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Using the Elixhauser risk adjustment model to predict outcomes among patients hospitalized in internal medicine at a large, tertiary-care hospital in Israel. 使用Elixhauser风险调整模型预测以色列一家大型三级护理医院内科住院患者的预后。
IF 4.5 4区 医学 Q1 Medicine Pub Date : 2023-11-01 DOI: 10.1186/s13584-023-00580-x
David E Katz, Gideon Leibner, Yaakov Esayag, Nechama Kaufman, Shuli Brammli-Greenberg, Adam J Rose

Background: In Israel, internal medicine admissions are currently reimbursed without accounting for patient complexity. This is at odds with most other developed countries and has the potential to lead to market distortions such as avoiding sicker patients. Our objective was to apply a well-known, freely available risk adjustment model, the Elixhauser model, to predict relevant outcomes among patients hospitalized on the internal medicine service of a large, Israeli tertiary-care hospital.

Methods: We used data from the Shaare Zedek Medical Center, a large tertiary referral hospital in Jerusalem. The study included 55,946 hospitalizations between 01.01.2016 and 31.12.2019. We modeled four patient outcomes: in-hospital mortality, escalation of care (intensive care unit (ICU) transfer, mechanical ventilation, daytime bi-level positive pressure ventilation, or vasopressors), 30-day readmission, and length of stay (LOS). We log-transformed LOS to address right skew. As is usual with the Elixhauser model, we identified 29 comorbid conditions using international classification of diseases codes, clinical modification, version 9. We derived and validated the coefficients for these 29 variables using split-sample derivation and validation. We checked model fit using c-statistics and R2, and model calibration using a Hosmer-Lemeshow test.

Results: The Elixhauser model achieved acceptable prediction of the three binary outcomes, with c-statistics of 0.712, 0.681, and 0.605 to predict in-hospital mortality, escalation of care, and 30-day readmission respectively. The c-statistic did not decrease in the validation set (0.707, 0.687, and 0.603, respectively), suggesting that the models are not overfitted. The model to predict log length of stay achieved an R2 of 0.102 in the derivation set and 0.101 in the validation set. The Hosmer-Lemeshow test did not suggest issues with model calibration.

Conclusion: We demonstrated that a freely-available risk adjustment model can achieve acceptable prediction of important clinical outcomes in a dataset of patients admitted to a large, Israeli tertiary-care hospital. This model could potentially be used as a basis for differential payment by patient complexity.

背景:在以色列,目前在不考虑患者复杂性的情况下对内科入院进行报销。这与大多数其他发达国家不一致,有可能导致市场扭曲,比如避免病情加重的患者。我们的目标是应用一个众所周知的、免费提供的风险调整模型,即Elixhauser模型,来预测在以色列一家大型三级护理医院的内科服务中住院的患者的相关结果。方法:我们使用了耶路撒冷一家大型三级转诊医院Shaare Zedek医疗中心的数据。该研究包括2016年1月1日至2019年12月31日期间的55946例住院患者。我们模拟了四种患者结果:住院死亡率、护理升级(重症监护室(ICU)转移、机械通气、日间双水平正压通气或血管升压药)、30天再次入院和住院时间(LOS)。我们对LOS进行了对数变换,以解决右偏斜问题。与Elixhauser模型一样,我们使用国际疾病分类代码,临床修改,第9版确定了29种共病情况。我们使用分样本推导和验证方法推导并验证了这29个变量的系数。我们使用c统计量和R2检查模型拟合,并使用Hosmer-Lemeshow检验进行模型校准。结果:Elixhauser模型对三种二元结果进行了可接受的预测,c统计量分别为0.712、0.681和0.605,用于预测住院死亡率、护理升级和30天再次入院。c统计量在验证集中没有减少(分别为0.707、0.687和0.603),这表明模型没有过度拟合。用于预测对数停留时间的模型在推导集中获得了0.102的R2,在验证集中获得了0.101的R2。Hosmer-Lemeshow测试并未表明模型校准存在问题。结论:我们证明,在以色列一家大型三级护理医院的患者数据集中,一个免费可用的风险调整模型可以实现对重要临床结果的可接受预测。该模型可能被用作按患者复杂性进行差异支付的基础。
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引用次数: 0
Addressing the second victim phenomenon in Israeli health care institutions. 处理以色列保健机构中的第二种受害者现象。
IF 4.5 4区 医学 Q1 Medicine Pub Date : 2023-09-04 DOI: 10.1186/s13584-023-00578-5
Rinat Cohen, Yael Sela, Rachel Nissanholtz-Gannot

