Background: Mongolia introduced liver transplantation 10 years ago, becoming the 46th country globally to successfully perform this procedure. However, the cost of liver transplantation treatment remains expensive in Mongolia, a lower-middle-income country. Thus, the need to calculate the cost of liver transplants, a highly-valued treatment, forms the basis for this study.
Methods: This study employed a retrospective research design with secondary data. The primary dataset comprised 143 cases of liver transplantation performed at the First Central Hospital of Mongolia between 2011 and 2021.
Results: The average cost of a liver transplant in Mongolia is $39,589 ± 10,308, with 79.6% being direct costs and 20.4% indirect costs. Of the direct costs, 71% were attributed to drugs, medical equipment, and supplies, while 8.6% accounted for salaries. In terms of the Model of End-Stage Liver Disease (MELD) scores, treatment costs were $39,205 ± 10,786 for patients with MELD ≤ 14 points, $40,296 ± 1,517 for patients with MELD 15-20 points, $39,352 ± 8,718 for patients with MELD 21-27 points, and $39,812 ± 9,954 for patients with MELD ≤ 28 points, with no statistically significant difference (P = 0.953). However, when calculated according to the Child-Turcotte-Pugh (CTP) score classification, treatment cost for CTP-A patients was $35,970 ± 6,879, for CTP-B patients $41,951 ± 12,195, and for CTP-C patients $37,396 ± 6,701, which was statistically significant (Р=0.015).
Conclusion: The average cost of liver transplantation treatment in Mongolia was $39,589. Despite medical facilities' capacity to treat up to 50 patients annually, the waiting list exceeds 300 individuals, highlighting significant unmet healthcare needs.
{"title":"A decade of liver transplantation in Mongolia: Economic insights and cost analysis.","authors":"Amarjargal Tsengel, Sergelen Orgoi, Otgonbayar Damdinbazar, Bat-Ireedui Badarch, Urnultsaikhan Ganbold, Batsaikhan Batsuuri, Yerkyebulan Mukhtar, Batsaikhan Bat-Erdene, Liu Lei, Tserenbat Bazarsad, Undarmaa Zandanbazar, Gantugs Yundendorj","doi":"10.1186/s13561-024-00528-0","DOIUrl":"10.1186/s13561-024-00528-0","url":null,"abstract":"<p><strong>Background: </strong>Mongolia introduced liver transplantation 10 years ago, becoming the 46th country globally to successfully perform this procedure. However, the cost of liver transplantation treatment remains expensive in Mongolia, a lower-middle-income country. Thus, the need to calculate the cost of liver transplants, a highly-valued treatment, forms the basis for this study.</p><p><strong>Methods: </strong>This study employed a retrospective research design with secondary data. The primary dataset comprised 143 cases of liver transplantation performed at the First Central Hospital of Mongolia between 2011 and 2021.</p><p><strong>Results: </strong>The average cost of a liver transplant in Mongolia is $39,589 ± 10,308, with 79.6% being direct costs and 20.4% indirect costs. Of the direct costs, 71% were attributed to drugs, medical equipment, and supplies, while 8.6% accounted for salaries. In terms of the Model of End-Stage Liver Disease (MELD) scores, treatment costs were $39,205 ± 10,786 for patients with MELD ≤ 14 points, $40,296 ± 1,517 for patients with MELD 15-20 points, $39,352 ± 8,718 for patients with MELD 21-27 points, and $39,812 ± 9,954 for patients with MELD ≤ 28 points, with no statistically significant difference (P = 0.953). However, when calculated according to the Child-Turcotte-Pugh (CTP) score classification, treatment cost for CTP-A patients was $35,970 ± 6,879, for CTP-B patients $41,951 ± 12,195, and for CTP-C patients $37,396 ± 6,701, which was statistically significant (Р=0.015).</p><p><strong>Conclusion: </strong>The average cost of liver transplantation treatment in Mongolia was $39,589. Despite medical facilities' capacity to treat up to 50 patients annually, the waiting list exceeds 300 individuals, highlighting significant unmet healthcare needs.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"14 1","pages":"55"},"PeriodicalIF":2.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11264777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-18DOI: 10.1186/s13561-024-00520-8
Yang Gao, Yang Yang, Shoupeng Wang, Wenqian Zhang, Jiao Lu
Background and objective: Developing harmonious doctor-patient relationships is a powerful way to promote the construction of a new pattern of medical reform in developing countries. We aim to analyze the effects of China's hierarchical medical system on doctor-patient relationships, thus contributing to China's medical and health system reform.
Methods: With panel data on prefectural-level cities in China from 2012 to 2019, we used a time-varying difference-in-differences model to evaluate the effect of hierarchical medical treatment policy.
