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The effect of Covid-19 pandemic on the primary health care utilization and cost: an interrupted time series analysis.
IF 1.7 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2025-02-12 DOI: 10.1186/s12962-025-00606-y
Mohsen Bayati, Farhad Lotfi, Mehdi Bayati, Zahra Goudarzi

Background: Changes in the demand behavior for primary care during the covid-19 pandemic may translate into changes in the overall public health situation in Iran with the increase in the prevalence of non-communicable diseases.

Objective: The present study aimed to investigate the impact of the Covid-19 pandemic on the primary health care utilization and cost in Fars province of Iran.

Methods: Monthly utilization and cost of primary health care was extracted from the data base of Fars province branch of Iran Health Insurance Organization (IHIO) in Iran. The interrupted time series analysis (ITSA) was used to investigate the short-term and long-term effects of Covid-19 on the utilization and cost of primary health care.

Results: The mean difference test showed that the monthly utilization and cost of primary health care after Covid-19 has decreased significantly (64307 for utilization and 11581 US dollars for cost). The ITSA estimates showed that the number of monthly primary health care visits after Covid-19 has decreased significantly by 53,003 in the short term and 2,330 in the long term. Moreover, the cost of primary health care shows a significant decrease of $24,722 and $3,822 per month in the short term and in the long term, respectively.

Conclusion: It found a significant reduction in the utilization of primary health care. Considering the role of primary care in controlling the burden of chronic diseases, planning for active follow-up of patients with chronic conditions should be on the agenda.

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引用次数: 0
Cost-effectiveness and budget impact of covering Burkitt lymphoma in children under Ghana's National Health Insurance Scheme.
IF 1.7 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2025-01-27 DOI: 10.1186/s12962-025-00603-1
Richmond Owusu, Dakota Pritchard, Lieke Fleur Heupink, Godwin Gulbi, Brian Asare, Ivy Amankwah, Joycelyn Azeez, Martha Gyansa-Lutterodt, Lydia Dsane-Selby, Ruby Aileen Mensah, William Omane-Adjekum, Francis Ruiz, Mohamed Gad, Justice Nonvignon, Lumbwe Chola

Background: Childhood cancer is not a high priority in health care financing for many countries, including in Ghana. Delayed care seeking and treatment abandonment, often due to the financial burden of care seeking to families, are common reasons for a relatively low overall survival (OS) in low-and middle-income countries. In this study, we analyzed the cost-effectiveness of extending health insurance coverage to children with Burkitt lymphoma (BL) in Ghana.

Methods: We developed a Markov model in Microsoft Excel to estimate the costs and effects of BL treatment when National Health Insurance Scheme (NHIS) was provided compared to the status quo where NHIS does not cover care for childhood cancer. The analysis was undertaken from the societal and health system (payer) perspective. Both costs (measured in $) and effects, measured using disability adjusted life years (DALYs), were discounted at a rate of 3%. The time horizon was a lifetime. Probabilistic sensitivity analysis was done to assess uncertainty in the measurement of the incremental cost-effectiveness ratio (ICER). A budget impact analysis was undertaken from the perspective of the NHIS.

Results: In the base-case analysis, the intervention (NHIS reimbursed treatment) was less costly than current practice ($8,302 vs $9,558). The intervention was also more effective with less DALYs per patient than the standard of care (17.6 vs 23.33). The ICER was -$219 per DALY averted from societal perspective and $113 per DALY averted from health system perspective. The probabilistic sensitivity analysis showed that the intervention is likely to be both less costly and more effective than current practice in 100% of the 1,000 simulations undertaken.

Conclusion: Providing health insurance coverage to children with BL is potentially cost-effective. The effectiveness and cost-savings relating to this strategy is driven by its positive impact on treatment initiation and retention. Based on this evidence, there has been a policy change where Ghana's NHIS has prioritized financing for cancer treatment in children.

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引用次数: 0
Validation of the PECUNIA reference unit costs templates in Spain: a useful tool for multi-national economic evaluations of health technologies. 在西班牙验证PECUNIA参考单位成本模板:一个对卫生技术进行多国经济评价的有用工具。
IF 1.7 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-12-18 DOI: 10.1186/s12962-024-00601-9
Lidia García-Pérez, Renata Linertová, Aránzazu Hernández-Yumar, Cristina Valcárcel-Nazco, Jhoner Perdomo-Vielma, Pedro Serrano-Aguilar, Mencia R Gutierrez-Colosia, Luis Salvador-Carulla, Enrique Fernández-Vega, Susanne Mayer, Judit Simon

Background: The PECUNIA Project was funded by the H2020 programme in which 10 partners from six countries participated. The aim was to develop standardized, harmonized and validated methods and tools to calculate costs in different sectors (such as health and social care, education among others), with the purpose of facilitating comparability of economic evaluations of health technologies across European countries. In this paper we report the first validation of the developed reference unit cost templates in Spain.

