In Colombia, health expenditure is highly concentrated, with a small portion of the population incurring most costs, particularly in rural areas. Men show greater inequality than women. The study suggests that current risk-adjustment models have opportunities for improvement, emphasizing the need for better health premium definitions and stronger health policies.
Objective: To examine a 2018 rule change allowing pediatric providers to bill the child's Medicaid ID for post-partum depression (PPD) screening of mothers conducted during well-child visits, and document its relationship with PPD treatment and infant hospitalizations.
Study setting and design: Screening rates during well-child visits are calculated at the zip code level and used in linear probability and Instrumental Variable (IV) models to examine increases in screening after the policy change and relate them to PPD treatment and infant hospitalizations.
Data sources and analytic sample: Individual-level Medicaid claims were used to compute PPD screening rates and measures of PPD treatment and infant hospitalization.
Principal findings: The policy was associated with increases in screening rates, although take up was uneven and overall screening rates remained low at 8.8%. There was little overall increase in treatment, although in zip codes in the top third of screening rates, higher screening was associated with 10.1% higher probability of maternal treatment. Zip codes with high fractions in poverty and/or minority had low screening rates, but screening was more likely to be associated with increases in treatment in these areas. There are no effects in the full sample of children, but among children above the poverty line, the observed increases in screening reduced the probability of infant hospitalization in the first six months by 7.7%.
Conclusions: The policy change had only limited success increasing screening, but increased screening could lead to more maternal PPD treatment and lower infant hospitalization rates if accompanied by expanded access to PPD treatment.
Background: The COVID-19 pandemic has been one of the most significant global health crises in recent years. This study aimed to assess the determinants of perceived financial threat of COVID-19 and its implications on household's economic stability in Ethiopia.
Methods: A cross-sectional study was conducted on 3058 households from the third round of the COVID-19 high-frequency phone survey of households (HFPS-HH) data, executed by the Central Statistical Agency of Ethiopia in partnership with the World Bank. The data were extracted and managed using STATA version 17. A partial proportional odds model was applied to assess the significant predictors that affect the perceived financial threat of COVID-19.
Result: The analysis revealed that 79.9% of respondents (95% CI: 78.5-81.4%) experienced some level of financial threat from the COVID-19 pandemic, with the majority of them (61.7%; 95% CI: 60.0-63.4%) perceiving it as a substantial financial threat. Key factors of financial threat included Age [AOR = 1.280, P = 0.008]; COVID-19 illness worry for substantial threat (AOR = 0.546, p < 0.001), for moderate threat (AOR = 0.562, P = 0.005)]; Ability to buy medicine for substantial threat [AOR = 0.546, p < 0.001], for moderate threat [AOR = 0.562, p = 0.005]; employed [AOR = 1.310, p = 0.014]; engagement in additional income activities for substantial threat [AOR = 3.428, p < 0.001], and for moderate threat [AOR = 3.043, P = 0.018].
Conclusion: The findings revealed that a significant proportion of respondents perceived COVID-19 as a financial threat, which adversely affected their economic stability. Vulnerability to financial threat was notably higher among older individuals, the unemployed, those unable to afford essential medicine, and respondents who expressed heightened concern about illness. In contrast, engagement in additional income-generating activities served as a protective factor. These results underscore the need for policymakers to prioritize inclusive social protection systems, expand access to affordable healthcare, promote employment opportunities, and facilitate income diversification. Such interventions are critical to enhancing household economic resilience and enabling a rapid response to future public health and economic crises. Additionally, future research should consider longitudinal designs to track changes in perceptions over time and incorporate broader economic indicators.
Background: Renal denervation (RDN) has been introduced as a novel non-pharmacological intervention for patients with hypertension that is poorly controlled by pharmacological means. Our study aims to evaluate the cost-effectiveness of the Netrod RDN treatment plus antihypertensives compared with antihypertensives alone for hypertension in Mainland China, Japan and Thailand.
Methods: A Markov decision-analytic model was developed to simulate the long-term clinical events, quality-adjusted life years (QALYs) and related costs among patients who underwent RDN regimen and antihypertensive regimen in line with Netrod-HTN trial, with yearly cycles over a 30-year horizon. This study adopted the perspectives of the healthcare systems. Cost and utility inputs were collected from published literature, price databases, expert consultations, and hospital information systems. Both costs and outcomes were discounted at a rate of 5%. Model validation, univariate and probabilistic sensitivity analyses, and scenario analyses were conducted to verify the robustness of the results.
Results: Compared with the antihypertensive regimen alone, the RDN regimen yielded a 30.61% reduction in cardiovascular, cerebral and renal events. Cost-effectiveness analysis showed the RDN regimen yielded the most favorable incremental cost-effectiveness ratio in Japan at $3,451 per QALY, followed by Thailand at $13,932 per QALY, and Mainland China at $19,049 per QALY. Sensitivity and scenario analyses confirmed the robustness of the findings.
Conclusions: Netrod RDN is a cost-effective intervention from the healthcare system perspective in Mainland China, Japan, and Thailand. However, its cost-effectiveness varies across countries, reflecting differences in socioeconomic contexts. In middle- and low-income countries, appropriate pricing strategies may play a key role in enhancing its affordability and cost-effectiveness.
Background: The difficulties in mobilizing financial resources in developing countries combined with the low level of health of populations reveal the need to seek levers for optimal use of available resources. This paper aims at analyzing the dynamics of the relationship between governance and public health expenditure in Côte d'Ivoire as part of the "health for all" policy.
