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1.
Pan Afr Med J ; 33: 10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303955

RESUMO

Epilepsy in Sudan accounts for 1.6 annual mortality rates and 238.7 disability adjusted life years per 100 000. These figures are higher among females; children and young adults. It is associated with notable stigma and social burdens. Patients of epilepsy are subjected to various forms of social discrimination that affect their quality of life. They are isolated, neglected and deprived of their education and employments rights and not able to achieve normal social and family life. Aiming at highlighting social implications of epilepsy among Sudanese patients, this study found that social encumbrances due to epilepsy in Sudan are more prevalent among highly vulnerable groups like women, children and poor populations living in remote areas. Lack of trained medical personnel in neurology and the medical equipment's required for proper diagnosis and treatment of epilepsy in Sudan are key reasons aggravating social and health burden of epilepsy both among patients and their caregivers.


Assuntos
Epilepsia/terapia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Qualidade de Vida , Serviços Urbanos de Saúde/normas , Criança , Epilepsia/economia , Epilepsia/epidemiologia , Feminino , Disparidades em Assistência à Saúde/economia , Humanos , Masculino , Pobreza , Discriminação Social , Sudão/epidemiologia , Serviços Urbanos de Saúde/economia , População Urbana/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adulto Jovem
3.
Int J Equity Health ; 18(1): 90, 2019 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200711

RESUMO

BACKGROUND: The inequity of healthcare utilization in rural China is serious, and the urban-rural segmentation of the medical insurance system intensifies this problem. To guarantee that the rural population enjoys the same medical insurance benefits, China began to establish Urban and Rural Resident Basic Medical Insurance (URRBMI) nationwide in 2016. Against this backdrop, this paper aims to compare the healthcare utilization inequity between URRBMI and New Cooperative Medical Schemes (NCMS) and to analyze whether the inequity is reduced under URRBMI in rural China. METHODS: Using the data from a national representative survey, the China Health and Retirement Longitudinal Study (CHARLS), which was conducted in 2015, a binary logistic regression model was applied to analyze the influence of income on healthcare utilization, and the decomposition of the concentration index was adopted to compare the Horizontal inequity index (HI index) of healthcare utilization among the individuals insured by URRBMI and NCMS. RESULTS: There is no statistically significant difference in healthcare utilization between URRBMI and NCMS, but in outpatient utilization, there are significant differences among different income groups in NCMS; high-income groups utilize more outpatient care. The Horizontal inequity indexes (HI indexes) in outpatient utilization for individuals insured by URRBMI and NCMS are 0.024 and 0.012, respectively, indicating a pro-rich inequity. Meanwhile, the HI indexes in inpatient utilization under the two groups are - 0.043 and - 0.028, respectively, meaning a pro-poor inequity. For both the outpatient and inpatient care, the inequity degree of URRBMI is larger than that of NCMS. CONCLUSIONS: This paper shows that inequity still exists in rural areas after the integration of urban-rural medical insurance schemes, and there is still a certain gap between the actual and the expected goal of URRBMI. Specifically, compared to NCMS, the pro-rich inequity in outpatient care and the pro-poor inequity in inpatient care are more serious in URRBMI. More chronic diseases should be covered and moral hazard should be avoided in URRBMI. For the vulnerable groups, special policies such as reducing the deductible and covering these groups with catastrophic medical insurance could be considered.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , Serviços Urbanos de Saúde/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , China , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Serviços de Saúde Rural/economia , Serviços Urbanos de Saúde/economia
4.
Ann Vasc Surg ; 54: 40-47.e1, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30217701

RESUMO

BACKGROUND: Cost-effectiveness in healthcare is being increasingly scrutinized. Data regarding claims variability for vascular operations are lacking. Herein, we aim to describe variability in charges and payments for aortoiliac (AI) and infrainguinal (II) revascularizations. METHODS: We analyzed 2012-2014 claims data from a statewide claims database for procedures grouped by Current Procedural Terminology codes into II-open (II-O), II-endovascular (II-E), AI-open (AI-O), and AI-endovascular interventions (AI-E). We compared charges and payments in urban (≥50,000 people, UAs) versus rural areas (<50,000 people, RAs). Amounts are reported in $US as median with interquartile range. Cost-to-charge ratios (CCRs) as a measure of reimbursement were calculated as the percentage of the charges covered by the payments. Wilcoxon rank-sum tests were performed to determine significant differences. RESULTS: A total of 5,239 persons had complete claims data. There were 7,239 UA and 6,891 RA claims, and 1,057 AI claims (AI-E = 879, AI-O = 178) and 4,182 II claims (II-E = 3,012, II-0 = 1,170). Median charges were $5,357 for AI [$1,846-$27,107] and $2,955 for II [$1,484-$9,338.5] (P < 0.0001). Median plan payment was $454 for AI [$0-$1,380] and $454 for II [$54-$1,060] (P = 0.67). For AI and II, charges were significantly higher for UA than RA (AI: UA $9,875 [$2,489-$34,427], RA $3,732 [$1,450-$20,595], P < 0.0001; II: UA $3,596 [$1,700-$21,664], RA $2,534 [$1,298-$6,169], P < 0.0001). AI-E charges were higher than AI-O (AI-E $7,960 [$1,699-$32,507], AI-O $4,774 [$2,636-$7,147], P < 0.0001), but AI-O payments were higher (AI-E $424 [$0-$1,270], AI-O $869 [$164-$1,435], P = 0.0067). II-E charges were higher (II-E $2,994 [$1,552-$22,164], II-O $2,873 [$1,108-$5,345], P < 0.0001), but II-O payments were higher (II-E $427 [$50-$907], II-O $596 [$73-$1,299], P < 0.0001). CCRs were highest for II operations and UAs. CONCLUSIONS: Wide variability in claim charges and payments exists for vascular operations. AI procedures had higher charges than II, without any difference in payments. UA charged more than RA for both AI and II operations, but RA had higher payments and CCRs. Endovascular procedures had higher charges, while open procedures had higher payments. Charge differences may be related to endovascular device costs, and further research is necessary to determine the reasons behind consistent claims variability between UA and RA.


