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PubMed1984

Maintaining the integrity of a biomedical communications department.

In a changing public economy, reductions in the number and size of awards for research, education, and public service in addition to government pressures to reduce Medicare and Medicaid health expenditures will have significant impact on levels of funds available to academic health sciences centers. As competition increases for shrinking financial resources the biomedical communications department must reshape itself to a broader market place if it is to survive. The development of a separate marketing corporation is proposed as one model to promote integrity.

Academic Medical Centers↗
PubMedDate not supplied

Racial differences in the impact of smoking-attributable disease on health care costs in Indiana.

The purpose of this investigation was to estimate the direct health care costs attributable to smoking in Indiana and address these costs in the context of the differential health impact of tobacco use on minorities. Estimates of direct health care costs for smoking in 1990 were calculated using the Smoking Attributable Morbidity and Mortality and Economic Costs (SAMMEC 2.1) computer-based program developed by the Centers for Disease Control and Prevention. The proportion of direct health care costs attributable to smoking were calculated by evaluating personal health expenditures from five cost centers including hospitalization, physician services, services of other health practitioners, nursing home care and drugs. Study findings indicate that direct health care costs were more than $700 million in 1990. Health care spending among whites accounted for 53% of total costs. Per capita costs among smokers and nonsmokers > or = 35 years of age amounted to $278. Although whites accounted for the majority of direct health care costs attributable to smoking, per capita costs were higher among African Americans compared to whites, reflecting the differential smoking-attributable mortality rates experienced by these two groups.

Adult↗
PubMed2003

Health policy in relation to improving equity in child health.

A major independent inquiry into inequalities in health-and policies that would reduce them-was published in December 1998.(1) It identified >40 recommendations designed to reduce inequalities in health. Lifting children out of poverty is among the most important strategies to improve child health. If we want to change policies on health and poverty, then we have to consider the broad political context within which our health systems work. In the United Kingdom, we have a welfare state that sends checks and cash income to 85% of households every month. Many people pay into the welfare state, many people get money back, and everybody receives services.(2) In the United States, the situation is different. There, many people pay into the state, but only the poor and corporations actually receive a check. I leave you to decide who gets the most out of these respective systems. We also have fundamental differences in our health systems. In the United Kingdom, 97% of expenditures on health are made by the state; there is virtually no private spending. In the United States, only 44% of health expenditures are made by the state. The limited amount of private health expenditures in the United Kingdom will be reduced further as the National Health Service provides more dentistry in the future. In terms of the amount of resources, the United States spends 14% of its gross domestic product on health, compared with 6% in the United Kingdom. The United States spent 3700 dollars per person on health care in 1997. In the United Kingdom, we spent less than one third of that.

Child↗
PubMed2002

Analysis of hospital charges for cerebral infarction stroke inpatients in Beijing, People's Republic of China.

OBJECTIVE: Stroke is a heavy economic burden on the individuals, society and health services in China, where health expenditure is rising rapidly. The purpose of the present study is to examine health services and demographic factors associated with inpatient charges for cerebral infarction in China, focusing on hospital charges of insured and uninsured patients. METHODS: The study subjects were 545 patients with a principal diagnosis of cerebral infarction stroke who were discharged from the China-Japan Friendship Hospital from January 1, 1997 through December 31, 1998. Demographic, clinical and administrative data were retrospectively collected from the medical record and financial database. The influence of social and medical factors on total charges was analyzed with stepwise multiple regression model. RESULTS: Of 545 subjects, 429 (79%) were the insured patients and 116 (21%) were the uninsured patients. Length of hospital stay (LOHS) for the insured patients (median, 32 days) was significantly longer (P<0.001) than that for the uninsured (median, 23 days). The hospital charges per discharge for the insured was significantly higher (geometric mean, 10407 yuan) (P<0.0001) than that for the uninsured patients (geometric mean, 5857 yuan). With stepwise multiple regression, factors associated independently with the hospital charge were: longer hospital stay, insurance status, increased number of head magnetic resonance imaging (MRI) and computerized tomography (CT), infection in hospital stay, and more severe condition of stroke. CONCLUSIONS: Inpatient charge for cerebral infarction stroke was positively associated with being the insured. The findings suggest an overuse of health care resources in insured patients and limited use of resources by those who are not.