Background: The 'second victim' phenomenon (SVP) refers to practitioners who experience a negative physical or emotional response, as well as a professional decline, after participating or witnessing an adverse event. Despite the Israeli Ministry of Health's implementation of specific protocols regarding the overall management of adverse events in health organizations over the past decade, there is limited knowledge regarding healthcare managers' perceptions of the 'second victim' occurrence.

Methods: A phenomenological qualitative approach was used to identify an accurate view of policy. Fifteen senior risk manager/and policy makers were interviewed about their knowledge and perceptions of the 'second victim'. Topics addressed included reporting mechanisms of an adverse event, the degree of organizational awareness of 'second victim', and identifying components of possible intervention programs and challenges to implementing those programs.

Results: Examining current procedures reveals that there is limited knowledge about uniform guidance for health care organizations on how to identify, treat, or prevent SVP among providers. The employee support programs that were offered were sporadic in nature and depended on the initiative of a direct manager or the risk manager.

Conclusions: Currently, there is little information or organizational discussion about the possible negative effects of AE on healthcare practitioners. To provide overall medical care that is safe and effective for patients, the health system must also provide a suitable response to the needs of the medical provider. This could be achieved by establishing a national policy for all healthcare organizations to follow, raising awareness of the possible occurrence of SVP, and creating a standard for the subsequent identification, treatment and future prevention for providers who may be suffering.

背景:“第二受害者”现象(SVP)是指从业人员在参与或目睹不良事件后经历负面的身体或情绪反应,以及专业水平下降。尽管以色列卫生部在过去十年中执行了关于卫生组织不良事件总体管理的具体议定书,但关于卫生保健管理人员对"第二受害者"事件的看法,人们所知有限。方法:采用现象学定性方法确定准确的政策观点。对15名高级风险经理和政策制定者进行了采访,了解他们对“第二受害者”的了解和看法。讨论的主题包括不良事件的报告机制,组织对“第二受害者”的意识程度,以及确定可能的干预计划的组成部分和实施这些计划的挑战。结果:检查当前的程序表明,卫生保健组织在如何识别、治疗或预防提供者之间的SVP方面的统一指导知识有限。提供的员工支持计划本质上是零星的,取决于直接经理或风险经理的主动性。结论:目前,关于AE对医护人员可能产生的负面影响的信息或组织讨论很少。为了向患者提供安全有效的全面医疗保健,卫生系统还必须对医疗提供者的需求作出适当的反应。这可以通过制定所有医疗保健组织都要遵循的国家政策来实现,提高对可能发生SVP的认识,并为可能遭受SVP的提供者创建后续识别、治疗和未来预防的标准。
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引用次数: 0
Factors affecting the use of dental services among Arab children in Israel: a qualitative study. 影响以色列阿拉伯儿童使用牙科服务的因素:一项定性研究。
IF 4.5 4区 医学 Q1 Medicine Pub Date : 2023-09-04 DOI: 10.1186/s13584-023-00579-4
Mohammad Khatib, Yael Ashkenazi, Yoav Loeff, Shlomo Paul Zusman, Lena Natapov

Background: In 2010, Israel reformed its hitherto dominantly privately financed dental services and included preventative and restorative dental care for children in the publicly-funded basket of healthcare services. A survey conducted by Brookdale Institute, found that only 67% of low-income Israeli-Arab children were using the new service (compared to 85% of Jewish children) while the majority of others continue using privately funded services. The aim of this study is to explore and explain Israeli-Arab children's low utilization of publicly-funded preventive and restorative dental care.