Assuntos
Demandas Administrativas em Assistência à Saúde/economia , Procedimentos Endovasculares/economia , Custos de Cuidados de Saúde , Preços Hospitalares , Mecanismo de Reembolso/economia , Procedimentos Cirúrgicos Vasculares/economia , Demandas Administrativas em Assistência à Saúde/classificação , Idoso , Idoso de 80 Anos ou mais , Colorado , Análise Custo-Benefício , Current Procedural Terminology , Bases de Dados Factuais , Procedimentos Endovasculares/classificação , Procedimentos Endovasculares/tendências , Feminino , Custos de Cuidados de Saúde/tendências , Preços Hospitalares/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Mecanismo de Reembolso/tendências , Serviços de Saúde Rural/economia , Fatores de Tempo , Serviços Urbanos de Saúde/economia , Procedimentos Cirúrgicos Vasculares/classificação , Procedimentos Cirúrgicos Vasculares/tendências
5.
BMC Health Serv Res ; 18(1): 979, 2018 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-30563519

RESUMO

BACKGROUND: General practice (GP) has historically been central to the prevention and treatment of childhood illnesses. In Ireland, this role has recently expanded with the introduction of free GP care for children aged under six years in 2015. The Republic of Ireland has the only health system in the European Union which does not offer universal coverage for primary care. This study aims to analyse general practice records to investigate the effect of point of care consultation fees on childhood attendances. METHODS: GPs affiliated to the medical school (n = 72) were invited to participate. 100 children aged 1 to 14 years were randomly sampled from each. Data was collected on service utilisation in the previous 12 months, specifically: age, gender, eligibility for free care and whether they had consulted their GP in the 12 month period. RESULTS: Sixty-four practices participated, producing data on 6007 eligible children. The median age of children was seven years; 3688(62%) were 'fee-paying'. GMS patients aged under six years had a median of three consultations/year, with a quarter attending six times a year or more, while fee paying patients had a median of two consultations/year with a quarter attending four times a year or more. CONCLUSIONS: Children eligible for free care attend more often with a subgroup attending very frequently. This study provides important information on the possible impact of fees on healthcare utilisation for countries considering co-payment.


Assuntos
Honorários e Preços , Medicina Geral/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Sistemas Automatizados de Assistência Junto ao Leito/economia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Irlanda , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/economia , Serviços de Saúde Rural/economia , Cobertura Universal do Seguro de Saúde/economia , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Serviços Urbanos de Saúde/economia
6.
J Am Board Fam Med ; 31(6): 952-956, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30413553

RESUMO

The Transforming Clinical Practice Initiative prioritized the delivery of free practice transformation assistance by Practice Transformation Networks (PTNs) to small and rural practices that may otherwise lack the resources needed to succeed in Medicare's value-based payment (VBP) programs. We assessed the enrollment of rural practices in PTNs using 2016 TCPI enrollment data and American Board of Family Medicine recertification examination registration data from 2013 to 2016. PTNs enrolled a higher proportion of rural family medicine practices than are represented across the general workforce (P < .0001). We await more comprehensive data releases to fully understand enrollment to this important initiative.