Results: Hierarchical medical treatment policies can significantly improve doctor-patient relationships, and this conclusion is supported by various robustness tests. And improving doctor-patient relationships can be indirectly realized by the optimization of resource allocation and saving of medical costs. In addition, the marginal effect of the pilot policy on doctor-patient relationships decreased with age within the city population. In focal cities and cities with high levels of fiscal spending on health care, the effect of the pilot policy on doctor-patient relationships was stronger.
Conclusion: While reinforcing the literature on the doctor-patient relationship, this study also provides a reference for further exploration of the pilot policy of hierarchical medical treatment and the development of new medical and health system reform in developing countries.
{"title":"Has China's hierarchical medical system improved doctor-patient relationships?","authors":"Yang Gao, Yang Yang, Shoupeng Wang, Wenqian Zhang, Jiao Lu","doi":"10.1186/s13561-024-00520-8","DOIUrl":"10.1186/s13561-024-00520-8","url":null,"abstract":"<p><strong>Background and objective: </strong>Developing harmonious doctor-patient relationships is a powerful way to promote the construction of a new pattern of medical reform in developing countries. We aim to analyze the effects of China's hierarchical medical system on doctor-patient relationships, thus contributing to China's medical and health system reform.</p><p><strong>Methods: </strong>With panel data on prefectural-level cities in China from 2012 to 2019, we used a time-varying difference-in-differences model to evaluate the effect of hierarchical medical treatment policy.</p><p><strong>Results: </strong>Hierarchical medical treatment policies can significantly improve doctor-patient relationships, and this conclusion is supported by various robustness tests. And improving doctor-patient relationships can be indirectly realized by the optimization of resource allocation and saving of medical costs. In addition, the marginal effect of the pilot policy on doctor-patient relationships decreased with age within the city population. In focal cities and cities with high levels of fiscal spending on health care, the effect of the pilot policy on doctor-patient relationships was stronger.</p><p><strong>Conclusion: </strong>While reinforcing the literature on the doctor-patient relationship, this study also provides a reference for further exploration of the pilot policy of hierarchical medical treatment and the development of new medical and health system reform in developing countries.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"14 1","pages":"54"},"PeriodicalIF":2.7,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11256484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141634957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Financial risk protection is one indicator of universal health coverage (UHC). All people should be protected from financial risks such as catastrophic health expenditures (CHE) to ensure equitable health services. Ethiopia has launched community-based health insurance (CBHI) since 2011 to protect people from financial risk. However, out-of-pocket health expenditure is a financial barriers to achieve UHC. The insured-non-insured disparity of CHE has not been well studied in Ethiopia in general and in Debre Tabor town in particular. Therefore, this study aimed to assess the disparity of CHE between insured and non-insured households and its contributing factors in Debre Tabor town.</p><p><strong>Methods: </strong>This study used the primary household survey data collected from May to June 2022 in Debre Tabor town. Data were collected from 825 household heads and analyzed using STATA version 17.0 statistical software. Logit-based multivariate decomposition analysis was conducted to determine insured-non-insured disparity of CHE. Statistical significance for all analysis was declared at a p < 0.05.</p><p><strong>Results: </strong>The incidence of CHE was 17.94% and 5.58% among non-insured and insured households, respectively. About 53% and 153.20% of the insured-non-insured disparities in the magnitude of CHE were due to the difference in characteristics (endowments) and the effect of characteristics (coefficients), respectively. Age of the household head between 46 and 60 years and above 60 years, divorced and widowed marital status of household head, and chronic health conditions were the explanatory variables widening the gap in the incidence of CHE. However, do not seeking traditional medicine, family size above 4, and age of household head between 31 and 45 years were the variables contribute in reducing the gap (i.e. due to endowments) in the incidence of CHE between insured and non-insured households. Moreover, the variables that contributed to the gap in the incidence of CHE due to covariate effects were age (31-45) and marital status of household head, wealth status, family size, ownership of the household, and seeking traditional medicines.</p><p><strong>Conclusion: </strong>This study revealed there is a significant disparity in the incidence of CHE between insured and non-insured households. Age, marital status and occupation of the household head, family size of household, presence of a chronically ill household member and seeking traditional medicine were significantly contributing factors for the disparity of CHE between insured and non-insured households due to endowments. The variables that contributed to the disparity in the incidence of CHE due to covariate effects were age and marital status of household head, wealth status, family size, ownership of the household, and seeking traditional medicines. Therefore, the policy makers need to emphasize in increasing the insurance coverage among households
