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Jadidfard MP, Tahani B. Painless cost control as a central strategy for universal oral health coverage: A critical review with policy guide. Int J Dent Hyg 2024. [PMID: 38764157 DOI: 10.1111/idh.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/19/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024]
Abstract
AIM This study aimed to critically review the methods used to control the significantly increasing costs of dental care. METHODS Through a comprehensive search of the available literature, the cost control (CC) mechanisms for health services were identified from a healthcare system perspective. The probable applicability of each CC method was evaluated mainly based on its potential contribution to oral health promotion. Each mechanism was then classified and discussed under any of the two headings of financing and service provision. An operational guide was finally presented for policy-making in each of the three main models of healthcare systems, including National Health Services, social/public health insurance and private insurance. RESULTS From a total of 142 articles/reports retrieved in PubMed, 73 in Scopus and 791 in Google Scholar, 35 were included in the final review after eliminating the duplicates and screening process. Totally ten mechanisms were identified for CC of dental care. Seven were discussed under the financing function, including cost sharing, preauthorization, mixed payment method and an evidence-based approach to benefit package definition, among others. Three further methods were classified under the service provision function, including workforce skill mix with emphasis on primary oral healthcare providers, development of primary healthcare (PHC) network and an appropriate use of tele-dentistry. CONCLUSION Painless control of dental expenditures requires a smart integration of prevention into the CC plans. The suggested policy guide emphasizes organizational factors; particularly including the development of PHC-based networks with midlevel providers (desirably extended-duty dental hygienists) as the frontline oral healthcare providers.
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Affiliation(s)
- Mohammad-Pooyan Jadidfard
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Community Oral Health, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Tahani
- Department of Oral Public Health, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Slavkin HC, Dubois PA, Kleinman DV, Fuccillo R. Science-Informed Health Policies for Oral and Systemic Health. J Healthc Leadersh 2023; 15:43-57. [PMID: 36960302 PMCID: PMC10028303 DOI: 10.2147/jhl.s363657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/21/2023] [Indexed: 03/18/2023] Open
Abstract
Oral, dental and craniofacial (ODC) health has a profound impact on general health and welfare throughout life, yet US dentists and physicians operate across misaligned silos. This protracted division limits access to optimal health, supports fee for services, and exacerbates health disparities. Early in the 20th century, the most frequent dental therapy was tooth extraction: removed infected teeth were substituted by prosthetic appliances - commonly, dentures or nothing. Most adults assumed becoming edentulous was a normal corollary of aging. With the discovery of penicillin and other antibiotics, healthcare professionals and policy makers predicted infectious diseases would become irrelevant. However, given numerous health threats, including SARS-CoV-2, HIV, multidrug-resistant bacteria, Zika virus, Ebola virus, and now monkeypox, public and professional awareness of transmissible infectious diseases has never been more evident. Ironically, little attention has been paid to unmet transmissible, infectious, common oral diseases - dental caries and periodontal diseases. Therefore, these persist within "the silent and invisible epidemic". The preventable death of a young boy in 2007 from an infected untreated tooth that produced bacterial meningitis is a profound reminder that our nation has vast inequities in education, health, and welfare. The impact of oral infections on hospital-acquired pneumonia, post-operative infection in cardiac valve surgery, and even academic performances of disadvantaged children displayed through sociodemographic characteristics and access to care determinants also are profound! This paper asserts that current and emerging ODC health knowledge and science will inform health policies and advance equity in access to care, affordable costs, and optimal healthcare outcomes. We recommend that legal and regulatory systems and public health programs be required to ensure health equity. A fair healthcare system that addresses holistic healthcare must be transparent, accessible, integrated and provide a standard of oral healthcare based upon scientific evidence for all people across the lifespan.