Assuntos
Medicina de Família e Comunidade/estatística & dados numéricos , Medicare/economia , Médicos de Família/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Serviços Urbanos de Saúde/estatística & dados numéricos , Medicina de Família e Comunidade/economia , Medicina de Família e Comunidade/organização & administração , Humanos , Medicare/estatística & dados numéricos , Médicos de Família/economia , Médicos de Família/organização & administração , Serviços de Saúde Rural/economia , Serviços de Saúde Rural/organização & administração , Estados Unidos , Serviços Urbanos de Saúde/economia , Serviços Urbanos de Saúde/organização & administração , Seguro de Saúde Baseado em Valor/economia , Seguro de Saúde Baseado em Valor/estatística & dados numéricos
7.
Int J Equity Health ; 17(1): 158, 2018 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-30340587

RESUMO

BACKGROUND: Essential medicines are those drugs that satisfy the priority health care needs of the population and help with functioning healthcare systems. Although many countries have formulated an essential medicine list, almost half of the global population still lack regular access to essential medicines. Research about the initiation of National Essential Medicines Policy in Chinese secondary and tertiary hospitals is inadequate, and the long-term effect on access after the reform is still unknown. This study's objective was to investigate the access to essential medicines in mainland China's secondary and tertiary hospitals. METHODS: Data on the access to 30 essential medicines from China's National Essential Medicine List were obtained from China Medicine Economic Information database covering 396 secondary hospitals and 763 tertiary hospitals. We improved the standard methodology developed by the World Health Organization and the Health Action International to measure the availability, median price ratio (MPR) and the incidence of catastrophic drug expenditure (CDE). RESULTS: Five essential medicines had > 50% availability and the nationwide availability kept steady; availability of drugs in eastern regions of China was significantly higher than the central and western regions. The median MPR of 30 drugs nationwide kept steady approximately 5; MPR of drugs in the eastern regions was significantly higher than the central and western regions and the ratio of MPR of innovator brands to generics increased from 3.66 to 6.32 during the study period. The incidence of CDE caused by essential medicines decreased from 2011 to 2014; brand name medicines were more likely to cause CDE than generics and rural patients have a greater tendency to fall into CDE. CONCLUSIONS: After the implementation of National Essential Medicines Policy, the MPR of essential medicines was well controlled and became more affordable in the context of steady availability. This has highlighted the problems associated with region disparity and inequity between rural and urban areas in the delivery of essential medicines and sustainable mechanisms are needed to deepen the National Essential Medicines Policy in mainland China.


Assuntos
Medicamentos Essenciais/economia , Medicamentos Essenciais/provisão & distribução , Acesso aos Serviços de Saúde/economia , Centros de Cuidados de Saúde Secundários , Centros de Atenção Terciária , China , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Serviços de Saúde Rural/economia , Inquéritos e Questionários , Serviços Urbanos de Saúde/economia
8.
East Mediterr Health J ; 24(7): 611-617, 2018 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-30215469

RESUMO

Background: The payment system is pivotal in implementing policies in the health sector. Equitable access to healthcare is the main principle of the payment system. Aims: This study aimed to investigate aspects of the payment system in the urban family physician programme (FPP) in the Islamic Republic of Iran. Methods: This was a qualitative study. We obtained data from key informants and both formal and grey literature. We used content analysis for data analysis. Results: A range of concepts was explored related to the payment system of the FPP. By merging similar expressions, we categorized the findings into four main themes including: payment method, payment criteria and incentives, payment process and amount of payment. Conclusions: FPP is required to follow convenient implementation methods. The mechanisms of payment in the health sector are weak and have no transparency. A blurred combination of criteria makes an unclear process for determining the payment mechanisms. It is recommended that the opinions of key stakeholders be taken into consideration prior to developing payment mechanisms and financial incentives.


Assuntos
Médicos de Família/economia , Mecanismo de Reembolso , Serviços Urbanos de Saúde/economia , Assistência à Saúde/economia , Assistência à Saúde/organização & administração , Planos de Pagamento por Serviço Prestado/economia , Planos de Pagamento por Serviço Prestado/organização & administração , Humanos , Irã (Geográfico) , Médicos de Família/organização & administração , Mecanismo de Reembolso/economia , Mecanismo de Reembolso/organização & administração , Reembolso de Incentivo/economia , Reembolso de Incentivo/organização & administração , Serviços Urbanos de Saúde/organização & administração
9.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 43(6): 668-678, 2018 Jun 28.
Artigo em Chinês | MEDLINE | ID: mdl-30110011