Methods: The evaluation of the PECUNIA Reference Unit Cost (RUC) Templates involved usability, transferability and feasibility assessment. Applicability tests were performed to estimate the cost of a selection of 15 resource items by means of the RUC templates in Spain and in four Spanish regions. External validation involved comparison with existing unit costs.

Results: It was possible to estimate the cost of five services (dental care and general practitioner in the Canary Islands, general practitioner in Spain [tariffs], health-related day care centre and education services provided in a special education school in the Basque Country), car vandalism as an example of potential health-related consequences, and informal care in Spain. The templates were feasible although data completeness depended on the type of data needed to estimate the costs. The templates are transferable across countries although comparability depends on the services available in each jurisdiction.

Conclusions: The PECUNIA RUC Templates are free and feasible tools to estimate comparable reference unit costs across countries. Although more validation exercises are needed, they seem useful tools to perform robust multi-national economic evaluations and increase the transferability of cost-effectiveness studies of health technologies in Europe. However, they cannot compensate for the lack of data across jurisdictions.

背景:PECUNIA项目由H2020计划资助,来自6个国家的10个合作伙伴参与了该计划。其目的是制定标准化、统一和有效的方法和工具来计算不同部门(如卫生和社会保健、教育等)的成本,以促进欧洲各国卫生技术经济评价的可比性。在本文中,我们报告了第一次验证开发的参考单位成本模板在西班牙。方法:对PECUNIA参考单位成本(RUC)模板进行可用性评估、可转移性评估和可行性评估。在西班牙和西班牙的四个地区,通过RUC模板进行了适用性测试,以估计选出的15个资源项目的成本。外部验证包括与现有单位成本的比较。结果:可以估计五项服务的成本(加那利群岛的牙科保健和全科医生,西班牙的全科医生[关税],与健康有关的日托中心和巴斯克地区一所特殊教育学校提供的教育服务),以汽车破坏为例,可能与健康有关的后果,以及西班牙的非正式护理。尽管数据的完整性取决于估算成本所需的数据类型,但模板是可行的。这些模板可在各国之间转让,但可比性取决于每个司法管辖区提供的服务。结论:PECUNIA RUC模板是估算各国可比参考单位成本的免费且可行的工具。虽然需要更多的验证工作,但它们似乎是进行强有力的多国经济评价和增加欧洲卫生技术成本效益研究的可转移性的有用工具。然而,它们无法弥补跨司法管辖区数据的缺乏。
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引用次数: 0
Itemized point cost method in human resource cost accounting in medical service projects. 医疗服务项目人力资源成本核算中的分项点成本法。
IF 1.7 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-12-18 DOI: 10.1186/s12962-024-00599-0
Yingqi Li, Siyuan Liang, Kui Qin, Hongtong Su, Peiyong Xia

Background: The cost accounting of medical service projects forms the basis for disease cost accounting and DRG (Diagnosis-Related Groups) cost accounting. Among the various costs involved, human resources represent a significant portion and are highly complex, making their accurate accounting a critical and challenging aspect of cost accounting for medical service projects.

Methods: This paper introduces the itemized point cost (IPC) method, a novel cost accounting approach based on the RBRVS (Resource-Based Relative Value Scale) theory. It outlines the core concepts of "points" and "process steps" within the IPC framework and details its application in human cost accounting. An example of impacted tooth extraction in the stomatology department of Hospital A is used to illustrate the IPC method's implementation process.

Findings: A comparative analysis with activity-based costing and time-estimation costing methods shows that the IPC method is concise, practical, and operable. It is also aligned with the principles of cost-effectiveness.

Conclusions: The paper proposes strategies to promote the IPC method, including leveraging information technology, enhancing top-level design, and standardizing processes, to improve its adoption and effectiveness in medical cost accounting.

背景:医疗服务项目成本核算是疾病成本核算和诊断相关组(DRG)成本核算的基础。在所涉及的各种成本中,人力资源占很大一部分,而且非常复杂,使其准确核算成为医疗服务项目成本核算的一个关键和具有挑战性的方面。方法:介绍了一种基于资源基础相对价值量表(RBRVS)理论的成本核算新方法——分项点成本法(IPC)。它概述了IPC框架内的“点”和“过程步骤”的核心概念,并详细介绍了其在人力成本会计中的应用。以A医院口腔科埋伏牙拔牙为例,说明IPC方法的实施过程。结果:与作业成本法和时间估算成本法的对比分析表明,IPC方法简洁、实用、可操作性强。它也符合成本效益原则。结论:本文提出了利用信息技术、加强顶层设计、规范流程等策略来推广IPC方法,以提高其在医疗成本核算中的采用率和有效性。
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引用次数: 0
IAPN: a simple framework for evaluating whether a population-based risk stratification tool will be cost-effective before implementation. IAPN:一个简单的框架,用于评估基于人群的风险分层工具在实施前是否具有成本效益。
IF 1.7 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-12-04 DOI: 10.1186/s12962-024-00594-5
Steven Wyatt, Mohammed A Mohammed, Peter Spilsbury

