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1.
Einstein (Sao Paulo) ; 18: eGS4442, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576910

RESUMO

OBJECTIVE: To analyze the legal demands of tiotropium bromide to treat chronic obstructive pulmonary disease. METHODS: We included secondary data from the pharmaceutical care management systems made available by the Paraná State Drug Center. RESULTS: Public interest civil action and ordinary procedures, among others, were the most common used by the patients to obtain the medicine. Two Health Centers in Paraná (Londrina and Umuarama) concentrated more than 50% of the actions. The most common specialty of physicians who prescribed (33.8%) was pulmonology. There is a small financial impact of tiotropium bromide on general costs with medicines of the Paraná State Drug Center. However, a significant individual financial impact was observed because one unit of the medicine represents 38% of the Brazilian minimum wage. CONCLUSION: Our study highlights the need of incorporating this medicine in the class of long-acting anticholinergic bronchodilator in the Brazilian public health system.


Assuntos
Broncodilatadores/economia , Medicamentos Essenciais/provisão & distribução , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Função Jurisdicional , Doença Pulmonar Obstrutiva Crônica/economia , Brometo de Tiotrópio/economia , Brasil , Medicamentos Essenciais/economia , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Programas Nacionais de Saúde , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Tempo
2.
PLoS Med ; 16(3): e1002751, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30822339

RESUMO

BACKGROUND: The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach. METHODS AND FINDINGS: We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given ("treated"), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. The prevalence of diabetes was 8.8% (95% CI: 8.2%-9.5%), and the prevalence of undiagnosed diabetes was 4.8% (95% CI: 4.5%-5.2%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. Total unmet need for diabetes care (defined as the sum of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but with diabetes not controlled) was 77.0% (95% CI: 74.9%-78.9%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys. CONCLUSIONS: The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured.


Assuntos
Assistência à Saúde/economia , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Necessidades e Demandas de Serviços de Saúde/economia , Inquéritos Epidemiológicos/economia , Pobreza/economia , Adolescente , Adulto , Estudos Transversais , Assistência à Saúde/tendências , Diabetes Mellitus/terapia , Feminino , Necessidades e Demandas de Serviços de Saúde/tendências , Inquéritos Epidemiológicos/tendências , Humanos , Renda/tendências , Masculino , Pessoa de Meia-Idade , Pobreza/tendências , Adulto Jovem
3.
World J Gastroenterol ; 25(11): 1327-1340, 2019 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-30918426

RESUMO

BACKGROUND: Hepatitis C virus (HCV) is a leading cause of worldwide liver-related morbidity and mortality. The World Health Organization released an integrated strategy targeting HCV-elimination by 2030. This study aims to estimate the required interventions to achieve elimination using updated information for direct-acting antiviral (DAA) treatment coverage, to compute the total costs (including indirect/societal costs) of the strategy and to identify whether the elimination strategy is cost-effective/cost-saving in Greece. AIM: To estimate the required interventions and subsequent costs to achieve HCV elimination in Greece. METHODS: A previously validated mathematical model was adapted to the Greek HCV-infected population to compare the outcomes of DAA treatment without the additional implementation of awareness or screening campaigns versus an HCV elimination strategy, which includes a sufficient number of treated patients. We estimated the total costs (direct and indirect costs), the disability-adjusted life years and the incremental cost-effectiveness ratio using two different price scenarios. RESULTS: Without the implementation of awareness or screening campaigns, approximately 20000 patients would be diagnosed and treated with DAAs by 2030. This strategy would result in a 19.6% increase in HCV-related mortality in 2030 compared to 2015. To achieve the elimination goal, 90000 patients need to be treated by 2030. Under the elimination scenario, viremic cases would decrease by 78.8% in 2030 compared to 2015. The cumulative direct costs to eliminate the disease would range from 2.1-2.3 billion euros (€) by 2030, while the indirect costs would be €1.1 billion. The total elimination cost in Greece would range from €3.2-3.4 billion by 2030. The cost per averted disability-adjusted life year is estimated between €10100 and €13380, indicating that the elimination strategy is very cost-effective. Furthermore, HCV elimination strategy would save €560-895 million by 2035. CONCLUSION: Without large screening programs, elimination of HCV cannot be achieved. The HCV elimination strategy is feasible and cost-saving despite the uncertainty of the future cost of DAAs in Greece.


