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1.
Rev Saude Publica ; 53: 58, 2019 Jul 18.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31340350

RESUMO

To advance in order to overcome the challenge of enabling greater autonomy in the use of financial resources in the Unified Health System (SUS), system managers agreed that transfers from the Union to other federated entities will be carried out through a financial investment account and a costing account. Over the past few years, states and municipalities managed more than 34,000 bank accounts dedicated to the Union's on-lendings, in which balance exceeded R$8 billion. However, from 2018, Ordinance 3,992/2017 unequivocally separated the budget flow from the financial flow, and the fund-to-fund transfers started to be carried out in only 11,190 bank accounts. Since then, managers have had financial autonomy in the management of financial resources received from the Union, if in accordance with the parameters established in their respective budget items at the end of each fiscal year.


Assuntos
Orçamentos/legislação & jurisprudência , Orçamentos/organização & administração , Gastos em Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência , Brasil , Orçamentos/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Humanos , Programas Nacionais de Saúde/organização & administração , Setor Público/economia , Setor Público/legislação & jurisprudência , Setor Público/organização & administração
3.
Expert Rev Pharmacoecon Outcomes Res ; 19(4): 409-420, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31210065

RESUMO

Introduction: Orphan diseases are low-prevalence conditions with chronically debilitating or life-threatening consequences. Their treatments are generally called orphan drugs (OD). Health-technology assessment processes have traditionally considered cost-effectiveness analysis (CEA), when making reimbursement and pricing decisions for health-care plans. Valuing OD with standard CEA raises important issues due to uncertain evidence, inability to meet cost-effectiveness thresholds for reimbursement and high budget impact, among others. Multi-criteria decision analysis (MCDA) allows to overcome these issues and improve the technical and ethical quality of decisions regarding prioritization, coverage, and reimbursement of OD. Areas covered: A scoping review was conducted in order to characterize MCDA frameworks for assessing OD and implementation experiences. We reviewed electronic databases (Medline, Embase, Cochrane Library, EBSCO, CINAHL, EconLit, Web of Science, LILACS, Google Scholar) key journals (Orphanet Journal of Rare Diseases and Value in Health) and organization repositories. Expert opinion: The theoretical framework for MCDA considers areas related to characteristics of orphan diseases and their technologies' clinical and economic impact. Participation processes are critical in incorporating societal values in weighting different dimensions and constructing decision rules. Local implementation pilots considering different stakeholders are necessary in order to pinpoint specific barriers and opportunities.


Assuntos
Técnicas de Apoio para a Decisão , Produção de Droga sem Interesse Comercial/métodos , Doenças Raras/tratamento farmacológico , Orçamentos , Análise Custo-Benefício , Tomada de Decisões , Humanos , Produção de Droga sem Interesse Comercial/economia , Doenças Raras/economia , Mecanismo de Reembolso , Avaliação da Tecnologia Biomédica/métodos
4.
Rev Saude Publica ; 53: 39, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31066817

RESUMO

OBJECTIVE: To analyze the allocation of financial resources in the Brazilian Unified Health System (SUS) in the state of São Paulo by level of care, health region, source of funds and level of government. METHODS: This is an exploratory study based on 2014 data extracted from the Public Health Budget Database, presented in absolute terms, relative terms and per capita . RESULTS: In 2014, R$52.1 bi were spent on public health, 58.0% having corresponded to the expenditures of the municipalities and 42.0% to those of the state government. Regional per capita spending varied from R$561.75 to R$824.85. As for the per capita spending on primary health care, which represented 37.5% of the municipalities' total expenditure, the lowest value was found in the city of São Paulo and the highest, in Araçatuba. Campinas had the highest per capita expenditure on medium and high complexity care, while Presidente Prudente had the lowest. The highest regional percentage of the current net revenue spent on health was verified in Registro, and the lowest, in the city of São Paulo. CONCLUSIONS: The paradigm of the health sector's financing in São Paulo revealed that the expenditure on primary health care, level elected by health policy as strategic because it depends on coordination and integral health care in the attention networks, was not considered a priority in relation to the expenditure with the medium and high complexity, exposing the iniquities in the state's regions.


