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1.
World Neurosurg ; 135: e716-e722, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31899389

RESUMO

BACKGROUND: Anterior lumbar interbody fusion (ALIF) is a commonly performed surgical procedure for the management of degenerative lumbar spine pathologic entities. Despite an increasing number of ALIFs performed nationally, to the best of our knowledge, no study has evaluated the costs associated with the 90-day episode of care postoperatively. METHODS: The 2007-2016 Humana Administrative Claims data set, a national database of commercial and Medicare Advantage (MA) beneficiaries, was queried using Current Procedural Terminology code 22558 for patients who had undergone single-level ALIF. The 90-day costs were defined using the following categories: facility, surgeon, anesthesia, other hospitalization costs and services, radiology, office visits, physical therapy/rehabilitation, emergency department visits, and readmissions. RESULTS: A total of 365 ALIF procedures (MA, n = 244; commercial, n = 121) were included in the analysis. The average 90-day cost of single-level ALIF was $25,568 and $51,741 for the MA and commercial enrollees, respectively. The major proportion of 90-day costs was attributable to facility reimbursement (74%-76%), followed by surgeon costs (9%-11%). Postacute care (i.e., office visits and physical therapy/rehabilitation) was not a major driver of the 90-day costs, consisting of only 0.7%-1.3% of the total 90-day reimbursement. Of patients who had required readmission, the costs of the readmission increased the average 90-day costs by 65%-66%. CONCLUSIONS: Facility costs were the major drivers of a stipulated 90-day reimbursement for patients undergoing single-level ALIF. Health policy makers and providers can use these data to better understand the distribution of costs in a stipulated bundled-payment model for ALIFs and allow them to identify areas in which cost reduction strategies can be performed.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Custos e Análise de Custo , Assistência à Saúde/economia , Cuidado Periódico , Instalações de Saúde/economia , Custos Hospitalares , Humanos , Degeneração do Disco Intervertebral/economia , Medicare/economia , Readmissão do Paciente/economia , Setor Privado/economia , Estudos Retrospectivos , Fusão Vertebral/economia , Cirurgiões/economia , Estados Unidos
2.
S Afr Med J ; 109(10): 771-783, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31635576

RESUMO

BACKGROUND: The proposed National Health Insurance (NHI) system aims to re-engineer primary healthcare (PHC) provision in South Africa, with strategic purchasing of services from both private and public sector providers by the NHI Fund. Currently, while access to the private sector is primarily restricted to high-income insured earners, an important proportion of the low-income segment is choosing to utilise private PHC providers over public sector clinics. In recent years, a number of private providers in SA have established innovative models of PHC delivery that aim to expand access beyond the insured population and provide affordable access to good-quality PHC services. OBJECTIVES: To describe the current landscape of private PHC clinic models targeting low-income, uninsured earners and the role they might play during the transition to NHI. METHODS: Key informant interviews were conducted with representatives of a sample of private PHC provider organisations providing services to low-income, uninsured earners with clinics - beyond the traditional private sector general practitioner model. Organisations were asked to describe their service delivery model, the population it serves, the PHC services offered and the financing model. Written responses were captured in Excel and coded manually, and the results were thematically analysed. RESULTS: Of the eight organisations identified, most have actively engaged strategies to ensure the provision of affordable quality care. Within these strategies, scale is an important pivot in spreading fixed costs across more paying patients as well as task shifting to lower cadres of healthcare workers. Access to government medicines and laboratory tests is an important factor in achieving lower costs per patient. Together, these strategies support the sustainability of these models. CONCLUSIONS: We have provided an exploratory analysis of private PHC service delivery models serving the low-income, uninsured patient population, establishing factors that increase the efficiency of such service delivery, and delineating combinations of strategies that could make these models successful both during the transition to NHI and during full-scale NHI implementation. A clear regulatory framework would act as a catalyst for further innovation and facilitate contracting. These existing models can enhance and complement government provision and could be scaled up to meet the needs of expanding PHC under NHI. Understanding these models and the space and parameters in which they operate is important.