Assuntos
Antivirais/uso terapêutico , Análise Custo-Benefício , Erradicação de Doenças/economia , Custos de Cuidados de Saúde , Hepatite C/prevenção & controle , Antivirais/economia , Antivirais/farmacologia , Redução de Custos , Efeitos Psicossociais da Doença , Erradicação de Doenças/métodos , Erradicação de Doenças/organização & administração , Estudos de Viabilidade , Grécia , Conhecimentos, Atitudes e Prática em Saúde , Implementação de Plano de Saúde/economia , Implementação de Plano de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/economia , Hepacivirus/efeitos dos fármacos , Hepacivirus/isolamento & purificação , Hepatite C/economia , Hepatite C/virologia , Humanos , Cobertura do Seguro/economia , Seguro Saúde/economia , Programas de Rastreamento/economia , Programas de Rastreamento/organização & administração , Educação de Pacientes como Assunto/economia , Anos de Vida Ajustados por Qualidade de Vida
5.
Issue Brief (Commonw Fund) ; 2019: 1-12, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30695855

RESUMO

Issue: In addition to medical care, individuals with functional or cognitive impairment often require long-term services and supports (LTSS), which Medicare does not cover. Little is known about the additional out-of-pocket expenses that individuals and their families incur to meet these needs. Goal: To analyze medical and LTSS spending among older Medicare beneficiaries, particularly the costs of assistive devices and personal care and the ways those costs are met. Methods: Descriptive analyses of the National Health and Aging Trends Study (NHATS), 2015. Key Findings and Conclusions: Beneficiaries with high LTSS needs have higher Medicare and out-of-pocket spending than those without such needs and are more likely to report that medical care makes up part of their credit card debt. Those with high LTSS needs are also more likely to report trouble paying for food, rent, utilities, medical care, and prescription drugs. Many older Medicare beneficiaries using LTSS are vulnerable to incurring substantial costs. Without an affordable, sustainable financing solution, Medicare beneficiaries with LTSS needs will continue to be at greater risk of delaying necessary care, being placed in a nursing home prematurely, and having to "spend down" into the Medicaid program.


Assuntos
Serviços de Saúde Comunitária/economia , Financiamento Pessoal/economia , Necessidades e Demandas de Serviços de Saúde/economia , Serviços de Assistência Domiciliar/economia , Assistência Domiciliar/economia , Assistência de Longa Duração/economia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Humanos , Medicare , Equipamentos de Autoajuda/economia , Estados Unidos
6.
PLoS One ; 13(12): e0208875, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30557384

RESUMO

INTRODUCTION: Patients with complex health care needs (PCHCN) are individuals who require numerous, costly care services and have been shown to place a heavy burden on health care resources. It has been argued that an important issue in providing value-based primary care concerns how to identify groups of patients with similar needs (who pose similar challenges) so that care teams and care delivery processes can be tailored to each patient subgroup. Our study aims to describe the most common chronic conditions and their combinations in a cohort of elderly PCHCN. METHODS: We focused on a cohort of PCHCN residing in an area served by a local public health unit (the "Azienda ULSS4-Veneto") and belonging to Resource Utilization Bands 4 and 5 according to the ACG System. For each patient we extracted Expanded Diagnosis Clusters, and combined them with information available from Rx-MGs diagnoses. For the present work we focused on 15 diseases/disorders, analyzing their combinations as dyads and triads. Latent class analysis was used to elucidate the patterns of the morbidities considered in the PCHCN. RESULTS: Five disease clusters were identified: one concerned metabolic-ischemic heart diseases; one was labelled as neurological and mental disorders; one mainly comprised cardiac diseases such as congestive heart failure and atrial fibrillation; one was largely associated with respiratory conditions; and one involved neoplasms. CONCLUSIONS: Our study showed specific common associations between certain chronic diseases, shedding light on the patterns of multimorbidity often seen in PCHCN. Studying these patterns in more depth may help to better organize the intervention needed to deal with these patients.


Assuntos
Doença Crônica/economia , Necessidades e Demandas de Serviços de Saúde/economia , Multimorbidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Itália , Masculino
7.
Ther Umsch ; 75(2): 127-134, 2018 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-30022721

RESUMO

Give the due value to the end of life: the systematic underfunding of specialised palliative care in the Swiss DRG system Abstract. Palliative care is an integral part of modern medicine, improving quality of life, treatment satisfaction, and reducing the costs of care in severe disease. Patients' access should be early, regardless of age, diagnosis and setting, when incurable or advanced disease has been diagnosed. The public expenditure for specialised palliative care units in hospitals can be seen as yardstick for an appropriate palliative care supply, but in Switzerland only a mere fraction of revenues is dedicated to the palliative care units. Every year, 66'000 patients die in Switzerland, 38 % of them in a hospital. Health care costs for the last year of life account for 1.9 billion Swiss francs, but palliative care units receive only estimated 51 million Swiss francs per year. Reasons are a too little number of palliative care units, a systemic underfunding of their services and a fragmentary supply chain for severely ill or dying patients. This leads to ethically conflicting situations for clinicians. They have to deal with shortage of supply and, due to economic reasons, are forced to transfer severely ill or dying patients into inadequate settings. Based on international recommendations, Switzerland is in need of further 500 beds for specialised palliative care (actually 335), and at least 11'000 patients per year need access to a specialised palliative care service (actually about 3'500). Under the actual tariffing system, units for palliative care in hospitals are endangered in their existence. Corrections of the remuneration system are urgently warranted. On the long run, a national legal basis should be elaborated to safeguard adequate palliative care supply for all patients in need and as a base for monitoring, formation and research in palliative care.