Adult↗
PubMed2003

Social capital, life expectancy and mortality: a cross-national examination.

This paper analyses the relationship between social capital and population health. The analysis is carried out within an econometric model of population health in 19 countries in the Organisation for Economic Co-operation and Development countries using panel data covering three different time periods. Social capital is measured by the proportion of people who say that that they generally trust other people and by membership in voluntary associations. The model performs well in explaining health outcomes. We find very little statistically significant evidence that the standard indicators of social capital have a positive effect on population health. By contrast, per capita income and the proportion of health expenditure financed by the government are both significantly and positively associated with better health outcomes. The paper casts doubt upon the widely accepted hypothesis that social capital has a positive effect on health and illustrates the importance of testing this kind of hypothesis in an extended model.

Cooperative Behavior↗
PubMed2005

Colombia: in vivo test of health sector privatization in the developing world.

The reform of the Colombian health sector in 1993 was founded on the internationally advocated paradigm of privatization of health care delivery. Taking into account the lack of empirical evidence for the applicability of this concept to developing countries and the documented experience of failures in other countries, Colombia tried to overcome these problems by a theoretically sound, although complicated, model. Some ten years after the implementation of "Law 100," a review of the literature shows that the proposed goals of universal coverage and equitable access to high-quality care have not been reached. Despite an explosion in costs and a considerable increase in public and private health expenditure, more than 40 percent of the population is still not covered by health insurance, and access to health care proves uncreasingly difficult. Furthermore, key health indicators and disease control programs have deteriorated. These findings confirm the results in other middle- and low-income countries. The authors suggest the explanation lies in the inefficiency of contracting-out, the weak economic, technical, and political capacity of the Colombian government for regulation and control, and the absence of real participation of the poor in decision-making on (health) policies.

Colombia↗
PubMed2004

Croatian pharmaceutical sector reform project: rational drug use.

The Croatian Pharmaceutical Sector Reform Project was one component of a larger Health Reform Project financed by the World Bank. The Croatian government was concerned that Croatia appeared to spend more money on medicinal drugs than most other countries in the region; that the price of drugs purchased in Croatia was higher than in some other countries, and that the prescribing habits of some Croatian physicians were perceived to be unnecessarily expensive. In addition, the Croatian Institute for Health Insurance (CIHI), which pays for most health care, had come under considerable financial pressure due to increasing health expenditure and a decreasing proportion of the population contributing to insurance. The Australian Health Insurance Commission won the contract for the pharmaceutical reform project. Australian experts were matched with Croatian experts in order to share knowledge, learn from each other, and provide the best advice. The project had two main components. The first addressed supply side issues and provided advice about savings that could be made by incorporating pharmacoeconomic principles into the selection and purchase of drugs on the Croatian positive list. The second component addressed demand side issues and provided advice aimed at evaluating and improving the quality and effectiveness of drug prescribing by Croatian physicians. This paper describes the second project component. We quantitatively and qualitatively evaluated the prescribing practice of Croatian physicians and ascertain how these might be improved. Croatian general practitioners are required to enter an International Classification of Diseases, 10th Revision (ICD10) diagnostic code on their prescription in order to indicate the clinical problem being treated. Quantitative research involved sorting CIHI prescription data for 2002 into ICD10 diagnostic categories and comparing the drugs prescribed for particular conditions with the recommendations in local and international best-practice guidelines. The results showed a number of areas where the prescribing of Croatian general practitioners and specialists could be improved, such as the use of antibiotics in upper respiratory tract infections and the treatment of hypertension. Qualitative research involved a series of workshops with local pharmacological experts and general practitioners during which the collected prescribing data was discussed, local factors which influenced prescribing were explored, and suggestions for improvement were collated. Many general practitioners felt pressured by increasingly assertive consumers, relentless pharmaceutical promotion, and strident government (CIHI) demands to restrain escalating health care costs. In addition, there was a lack of information about what constituted cost-effective treatment appropriate to the Croatian economic situation. There was support for the production of concise Croatian therapeutic guidelines that provided a limited number of best-practice treatment options for common conditions. A pilot set of such guidelines was devised and incorporated into a clinical software trialed in a Primary Health Care Information Technology Project in Koprivnica. This initiative received support from the general practitioners involved. It was recommended that a unit for the quality use of medicines should be set up to sustain the production of therapeutic guidelines and coordinate this activity with related initiatives. In addition, a quality assurance system (including performance indicators linked to financial incentives) was recommended that would encourage general practitioners to practice in accord with guidelines. We understand that the Croatian government has accepted a number of these recommendations and, in particular, performance indicators (and financial incentives) are written into new contracts for Croatian general practitioners in 2004.