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Affiliation(s)
- Harold C Slavkin
- Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | - Peter A Dubois
- California Dental Association, California Dental Association Holding Company, Inc., Sacramento, California, USA
| | | | - Ralph Fuccillo
- Cambridge Concord Associates, Stoneham, Massachusetts, USA
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3
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Bernard ME, Halasy MP, Rushlow DR, Sobolik GJ, Garrison GM, Matthews MR, Allen SV, Thacher TD. The effect of primary care clinician type and care team characteristics on health care costs. J Eval Clin Pract 2022; 28:1055-1060. [PMID: 35434886 DOI: 10.1111/jep.13686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate health care costs as a function of assigned primary care clinician type and care team characteristics. METHODS Administrative data were collected for 68 family medicine clinicians (40 physicians and 28 nurse practitioners [NPs]/physician assistant [PAs]), on 11 care teams (variable MD, NP and PA on teams), caring for 77,141 patients. We performed a generalized linear mixed multivariable regression model of standardized per member per month (PMPM) median cost as the outcome, with four practice sites included as random effects. RESULTS In bivariate analysis, cost was higher in physicians than NP/PAs, in more complex patients, and associated with emergency department (ED) visit rate. On multivariate analysis, patient complexity, ED visit rate and higher patient experience ratings were independently associated with greater PMPM cost. More time in practice was associated with lower PMPM cost. In the adjusted multivariate model, physicians had 8.3% lower median PMPM costs than NP/PAs (p = 0.046). CONCLUSIONS The primary drivers of greater PMPM cost were patient complexity, ED visits and patient satisfaction.
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Affiliation(s)
- Matthew E Bernard
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David R Rushlow
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Gerald J Sobolik
- Employee and Community Health, Primary Care and Population Health, Rochester, Minnesota, USA
| | | | - Marc R Matthews
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Summer V Allen
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas D Thacher
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Baker SA, Wong LK, Wieland R, Bulterys P, Allard L, Nguyen L, Quach T, Nguyen A, Chaesuh E, Cheng P, Bowen R, Virk M. Validated transport conditions maintain the quality of washed red blood cells. Transfusion 2022; 62:1860-1870. [DOI: 10.1111/trf.17062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Steven Andrew Baker
- Division of Transfusion Medicine, Department of Pathology Stanford University Stanford California USA
- Transfusion Medicine Section, Department of Pathology University of Utah Salt Lake City Utah USA
| | - Lisa Kanata Wong
- Division of Transfusion Medicine, Department of Pathology Stanford University Stanford California USA
| | - Rebekah Wieland
- Department of Pathology Stanford University Stanford California USA
| | - Philip Bulterys
- Department of Pathology Stanford University Stanford California USA
| | - Libby Allard
- Department of Pathology Stanford University Stanford California USA
| | - Lang Nguyen
- Division of Transfusion Medicine, Department of Pathology Stanford University Stanford California USA
| | - Thinh Quach
- Division of Transfusion Medicine, Department of Pathology Stanford University Stanford California USA
| | - AnhThu Nguyen
- Division of Transfusion Medicine, Department of Pathology Stanford University Stanford California USA
| | - Eunkyong Chaesuh
- Division of Clinical Chemistry, Department of Pathology Stanford University Stanford California USA
| | - Phil Cheng
- Division of Clinical Chemistry, Department of Pathology Stanford University Stanford California USA
| | - Raffick Bowen
- Division of Clinical Chemistry, Department of Pathology Stanford University Stanford California USA
| | - Mrigender Virk
- Division of Transfusion Medicine, Department of Pathology Stanford University Stanford California USA
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Tranvåg EJ, Haaland ØA, Robberstad B, Norheim OF. Appraising Drugs Based on Cost-effectiveness and Severity of Disease in Norwegian Drug Coverage Decisions. JAMA Netw Open 2022; 5:e2219503. [PMID: 35767256 PMCID: PMC9244608 DOI: 10.1001/jamanetworkopen.2022.19503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Rising health care costs are a major health policy challenge globally. Norway has implemented a priority-setting system intended to balance cost-effectiveness and concerns for fair distribution, but little is known about this strategy and whether it works in practice. OBJECTIVE To present and evaluate a systematic drug appraisal method that uses the severity of disease to account for a fair distribution of health in cost-effectiveness analysis, forming the basis for price negotiations and coverage decisions. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study uses confidential drug price information and publicly available data from health technology assessments and logistic and linear regression analyses to evaluate drug coverage decisions for the Norwegian specialized health care sector from 2014 to 2019. MAIN OUTCOMES AND MEASURES Drug coverage decisions by Norwegian authorities and incremental cost-effectiveness and severity of disease measured as absolute shortfall of quality adjusted life years. RESULTS Between 2014 and 2019, a total of 188 drugs were appraised, of which 113 were cancer drugs. The overall coverage rate was 73% (138 of 188). The number of annual appraisals increased during the observation period. Based on 83 chosen decisions, regression analysis showed that incremental cost-effectiveness ratios (ICER) based on negotiated drug prices, adjusted for severity-differentiated cost-effectiveness thresholds, was the variable that best projected drug approvals (OR, 0.60; 95% CI, 0.42-0.86). An increase in the ICER by $10 000 was associated with a reduction in the odds for approval of 40% for drugs assessed from 2018 to 2019. CONCLUSIONS AND RELEVANCE This cross-sectional study demonstrated how concerns for efficiency and fair distribution of health can be implemented systematically into drug appraisals and reimbursement decisions. New, expensive drugs are expected to escalate health care costs in the years to come, and it may be feasible to control costs by negotiating the prices of new drugs while appraising both their cost-effectiveness and how their health benefits are distributed.