Assuntos
Assistência à Saúde/organização & administração , Pessoas sem Cobertura de Seguro de Saúde , Programas Nacionais de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Assistência à Saúde/economia , Assistência à Saúde/normas , Clínicos Gerais/organização & administração , Acesso aos Serviços de Saúde , Humanos , Renda , Programas Nacionais de Saúde/economia , Pobreza , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/normas , Setor Privado/economia , Setor Público/economia , Qualidade da Assistência à Saúde , África do Sul
5.
BMC Health Serv Res ; 19(1): 690, 2019 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-31606031

RESUMO

BACKGROUND: In Asia, over 50% of patients with symptoms of tuberculosis (TB) access health care from private providers. These patients are usually not notified to the National TB Control Programs, which contributes to low notification rates in many countries. METHODS: From January 1, 2011 to December 31, 2012, Karachi's Indus Hospital - a private sector partner to the National TB Programme - engaged 80 private family clinics in its catchment area in active case finding using health worker incentives to increase notification of TB disease. The costs incurred were estimated from the perspective of patients, health facility and the program providing TB services. A Markov decision tree model was developed to calculate the cost-effectiveness of the active case finding as compared to case detection through the routine passive TB centers. Pakistan has a large private health sector, which can be mobilized for TB screening using an incentivized active case finding strategy. Currently, TB screening is largely performed in specialist public TB centers through passive case finding. Active and passive case finding strategies are assumed to operate independently from each other. RESULTS: The incentive-based active case finding program costed USD 223 per patient treated. In contrast, the center based non-incentive arm was 23.4% cheaper, costing USD 171 per patient treated. Cost-effectiveness analysis showed that the incentive-based active case finding program was more effective and less expensive per DALY averted when compared to the baseline passive case finding as it averts an additional 0.01966 DALYs and saved 15.74 US$ per patient treated. CONCLUSION: Both screening strategies appear to be cost-effective in an urban Pakistan context. Incentive driven active case findings of TB in the private sector costs less and averts more DALYs per health seeker than passive case finding, when both alternatives are compared to a common baseline situation of no screening.


Assuntos
Setor Privado/economia , Tuberculose/prevenção & controle , Adolescente , Adulto , Análise Custo-Benefício , Árvores de Decisões , Notificação de Doenças/economia , Notificação de Doenças/normas , Diagnóstico Precoce , Feminino , Humanos , Masculino , Programas de Rastreamento/economia , Motivação , Paquistão , Tuberculose/economia , Conduta Expectante/economia , Adulto Jovem
6.
Expert Rev Pharmacoecon Outcomes Res ; 19(6): 677-684, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31456453

RESUMO

Introduction: The prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) has risen over the last two decades, with a corresponding increase in the cost of its medication. Drug utilization studies in South Africa focusing on ADHD are limited.Areas covered: The primary aim was to determine the cost of methylphenidate and atomoxetine (used for ADHD). The Intercontinental Marketing Service (IMS) database which contains data of the private healthcare sector was interrogated from 2013 to 2016 (48-month period) focussing on methylphenidate and atomoxetine. Drug consumption was expressed in number of DDDs, DDDs/1000 inhabitants/day and cost in Rands.Expert opinion: Methylphenidate-containing products constituted a considerably higher percentage of the market share when compared to atomoxetine (90.30% versus 9.70%). The DDD/1000 inhabitants/day for methylphenidate was 6.010 with an annual cost for R266 691 778 in 2013, which increased to 7.827 DDDs/1000 inhabitants/day with an annual cost of R436 041 506 in 2016. Consumption of both methylphenidate and atomoxetine increased from 2013 to 2016. There was a preference for long-acting extended-release methylphenidate tablets even though the unit costs were higher when compared to the short-acting formulations. Despite increases in unit costs, the spend in South Africa showed an upward trend for methylphenidate and atomoxetine.


Assuntos
Cloridrato de Atomoxetina/administração & dosagem , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Metilfenidato/administração & dosagem , Inibidores da Captação Adrenérgica/administração & dosagem , Inibidores da Captação Adrenérgica/economia , Cloridrato de Atomoxetina/economia , Transtorno do Deficit de Atenção com Hiperatividade/economia , Estimulantes do Sistema Nervoso Central/administração & dosagem , Estimulantes do Sistema Nervoso Central/economia , Humanos , Metilfenidato/economia , Setor Privado/economia , África do Sul
7.
Environ Sci Pollut Res Int ; 26(25): 26082-26089, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31278642