Risk prediction tools are widely used in healthcare to identify individuals at high risk of adverse events who may benefit from proactive interventions. Traditionally, these tools are evaluated primarily on statistical performance measures-such as sensitivity, specificity, discrimination, and positive predictive value (PPV)-with minimal attention given to their cost-effectiveness. As a result, while many published tools report high performance statistics, evidence is limited on their real-world efficacy and potential for cost savings. To address this gap, we propose a straightforward framework for evaluating risk prediction tools during the design phase, which incorporates both PPV and intervention effectiveness, measured by the number needed to treat (NNT). This framework shows that to be cost-effective, the per-unit cost of an intervention (I) must be less than the average cost of the adverse event (A) multiplied by the PPV-to-NNT ratio: I < A*PPV/NNT. This criterion enables decision-makers to assess the economic value of a risk prediction tool before implementation.

风险预测工具在医疗保健中广泛用于识别可能从主动干预中受益的高危不良事件个体。传统上,这些工具的评估主要基于统计性能指标,如敏感性、特异性、辨别力和阳性预测值(PPV),而很少关注其成本效益。因此,尽管许多已发布的工具报告了高性能统计数据,但证据有限,无法证明它们在现实世界中的有效性和节省成本的潜力。为了解决这一差距,我们提出了一个在设计阶段评估风险预测工具的简单框架,该框架结合了PPV和干预有效性,通过治疗所需的数量(NNT)来衡量。该框架表明,为了具有成本效益,干预措施的单位成本(I)必须小于不良事件的平均成本(A)乘以ppv - nnt比率:I
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引用次数: 0
Cost of the national malaria control program and cost-effectiveness of indoor residual spraying and insecticide-treated bed net interventions in two districts of Madagascar. 马达加斯加两个地区国家疟疾控制规划的成本以及室内滞留喷洒和驱虫蚊帐干预措施的成本效益。
IF 1.7 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-12-03 DOI: 10.1186/s12962-024-00598-1
Voahirana Tantely Annick Andrianantoandro, Martine Audibert, Thomas Kesteman, Léonora Ravolanjarasoa, Milijaona Randrianarivelojosia, Christophe Rogier

Background: Madagascar has made significant progress in the fight against malaria. However, the number of malaria cases yearly increased since 2012. ITNs and IRS are key interventions for reducing malaria in Madagascar. Given the increasing number of cases and limited resources, understanding the cost-effectiveness of these strategies is essential for policy development and resource allocation.

Methods: Using a societal perspective, this study aims to estimate the cost of the National Malaria Control Program (NMCP) through the first national malaria strategic plan (implemented over the period 2009-2013) and to assess the cost-effectiveness of two individually implemented malaria control interventions (ITNs and IRS) in two districts, Ankazobe and Brickaville. The cost-effectiveness ratio (CER) of ITN intervention was then compared to the CER of IRS intervention to identify the most cost-effective intervention. The cost of the NMCP and the costs incurred in the implementation of each intervention at the district level were initially estimated. On the basis of two results, the CERs of ITN or IRS correspond to the total cost of ITN or IRS divided by the number of people protected or the number of disability-adjusted life years (DALYs) averted. A deterministic univariate sensitivity analysis was conducted to assess the robustness of the results with a discount rate of 2.5% (0-5%) (costs and DALYs) and a 95% CI (person protected).

Results: From 2009 to 2013, the NMCP cost USD 45.4 million (USD 43.5-47.5, r = 0-5%) per year, equivalent to USD 2.0 per capita per year. IRS implementation costs were four times higher than those of ITNs. The CER of IRS per case protected (USD 295.1 [285.1-306.1], r = 0-5%) was higher than the CER of ITNs (USD 48.6 [USD 46.0-51.5, r = 0-5%] in Ankazobe and USD 26.5 [USD 24.8-28.4, r = 0-5%] in Brickaville). The CERs per DALY averted of IRS was USD 427.6 [USD 413.0-546.3, r = 0-5%] in Ankazobe and, for ITNs, it was USD 85.4 [USD 80.8-90.5, r = 0-5%] in Ankazobe and USD 45.3 [USD 42.2-48.4, r = 0-5%] in Brickaville. Compared to the country GDP per capita (USD PPP 1494.6 in 2013), ITN intervention was "highly cost-effective" while the CER for IRS interventions was sensitive to parameter variation (CI, 95% of persons protected), which ranges from highly cost-effective to only cost-effective (USD 291.5-2004, r = 2.5%).

Conclusion: In the Malagasy context, IRS intervention cost more and was less effective than ITN intervention. Willingness to pay for IRS is questioned. A relevant budget impact analysis should be conducted before a potential extension of this intervention.

