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PubMed1983

The health care cost spiral. Monster or myth?

Australia's total national and per capita health expenditures (both public and private) were compared with each other and with the proportion of the Gross Domestic Product (GDP) spent on health care for the years 1970-1971 to 1979-1980. A triphasic pattern was noted, with steep increases in 1974-1975 and 1975-1976 but a levelling in the rate of increase since then. The concept of an inexorable health care cost spiral during the 1970s is not borne out by these results.

Aged↗
PubMed1984

Health spending in the 1980's: integration of clinical practice patterns with management.

Health care spending in the United States more than tripled between 1972 and 1982, increasing from $94 billion to $322 billion. This growth substantially outpaced overall growth in the economy. National health expenditures are projected to reach approximately $690 billion in 1990 and consume roughly 12 percent of the gross national product. Government spending for health care is projected to reach $294 billion by 1990, with the Federal Government paying 72 percent. The Medicare prospective payment system and increasing competition in the health services sector are providing incentives to integrate clinical practice patterns with improved management practices.

Delivery of Health Care↗
PubMed1996

Private-sector share of health spending hits record level.

The private-sector share of health expenditures hit a record 28.2% in Canada in 1994, according to a recent federal report. Canadians spent $698 per person for private health-related goods and services, a 1-year increase of 3.8%. Ontarians paid the most--$790 per person--while Newfoundlanders paid the least, $538.

Canada↗
PubMedDate not supplied

The French prescription for health care reform.

In 1996, the French government introduced a wide-ranging health care reform which aimed to resolve the problems of rising health expenditure and a levelling off in health sector income. Changes in the regulation of the health care system sought to strengthen quality while improving professional practice. At the same time the changes were intended to encourage greater synergy both between professionals and between the different parts of the system, thus promoting greater cost-effectiveness. The tools designed to achieve these results included: the creation of new regional hospital agencies, the introduction of cash-limited budgets at national and regional level, the launching of a contracting procedure between health authorities and hospitals and the setting up of a new health care accreditation agency. With some signs of improvement in the overall health insurance budgetary situation, the Jospin government seems to be supporting the broad lines of the reform introduced by its predecessor.

Cost Control↗
PubMedDate not supplied

[Health inequalities in Panama].

OBJECTIVES: To document socioeconomic inequalities in health and health services in Panama and thus create a baseline for the prospective monitoring of the impact of health policies on equity. METHODS: Analysis of data from the 1997 Living Standards Measurement Survey, the 1990 National Population Census and birth registration data for 1996. The relative index of inequality and concentration coefficient were calculated for a wide range of indicators of out-of-pocket health expenditure, access, utilization and quality of health services and of health outcomes. RESULTS: Large and statistically significant socioeconomic differences in many of the variables examined were detected, almost all of which favored the rich. The inequalities identified included qualitative factors such as the type of care received as well as quantitative factors such as travelling times and utilization rates. Some of the inequalities were concentrated among a small, very poor segment of the population whilst others were the result of gradually increasing advantage with increased levels of outcome. CONCLUSIONS: The results obtained provide a valuable starting point for the Panamanian government from which it can identify the most serious inequalities in health and health service provision and develop policies to eliminate or reduce them. They also offer a baseline to monitor changes in the magnitude of these inequalities over time.

Delivery of Health Care↗
PubMed2001

Community participation in local health boards in a decentralized setting: cases from the Philippines.

Decentralization has been associated traditionally with participation and empowerment in local decision-making. This study of four cases analyzed the role of local health boards in enhancing community participation and empowerment under a decentralized system in the Philippines. Local government units (LGUs) with functioning local health boards were compared with LGUs whose health boards were not meeting regularly as mandated by law. The study found that there were more consultations with the community, fund-raising activities, health initiatives and higher per capita health expenditure in LGUs with functioning local health boards. Only the mayors and municipal health officers felt empowered by devolution. In general, awareness of devolution and their potential roles in health decision-making was low among members of the community. These findings can be attributed to the socio-cultural and historical traditions of centralized governance with little popular participation, overall attitudes of the community and board members, perceptions of health as primarily a medical matter, economic circumstances of LGUs, and insufficient preparation for devolution. Recommendations are suggested in response to these findings.

Community Participation↗
PubMed2000

Syndrome packets and health worker training improve sexually transmitted disease case management in rural South Africa: randomized controlled trial.