RESUMO

OBJECTIVE: To analyze the equity of outpatient service utilization for hypertensive patients (HPs) under 3 kinds of social medical insurance, and to explore its influential factors.
 Methods: A total of 8 670 HPs (aged at 15 years old from 28 sub-centers) in 14 provinces were selected. Indirectly standardized method and concentration index were used to analyze the equity of outpatient utilization in HPs, and decomposition analysis was used to explore the impact factors of outpatient treatment among the whole sample population, population with urban employees' basic medical insurance (UEBMI), and population with urban residents' basic medical insurance (URBMI) and new rural cooperative medical systems (NCMS).
 Results: The overall concentration index (CI) for the whole sample population was 0.2378. After the standardizing "need" variable, horizontal inequity (HI) was 0.2360, indicating that the outpatient service of HPs was inequity and that the higher economic level, the more outpatient services received. The decomposition of overall CI results showed that the positive factors for contribution were gross domestic product (GDP) level, retired, UEBMI and URBMI, and the negative factors for contribution were NCMS. The CI of UEBMI, URBMI and NCMS was 0.2017, 0.1208 and 0.0288, respectively; the HI was 0.1889, 0.1215 and 0.0219, respectively. The inequity in UEBMI is the most serious, followed by NRCMS and URBMI. The economic level was the main factor that caused inequity in the outpatient services utilization in three social medical insurance. In addition to the economic level, a common positive factor for the contribution to UEBMI and URBMI was district of residence, and the age was the positive factor to UEBMI as well.
 Conclusion: There are different levels of inequity in the HPs covered by 3 kinds of social medical insurance, and the inequity of UEBMI is the highest one among 3 kinds social medical insurance. The economic level is the main factor that affects the equity of outpatient in the HPs under 3 kinds of social medical insurance.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hipertensão/terapia , Seguro Saúde/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Fatores Socioeconômicos , Serviços Urbanos de Saúde/estatística & dados numéricos , Adolescente , Assistência Ambulatorial/economia , China , Disparidades em Assistência à Saúde/economia , Humanos , Seguro Saúde/economia , Pacientes Ambulatoriais/estatística & dados numéricos , Serviços de Saúde Rural/economia , Serviços Urbanos de Saúde/economia
10.
Biosci Trends ; 12(3): 215-219, 2018 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-29925702

RESUMO

The aims of this study were to describe health insurance reforms initiated by the Chinese government over the past two decades, to review their achievements in reducing the medical economic burden, and to summarize the challenges that still exist regarding a further reduction in out-of-pocket expenditures in this country. China has successfully attained the goal of providing health insurance coverage to almost the entire population by developing a mixed health insurance system, which consists of Urban Employees Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), New Rural Cooperative Medical Scheme (NCMS), and supplementary Catastrophic Health Insurance. Despite this achievement, China is still facing the challenges of a disparity in the medical economic burden by region and by health insurance scheme, relatively little protection from financial risk compared to developed countries, as well as low efficiency and quality of care under current payment systems. To further reduce the disparity in the medical economic burden and to increase the overall protection from financial risk in China, the Government should increase central government transfers to NCMS and URBMI enrollees in poor regions and increase the total amount of government subsidies to NCMS. In addition, China should improve the efficiency and quality of health insurance by further reforming the payment system.


Assuntos
Financiamento Governamental/economia , Reforma dos Serviços de Saúde/economia , Gastos em Saúde/tendências , Seguro Saúde/economia , China , Financiamento Governamental/estatística & dados numéricos , Financiamento Governamental/tendências , Reforma dos Serviços de Saúde/estatística & dados numéricos , Reforma dos Serviços de Saúde/tendências , Gastos em Saúde/estatística & dados numéricos , Humanos , Serviços de Saúde Rural/economia , Serviços de Saúde Rural/estatística & dados numéricos , Serviços de Saúde Rural/tendências , Serviços Urbanos de Saúde/economia , Serviços Urbanos de Saúde/estatística & dados numéricos , Serviços Urbanos de Saúde/tendências
11.
Int J Health Policy Manag ; 7(5): 394-401, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29764103

RESUMO

BACKGROUND: Over the last decade, Ethiopia has made impressive national improvements in health outcomes, including reductions in maternal, neonatal, infant, and child mortality attributed in large part to their Health Extension Program (HEP). As this program continues to evolve and improve, understanding the unit cost of health extension worker (HEW) services is fundamental to planning for future growth and ensuring adequate financial support to deliver effective primary care throughout the country. METHODS: We sought to examine and report the data needed to generate a HEW fee schedule that would allow for full cost recovery for HEW services. Using HEW activity data and estimates from national studies and local systems we were able to estimate salary costs and the average time spent by an HEW per patient/community encounter for each type of services associated with specific users. Using this information, we created separate fee schedules for activities in urban and rural settings with two estimates of non-salary multipliers to calculate the total cost for HEW services. RESULTS: In the urban areas, the HEW fees for full cost recovery of the provision of services (including salary, supplies, and overhead costs) ranged from 55.1 birr to 209.1 birr per encounter. The rural HEW fees ranged from 19.6 birr to 219.4 birr. CONCLUSION: Efforts to support health system strengthening in low-income settings have often neglected to generate adequate, actionable data on the costs of primary care services. In this study, we have combined time-motion and available financial data to generate a fee schedule that allows for full cost recovery of the provision of services through billable health education and service encounters provided by Ethiopian HEWs. This may be useful in other country settings where managers seek to make evidence-informed planning and resource allocation decisions to address high burden of disease within the context of weak administrative data systems and severe financial constraints.