Assuntos
Grupos Diagnósticos Relacionados/economia , Financiamento Governamental/economia , Necessidades e Demandas de Serviços de Saúde/economia , Programas Nacionais de Saúde/economia , Cuidados Paliativos/economia , Assistência Terminal/economia , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/economia , Doença Crônica/terapia , Financiamento Governamental/tendências , Previsões , Gastos em Saúde/estatística & dados numéricos , Gastos em Saúde/tendências , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Número de Leitos em Hospital/economia , Unidades Hospitalares/economia , Humanos , Programas Nacionais de Saúde/tendências , Cuidados Paliativos/tendências , Dinâmica Populacional , Suíça , Assistência Terminal/tendências
8.
Cochrane Database Syst Rev ; 7: CD001271, 2018 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-30011347

RESUMO

BACKGROUND: Current and expected problems such as ageing, increased prevalence of chronic conditions and multi-morbidity, increased emphasis on healthy lifestyle and prevention, and substitution for care from hospitals by care provided in the community encourage countries worldwide to develop new models of primary care delivery. Owing to the fact that many tasks do not necessarily require the knowledge and skills of a doctor, interest in using nurses to expand the capacity of the primary care workforce is increasing. Substitution of nurses for doctors is one strategy used to improve access, efficiency, and quality of care. This is the first update of the Cochrane review published in 2005. OBJECTIVES: Our aim was to investigate the impact of nurses working as substitutes for primary care doctors on:• patient outcomes;• processes of care; and• utilisation, including volume and cost. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), part of the Cochrane Library (www.cochranelibrary.com), as well as MEDLINE, Ovid, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and EbscoHost (searched 20.01.2015). We searched for grey literature in the Grey Literature Report and OpenGrey (21.02.2017), and we searched the International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov trial registries (21.02.2017). We did a cited reference search for relevant studies (searched 27.01 2015) and checked reference lists of all included studies. We reran slightly revised strategies, limited to publication years between 2015 and 2017, for CENTRAL, MEDLINE, and CINAHL, in March 2017, and we have added one trial to 'Studies awaiting classification'. SELECTION CRITERIA: Randomised trials evaluating the outcomes of nurses working as substitutes for doctors. The review is limited to primary healthcare services that provide first contact and ongoing care for patients with all types of health problems, excluding mental health problems. Studies which evaluated nurses supplementing the work of primary care doctors were excluded. DATA COLLECTION AND ANALYSIS: Two review authors independently carried out data extraction and assessment of risk of bias of included studies. When feasible, we combined study results and determined an overall estimate of the effect. We evaluated other outcomes by completing a structured synthesis. MAIN RESULTS: For this review, we identified 18 randomised trials evaluating the impact of nurses working as substitutes for doctors. One study was conducted in a middle-income country, and all other studies in high-income countries. The nursing level was often unclear or varied between and even within studies. The studies looked at nurses involved in first contact care (including urgent care), ongoing care for physical complaints, and follow-up of patients with a particular chronic conditions such as diabetes. In many of the studies, nurses could get additional support or advice from a doctor. Nurse-doctor substitution for preventive services and health education in primary care has been less well studied.Study findings suggest that care delivered by nurses, compared to care delivered by doctors, probably generates similar or better health outcomes for a broad range of patient conditions (low- or moderate-certainty evidence):• Nurse-led primary care may lead to slightly fewer deaths among certain groups of patients, compared to doctor-led care. However, the results vary and it is possible that nurse-led primary care makes little or no difference to the number of deaths (low-certainty evidence).• Blood pressure outcomes are probably slightly improved in nurse-led primary care. Other clinical or health status outcomes are probably similar (moderate-certainty evidence).• Patient satisfaction is probably slightly higher in nurse-led primary care (moderate-certainty evidence). Quality of life may be slightly higher (low-certainty evidence).We are uncertain of the effects of nurse-led care on process of care because the certainty of this evidence was assessed as very low.The effect of nurse-led care on utilisation of care is mixed and depends on the type of outcome. Consultations are probably longer in nurse-led primary care (moderate-certainty evidence), and numbers of attended return visits are slightly higher for nurses than for doctors (high-certainty evidence). We found little or no difference between nurses and doctors in the number of prescriptions and attendance at accident and emergency units (high-certainty evidence). There may be little or no difference in the number of tests and investigations, hospital referrals and hospital admissions between nurses and doctors (low-certainty evidence).We are uncertain of the effects of nurse-led care on the costs of care because the certainty of this evidence was assessed as very low. AUTHORS' CONCLUSIONS: This review shows that for some ongoing and urgent physical complaints and for chronic conditions, trained nurses, such as nurse practitioners, practice nurses, and registered nurses, probably provide equal or possibly even better quality of care compared to primary care doctors, and probably achieve equal or better health outcomes for patients. Nurses probably achieve higher levels of patient satisfaction, compared to primary care doctors. Furthermore, consultation length is probably longer when nurses deliver care and the frequency of attended return visits is probably slightly higher for nurses, compared to doctors. Other utilisation outcomes are probably the same. The effects of nurse-led care on process of care and the costs of care are uncertain, and we also cannot ascertain what level of nursing education leads to the best outcomes when nurses are substituted for doctors.


