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PubMed1993

Resource allocation and the beginning of life.

Like many other countries, Australia is increasingly being forced to face the spiralling costs of health care. Population increases, an aging population, and the high cost of many items of modern medical equipment and of medical care generally, have all contributed to the pressure on health care resources. Within this climate of resource scarcity, more and more questions are being asked about the prioritization of items of health expenditure. The aim of this article is to consider the claim of reproductive technology, prenatal care, and prenatal diagnosis on health care resources and to evaluate the balance between treatments and preventative measures.

Australia↗
PubMed2000

Organization of ambulatory care provision: a critical determinant of health system performance in developing countries.

Success in the provision of ambulatory personal health services, i.e. providing individuals with treatment for acute illness and preventive health care on an ambulatory basis, is the most significant contributor to the health care system's performance in most developing countries. Ambulatory personal health care has the potential to contribute the largest immediate gains in health status in populations, especially for the poor. At present, such health care accounts for the largest share of the total health expenditure in most lower income countries. It frequently comprises the largest share of the financial burden on households associated with health care consumption, which is typically regressively distributed. The "organization" of ambulatory personal health services is a critical determinant of the health system's performance which, at present, is poorly understood and insufficiently considered in policies and programmes for reforming health care systems. This article begins with a brief analysis of the importance of ambulatory care in the overall health system performance and this is followed by a summary of the inadequate global data on ambulatory care organization. It then defines the concept of "macro organization of health care" at a system level. Outlined also is a framework for analysing the organization of health care services and the major pathways through which the organization of ambulatory personal health care services can affect system performance. Examples of recent policy interventions to influence primary care organization--both government and nongovernmental providers and market structure--are reviewed. It is argued that the characteristics of health care markets in developing countries and of most primary care goods result in relatively diverse and competitive environments for ambulatory care services, compared with other types of health care. Therefore, governments will be required to use a variety of approaches beyond direct public provision of services to improve performance. To do this wisely, much better information on ambulatory care organization is needed, as well as more experience with diverse approaches to improve performance.

Adult↗
PubMed1997

Estimated expenditures for essential public health services--selected states, fiscal year 1995.

Essential public health services are activities that public health departments and other partners undertake to protect and ensure the health of the public. To characterize expenditures for those services and to distinguish within them expenditures for personal health-care services from community-based health services directed toward populations, the Public Health Service (PHS) and the Public Health Foundation surveyed senior health officials in eight states (Arizona, Iowa, Louisiana, New York, Oregon, Rhode Island, Texas and Washington [combined 1995 population: 57.8 million]). This report summarizes the results of that survey, which indicate that spending on community-based health services is a small proportion of spending on essential services and an even smaller proportion of total health-care expenditures.

Arizona↗
PubMedDate not supplied

Wasteful use of financial resources in public hospitals in Turkey: a trend analysis.

The Turkish health system is mainly financed by public sources such as taxes and premiums collected from workers. According to 2003 data, total health expenditures were 4.5% of the country's Gross Domestic Product. Currently, 56% of the system is financed by the Ministry of Health, and services are also provided by the Ministry. The main sources of finance among the Ministry of Health hospitals are general budget contributions made by the Ministry and revolving funds. The purpose of this study is to evaluate the financial conditions of those Ministry of Health hospitals that have revolving funds. The financial trends of 2514 hospitals were followed from 1996 to 2000, and financial statement analyses were conducted. The results of the study show that the Ministry of Health hospitals are not professionally administered for their financial situation and also that their financial resources are not used effectively. The hospitals had difficulty in collecting debts and had problems in cash returns. At the end of the study, policy suggestions are made for health care managers toward improving financial conditions in these public hospitals.

Efficiency, Organizational↗
PubMed2004

[Pharmacoeconomic evaluation of oseltamivir as prophylaxis against influenza infection].