Methods: A qualitative study designed to describe and understand the parents' motivations and choices. As a preliminary stage, eight semi-structured interviews were conducted with directors of HMO dental departments and Israeli-Arab dentists. In the second stage, ten one-on-one interviews with parents, and five focus group discussions with 55 parents held on February-March 2017. All discussions in the focus groups were conducted in Arabic and each group was moderated by one of the research team accompanied by another person who documented and recorded the discussion. All interviews and discussions were recorded, transcribed in full and translated into Hebrew.

Results: The prevalent attitude is that one goes to the dentist only when there is a serious problem. The importance of preventive care is not appreciated. A childhood fear of the drill is very remembered and passed onto the children. Social and cultural factors such as kinship with service providers (GPs and dentists) influence the choice and utilization of health services. Economic barriers are still existing since even the small co-payment is daunting to low-income parents of large families. Provision of the public service is inadequate in some Arab villages.

Conclusions: The extension of Israel's National Health Insurance Law's basket of services to include dental care for children, while important, is not sufficiently embraced by Israeli Arab children. The remaining barriers include poor living conditions, low educational level that requires very clear sharing of information about the new service, and the resistance of cultural and social traditions. Public dental services providers should focus on conveying relevant oral health messages to the parents too, either through their children or directly.

背景:2010年,以色列改革了迄今为止主要由私人供资的牙科服务,并将儿童预防性和恢复性牙科护理纳入公共供资的一揽子保健服务。布鲁克代尔研究所进行的一项调查发现,只有67%的低收入以色列裔阿拉伯儿童在使用这项新服务(相比之下,犹太儿童的这一比例为85%),而其他大多数人继续使用私人资助的服务。本研究的目的是探讨和解释以色列-阿拉伯儿童对公共资助的预防性和恢复性牙科护理的低利用率。方法:采用定性研究方法,描述和理解家长的动机和选择。作为初步阶段,与卫生组织牙科部门主任和以色列-阿拉伯牙医进行了8次半结构化访谈。第二阶段于2017年2月至3月进行了10次家长一对一访谈和5次家长焦点小组讨论。焦点小组的所有讨论都以阿拉伯语进行,每个小组由一名研究小组成员主持,并由另一名记录和记录讨论的人员陪同。所有的采访和讨论都被记录下来,全部抄写并翻译成希伯来语。结果:普遍的态度是只有在有严重问题时才去看牙医。预防保健的重要性没有得到重视。童年时对演习的恐惧是非常清楚的,并传递给了孩子们。社会和文化因素,如与服务提供者(全科医生和牙医)的亲属关系,影响保健服务的选择和利用。经济障碍仍然存在,因为即使是小额的共同支付也会让大家庭的低收入父母望而生畏。一些阿拉伯村庄提供的公共服务不足。结论:将以色列《国民健康保险法》的一揽子服务扩大到包括儿童牙科保健,虽然很重要,但没有得到以色列阿拉伯儿童的充分接受。其余的障碍包括恶劣的生活条件,教育水平低,需要非常明确地分享有关新服务的信息,以及文化和社会传统的抵制。公立牙科服务提供者亦应透过子女或直接向家长传递相关的口腔健康讯息。
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引用次数: 0
Crisis management for Patient Safety Officers: lessons learned from the Covid-19 pandemic. 患者安全官员的危机管理:从Covid-19大流行中吸取的教训。
IF 4.5 4区 医学 Q1 Medicine Pub Date : 2023-09-01 DOI: 10.1186/s13584-023-00577-6
Ilya Kagan, Dana Arad, Riki Aharoni, Yossi Tal, Yaron Niv

Background: There is no consensus for the role definition for Patient Safety Officers (PSOs) in healthcare during pandemics or other crises as opposed to their routine activities. This study aimed to examine the contribution of personality traits and systemic factors on the performance of PSOs during the pandemic, and to compare these variables during the first and third waves of the Covid-19 pandemic in Israel.