Assuntos
Medicina de Família e Comunidade/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Recursos Humanos de Enfermagem/organização & administração , Designação de Pessoal/organização & administração , Padrões de Prática em Enfermagem , Atenção Primária à Saúde/organização & administração , Medicina de Família e Comunidade/economia , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Profissionais de Enfermagem/organização & administração , Atenção Primária à Saúde/economia , Qualidade da Assistência à Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Congenit Heart Dis ; 13(4): 554-562, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29624879

RESUMO

OBJECTIVE: To examine the financial burdens and mental health needs of families of children with special healthcare needs (CSHCN) with congenital heart disease (CHD). METHODS: Data from the 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) were used to examine parent-reported financial burdens (out-of-pocket expenses, financial problems, employment impact, caregiving hours) and family members' need for mental health services in families of CSHCN with CHD. Multivariable logistic regression was used to compare financial burdens and family members' need for mental health services among CSHCN with and without CHD. Among CSHCN with CHD, multivariable logistic regression, stratified by age (0-5 and 6-17 years), was used to assess characteristics associated with the outcomes. RESULTS: Overall, families of 89.1% of CSHCN with CHD experienced at least one financial burden and 14.9% needed mental health services due to the child's condition. Compared with CSHCN without CHD, those with CHD had families with a higher prevalence of all financial burdens (adjusted prevalence ratio [aPR] range: 1.4-1.8) and similar family member need for mental health services (aPR = 1.3, 95% CI [1.0, 1.6]). Across both age groups, insurance type, activity limitations, and comorbidities were significantly associated with financial burdens and/or family members' need for mental health services. CONCLUSIONS: CSHCN with CHD, compared with those without CHD, lived in families with more financial burdens. Interventions that reduce financial burdens and improve mental health of family members are needed, especially among CSHCN with CHD who are uninsured and have comorbidities or activity limitations.


Assuntos
Efeitos Psicossociais da Doença , Necessidades e Demandas de Serviços de Saúde/economia , Cardiopatias Congênitas/economia , Seguro Saúde/economia , Saúde Mental/economia , Adolescente , Criança , Pré-Escolar , Feminino , Pesquisas sobre Serviços de Saúde , Gastos em Saúde/tendências , Acesso aos Serviços de Saúde , Cardiopatias Congênitas/psicologia , Cardiopatias Congênitas/terapia , Humanos , Lactente , Recém-Nascido , Masculino , Estados Unidos
10.
Cochrane Database Syst Rev ; 4: CD008133, 2018 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-29611869

RESUMO

BACKGROUND: Contracting out of governmental health services is a financing strategy that governs the way in which public sector funds are used to have services delivered by non-governmental health service providers (NGPs). It represents a contract between the government and an NGP, detailing the mechanisms and conditions by which the latter should provide health care on behalf of the government. Contracting out is intended to improve the delivery and use of healthcare services. This Review updates a Cochrane Review first published in 2009. OBJECTIVES: To assess effects of contracting out governmental clinical health services to non-governmental service provider/s, on (i) utilisation of clinical health services; (ii) improvement in population health outcomes; (iii) improvement in equity of utilisation of these services; (iv) costs and cost-effectiveness of delivering the services; and (v) improvement in health systems performance. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, NHS Economic Evaluation Database, EconLit, ProQuest, and Global Health on 07 April 2017, along with two trials registers - ClinicalTrials.gov and the International Clinical Trials Registry Platform - on 17 November 2017. SELECTION CRITERIA: Individually randomised and cluster-randomised trials, controlled before-after studies, interrupted time series, and repeated measures studies, comparing government-delivered clinical health services versus those contracted out to NGPs, or comparing different models of non-governmental-delivered clinical health services. DATA COLLECTION AND ANALYSIS: Two authors independently screened all records, extracted data from the included studies and assessed the risk of bias. We calculated the net effect for all outcomes. A positive value favours the intervention whilst a negative value favours the control. Effect estimates are presented with 95% confidence intervals. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of the evidence and we prepared a Summary of Findings table. MAIN RESULTS: We included two studies, a cluster-randomised trial conducted in Cambodia, and a controlled before-after study conducted in Guatemala. Both studies reported that contracting out over 12 months probably makes little or no difference in (i) immunisation uptake of children 12 to 24 months old (moderate-certainty evidence), (ii) the number of women who had more than two antenatal care visits (moderate-certainty evidence), and (iii) female use of contraceptives (moderate-certainty evidence).The Cambodia trial reported that contracting out may make little or no difference in the mortality over 12 months of children younger than one year of age (net effect = -4.3%, intervention effect P = 0.36, clustered standard error (SE) = 3.0%; low-certainty evidence), nor to the incidence of childhood diarrhoea (net effect = -16.2%, intervention effect P = 0.07, clustered SE = 19.0%; low-certainty evidence). The Cambodia study found that contracting out probably reduces individual out-of-pocket spending over 12 months on curative care (net effect = $ -19.25 (2003 USD), intervention effect P = 0.01, clustered SE = $ 5.12; moderate-certainty evidence). The included studies did not report equity in the use of clinical health services and in adverse effects. AUTHORS' CONCLUSIONS: This update confirms the findings of the original review. Contracting out probably reduces individual out-of-pocket spending on curative care (moderate-certainty evidence), but probably makes little or no difference in other health utilisation or service delivery outcomes (moderate- to low-certainty evidence). Therefore, contracting out programmes may be no better or worse than government-provided services, although additional rigorously designed studies may change this result. The literature provides many examples of contracting out programmes, which implies that this is a feasible response when governments fail to provide good clinical health care. Future contracting out programmes should be framed within a rigorous study design to allow valid and reliable measures of their effects. Such studies should include qualitative research that assesses the views of programme implementers and beneficiaries, and records implementation mechanisms. This approach may reveal enablers for, and barriers to, successful implementation of such programmes.