RESUMO

Proper management of biomedical waste (BMW) is required to avoid environmental and human health risks. The current study evaluated the BWM practices in public and private health care facilities of Fatehgarh Sahib District in Punjab, India. The study was conducted, using a modified World Health Organization (WHO) tool in 120 health care facilities randomly selected from rural and urban areas. At primary health care level, BMW management guidelines were followed in 67.2% of the public sector and 40.4% of the private sector facilities, whereas in secondary health care sectors both private and public sector follows 100% compliance. Health facilities were graded into different categories according to median score, i.e., scores less than < 2.5 was categorized as red (no credible BMW management system in place), scores between 2.5 to 7.5 as yellow (system present but needs major improvement) and scores > 7.5 as green (good system in place for BMW). It was observed that among primary health care facilities, 85% of the public sector and 64% of private sector facilities falls in the red category, whereas for secondary health care facilities only 8% fall in the red category. Logistic regression helped to identify the major factors that affect the performance of the health care facility, and it shows that regular training on BMW and improved infrastructure can improve the BMW management practices. Further, proper management of BMW requires multi-sectoral coordination, which can be better addressed through policies and by providing periodical training to all stakeholders.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Setor Privado/economia , Setor Público/economia , Gerenciamento de Resíduos , Humanos , Índia
8.
Artigo em Inglês | MEDLINE | ID: mdl-31163652

RESUMO

Environmental pollution, rapid economic growth, and other social factors have adverse effects on public health, which have consequently increased the burden of health expenditures during the last two decades. This paper provides a comprehensive analysis of carbon dioxide (CO2) emissions and the environment index, as well as economic and non-economic factors such as Gross Domestic Product (GDP) growth, foreign direct investment, population aging, and secondary education impacts on per capita government and private health expenditures in 13 emerging economies for the time period of 1994-2017. We employ robust econometric techniques in this endeavor of panel data analysis to account for the issues of heterogeneity and cross-sectional dependence. This study applies the Lagrange Multiplier (LM) bootstrap approach to investigate the presence of panel cointegration and empirical results underscore the existence of cointegration among variables. For the execution of long-run analysis, we incorporate the two latest estimators, i.e., continuously updated-fully modified (CUP-FM) and continuously updated- bias corrected (CUP-BC). Findings of long-run elasticities have documented that the air-pollution indicators, i.e., CO2 emissions and the environment index, have a positive and significant influence on government health expenditures, while in contrast, both factors negatively influence private health expenditures in emerging economies. We find that economic factors such as GDP growth consistently show a positive impact on both government and private health expenditures, whereas, foreign direct investment exhibits a significant negative and positive impact on government and private health expenditures respectively. Findings of non-economic factors can be used to argue that population aging increases health expenditures while secondary education lowers private health spending in emerging markets. Furthermore, empirical analysis of heterogeneous causality indicates that CO2 emissions, the environment index, GDP growth, foreign direct investment, and secondary education have a unidirectional causal relationship with government and private health expenditures. Population aging has a strong relationship of bidirectional causality with government health expenditures and unidirectional causal relationship with private health expenditures. Findings of this paper put forward key suggestions for policy makers which can be used as valuable instruments for better understanding and aiming to maximize public healthcare and environmental quality gains which are highly connected with sustainable GDP growth and developments in emerging economies.


Assuntos
Poluição do Ar/análise , Dióxido de Carbono/análise , Gastos em Saúde/estatística & dados numéricos , Setor Privado/economia , Setor Público/economia , Envelhecimento , Países em Desenvolvimento/economia , Educação/estatística & dados numéricos , Produto Interno Bruto/estatística & dados numéricos , Internacionalidade , Investimentos em Saúde/estatística & dados numéricos
9.
PLoS One ; 14(6): e0214928, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31166942