Methods: This cross-sectional study invited 117 PSOs to complete a questionnaire addressing their role during the Covid-19 pandemic. The questionnaire included items concerning: Personal and socio-demographic characteristics; Uncertainty; Personal initiative; Burnout; Professional functioning; Patient Safety and Risk Management policies and practices; Organizational functioning; and Personal Involvement in risk management activities. Qualitative data was collected by two open-ended questions.

Results: A total of 78 PSOs (67%) completed the questionnaire. The results revealed that many PSOs reduced their involvement in risk management processes or even left their position temporarily in order to return to their primary specialization as clinicians. Only 51.3% and 57.7% reported practicing risk management in the first and third waves, respectively. The three main factors that kept PSOs functioning were managerial support, mobilization of their team, and the belief in the importance of their position.

Conclusions: A crisis generates uncertainty, a plethora of frequent and urgent tasks, and the need to adapt policy to changing circumstances and to the increased risks. The risk manager must be a member of the crisis management team and participate in every important discussion in order to represent essential staff and patient safety issues and ensure that these are fully addressed already in the early stages of planning.

背景:对于大流行或其他危机期间医疗保健中的患者安全官员(PSOs)的角色定义,与他们的日常活动相反,尚未达成共识。本研究旨在研究大流行期间人格特质和系统因素对pso表现的贡献,并在以色列的第一波和第三波Covid-19大流行期间比较这些变量。方法:本横断面研究邀请117名pso填写一份问卷,调查他们在Covid-19大流行期间的角色。调查表包括以下项目:个人和社会人口特征;不确定性;个人主动性;倦怠的;专业的功能;患者安全和风险管理政策和做法;组织功能;亲自参与风险管理活动。定性数据通过两个开放式问题收集。结果:78名pso(67%)完成了问卷调查。结果显示,许多pso减少了他们对风险管理过程的参与,甚至暂时离开他们的职位,以便回到他们作为临床医生的主要专业。分别只有51.3%和57.7%的人报告在第一波和第三波中实施风险管理。保持pso运作的三个主要因素是管理支持、团队动员和对其职位重要性的信念。结论:危机产生了不确定性,产生了大量频繁和紧急的任务,需要调整政策以适应不断变化的环境和增加的风险。风险管理人员必须是危机管理团队的一员,并参与每一次重要的讨论,以代表基本的工作人员和患者安全问题,并确保这些问题在规划的早期阶段就得到充分解决。
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引用次数: 0
Healthcare policy changes in an era of health workforce shortage. 卫生人力短缺时代的卫生保健政策变化。
IF 4.5 4区 医学 Q1 Medicine Pub Date : 2023-08-10 DOI: 10.1186/s13584-023-00576-7
Yoel Angel, Gil Fire

In their recent IJHPR article, Wimpfheimer and colleagues outline the implications for the field of anesthesia of two major healthcare policy changes in Israel: The Yatziv Reform in licensing foreign medical graduates and the efforts to reduce residents' on-call shift duration. We argue that these reforms are necessary to strengthen the healthcare workforce and improve the quality of care in the long term, even though they may limit the availability of healthcare personnel for several years, particularly in the field of anesthesia. In this commentary, we examine the background to these policy changes, their likely impact on the medical workforce in Israel in general, and propose steps to reconcile these reforms with the global and national shortage of physicians. We urge policymakers to allocate the required resources and begin preparing for an era of continuous mismatch between physician supply and demand, which will necessitate creative solutions, increased reliance on technology, and the introduction of paramedical professionals to help offload tasks and better utilize the scarce physician workforce.