Assuntos
Países em Desenvolvimento , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Serviços Terceirizados , Avaliação de Processos (Cuidados de Saúde) , Camboja , Anticoncepcionais Femininos/administração & dosagem , Estudos Controlados Antes e Depois , Diarreia/epidemiologia , Guatemala , Gastos em Saúde , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Imunização/economia , Lactente , Mortalidade Infantil , Serviços Terceirizados/economia , Serviços Terceirizados/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
J Vasc Surg Venous Lymphat Disord ; 6(4): 471-476.e6, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29602759

RESUMO

BACKGROUND: In mid-2007, endovenous ablation (EVA) of the great saphenous vein was introduced into the publicly funded health care system in Saskatchewan, Canada. We hypothesize that the introduction of EVA resulted in a decrease in use of high ligation and stripping (HL/S), decreased costs to the health care system, and increased demand of patients for great saphenous vein ablative procedures. METHODS: We retrospectively reviewed administrative data to capture cases of HL/S between 2003 and 2014 and cases of EVA of the great saphenous vein (endovenous laser treatment and radiofrequency ablation) between 2007 and 2014. Accounting for the change in practice pattern that occurred slowly between 2007 and 2009, we divided our patients into the pre-EVA era (2003-2006) and the post-EVA era (2010-2014). Procedure costs were determined with models used by our health region for this purpose. RESULTS: Utilization rates for great saphenous vein intervention remained similar in the pre-EVA (90 procedures per year) and post-EVA (92 procedures per year; P = .83) eras. Case costs of HL/S ($1965.12/case) were higher than those of EVA (endovenous laser treatment, $1295.08/case; radiofrequency ablation, $1410.54/case). The total annual costs of great saphenous vein intervention decreased from $176,861 in the pre-EVA era to $134,525 (P = .02). CONCLUSIONS: Introduction of publicly funded EVA has reduced rates of HL/S and reduced costs to our health system by approximately $42,000 per year, without increasing great saphenous vein intervention rates.


Assuntos
Ablação por Cateter/economia , Assistência à Saúde/economia , Procedimentos Endovasculares/economia , Custos de Cuidados de Saúde , Planejamento Hospitalar/economia , Terapia a Laser/economia , Avaliação de Processos (Cuidados de Saúde)/economia , Saúde Pública/economia , Veia Safena/cirurgia , Varizes/economia , Varizes/cirurgia , Demandas Administrativas em Assistência à Saúde , Ablação por Cateter/efeitos adversos , Redução de Custos , Análise Custo-Benefício , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Terapia a Laser/efeitos adversos , Determinação de Necessidades de Cuidados de Saúde/economia , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Saskatchewan , Fatores de Tempo , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/fisiopatologia
12.
Psychiatr Pol ; 52(1): 143-156, 2018 Feb 28.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-29704421

RESUMO

OBJECTIVES: The main objective of the study was to verify the hypothesis about the high growth rate of expenditure on the provision of mental health in the past few years. High dynamics of the expenditure increase will result in the development of a model of community psychiatry and a gradual move away from the hospital psychiatric treatment towards mental health care in the open system, including the community one. METHODS: This research is based on data on the implementation of services for mental health care in the framework of agreements with the National Health Fund, which has been collected in the NFZ IT system. Some information is from 2010, which was adopted as the base date for the implementation of the principles of the National Mental Health Program in 2011. The data from the implementation of individual benefits in 2013 were used for the comparison. In addition, other selected organizational, economic and financial elements of the psychiatric care system were analyzed. RESULTS: In 2013, compared to 2010, increased the number of mental health care organizations: outpatient mental health clinics (an increase of 37 clinics), outpatient mental health day hospital wards (an increase of 25 wards) and community psychiatric treatment teams (an increase of 74 teams). The largest increase in the value of contracts (approx. 150%) was related to community treatment teams. CONCLUSIONS: Between 2010 and 2013 there was an increase in the value of cleared contracts in psychiatric care, in general and in each of the three forms of psychiatric care (i.e., in day wards, outpatient mental health clinics and in community teams). The highest increase in investments included community treatment teams, to a lesser extent day wards and outpatient clinics. The adopted organizational, economic and financial solutions in the mental health care system are in line with the objectives of the National Mental Health Program, including the assumed structure of Mental Health Centers.