背景:马达加斯加在防治疟疾方面取得了重大进展。然而,自2012年以来,疟疾病例数每年都在增加。ITNs和IRS是马达加斯加减少疟疾的关键干预措施。鉴于案例数量不断增加而资源有限,了解这些战略的成本效益对于政策制定和资源分配至关重要。方法:本研究旨在从社会角度出发,通过首个国家疟疾战略计划(2009-2013年实施)估算国家疟疾控制规划(NMCP)的成本,并评估在Ankazobe和Brickaville两个地区单独实施的两项疟疾控制干预措施(ITNs和IRS)的成本效益。然后将ITN干预的成本效益比(CER)与IRS干预的成本效益比进行比较,以确定最具成本效益的干预措施。初步估计了NMCP的成本以及在地区一级实施每项干预措施所产生的成本。基于两个结果,ITN或IRS的CERs对应于ITN或IRS的总成本除以受保护的人数或避免的残疾调整生命年(DALYs)的数量。采用确定性单变量敏感性分析评估结果的稳健性,折现率为2.5%(0-5%)(成本和DALYs), CI为95%(受保护人员)。结果:2009 - 2013年,NMCP每年花费4540万美元(43.5-47.5美元,r = 0-5%),相当于人均每年2.0美元。IRS的实施成本是ITNs的四倍。每例受保护的IRS的CER(295.1美元[285.1 ~ 306.1美元],r = 0 ~ 5%)高于ITNs的CER (Ankazobe为48.6美元[46.0 ~ 51.5美元,r = 0 ~ 5%], Brickaville为26.5美元[24.8 ~ 28.4美元,r = 0 ~ 5%])。在Ankazobe, IRS避免的每DALY CERs为427.6美元[413.0-546.3美元,r = 0-5%],在Ankazobe, ITNs为85.4美元[80.8-90.5美元,r = 0-5%],在Brickaville为45.3美元[42.2-48.4美元,r = 0-5%]。与国家人均GDP(2013年美元购买力平价为1494.6)相比,ITN干预具有“高成本效益”,而IRS干预的CER对参数变化很敏感(CI, 95%的受保护人员),其范围从高成本效益到仅成本效益(291.5-2004美元,r = 2.5%)。结论:在马达加斯加,IRS干预比ITN干预成本更高,效果更差。支付国税局的意愿受到质疑。在可能延长这一干预之前,应进行有关的预算影响分析。
{"title":"Cost of the national malaria control program and cost-effectiveness of indoor residual spraying and insecticide-treated bed net interventions in two districts of Madagascar.","authors":"Voahirana Tantely Annick Andrianantoandro, Martine Audibert, Thomas Kesteman, Léonora Ravolanjarasoa, Milijaona Randrianarivelojosia, Christophe Rogier","doi":"10.1186/s12962-024-00598-1","DOIUrl":"10.1186/s12962-024-00598-1","url":null,"abstract":"<p><strong>Background: </strong>Madagascar has made significant progress in the fight against malaria. However, the number of malaria cases yearly increased since 2012. ITNs and IRS are key interventions for reducing malaria in Madagascar. Given the increasing number of cases and limited resources, understanding the cost-effectiveness of these strategies is essential for policy development and resource allocation.</p><p><strong>Methods: </strong>Using a societal perspective, this study aims to estimate the cost of the National Malaria Control Program (NMCP) through the first national malaria strategic plan (implemented over the period 2009-2013) and to assess the cost-effectiveness of two individually implemented malaria control interventions (ITNs and IRS) in two districts, Ankazobe and Brickaville. The cost-effectiveness ratio (CER) of ITN intervention was then compared to the CER of IRS intervention to identify the most cost-effective intervention. The cost of the NMCP and the costs incurred in the implementation of each intervention at the district level were initially estimated. On the basis of two results, the CERs of ITN or IRS correspond to the total cost of ITN or IRS divided by the number of people protected or the number of disability-adjusted life years (DALYs) averted. A deterministic univariate sensitivity analysis was conducted to assess the robustness of the results with a discount rate of 2.5% (0-5%) (costs and DALYs) and a 95% CI (person protected).</p><p><strong>Results: </strong>From 2009 to 2013, the NMCP cost USD 45.4 million (USD 43.5-47.5, r = 0-5%) per year, equivalent to USD 2.0 per capita per year. IRS implementation costs were four times higher than those of ITNs. The CER of IRS per case protected (USD 295.1 [285.1-306.1], r = 0-5%) was higher than the CER of ITNs (USD 48.6 [USD 46.0-51.5, r = 0-5%] in Ankazobe and USD 26.5 [USD 24.8-28.4, r = 0-5%] in Brickaville). The CERs per DALY averted of IRS was USD 427.6 [USD 413.0-546.3, r = 0-5%] in Ankazobe and, for ITNs, it was USD 85.4 [USD 80.8-90.5, r = 0-5%] in Ankazobe and USD 45.3 [USD 42.2-48.4, r = 0-5%] in Brickaville. Compared to the country GDP per capita (USD PPP 1494.6 in 2013), ITN intervention was \"highly cost-effective\" while the CER for IRS interventions was sensitive to parameter variation (CI, 95% of persons protected), which ranges from highly cost-effective to only cost-effective (USD 291.5-2004, r = 2.5%).</p><p><strong>Conclusion: </strong>In the Malagasy context, IRS intervention cost more and was less effective than ITN intervention. Willingness to pay for IRS is questioned. A relevant budget impact analysis should be conducted before a potential extension of this intervention.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"89"},"PeriodicalIF":1.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Controversies in implementing the exemption policy for the elderly healthcare services in Tanzania: experiences from the priority setting process in two selected districts. 在坦桑尼亚实施老年人保健服务豁免政策方面的争议:来自两个选定地区确定优先事项过程的经验。
IF 1.7 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-12-03 DOI: 10.1186/s12962-024-00595-4
Malale Tungu, Nathanael Sirili, Alphoncina Kagaigai, Pankras Luoga, Novatus Tesha, Thadeus Ruwaichi, Gasto Frumence