Assuntos
Alocação de Recursos para a Atenção à Saúde/economia , Gastos em Saúde/estatística & dados numéricos , Política de Saúde , Financiamento da Assistência à Saúde , Programas Nacionais de Saúde/economia , Brasil , Orçamentos/estatística & dados numéricos , Cidades , Financiamento Governamental/economia , Financiamento Governamental/estatística & dados numéricos , Humanos , Valores de Referência
5.
Rev Saude Publica ; 53: 50, 2019 May 20.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31116239

RESUMO

OBJECTIVE: To analyze the regional allocation of the resources from the Brazilian Popular Pharmacy Program, taking into account the relative availability of the program and the potential needs of the region. METHODS: Data from the National Health Survey of the Annual Report of Social Information and the administrative database of the program were used to create a non-parametric indicator of coverage using multiple data envelopment analysis technique. This indicator considers the relative availability of the program, taking into account equal access to equal needs (equity based on regional needs). The analysis of this indicator shows if the regions that most need pharmaceutical assistance are those that receive more resources from the Brazilian Popular Pharmacy Program. RESULTS: The states belonging to the richest regions of the country, Southeast and South, present wider relative coverage of the Brazilian Popular Pharmacy Program compared to poorer localities. In addition, the inequalities observed between locations are better explained by inefficiency in the transfer of resources to the basic component of pharmaceutical care than by the Brazilian Popular Pharmacy Program itself. According to the model, a 43.76% increase in the transfer to the basic component of pharmaceutical care would be required in order to improve equity, whereas the increase required by the Brazilian Popular Pharmacy Program is equivalent to 22.71%. CONCLUSIONS: Although the Brazilian Popular Pharmacy Program seeks to reduce the socioeconomic inequalities observed in access to pharmaceutical care, which integrates health care services, regional disparities in access to medicine persist. These regional differences are attributed mostly to allocation failures and problems in managing the conventional pharmaceutical care cycle provided through SUS pharmacies.


Assuntos
Medicamentos Essenciais/provisão & distribução , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Equidade em Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Alocação de Recursos/estatística & dados numéricos , Brasil , Orçamentos/estatística & dados numéricos , Estudos Transversais , Medicamentos Essenciais/economia , Alocação de Recursos para a Atenção à Saúde/economia , Equidade em Saúde/economia , Necessidades e Demandas de Serviços de Saúde , Humanos , Programas Nacionais de Saúde/economia , Valores de Referência , Alocação de Recursos/economia , Fatores Socioeconômicos , Análise Espacial
6.
Value Health ; 22(5): 505-510, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31104727

RESUMO

A number of methods have sought to determine the value of interventions and services that promote health, even when no agreement exists on the proper way to determine and define "value." Previous valuation efforts began simply by counting deaths or measuring life expectancy, slowly evolving to the widespread use of cost-effectiveness analysis (CEA) as the de facto normative standard for medical interventions. Users of CEA recognize that the method is incomplete. Further, no meaningful agreement exists on how best to apply CEA in decision settings because of either inadequacies in the CEA framework or lack of consensus on how to use it in a setting with budget constraints. Yet efforts to value health still predominantly use (and continue to recommend) this limited framework. Is this owing to a lack of new ideas and motivation, resistance to change, or an aversion to embrace more comprehensive systems approaches? We argue that tools of systems engineering can advance our capabilities, but they have had only limited use in health policy. We identify some reasons and specifically highlight the promise of systems-analytic platforms-such as multicriteria decision support systems-and the need to make them more accessible for different uses in real situations with real consequences. We also explore the need for comparative testing of different multicriteria approaches (including direct comparisons with CEA) to learn when and by how much the recommendations differ and what the consequences might be.


Assuntos
Orçamentos , Análise Custo-Benefício , Sistemas de Apoio a Decisões Clínicas , Política de Saúde , Anos de Vida Ajustados por Qualidade de Vida , Tomada de Decisões , Humanos
7.
Int J Equity Health ; 18(1): 63, 2019 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-31053077