Assuntos
Serviços Comunitários de Saúde Mental/economia , Necessidades e Demandas de Serviços de Saúde/economia , Seguro Psiquiátrico/economia , Transtornos Mentais/economia , Saúde Mental/economia , Serviços Comunitários de Saúde Mental/organização & administração , Acesso aos Serviços de Saúde/economia , Humanos , Transtornos Mentais/terapia , Saúde Mental/estatística & dados numéricos , Polônia , Unidade Hospitalar de Psiquiatria/economia
13.
BMJ Open ; 8(3): e017824, 2018 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-29540407

RESUMO

OBJECTIVES: The Lancet Commission on Global Surgery estimated that low/middle-income countries will lose an estimated cumulative loss of US$12.3 trillion from gross domestic product (GDP) due to the unmet burden of surgical disease. However, no country-specific data currently exist. We aimed to estimate the costs to the Sierra Leone economy from death and disability which may have been averted by surgical care. DESIGN: We used estimates of total, met and unmet need from two main sources-a cluster randomised, cross-sectional, countrywide survey and a retrospective, nationwide study on surgery in Sierra Leone. We calculated estimated disability-adjusted life years from morbidity and mortality for the estimated unmet burden and modelled the likely economic impact using three different methods-gross national income per capita, lifetime earnings foregone and value of a statistical life. RESULTS: In 2012, estimated, discounted lifetime losses to the Sierra Leone economy from the unmet burden of surgical disease was between US$1.1 and US$3.8 billion, depending on the economic method used. These lifetime losses equate to between 23% and 100% of the annual GDP for Sierra Leone. 80% of economic losses were due to mortality. The incremental losses averted by scale up of surgical provision to the Lancet Commission target of 80% were calculated to be between US$360 million and US$2.9 billion. CONCLUSION: There is a large economic loss from the unmet need for surgical care in Sierra Leone. There is an immediate need for massive investment to counteract ongoing economic losses.


Assuntos
Efeitos Psicossociais da Doença , Necessidades e Demandas de Serviços de Saúde/economia , Disparidades em Assistência à Saúde/economia , Procedimentos Cirúrgicos Operatórios/economia , Países em Desenvolvimento/economia , Produto Interno Bruto/estatística & dados numéricos , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Estudos Retrospectivos , Serra Leoa , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Inquéritos e Questionários
14.
Health Policy Plan ; 33(suppl_1): i14-i23, 2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29415236

RESUMO

Gross national income (GNI) per capita is widely regarded as a key determinant of health outcomes. Major donors heavily rely on GNI per capita to allocate development assistance for health (DAH). This article questions this paradigm by analysing the determinants of health outcomes using cross-sectional data from 99 countries in 2012. We use disability-adjusted life years (Group I) per capita as our main indicator for health outcomes. We consider four primary variables: GNI per capita, institutional capacity, individual poverty and the epidemiological surroundings. Our empirical strategy has two innovations. First, we construct a health poverty line of 10.89 international-$ per day, which measures the minimum level of income an individual needs to have access to basic healthcare. Second, we take the contagious nature of communicable diseases into account, by estimating the extent to which the population health in neighbouring countries (the epidemiological surroundings) affects health outcomes. We apply a spatial two-stage least-squares model to mitigate the risks of reverse causality. Our model captures 92% of the variation in health outcomes. We emphasize four findings. First, GNI per capita is not a significant predictor of health outcomes once other factors are controlled for. Second, the poverty gap below the 10.89 health poverty line is a good measure of universal access to healthcare, as it explains 19% of deviation in health outcomes. Third, the epidemiological surroundings in which countries are embedded capture as much as 47% of deviation in health outcomes. Finally, institutional capacity explains 10% of deviation in health outcomes. Our empirical findings suggest that allocation frameworks for DAH should not only take into account national income, which remains an important indicator of countries' financial capacity, but also individual poverty, governance and epidemiological surroundings to increase impact on health outcomes.


Assuntos
Assistência à Saúde/economia , Necessidades e Demandas de Serviços de Saúde/economia , Renda , Alocação de Recursos , Controle de Doenças Transmissíveis/economia , Estudos Transversais , Países em Desenvolvimento , Humanos , Modelos Estatísticos , Pobreza , Alocação de Recursos/economia
15.
BMJ Open ; 8(2): e017816, 2018 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-29437751