Benchmarking↗
PubMed1996

Mammography screening: prospects and opportunity costs.

Health care costs in the United States now consume nearly 15% of the gross domestic product. Continued expansion of health expenditures may have serious economic consequences, including reduction in the standard of living. Health care reform must include cost control without consequent detrimental effects on health status. As a case example, we consider the controversy surrounding mammography screening for premenopausal women. Several literature reviews of published studies suggest that screening of women less than 50 years of age does not statistically significantly reduce mortality from breast cancer. These results are not explained by screening interval, recentness of study, or patient compliance to screening. We conclude that screening is effective in decreasing mortality from breast cancer for women older than 50 years. For women less than 50, mammography screening programs displace resources that could have a greater benefit in women's health status if used for other purposes.

Adult↗
PubMed1991

The Health Security Partnership. A federal-state universal insurance and cost-containment program.

The Health Security Partnership attempts to assure (1) that all Americans have insurance coverage for a set of comprehensive health care benefits, (2) that cost-containment issues are addressed in a manner that does not impinge negatively on the quality of care, and (3) that provider freedom to deliver appropriate clinical care is strengthened. It assigns important responsibilities to the federal government (eg, specification of benefits, review of proposed state health care budgets), while permitting states to select, develop, and administer specific program design features they deem appropriate (eg, states could build on and expand the existing health system infrastructure, including private insurance, and/or extend the role of tax-supported programs). It is estimated that in its first year the program would add about 5% to America's health expenditures, but within a few years, cost-containment efforts and administrative efficiencies would reduce overall expenditures below what they otherwise would be.

Comprehensive Health Care↗
PubMed2005

Financial anatomy of biomedical research.

CONTEXT: Public and private financial support of biomedical research have increased over the past decade. Few comprehensive analyses of the sources and uses of funds are available. This results in inadequate information on which to base investment decisions because not all sources allow equal latitude to explore hypotheses having scientific or clinical importance and creates a barrier to judging the value of research to society. OBJECTIVE: To quantify funding trends from 1994 to 2004 of basic, translational, and clinical biomedical research by principal sponsors based in the United States. DESIGN: Publicly available data were compiled for the federal, state, and local governments; foundations; charities; universities; and industry. Proprietary (by subscription but openly available) databases were used to supplement public sources. MAIN OUTCOME MEASURES: Total actual research spending, growth rates, and type of research with inflation adjustment. RESULTS: Biomedical research funding increased from 37.1 billion dollars in 1994 to 94.3 billion dollars in 2003 and doubled when adjusted for inflation. Principal research sponsors in 2003 were industry (57%) and the National Institutes of Health (28%). Relative proportions from all public and private sources did not change. Industry sponsorship of clinical trials increased from 4.0 dollars to 14.2 billion dollars (in real terms) while federal proportions devoted to basic and applied research were unchanged. The United States spent an estimated 5.6% of its total health expenditures on biomedical research, more than any other country, but less than 0.1% for health services research. From an economic perspective, biotechnology and medical device companies were most productive, as measured by new diagnostic and therapeutic devices per dollar of research and development cost. Productivity declined for new pharmaceuticals. CONCLUSIONS: Enhancing research productivity and evaluation of benefit are pressing challenges, requiring (1) more effective translation of basic scientific knowledge to clinical application; (2) critical appraisal of rapidly moving scientific areas to guide investment where clinical need is greatest, not only where commercial opportunity is currently perceived; and (3) more specific information about sources and uses of research funds than is generally available to allow informed investment decisions. Responsibility falls on industry, government, and foundations to bring these changes about with a longer-term view of research value.

