999 through 2009). The final follow-up date ranged from 11 to 21 years after randomization. Exposures: Receipt of a traditional or low-poverty voucher vs control group. Main Outcomes and Measures: Rates of hospitalizations and hospital days, and hospital spending. Results: Among 4602 eligible individuals randomized as adults, 4072 (88.5%) were linked to health data (mean age, 33 years [SD, 9.0 years]; 98% female; median follow-up, 11 years). There were no significant differences in primary outcomes among adults randomized to receive a voucher compared with the control group (unadjusted hospitalization rate, 14.0 vs 14.7 per 100 person-years, adjusted incidence rate ratio [IRR], 0.95 [95% CI, 0.84-1.08; P = .45]; hospital days, 62.8 vs 67.0 per 100 person-years; IRR, 0.93 [95% CI, 0.77-1.13; P = .46]; yearly spending, $2075 vs $1977; adjusted difference, -$129 [95% CI, -$497 to $239; P = .49]). Among 11 290 eligible individuals randomized as children, 9118 (80.8%) were linked to health data (mean age, 8 years [SD, 4.6 years]; 49% female; median follow-up, 11 years). Receipt of a housing voucher during childhood was significantly associated with lower hospitalization rates (6.3 vs 7.3 per 100 person-years; IRR, 0.85 [95% CI, 0.73-0.99; P = .03]) and yearly inpatient spending ($633 vs $785; adjusted difference, -$143 [95% CI, -$256 to -$31; P = .01]) and no significant difference in hospital days (25.7 vs 28.8 per 100 person-years; IRR, 0.92 [95% CI, 0.77-1.11; P = .41]). Conclusions and Relevance: In this exploratory analysis of a randomized housing voucher intervention, adults who received a housing voucher did not experience significant differences in hospital use or spending. Receipt of a voucher during childhood was significantly associated with lower rates of hospitalization and less inpatient spending during long-term follow-up.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Habitação/economia , Habitação Popular , Adulto , Criança , Feminino , Seguimentos , Hospitalização/economia , Humanos , Masculino , Áreas de Pobreza , Habitação Popular/economia , Características de Residência , Estados Unidos
7.
J Ment Health Policy Econ ; 22(3): 85-94, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31811752

RESUMO

BACKGROUND: Since the introduction and soaring popularity of the managed behavioral healthcare (BH) "carve-out" model in the 1980s, policymakers have been concerned with their impact on access. In carve-outs, BH and medical benefits are administered separately. Earlier literature found they reduced intensity of service use while maintaining penetration rates. Recently it has become more common for employers to drop existing carve-out contracts, partly due to the Mental Health Parity and Addiction Equity Act (MHPAEA), which placed a greater administrative burden on carve-outs for parity compliance. Although prior studies focused exclusively on the impact of moving from carve-in to carve-out models, it is now more policy-relevant to understand the effects of the move from carve-out to carve-in, which may not be symmetric. Moreover, the natural experiment resulting from MHPAEA implementation may attenuate concerns about selection bias. STUDY AIMS: This study examines how specialty BH care patterns change when employees and dependents are moved from a "carve-out" plan to a "carve-in" plan. METHODS: Linked insurance claims, eligibility, plan and employer data from 2008-14 were obtained for three Optum( employers who dropped their carve-out contracts but retained their carve-in plans. A longitudinal "difference-in-differences" study design was used to compare changes in BH services use over time among individuals who were: (i) moved to carve-in plans when the employer dropped its carve-out contract (N=177,653); and (ii) enrolled in carve-in plans before and after the transition (N=58,658). Outcomes included total and inpatient expenditures, broken down by plan, patient, and total; outpatient visits for assessment, individual psychotherapy, family psychotherapy, and medication management; and days of structured outpatient care, day treatment, residential care, and acute inpatient care. We pooled person-year observations and estimated regressions including individual fixed effects, year dummies and interactions between indicators for post-transition period and whether transitioned from carve-out to carve-in. RESULTS: Relative to individuals continuously in carve-in plans, those who were transitioned experienced significant increases in inpatient utilization (beta =.02; p=.05) and patient inpatient costs (beta =2.35; p=.01) and decreases in day treatment (beta =-0.01; p=.02). Our conclusions proved robust against potential biases due to differing secular time trends and differential changes in benefits resulting from MHPAEA. DISCUSSION: The increased inpatient utilization associated with switching from carve-out to carve-in plans is consistent with previous literature. Carve-outs may use day treatment to reduce inpatient care so that increased inpatient utilization post-transition reduced demand for day treatment. Limitations include possible selection bias at the employer level; lack of data on medication and generalist use, quality, clinical endpoints and quality of life; and potential lack of generalizability. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The reduction in the use of carve-out contracts by private employers associated with MHPAEA implementation likely did not have a net negative impact and may have actually increased access to care among former carve-out enrollees in need of inpatient services. IMPLICATIONS FOR HEALTH POLICIES: Policymakers should consider and evaluate possible unintended consequences of legislation designed to improve access to care. IMPLICATIONS FOR FURTHER RESEARCH: Future work should replicate these analyses with a more representative sample.