RESUMO

INTRODUCTION: The current literature in Australia demonstrates that there are variations in access and outcomes in perinatal care based on socioeconomic factors. However, little has been done looking at the level of out-of-pocket healthcare costs associated with perinatal care. The primary aim of this project will be to quantify health service use and out-of-pocket healthcare expenditure associated with childbearing and early childhood in Queensland, Australia. METHODS AND ANALYSIS: This project will build Australia's first model (called Maternal & Child Cost MOD) of out-of-pocket healthcare expenditure by using administrative data from the Queensland Perinatal Data Collection, of all childbearing women and their resultant children, who gave birth in Queensland between 1 July 2012 and 30 June 2016.The current costs to the health system and out-of-pocket health care expenditure of patients associated with maternity and early childhood health care will be identified. The differences in costs based on indigenous identification, socioeconomic status and geographic location will be assessed using linear regression modelling and counterfactual modelling techniques. ETHICS AND DISSEMINATION: Human Research Ethics approval has been obtained from Townsville Hospital and Health Service Human Research Ethics Committee (HREC) (HREC Reference number: HREC/16/QTHS/223). Consent will not be sought from participants whose de-identified data will be used in this study. Permission to waive consent has been gained from Queensland Health under the Public Health Act 2005.The results of this study will be disseminated through publications in peer-reviewed journals and through presentations at conferences, regionally and nationally. Our target audience is clinicians, health professionals and health policy-makers.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/economia , Armazenamento e Recuperação da Informação/métodos , Serviços de Saúde Materno-Infantil/economia , Assistência Perinatal/economia , Adulto , Criança , Pré-Escolar , Coleta de Dados/métodos , Feminino , Programas Governamentais , Disparidades em Assistência à Saúde , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Mães/estatística & dados numéricos , Grupo com Ancestrais Oceânicos , Assistência Perinatal/estatística & dados numéricos , Gravidez , Queensland , Fatores Socioeconômicos
16.
BMJ Open ; 8(2): e018729, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29391378

RESUMO

OBJECTIVE: In the UK, families of disabled children are entitled to receive disability benefits to help meet costs associated with caring for their child. Evidence of actual costs incurred is scant, especially for mental health disability. In this study, we aimed to quantify the cost of mental and physical health disability in childhood and adolescence to families in the UK using the concept of compensating variation (CV). DESIGN: Repeated cross-sectional survey. SETTING: The UK general population PARTICIPANTS: 85 212 children drawn from 8 waves of the Family Resources Survey. OUTCOMES: Using propensity score matching we matched families with a disabled child to similar families without a disabled child and calculated the extra income the former require to achieve the same living standards as the latter, that is, their CV. We calculated the additional costs specifically associated with several definitions of mental health and physical health disability. RESULTS: Families of a child with any mental health disability, regardless of the presence of physical health comorbidity, needed an additional £49.31 (95% CI: 21.95 to 76.67) and, for more severe disabilities, an additional £57.56 (95% CI: 17.69 to 97.44) per week to achieve the same living standards of families without a disabled child. This difference was greater for more deprived families, who needed between £59.28 (95% CI: 41.38 to 77.18) and £81.26 (95% CI: 53.35 to 109.38) more per week depending on the extent of mental health disability. Families of children with physical health disabilities, with or without mental health disabilities, required an additional £35.86 (95% CI: 13.77 to 57.96) per week, with economically deprived families requiring an extra £42.18 (95% CI: 26.38 to 57.97) per week. CONCLUSIONS: Mental and physical health disabilities among children and adolescents were associated with high additional costs for the family, especially for those from deprived economic backgrounds. Means testing could help achieve a more equitable redistribution of disability benefit.


Assuntos
Avaliação da Deficiência , Crianças com Deficiência , Financiamento Governamental/economia , Necessidades e Demandas de Serviços de Saúde/economia , Renda/estatística & dados numéricos , Pontuação de Propensão , Adolescente , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Estudos Transversais , Crianças com Deficiência/reabilitação , Feminino , Custos de Cuidados de Saúde , Humanos , Deficiência Intelectual , Masculino , Fatores Socioeconômicos , Reino Unido/epidemiologia
17.
Orv Hetil ; 159(5): 183-191, 2018 Feb.
Artigo em Húngaro | MEDLINE | ID: mdl-29376425

RESUMO

INTRODUCTION AND AIM: This paper describes both the English health resource allocation and the attempt of its Hungarian adaptation. METHOD: We describe calculations for a Hungarian regression model using the English 'weighted capitation formula'. RESULTS: The model has proven statistically correct. New independent variables and homogenous regional units have to be found for Hungary. CONCLUSION: The English method can be used with adequate variables. Hungarian patient-level health data can support a much more sophisticated model. Further research activities are needed. Orv Hetil. 2018; 159(5): 183-191.


Assuntos
Alocação de Recursos para a Atenção à Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Modelos Organizacionais , Alocação de Recursos para a Atenção à Saúde/economia , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Hungria , Objetivos Organizacionais , Atenção Primária à Saúde/organização & administração , Alocação de Recursos
18.
Contact Dermatitis ; 78(1): 18-27, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28833233

RESUMO

BACKGROUND: Health utilities provide a universally applicable method for measuring the relative preferences or values of specific health states. Health economic studies use health utilities to estimate disease burden and the cost-effectiveness of interventions. Chronic hand eczema (CHE) affects many individuals and adversely affects work productivity. Health utilities for CHE from the perspective of healthcare professionals are lacking. OBJECTIVES: To assess health utilities for CHE from the perspectives of employees in the healthcare sector and affected patients. METHODS: A cross-sectional study with volunteers from the healthcare sector (n = 126) and patients (n = 32) was conducted to establish health utilities (ranging from 1 = perfect health to 0 = death) for mild and severe CHE. RESULTS: The median health utilities of the healthy volunteers derived with the time trade-off method were 0.97 (mean: 0.92) for mild CHE and 0.77 (mean: 0.75) for severe CHE. The median health utilities for mild and severe CHE from the perspective of affected patients were 0.98 (mean: 0.91) and 0.82 (mean: 0.77), respectively. Differences in health utilities between the two study groups were not significant. CONCLUSION: CHE constitutes a considerable burden from the perspective of healthcare employees. Effective control of CHE constitutes an important public health goal.


