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2.
PLoS One ; 15(7): e0235040, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628684

RESUMO

The objective of this analysis was to evaluate and report on the economic impact of implementing an integrated, quality, and operational improvement program on chronic obstructive pulmonary disease (COPD) care from acute through post-acute care settings. This initiative was established in a cohort of 12 hospitals in Alabama and sought to address COPD readmission through improved workflows pertaining to early diagnosis, efficient care transitions, and patient visibility across the entire care episode. Implementation of the initiative was influenced by lean principles, particularly cross-functional agreement of workflows to improve COPD care delivery and outcomes. A budget impact model was developed to calculate cost savings directly from objective data collected during this initiative. The model estimated payer annual savings over 5 years. Patients were classified for analysis based on whether or not they received noninvasive ventilation. Scenario analyses calculated savings for payers covering different COPD cohort sizes. The base case revealed annual per patient savings of $11,263 for patients treated through the quality improvement program versus traditional care. The model projected cumulative savings of $52 million over a 5-year period. Clinical incorporation of non-invasive ventilation (NIV) resulted in $20,535 annual savings per patient and projected $91 million over 5 years. We conclude that an integrated management program for COPD patients across the care continuum is associated with substantial cost savings and significantly reduced hospital readmissions.


Assuntos
Redução de Custos/estatística & dados numéricos , Análise Custo-Benefício/estatística & dados numéricos , Modelos Econômicos , Doença Pulmonar Obstrutiva Crônica/economia , Melhoria de Qualidade/economia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Alabama/epidemiologia , Orçamentos/estatística & dados numéricos , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/economia , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia
6.
Stud Health Technol Inform ; 272: 354-357, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32604675

RESUMO

In recent years, Slovenian public health has been a very prominent topic, both politically and professionally. In 2017, a one-off cash transfer to hospitals from the state budget in the total amount of EUR 136.24 million cash has been ensured to pay debts to suppliers of medical materials and medicines. At the same time, emergency legislation enacted the recovery plans to ensure operational and payment stability. The in-depth analysis of the recovery plans for 15 hospitals revealed that management boards highlight the infrastructure and financial challenges as the greatest, whereas the challenges concerning the services/products and patients/users are perceived to be less important.


Assuntos
Assistência à Saúde , Planejamento Hospitalar , Orçamentos , Humanos
7.
PLoS One ; 15(7): e0235250, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730256

RESUMO

OBJECTIVES: To elicit citizen preferences for national budget resource allocation in Uganda, examine respondents' preferences for health vis-à-vis other sectors, and compare these preferences with actual government budget allocations. METHODS: We surveyed 432 households in urban and rural areas of Mukono district in central Uganda.We elicited citizens' preferences for resource allocation across all sectors using a best-worst scaling (BWS) survey. The BWS survey consisted of 16 sectors corresponding to the Uganda national budget line items. Respondents chose, from a subset of four sectors across 16 choice tasks, which sectors they thought were most and least important to allocate resources to. We utilized the relative best-minus-worst score method and a conditional logistic regression to obtain ranked preferences for resource allocation across sectors. We then compared the respondents' preferences with actual government budget allocations. RESULTS: The health sector was the top ranked sector where 82% of respondents selected health as the most important sector for the government to fund, but it was ranked sixth in national budget allocation, encompassing 6.4% of the total budget. Beyond health, water and environment, agriculture, and social development sectors were largely underfunded compared to respondents' preferences. Works and transport, education, security, and justice, law and order received a larger share of the national budget compared to respondents' preferences. CONCLUSIONS: Among respondents from Mukono district in Uganda, we found that citizens' preferences for resource allocation across sectors, including for the health sector, were fundamentally misaligned with current government budget allocations. Evidence of respondents' strong preferences for allocating resources to the health sector could help stakeholders make the case for increased health sector allocations. Greater investment in health is not only essential to satisfy citizens' needs and preferences, but also to meet the government's health goals to improve health, strengthen health systems, and achieve universal health coverage.


Assuntos
Orçamentos/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Governo Local , Alocação de Recursos/estatística & dados numéricos , Adulto , Orçamentos/organização & administração , Estudos Transversais , Feminino , Alocação de Recursos para a Atenção à Saúde/organização & administração , Habitação/economia , Habitação/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Setor Público/economia , Setor Público/organização & administração , Alocação de Recursos/organização & administração , Participação dos Interessados , Transportes/economia , Uganda , Assistência de Saúde Universal , Reforma Urbana/economia , Reforma Urbana/organização & administração , Adulto Jovem
8.
S Afr Med J ; 110(4): 271-273, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32657737

RESUMO

Trastuzumab was added to the South African Essential Medicines List (EML) in 2017 for the adjuvant management of human epidermal growth factor receptor 2 (HER2)-positive early breast cancer. However, access has remained inconsistent, as some provinces continue to regard trastuzumab as unaffordable within the contexts of their respective oncology budgets. The intention of providing access to trastuzumab through its inclusion on the EML, therefore, has not been met. The National EML Committee (NEMLC) recently reviewed newly published peer-reviewed information investigating the impact of a shorter trastuzumab treatment period on both clinical efficacy and safety. On account of this review, and with a view to improving access while reducing cost and toxicity, the NEMLC has revised the duration of trastuzumab therapy, i.e. from 12 months to 6 months in the adjuvant management of early HER2-positive breast cancer. This article explores and reports on the data used to make this policy amendment.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Medicamentos Essenciais , Duração da Terapia , Política de Saúde , Mastectomia , Formulação de Políticas , Trastuzumab/uso terapêutico , Antineoplásicos Imunológicos/economia , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Orçamentos , Cardiotoxicidade/etiologia , Quimioterapia Adjuvante , Feminino , Acesso aos Serviços de Saúde , Humanos , Mastectomia Segmentar , Estadiamento de Neoplasias , Receptor ErbB-2/metabolismo , África do Sul , Trastuzumab/economia
9.
S Afr Med J ; 110(4): 274-283, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32657738