BACKGROUND: Sexually transmitted diseases (STD) are important co-factors in HIV transmission. We studied the impact of health worker training and STD syndrome packets (containing recommended drugs, condoms, partner notification cards and information leaflets) on the quality of STD case management in primary care clinics in rural South Africa. METHODS: A randomized controlled trial of five matched pairs of clinics compared the intervention with routine syndromic management. Outcomes were measured by simulated patients using standardized scripts, and included the proportion given recommended drugs; correctly case managed (given recommended drugs plus condoms and partner cards); adequately counselled; reporting good staff attitude; and consulted in privacy. RESULTS: At baseline, the quality of STD case management was similarly poor in both groups. Only 36 and 46% of simulated patients visiting intervention and control clinics, respectively, were given recommended drugs. After the intervention, intervention clinics provided better case management than controls: 88 versus 50% (P < 0.01) received recommended drugs; 83 versus 12% (P < 0.005) were correctly case managed; 68 versus 46% (P = 0.06) were adequately counselled; 84 versus 58% experienced good staff attitude (P = 0.07); and 92 versus 86% (P = 0.4) were consulted privately. A syndrome packet cost US$1.50; the incremental cost was US$6.80. The total intervention cost equalled 0.3% of annual district health expenditure. INTERPRETATION: A simple and affordable health service intervention achieved substantial improvements in STD case management. Although this is a critical component of STD control and can reduce HIV transmission, community-level interventions to influence health-seeking behaviour are also needed.

Adolescent↗
PubMed1994

Health and economic evaluation in schizophrenia: implications for health policies.

Programmes for controlling health care costs and improving the quality of care are going to be developed in some countries, with the development of health services research and outcome evaluation. The reliable and comprehensive evaluation of the specific health and economic picture of each illness as well as of the health care results and costs savings related to the treatments or coordination of treatments requires close, interdisciplinary collaboration between the clinician and the health economist. The production and diffusion of health and economic evaluation results is aimed at informing policy makers, providers, consumers, health technology producers, etc. in order to enable them to do their best choices. The allocation in each country of a significant percentage of the annual health expenditures to economic evaluation in mental health seems important for the international development of this field.

Cost Control↗
PubMed1990

[An operations study on a home health nursing demonstration program for the patient discharged with chronic residual health care problems].

The study was conceived in relation to a concern over the growing gap between the needs of chronic patients and the availability of care from the current health care system in Korea. Patients with agonizing chronic pain, discomfort, despair and disability are left with helplessly unprepared families with little help from the acute care oriented health care system after discharge from hospital. There is a great need for the development of an alternative means of quality care that is economically feasible and culturally adaptable to our society. Thus, the study was designed to demonstrate the effectiveness of home health care as an alternative to bridge the existing gap between the patients' needs and the current practice of health care. The study specifically purports to test the effects of home care on health expenditure, readmission, job retention, compliance to health care regime, general conditions, complications, and self-care knowledge and practices. The study was guided by the operations research method advocated by the Primary Health Care Operations Research Institute (PRICOR) which constitutes 3 stages of research: namely, problem analysis solution development, and solution validation. The first step in the operations research was field preparation to develop the necessary consensus and cooperation. This was done through the formation of a consulting body at the hospital and a steering committee among the researchers. For the stage of problem analysis, the Annual Report of Seoul National University Hospital and the patients records for last 5 years were reviewed and selective patient interviews were conducted to find out the magnitude of chronic health problems and areas of unmect health care needs to finally decide on the kinds of health problems to study. On the basis of problem analysis, the solution development stage was devoted to home care program development asa solution alternative. Assessment tools, teaching guidelines and care protocols were developed and tested for their validity. The final stage was the stage of experimentation and evaluation. Patients with liver diseases, hemiplegic and diabetic conditions were selected as study samples. Discharge evaluation, follow up home care, measurement and evaluation were carried out according to the protocols of care and measurement plan for each patient for the period of 6 months after discharge. The study was carried out for the period from Jan. 1987 to Dec. 1989. The following are the results of the study presented according to the hypotheses set forth for the study; 1.(ABSTRACT TRUNCATED AT 400 WORDS)

Chronic Disease↗
PubMed1988

Descriptive epidemiology of perinatal and infant mortality in various Italian geographic areas.

On the basis of the number of livebirths, stillbirths and deaths within the first year of life published annually by the Central Institute of Statistics and data on demographic, environmental variables, general indicators of health organization, and reproductive habits, the descriptive epidemiology of perinatal and infant mortality in Italy between 1955 and 1984 has been reviewed. Although a marked reduction in Italian stillbirth (from 28.4 in 1955 to 7.1/1,000 births in 1984), perinatal (from 46.2 to 14.5/1,000 births) and infant mortality rate (from 51.0 to 11.3/1,000 live births) was observed, still broad differences between geographical areas within the country remained largely unchanged in proportional terms, since perinatal and infant mortality remained substantially lower in Northern, richer areas. Strong correlation coefficients emerged between perinatal and infant mortality rates and general indicators of health care organization such as number of hospital beds/1,000 inhabitants (and less strongly with number of obstetric beds) or per capita health expenditure. If rates from Northern Italy for the year 1984 were applied to the whole of the country, over 1,000 deaths in the first year of life could be avoided.