RESUMO

BACKGROUND: Private providers dominate health care in India and provide most tuberculosis (TB) care. Yet efforts to engage private providers were viewed as unsustainably expensive. Three private provider engagement pilots were implemented in Patna, Mumbai and Mehsana in 2014 based on the recommendations in the National Strategic Plan for TB Control, 2012-17. These pilots sought to improve diagnosis and treatment of TB and increase case notifications by offering free drugs and diagnostics for patients who sought care among private providers, and monetary incentives for providers in one of the pilots. As these pilots demonstrated much higher levels of effectiveness than previously documented, we sought to understand program implementation costs and predict costs for their national scale-up. METHODS AND FINDINGS: We developed a common cost structure across these three pilots comprising fixed and variable cost components. We conducted a retrospective, activity-based costing analysis using programmatic data and qualitative interviews with the respective program managers. We estimated the average recurring costs per TB case at different levels of program scale for the three pilots. We used these cost estimates to calculate the budget required for a national scale up of such pilots. The average cost per privately-notified TB case for Patna, Mumbai and Mehsana was estimated to be US$95, US$110 and US$50, respectively, in May 2016 when these pilots were estimated to cover 50%, 36% and 100% of the total private TB patients, respectively. For Patna and Mumbai pilots, the average cost per case at full scale, i.e. 100% coverage of private TB patients, was projected to be US$91 and US$101, respectively. In comparison, the national TB program's budget for 2015 averages out to $150 per notified TB case. The total annual additional budget for a national scale up of these pilots was estimated to be US$267 million. CONCLUSIONS: As India seeks to eliminate TB, extensive national engagement of private providers will be required. The cost per privately-notified TB case from these pilots is comparable to that already being spent by the public sector and to the projected cost per privately-notified TB case required to achieve national scale-up of these pilots. With additional funds expected to execute against national TB elimination commitments, the scale-up costs of these operationally viable and effective private provider engagement pilots are likely to be financially viable.


Assuntos
Setor Privado/economia , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Análise Custo-Benefício , Gerenciamento Clínico , Humanos , Índia , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Setor Público , Estudos Retrospectivos , Tuberculose/economia
10.
J R Soc Med ; 112(7): 292-303, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31170358

RESUMO

OBJECTIVES: To examine the impact of NHS-funded private provision on NHS provision, access and inequalities. DESIGN: Ecological study using routinely collected NHS inpatient data. SETTING: England. PARTICIPANTS: All individuals undergoing an NHS-funded elective hip arthroplasty in England from 2003/2004 to 2012/2013. MAIN OUTCOME MEASURES: Annual crude and standardised rates of hip arthroplasties per 100,000 population performed by NHS and private providers between 2004/2005 and 2012/2013. RESULTS: Age standardised rates of hip arthroplasty increased from 116.4 (95% CI 115.4-117.4) to 148.7 (147.6-149.8) per 100,000 between 2004/2005 and 2012/2013. Provision shifted from NHS providers to private providers from 2007/2008; NHS provision decreased 8.6% and private provision increased 188% between 2007/2008 and 2012/2013. There is evidence of risk selection; private sector hip arthroplasties on NHS patients from the most affluent areas increased 228% from 10.8 (10.2-11.5) to 35.4 (34.3-36.5) per 100,000 compared to an increase of 186% from 8.8 (8.1-9.4) to 25.2 (24.1-26.4) per 100,000 among patients from the least affluent areas between 2007/2008 and 2012/2013. There was no statistically significant (p > 0.05) widening in any measure of inequality (absolute, relative difference and slope and relative slope of index inequality) in hip arthroplasty rates between 2004/2005 and 2012/2013. CONCLUSION: Private provision substituted for NHS provision and did not add to overall provision favouring patients living in the most affluent area. Continuing the trend towards private provision and reducing NHS provision is likely to result in risk selection and widening inequalities in provision of elective hip arthroplasty in England.


Assuntos
Artroplastia de Quadril/economia , Custos de Cuidados de Saúde , Política de Saúde , Setor Privado/economia , Medicina Estatal/economia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Inglaterra , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
11.
PLoS One ; 14(4): e0216122, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31022276

RESUMO

Inadequate access to medicines affected by un-controlled prices is a major concern in developing countries, including Pakistan, which lacks comprehensive data on medicine prices. Thus, the objective of this study was to evaluate the prices, availability and affordability of essential medicines in Lahore division, Pakistan. The survey was undertaken from November, 2016 till March, 2017 by including 50 medicines, 14 from the WHO/HAI core list and 36 supplementary medicines from national essential medicine list (NEML) at public (n = 16) and private (n = 16) health facilities. The prices, availability and affordability of selected medicines were measured using a variant of the WHO/HAI standard methodology available on HAI website and WHO/HAI manual. A questionnaire was used for data collection from Lahore division. The prices were compared to International reference prices (IRPs) and the daily wage of a lowest paid unskilled government worker was used to calculate medicine affordability. Data suggested poor availability of originator brands (OB) in public and private sector facilities, i.e., 6.8% and 55.0%, respectively. Similarly, low availability was observed for lowest price generics (LPGs), both in public (35.3%) and private sector (20.3%) facilities-far below the WHO global action plan targets of 80% availability of essential medicines by 2025. In private sector, 53% OB and 38% LPG medicines were found excessively priced. The cost of standard treatment with OBs was unaffordable, i.e., above a single daily wage (1.4 day's wages) was demanded to purchase the standard treatment for the selected diseases in case of OBs medicines. Whereas, the cost of LPGs medicine required to purchase the standard treatment of the selected diseases was 0.6 day's wage (median), below a single daily wage. In conclusion, access to essential medicines, especially at public sector facilities was affected by low availability, particularly of OBs in comparison to LPGs. Thus, the better availability of LPGs might be a rational basis of transition into a generic system of prescribing that may improve the availability and accessibility of essential medicines in Lahore division. Medicine prices in Lahore division were found higher in comparison to IRPs. Thus, the efforts must be made to formulate patient's pocket friendly drug pricing policy that favors price cuts and improves affordability.