Assuntos
Agentes Comunitários de Saúde/economia , Modelos Econômicos , Atenção Primária à Saúde/economia , Serviços de Saúde Rural/economia , Serviços Urbanos de Saúde/economia , Custos e Análise de Custo , Etiópia , Humanos , Programas Nacionais de Saúde , Atenção Primária à Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , Serviços Urbanos de Saúde/organização & administração
12.
Trials ; 19(1): 252, 2018 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-29690899

RESUMO

BACKGROUND: Acute malnutrition is currently divided into severe (SAM) and moderate (MAM) based on level of wasting. SAM and MAM currently have separate treatment protocols and products, managed by separate international agencies. For SAM, the dose of treatment is allocated by the child's weight. A combined and simplified protocol for SAM and MAM, with a standardised dose of ready-to-use therapeutic food (RUTF), is being trialled for non-inferior recovery rates and may be more cost-effective than the current standard protocols for treating SAM and MAM. METHOD: This is the protocol for the economic evaluation of the ComPAS trial, a cluster-randomised controlled, non-inferiority trial that compares a novel combined protocol for treating uncomplicated acute malnutrition compared to the current standard protocol in South Sudan and Kenya. We will calculate the total economic costs of both protocols from a societal perspective, using accounting data, interviews and survey questionnaires. The incremental cost of implementing the combined protocol will be estimated, and all costs and outcomes will be presented as a cost-consequence analysis. Incremental cost-effectiveness ratio will be calculated for primary and secondary outcome, if statistically significant. DISCUSSION: We hypothesise that implementing the combined protocol will be cost-effective due to streamlined logistics at clinic level, reduced length of treatment, especially for MAM, and reduced dosages of RUTF. The findings of this economic evaluation will be important for policymakers, especially given the hypothesised non-inferiority of the main health outcomes. The publication of this protocol aims to improve rigour of conduct and transparency of data collection and analysis. It is also intended to promote inclusion of economic evaluation in other nutrition intervention studies, especially for MAM, and improve comparability with other studies. TRIAL REGISTRATION: ISRCTN 30393230 , date: 16/03/2017.


Assuntos
Serviços de Saúde da Criança , Transtornos da Nutrição Infantil/dietoterapia , Transtornos da Nutrição do Lactente/dietoterapia , Desnutrição/dietoterapia , Terapia Nutricional/métodos , Serviços de Saúde Rural , Serviços Urbanos de Saúde , Doença Aguda , Fatores Etários , Desenvolvimento Infantil , Serviços de Saúde da Criança/economia , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/economia , Transtornos da Nutrição Infantil/fisiopatologia , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Análise Custo-Benefício , Estudos de Equivalência como Asunto , Feminino , Alimentos Formulados , Alimentos Fortificados , Custos de Cuidados de Saúde , Humanos , Lactente , Transtornos da Nutrição do Lactente/diagnóstico , Transtornos da Nutrição do Lactente/economia , Transtornos da Nutrição do Lactente/fisiopatologia , Quênia , Masculino , Desnutrição/diagnóstico , Desnutrição/economia , Desnutrição/fisiopatologia , Estudos Multicêntricos como Assunto , Terapia Nutricional/economia , Estado Nutricional , Serviços de Saúde Rural/economia , Sudão , Fatores de Tempo , Resultado do Tratamento , Serviços Urbanos de Saúde/economia , Ganho de Peso
13.
Public Health ; 157: 43-49, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29477788

RESUMO

OBJECTIVES: To explore the future implications of diabetes for urban centres, we projected the prevalence and cost of diabetes from 2015 to 2040 in three very different North American cities: Houston, Mexico City and Vancouver. STUDY DESIGN: We use a simple demographic transition model using existing sources to project future prevalence and financial burden of diabetes. METHODS: Based on data from each individual city, projections of the diabetes prevalence and financial burden were created through a three-stage transition model where the likelihood of moving across stages is based on incidence rates for age and gender groups. RESULTS: According to our projections from 2015 to 2040, diabetes prevalence will approximately double in Houston to 1,051,900 people and in Vancouver to 379,778 people and increase by >1 million to 3,080,013 people in Mexico City. Prevalence rates will increase from 8.5% to 11.7% in Houston, from 9.1% to 11.9% in Mexico City and from 7.2% to 11.3% in Vancouver. Associated costs will rise 1.9-fold to $11.5 billion (in US dollars) in Houston, 1.6-fold to $2.8 billion in Mexico City and 2.1-fold to $2.6 billion in Vancouver. CONCLUSIONS: Unless actions are taken to decrease its incidence, diabetes is expected to increasingly contribute to the societal and financial burden, particularly for urban areas. Resources and policy actions are needed immediately to promote healthy lifestyles and to implement secondary prevention of diabetes complications.