A pharmacoeconomic evaluation was made of prophylaxis against influenza using the oral neuraminidase inhibitor oseltamivir. Two patterns consisting of administration for 7 days as postcontact prophylaxis (7 day model) and seasonal administration for 6 weeks (6 week model) were examined. Decision analysis models were created on the basis of reports of clinical studies and epidemiologic studies relating to the drug and vaccination, and cost-effectiveness analyses were conducted based on the number of persons who had influenza and pneumonia as health outcomes. Costs were estimated with respect to health expenditures from the societal perspective as well as productivity costs. In the case of administration for 1-week postcontact prophylaxis, the health outcomes improved and costs were reduced in comparison with nontreatment, thus making this administration schedule the dominant choice. With administration for 6 weeks during the infectious period, vaccination involved lower costs and was superior in terms of health outcomes.

Acetamides↗
PubMed2002

[The social and economic cost of diabetes mellitus].

OBJECTIVE: To evaluate the economic impact in terms of the direct costs (health care costs) and the indirect costs (effects on production caused by mortality and morbidity) of diabetes mellitus (DM) in the Canary Islands (Spain) during 1998. DESIGN: The approach used was to study the cost of the disease through looking only at people in the productive sphere (human capital). Direct and indirect costs were calculated by using costs of prevalence, i.e. the costs caused during 1998. SETTING: Direct costs were broken down into hospital care, primary care, out-patient consultations, drugs and further tests; indirect costs, into premature mortality and time off work. Measurements and main results. The total cost of DM amounted to 6468.76 million pesetas (38.88 millio ), or the equivalent of 126 168 pesetas (758.28 ) a year for each known diabetic patient. Total direct cost of DM was 4011.51 million pesetas (24.11 million ), which amounts to 2.13% of health expenditure in the Canaries; or the equivalent of 78 240 pesetas (470.23 ) a year for each known diabetic patient. Direct cost of health care was 62% of the total cost. Total indirect cost was 2457.25 million pesetas (14.77 million ), 38% of the total cost. CONCLUSIONS: Despite the conservatism of the approach, in that the study omitted costs linked to pain and suffering, permanent disability or home care by family members, the high social and economic cost of DM patients calls for cost-effectiveness studies that would permit a more transparent debate on this question.

Adolescent↗
PubMed1983

Public money, private control: a case study of hospital financing in Oakland and Berkeley, California.

Government support of public and private hospitals in Oakland and Berkeley, California was investigated. The private hospitals received government subsidies amounting to at least 60 per cent of their total revenues. The dollar amount of the subsidies to private hospitals was four and one-half times greater than government expenditures on the public hospital. In Oakland and Berkeley, as in many cities, public medical services have been reduced while both government health expenditures and private hospital revenues have increased sharply. The private hospitals, although all nominally non-profit, exhibit revenue maximizing behavior which results in socially unjust and medically irrational resource allocation. Funds might be found for public hospitals and clinics, and resources allocated more justly and rationally, if government expenditures in the private sector were brought under greater public scrutiny and control.

California↗
PubMed1998

Economic evaluations and diabetes.

Diabetes and its treatment have significant economic implications for society, as evidenced by estimated health expenditures for diabetes and its complications in the range of $85-$105 billion in the United States in 1992. With constrained resources, health care professionals need to understand the burden of any illness, benefits and costs of alternative treatments, and the process of combining benefits and costs for the purpose of comparing alternatives. The economic evaluation approach seems best suited for this task. Full and partial economic evaluation techniques will be reviewed with descriptions that have appeared in the recent diabetes literature.

Cost of Illness↗
PubMed2000

Reforming health insurance in Argentina and Chile.

The paper examines the recent reforms of health insurance in Chile and Argentina. These partially replace social health insurance with individual insurance administered through the private sector. In Chile, reforms in the early 1980s allowed private health insurance funds to compete for affiliates with the social health insurance system. In Argentina, reforms in the 1990s aim to open up the union-administered social insurance system to competition both internally and from private insurers. The paper outlines the specific articulation of social and individual health insurance produced by these reforms, and discusses the implications for health insurance coverage, inequalities in access to healthcare, and health expenditures.

