[Can the goals of health care be reached in a market model?].
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Europe↗
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[Therapeutic management of schizophrenic patients and its cost].
The purpose of this study was to observe the treatment of patients suffering from schizophrenic disorders and to assess the cost of this treatment in medical and social terms. The survey based on a questionnaire was sent to 6,000 French psychiatrists practising both in the hospital sector and in the ambulatory sector, whether acting through the national health service or privately. The psychiatrists who accepted to answer (N = 494) described all the treatment and assistance undergone by the last patient suffering from schizophrenia, as defined by the DSM III-R, seen either during a consultation or when hospitalized during the previous year. The clinical, epidemiological and therapeutic information collected for 356 patients treated as out-patients (72%) and 138 hospitalized patients (28%) in the public (49%) or private (51%) sectors underwent medical and economic modelling. The most frequent forms of schizophrenia encountered were paranoid type (48.6%) and those which developed chronically without severe exacerbation (32%). The average length of time between the date of the survey and the first symptoms is on average 11 +/- 8 years and the average length of time between the date of the survey and the first symptoms is on average 11 +/- 8 years and the average length of time between the first hospitalization is 9.5 +/- 8 years. This means that the time between the first symptoms and the first hospitalization is 25 +/- 4 months on average. The average number of previous full-time hospitalizations is 4 and the patients spent 22 months (+/- 48) in hospital on a full-time basis and 26 months (+/- 39) as day patients in hospital, from the start of their disorders. 27% of patients had at least one previous suicide attempt and 28% had already committed a medico-legal act.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Cost of non-insulin-dependent diabetes in women with a history of gestational diabetes: implications for prevention.
Women with gestational diabetes have a 50% risk of developing non-insulin-dependent diabetes mellitus within 10 years of delivery and thus constitute a well-defined target population for primary prevention. Current obstetric standards advocate universal screening of all pregnant women for gestational diabetes. Therefore, approximately half the reproductive-age United States population is screened for carbohydrate intolerance before the onset of overt disease. Continuation of dietary and behavioral changes initiated during pregnancy theoretically could delay or prevent progression to overt diabetes. We present an economic model of the health care dollars that could be saved by promoting postpartum life-style changes in women diagnosed with gestational diabetes. Assuming the incidence of diabetes could be reduced by 10, 25, or 50% in a national cohort of women with gestational diabetes, then 32, 140, or 331 million health care dollars could be saved over 10 years.
Diabetes Mellitus, Type 2↗
Improving the cost, quality, and access to healthcare in community hospitals through the use of reorganized integrated delivery systems and implementation of sophisticated clinical information systems: an organizational experience.
It is well recognized that health care is undergoing fundamental and necessary change. These changes rival, if not exceed, changes that have occurred in other industries. The factors underlying the changes are varied, but fundamentally, the economics of health care have altered. A new economic model is evolving that is disciplined by the marketplace and/or regulatory determination of "price" on a per capita basis. Success in this new model will require integrated delivery systems (IDS) serving local communities linked to purchasers through affiliations that span broader geographic areas. The demands of this model are placing unparalleled requirements for change on health care providers including the need to develop new forms of delivery systems and implement sophisticated new information systems that allow collection and detailed analysis of important clinical and financial data in an effort to achieve better value in health care. A case study of the Health and Hospital Services, Inc. (HHS) integrated delivery system and information system strategy will be discussed.
Community Health Planning↗
Explaining reduced cancer survival among the disadvantaged.
The fact that socially disadvantaged cancer patients face a greater risk of mortality than the advantaged is well recognized but poorly understood. Existing research and a newly completed 10-year survival study suggest that complex interrelations among biological factors, medical interventions, and specific dimensions of social differentiation determine survival differences. Patterns of interrelations among determinants of survival appear compatible with an "economic" model in some forms of cancer and a "cognitive-behavioral" model in others. Findings presented here suggest that improved access to health care will reduce mortality risk among the disadvantaged in at least some malignancies, but will not alone make their survival chances equal to those of the advantaged.
Adult↗
Economic value of gemcitabine in non-small cell lung cancer.