Assuntos
Comércio/economia , Custos e Análise de Custo/economia , Medicamentos Essenciais/economia , Acesso aos Serviços de Saúde/economia , Inquéritos Epidemiológicos , Organização Mundial da Saúde , Estudos Transversais , Humanos , Internacionalidade , Paquistão , Farmácias , Setor Privado/economia , Setor Público/economia , Padrões de Referência
12.
Fertil Steril ; 111(6): 1211-1216, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31029433

RESUMO

OBJECTIVE: To characterize the available support for infertility treatment and populations served by private foundations across the United States. DESIGN: Web-based cross-sectional survey. SETTING: Not applicable. PATIENT(S): Not applicable. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Geographies and populations served, dollar-amount and scope of financial assistance provided by private foundations for individuals seeking financial assistance for infertility treatment. RESULT(S): Thirty-seven private foundations were identified, 25 responded (68% response rate). More than one-half of the foundations had awarded grants to lesbian, gay, and transgender individuals, as well as single men and women. Forty percent of the foundations serve only a single state or geographic region. Foundations have provided 9,996 grants for infertility treatment, 1,740 in 2016 alone, with an average value of $8,191 per grant. The Livestrong foundation has provide more than 90% of these grants, and only to patients with a history of cancer. Twelve percent of foundations provide assistance for fertility preservation in patients with cancer, and 20% provide assistance for elective oocyte cryopreservation. CONCLUSION(S): Private foundations significantly increase access to infertility care for individuals and couples affected by cancer who could otherwise not afford treatment. Significant heterogeneity exists regarding the populations served and the services available for grant support by these foundations, and the landscape of options for patients unaffected by cancer is severely limited.


Assuntos
Fertilidade , Fundações , Infertilidade/terapia , Setor Privado , Técnicas de Reprodução Assistida , Sobreviventes de Câncer , Estudos Transversais , Definição da Elegibilidade , Feminino , Organização do Financiamento , Fundações/economia , Fundações/tendências , Custos de Cuidados de Saúde , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/economia , Disparidades em Assistência à Saúde , Humanos , Infertilidade/economia , Infertilidade/epidemiologia , Infertilidade/fisiopatologia , Masculino , Gravidez , Setor Privado/economia , Setor Privado/tendências , Técnicas de Reprodução Assistida/economia , Técnicas de Reprodução Assistida/tendências , Minorias Sexuais e de Gênero , Estados Unidos/epidemiologia
14.
BMC Health Serv Res ; 19(1): 147, 2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30841929