Adolescent↗
PubMedDate not supplied

[The risks of good health in France in the year 2020].

Since 1995 onwards, health cost containment is the order of the day in France. Successively, the Right and the Left were implementing strong policies aimed at curbing hospital costs, controlling drug prescriptions, promoting early retirement of practicing doctors.... As expected, all these actions have encountered hard resistances from health professionals (As a matter of fact, the demand side was not affected by cost containment policies). The inertia of all the system and the resistance from health personnel made it clear that cost containment measures will obtain a significant impact only after 2003 or 2005. Precisely, at that date, or some years later, the medical profession will start a sharp decrease of its numbers as the graduate-boom cohorts of the period 1975-1990 will arrive at retirement age. On the demand side, the French population will accelerate its aging process as the baby-boomers born during the period 1945-1965 will reach successively their 60th anniversary. In other words, the decade 2010-2020 will see a sharp growth of the demand for health services and a decrease in the supply. As cost containment is a painful and long-harvesting process, the health authorities of the decade 2010-2020 will probably not let "the horse run freely again". Most probably, supply of health care will be kept under strict control. Will France then adopt the British model (health expenditures kept at low level and queuing for care)? Or will the nation be innovative enough to invent a new model for its health system?

Adolescent↗
PubMedDate not supplied

[Household behaviour regarding health and drug consumption in Cameroon].

To begin a renewal of national health policy in Cameroon, a steering committee from the Cameroon Ministry of Health and its partners sought to analyze health demand through a national population survey and supply capacity through a national survey of retail drug stores. A survey of healthcare consumers was also conducted. The present publication describes the results of the population survey. It measured perceived, rather than objective (diagnosed), morbidity. The morbidity ratio, defined as the proportion of persons who reported having been ill during the reference period, two weeks before the survey, was measured at 23% and varied with demographic, social, and economic characteristics such as age, sex, poverty, the sex and educational level of the head of the household, and place of residence (urban or rural). We asked about six types of response to illness: modern consultation, traditional consultation, modern self-medication, traditional self-medication, expectant management, and prayer. The approaches of individual therapeutic itineraries fluctuated for each subject, depending first on financial capacity, second on geographic accessibility, and third on socio-cultural perception of the illness, which governed in particular choice of a modern or traditional approach. Thus, less than a quarter of all subjects initially chose consultation in a health care centre, which accounted for only 31% of all approaches, and 37% of the effective health responses (excluding treatment abstention). Half, however, chose it as a second step, and 40% as a third. Globally, 56% of those who reported illness did not seek a modern consultation during this illness, and 23% of those who took three separate steps for the same illness never sought a modern consultation. Half of all household health expenditures were for medication, and this proportion was highest in the poorest population. In 2002, the population spent 366 billion CFA Francs on health care: 170 billion for drugs, 75 billion for medical examinations, 53 billion for hospitalization, 30 billion for consultations; and 22 billion for transportation.

Adult↗
PubMed2006

Employer-sponsored insurance coverage of smoking cessation treatments.

OBJECTIVE: To investigate the costs and benefits of covering smoking cessation interventions from insurers' and employers' perspectives. STUDY DESIGN: A Monte Carlo model was used to simulate smoking status and health expenditures in a hypothetical population of employees over a period of 20 years. METHODS: Population characteristics were drawn from the 1997-2002 National Health Interview surveys. Multivariate regressions using a number of publicly available datasets from 1996-2002 generated transition probabilities for the simulation. The costs and benefits of scenarios where smoking cessation treatments were covered were compared with a scenario where none were covered. Sensitivity to parameter estimates was evaluated. RESULTS: By the final simulation year, insurers had benefit-cost ratios of 0.56 to 1.67 with per member per month costs of -$0.22 to $0.43. The earliest year at which savings were achieved for insurers was year 8. Employers saw benefit-cost ratios of 1.88 to 5.58 by the final simulation year with per member per month costs of -$1.23 to -$0.15. Employers achieved savings as early as year 3 and as late as year 8. Models were sensitive to the rate at which population members were assumed to exit the insurer or employer. CONCLUSION: Both insurers and employers may add smoking cessation benefits at minimal burden to their members and with potential savings, particularly where the population of interest is relatively stable.