背景：财务风险保护是全民医保（UHC）的一项指标。所有人都应受到保护，免受灾难性医疗支出（CHE）等财务风险的影响，以确保公平的医疗服务。埃塞俄比亚自 2011 年起推出了社区医疗保险（CBHI），以保护人们免受财务风险。然而，自付医疗支出是实现全民医保的财务障碍。在埃塞俄比亚，尤其是在 Debre Tabor 镇，对自付医疗费用的投保与未投保差异尚未进行深入研究。因此，本研究旨在评估 Debre Tabor 镇投保家庭与未投保家庭之间的医疗费用差距及其诱因：本研究使用了 2022 年 5 月至 6 月在德布雷塔博尔镇收集的主要家庭调查数据。数据收集自 825 个户主，并使用 STATA 17.0 版统计软件进行分析。采用基于 Logit 的多元分解分析来确定 CHE 的投保-未投保差异。所有分析的统计显著性均以 p 表示：非投保家庭和投保家庭的 CHE 发生率分别为 17.94% 和 5.58%。投保家庭与未投保家庭在 CHE 发生率上的差异中，分别约有 53% 和 153.20% 是由特征（禀赋）差异和特征影响（系数）造成的。户主年龄在 46 至 60 岁之间和 60 岁以上、户主的离婚和丧偶婚姻状况以及慢性健康状况是拉大 CHE 发生率差距的解释变量。然而，不寻求传统医学、家庭人口在 4 人以上以及户主年龄在 31 至 45 岁之间的变量则有助于缩小投保家庭与非投保家庭之间的 CHE 发生率差距（即由于禀赋）。此外，由于协变量效应而导致 CHE 发生率差距的变量是户主的年龄（31-45 岁）和婚姻状况、财富状况、家庭规模、家庭所有权和寻求传统药物：本研究表明，投保家庭与未投保家庭的 CHE 发生率存在显著差异。年龄、户主的婚姻状况和职业、家庭规模、是否有长期患病的家庭成员以及是否寻求传统药物是造成投保家庭和非投保家庭之间因禀赋而导致的 CHE 发病率差异的重要因素。由于协变量效应而导致 CHE 发病率差异的变量是户主的年龄和婚姻状况、财富状况、家庭规模、家庭所有权和寻求传统药物。因此，政策制定者需要重视提高家庭保险覆盖率，并在埃塞俄比亚，特别是德布雷塔博镇，提供负担得起的医疗服务。
{"title":"Insured-non-insured disparity of catastrophic health expenditure in Northwest Ethiopia: a multivariate decomposition analysis.","authors":"Yawkal Tsega, Gebeyehu Tsega, Asnakew Molla Mekonen, Tesfaye Birhane, Elsabeth Addisu, Abebe Getie, Fekade Demeke Bayou, Mulugeta Desalegn Kasaye, Natnael Kebede, Amare Muche","doi":"10.1186/s13561-024-00533-3","DOIUrl":"10.1186/s13561-024-00533-3","url":null,"abstract":"<p><strong>Background: </strong>Financial risk protection is one indicator of universal health coverage (UHC). All people should be protected from financial risks such as catastrophic health expenditures (CHE) to ensure equitable health services. Ethiopia has launched community-based health insurance (CBHI) since 2011 to protect people from financial risk. However, out-of-pocket health expenditure is a financial barriers to achieve UHC. The insured-non-insured disparity of CHE has not been well studied in Ethiopia in general and in Debre Tabor town in particular. Therefore, this study aimed to assess the disparity of CHE between insured and non-insured households and its contributing factors in Debre Tabor town.</p><p><strong>Methods: </strong>This study used the primary household survey data collected from May to June 2022 in Debre Tabor town. Data were collected from 825 household heads and analyzed using STATA version 17.0 statistical software. Logit-based multivariate decomposition analysis was conducted to determine insured-non-insured disparity of CHE. Statistical significance for all analysis was declared at a p < 0.05.</p><p><strong>Results: </strong>The incidence of CHE was 17.94% and 5.58% among non-insured and insured households, respectively. About 53% and 153.20% of the insured-non-insured disparities in the magnitude of CHE were due to the difference in characteristics (endowments) and the effect of characteristics (coefficients), respectively. Age of the household head between 46 and 60 years and above 60 years, divorced and widowed marital status of household head, and chronic health conditions were the explanatory variables widening the gap in the incidence of CHE. However, do not seeking traditional medicine, family size above 4, and age of household head between 31 and 45 years were the variables contribute in reducing the gap (i.e. due to endowments) in the incidence of CHE between insured and non-insured households. Moreover, the variables that contributed to the gap in the incidence of CHE due to covariate effects were age (31-45) and marital status of household head, wealth status, family size, ownership of the household, and seeking traditional medicines.</p><p><strong>Conclusion: </strong>This study revealed there is a significant disparity in the incidence of CHE between insured and non-insured households. Age, marital status and occupation of the household head, family size of household, presence of a chronically ill household member and seeking traditional medicine were significantly contributing factors for the disparity of CHE between insured and non-insured households due to endowments. The variables that contributed to the disparity in the incidence of CHE due to covariate effects were age and marital status of household head, wealth status, family size, ownership of the household, and seeking traditional medicines. Therefore, the policy makers need to emphasize in increasing the insurance coverage among households","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"14 1","pages":"53"},"PeriodicalIF":2.7,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11253456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141628092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1186/s13561-024-00523-5
Koffi Adzinyo Agbemanyole, Kokouvi Geovani Agbohessou, Christelle Pons, Philippe Lenca, Olivier Rémy-Néris, Myriam Le Goff-Pronost
