International Journal of Health Services最新文献

To control pharmaceutical spending and improve access, the United States could adopt strategies similar to those introduced in Germany by the 2011 German Pharmaceutical Market Reorganization Act. In Germany, manufacturers sell new drugs immediately upon receiving marketing approval. During the first year, the German Federal Joint Committee assesses new drugs to determine their added medical benefit. It assigns them a score indicating their added benefit. New drugs comparable to drugs in a reference price group are assigned to that group and receive the same reimbursement, unless they are therapeutically superior. The National Association of Statutory Health Insurance Funds then negotiates with manufacturers the maximum reimbursement starting the 13th month, consistent with the drug's added benefit assessment and price caps in other European countries. In the absence of agreement, an arbitration board sets the price. Manufacturers accept the price resolution or exit the market. Thereafter, prices generally are not increased, even for inflation. US public and private insurers control prices in diverse ways, but typically obtain discounts by designating certain drugs as preferred and by restricting patient access or charging high copayment for nonpreferred drugs. This article draws 10 lessons for drug pricing reform in US federal programs and private insurance.

The purpose of this study is to find the demographic factors associated with the spread of COVID-19 and to suggest a measure for identifying the effectiveness of government policies in controlling COVID-19. The study hypothesizes that the cumulative number of confirmed COVID-19 patients depends on the urban population, rural population, number of persons older than 50, population density, and poverty rate. A log-linear model is used to test the stated hypothesis, with the cumulative number of confirmed COVID-19 patients up to period $t$ as a dependent variable and demographic factors as an independent variable. The policy effectiveness indicator is calculated by taking the difference of the COVID rank of the $i$th state based on the predicted model and the actual COVID rank of the $i$th state$.$Our study finds that the urban population significantly impacts the spread of COVID-19. On the other hand, demographic factors such as rural population, density, and age structure do not impact the spread of COVID-19 significantly. Thus, people residing in urban areas face a significant threat of COVID-19 as compared to people in rural areas.

The impact of public health measures on the coronavirus-2019 pandemic was analyzed by comparing mandatory versus voluntary nonpharmaceutical interventions between 2 comparable European countries and among 3 U.S. states. Using an ecological retrospective cohort study design, we examine differences in mortality, economic impact, and equity. Compared to voluntary policies, mandatory shelter-in-place policies were associated with a 3- to 5-fold lower population-adjusted mortality in the U.S. model and between 11- to 12-fold lower in the European one. Voluntary shelter-in-place measures were associated with overall increased mortality cost, as measured by value of a statistical life; somewhat greater decreases in gross domestic product; and substantial negative impacts on minority communities, who experienced markedly increased mortality rates (the percentage of minority deaths was 2.3 and 4 times greater in the U.S. model and 14.5 times higher in the European one) and mortality cost (2.7- and 4.5-fold higher in the U.S. model and 11.1-fold higher in the European one). We conclude that voluntary policies are less effective than mandatory ones, based on historical precedent and the current analysis. Negative effects on health equity mirrored the increased mortality outcomes of voluntary policies, and there was no apparent economic benefit associated with voluntary measures.

The COVID-19 pandemic has wrought fundamental changes in the US workplace, placing employer-sponsored health insurance (ESI) in disarray. Before the pandemic, ESI was the single largest share of private health insurance in the country, including some 150 million Americans. Even before the pandemic, however, ESI had become increasingly volatile and more unaffordable for both employers and employees. During the pandemic, many workers found that they could work at home remotely. Job losses during the pandemic left many millions uninsured, with many jobs lost indefinitely. Today, many Americans are rethinking how and where they want to be involved in the workplace, while many businesses are considering a future when more people are working from home or being replaced by robots, placing ESI in further jeopardy. This article brings historical perspective to these problems, showing how the private health insurance industry has failed the public interest by being too fragmented and unreliable to be afforded or depended upon. Three major reform alternatives are described, only 1 of which-single-payer improved Medicare for All-can provide stable universal coverage that meets the needs of all Americans while being affordable for patients, families, and taxpayers.

After more than 1 year from the beginning of the pandemic, the coronavirus disease 2019 (COVID-19) has reached all continents. The number of infected people is still increasing, and Brazil is among the countries with the highest number of registered cases in the world. In this study, we investigated the profile of hospitalized COVID-19 cases and the eventual clusters of similar areas, using geographic information systems. The study was conducted using secondary data. Variables such as sociodemographic characteristics, comorbidities, hospitalization, signs, and symptoms among confirmed cases were considered for each microregion/city of the state of Rio de Janeiro. These proportions were used when calculating the Global Moran's I. The local indicator of spatial association was used to identify local clusters. A significant global spatial auto correlation was found in 28% of the variables. The presence of spatial autocorrelation indicates that the proportions of patients with COVID-19 according to these characteristics are spatially oriented. Moran maps reveal 2 clusters, 1 of high proportions and 1 of low proportions. Understanding the geographic patterns of COVID-19 may assist public health investigators, contributing to actions to prevent and control the pandemic in the state.