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Affiliation(s)
- Eirik Joakim Tranvåg
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Øystein Ariansen Haaland
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bjarne Robberstad
- Research Group in Health Economics, Leadership, and Translational Ethics Research, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ole Frithjof Norheim
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Bernard ME, Laabs SB, Nagaraju D, Allen SV, Halasy MP, Rushlow DR, Garrison GM, Maxson JA, Matthews MR, Sobolik GJ, Lampman MA, Foss RM, Rosas SL, Thacher TD. Clinician Care Team Composition and Health Care Utilization. Mayo Clin Proc Innov Qual Outcomes 2021; 5:338-346. [PMID: 33997633 PMCID: PMC8105520 DOI: 10.1016/j.mayocpiqo.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To test the hypothesis that a greater proportion of physician time on primary care teams are associated with decreased emergency department (ED) visits, hospital admissions, and readmissions, and to determine clinician and care team characteristics associated with greater utilization. Patients and Methods We retrospectively analyzed administrative data collected from January 1 to December 31, 2017, of 420 family medicine clinicians (253 physicians, 167 nurse practitioners/physician assistants [NP/PAs]) with patient panels in an integrated health system in 59 Midwestern communities serving rural and urban areas in Minnesota, Wisconsin, and Iowa. These clinicians cared for 419,581 patients through 110 care teams, with varying numbers of physicians and NP/PAs. Primary outcome measures were rates of ED visits, hospitalizations, and readmissions. Results The proportion of physician full-time equivalents on the team was unrelated to rates of ED visits (rate ratio [RR] = 0.826; 95% confidence interval [CI], 0.624 to 1.063), hospitalizations (RR = 0.894; 95% CI, 0.746 to 1.072), or readmissions (RR = –0.026; 95% CI, 0.364 to 0.312). In separate multivariable models adjusted for clinician and practice-level characteristics, the rate of ED visits was positively associated with mean panel hierarchical condition category (HCC) score, urban vs rural setting, NP/PA vs physician, and lower years in practice. The rate of inpatient admissions was associated with HCC score, and 30-day hospital readmissions were positively associated with HCC score, lower years in practice, and male clinicians. Conclusion Care team physician and NP/PA composition was not independently related to utilization. More complex panels had higher rates of ED visits, hospitalization, and readmissions. Statistically significant differences between physician and NP/PA panels were only evident for ED visits.
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Affiliation(s)
| | - Susan B Laabs
- Department of Family Medicine, Mayo Clinic, Rochester, MN
| | | | - Summer V Allen
- Department of Family Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | - Julie A Maxson
- Department of Family Medicine, Mayo Clinic, Rochester, MN
| | | | - Gerald J Sobolik
- Department of Health Care Administration, Mayo Clinic, Rochester, MN
| | | | - Randy M Foss
- Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Steven L Rosas
- Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Tom D Thacher
- Department of Family Medicine, Mayo Clinic, Rochester, MN
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Peterson MA. The ACA a Decade In: Resilience, Impact, and Vulnerabilities. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2020; 45:595-608. [PMID: 32186327 DOI: 10.1215/03616878-8255517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A decade after its enactment, the Affordable Care Act remains both politically viable and consequential, despite Republican efforts to end it. The law's impact on insurance coverage is substantial but remains distant from universal coverage, while its contributions to cost control are at best limited. National public opinion data collected by the author in 2018 reveal both strengths and vulnerabilities in the act.