Background: Health financing system in Tanzania changed in the early 1990s as a result of the introduction of cost-sharing policies by the 1990s health sector reforms. The reforms brought about user fees which has led to inequity in access to health care services and catastrophic health expenditure among the elderly. In efforts to reduce the inequity gap among vulnerable groups, in 1994, the government introduced an exemption and waiver policy. More than three decades later, inequity in health care services access has persisted with the elderly population being more affected. The latter poses questions on the implementation efficiency of the exemption policy. We aimed to assess the implementation of the exemption policy on access to health services among the elderly in Tanzania by learning from the experiences of the priority setting process in two districts of western Tanzania.

Methods: An exploratory qualitative case study adopting Key informant interviews (KIIs) was used to collect data in Nzega and Igunga districts. The key informants involved the representatives of the planning team and decision makers from the community, health facility and district level. Information saturation was attained after the 24th interview and thus data collection ended. The content analysis approach was used to analyse the data.

Findings: Although there is a designated office that deals with exemptions for the elderly in health facilities, there are challenges in accessing health services. The challenges include insufficient drugs, some laboratory tests not covered by the exemption, a lengthy process to access service, poor financial mechanisms for exempted services, inadequate information and clarity of the exemption categories, and limited to no involvement of different stakeholders in the exemption process.

Conclusion: The exemption policy was introduced to help disadvantaged groups, including the elderly. However, its implementation encountered challenges which burden both the elderly and the health facilities. Its implementation has thus become a controversy to its initial aim that was to relieve the elderly from high healthcare costs. Revisiting the policy through a thorough stakeholders' engagement and establishing alternative financing of the exemption policy are recommended.

背景:由于1990年代卫生部门改革引入了费用分摊政策,坦桑尼亚的卫生筹资制度在1990年代初发生了变化。改革带来了用户收费,这导致了获得保健服务的不平等和老年人的灾难性保健支出。为了缩小弱势群体之间的不平等差距,政府于1994年推出了豁免和豁免政策。30多年后,在获得保健服务方面的不平等现象依然存在,老年人受到的影响更大。后者对豁免政策的执行效率提出了质疑。我们的目的是通过学习坦桑尼亚西部两个地区确定优先事项进程的经验,评估坦桑尼亚老年人获得保健服务豁免政策的执行情况。方法:采用关键举报人访谈法(KIIs)在恩泽加和伊贡加地区进行探索性定性案例研究。主要的举报人包括规划小组的代表以及社区、保健设施和地区一级的决策者。第24次访谈后信息饱和,数据收集结束。采用内容分析法对数据进行分析。调查结果:虽然有一个指定的办公室处理保健设施中老年人的豁免问题,但在获得保健服务方面存在挑战。面临的挑战包括药品不足、豁免不包括一些实验室测试、获得服务的过程漫长、豁免服务的财务机制不健全、豁免类别的信息和透明度不足,以及不同利益攸关方没有参与豁免程序。结论:出台免征政策,帮助包括老年人在内的弱势群体。然而,它的执行遇到了挑战,给老年人和保健设施都带来了负担。因此,它的实施已经成为对其最初目标的争议,该目标是减轻老年人的高额医疗费用。建议通过利益相关者的全面参与重新审视该政策,并为豁免政策建立替代融资。
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引用次数: 0
Assessing diagnosis-related groups based direct medical expenditures of chronic disease patients in general hospital of lower southern Thailand. 评估泰国南部综合医院慢性病患者基于诊断相关组别的直接医疗支出。
IF 1.7 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-11-27 DOI: 10.1186/s12962-024-00596-3
Akemat Wongpairin, Apiradee Lim, Phattrawan Tongkumchum, Wichayaporn Thongpeth, Haris Khurram

Background: Assessment of the cost-related burden of chronic diseases is important for making informed decisions. An effective and efficient methodology for examining medical expenditures is one of the most significant challenges for stakeholders. The objective of this study was to examine the role of the variables of diagnosis-related group (DRG) in determining the direct expense of chronic diseases in lower southern Thailand and suggest the determinants having high explainability.