Rehabilitation technologies offer promising opportunities for interventions for patients with motor disabilities. However, their use in routine care remains limited due to their high cost and persistent doubts about their cost-effectiveness. Providing solid evidence of the economic efficiency of rehabilitation technologies would help dispel these doubts in order to better take advantage of these technologies. In this context, this systematic review aimed to examine the cost-effectiveness of rehabilitation interventions based on the use of digital technologies. In total, 660 articles published between 2011 and 2021 were identified, of which eleven studies met all the inclusion criteria. Of these eleven studies, seven proved to be cost-effective, while four were not. Four studies used cost-utility analyses (CUAs) and seven used cost-minimization analyses (CMAs). The majority (ten studies) focused on the rehabilitation of the upper and/or lower limbs after a stroke, while only one study examined the rehabilitation of the lower limbs after knee arthroplasty. Regarding the evaluated devices, seven studies analyzed the cost-effectiveness of robotic rehabilitation and four analyzed rehabilitation with virtual reality.The assessment of the quality of the included studies using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) suggested that the quality was related to the economic analysis method: all studies that adopted a cost-utility analysis obtained a high quality score (above 80%), while the quality scores of the cost-minimization analyses were average, with the highest score obtained by a CMA being 72%. The average quality score of all the articles was 75%, ranging between 52 and 100. Of the four studies with a considering score, two concluded that there was equivalence between the intervention and conventional care in terms of cost-effectiveness, one concluded that the intervention dominated, while the last one concluded that usual care dominated. This suggests that even considering the quality of the included studies, rehabilitation interventions based on digital technologies remain cost-effective, they improved health outcomes and quality of life for patients with motor disorders while also allowing cost savings.
{"title":"Economic analysis of digital motor rehabilitation technologies: a systematic review.","authors":"Koffi Adzinyo Agbemanyole, Kokouvi Geovani Agbohessou, Christelle Pons, Philippe Lenca, Olivier Rémy-Néris, Myriam Le Goff-Pronost","doi":"10.1186/s13561-024-00523-5","DOIUrl":"10.1186/s13561-024-00523-5","url":null,"abstract":"<p><p>Rehabilitation technologies offer promising opportunities for interventions for patients with motor disabilities. However, their use in routine care remains limited due to their high cost and persistent doubts about their cost-effectiveness. Providing solid evidence of the economic efficiency of rehabilitation technologies would help dispel these doubts in order to better take advantage of these technologies. In this context, this systematic review aimed to examine the cost-effectiveness of rehabilitation interventions based on the use of digital technologies. In total, 660 articles published between 2011 and 2021 were identified, of which eleven studies met all the inclusion criteria. Of these eleven studies, seven proved to be cost-effective, while four were not. Four studies used cost-utility analyses (CUAs) and seven used cost-minimization analyses (CMAs). The majority (ten studies) focused on the rehabilitation of the upper and/or lower limbs after a stroke, while only one study examined the rehabilitation of the lower limbs after knee arthroplasty. Regarding the evaluated devices, seven studies analyzed the cost-effectiveness of robotic rehabilitation and four analyzed rehabilitation with virtual reality.The assessment of the quality of the included studies using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) suggested that the quality was related to the economic analysis method: all studies that adopted a cost-utility analysis obtained a high quality score (above 80%), while the quality scores of the cost-minimization analyses were average, with the highest score obtained by a CMA being 72%. The average quality score of all the articles was 75%, ranging between 52 and 100. Of the four studies with a considering score, two concluded that there was equivalence between the intervention and conventional care in terms of cost-effectiveness, one concluded that the intervention dominated, while the last one concluded that usual care dominated. This suggests that even considering the quality of the included studies, rehabilitation interventions based on digital technologies remain cost-effective, they improved health outcomes and quality of life for patients with motor disorders while also allowing cost savings.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"14 1","pages":"52"},"PeriodicalIF":2.7,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11253330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141628091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-13DOI: 10.1186/s13561-024-00527-1
J Oliva-Moreno, C Vilaplana-Prieto
Background: Fibromyalgia is a chronic rheumatic disease of unknown aetiology, highly disabling and mainly affecting women. The aim of our work is to estimate, on a national scale, the economic impact of this disease on the employment of patients and non-professional (informal) care dimension.