RESUMO

BACKGROUND: Mauritius embraces principles of a welfare state with free health care at point of use in any public facilities. However, the health financing landscape changed in 2007 when Private Health Expenditure (PvtHE) surpassed General Government Health Expenditure. PvtHE is predominately out of pocket (OOP) with only 3.4% related to premiums for private insurance. In 2014, Household OOP Expenditure on health accounted for 52.8% of total health expenditure. OOP is known to be regressive and to impact negatively on households' living standards. OBJECTIVES: This paper aims to examine trends in OOP in Mauritius, to assess its impacts through an analysis of key indicators of financial protection, namely catastrophic health expenditure (CHE) and impoverishment due to OOP health expenditure. It also aims to predict core determinants of CHEs. METHODS: Household Budget Surveys (HBS) of 2001/2002, 2006/2007 and 2012 were the primary source data. CHE and impoverishment were used to assess financial hardships resulting from OOP health payments. The incidence of CHE was estimated at three threshold levels (10,25 and 40%), using the budget share and the capacity to pay approaches. Impoverishment due to OOP was measured by changes in the incidence of poverty and intensity of poverty using the US$ 3.1 international poverty line. Logistic regression analysis was used to identify determinants of CHE. FINDINGS: Household CHE increased from 5.78% in 2001/02 to 8.85% in 2012 and 0.61% in 2001/02 to 1.25% in 2012, for 10 and 40% thresholds, respectively. The incidence of CHE was significantly higher in urban areas compared to rural areas. The highest levels of CHEs were among households' heads, who are retired rising from 1.62% in 2001/02 to 3.71% in 2012, followed by households' head who are widowed from 2.29% in 2001/02 to 2.63% in 2012 and homemakers from 2.12% in 2001/02 to 2.57% in 2012 at the 40% threshold. The share of households pushed below the poverty line due to OOP dropped from 0.4% in 2001/02 to 0.2% in 2006/07 before rising to 0.34% in 2012. In 2012, poverty gap occurred only among households under poorest quintile 1 (0.24%) and quintile 2 (0.03%). Overall poverty gap dropped from 0.08% in 2001/02 to 0.05% in 2012. Logistic regression analysis revealed that the odds ratio of facing CHE were significant only among households with heads being retired and with a presence of an elderly member in the household. CONCLUSION: Despite the rise in incidence of CHE between 2001 and 2012 the impact of OOP on the level of impoverishment and poverty gap has not been significant.


Assuntos
Doença Catastrófica/economia , Assistência à Saúde/economia , Gastos em Saúde/estatística & dados numéricos , Participação no Risco Financeiro , Adolescente , Adulto , Orçamentos , Criança , Pré-Escolar , Características da Família , Honorários e Preços/estatística & dados numéricos , Feminino , Humanos , Masculino , Maurício , Pessoa de Meia-Idade , Pobreza/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
8.
Value Health ; 22(4): 399-407, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30975390

RESUMO

BACKGROUND: Conditional financing (CF) of hospital drugs was implemented in the Netherlands as a form of managed entry agreements between 2006 and 2012. CF was a 4-year process comprising 3 stages: initial health technology assessment of the drug (T = 0), conduct of outcomes research studies, and reassessment of the drug (T = 4). OBJECTIVES: To analyze stakeholder experiences in implementing CF in practice. METHODS: Public and private stakeholders were approached for participation in stakeholder interviews through standardized email invitations. An interview guide was developed to guide discussions that covered the following topics: perceived aims of CF, functioning of CF, impact of CF, and conclusions and future perspectives. Extensive summaries were generated for each interview and subsequently used for directed content analysis. RESULTS: Thirty stakeholders were interviewed. Differences emerged among the stakeholders on the perceived aims of CF. Conversely, there was some agreement among stakeholders on the shortcomings in the functioning of CF, the positive impact of CF on the Dutch healthcare setting, and improvement points for CF. CONCLUSIONS: Despite stakeholders' belief that CF either did not meet its aims or only partially did so, there was agreement on the need for new policy to address the same aims of CF in the future. Nevertheless, stakeholders diverged on whether CF should be improved on the basis of learnings identified and reintroduced into practice or replaced with new policy schemes.


Assuntos
Aprovação de Drogas/economia , Custos de Medicamentos , Administração Financeira de Hospitais/economia , Gastos em Saúde , Custos Hospitalares , Participação dos Interessados , Avaliação da Tecnologia Biomédica/economia , Orçamentos , Aprovação de Drogas/legislação & jurisprudência , Custos de Medicamentos/legislação & jurisprudência , Administração Financeira de Hospitais/legislação & jurisprudência , Gastos em Saúde/legislação & jurisprudência , Política de Saúde/economia , Custos Hospitalares/legislação & jurisprudência , Humanos , Entrevistas como Assunto , Países Baixos , Formulação de Políticas , Avaliação de Programas e Projetos de Saúde , Avaliação da Tecnologia Biomédica/legislação & jurisprudência
9.
San Salvador; s.n; abr. 2019. 56 p. ilus, graf, tab.
Tese em Espanhol | LILACS | ID: biblio-1007233