RESUMO

BACKGROUND: Many countries are facing overlapping epidemics of tuberculosis (TB) and diabetes mellitus (DM). Diabetes increases the overall risk of developing Tuberculosis (TB) and contributes to adverse treatment outcomes. Active screening for both diseases can reduce TB transmission and prevent the development of complications of DM. We investigated bi-directional TB-DM screening in Karachi, Pakistan, a country that ranks fifth among high TB burden countries, and has the seventh highest country burden for DM. METHODS: Between February to November 2014, community-based screeners identified presumptive TB and DM through verbal screening at private health clinics. Individuals with presumptive TB were referred for a chest X-ray and Xpert MTB/RIF. Presumptive DM cases had random blood glucose (RBS) tested. All individuals with bacteriologically positive TB were referred for diabetes testing (RBS). All pre-diabetics and diabetics were referred for a chest X-ray and Xpert MTB/RIF test. The primary outcomes of this study were uptake of TB and DM testing. RESULTS: A total of 450,385 individuals were screened, of whom 18,109 had presumptive DM and 90,137 had presumptive TB. 14,550 of these individuals were presumptive for both DM and TB. The uptake of DM testing among those with presumptive diabetes was 26.1% while the uptake of TB testing among presumptive TB cases was 5.9%. Despite efforts to promote bi-directional screening of TB and DM, the uptake of TB testing among pre-diabetes and diabetes cases was only 4.7%, while the uptake of DM testing among MTB positive cases was 21.8%. CONCLUSION: While a high yield for TB was identified among pre-diabetics and diabetics along with a high yield of DM among individuals diagnosed with TB, there was a low uptake of TB testing amongst presumptive TB patients who were recorded as pre-diabetic or diabetic. Bi-directional screening for TB and DM which includes the integration of TB diagnostics, DM screening and TB-DM treatment within existing health care programs will need to address the operational challenges identified before implementing this as a strategy in public health programs.


Assuntos
Diabetes Mellitus/diagnóstico , Programas de Rastreamento , Setor Privado , Tuberculose/diagnóstico , Adulto , Idoso , Comorbidade , Estudos Transversais , Diabetes Mellitus/epidemiologia , Diagnóstico Precoce , Feminino , Humanos , Masculino , Programas de Rastreamento/economia , Programas de Rastreamento/organização & administração , Pessoa de Meia-Idade , Paquistão/epidemiologia , Setor Privado/economia , Setor Privado/organização & administração , Tuberculose/transmissão , Adulto Jovem
15.
Cien Saude Colet ; 24(3): 705-714, 2019 Mar.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30892493

RESUMO

The present study highlighted the labour process of the dental surgeon (DS) in the private healthcare sector from the healthcare professional's perspective based on intervention bioethics. An observational, cross-sectional survey study was performed within the Federal District (Distrito Federal) region. Data were collected from 108 questionnaires completed by DSs affiliated with two types of private health insurers, self-insurance and group insurance, to assess job perception and the degree of job satisfaction in the dentistry market. The main source of dissatisfaction for healthcare professionals was related to the pay for dental procedures by insurers. For self-insurer 1, 38.1% healthcare professionals replied that the pay was satisfactory, whereas in self-insurance 2 and in the group insurance, 100% of healthcare professionals were dissatisfied. Another finding was that the group insurer considerably restricted elective treatments. In conclusion, loss of professional autonomy, depreciation of insurance claims and precarisation of dentistry occurs in the private healthcare sector, thus demonstrating the ethical conflicts in this relationship.


Assuntos
Atitude do Pessoal de Saúde , Odontologia/organização & administração , Odontólogos/estatística & dados numéricos , Satisfação no Emprego , Bioética , Estudos Transversais , Odontólogos/economia , Odontólogos/psicologia , Setor de Assistência à Saúde/economia , Setor de Assistência à Saúde/organização & administração , Humanos , Seguro Saúde/economia , Setor Privado/economia , Setor Privado/organização & administração , Autonomia Profissional , Inquéritos e Questionários
18.
20 Century Br Hist ; 30(2): 205-230, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30753661

RESUMO

In 1977, the John Lewis Partnership (JLP) was blacklisted for breaching the Labour government's pay controls under the Social Contract. As the Callaghan administration struggled to establish economic credibility, extending its reach into the private sector emerged as a political priority. JLP became a test case of government resolve months before the Ford strike of autumn 1978 that ushered in the Winter of Discontent. This article uses JLP records to create a more nuanced picture of the tensions, contestations, and vacillations of pay policy in the late 1970s. By doing so, gaps between policy conception and implementation emerge and intersect; both the business and the government faced constraints in implementing policy, despite powerful beliefs about the integrity of their actions. The article is not primarily a case study, however, and aims to contribute to broader debates. The constitutional significance, rather than the commercial impact, of government sanctions became a keynote of critique of JLP's blacklisting, suggesting that contemporaries recognized this was a confrontation of the political moment between the state and the private sector. By looking from a business's perspective, we also gain insight into how organizations approached, negotiated with, and responded to the government. Recovering the JLP blacklisting episode further shows how business archives offer great promise as resources for political history.