Methods: Survey on Disabilities, Autonomy and Dependency carried out in Spain in 2020/21 was used to obtain information on disabled individuals with AD and their informal caregivers. Six estimation scenarios were defined as base case, depending on whether the maximum daily informal caregiving time was censored or not, and on the approach chosen for the valuation of informal caregiving time (contingent valuation and replacement time). Another six conservative scenarios were developed using the minimum wage for the estimation of labour losses.
Results: Our estimates range from 2,443.6 (willingness to pay, censored informal care time) to 7,164.8 million euros (replacement cost, uncensored informal care time) (base year 2021). Multivariate analyses identified that the degree of dependency of the person suffering from fibromyalgia is the main explanatory variable for both the probability of being employed and the time spent in informal care. Conservative scenarios estimates range from 1,807 to 6,528 million euros.
Conclusions: The high economic impact revealed should help to position a health problem that is relatively unknown in society and for which there are significant research and care gaps to be filled.
{"title":"Social costs associated with fibromyalgia in Spain.","authors":"J Oliva-Moreno, C Vilaplana-Prieto","doi":"10.1186/s13561-024-00527-1","DOIUrl":"10.1186/s13561-024-00527-1","url":null,"abstract":"<p><strong>Background: </strong>Fibromyalgia is a chronic rheumatic disease of unknown aetiology, highly disabling and mainly affecting women. The aim of our work is to estimate, on a national scale, the economic impact of this disease on the employment of patients and non-professional (informal) care dimension.</p><p><strong>Methods: </strong>Survey on Disabilities, Autonomy and Dependency carried out in Spain in 2020/21 was used to obtain information on disabled individuals with AD and their informal caregivers. Six estimation scenarios were defined as base case, depending on whether the maximum daily informal caregiving time was censored or not, and on the approach chosen for the valuation of informal caregiving time (contingent valuation and replacement time). Another six conservative scenarios were developed using the minimum wage for the estimation of labour losses.</p><p><strong>Results: </strong>Our estimates range from 2,443.6 (willingness to pay, censored informal care time) to 7,164.8 million euros (replacement cost, uncensored informal care time) (base year 2021). Multivariate analyses identified that the degree of dependency of the person suffering from fibromyalgia is the main explanatory variable for both the probability of being employed and the time spent in informal care. Conservative scenarios estimates range from 1,807 to 6,528 million euros.</p><p><strong>Conclusions: </strong>The high economic impact revealed should help to position a health problem that is relatively unknown in society and for which there are significant research and care gaps to be filled.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"14 1","pages":"51"},"PeriodicalIF":2.7,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11245780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-12DOI: 10.1186/s13561-024-00530-6
Margit Sommersguter-Reichmann, Gerhard Reichmann
Background: Healthcare corruption poses a significant threat to individuals, institutions, sectors, and states. Combating corruption is paramount for protecting patients, maintaining the healthcare system's integrity, and preserving public trust. As corruption evolves, takes new forms, and adapts to changing socio-political landscapes, understanding its manifestations is critical to developing effective anti-corruption strategies at individual and institutional levels.
Objective: The aim was to comprehensively collate the manifestations of different types of corruption in healthcare to illustrate prevailing patterns and trends and to provide policymakers, practitioners, and researchers with practical insights to inform research agendas, regulatory and governance strategies, and accountability measures.
Method: We conducted a narrative review of scientific articles published between 2013 and 2022 using keyword searches in SCOPUS and EBSCO. We utilized the corruption typology proposed by the European Union and Thompson's Institutional Corruption Framework to systematically identify manifestations across different corruption types. The Prisma scheme was employed to document the selection process and ensure reproducibility.
Findings: Bribery in medical service provision was the most frequently investigated form of corruption, revealing rather uniform manifestations. Misuse of high-level positions and networks and institutional corruption also received considerable attention, with a wide range of misconduct identified in institutional corruption. Extending the analysis to institutional corruption also deepened the understanding of misconduct in the context of improper marketing relations and highlighted the involvement of various stakeholders, including academia. The pandemic exacerbated the vulnerability of the healthcare sector to procurement corruption. Also, it fostered new types of misconduct related to the misuse of high-level positions and networks and fraud and embezzlement of medical drugs, devices, and services.
Conclusions: The review spotlights criminal actions by individuals and networks and marks a notable shift towards systemic misconduct within specific types of corruption. The findings highlight the necessity of customized anti-corruption strategies throughout the healthcare sector. These insights are crucial for policymakers, practitioners, and researchers in guiding the formulation of legal frameworks at local and global levels, governance strategies, and research priorities.