Biomedical Research↗
PubMed2005

Health care reform in Belgium.

Curbing the growth of public sector health expenditures has been the proclaimed government objective in Belgium since the 1980s. However, the respect for freedom of choice for patients and for therapeutic freedom for providers has blocked the introduction of microeconomic incentives and quality control. Therefore--with some exceptions, particularly in the hospital sector--policy has consisted mainly of tariff and supply restrictions and increases in co-payments. These measures have not been successful in curbing the growth of expenditures. Moreover, there remains a large variation in medical practices. While the structure of health financing is relatively progressive from an international perspective, socioeconomic and regional inequalities in health persist. The most important challenge is the restructuring of the basic decision-making processes; i.e. a simplification of the bureaucratic procedures and a re-examination of the role of regional authorities and sickness funds.

Belgium↗
PubMed1998

The importance of developing an informatics framework for mental health.

Though mental health services are important in human terms, and account for a tenth of health expenditure, they are not well served in informatics developments. There are no specific mental health components in the European Union's health telematics programmes, and there is similar under-representation in national programmes. Yet telematics has much to offer mental health services and their management, and can address directly current service anxieties. Telematics concepts which could benefit mental health include integrated, multi-disciplinary records, real-time multi-site record access, and structured programmes to plan, schedule, and monitor care delivery. The power of information systems to sort data, and to represent them graphically, can sift like data items from complex records, and can present them in displays which highlight their significance. Above all, quality of care can be enhanced by monitoring, and by improved outcome measurement. However, a planned programme of research and development is needed, to relate and adjust current health informatics techniques to the special attributes of mental health. The World Health Organisation has identified the potential of such a programme, but greater vision and commitment is needed at policy level if mental health services and patients are to receive the benefits from health informatics which are available to the physically ill.

Abstracting and Indexing↗
PubMed2003

Health reform in Brazil: lessons to consider.

US analysts and decisionmakers interested in comparative health policy typically turn to European perspectives, but Brazil-notwithstanding its far smaller gross domestic product and lower per capita health expenditures and technological investments-offers an example with surprising relevance to the US health policy context. Not only is Brazil comparable to the United States in size, racial/ethnic and geographic diversity, federal system of government, and problems of social inequality. Within the health system the incremental nature of reforms, the large role of the private sector, the multitiered patchwork of coverage, and the historically large population excluded from health insurance coverage resonate with health policy challenges and developments in the United States.

Brazil↗
PubMed2000

Controlling health care costs whilst improving population health: what are the issues and can it be done in Hong Kong?

Many countries are experiencing two related types of 'transition', one leading to Improved Population Health, but the other leading to Rising Health Care Costs. This paper will present and discuss a conceptual framework for each of these trends, which illustrate key factors that are, or may be, contributing to such outcomes. Factors contributing to improved population health include: health promotion and disease prevention; effective public health; effective housing policies. Factors contributing to Rising Health Care Costs include: demographic transition, increasing life expectancy; medical technology. Hong Kong is currently digesting the recommendations of the 'Harvard Report', which considered future options for meeting the following five reform objectives: (1) Maintaining and improving equity; (2) Improving quality and efficiency; (3) Improving financial sustainability; (4) Meeting the future needs of the population; (5) Managing overall health expenditure inflation. As can be seen, the two related transition trends of improved population health and rising health care costs are reflected in these objectives. The Harvard Report recommends a Competitive Integrated Health Care option as the most appropriate 'solution' for Hong Kong in the long run. The paper will briefly comment on this proposal.