RESUMO

OBJETIVO: Determinar el alcance y nivel de desarrollo de los procesos de gestión en la ejecución del presupuesto del primer nivel de atención del MINSAL El Salvador en el período 2014, 2015, 2016 y 2017. DISEÑO: Es un estudio descriptivo retrospectivo de corte transversal. La unidad de análisis fueron los informes de la ejecución presupuestaria del Primer Nivel de Atención, elaborados por la Unidad Financiera Institucional y las entrevistas a actores claves. RESULTADOS: Existe marco legal que orienta y da seguimiento a la ejecución presupuestaria del MINSAL; que el presupuesto aprobado al primer nivel de atención es insuficiente para responder a las necesidades de la población, con una tasa constante a la baja entre lo presentado y aprobado, hay rubros vitales que no logran ejecutarse según lo esperado; puntos críticos en los mecanismos de coordinación para la toma de decisiones y modalidad de gestión. CONCLUSIONES: El marco legal da seguimiento a la ejecución presupuestaria de todas las instancias de la administración pública; las tasas de variación de los rubros han decrecido, solo en rubro de remuneraciones denota incremento, pero menor de un año con respecto al siguiente; en los mismos periodos el rubro de adquisiciones de bienes y servicios disminuyó, de igual forma inversiones de activo fijo, seguido de gastos financieros, transferencias corrientes se mantuvo; se revisan aspectos que influyen en el funcionamiento de los mecanismos de gestión para la toma de decisiones oportunas durante la ejecución presupuestaria


Assuntos
Humanos , Organização e Administração , Orçamentos , Legislação , Gestão em Saúde
13.
Int J Technol Assess Health Care ; 35(1): 64-68, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30938278

RESUMO

OBJECTIVES: The recent development of value frameworks to inform healthcare resource allocation responds to a demand to make the decision-making process more inclusive and explicit. The objectives of the 2018 Latin American (LAtam) Health Technology Assessment International (HTAi) Policy Forum were to explore the current international experiences and to discuss the potential application of value frameworks in Latin America. METHODS: A background paper, presentations, and group discussions of Policy Forum members (43 participants, 12 LAtam countries represented) at the 2018 HTAi Policy Forum meeting informed this paper. RESULTS: Participants agreed that HTA and decision making based on more comprehensive and inclusive value frameworks could improve health system effectiveness, efficiency, sustainability, and equity; promote transparency in the decision process; sustain a more comprehensive assessment of technologies; and facilitate stakeholder participation as well as accountability of decisions. Criteria that were identified as essential to be included in a value framework for LAtam were burden of illness and severity of the disease, effectiveness and safety of the technology, quality of the evidence, cost-effectiveness, and budget impact. Potential challenges identified for the application of value frameworks in LAtam, included scarcity of human resources and delays in the assessment process. CONCLUSIONS: Forum participants agreed that the next steps should be to identify appropriate processes and methodologies, adapted to the context of each country, regarding the application of value frameworks to improve the link between HTA and decision making.


Assuntos
Tomada de Decisões , Alocação de Recursos para a Atenção à Saúde/organização & administração , Avaliação da Tecnologia Biomédica/organização & administração , Orçamentos , Análise Custo-Benefício , Alocação de Recursos para a Atenção à Saúde/normas , Política de Saúde , Humanos , América Latina , Índice de Gravidade de Doença , Avaliação da Tecnologia Biomédica/normas , Fatores de Tempo
14.
BMC Health Serv Res ; 19(1): 140, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819153