Although cost considerations traditionally have not been important in cancer treatment decision making, there is increasing concern worldwide about the economic impact of therapeutic alternatives in the field of oncology. In particular, there is greater pressure for pharmaceutical companies to assess the economic value of new products. We have investigated and compared the clinical outcomes and corresponding cost savings of a novel nucleoside analog, gemcitabine, with other chemotherapy options in three different health care settings: Germany, the United States, and Spain. To date, most of the work with gemcitabine has been done in non-small cell lung cancer. Most non-small cell lung cancer patients present with advanced disease that is unsuitable for surgery and, in many cases, unsuitable for potentially curative chemotherapy. Chemotherapy for the majority of patients is therefore administered with palliative intent. For this reason, the comparative agents chosen for the economic models were palliative treatments (cisplatin/etoposide and ifosfamide/etoposide). As is customary with oncolytics, gemcitabine was investigated first as a single agent in noncomparative trials. Since data were not available from a comparator trial, we estimated comparative data from the literature sources and expert opinion (German and Spanish cost models) and from retrospective chart reviews (US cost model). In all three models, the efficacy was assumed to be equal, so a cost-minimization approach was used. Gemcitabine monotherapy showed cost savings compared with both cisplatin/etoposide and ifosfamide/etoposide in all treatment settings. The majority of these savings were due to differences in hospitalization for drug administration, and the incidence and treatment of nausea and vomiting and febrile neutropenia.
Antimetabolites, Antineoplastic↗
Aggregate population and economic growth correlations: the role of the components of demographic change.
The results of recent correlations showing a negative impact of population growth on economic development in cross-country data for the 1980s, versus "nonsignificant" correlations widely found for the 1960s and 1970s, are examined with contemporaneous and lagged components of demographic change, convergence-type economic modeling, and several statistical frameworks. The separate impacts of births and deaths are found to be notable but offsetting in the earlier periods. In contrast, the short-run costs (benefits) of births (mortality reduction) increase (decrease) significantly in the 1980s, and the favorable labor-force impacts of past births are not fully offsetting.
Birth Rate↗
[The art of distributing resources according to needs. Criteria of the Stockholm model].
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Adult↗
A cost estimation model for measuring professional practice.
A cost estimation model was developed to monitor the effect of an enhanced professional practice model on cost to the institution. The model detected differences across units and changes in unit activities. One unit's cost savings were greater than the others and this difference was believed to be related to stable leadership over the course of the study.
Cost Savings↗
[The economic expenses related to bronchial asthma morbidity].
Estimations of the cost of bronchial asthma treatment per 1 patient in Samara Province made up an annual average of 520 dollars and 531 dollars in 1993 and 1994, respectively. 70% of the expenditures were medical, 30% social. It is demonstrated that updated approaches to diagnosis and treatment of asthma unless the patients are noncompliant provided good results at reduced expenses. The economic-mathematical model is proposed basing on which one can predict prevalence of bronchial asthma, cost-effect treatment relations for 5 years to come. The model reflects both current and forthcoming trends in care for bronchial asthma.
Adult↗
Data mining in finance: introducing the special issue of IJNS.
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Economics↗
[Cost-benefit in perinatology--II. Its application to conditions in the Czech Republic].
Using western economic models evaluating cost/benefit in perinatal care, the author analyzed on examples of undesirable perinatal outcomes the health benefit as a result of extension of screening and therapeutic procedures in the Czech Republic in 1990-1996 as well as the efficacy, effectivity and efficiency of these procedures. The results of analyses provided evidence that extension of the above procedures led to a decline of undesirable outcomes, different for each of the five investigated types, but at the same time a considerable increase of costs was recorded which exceed resources available at present for health services in the Czech Republic. Further development of perinatal care which will have to overcome this discrepancy without jeopardizing the present high standard of perinatal care will have to consider a compromise which will achieve a balance between present professional knowledge and possibilities, the moral aspect, demands of society and available funds.
Cost-Benefit Analysis↗
Pediatric considerations in homecare.