Methods: The records of 6,147 patients admitted to Satun Hospital from 2014 to 2018 and diagnosed with chronic conditions were analyzed in this study. Descriptive analysis was used to summarize the main characteristics. Correlation was used to analyze the strength of the relationship. A log-linear regression model was used to evaluate the adjusted mean cost using determinants of DRG.

Results: The overall average medical expense for chronic disease was Thailand Baht (THB) 17,985. Chronic kidney and chronic obstructive pulmonary diseases were the most expensive chronic diseases with an average expense of about THB 20,000 and 25,000. All the determinants were significantly contributing to overall expense of chronic disease with a p-value < 0.001. However, the length of stay, number of diagnoses, and number of procedures had high explainability in the expense model.

Conclusions: The expense assessment model plays a significant role in controlling and preventing the medical costs associated with chronic diseases. Healthcare administrators, stakeholders, and researchers need to make strategies by considering the results of this study to improve the DRGs-based hospital cost model.

背景:评估慢性病与成本相关的负担对于做出明智的决策非常重要。对于利益相关者来说,有效和高效的医疗支出审查方法是最重大的挑战之一。本研究旨在探讨诊断相关组(DRG)变量在确定泰国南部较低地区慢性病直接费用中的作用,并提出具有高度可解释性的决定因素:本研究分析了沙吞医院从 2014 年至 2018 年收治的 6147 名慢性病患者的病历。采用描述性分析总结主要特征。相关性用于分析关系的强度。采用对数线性回归模型,利用 DRG 的决定因素评估调整后的平均费用:慢性病的总体平均医疗费用为 17,985 泰铢。慢性肾病和慢性阻塞性肺病是最昂贵的慢性病,平均费用分别约为 20,000 泰铢和 25,000 泰铢。所有决定因素都对慢性病的总体费用有明显影响,P 值为 结论:费用评估模型在慢性病的费用评估中发挥了重要作用:费用评估模型在控制和预防与慢性病相关的医疗费用方面发挥着重要作用。医疗管理者、利益相关者和研究人员需要根据本研究的结果制定策略,以改进基于 DRGs 的医院费用模型。
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引用次数: 0
Health system efficiency and equity in ASEAN: an empirical investigation. 东盟卫生系统的效率与公平:实证调查。
IF 1.7 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-11-26 DOI: 10.1186/s12962-024-00588-3
Yaqing Liu, Liwen Gong, Haoran Niu, Feng Jiang, Sixian Du, Yiyun Jiang

Background: Equity and efficiency are two fundamental principles for the sound development of health systems, as advocated by the World Health Organization (WHO). Despite the notable progress made by the Association of Southeast Asian Nations (ASEAN) in advancing their health systems, gaps persist in achieving global health goals. This paper examines the efficiency of health system stages and the fairness of health resource distribution in ASEAN countries, analyzes the underlying causes of the existing gaps, and suggests potential solutions to bridge them.

Methods: Data spanning 2011 to 2019, sourced from the WHO Global Health Observatory and the World Bank Database, form the foundation of this study. This study employs an enhanced two-stage data envelopment analysis (DEA) to assess the efficiency of health system stages in ASEAN countries. Equity in health resource distribution is evaluated using health resource agglomeration degree and concentration curves across demographic, geographic, and economic aspects. Furthermore, the Entropy-Weighted TOPSIS method is utilized to integrate equity across these dimensions, measuring the overall fairness in health resource allocation across different countries. Finally, rankings of health system fairness and efficiency are compared to assess the overall development level of health systems.

Results: The overall efficiency of the ASEAN health systems from 2011 to 2019 averaged 0.231, with an upward trend in the first stage efficiency at 0.559 and a downward trend in the second stage at 0.502. The health resource agglomeration degree indicated that Singapore, Brunei, and Malaysia had HRAD and HRPD values significantly greater than 1, and Cambodia, Myanmar, and Laos predominantly had indices significantly less than 1. The concentration curve for hospital beds was the closest to the line of absolute equity. During the study period, the health resource concentration curve increasingly approached absolute equity, shifting from above to below the concentration curve. Singapore, Brunei, and Malaysia consistently remained in the first quadrant of the quadrant plot, and Myanmar and Cambodia were consistently in the third quadrant.

Conclusion: ASEAN countries face two key challenges in their healthcare systems: first, while many nations such as Indonesia, Thailand, and Vietnam have improved resource allocation efficiency, this hasn't yet translated into better health services. To address this, establishing national health sector steering committees, focusing on workforce training and retention, and implementing centralized monitoring systems are crucial. Second, there is a growing disparity in healthcare development across ASEAN. Promoting balanced resource distribution and leveraging ASEAN's economic integration for regional collaboration will help bridge these gaps and foster more equitable healthcare systems.