Assuntos
Custos e Análise de Custo/estatística & dados numéricos , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Serviços Urbanos de Saúde/economia , Cidades , Humanos , Modelos Teóricos , América do Norte/epidemiologia , Prevalência
14.
Int J Equity Health ; 16(1): 194, 2017 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-29115955

RESUMO

BACKGROUND: China is in the process of integrating the new cooperative medical scheme (NCMS) and the urban residents' basic medical insurance system (URBMI) into the urban and rural residents' basic medical insurance system (URRBMI). However, how to integrate the financing policies of NCMS and URBMI has not been described in detail. This paper attempts to illustrate the differences between the financing mechanisms of NCMS and URBMI, to analyze financing inequity between urban and rural residents and to identify financing mechanisms for integrating urban and rural residents' medical insurance systems. METHODS: Financing data for NCMS and URBMI (from 2008 to 2015) was collected from the China health statistics yearbook, the China health and family planning statistics yearbook, the National Handbook of NCMS Information, the China human resources and social security statistics yearbook, and the China social security yearbook. "Ability to pay" was introduced to measure inequity in health financing. Individual contributions to NCMS and URBMI as a function of per capita disposable income was used to analyze equity in health financing between rural and urban residents. RESULTS: URBMI had a financing mechanism that was similar to that used by NCMS in that public finance accounted for more than three quarters of the pooling funds. The scale of financing for NCMS was less than 5% of the per capita net income of rural residents and less than 2% of the per capita disposable income of urban residents for URBMI. Individual contributions to the NCMS and URBMI funds were less than 1% of their disposable and net incomes. Inequity in health financing between urban and rural residents in China was not improved as expected with the introduction of NCMS and URBMI. The role of the central government and local governments in financing NCMS and URBMI was oscillating in the past decade. CONCLUSIONS: The scale of financing for URRBMI is insufficient for the increasing demands for medical services from the insured. The pooling fund should be increased so that it can better adjust to China's rapidly aging population and epidemiological transitions as well as protect the insured from poverty due to illness. Individual contributions to the URBMI and NCMS funds were small in terms of contributors' incomes. The role of the central government and local governments in financing URRBMI was not clearly identified. Individual contributions to the URRBMI fund should be increased to ensure the sustainable development of URRBMI. Compulsory enrollment should be required so that URRBMI improves the social medical insurance system in China.


Assuntos
Financiamento Governamental/economia , Financiamento da Assistência à Saúde , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Serviços de Saúde Rural/economia , Cobertura Universal do Seguro de Saúde/economia , Serviços Urbanos de Saúde/economia , China/epidemiologia , Feminino , Humanos , Governo Local , Pobreza/estatística & dados numéricos , População Rural/estatística & dados numéricos
15.
J Gen Intern Med ; 32(12): 1330-1341, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28900839

RESUMO

BACKGROUND: New payments from Medicare encourage behavioral health services to be integrated into primary care practice activities. OBJECTIVE: To evaluate the financial impact for primary care practices of integrating behavioral health services. DESIGN: Microsimulation model. PARTICIPANTS: We simulated patients and providers at federally qualified health centers (FQHCs), non-FQHCs in urban and rural high-poverty areas, and practices outside of high-poverty areas surveyed by the National Association of Community Health Centers, National Ambulatory Medical Care Survey, National Health and Nutrition Examination Survey, and National Health Interview Survey. INTERVENTIONS: A collaborative care model (CoCM), involving telephone-based follow-up from a behaviorist care manager, or a primary care behaviorist model (PCBM), involving an in-clinic behaviorist. MAIN MEASURES: Net revenue change per full-time physician. KEY RESULTS: When behavioral health integration services were offered only to Medicare patients, net revenue was higher under CoCM (averaging $25,026 per MD in year 1 and $28,548/year in subsequent years) than PCBM (-$7052 in year 1 and -$3706/year in subsequent years). When behavioral health integration services were offered to all patients and were reimbursed by Medicare and private payers, only practices adopting the CoCM approach consistently gained net revenues. The outcomes of the model were sensitive to rates of patient referral acceptance, presentation, and therapy completion, but the CoCM approach remained consistently financially viable whereas PCBM would not be in the long-run across practice types. CONCLUSIONS: New Medicare payments may offer financial viability for primary care practices to integrate behavioral health services, but this viability depends on the approach toward care integration.


Assuntos
Serviços Comunitários de Saúde Mental/economia , Prestação Integrada de Cuidados de Saúde/economia , Atenção Primária à Saúde/economia , Centros Comunitários de Saúde/economia , Centros Comunitários de Saúde/organização & administração , Serviços Comunitários de Saúde Mental/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Renda/estatística & dados numéricos , Medicare/economia , Modelos Econométricos , Áreas de Pobreza , Atenção Primária à Saúde/organização & administração , Serviços de Saúde Rural/economia , Sensibilidade e Especificidade , Estados Unidos , Serviços Urbanos de Saúde/economia , Serviços Urbanos de Saúde/organização & administração
16.
Cancer Epidemiol Biomarkers Prev ; 26(7): 992-997, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28600296