Community Health Planning↗
PubMed2004

[Toward strengthening the health politics in Africa: the military health system and its contribution to health policy in Senegal].

Since the following days of independences, the Senegalese army mission has mainly consisted in defending the national territory integrity and in ensuring the protection of the populations and their goods. In the public health system, thanks to the quality of its human resources the army intervenes specifically at every level of the health care structure. The mission assigned to the Senegalese army health unit is therefore multidimensional. In 2001, the operational budget of the army health services is estimated at 177 millions CFA F (265500 euros), its medical consumption at 212 millions CFA F (323 000 Euros) and its health expenditure at 385 millions CFA F (585 000 euros). The army supports the government health policies in different ways: on the one hand, availability of the ministry of health staff, on the other hand, the direct involvement in health care and the implementation of the national and international health programmes.

Budgets↗
PubMed2005

Household out-of-pocket medical expenditures and National Health Insurance in Taiwan: income and regional inequality.

BACKGROUND: Unequal geographical distribution of medical care resources and insufficient healthcare coverage have been two long-standing problems with Taiwan's public health system. The implementation of National Health Insurance (NHI) attempted to mitigate the inequality in health care use. This study examines the degree to which Taiwan's National Health Insurance (NHI) has reduced out-of-pocket medical expenditures in households in different regions and varying levels of income. METHODS: Data used in this study were drawn from the 1994 and 1996 Surveys of Family Income and Expenditure. We pooled the data from 1994 and 1996 and included a year dummy variable (NHI), equal to 1 if the household data came from 1996 in order to assess the impact of NHI on household out-of-pocket medical care expenditures shortly after its implementation in 1995. RESULTS: An individual who was older, female, married, unemployed, better educated, richer, head of a larger family household, or living in the central and eastern areas was more likely to have greater household out-of-pocket medical expenditures. NHI was found to have effectively reduced household out-of-pocket medical expenditures by 23.08%, particularly for more affluent households. With the implementation of NHI, lower and middle income quintiles had smaller decreases in out-of-pocket medical expenditure. NHI was also found to have reduced household out-of-pocket medical expenditures more for households in eastern Taiwan. CONCLUSION: Although NHI was established to create free medical care for all, further effort is needed to reduce the medical costs for certain disadvantaged groups, particularly the poor and aborigines, if equality is to be achieved.

Adult↗
PubMed2003

Allocating health care resources when people are risk averse with respect to life time.

The criterion of cost-effectiveness in health management may be given a welfare-theoretical justification if people are risk neutral with respect to life years. With risk aversion, the optimal allocation of health expenditures changes: Compared to the cost-effective allocation, more resources should be allocated to health conditions for which the expected outcomes even after treatment are worse than average. The consequences of medical interventions are usually not known with certainty. Given this type of uncertainty, simple application of cost-effectiveness analysis would recommend maximization of expected health benefits given the health budget. We show that when people are risk averse with respect to the number of life years they live, the uncertainty associated with different types of interventions should play a role in allocating the health budget.

Cost-Benefit Analysis↗
PubMed2000

Report from Spain.

Palliative care programmes have expanded enormously in recent years in Spain, with great success in terms of coverage of the target population and opioid consumption, but at the expense of deficiencies in the training of professionals and scarcity of fully comprehensive palliative care systems. A balance has developed with an almost even distribution of resources between home care and in-patient services, in spite of a strong tendency in recent years to prioritize domiciliary care in the wake of policies requiring limitation of health expenditure.

Education, Medical, Undergraduate↗