背景:公平和效率是世界卫生组织(WHO)倡导的健全卫生系统发展的两大基本原则。尽管东南亚国家联盟(东盟)在推进其卫生系统方面取得了显著进展,但在实现全球卫生目标方面仍存在差距。本文研究了东盟国家卫生系统各阶段的效率和卫生资源分配的公平性,分析了造成现有差距的根本原因,并提出了缩小差距的潜在解决方案:本研究的基础数据来自世界卫生组织全球卫生观察站和世界银行数据库,时间跨度为 2011 年至 2019 年。本研究采用增强型两阶段数据包络分析法(DEA)评估东盟国家卫生系统各阶段的效率。利用卫生资源集聚程度和人口、地理和经济方面的集中曲线来评估卫生资源分配的公平性。此外,还利用熵加权 TOPSIS 方法整合这些维度的公平性,衡量不同国家卫生资源分配的整体公平性。最后,通过比较卫生系统公平性和效率的排名来评估卫生系统的整体发展水平:从 2011 年到 2019 年,东盟卫生系统的整体效率平均为 0.231,第一阶段效率为 0.559,呈上升趋势,第二阶段效率为 0.502,呈下降趋势。卫生资源集聚度表明,新加坡、文莱和马来西亚的 HRAD 和 HRPD 值显著大于 1,柬埔寨、缅甸和老挝的指数主要显著小于 1,医院床位的集聚曲线最接近绝对公平线。在研究期间,卫生资源集中曲线越来越接近绝对公平线,从集中曲线的上方转到下方。新加坡、文莱和马来西亚始终位于曲线的第一象限,缅甸和柬埔寨始终位于第三象限:东盟国家的医疗保健系统面临两大挑战:首先,虽然印尼、泰国和越南等许多国家提高了资源分配效率,但这尚未转化为更好的医疗服务。为解决这一问题,建立国家卫生部门指导委员会、重视劳动力培训和保留以及实施中央监控系统至关重要。其次,东盟各国医疗卫生发展的差距越来越大。促进资源的均衡分配,利用东盟的经济一体化促进地区合作,将有助于缩小这些差距,建立更加公平的医疗保健体系。
{"title":"Health system efficiency and equity in ASEAN: an empirical investigation.","authors":"Yaqing Liu, Liwen Gong, Haoran Niu, Feng Jiang, Sixian Du, Yiyun Jiang","doi":"10.1186/s12962-024-00588-3","DOIUrl":"10.1186/s12962-024-00588-3","url":null,"abstract":"<p><strong>Background: </strong>Equity and efficiency are two fundamental principles for the sound development of health systems, as advocated by the World Health Organization (WHO). Despite the notable progress made by the Association of Southeast Asian Nations (ASEAN) in advancing their health systems, gaps persist in achieving global health goals. This paper examines the efficiency of health system stages and the fairness of health resource distribution in ASEAN countries, analyzes the underlying causes of the existing gaps, and suggests potential solutions to bridge them.</p><p><strong>Methods: </strong>Data spanning 2011 to 2019, sourced from the WHO Global Health Observatory and the World Bank Database, form the foundation of this study. This study employs an enhanced two-stage data envelopment analysis (DEA) to assess the efficiency of health system stages in ASEAN countries. Equity in health resource distribution is evaluated using health resource agglomeration degree and concentration curves across demographic, geographic, and economic aspects. Furthermore, the Entropy-Weighted TOPSIS method is utilized to integrate equity across these dimensions, measuring the overall fairness in health resource allocation across different countries. Finally, rankings of health system fairness and efficiency are compared to assess the overall development level of health systems.</p><p><strong>Results: </strong>The overall efficiency of the ASEAN health systems from 2011 to 2019 averaged 0.231, with an upward trend in the first stage efficiency at 0.559 and a downward trend in the second stage at 0.502. The health resource agglomeration degree indicated that Singapore, Brunei, and Malaysia had HRAD and HRPD values significantly greater than 1, and Cambodia, Myanmar, and Laos predominantly had indices significantly less than 1. The concentration curve for hospital beds was the closest to the line of absolute equity. During the study period, the health resource concentration curve increasingly approached absolute equity, shifting from above to below the concentration curve. Singapore, Brunei, and Malaysia consistently remained in the first quadrant of the quadrant plot, and Myanmar and Cambodia were consistently in the third quadrant.</p><p><strong>Conclusion: </strong>ASEAN countries face two key challenges in their healthcare systems: first, while many nations such as Indonesia, Thailand, and Vietnam have improved resource allocation efficiency, this hasn't yet translated into better health services. To address this, establishing national health sector steering committees, focusing on workforce training and retention, and implementing centralized monitoring systems are crucial. Second, there is a growing disparity in healthcare development across ASEAN. Promoting balanced resource distribution and leveraging ASEAN's economic integration for regional collaboration will help bridge these gaps and foster more equitable healthcare systems.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"86"},"PeriodicalIF":1.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Coverage and distributional benefit-cost of rotavirus vaccine in Uganda: an analysis of routine health facility aggregated data. 乌干达轮状病毒疫苗的覆盖率和分配效益成本:对常规医疗机构汇总数据的分析。
IF 1.7 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-11-22 DOI: 10.1186/s12962-024-00586-5
Rornald Muhumuza Kananura, Gatien de Broucker, Anthony Ssebagereka, Aloysius Mutebi, Elizabeth Ekirapa Kiracho, Bryan Patenaude

Introduction: Owing to the lack of local cost and clinical effectiveness data in sub-Saharan Africa, economic evaluations of the rotavirus vaccine are still limited in the region. In this study, we utilize different data sources, including aggregated routine health information system data to examine the net benefits of the rotavirus vaccine in Uganda. We also present ways in which health facility data can be used to assess subnational vaccination coverage as well as the effect of the vaccine on diarrhoea hospitalization.