在他们最近的IJHPR文章中,Wimpfheimer及其同事概述了以色列两项主要医疗政策变化对麻醉领域的影响:外国医学毕业生许可的Yatziv改革和减少住院医生随叫随到轮班时间的努力。我们认为,这些改革是必要的,以加强医疗队伍和提高长期护理质量,即使他们可能会限制医疗人员的可用性数年,特别是在麻醉领域。在这篇评论中,我们研究了这些政策变化的背景,它们对以色列医疗队伍的可能影响,并提出了一些步骤,以协调这些改革与全球和全国医生短缺的关系。我们敦促政策制定者分配所需的资源,并开始为医生供需持续不匹配的时代做好准备,这将需要创造性的解决方案,增加对技术的依赖,并引入辅助医疗专业人员来帮助减轻任务,更好地利用稀缺的医生劳动力。
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引用次数: 0
To charge or not to charge: reducing patient no-show. 收费还是不收费:减少病人缺勤。
IF 4.5 4区 医学 Q1 Medicine Pub Date : 2023-08-08 DOI: 10.1186/s13584-023-00575-8
Gideon Leibner, Shuli Brammli-Greenberg, Joseph Mendlovic, Avi Israeli

Background: In order to reduce patient no-show, the Israeli government is promoting legislation that will allow Health Plans to require a co-payment from patients when reserving an appointment. It is hoped that this will create an incentive for patients to cancel in advance rather than simply not show up. The goal of this policy is to improve patient access to medical care and ensure that healthcare resources are utilized effectively. We explore this phenomenon to support evidence-based decision making on this issue, and to determine whether the proposed legislation is aligned with the findings of previous studies.

Main body: No-show rates vary across countries and healthcare services, with several strategies in place to mitigate the phenomenon. There are three key stakeholders involved: (1) patients, (2) medical staff, and (3) insurers/managed care organizations, each of which is affected differently by no-shows and faces a different set of incentives. The decision whether to impose financial penalties for no-shows should take a number of considerations into account, such as the fine amount, service type, the establishment of an effective fine collection system, the patient's socioeconomic status, and the potential for exacerbating disparities in healthcare access. The limited research on the impact of fines on no-show rates has produced mixed results. Further investigation is necessary to understand the influence of fine amounts on no-show rates across various healthcare services. Additionally, it is important to evaluate the implications of this proposed legislation on patient behavior, access to healthcare, and potential disparities in access.

Conclusion: It is anticipated that the proposed legislation will have minimal impact on attendance rates. To achieve meaningful change, efforts should focus on enhancing medical service availability and improving the ease with which appointments can be cancelled or alternatively substantial fines should be imposed. Further research is imperative for determining the most effective way to address the issue of patient no-show and to enhance healthcare system efficiency.

背景:为了减少病人不来看病的情况,以色列政府正在推动立法,允许健康计划在预约预约时要求病人共同支付费用。希望这能激励病人提前取消预约,而不是干脆不来。这项政策的目标是改善病人获得医疗服务的机会,并确保有效利用医疗资源。我们探讨这一现象,以支持在这一问题上的循证决策,并确定拟议的立法是否与以往的研究结果一致。正文:逃诊率因国家和医疗保健服务而异,有几种策略可以缓解这一现象。有三个关键的利益相关者参与其中:(1)患者,(2)医务人员,(3)保险公司/管理的医疗机构,每个人都受到不同的影响,并面临不同的激励措施。在决定是否对失约者进行经济处罚时,应考虑多项因素,如罚款金额、服务类型、有效的罚款征收制度的建立、患者的社会经济地位以及加剧医疗保健机会差距的可能性。关于罚款对缺勤率影响的有限研究得出了好坏参半的结果。为了了解罚金数额对各种医疗保健服务的失诊率的影响,有必要进行进一步的调查。此外,重要的是要评估这一拟议的立法对患者行为的影响,获得医疗保健的机会,以及在获得的潜在差异。结论:预计拟议的立法对出勤率的影响微乎其微。为实现有意义的变革,应侧重于提高医疗服务的可得性,提高取消预约或处以巨额罚款的便利性。进一步的研究是必要的,以确定最有效的方法来解决病人的问题,并提高医疗保健系统的效率。
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引用次数: 1
"A picture is worth a thousand words": smoking in multi-unit housing in Israel. “一张图片胜过千言万语”:在以色列的多单元住房中吸烟。
IF 4.5 4区 医学 Q1 Medicine Pub Date : 2023-08-07 DOI: 10.1186/s13584-023-00574-9
Mitchell Zeller