RESUMO

BACKGROUND: Over the past 18 years, the South African (SA) Ministry of Health has committed to allocate 2% of the national health budget to research, while the National Health Research Policy (2001) proposed that the health research budget should be 2% of total public sector health expenditure. A review was conducted by the National Health Research Committee (NHRC) in 2014 to determine whether these goals had been met, using available data up to 2009/10. It revealed that public sector health research funding remained below 2% of the national health budget, supporting the perception of reduced public sector health research funding. OBJECTIVES: To provide an update on the previous review to investigate changes in the health research landscape since 2009/10 and whether goals have been met. METHODS: Various publicly available sources of information on public and private expenditure on health research in SA were used to investigate health research funding and expenditure. In addition, questionnaires were sent to 35 major national and international funders of health research in SA to obtain data on the level of funding provided and the fields of research funded. RESULTS: Total health research expenditure in SA was ZAR6.9 billion in 2016/17, or 19.2% of gross expenditure on research and development, with 1.7% of the ZAR38.6 billion National Department of Health budget from National Treasury being spent on health research through the South African Medical Research Council (ZAR658 million), corresponding to 0.4% of the consolidated government expenditure on health. However, although the total government plus science council spend on health research in 2016/17 was ZAR1.45 billion, this represents just 0.033% of the gross domestic product (GDP), thus remaining well below the aspirational target of 0.15% of the GDP set by the NHRC in 2014. Based on feedback from the funders, the estimated baseline health research funding in 2016/17 was in excess of ZAR4.1 billion, which is considerably higher than many researchers may realise. Three-quarters of this funding originated from foreign sources, suggesting both strengths and opportunities for health research in SA, but also highlighting increasing dependence on foreign funding. Notably, the majority of funders approached were not able to readily break down expenditure according to disease area. CONCLUSIONS: Health research funding has changed significantly since our previous review, although the government's own commitments to it remain unmet. Improved mechanisms to track health research expenditure are urgently required for better alignment of funding priorities and increased co-ordination between science councils in health research funding.


Assuntos
Pesquisa Biomédica/economia , Governo , Gastos em Saúde/tendências , Apoio à Pesquisa como Assunto/economia , Pesquisa Biomédica/tendências , Orçamentos , Educação/economia , Humanos , Organizações/economia , Organizações sem Fins Lucrativos/economia , Setor Privado/economia , Setor Público/economia , Apoio à Pesquisa como Assunto/tendências , África do Sul
12.
Brasília; IPEA; jun. 2020. 21 p. ilus.(Nota Técnica / IPEA. Disoc, 76).
Monografia em Português | LILACS, ECOS | ID: biblio-1102403

RESUMO

Este texto aborda diversos aspectos do Programa Abono Salarial, uma política social no Brasil que, embora mobilize um volume considerável de recursos orçamentários e atenda a um amplo contingente de indivíduos, ainda é pouco estudada. São gastos anualmente em torno de R$ 20 bilhões, algo próximo a 0,3% do PIB, depositados em parcela única com diferentes valores até o teto de 1 SM a mais de 20 milhões de trabalhadores. Esse montante de recursos impacta diretamente na renda disponível das famílias, aumentando o consumo agregado e contribuindo na dinâmica da economia real.


Assuntos
Política Pública , Orçamentos , Coronavirus , Pandemias , Despesas Públicas
13.
J Aging Soc Policy ; 32(4-5): 343-349, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32475257

RESUMO

Medicaid provides essential coverage for health care and long-term services and supports (LTSS) to low-income older adults and disabled individuals but eligibility is complicated and restrictive. In light of the current public health emergency, states have been given new authority to streamline and increase the flexibility of Medicaid LTSS eligibility, helping them enroll eligible individuals and ensure that current beneficiaries are not inadvertently disenrolled. Though state budgets are under increased pressure during the economic crisis created by the coronavirus, we caution states against cutting Medicaid LTSS eligibility or services to balance their budgets. These services are critical to an especially vulnerable population during a global pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Definição da Elegibilidade/organização & administração , Assistência de Longa Duração/organização & administração , Medicaid/organização & administração , Pneumonia Viral/epidemiologia , Idoso , Betacoronavirus , Orçamentos , Gastos em Saúde , Serviços de Assistência Domiciliar/organização & administração , Humanos , Assistência de Longa Duração/economia , Medicaid/economia , Pandemias , Estados Unidos
18.
Washington, D.C.; PAHO; 2020-06. (CE166/11).
Não convencional em Inglês, Espanhol, Francês | PAHO-IRIS | ID: phr-52354
19.
Washington, D.C.; PAHO; 2020-06. (CE166/9).
Não convencional em Inglês, Espanhol, Francês | PAHO-IRIS | ID: phr-52351
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