RESUMO

BACKGROUND: With some Medicaid state programs still restricting patient access to hepatitis C (HCV) treatment, it is important to demonstrate how states could expand treatment access to a broader Medicaid population and balance short-term budget concerns. METHODS: We used the HCV Transmission and Progression (TaP) Markov model to quantify the impact of removing restrictions to HCV treatment access on the infected populations, expenditures, and net social value for the North Carolina (NC), Oregon (OR), and Wisconsin (WI) Medicaid programs. Four HCV treatment access scenarios were modeled: 1) Baseline: Patients were treated according to Medicaid disease severity and sobriety requirements in 2015; 2) Remove Sobriety Restrictions: Disease severity restrictions were maintained, but people who inject drugs (PWID) were given access to treatment; 3) Treat Early: All patients, except for PWIDs, regardless of disease severity, were eligible for treatment and the diagnosis rate increased from 50 to 66%; and 4) Remove Access Restrictions: all patients, regardless of disease severity and sobriety, were eligible for treatment. Our key model outputs were: number of infected Medicaid beneficiaries, HCV-related medical and treatment expenditures, total social value, and state Medicaid spending over 10 years. RESULTS: Across all three states, removing access restrictions resulted in the greatest benefits over 10 years (net social value relative to baseline = $408 M in NC; $408 M in OR; $271 M in WI) and the smallest infected population (5200 in NC; 2000 in OR; 614 in WI). Reduced disease transmission resulted in lower health care expenditures (-$66 M in NC; -$50 M in OR; -$54 M in WI). All of the expanded treatment access policies achieved break-even costs-where total treatment and health care expenditures fell below those of Baseline-in 4 to 8 years. Removing access restrictions yielded the greatest improvement in social value (net of medical expenditures and treatment costs, QALYs valued at $150 K per QALY). CONCLUSIONS: While increasing treatment access in Medicaid will raise short-term costs, it will also provide clear benefits relatively quickly by saving money and improving health within a 10-year window. Patients and taxpayers would benefit by considering these gains and taking a more expansive and long-term view of HCV treatment policies.


Assuntos
Orçamentos , Custos de Cuidados de Saúde , Acesso aos Serviços de Saúde , Hepatite C/tratamento farmacológico , Medicaid , Progressão da Doença , Feminino , Hepacivirus , Hepatite C/epidemiologia , Humanos , Masculino , Cadeias de Markov , Anos de Vida Ajustados por Qualidade de Vida , Estados Unidos/epidemiologia
15.
Value Health ; 22(3): 332-339, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30832971

RESUMO

BACKGROUND: Payers frequently rely on budget impact model (BIM) results to help determine drug coverage policy and its effect on their bottom line. It is unclear whether BIMs typically overestimate or underestimate real-world budget impact. OBJECTIVE: We examined how different modeling assumptions influenced the results of 6 BIMs from the Institute for Clinical and Economic Review (ICER). STUDY DESIGN: Retrospective analysis of pharmaceutical sales data. METHODS: From ICER reports issued before 2016, we collected estimates of 3 BIM outputs: aggregate therapy cost (ie, cost to treat the patient population with a particular therapy), therapy uptake, and price. We compared these against real-world estimates that we generated using drug sales data. We considered 2 classes of BIM estimates: those forecasting future uptake of new agents, which assumed "unmanaged uptake," and those describing the contemporaneous market state (ie, estimates of current, managed uptake and budget impact for compounds already on the market). RESULTS: Differences between ICER's estimates and our own were largest for forecasted studies. Here, ICER's uptake estimates exceeded real-world estimates by factors ranging from 7.4 (sacubitril/valsartan) to 54 (hepatitis C treatments). The "unmanaged uptake" assumption (removed from ICER's approach in 2017) yields large deviations between BIM estimates and real-world consumption. Nevertheless, in some cases, ICER's BIMs that relied on current market estimates also deviated substantially from real-world sales data. CONCLUSIONS: This study highlights challenges with forecasting budget impact. In particular, assumptions about uptake and data source selection can greatly influence the accuracy of results.


Assuntos
Orçamentos/tendências , Análise de Dados , Bases de Dados de Produtos Farmacêuticos/economia , Bases de Dados de Produtos Farmacêuticos/tendências , Tecnologia Farmacêutica/economia , Tecnologia Farmacêutica/tendências , Previsões , Humanos , Modelos Econômicos
16.
J Manag Care Spec Pharm ; 25(3): 342-349, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30816818