Methods: The estimates show, from a cointegration model based on the ARDL (self-regressive with staggered delays) approach and causality in the sense of that corruption influences and causes the increase in public health expenditure in the long term.
Results: The results includes poor health outcomes due to the diversion of resources on budgetary allocations. A 1% increase in the level of corruption generates 0.9% short-term and 0.5% long-term decrease in public health spending. Also, causality indicates a unidirectional link between the two variables ranging from corruption to the level of public health resources.
Conclusions: The authorities should therefore strengthen the institutional framework and the quality of central and internal governance of vertical health structures and programs in order to induce better use of resources likely to improve health outcomes.
Background: The outbreak of COVID-19 posed significant health and economic challenges worldwide, prompting governments to implement various containment measures, including quarantine policies. This study examines the cost-benefit analysis of Iran's quarantine policy during the pandemic, evaluating its economic impact, public health outcomes, and overall effectiveness. The research explores the direct and indirect costs of quarantine, including reduced economic activity, government expenditures, and social consequences, while assessing the benefits in terms of lives saved, healthcare system relief, and long-term economic stability. Findings suggest that while quarantine measures imposed substantial financial burdens, they played a crucial role in controlling the virus's spread and preventing a greater economic and human toll. The study highlights the necessity of balancing public health interventions with economic sustainability, offering insights for future pandemic response strategies.
Methods: This study has used the cost-benefit analysis method. In the financial evaluation, benefits such as the reduction of fuel costs, gratuitous payments, and the benefit of credits paid to employees have been compared to expenses such as the average cost of corona treatment in the hospital and at home for the population of employees who have contracted the disease. Also, in the economic evaluation, the benefits of reducing electricity costs and food for employees, the willingness of people to pay the government for protective measures, and reducing overtime payments to employees compared to costs such as food for hospitalized employees, paying subsidies to employees and reducing GDP Has been studied.
Results: Application of quarantine is optimal from the view of government employees (financial point of view) with a benefit-cost ratio of 1.98, and the government's point of view (economic point of view) is cost-effective with a benefit-cost ratio of 2.68.
Conclusions: These results indicate that applying quarantine for employees benefits both the people and the government. Thus, the results of this study can be a guide for policymakers in managing similar disasters or the spread of other strains of the Coronavirus in the future.
Background: Public transportation, including high-speed rail (HSR), exerts a significant influence on people's health and health-related behaviors in various ways around the world. Several studies have investigated the impact of HSR on patients' health-seeking behavior, however, many issues regarding the impact of HSR remain to be investigated in depth. We aim to explore whether the effect of HSR on patients' health-seeking behavior crowds out the market for medical services in county regions based on China's practice.
Methods: The opening of two important HSR lines connecting two megacities in western China, Xi'an to Chengdu (opened on December 6, 2017) and Yinchuan to Xi'an (opened on December 26, 2020), were considered as quasi-experimental intervention, and Event Study and Synthetic Difference-in-Differences (DID) research design were applied in this study. A monthly report database about county-level hospitals of the health statistical data collection from 2017 to 2018 and 2020 to 2021 was used.
Results: There is no significant change in the total number of visits (TOV) and the number of bed days occupied by discharged persons (BDODP) in county-level hospitals before and after the opening of two major HSR lines being observed. The estimates of TOV from synthetic DID were 319.38 (95% CI, -761.01, 1399.77) and -915.69 (95% CI, -5079.07, 3247.68) for the two HSR lines, respectively. The estimates of BDODP from synthetic DID were -581.34 (95% CI, -1555.27, 392.59) and -960.62 (95% CI, -3932.40, 2011,17) for the two HSR lines, respectively. The results from the event study DID estimates are in line with the synthetic DID.
Conclusions: Our findings suggest that the construction of HSR does not substantially modify the utilization of medical services at the county level. Moreover the effect of the construction of HSR on the flow of patients to large hospitals may be an incremental effect. These findings hold important implications for infrastructure policy, suggesting that improvements in transportation can coexist with and perhaps even bolster local healthcare services without compromising their usage.
Health shocks are a critical driver of poverty in low- and middle-income countries (LMICs). This study investigates the impact of health shocks on household poverty risk in Nigeria and evaluates the protective capacity of existing health insurance mechanisms, using data from the 2023/2024 General Household Survey (n = 4,779 households). We first estimated household vulnerability using Chaudhuri's (2003) Vulnerability as Expected Poverty framework, addressing heteroskedasticity in consumption estimation via feasible generalized least squares. We then modeled the probability of household vulnerability following health shocks using probit regression. Finally, we implemented propensity score matching to isolate the effect of health shocks on households' vulnerability. Our results indicate that 56.1% and 59.2% of Nigerian households are vulnerable to poverty, using the international ($2.15/day) and national ($2.48/day) poverty lines, respectively. Vulnerable households are more prevalent in northern regions, rural areas, larger households, and poorer households. We found evidence that, based on the international poverty line, health shocks significantly increased the probability of household vulnerability (ATT = 0.053, SE = 0.023) compared to matched households without health shocks, with a slightly higher impact (ATT = 0.054, SE = 0.023) if using the national poverty line. Household size, dependency ratio, household head's education and employment status, and residence were significant predictors of vulnerability. Despite their potential, health insurance, covering only 2.2% of households, did not offer adequate protection against health shocks. This study provides robust evidence that health shocks increase households' vulnerability to poverty and perpetuate existing poverty. Financial protection measures need to be considered in broader poverty reduction policies.
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