{"title":"Untangling the corruption maze: exploring the complexity of corruption in the health sector.","authors":"Margit Sommersguter-Reichmann, Gerhard Reichmann","doi":"10.1186/s13561-024-00530-6","DOIUrl":"10.1186/s13561-024-00530-6","url":null,"abstract":"<p><strong>Background: </strong>Healthcare corruption poses a significant threat to individuals, institutions, sectors, and states. Combating corruption is paramount for protecting patients, maintaining the healthcare system's integrity, and preserving public trust. As corruption evolves, takes new forms, and adapts to changing socio-political landscapes, understanding its manifestations is critical to developing effective anti-corruption strategies at individual and institutional levels.</p><p><strong>Objective: </strong>The aim was to comprehensively collate the manifestations of different types of corruption in healthcare to illustrate prevailing patterns and trends and to provide policymakers, practitioners, and researchers with practical insights to inform research agendas, regulatory and governance strategies, and accountability measures.</p><p><strong>Method: </strong>We conducted a narrative review of scientific articles published between 2013 and 2022 using keyword searches in SCOPUS and EBSCO. We utilized the corruption typology proposed by the European Union and Thompson's Institutional Corruption Framework to systematically identify manifestations across different corruption types. The Prisma scheme was employed to document the selection process and ensure reproducibility.</p><p><strong>Findings: </strong>Bribery in medical service provision was the most frequently investigated form of corruption, revealing rather uniform manifestations. Misuse of high-level positions and networks and institutional corruption also received considerable attention, with a wide range of misconduct identified in institutional corruption. Extending the analysis to institutional corruption also deepened the understanding of misconduct in the context of improper marketing relations and highlighted the involvement of various stakeholders, including academia. The pandemic exacerbated the vulnerability of the healthcare sector to procurement corruption. Also, it fostered new types of misconduct related to the misuse of high-level positions and networks and fraud and embezzlement of medical drugs, devices, and services.</p><p><strong>Conclusions: </strong>The review spotlights criminal actions by individuals and networks and marks a notable shift towards systemic misconduct within specific types of corruption. The findings highlight the necessity of customized anti-corruption strategies throughout the healthcare sector. These insights are crucial for policymakers, practitioners, and researchers in guiding the formulation of legal frameworks at local and global levels, governance strategies, and research priorities.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"14 1","pages":"50"},"PeriodicalIF":2.7,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11241952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-10DOI: 10.1186/s13561-024-00524-4
Sharmily Roy, Henry Shelton Brown, Lisa Sanger Blinn, Sarah Carter Narendorf, Jane E Hamilton
{"title":"Correction: A microcosting approach for planning and implementing community‑based mental health prevention programs: what does it cost?","authors":"Sharmily Roy, Henry Shelton Brown, Lisa Sanger Blinn, Sarah Carter Narendorf, Jane E Hamilton","doi":"10.1186/s13561-024-00524-4","DOIUrl":"10.1186/s13561-024-00524-4","url":null,"abstract":"","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"14 1","pages":"49"},"PeriodicalIF":2.7,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11234761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141564810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-05DOI: 10.1186/s13561-024-00526-2
Hongyu Gong, Siew Chin Ong, Fan Li, Yan Shen, Zhiying Weng, Keying Zhao, Zhengyou Jiang, Meng Wang
Since 2017, immune checkpoint inhibitors (ICIs) have been available for the treatment of advanced hepatocellular carcinoma (HCC) or unresectable HCC, but their adoption into national medical insurance programs is still limited. Cost-effectiveness evidence can help to inform treatment decisions. This systematic review aimed to provide a critical summary of economic evaluations of ICIs as a treatment for advanced HCC and identify key drivers (PROSPERO 2023: CRD42023417391). The databases used included Scopus, Web of Science, PubMed, Embase, and Cochrane Central. Economic evaluations of ICIs for the treatment of advanced HCC were included. Studies were screened by two people. Of the 898 records identified, 17 articles were included. The current evidence showed that ICIs, including atezolizumab plus bevacizumab, sintilimab plus bevacizumab/bevacizumab biosimilar, nivolumab, camrelizumab plus rivoceranib, pembrolizumab plus lenvatinib, tislelizumab, durvalumab, and cabozantinib plus atezolizumab, are probably not cost-effective in comparison with tyrosine kinase inhibitors or other ICIs. The most influential parameters were price of anticancer drugs, hazard ratios for progression-free survival and overall survival, and utility for health statest. Our review demonstrated that ICIs were not a cost-effective intervention in advanced HCC. Although ICIs can significantly enhance the survival of patients with advanced HCC, decision-makers should consider the findings of economic evaluations and affordability before adoption of new therapies.