RESUMO

BACKGROUND: Traditional budget impact models predict the financial consequences of a new drug entering the market. This study provides an example of applying the budget impact framework to a new research question of interest to managed care organizations-what is the budget impact of our formulary and utilization management (UM) policy changes? OBJECTIVE: To predict the 3-year annual budgetary impact of TRICARE's antidiabetic formulary and UM policy changes using TRICARE claims data. METHODS: A budget impact model was built in Microsoft Excel using health plan claims data for a 3-year time horizon. Model outcomes included spending on antidiabetic medications and medications used for side effect treatment. In sensitivity analyses, medical costs from inpatient, outpatient, and emergency room visits were also estimated. Model inputs included health plan antidiabetic medication utilization, as well as publicly available drug cost, rebate, dispensing fee, and patient cost-sharing estimates. Type of enrollee and pharmacy were also incorporated into the model. Sensitivity analyses varied estimates for utilization switch rates between preferred and nonpreferred agents, drug costs, rebates, and dispensing fees, as well as predicted impact from implementation delays. RESULTS: For the 623,827 affected by the formulary and UM policy changes, the model predicted annual savings that increased from $24 million in the first year to $43 million in the third year after the changes. The majority of savings came from drug acquisition costs, as opposed to rebates, copays, and dispensing fees. Sensitivity analyses found savings across all varied parameters and scenarios except an unlikely scenario when 0% of utilization switched from nonpreferred to preferred agents. The model also predicted that the formulary and UM policy changes would lead to $529,439 in savings from medical visit costs in Year 3. CONCLUSIONS: This budget impact model predicted cost savings from the payer's formulary and UM policy changes. DISCLOSURES: This project was supported by grant number F32HS024857 from the Agency for Healthcare Research and Quality (AHRQ), which contracted with the University of Maryland School of Pharmacy to conduct this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ, which had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or design to submit the manuscript for publication. The findings discussed in this manuscript represent the views of the authors and do not necessarily reflect the views of the Department of Defense, the Defense Health Agency, nor the Departments of the Army, Navy, and Air Force. Hung reports a grant from the AHRQ, during the conduct of the study, and personal fees from CVS Health and BlueCross BlueShield Association, outside the submitted work. Mullins reports grants and personal fees from Bayer and Pfizer and personal fees from Boehringer-Ingelheim, Janssen/J&J, Regeneron, and Sanofi, outside the submitted work. Mullins, Slejko, and Shaya are employed by the University of Maryland School of Pharmacy. Haines and Lugo have nothing to disclose. Part of this content was previously presented as a poster at the 2017 AMCP Managed Care & Specialty Pharmacy Annual Meeting; March 27-30, 2017; Denver, CO, and as poster and oral presentations at the 2017 AMCP Nexus Meeting; October 16-19, 2017; Dallas, TX. Part of this content was published as Hung's PhD dissertation.


Assuntos
Orçamentos , Hipoglicemiantes/economia , Programas de Assistência Gerenciada/economia , Modelos Econômicos , Idoso , Idoso de 80 Anos ou mais , Redução de Custos , Custos de Medicamentos , Feminino , Formulários Farmacêuticos como Assunto , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Masculino , Pessoa de Meia-Idade , Política Organizacional
17.
Curr Opin Anaesthesiol ; 32(2): 195-199, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30817395

RESUMO

PURPOSE OF REVIEW: Against the background of increasing healthcare costs and diminishing budgets, this review aims to present clinicians with ethically viable options to overcome budgetary restraints when seeking to introduce novel products. RECENT FINDINGS: Healthcare administrators and primary healthcare providers are not unlikely to have different opinions when discussing the introduction of novel products. However, rather than taking a 'no' for an answer, doctors may be able to argue for a change - even if this may seem to come at a higher cost. The recent introduction of the reversal agent sugammadex may provide a timely example for the possibility of success 'against all financial odds'. SUMMARY: Health professionals have the responsibility to deliver high-quality care while acknowledging the financial budget constraints. However, evidence (vs. perception) for outcome benefits of novel drugs or devices should stimulate a robust desire for their timely introduction. Demonstrating actual benefits understandable to administrators, seeking alliances with other medical specialties or patient groups, as well as negotiations with the healthcare industry may all represent viable options. Simply waiting for patents to expire should remain a measure of last resort.


Assuntos
Orçamentos/organização & administração , Custos de Cuidados de Saúde , Diretores Médicos/psicologia , Médicos de Atenção Primária/psicologia , Austrália , Comportamento de Escolha , Redução de Custos , Análise Custo-Benefício , Medicina Baseada em Evidências/economia , Humanos , Avaliação de Resultados (Cuidados de Saúde) , Percepção
18.
Proc Natl Acad Sci U S A ; 116(13): 6221-6225, 2019 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-30858309

RESUMO

Healthcare-associated infections (HAIs) pose a significant burden to patient safety. Institutions can implement hospital infection control (HIC) measures to reduce the impact of HAIs. Since patients can carry pathogens between institutions, there is an economic incentive for hospitals to free ride on the HIC investments of other facilities. Subsidies for infection control by public health authorities could encourage regional spending on HIC. We develop coupled mathematical models of epidemiology and hospital behavior in a game-theoretic framework to investigate how hospitals may change spending behavior in response to subsidies. We demonstrate that under a limited budget, a dollar-for-dollar matching grant outperforms both a fixed-amount subsidy and a subsidy on uninfected patients in reducing the number of HAIs in a single institution. Additionally, when multiple hospitals serve a community, funding priority should go to the hospital with a lower transmission rate. Overall, subsidies incentivize HIC spending and reduce the overall prevalence of HAIs.