Methods: We used monthly health facility data collected between 2015 and 2021 to study the relationship between rollout of rotavirus vaccine and diarrhoea hospitalization. We gathered information from empirical studies on the cost of diarrhoea (household and health facility) and vaccine administration to estimate the costs averted due to the rotavirus vaccine. As household costs, we considered out-of-pocket payments associated with the episodes of diarrhoea and the productivity loss associated with time spent on treatment and with mortality using a human capital approach. Finally, we employed an interrupted time series analysis to examine the effect of rotavirus vaccine on diarrhoea hospitalization. Costs are presented in 2018 US dollars.

Results: As of 2021, nationwide coverage of the first and second doses of the rotavirus vaccine (RV) in Uganda was estimated at 89% and 65% respectively, with variations observed across the regions. The study revealed a decrease in diarrhoea hospitalization by 1% for each 1% increase in RV coverage. Moreover, the study showed that diarrhoea hospitalization reduced by 2% for each additional month post- vaccine rollout. Excluding productivity losses due to mortality, the analyses of costs averted due to the RV reveal that between 2018 and 2021, Uganda saved approximately $57 million ($7 per capita) in expenses associated with diarrhoea. The return on investment (ROI) due to RV was calculated to be $1.48 per dollar invested. When including mortality costs, the net benefit reached up to $3 billion in economic cost ($385 per capita), and an ROI of $78 overall. Furthermore, the study demonstrated that RV provided substantial health benefits, particularly for socially disadvantaged groups. Excluding mortality costs, the ROI for the two most disadvantaged groups ranged from $1.71 to $2.03 per dollar spent, while for the remaining groups, it ranged from $1.10 to $1.14.

Conclusion: This manuscript stresses the importance of RV in alleviating the burden of diarrhoeal diseases and associated costs in Uganda. The study not only emphasizes the tangible benefits derived from the vaccine but also highlights the role of routine aggregated healthcare information systems in systematically monitoring the effectiveness and coverage of interventions.

导言:由于撒哈拉以南非洲地区缺乏当地的成本和临床效果数据,该地区对轮状病毒疫苗的经济评估仍然有限。在本研究中,我们利用不同的数据来源,包括常规卫生信息系统的汇总数据,来考察轮状病毒疫苗在乌干达的净效益。我们还介绍了如何利用卫生机构数据评估次国家级疫苗接种覆盖率以及疫苗对腹泻住院治疗的影响:我们利用在 2015 年至 2021 年间收集的每月医疗机构数据来研究轮状病毒疫苗的推广与腹泻住院率之间的关系。我们从有关腹泻(家庭和医疗机构)和疫苗接种成本的实证研究中收集了信息,以估算轮状病毒疫苗避免的成本。作为家庭成本,我们考虑了与腹泻发作相关的自付费用以及与治疗时间相关的生产力损失,并采用人力资本方法考虑了死亡率。最后,我们采用了间断时间序列分析法来研究轮状病毒疫苗对腹泻住院治疗的影响。成本以 2018 美元为单位:截至 2021 年,乌干达轮状病毒疫苗(RV)第一剂和第二剂的全国覆盖率估计分别为 89% 和 65%,各地区之间存在差异。研究显示,轮状病毒疫苗覆盖率每提高 1%,腹泻住院率就会降低 1%。此外,研究还显示,疫苗推广后每增加一个月,腹泻住院人数就会减少 2%。如果不考虑死亡率造成的生产力损失,对因流脑疫苗而避免的成本进行的分析表明,2018 年至 2021 年期间,乌干达在腹泻相关费用方面可节省约 5700 万美元(人均 7 美元)。根据计算,每投资 1 美元,可获得 1.48 美元的投资回报(ROI)。如果将死亡率成本计算在内,净收益可达 30 亿美元的经济成本(人均 385 美元),总体投资回报率为 78 美元。此外,研究还表明,房车还能带来巨大的健康效益,尤其是对社会弱势群体而言。除去死亡率成本,两个最弱势群体每花费 1 美元的投资回报率从 1.71 美元到 2.03 美元不等,而其余群体的投资回报率则从 1.10 美元到 1.14 美元不等:本手稿强调了 RV 在减轻乌干达腹泻疾病负担和相关成本方面的重要性。该研究不仅强调了疫苗带来的实际益处,还突出了常规综合医疗信息系统在系统监测干预措施的有效性和覆盖面方面的作用。
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引用次数: 0
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