"If I had known beforehand how difficult, demanding, time consuming, and exhausting it would be--having my child home on a ventilator--I would never have agreed to bring her home" (personal communication with a parent, 1994). This mother's statement strikes at the heart of pediatric high-tech homecare. Parents assume caregiver roles that professional health providers have taken years to develop. Nurses, as strangers, intrude into intimate family relationships that have cultivated over years. Pioneering agencies attempt to fill a gap in pediatric care using guidelines that have been entrenched in the medical and economic models for years. The multiple dimensions of high-tech pediatric homecare require more than provision of technical nursing services. In homecare, nurses are challenged by cultural differences, language barriers, loss of control, family dynamics, practicing in unfamiliar environments, and new technology. To ensure quality nursing care, all professional dimensions need to be considered to be of equal importance.
Child↗
Health economic consequences of the pharmacological treatment of heart failure.
Health economics is about spending limited resources wisely and, as with so many fields in medicine, combines science with art and ingenuity. In order to know whether money is well spent it is necessary to have some reference points to make comparisons. Many accepted cardiovascular interventions, such as revascularization for multivessel disease (US$50000 per life year gained) or the use of a statin for hypercholesterolaemia in middle-aged men at high risk of cardiovascular events (US$30000 per life year gained) are associated with moderate expense. By contrast heart failure is one of the few conditions in which, under some circumstances, lives may be saved while significantly reducing costs. This article seeks to review currently available reports on the health economic consequences of interventions for heart failure and describes the development of a new health economic model. Digoxin, ACE inhibitors and beta-blockers all appear to be cost-effective under widely differing sets of assumptions. Estimates range from a substantial cost-saving to a few thousand dollars per life year gained. The major factor limiting the reduction in costs associated with effective treatment for heart failure (with the exception of digoxin) is the costs incurred as a consequence of improved longevity. Money spent on treating heart failure well is money wisely spent.
Cost-Benefit Analysis↗
Does the "Thunderbirds syndrome" still exist.
Rationing of resources within both the private and public health care systems is a fact of life. The Thunderbirds TV series encapsulated an idealistic philosophy that life should be saved independent of the pecuniary cost. Doctors, in particular, are trapped between their role as advocates for the patient within the "Thunderbirds" philosophy and as citizens with a responsibility to use resources wisely. This dichotomy is challenged by point of care rationing, which can conflict with clinical responsibilities, undermines the patient-doctor relationship and is often undertaken in a clandestine manner. This form of controlling health costs is difficult to justify from an ethical perspective, particularly when other forms of health care rationing and expenditure are frequently modulated by political expediency and inadequate economic modelling. Indeed, focusing on improving quality and disease prevention, rather than reducing marginal costs can often control the long-term growth in health expenditure. Doctors have a responsibility to ensure that rationing decisions are made but these should be made as part of a transparent, evidence-based and democratic process away from the point of care. While the resources to implement the "Thunderbirds Syndrome" have never been available, the philosophy must remain at the heart of patient-doctor relationship.
Cost Control↗
Improving efficiencies in pharmaceutical distribution channels using the economic order quantity model.
The purpose of this study was to investigate empirically the potential cost savings to a pharmaceutical wholesaler using the Economic Order Quantity (EOQ) model. This model allows for calculating the order quantity that minimizes both ordering and holding costs. A regional pharmaceutical wholesaler was selected for a case analysis study using the EOQ model. Eleven brand name products were randomly selected for the analysis. The average yearly cost savings using EOQ was $31.92 per product. The potential yearly cost savings based on 8500 brand name stock-keeping units was $271,320. Using EOQ can therefore assist pharmaceutical wholesalers in minimizing holding and ordering costs and improve efficiency for pharmaceutical distribution channels.
Cost Savings↗
[Status of medical economics investigated by the Central Medical Committee. IV. On the "study of supply and demand situation in the field of medicine using a macro-model"].
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Economics, Medical↗
Multilevel models and health economics.
Multilevel analyses have become an accepted statistical technique in the field of education where over the past decade or so the methods have been developed to explore the relationships between pupil characteristics and the characteristics of the schools they attend. More recently, widespread use has extended to other social sciences and health research. However, to date, little use has been made of these techniques within the health economics literature. This paper presents an introductory account of multilevel models and describes some of the areas of health economics research that may benefit from their use.
Adult↗