Adolescent↗
PubMed1988

The National WIC Evaluation: evaluation of the Special Supplemental Food Program for Women, Infants, and Children. IV. Study methodology and sample characteristics in the longitudinal study of pregnant women, the study of children, and the food expenditures study.

The longitudinal study of pregnant women enrolled a national probability sample of 5,205 women first certified for WIC and 1,358 comparable low-income pregnant women in 174 WIC clinics located in 58 areas in the contiguous 48 states and in 55 prenatal clinics without WIC programs in counties with low program coverage. The women completed 24-h dietary recalls, histories of food expenditures, health care utilization, health and sociodemographic status, and anthropometric assessment. At late-pregnancy follow-up 3,967 WIC and 1043 control women were interviewed and 853 WIC and 762 control women completed 1-wk food expenditure diaries. Birth outcome was abstracted (from hospital records) for 3,863 WIC and 1058 control women. Anthropometry, dietary intake, health, and use of health services were related to WIC among 2,619 random low-income preschoolers. Psychological development was assessed in 526 children aged 4 and 5 y. Control women had higher income, education, and employment status; therefore, WIC program benefits probably were underestimated.

Child Nutritional Physiological Phenomena↗
PubMed1992

HMO membership, treatment, and mortality risk among prostatic cancer patients.

OBJECTIVES: Treatment and mortality risk were compared between prostate cancer patients receiving care in fee-for-service settings and those receiving care in a health maintenance organization (HMO). METHODS: Two samples were obtained from a population-based tumor registry. Patients in the first sample (n = 201) were interviewed shortly after diagnosis to obtain data on income, education, overall health status, and expenditures for health status, and expenditures for health care. These data were combined with information from the tumor registry on cancer stage, age, treatment, place of residence, and source of care. Only tumor registry data were obtained for most patients in the second sample (n = 962). For both samples, survival time was monitored for up to 80 months. RESULTS: Multivariate analysis of data from the interviewed sample indicated that HMO patients were less likely to receive surgery but more likely to receive radiation therapy than were those in fee-for-service settings. Mortality risk was lower for the HMO patients than for those in fee-for-service plans. Findings based on the second sample were nearly identical. CONCLUSIONS: This study suggests that HMOs may offer important advantages to lower-income patients at risk for specific life-threatening diseases.

Aged↗
PubMed2005

Health care reform and change in public-private mix of financing: a Korean case.

The objective of this paper is to examine the changes in the Korean health care system invoked by the reform (in the latter part of 2000) in regard to the separation of drug prescription and dispensation, especially from the point of view of the public-private financing mix. It seeks particularly to estimate and analyse the relative financing mix in terms of both modes of production and types of medical provider. The data used to estimate health care expenditure financed by out-of-pocket expenditure by were sourced from the National Health and Nutritional Survey (conducted by interviewing representatives of households) and the General Household Survey (a household diary survey). National Health Insurance data, etc. were used to estimate health expenditure financed by public sources. This study concentrates on the short-run empirical links between the reform and the public-private mix in finance. The reform increased remarkably the public share in total health expenditure. This public share increase has been prominent particularly in the case of expenditure on drugs since the reform has absorbed much of the previously uncovered drugs into the National Health Insurance coverage. However, a higher public share in medical goods than in out-patient care would raise an issue in terms of prioritization of benefit packages. The five-fold increase in the public share of expenditure at pharmacies reflects not only the fact that drugs previously not covered by NHI are covered now but also the fact that prescribed drugs are currently purchased mainly at pharmacies, as opposed to in doctors' clinics, as a result of the reform.

Delivery of Health Care↗