Assuntos
Financiamento Pessoal/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/estatística & dados numéricos , Humanos , Saúde Mental , Psiquiatria , Qualidade de Vida , Estados Unidos
8.
Epidemiol Psychiatr Sci ; 29: e81, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31839018

RESUMO

AIMS: Patients with severe mental disorders in low-resource settings have limited access to services, resulting in overwhelming caregiving burden for families. In extreme cases, this has led to the long-term restraining of patients in their homes. China underwent a nationwide initiative to unlock patients and provide continued treatment. This study aims to quantify household economic burden in families after unlocking and treatment, and to identify factors associated with increased burden due to schizophrenia. METHODS: A total of 264 subjects were enrolled from three geographically diverse provinces in 2012. Subjects were patients with schizophrenia who were previously put under restraints and had participated in the 'unlocking and treatment' intervention. The primary outcome was the current household economic burden, obtained from past year financial information collected through on-site interview. Patient disease characteristics, treatment, outcomes and family caregiving burden were collected as well. Univariate and multivariate linear regression were used to construct risk factor models for indirect economic burden. RESULTS: After participating in the intervention, 85% of patients continued to receive mental health services, 70% used medication as prescribed and 80% were never relocked. Family members reported significantly decreased caregiving burden after receiving the intervention. Mean direct and indirect household economic burdens were CNY963 (US$31.7) and CNY11 724 (US$1670) per year, respectively, while family total income was on average CNY12 108 (US$1913) per year. Greater disease severity and poorer patient psychosocial function at time of study were found to be independent factors related to increased indirect burden. CONCLUSIONS: The 'unlocking and treatment' intervention has improved the lives of patients and families. Indirect burden due to disease is still a major economic issue that needs to be addressed, potentially through improving treatment and patient functioning. Our findings contribute to the unravelling and eventual elimination of chronic restraining of mentally ill patients in low-resource settings.


Assuntos
Cuidadores/psicologia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Gastos em Saúde , Serviços de Saúde Mental/economia , Esquizofrenia/terapia , Adolescente , Adulto , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esquizofrenia/economia , Psicologia do Esquizofrênico , Inquéritos e Questionários , Adulto Jovem
9.
Georgian Med News ; (295): 164-170, 2019 Oct.
Artigo em Russo | MEDLINE | ID: mdl-31804221

RESUMO

The aim of the study was to substantiate the effectiveness and feasibility of the practical application of the multifactorial model of financing the prevention and treatment of dirofilariasis, its principles and methodological approaches. The basic principles of the multifactor model - an integrated approach, a combination of public and private financing, ensuring continuity of financing, discreteness of expenses; methodology for determining the effectiveness of the use of financial resources on the calculation of the return on costs for the prevention and treatment of dirofilariasis were justified. The effectiveness of local budget spending on the treatment of territories of the Kharkov region from mosquitoes on the base on the proposed principles and methodology was analyzed. As a result of the study, it has been proven the limited budgetary funds do not allow the implementation of long-term comprehensive programs for the prevention and treatment of dirofilariasis. The use of a multifactorial model of financing will allow overcoming budgetary constraints, significantly increasing the financial resources of the fight against dirofilariasis, optimizing the expenditures of state and local budgets, and ensuring targeted use of funds from the state, territorial communities, enterprises and the population.


