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At least 739 records · Page 41Linked to original sources
PubMed2003

[Refractive benefit and incremental costs of LASIK: results of a cost benefit study in two universities' LASIK departments].

BACKGROUND: No data is available to date on the cost effectiveness of laser in situ keratomileusis (LASIK) with regard to the German-speaking health care system. Hence we compared the clinical outcome and cost data of two German LASIK centres in respect of procedure cost effectiveness from the patient perspective. MATERIAL AND METHODS: A retrospective cohort study was implemented at the University Hospitals of Mainz and Mannheim. Data on refractive outcome were obtained from the LASIK centres' patient documentation, cost data on the surgery as well as on eyeglasses etc. before and after the surgery were obtained from patient interviews. The primary endpoint of this investigation was the individual incremental cost effectiveness ratio linking direct cost with the LASIK associated refractive gain. RESULTS: Clinical and economical data of 178 patients (Mainz: 45, Mannheim 133) was evaluated. After biplanar simultaneous LASIK 71% (Mainz) and 73% (Mannheim) reported, that they did not need eyeglasses etc. any longer after surgery; 31% (Mainz) versus 13% (Mannheim) had to undergo LASIK re-treatment. Median direct cost for the surgery was reported to be 3000 euro; (Mainz) versus 3910 euro; (Mannheim); the corresponding LASIK associated refractive gain was +5.6 D (median Mainz) versus +4.2 D (median Mannheim), resulting in median incremental cost effectiveness ratios of 667 euro; (Mainz) versus 831 euro; (Mannheim) per gained refractive unit. This investment has to be related to median annual cost of 250 euro; for eyeglasses etc. before surgery and 0 euro; afterwards. CONCLUSION: Depending on the performing surgical centre, German LASIK patients have to face a median investment of 667-831 euro; per gained refractive benefit unit. This incremental cost benefit ratio can be regarded as a surrogate parameter for comparison with alternative surgical or conservative treatment strategies in myopia.

Adolescent↗
PubMed2004

[Illness related costs for spouses of patients suffering from a mental illness: results of a study with repeated measurements].

OBJECTIVE: Aim of this study is the documentation of illness-associated costs for spouses, whose relative is suffering from a mental illness. METHOD: Over a period of 12 month, 117 spouses of patients who are suffering from schizophrenia, depression or anxiety disorders repeatedly filled in a standardized questionnaire about illness related expenses and financial losses. RESULTS: 90 % of the spouses reported direct cash expenditures on behalf of the patients' illness. On average, these costs amounted to yearly expenditures of euro 1146 (range: euro 0 - 11 910). Costs did not differ significantly across types of illness and income was not found to be a significant covariate. CONCLUSIONS: Spouses reported substantial direct cash expenditures on behalf of the patients' illness. Since these expenditures varied to a large extent over the three points of measurement, repeated measurement designs seem to be a prerequisite for a reliable assessment of illness-associated costs. Since living together with a mentally ill partner is associated with an increased risk of developing a burden-related psychiatric illness for spouses themselves which may lead to double costs and double decreases in income, these aspects should be taken into consideration when planning changes in health policy.

Adult↗
PubMed2004

["Suddenly, no more money was left". The role of financing in the Austrian mental health care reform].

OBJECTIVE: The article studies the role of financing mental health care for the mental health care service structure in the process of moving towards a patient-oriented and decentralised mental health care system. METHOD: The analysis is based on a description of the Austrian mental health care financing system and a discourse-analytical examination of reform documents and interviews with key actors in this country. RESULTS: Existing structures of mental health care services are a reflection of mental health care financing structures. Reform goals are in various forms linked to financing issues. However, an explicit discussion of the finance issues in reform documents is widely missing. CONCLUSIONS: Adapting the finance of mental health care to new paradigms of mental health care provision requires not just technical modifications, but also improved transparency of processes and implications involved.

Austria↗
PubMed2005

[Measuring preferences for depressive health states].

OBJECTIVE: The purpose of this study was to analyse the construct validity and the concurrent validity of the EuroQol instrument (EQ-5D self-classifier, EQ VAS and EQ-5D indices), time trade-off (TTO) and contingent valuation (willingness-to-pay) for preference-based valuation of depressive health states. METHODS: A survey of a representative sample (N = 3522) of the non-institutionalised population aged 18 and above in Germany was conducted using the EQ-5D, TTO and contingent valuation as well as the SF-12 questionnaire. Construct validity was analysed by comparing 130 respondents in whom 12-month prevalence for major depression, minor depression, or dystimia according to DSM-IV was identified based on a version of the Composite International Diagnostic Interview (WMH-CIDI) to respondents without depressive disorders. Concurrent validity was analysed by assessing the correlation between these measures in the group with depressive disorders. RESULTS: In the group with depressive disorders, problems in all EuroQol dimension except for mobility were significantly more frequent, and mean values of all analysed preference measures except for willingness-to-pay were less favourable than in the group without depressive disorders (EQ VAS score 67 vs. 78; EQ-5D index [VAS] 83 vs. 94; EQ-5D index [TTO] 0.81 vs. 0.91; TTO 0.89 vs. 0.95; always p < 0.001). In the group with depressive disorders, EQ VAS score and EQ-5D indices were significantly correlated one with another (ranging from r = 0.63 to r = 0.92) as well as with the mental and the physical component scale of the SF-12 (ranging from r = 0.26 to r = 0.45) and with willingness-to-pay (ranging from r = - 0.20 to r = - 0.22); besides, willingness-to-pay was significantly correlated with TTO (r = - 0.46). CONCLUSIONS: The results of this study point to the construct validity and concurrent validity of preference measures in patients with depressive disorders.

Activities of Daily Living↗
PubMed1989

Conductive education--magic or myth?

Subjective reports on the results of conductive education (CE) in 18 groups of children in English schools, and in 16 children who had been to Hungary were examined. Although many improvements seem to be indicated, rigorous scientific methods were not used, and the verdict on CE must remain open. The newly established Foundation for Conductive Education in Birmingham may help to resolve current uncertainty.

Activities of Daily Living↗
PubMed1975

The teaching hospital and primary care. Closing down the clinics.

Hospitals have become major providers of primary medical care by default rather than design because of the decreasing availability of primary physicians in community practice. In 1972, Beth Israel Hospital in Boston closed its traditional general clincs and estblished a primary-care group practice--Beth Israel Ambulatory Care. The practice is staffed by teams of full-time salaried physicians, other health professionals and paraprofessionals, house staff and medical students. More than 25 per cent of patient visits are managed by nonphysicians. Subspecialty clinics have been relieved of primary-care case loads and limited to referral and consultative functions. In 1973-74, the cost per visit was $20.32. Patient-visit volume in primary care has increased from a figure of 29,144 in 1971-72 to 41,650 in 1973-74. Broken appointments have declined by one third.

Boston↗