{"title":"Cost-effectiveness of immune checkpoint inhibitors as a first-line therapy for advanced hepatocellular carcinoma: a systematic review.","authors":"Hongyu Gong, Siew Chin Ong, Fan Li, Yan Shen, Zhiying Weng, Keying Zhao, Zhengyou Jiang, Meng Wang","doi":"10.1186/s13561-024-00526-2","DOIUrl":"10.1186/s13561-024-00526-2","url":null,"abstract":"<p><p>Since 2017, immune checkpoint inhibitors (ICIs) have been available for the treatment of advanced hepatocellular carcinoma (HCC) or unresectable HCC, but their adoption into national medical insurance programs is still limited. Cost-effectiveness evidence can help to inform treatment decisions. This systematic review aimed to provide a critical summary of economic evaluations of ICIs as a treatment for advanced HCC and identify key drivers (PROSPERO 2023: CRD42023417391). The databases used included Scopus, Web of Science, PubMed, Embase, and Cochrane Central. Economic evaluations of ICIs for the treatment of advanced HCC were included. Studies were screened by two people. Of the 898 records identified, 17 articles were included. The current evidence showed that ICIs, including atezolizumab plus bevacizumab, sintilimab plus bevacizumab/bevacizumab biosimilar, nivolumab, camrelizumab plus rivoceranib, pembrolizumab plus lenvatinib, tislelizumab, durvalumab, and cabozantinib plus atezolizumab, are probably not cost-effective in comparison with tyrosine kinase inhibitors or other ICIs. The most influential parameters were price of anticancer drugs, hazard ratios for progression-free survival and overall survival, and utility for health statest. Our review demonstrated that ICIs were not a cost-effective intervention in advanced HCC. Although ICIs can significantly enhance the survival of patients with advanced HCC, decision-makers should consider the findings of economic evaluations and affordability before adoption of new therapies.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"14 1","pages":"48"},"PeriodicalIF":2.7,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11225220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-03DOI: 10.1186/s13561-024-00529-z
Yakubu Adole Agada-Amade, Daniel Chukwuemeka Ogbuabor, Eric Obikeze, Ejemai Eboreime, Obinna Emmanuel Onwujekwe
Background: Significant gaps in scholarship on the cost-benefit analysis of haemodialysis exist in low-middle-income countries, including Nigeria. The study, therefore, assessed the cost-benefit of haemodialysis compared with comprehensive conservative care (CCC) to determine if haemodialysis is socially worthwhile and justifies public funding in Nigeria.
Methods: The study setting is Abuja, Nigeria. The study used a mixed-method design involving primary data collection and analysis of secondary data from previous studies. We adopted an ingredient-based costing approach. The mean costs and benefits of haemodialysis were derived from previous studies. The mean costs and benefits of CCC were obtained from a primary cross-sectional survey. We estimated the benefit-cost ratios (BCR) and net benefits to determine the social value of the two interventions.
Results: The net benefit of haemodialysis (2,251.30) was positive, while that of CCC was negative (-1,197.19). The benefit-cost ratio of haemodialysis was 1.09, while that of CCC was 0.66. The probabilistic and one-way sensitivity analyses results demonstrate that haemodialysis was more cost-beneficial than CCC, and the BCRs of haemodialysis remained above one in most scenarios, unlike CCC's BCR.
Conclusion: The benefit of haemodialysis outweighs its cost, making it cost-beneficial to society and justifying public funding. However, the National Health Insurance Authority requires additional studies, such as budget impact analysis, to establish the affordability of full coverage of haemodialysis.
{"title":"Cost-benefit analysis of haemodialysis in patients with end-stage kidney disease in Abuja, Nigeria.","authors":"Yakubu Adole Agada-Amade, Daniel Chukwuemeka Ogbuabor, Eric Obikeze, Ejemai Eboreime, Obinna Emmanuel Onwujekwe","doi":"10.1186/s13561-024-00529-z","DOIUrl":"10.1186/s13561-024-00529-z","url":null,"abstract":"<p><strong>Background: </strong>Significant gaps in scholarship on the cost-benefit analysis of haemodialysis exist in low-middle-income countries, including Nigeria. The study, therefore, assessed the cost-benefit of haemodialysis compared with comprehensive conservative care (CCC) to determine if haemodialysis is socially worthwhile and justifies public funding in Nigeria.</p><p><strong>Methods: </strong>The study setting is Abuja, Nigeria. The study used a mixed-method design involving primary data collection and analysis of secondary data from previous studies. We adopted an ingredient-based costing approach. The mean costs and benefits of haemodialysis were derived from previous studies. The mean costs and benefits of CCC were obtained from a primary cross-sectional survey. We estimated the benefit-cost ratios (BCR) and net benefits to determine the social value of the two interventions.</p><p><strong>Results: </strong>The net benefit of haemodialysis (2,251.30) was positive, while that of CCC was negative (-1,197.19). The benefit-cost ratio of haemodialysis was 1.09, while that of CCC was 0.66. The probabilistic and one-way sensitivity analyses results demonstrate that haemodialysis was more cost-beneficial than CCC, and the BCRs of haemodialysis remained above one in most scenarios, unlike CCC's BCR.</p><p><strong>Conclusion: </strong>The benefit of haemodialysis outweighs its cost, making it cost-beneficial to society and justifying public funding. However, the National Health Insurance Authority requires additional studies, such as budget impact analysis, to establish the affordability of full coverage of haemodialysis.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"14 1","pages":"47"},"PeriodicalIF":2.7,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11221004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-27DOI: 10.1186/s13561-024-00521-7
Yunhan Wang, Nan Jiang, Haiya Shao, Zhonghua Wang
Background: Given the rapid population aging in China, achieving universal health coverage (UHC) presents a primary challenge in addressing unmet healthcare needs and associated inequalities among middle-aged and older adults. Several studies have focused on healthcare utilization and its inequalities, but little attention has been paid to the inequality in unmet healthcare needs. This study aimed to analyze the inequalities in unmet the healthcare needs of middle-aged and older adults in eastern China during the progression toward UHC.