RESUMO

Estimates of those living in rural counties vary from 46.2 to 59 million, or 14% to 19% of the U.S. POPULATION: Rural communities face disadvantages compared with urban areas, including higher poverty, lower educational attainment, and lack of access to health services. We aimed to demonstrate rural-urban disparities in cancer and to examine NCI-funded cancer control grants focused on rural populations. Estimates of 5-year cancer incidence and mortality from 2009 to 2013 were generated for counties at each level of the rural-urban continuum and for metropolitan versus nonmetropolitan counties, for all cancers combined and several individual cancer types. We also examined the number and foci of rural cancer control grants funded by NCI from 2011 to 2016. Cancer incidence was 447 cases per 100,000 in metropolitan counties and 460 per 100,000 in nonmetropolitan counties (P < 0.001). Cancer mortality rates were 166 per 100,000 in metropolitan counties and 182 per 100,000 in nonmetropolitan counties (P < 0.001). Higher incidence and mortality in rural areas were observed for cervical, colorectal, kidney, lung, melanoma, and oropharyngeal cancers. There were 48 R- and 3 P-mechanism rural-focused grants funded from 2011 to 2016 (3% of 1,655). Further investment is needed to disentangle the effects of individual-level SES and area-level factors to understand observed effects of rurality on cancer. Cancer Epidemiol Biomarkers Prev; 26(7); 992-7. ©2017 AACR.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Neoplasias/epidemiologia , Serviços de Saúde Rural/organização & administração , Saúde da População Rural/normas , População Rural/estatística & dados numéricos , Financiamento Governamental/normas , Financiamento Governamental/tendências , Disparidades em Assistência à Saúde/tendências , Humanos , Incidência , National Cancer Institute (U.S.)/economia , National Cancer Institute (U.S.)/estatística & dados numéricos , National Cancer Institute (U.S.)/tendências , Neoplasias/terapia , Saúde da População Rural/tendências , Serviços de Saúde Rural/economia , Serviços de Saúde Rural/estatística & dados numéricos , Serviços de Saúde Rural/tendências , Programa de SEER/estatística & dados numéricos , Estados Unidos , Saúde da População Urbana , Serviços Urbanos de Saúde/economia , Serviços Urbanos de Saúde/organização & administração , Serviços Urbanos de Saúde/estatística & dados numéricos , Serviços Urbanos de Saúde/tendências , População Urbana/estatística & dados numéricos
17.
Public Health ; 148: 37-48, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28404532

RESUMO

OBJECTIVES: Population-based screening for glaucoma has been demonstrated to be cost-effective if targeted at high-risk groups such as older adults and those with a family history of glaucoma, and through use of a technician for conducting initial assessment rather than a medical specialist. This study attempts to investigate the cost-effectiveness of a hypothetical community screening and subsequent treatment programme for glaucoma in comparison with current practice (i.e. with no screening programme but with some opportunistic case finding) in the urban areas of India. STUDY DESIGN: A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in the urban areas of India. METHODS: Screening and treatment costs were obtained from an administrator of a tertiary eye hospital in India. The probabilities for the screening pathway were derived from published literature and expert opinion. The glaucoma prevalence rates for urban areas were adapted from the Chennai Glaucoma Study findings. A decision-analytical model using TreeAge Pro 2015 was built to model events, costs and treatment pathways. One-way sensitivity analyses were conducted. RESULTS: The introduction of a community screening programme for glaucoma is likely to be cost-effective, the estimated incremental cost-effectiveness ratio (ICER) values being 10,668.68 when compared with no screening programme and would treat an additional 4443 cases and prevent 1790 person-years of blindness over a 10-year period in the urban areas of India. Sensitivity analyses revealed that glaucoma prevalence rates across various age groups, screening uptake rate, follow-up compliance after screening, treatment costs and utility values of health states associated with medical and surgical treatment of glaucoma had an impact on the ICER values of the screening programme. CONCLUSIONS: In comparison with current practice (i.e. without a screening programme but with some opportunistic case finding), the introduction of a community screening programme for glaucoma for the 40-69 years age group is likely to be relatively cost-effective if implemented in the urban areas of India.


Assuntos
Glaucoma/prevenção & controle , Serviços Urbanos de Saúde/economia , Seleção Visual/economia , Adulto , Idoso , Análise Custo-Benefício , Glaucoma/epidemiologia , Custos de Cuidados de Saúde , Humanos , Índia/epidemiologia , Pessoa de Meia-Idade , Prevalência , Avaliação de Programas e Projetos de Saúde
18.
J Subst Abuse Treat ; 77: 133-140, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28189289

RESUMO

Continuous quality improvement (CQI) has grown in the U.S. since the 1970s, yet little is known about the costs to implement CQI in substance abuse treatment facilities. This paper is part of a larger group randomized control trial in a large urban county evaluating the impact of Plan-Study-Do-Act (PDSA)-CQI designed for community service organizations (Hunter, Ober, Paddock, Hunt, & Levan, 2014). Operated by one umbrella organization, each of the eight facilities of the study, four residential and four outpatient substance abuse treatment facilities, selected their own CQI Actions, including administrative- and clinical care-related Actions. Using an activity-based costing approach, we collected labor and supplies and equipment costs directly attributable to CQI Actions over a 12-month trial period. Our study finds implementation of CQI and meeting costs of this trial per facility were approximately $2000 to $10,500 per year ($4500 on average), or $10 to $60 per admitted client. We provide a description of the sources of variation in these costs, including differing intensity of the CQI Actions selected, which should help decision makers plan use of PDSA-CQI.