Assuntos
Dirofilariose , Gastos em Saúde , Dirofilariose/economia , Dirofilariose/prevenção & controle , Humanos
10.
Medicine (Baltimore) ; 98(49): e18082, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804317

RESUMO

OBJECTIVES: Our study provides phase-specific cost estimates for pancreatic cancer based on stage and treatment. We compare treatment costs between the different phases and within the stage and treatment modality subgroups. METHODS: Our cohort included 20,917 pancreatic cancer patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database diagnosed between 2000 and 2011. We allocated costs into four phases of care-staging (or surgery), initial, continuing, and terminal- and calculated the total, cancer-attributable, and patient-liability costs in 2018 US dollars. We fit linear regression models using log transformation to determine whether costs were predicted by age and calendar year. RESULTS: Monthly cost estimates were high during the staging and surgery phases, decreased over the initial and continuing phases, and increased during the three-month terminal phase. Overall, the linear regression models showed that cancer-attributable costs either remained stable or increased by year, and either were unaffected by age or decreased with older age; continuing phase costs for stage II patients increased with age. CONCLUSIONS: Our estimates demonstrate that pancreatic cancer costs can vary widely by stage and treatment received. These cost estimates can serve as an important baseline foundation to guide resource allocation for cancer care and research in the future.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Neoplasias Pancreáticas/economia , Neoplasias Pancreáticas/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Lineares , Masculino , Medicare/estatística & dados numéricos , Modelos Econométricos , Estadiamento de Neoplasias , Programa de SEER , Assistência Terminal/economia , Estados Unidos
12.
Isr J Health Policy Res ; 8(1): 87, 2019 12 20.
Artigo em Inglês | MEDLINE | ID: mdl-31862016

RESUMO

BACKGROUND: The mixture of public vs. private financing of the healthcare system has important fiscal and economic welfare implications. The consequences of this mixture for access to health services and for equity have become highly debated policy issues. In the first decade of 2000s, Israel experienced a continuous upward trend in the proportion of private financing, reaching a peak of 37-38%, which has subsequently leveled off. The 38% level is significantly higher than the 26% average across the Organization for Economic Co-operation and Development (OECD) countries. MAIN TEXT: A recent paper by Tur-Sinai et al. in this journal shows that private spending by Israelis on health care is positively related to the income of individuals and to the socioeconomic status of their place of residence. This commentary draws attention to studies that integrate into one model both demand-side and supply-side determinants of private expenditures on healthcare. It also discusses inequity. CONCLUSIONS: Overall, the financing of national health expenditures in Israel is slightly regressive, but the progressivity of public financing is almost enough to offset the regressive effect of out-of-pocket payments and payments for voluntary complementary insurance.


Assuntos
Financiamento Pessoal , Gastos em Saúde , Assistência à Saúde , Características da Família , Humanos , Israel
14.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46897

RESUMO

Plataforma do IBGE com dados indicadores sobre a proporção de pessoas em famílias com grandes gastos em saúde em relação ao total de despesas familiares. Agenda 2030 - objetivo 3 - Saúde e bem estar


Assuntos
Desenvolvimento Sustentável , Gastos em Saúde , Relações Familiares
16.
Global Health ; 15(Suppl 1): 72, 2019 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-31775796

RESUMO

The triple goals of Universal Health Coverage (UHC) are to cover the whole population, to reduce patients' costs, and to expand coverage to all effective services, equitably available to all. This paper analyses the experience of Japan in achieving these goals, focusing on the central role played by the payment system. The payment system, or fee schedule, sets the price of services and pharmaceuticals, as well as the conditions that providers must comply with in order to receive payment. The fee schedule was first introduced following the enactment of social health insurance (SHI) in 1922. Initially, the SHI program covered only manual workers, who comprised a mere 3% of the population. However, the fee schedule of the largest SHI plan was subsequently adopted by all other SHI plans. From 1958, there has been only one fee schedule. Population coverage was achieved in 1961 by mandating all residing in Japan to enroll in SHI, thereby making everyone entitled to all the services and pharmaceuticals listed in the fee schedule. Next, co-insurance was capped to an affordable level by the introduction of catastrophic coverage in 1973. Lastly, extra billing and balance billing were explicitly restricted in 1984. The key to achieving and sustaining UHC goals in Japan lies in being able to contain costs and reallocate resources by revising the fee schedule.