Data Interpretation, Statistical↗
PubMedDate not supplied

Spending on mental health and substance abuse treatment, 1987-1997.

This paper is the result of an ongoing effort to track spending on mental health and substance abuse (MH/SA) treatment nationwide. Spending for MH/SA treatment was $85.3 billion in 1997: $73.4 billion for mental illness and $11.9 billion for substance abuse. MH/SA spending growth averaged 6.8 percent a year between 1987 and 1997, while national health expenditures grew by 8.2 percent.

Adult↗
PubMed2002

Australia's National Mental Health Strategy.

BACKGROUND: Australia commenced a 5-year reform of mental health services in 1993. AIMS: To report on the changes to mental health services achieved by 1998. METHOD: Analysis of data from the Australian National Mental Health Report 2000 and an independent evaluation of the National Mental Health Strategy. RESULTS: Mental health expenditure increased 30% in real terms, with an 87% growth in community expenditures, a 38% increase in general hospitals and a 29% decrease in psychiatric hospitals. The growth in private psychiatry, averaging 6% annually prior to 1992, was reversed. Consumer and carer involvement in services increased. CONCLUSIONS: Major structural reform was achieved but there was limited evidence that these changes had been accompanied by improved service quality. The National Mental Health Strategy was renewed for another 5 years.

Australia↗
PubMed1987

[Economic implications of the various treatment methods in myocardial ischemia].

Modern treatments of myocardial ischaemia are effective. Surgical coronary revascularization involves high immediate expenditures, but these are tempered by a subsequent reduction in medical consumption and costs. Coronary angioplasty is a more comfortable revascularization procedure than bypass surgery which it increasingly tends to supersede. The overall health expenditures involved are about 20% lower than those of surgery. Treatment of incipient infarction has recently been introduced. Its generalization implies a reorganization of medical care and a major increase in expenditures. To what extent this increase will be upset by the benefits of avoided or limited infarction can only be determined by detailed and accurate evaluation.

Angioplasty, Balloon↗
PubMed1998

[International comparisons of health care resources. Expenditure shared the GNP is inadequate. Complementary real measures are necessary].

Since the health care expenditure share of the GNP (gross national product) is a measure difficult to interpret, its use can yield erroneous results in comparing health care sector development in different countries. A complementary measure of health care resources is the size and structure of the health care labour force. Information from Sweden, Denmark, the United Kingdom and the USA shows that development in expenditure share of the GNP in no way reflects development in labour resources in the respective countries. Ranking of national costs differs depending on the measures used, which is partly to be explained by differences in relative prices in terms of various investment factors--e.g., salaries of qualified personnel. The generally slow wages trend in the Swedish health care sector is a contributory factor explaining why the marked increase in the labour force during the 1970s and 1980s is incompletely reflected in the health care expenditure share of the GNP. Studies of personnel resources at the hospital level in the above-mentioned countries have shown marked national differences to exist in terms of working hours, service contracts and job descriptions, which further explains the differences manifest at an aggregate level.

Costs and Cost Analysis↗
PubMedDate not supplied

A price index for biomedical research and development.

Price changes of goods and services used in biomedical research and development have important effects on the costs of conducting research. We summarize the trends suggested by a recently constructed biomedical research and development price index, which measures the effects of price changes on the inputs to biomedical research from 1979 to 1986. The fixed-weighted index uses fiscal year 1984 National Institutes of Health expenditure patterns in developing the weights. The rate of increase shown in the price index peaked in 1981 and slowed in following years. However, in most years, the rate of increase in the price index has exceeded the rate of increase in other major price indexes, such as the consumer price index, the producer price index, and the Gross National Product fixed-weighted price index.

Economics↗
PubMed1985

Health spending trends in the 1980's: adjusting to financial incentives.

Health expenditure growth is projected to moderate considerably during 1983-90, reaching $660 billion in 1990 and consuming over 11 percent of the gross national product. During 1973-83, spending for health care more than tripled, increasing from $103 billion to $355 billion and moving from 7.8 percent to 10.8 percent of the gross national product. Government spending for health care is projected to reach $284 billion by 1990, with the Federal Government paying 73 percent. The Medicare Prospective Payment System, private sector initiatives, and State and local government actions are providing incentives to substantially increase competition and cost effectiveness in health care provision.

Data Collection↗
PubMed1989

Some of the tough decisions required by a national health plan.

The goals of providing coverage for everyone in the United States and controlling the growth in national health expenditures require difficult decisions about what medical services to provide. Currently accepted practices vary enormously in the amount of health they produce for a given expenditure. Studies of the health effects of several major interventions in relation to their costs--Pap smears, mammography, coronary care units, bypass surgery, and cholesterol reduction--indicate the kinds of choices to be made.

Cost-Benefit Analysis↗