Assuntos
Melhoria de Qualidade , Centros de Tratamento de Abuso de Substâncias/normas , Transtornos Relacionados ao Uso de Substâncias/terapia , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/normas , Custos de Cuidados de Saúde , Humanos , Projetos Piloto , Centros de Tratamento de Abuso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/economia , Estados Unidos , Serviços Urbanos de Saúde/economia , Serviços Urbanos de Saúde/normas
19.
BMC Med Educ ; 17(1): 1, 2017 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-28056975

RESUMO

INTRODUCTION: Medical schools are in general over-represented by students from high socio-economic status backgrounds. The University of Western Australia Medical School has been progressively widening the participation of students from a broader spectrum of the community both through expanded selection criteria and quota-based approaches for students of rural, indigenous and other socio-educationally disadvantaged backgrounds. We proposed that medical students entering medical school from such backgrounds would ultimately be more likely to practice in areas of increased socio-economic disadvantage. METHODS: The current practice address of 2829 medical students who commenced practice from 1980 to 2011 was ascertained from the Australian Health Practitioner Regulation Agency (AHPRA) Database. Logistic regression was utilised to determine the predictors of the likelihood of the current practice address being in the lower 8 socio-economic deciles versus the top 2 socio-economic deciles. RESULTS: Those who were categorised in the lower 8 socio-economic deciles at entry to medical school had increased odds of a current practice address in the lower 8 socio-economic deciles 5 or more years after graduation (OR 2.05, 95% CI 1.72, 2.45, P < 0.001). Other positive univariate predictors included age at medical degree completion (for those 25 years or older vs those 24 years or younger OR 1.53, 95% CI 1.27, 1.84, P < 0.001), being female (OR 1.26, 95% CI 1.07, 1.48, P = 0.005) and having a general practice versus specialist qualification (OR 4.16, 95% CI 3.33, 5.19, P < 0.001). Negative predictors included having attended an independent school vs a government school (OR 0.77, 95% CI 0.64, 0.92, P < 0.001) or being originally from overseas vs being born in Oceania (OR 0.80, 95% CI 0.67, 0.96, P = 0.017). After adjustment for potential confounders in multivariate logistic regression, those in the lower 8 socio-economic deciles at entry to medical school still had increased odds of having a current practice address in the lower 8 socio-economic deciles (OR 1.63, 95% CI 1.34, 1.99, P < 0.001). CONCLUSION: Widening participation in medical school to students from more diverse socio-educational backgrounds is likely to increase the distribution of the medical workforce to ultimate service across areas representative of a broader socio-economic spectrum.


Assuntos
Escolha da Profissão , Serviços de Saúde do Indígena , Área Carente de Assistência Médica , Serviços de Saúde Rural , Classe Social , Estudantes de Medicina/estatística & dados numéricos , Serviços Urbanos de Saúde , Atitude do Pessoal de Saúde , Austrália/epidemiologia , Educação de Graduação em Medicina , Feminino , Serviços de Saúde do Indígena/economia , Humanos , Masculino , Serviços de Saúde Rural/economia , Serviços Urbanos de Saúde/economia
20.
Rural Policy Brief ; (2016 1): 1-4, 2016 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-27416649

RESUMO

Since 2014, when the Health Insurance Marketplaces (HIMs) authorized by the Patient Protection and Affordable Care Act (ACA) were implemented, considerable premium changes have been observed in the marketplaces across the 50 states and the District of Columbia. This policy brief assesses the changes in average HIM plan premiums from 2014 to 2016, before accounting for subsidies, with an emphasis on the widening variation across rural and urban places. Since this brief focuses on premiums without accounting for subsidies, this is not intended to be an analysis of the "affordability" of ACA premiums, as that would require assessment of premiums, cost-sharing adjustments, and other factors.


Assuntos
Trocas de Seguro de Saúde/economia , Trocas de Seguro de Saúde/tendências , Seguro Saúde/economia , Seguro Saúde/tendências , Saúde da População Rural/economia , Saúde da População Rural/tendências , Previsões , Trocas de Seguro de Saúde/estatística & dados numéricos , Humanos , Seguro Saúde/estatística & dados numéricos , Patient Protection and Affordable Care Act/economia , Saúde da População Rural/estatística & dados numéricos , Serviços de Saúde Rural/economia , Serviços de Saúde Rural/estatística & dados numéricos , Serviços de Saúde Rural/tendências , Estados Unidos , Saúde da População Urbana/economia , Saúde da População Urbana/estatística & dados numéricos , Saúde da População Urbana/tendências , Serviços Urbanos de Saúde/economia , Serviços Urbanos de Saúde/estatística & dados numéricos , Serviços Urbanos de Saúde/tendências
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