Assuntos
Dermatite Ocupacional , Eczema , Dermatoses da Mão , Setor de Assistência à Saúde , Nível de Saúde , Adulto , Fatores Etários , Doença Crônica , Estudos Transversais , Dermatite Ocupacional/economia , Eczema/economia , Feminino , Dermatoses da Mão/economia , Necessidades e Demandas de Serviços de Saúde/economia , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Índice de Gravidade de Doença , Fatores Sexuais , Escala Visual Analógica , Adulto Jovem
19.
Int J Health Serv ; 48(1): 128-147, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28853338

RESUMO

Population aging is expected to increase long-term care (LTC) costs in both Japan and Sweden. This study projected LTC costs for 2010 through 2040 for different assumptions of population change, LTC need by age group and gender, and LTC provided per level of need and cost in Japan and Sweden. Population data were taken from the official national forecasts. Needs projections were based on epidemiological data from the Nihon University Japanese Longitudinal Study of Aging and the Swedish Survey of Living Conditions. Data on LTC provision by need and cost were taken from nine Japanese municipalities collected by assessments in the LTC insurance system and from surveys in eight Swedish municipalities. Total initial costs were calibrated to official national figures. Two projections based on two different scenarios were made for each country from 2010 to 2040. The first scenario assumed a constant level of need for LTC by age group and gender, and the other assumed a continuation of the present LTC need trends until 2025. For Japan, this resulted in a projected cost increase of 93% for the one and 80% for the other; for Sweden it was 52% and 24%, respectively. The results reflected differences in population aging and health development.


Assuntos
Necessidades e Demandas de Serviços de Saúde/economia , Serviços de Saúde para Idosos/economia , Assistência de Longa Duração/economia , Previsões , Custos de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde/tendências , Serviços de Saúde para Idosos/tendências , Humanos , Japão , Assistência de Longa Duração/tendências , Suécia
20.
J Ment Health Policy Econ ; 21(4): 171-180, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30676994

RESUMO

BACKGROUND: Beginning in late 2010, private health insurance plans were required to allow dependents up to age 26 to remain on a parent's plan. Known as the dependent coverage or young adult mandate, this provision increased coverage substantially within the group of 19-25 year-olds affected by the policy change. Subsequent work evaluating whether increased coverage had a positive effect on mental health found mild improvements in self-reported mental health. This work focused exclusively on average effects among young adults in the years after the policy change, leaving open the question of how young adults fared depending on where they reside in terms of the distribution of risk for mental health issues. AIMS OF THE STUDY: We assess the effects of the dependent coverage mandate on young adult mental well-being focusing on the distribution of mental health issues. We seek to understand how potential improvements (or degradations) differ across the entire risk profile. Gains among individuals who are at low risk for severe mental health issues may send a far different signal than gains among those with higher risks. METHODS: Using MEPS data from 2006 through 2013, we use quantile regression within a difference-in-differences design to compare pre/post outcomes across the distribution of risk for young adults ages 23-25 affected by the mandate to 27-29 year-olds not affected by the mandate. Further, we evaluate differences in the effect of the mandate by sex, given well-known disparities in incidence and prevalence of mental illness between men and women. To gauge the effects of the mandate on mental health, we use the Mental Component Score measure within the MEPS, ideal for our quantile regression given the broad range of scores. The key premise in our evaluation is that individuals with higher risks for mental health problems due to biological or socioeconomics factors are more likely to rank at locations of the mental health score distribution indicating worse outcomes. RESULTS: We find significant improvements in self-reported mental health in the 23-25 year-old group following the mandate. However, the gains were not equal across the risk distribution. For individuals at the 0.1 quantile (worse self-reported mental health), the improvement in MCS scores was significant, a 6.1% increase compared to the pre-mandate baseline at that quantile. Effects were smaller but still significant at the median but there was no apparent effect for those that were at higher levels of self-reported mental health. Our results also suggest improvements for women (+9% relative to baseline at the 0.1 quantile, e.g.) but limited evidence of an effect for men. IMPLICATIONS FOR FUTURE RESEARCH: The finding that increased insurance coverage led to improved self-reported mental health foremost for young adults with the highest risk of mental health problems is encouraging. However, the mechanism for this effect is unclear and in need of further study. Whether improvements in the mental health status of the population depend more on increased access to services or derive primarily from improved financial security is an important research area.


Assuntos
Necessidades e Demandas de Serviços de Saúde/economia , Benefícios do Seguro/economia , Cobertura do Seguro/economia , Pessoas Mentalmente Doentes/psicologia , Patient Protection and Affordable Care Act/economia , Qualidade de Vida/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoas Mentalmente Doentes/estatística & dados numéricos , Avaliação de Resultados (Cuidados de Saúde) , Fatores Sexuais , Estados Unidos , Adulto Jovem
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