A brief commentary on the need for policy change by the Israeli government to address the problem of tobacco smoke incursion in multi-unit housing. The commentary also includes a call for enhanced products, programs, and services to help smokers in Israel quit.

简要评论以色列政府需要改变政策,以解决多单元住房中烟草烟雾入侵的问题。该评论还呼吁加强产品、计划和服务,以帮助以色列的吸烟者戒烟。
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引用次数: 0
Tobacco smoke incursion into private residences in Israel: a cross-sectional study examining public perceptions of private rights and support for governmental policies. 烟草烟雾侵入以色列私人住宅:一项调查公众对私人权利和对政府政策支持的看法的横断面研究。
IF 4.5 4区 医学 Q1 Medicine Pub Date : 2023-07-21 DOI: 10.1186/s13584-023-00573-w
Noa Theitler, Vaughan W Rees, Maya Peled-Raz, Michal Bitan, Laura J Rosen

Background: Tobacco smoke incursion (TSI) into private residences is a widespread problem in many countries. We sought to assess the prevalence of self-reported TSI and public attitudes about TSI in Israel, a country with a relatively high smoking prevalence and high population density.

Methods: We conducted a random digit dial survey among residents in Israel (N = 285) in 2017, which examined the frequency, source, correlates of, and attitudes towards TSI and potential regulatory options. The cooperation rate was 63.9%.

Results: Among respondents, 44.7% reported ever experiencing home TSI, with higher exposure among residents of multi-unit housing (MUH) (MUH versus private homes: aOR (Adjusted Odds Ratio): 3.60, CI (Confidence Interval): [1.96, 6.58], p < .001). Most respondents (69.8%), including nearly half of smokers, prioritized the right of individuals to breath smoke-free air in their apartments over the right of smokers to smoke in their apartments. Women and non-smokers were more likely to support the right to breathe smoke-free air (Women versus men: aOR: 2.77 CI: [1.48, 5.16], p = .001; Nonsmokers versus smokers: aOR: 3.21 CI [1.59, 6.48], p = .001). However, only about a quarter (24.8%) of respondents who ever experienced TSI raised the issue with the neighbor who smoked, the neighbor's landlord, or the building committee. The vast majority (85.2%) of all respondents, including three-quarters of smokers, supported smoke-free legislation for multi-unit housing (MUH), with those ever-exposed to TSI and non-smokers more likely to support legislation (ever-exposed versus never-exposed aOR = 2.99, CI [1.28, 6.97], p = 0.011; nonsmokers versus smokers aOR = 3.00, CI [1.28, 7.01], p = 0.011).

Conclusions: Among study participants, tobacco smoke incursion was a common, yet unwelcome experience. Most respondents believed that the right to breathe smoke-free air in one's apartment superseded that of neighbors to smoke anywhere in their home, and most supported legislation to prevent TSI. Though further study is needed to understand better TSI and effective methods for its prevention, our findings suggest that policy interventions, including legal action at the level of the Supreme Court and/or the Knesset, are needed. Regulation, policy initiatives and campaigns to denormalize smoking in proximity to other people and private residences globally could reduce the scope of this widespread problem, protect individuals from home TSI, and improve population health.