Assuntos
Gastos em Saúde/legislação & jurisprudência , Cobertura Universal do Seguro de Saúde/economia , Cobertura Universal do Seguro de Saúde/organização & administração , Metas , Humanos , Japão
17.
BMJ ; 367: l6326, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31776110

RESUMO

OBJECTIVE: To determine how the UK National Health Service (NHS) is performing relative to health systems of other high income countries, given that it is facing sustained financial pressure, increasing levels of demand, and cuts to social care. DESIGN: Observational study using secondary data from key international organisations such as Eurostat and the Organization for Economic Cooperation and Development. SETTING: Healthcare systems of the UK and nine high income comparator countries: Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland, and the US. MAIN OUTCOME MEASURES: 79 indicators across seven domains: population and healthcare coverage, healthcare and social spending, structural capacity, utilisation, access to care, quality of care, and population health. RESULTS: The UK spent the least per capita on healthcare in 2017 compared with all other countries studied (UK $3825 (£2972; €3392); mean $5700), and spending was growing at slightly lower levels (0.02% of gross domestic product in the previous four years, compared with a mean of 0.07%). The UK had the lowest rates of unmet need and among the lowest numbers of doctors and nurses per capita, despite having average levels of utilisation (number of hospital admissions). The UK had slightly below average life expectancy (81.3 years compared with a mean of 81.7) and cancer survival, including breast, cervical, colon, and rectal cancer. Although several health service outcomes were poor, such as postoperative sepsis after abdominal surgery (UK 2454 per 100 000 discharges; mean 2058 per 100 000 discharges), 30 day mortality for acute myocardial infarction (UK 7.1%; mean 5.5%), and ischaemic stroke (UK 9.6%; mean 6.6%), the UK achieved lower than average rates of postoperative deep venous thrombosis after joint surgery and fewer healthcare associated infections. CONCLUSIONS: The NHS showed pockets of good performance, including in health service outcomes, but spending, patient safety, and population health were all below average to average at best. Taken together, these results suggest that if the NHS wants to achieve comparable health outcomes at a time of growing demographic pressure, it may need to spend more to increase the supply of labour and long term care and reduce the declining trend in social spending to match levels of comparator countries.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Países Desenvolvidos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Saúde da População/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Produto Interno Bruto , Gastos em Saúde/estatística & dados numéricos , Humanos , Renda , Reino Unido
18.
Artigo em Russo | MEDLINE | ID: mdl-31765542

RESUMO

The analysis of a state and development of health sector in Russia is presented in article. The developed trends in receipt and expenditure of means of financing of medical services of health care in the country are revealed. The authors have identified existing problems in the field of health related to its lack of funding. Comparative characteristic of the amounts of financing of medicine is manufactured in Russia and a number of the leading foreign countries. The typology, advantages and shortcomings of various ways of financing of health sector are revealed. Characteristic and an assessment of national peculiarities of financing of health care in world practice is given. The author's approach on modernization of the model of financing of health sector existing in the country with attraction for this purpose means of the state, business and the population allowing to pass to real, ordered, economically rational consumption of medical services and to increase the responsibility of citizens for strengthening of own health is offered. This approach is focused on a gradual transition from a budget-insurance type of financing of medical services with a private-insurance type and is based on expanding the ability of citizens to manage their financial resources on accumulative medical bills. In addition, the author's approach assumes that the functions of the state will include the implementation of programs to provide socially unprotected segments of the population with medical services on favorable terms. This approach forms model of financing of health sector with considerable participation of the population in joint financing of expenses on medical services, conditions for development of systems of voluntary health insurance and implementation of programs of medical insurance taking into account a possibility of the free choice by the citizen of volume of the consumed medical services.


Assuntos
Gastos em Saúde , Financiamento da Assistência à Saúde , Assistência à Saúde , Financiamento Governamental , Seguro Saúde , Federação Russa
20.
Handb Exp Pharmacol ; 260: 453-466, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31696349

RESUMO

Increasing life expectancy leading to a higher median age causes an increasing need for healthcare resources, which is aggravated by an increasing prevalence of preventable diseases such as type 2 diabetes. This includes increasing expenditures for medicines, although these increases when expressed as a share of overall societal wealth are more moderate than often claimed. An increasing use of generic medicines (currently about 90% of all prescriptions) means that costs for discovery and development of innovative drugs must be recovered on a shrinking percentage of prescriptions. However, the key challenge to affordable drugs is exponentially increasing costs to bring a new medicine to the market, which in turn are largely driven by an about 90% attrition rate after start of clinical development. While many factors will be required in concert to keep innovative medicines affordable, reducing attrition appears to be the factor with the greatest potential to contain escalating drug development costs and thereby medication expenditures.


Assuntos
Custos de Medicamentos , Gastos em Saúde , Humanos
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