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Discussion: Autologous Breast Reconstruction versus Implant-Based Reconstruction: How Do Long-Term Costs and Health Care Use Compare? Plast Reconstr Surg 2020; 145:312-314. [DOI: 10.1097/prs.0000000000006498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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D'Souza MJ, Li RC, Wentzien DE. Delaware's 1999-2017 Leading Causes of Death Information Illustrates Its Obesity and Obesity-Related Life-Limiting Disease Burdens. ACTA ACUST UNITED AC 2019; 4:327-346. [PMID: 31768484 DOI: 10.22158/rhs.v4n4p327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Using commercially available but powerful big data analytics, this non-clinical obesity and underlying causes of death observational study, analyzed the very large US Centers for Disease Control and Prevention's (CDC) State of Obesity records, the CDC WONDER data, and the US census records. Compared to the 1999-to-2017 US obesity rate increase of 29.8%, an uncontrolled increase in Delaware's obesity rate (81.7%) was observed. During the same time period, CDC WONDER death certificate archives disclosed that there was a 60.53% surge in crude Delawarean mortality rate when obesity was listed as a single underlying cause of death. When any mention of obesity was documented on the death certificate, Delaware's 1999-2017 crude mortality rate advanced by 75.69% and its age-adjusted rate rose by 53.18%. Likewise, except for one year, Delaware's African American/Black population experienced higher crude mortality rate averages but however, between the years of 1997 and 2017, its Caucasian/White inhabitants had an enormous 87.34% death rate increase. With additional available CDC mortality data, Delaware males saw substantially larger age-adjusted death rate increases (79.87%) than their female counterparts (28.92%). Diabetes, circulatory system diseases, and neoplasms (cancer), are three common obesity comorbidities. For these three conditions, Delaware's 1999-2017 mortality rate figures mimic the falling national patterns of mortality rate averages, when each disease is listed as the single underlying cause of death, including observations where there are disproportionate numbers of cases that affect the African American/Black race.
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Affiliation(s)
- Malcolm J D'Souza
- Wesley College STEM Undergraduate Research Center for Analytics, Talent, and Success, Wesley College, Dover, DE 19901, United States
| | - Riza C Li
- Wesley College STEM Undergraduate Research Center for Analytics, Talent, and Success, Wesley College, Dover, DE 19901, United States.,Center for Bioinformatics and Computational Biology, University of Delaware, Newark, Delaware, 19711, United States
| | - Derald E Wentzien
- Wesley College STEM Undergraduate Research Center for Analytics, Talent, and Success, Wesley College, Dover, DE 19901, United States
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Kislyakov A, Mayes R. The Physics of Health Care: Viewing the U.S. Health‐Care “System” from the Perspective of Quantum Mechanics. WORLD MEDICAL & HEALTH POLICY 2019. [DOI: 10.1002/wmh3.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ballard DJ, Fleming NS. Rising Health Care Charges: A Red Herring in a Value-Based Health Care World? Mayo Clin Proc 2019; 94:946-948. [PMID: 31171131 DOI: 10.1016/j.mayocp.2019.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/18/2019] [Indexed: 11/28/2022]
Affiliation(s)
- David J Ballard
- Mentice AB, Gothenburg, Sweden; Department of Health Policy and Management, UNC Gillings School of Public Health, The University of North Carolina at Chapel Hill.
| | - Neil S Fleming
- Center for Clinical Effectiveness, Baylor Health Care System, Dallas, TX; Robbins Institute for Health Policy and Leadership, Hankamer School of Business Baylor University, Waco, TX
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Humphries B, Xie F. Canada's Amendment to Patented Drug Price Regulation: A Prescription for Global Drug Cost Control? JAMA 2019; 321:1565-1566. [PMID: 30924840 DOI: 10.1001/jama.2019.2280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Brittany Humphries
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
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