Methods: Data were obtained from the fourth, fifth, and sixth National Health Service Survey (NHSS) of Jiangsu Province, located in eastern China, during the years 2008, 2013, and 2018, respectively. Logistic regression models were used to assess the associated factors of unmet healthcare needs. The inequality was measured according to the concentration index (CI) and its decomposition.
Results: In this study, we found that 12.86%, 2.22%, and 48.89% of middle-aged and older adults reported unmet needs for outpatient and inpatient services and physical examinations, respectively. The prevalence of unmet outpatient needs increased from 2008 to 2018, while the prevalence of unmet inpatient services was lower but maintained. The prevalence of unmet needs for physical examinations among middle-aged and older adults markedly decreased since 2008. Rural areas had a higher prevalence of unmet needs for inpatient services and physical examinations than urban areas. Unmet healthcare needs were more prevalent among the poor. The pro-poor inequalities of unmet healthcare needs have been mitigated during the progression toward UHC; however, they remain predominant among rural middle-aged and older adults for outpatient and inpatient services. Socioeconomic factors significantly influenced unmet healthcare needs and contributed to their inequalities.
Conclusions: The findings characterize the prevalence and inequality of unmet healthcare need among middle-aged and older adults in eastern China during the progression toward UHC. Policy interventions should be actively advocated to effectively mitigate the unmet healthcare needs and address the associated inequalities.
{"title":"Exploring unmet healthcare needs and associated inequalities among middle-aged and older adults in Eastern China during the progression toward universal health coverage.","authors":"Yunhan Wang, Nan Jiang, Haiya Shao, Zhonghua Wang","doi":"10.1186/s13561-024-00521-7","DOIUrl":"10.1186/s13561-024-00521-7","url":null,"abstract":"<p><strong>Background: </strong>Given the rapid population aging in China, achieving universal health coverage (UHC) presents a primary challenge in addressing unmet healthcare needs and associated inequalities among middle-aged and older adults. Several studies have focused on healthcare utilization and its inequalities, but little attention has been paid to the inequality in unmet healthcare needs. This study aimed to analyze the inequalities in unmet the healthcare needs of middle-aged and older adults in eastern China during the progression toward UHC.</p><p><strong>Methods: </strong>Data were obtained from the fourth, fifth, and sixth National Health Service Survey (NHSS) of Jiangsu Province, located in eastern China, during the years 2008, 2013, and 2018, respectively. Logistic regression models were used to assess the associated factors of unmet healthcare needs. The inequality was measured according to the concentration index (CI) and its decomposition.</p><p><strong>Results: </strong>In this study, we found that 12.86%, 2.22%, and 48.89% of middle-aged and older adults reported unmet needs for outpatient and inpatient services and physical examinations, respectively. The prevalence of unmet outpatient needs increased from 2008 to 2018, while the prevalence of unmet inpatient services was lower but maintained. The prevalence of unmet needs for physical examinations among middle-aged and older adults markedly decreased since 2008. Rural areas had a higher prevalence of unmet needs for inpatient services and physical examinations than urban areas. Unmet healthcare needs were more prevalent among the poor. The pro-poor inequalities of unmet healthcare needs have been mitigated during the progression toward UHC; however, they remain predominant among rural middle-aged and older adults for outpatient and inpatient services. Socioeconomic factors significantly influenced unmet healthcare needs and contributed to their inequalities.</p><p><strong>Conclusions: </strong>The findings characterize the prevalence and inequality of unmet healthcare need among middle-aged and older adults in eastern China during the progression toward UHC. Policy interventions should be actively advocated to effectively mitigate the unmet healthcare needs and address the associated inequalities.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"14 1","pages":"46"},"PeriodicalIF":2.7,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11212176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141459875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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