This study aims to assess the impacts of absolute and relative income on self-rated health (SRH) of residents in rural and urban China. Data were derived from the China Health and Nutrition Survey. Three distinct measures of relative income were considered (Gini coefficient, Yitzhaki index, and Deaton index) and computed for 3 geographic units (nation, province, and community). Nonlinear dynamic models for panel data were employed to test the absolute and relative income hypotheses. Absolute income was significantly associated with SRH among urban and rural populations. Relative income, as measured by the Gini coefficient, the Yitzhaki index, and the Deaton index, had statistically significant and negative impacts on SRH among the rural population, regardless of the reference group. For the urban population, the Gini coefficient was associated with SRH regardless of the reference group. In contrast, only the Yitzhaki index and the Deaton index at the provincial level were associated with SRH among the urban population. Our findings may provide a reference for policymakers to implement health policies designed to improve population health.

Economic recessions can increase socioeconomic inequalities in health. The objective of this study was to analyze socioeconomic inequalities in small-for-gestational-age (SGA) births before and during the Spanish economic crisis. We conducted an ecological study of trends based on 2 periods before the crisis (1999-2003 and 2004-2008) and another during the crisis (2009-2013). The study population was Spanish women resident in 13 cities who had given birth during 1999-2013. The prevalence of SGA was calculated for each census tract. A hierarchical Bayesian model was used to obtain the prevalence ratio (PR) and 95% credible intervals (CI). We analyzed the association between SGA and socioeconomic deprivation in each period for each city and for 3 age groups. The PR was above 1 and statistically significant for all 3 time periods in most of the 13 cities. The differences in PR between periods were only statistically significant for Madrid (PR = 1.56, 95% CI 1.48-1.65 for 1999-2003; PR = 1.28, 95% CI 1.19-1.38 for 2004-2008) and Barcelona (PR = 0.99, 95% CI 0.87-1.12 for 2004-2008; PR = 1.20, 95% CI 1.05-1.36 for 2009-2013). Socioeconomic inequalities in SGA births in small areas (census tracts) of most Spanish cities studied remained stable before and during the economic crisis.

This study aims to address the question: Why did transition countries enact laws related to social health insurance (SHI) at different times, even though they experienced dissolution of the Soviet Union at the same time in the early 1990s? We used Ragin's fuzzy-set qualitative comparative analysis to investigate the configurations of causal conditions that affected the speed of developing SHI-related legislation in 24 post-socialist countries. The potential causal conditions were health status, economic status, level of governance, level of democracy, issue salience, and number of medical professionals. We found 3 pathways that led to the enactment of SHI-related laws and 1 pathway that inhibits enactment. The key factors impacting enactment of SHI-related laws were non-corrupt governments and realization of democracy. In addition, medical professionals' involvement in policymaking could be the factor to enact SHI-related laws. Further research is needed for more in-depth analysis regarding what the laws specifically include, type of health insurance systems that were adopted based on the laws, and if the legislation contributed toward achieving universal health coverage.

Korean cosmetics sales workers in department stores face harmful working environments, including limited restroom access, working long hours in a standing position, and customer violence. This study investigated health disparities between cosmetics saleswomen and the general population of working women in South Korea. We assessed the prevalence of health indicators, including physician-diagnosed disease, using a cross-sectional survey of 860 Korean cosmetics saleswomen in September 2018. Health indicators of cosmetics saleswomen were compared to those of general working women from the nationally representative datasets (e.g., National Health Insurance Service-National Sample Cohort). We estimated age-standardized prevalence ratios (SPRs) for health outcomes, including physical, mental, and health-related behavioral conditions. Cosmetics saleswomen were more likely to be diagnosed or treated for physical and mental conditions (e.g., cystitis SPR: 4.03, 95% confidence interval [CI]: 3.48-4.65; plantar fasciitis SPR: 23.48, 95% CI: 18.12-29.93; varicose vein SPR: 38.41, 95% CI: 32.18-45.49; and depression SPR: 11.18, 95% CI: 8.53-14.40) compared to general working women. Prevalence of smoking and hazardous alcohol consumption was also higher among cosmetics saleswomen than those of general women workers. Given our findings, further research is needed to identify work-related risk factors that could deteriorate cosmetic sales workers' health in South Korea.