背景:烟草烟雾侵入(TSI)进入私人住宅是许多国家普遍存在的问题。我们试图评估以色列自我报告的TSI患病率和公众对TSI的态度,以色列是一个吸烟率和人口密度相对较高的国家。方法:我们于2017年对以色列居民(N = 285)进行了随机数字拨号调查,调查了TSI的频率、来源、相关因素和对TSI的态度以及潜在的监管选择。合作率为63.9%。结果:在受访者中,44.7%的人报告曾经历过家庭TSI,多单元住房(MUH)的居民暴露率更高(MUH与私人住宅:aOR(调整优势比):3.60,CI(置信区间):[1.96,6.58],p)结论:在研究参与者中,烟草烟雾入侵是一种常见但不受欢迎的经历。大多数受访者认为,在自己的公寓里呼吸无烟空气的权利高于邻居在家中任何地方吸烟的权利,大多数人支持立法防止TSI。虽然需要进一步的研究来更好地了解TSI和有效的预防方法,但我们的研究结果表明,需要政策干预,包括最高法院和/或以色列议会的法律行动。在全球范围内禁止在他人和私人住宅附近吸烟的法规、政策举措和运动可以减少这一普遍问题的范围,保护个人免受家中TSI的伤害,并改善人口健康。
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引用次数: 1
High out‑of‑pocket spending and financial hardship at the end of life among cancer survivors and their families. 癌症幸存者及其家属在生命末期的高额自付支出和经济困难。
IF 4.5 4区 医学 Q1 Medicine Pub Date : 2023-07-06 DOI: 10.1186/s13584-023-00572-x
Jingxuan Zhao, K Robin Yabroff

Cancer is one of the most expensive medical conditions to treat worldwide, affecting national and local spending, as well as household budgets for patients and their families. In this commentary about a recent paper from Tur‑Sinai et al., we discuss the high out-of-pocket spending and medical and non-medical financial hardship faced by cancer patients and their families at the end-of-life in Israel. We provide recent information about the costs of health care in Israel and other high-income countries with (i.e., Canada, Australia, Japan, and Italy) and without universal health insurance coverage (i.e., United States, a country with high healthcare costs and uninsurance rate), and highlight the role of improving health insurance coverage and benefit design in reducing financial hardship among cancer patients and their families. Recognizing that financial hardship at the end of life affects both patients and their families, developing comprehensive programs and policies in Israel as well as in other countries is warranted.

癌症是世界范围内最昂贵的医疗疾病之一,影响着国家和地方的支出,以及患者及其家属的家庭预算。在这篇关于Tur - Sinai等人最近发表的一篇论文的评论中,我们讨论了以色列癌症患者及其家属在生命末期面临的高额自付支出以及医疗和非医疗经济困难。我们提供了以色列和其他高收入国家(即加拿大、澳大利亚、日本和意大利)和没有全民医疗保险的国家(即美国,一个医疗费用和无保险率高的国家)的医疗保健费用的最新信息,并强调了改善医疗保险覆盖面和福利设计在减少癌症患者及其家属的经济困难方面的作用。认识到生命末期的经济困难会影响病人和他们的家庭,在以色列和其他国家制定全面的计划和政策是有必要的。
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引用次数: 0
Correction: Cytomegalovirus (CMV) seroprevalence among women at childbearing age, maternal and congenital CMV infection: policy implications of a descriptive, retrospective, community-based study. 更正:巨细胞病毒(CMV)在育龄妇女、产妇和先天性巨细胞病毒感染中的血清患病率:一项描述性、回顾性、基于社区的研究的政策意义。
IF 4.5 4区 医学 Q1 Medicine Pub Date : 2023-05-25 DOI: 10.1186/s13584-023-00571-y
Assaf Ben Shoham, Yechiel Schlesinger, Ian Miskin, Ziva Kalderon, Rachel Michaelson-Cohen, Yonit Wiener-Well
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引用次数: 0
期刊
Israel Journal of Health Policy Research
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