Assuntos
Infecção Hospitalar/epidemiologia , Teoria do Jogo , Hospitais , Controle de Infecções , Modelos Teóricos , Orçamentos , Infecção Hospitalar/economia , Resistência Microbiana a Medicamentos , Economia Hospitalar , Custos Hospitalares , Humanos , Prevalência
19.
Tech Vasc Interv Radiol ; 22(1): 3-6, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30765073

RESUMO

Interventional Radiology (IR) incorporates a unique set of technical skills such as ultrasound-guided needle placement, inferior vena cava filter placement, and wire/catheter exchange, which are not easily attained in other aspects of medical training. Simple, low cost models can allow medical students and residents to attain these skills in a low risk setting. These simulated tasks will ultimately combine to improve preparedness of trainees during patient procedures allowing them to advance more quickly through the training paradigm without patient risk. Many commercially available devices may be cost prohibitive, so low cost solutions are presented.


Assuntos
Orçamentos , Educação de Pós-Graduação em Medicina/métodos , Educação de Graduação em Medicina/métodos , Radiografia Intervencionista , Radiologia Intervencionista , Competência Clínica , Currículo , Educação de Pós-Graduação em Medicina/economia , Educação de Graduação em Medicina/economia , Desenho de Equipamento , Humanos , Curva de Aprendizado , Radiografia Intervencionista/economia , Radiografia Intervencionista/instrumentação , Radiologia Intervencionista/economia , Radiologia Intervencionista/educação , Radiologia Intervencionista/instrumentação , Estudantes de Medicina
20.
BMC Health Serv Res ; 19(1): 84, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30709374

RESUMO

BACKGROUND: The increasing cost on healthcare exposes China's healthcare budgets and system to financial crisis. To control the excessive growth of healthcare expenditure, China's healthcare reforms emphasize the control of the global budget for healthcare, which leads to the release of relevant policy and a series of cost-control actions implemented by different hospitals. This work aims to identify the effects brought by the cost-control policy and actions via surveying and analysing feedback from clinicians. METHODS: Questionnaires on the cost-control policy and actions were designed for surveying 110 clinicians in hospitals from different regions of China. The data on the implementation of the cost-control actions and doctors' feedback on these actions were analysed using descriptive statistics. Pearson's chi-squared tests were performed to detect associations between doctors' opinions and specific cost-control actions. A value of p < 0.05 was considered statistically significant. Association relationships between doctors' opinions and cost-control actions were modelled into network models, and key factors were identified in a multi-variate framework. Last, we visualized our resultant data using a network model, and further multi-variate analysis was performed. RESULTS: There were three main findings. (1) The cost-control policy has been widely implemented in the sampled hospitals in different regions of China, with more than 80% of those surveyed acknowledging that their hospitals take actions of reducing average prescription fees for outpatients, drug costs, and in-hospitalization durations. (2) Most doctors have a negative view of some cost-control actions; this is mainly due to concerns about the effects of these actions on the doctors' own healthcare performance and patient satisfaction. (3) Cost-control actions that had a significant impact on doctors' performance included limiting average prescription fees for outpatients and limiting the use of examinations/drugs/surgeries. Decreased patient satisfaction was associated with fewer admissions of critically ill patients, reduced use of brand-name drugs, and increased total costs to patients due to increased frequencies of visits to the hospitals. CONCLUSIONS: Cost-control actions implemented in hospitals in response to the government's policy to reduce its national healthcare budget affect both doctors and patients in several ways. Moreover, the cost-control policy and actions can be improved.


Assuntos
Reforma dos Serviços de Saúde/economia , Política de Saúde/economia , Assistência Ambulatorial/economia , Atitude do Pessoal de Saúde , Orçamentos , China , Controle de Custos , Custos de Medicamentos , Economia Hospitalar , Hospitais/estatística & dados numéricos , Humanos , Pacientes Ambulatoriais , Satisfação do Paciente , Médicos/psicologia , Honorários por Prescrição de Medicamentos , Inquéritos e Questionários
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