Assuntos
Comércio/história , Governo/história , Política , Setor Privado/história , Controle Social Formal , Comércio/normas , História do Século XX , Setor Privado/economia , Setor Privado/normas , Reino Unido
19.
Health Aff (Millwood) ; 38(1): 87-95, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30615520

RESUMO

A 2003 article titled "It's the Prices, Stupid," and coauthored by the three of us and the recently deceased Uwe Reinhardt found that the sizable differences in health spending between the US and other countries were explained mainly by health care prices. As a tribute to him, we used Organization for Economic Cooperation and Development (OECD) Health Statistics to update these analyses and review critiques of the original article. The conclusion that prices are the primary reason why the US spends more on health care than any other country remains valid, despite health policy reforms and health systems restructuring that have occurred in the US and other industrialized countries since the 2003 article's publication. On key measures of health care resources per capita (hospital beds, physicians, and nurses), the US still provides significantly fewer resources compared to the OECD median country. Since the US is not consuming greater resources than other countries, the most logical factor is the higher prices paid in the US. Because the differential between what the public and private sectors pay for medical services has grown significantly in the past fifteen years, US policy makers should focus on prices in the private sector.


Assuntos
Comércio/economia , Assistência à Saúde/economia , Gastos em Saúde/estatística & dados numéricos , Países Desenvolvidos/economia , Países Desenvolvidos/estatística & dados numéricos , Política de Saúde , Recursos em Saúde/estatística & dados numéricos , Humanos , Organização para a Cooperação e Desenvolvimento Econômico/normas , Médicos/estatística & dados numéricos , Setor Privado/economia , Setor Público/economia
20.
Circ Cardiovasc Qual Outcomes ; 12(1): e004971, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30606054

RESUMO

BACKGROUND: Medicaid expansion among previously uninsured individuals has led to improved healthcare access. However, considerably lower reimbursement rates of Medicaid have raised concerns on the unintended consequence of lower utilization of life-saving therapies and inferior outcomes compared with private insurance. We examined the rates of revascularization and in-hospital mortality among Medicaid beneficiaries versus privately insured individuals hospitalized with ST-segment-elevation myocardial infarction (STEMI). METHODS AND RESULTS: We queried the National Inpatient Sample from 2012 to 2015 for STEMI hospitalizations with Medicaid or private insurance as primary payer. Hospitalizations with the following criteria were excluded: (1) age <18 or ≥65 years, (2) transfer to another acute care facility, and (3) left against medical advice. Outcomes were compared in propensity score-matched cohort based on demographics, socioeconomic status (income based), clinical comorbidities, including drug and alcohol use, STEMI acuity (cardiac arrest and cardiogenic shock), and hospital characteristics. A total of 42 645 and 171 545 STEMI hospitalizations were identified as having Medicaid and private insurance, respectively. In unadjusted analyses, Medicaid beneficiaries with STEMI had lower rates of coronary revascularization (88.9% versus 92.3%; odds ratio, 0.67; 95% CI, 0.65-0.70) and higher rates of in-hospital mortality (4.9% versus 2.8%; odds ratio, 1.81; 95% CI, 1.72-1.91) compared with privately insured individuals ( P<0.001 for both). In propensity-matched cohort of 40 870 hospitalizations per group, similar results for lower rates of revascularization (89.1% versus 91.1%; odds ratio, 0.80; 95% CI, 0.76-0.84) and higher in-hospital mortality (4.9% versus 3.7%; odds ratio, 1.35; 95% CI, 1.26-1.45) were observed in Medicaid compared with private insurance, despite extensive matching ( P<0.001 for both). CONCLUSIONS: Medicaid beneficiaries with STEMI had lower rates of revascularization, although small absolute difference, and higher in-hospital mortality compared with privately insured individuals. Further studies are needed to identify and understand the variation in STEMI outcomes by insurance status.


Assuntos
Disparidades em Assistência à Saúde/tendências , Benefícios do Seguro/tendências , Medicaid/tendências , Revascularização Miocárdica/tendências , Setor Privado/tendências , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Adolescente , Adulto , Bases de Dados Factuais , Feminino , Disparidades em Assistência à Saúde/economia , Mortalidade Hospitalar/tendências , Humanos , Benefícios do Seguro/economia , Masculino , Medicaid/economia , Pessoa de Meia-Idade , Revascularização Miocárdica/efeitos adversos , Revascularização Miocárdica/economia , Revascularização Miocárdica/mortalidade , Setor Privado/economia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
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