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McCombie A, Bothara R, MacCormick A, Carne B, Hercus A, Eglinton T. A longitudinal study examining the relationship between prioritization scores and changes in impact on life scores in elective surgery patients. ANZ J Surg 2024. [PMID: 38661117 DOI: 10.1111/ans.19014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Healthcare systems globally face the issue of resource constraints and need for prioritization of elective surgery. Inclusive, explicit prioritization tools are important in improving consistency and equity of access to surgery across health systems. The General Surgical Prioritization Tool developed by New Zealand's Ministry of Health scores patients for elective non-cancer surgery based on surgeon's clinical judgement and patient derived Impact on Life (IoL) scores. This study aims to measure the changes in patient derived IoL scores after common general surgical procedures to enable direct comparison and inform future prioritization. METHOD This longitudinal observational study enrolled 322 participants who had undergone elective general surgical procedures. Participants were contacted 3 to 9 months after their procedures and requested to complete the IoL questionnaire. The primary endpoint was the change in IoL scores after surgery among the different procedures. RESULTS Overall, 229/304 (75%) participants responded to the questionnaire and there were no significant baseline differences between responders and non-responders. Patients in the gallbladder treatment group had the greatest improvement in IoL scores. Patients across all ethnic groups had similar changes in IoL scores. Multivariate analysis showed that gallbladder surgery (relative to hernia surgery) and pre-surgery IoL scores significantly predicted improvement. CONCLUSION The patient reported IoL score recorded at prioritization for surgery all reduced, albeit to varying amounts, after common general surgical procedures. This, combined with the fact that IoL scores predicted post-operative improvement support their inclusion in prioritization tools in addition to surgeon derived components.
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Affiliation(s)
- Andrew McCombie
- Health New Zealand (Te Whatu Ora), Aotearoa, New Zealand
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Roshit Bothara
- Health New Zealand (Te Whatu Ora), Aotearoa, New Zealand
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Andrew MacCormick
- Health New Zealand (Te Whatu Ora), Aotearoa, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Brennan Carne
- Health New Zealand (Te Whatu Ora), Aotearoa, New Zealand
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Alastair Hercus
- Health New Zealand (Te Whatu Ora), Aotearoa, New Zealand
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Tim Eglinton
- Health New Zealand (Te Whatu Ora), Aotearoa, New Zealand
- Department of Surgery, University of Otago, Christchurch, New Zealand
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Yang C, Cui D, Yin S, Wu R, Ke X, Liu X, Yang Y, Sun Y, Xu L, Teng C. Fiscal autonomy of subnational governments and equity in healthcare resource allocation: Evidence from China. Front Public Health 2022; 10:989625. [PMID: 36249207 PMCID: PMC9561467 DOI: 10.3389/fpubh.2022.989625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/08/2022] [Indexed: 01/26/2023] Open
Abstract
Objectives Promoting equity in healthcare resource allocation (EHRA) has become a critical political agenda of governments at all levels since the ambitious Universal Health Coverage was launched in China in 2009, while the role of an important institutional variable-fiscal autonomy of subnational governments-is often overlooked. The present study was designed to determine the effect of FASG on EHRA and its potential mechanism of action and heterogeneity characteristics to provide empirical support for the research field expansion and relative policies making of EHRA. Methods From the start, we utilized the Theil index and the entropy method to calculate the EHRA index of 22 provinces (2011-2020) based on the medical resource data of 287 prefecture-level cities. Furthermore, we used the two-way fixed effects model (FE) to identify and analyze the impact of FASG on EHRA and then used three robustness test strategies and two-stage least squares (2SLS) regression to verify the reliability of the conclusions and deal with potential endogeneity problems, respectively. At last, we extend the baseline regression model and obtain the two-way FE threshold model for conducting heterogeneity analysis, which makes us verify whether the baseline model has nonlinear characteristics. Results The static value and the trend of interannual changes in the EHRA values in different provinces are both very different. The regression results of the two-way FE model show that FASG has a significant positive impact on EHRA, and the corresponding estimated coefficient is - 0.0849 (P < 0.01). Moreover, this promotion effect can be reflected through two channels: enhancing the intensity of government health expenditure (IGHE) and optimizing the allocation of human resources for health (AHRH). At last, under the different economic and demographic constraints, the impact of FASG on EHRA has nonlinear characteristics, i.e., after crossing a specific threshold of per capita DGP (PGDP) and population density (PD), the promotion effect is reduced until it is not statistically significant, while after crossing a particular threshold of dependency ratio (DR), the promotion effect is further strengthened and still statistically significant. Conclusions FASG plays an essential role in promoting EHRA, which shows that subnational governments need to attach great importance to the construction of fiscal capability in the allocation of health care resources, effectively improve the equity of medical and health fiscal expenditures, and promote the sustainable improvement of the level of EHRA.
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Affiliation(s)
- Ciran Yang
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China
| | - Dan Cui
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China,*Correspondence: Dan Cui
| | - Shicheng Yin
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China
| | - Ruonan Wu
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China
| | - Xinfeng Ke
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China
| | - Xiaojun Liu
- Public Health School, Fujian Medical University, Fuzhou, China
| | - Ying Yang
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China
| | - Yixuan Sun
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China
| | - Luxinyi Xu
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China
| | - Caixia Teng
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China,Global Health Institute, Wuhan University, Wuhan, China
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Persson K. Why Bariatric surgery should be given high priority: an argument from law and morality. HEALTH CARE ANALYSIS 2016; 22:305-24. [PMID: 22791464 DOI: 10.1007/s10728-012-0216-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In recent years, bariatric surgery has become an increasingly popular treatment of obesity. The amount of resources spent on this kind of surgery has led to a heated debate among health care professionals and the general public, as each procedure costs at minimum $14,500 and thousands of patients undergo surgery every year. So far, no substantial argument for or against giving this treatment a high priority has, however, been presented. In this article, I argue that regardless which moral perspective we consider--greatest need, utility or personal responsibility--the conclusion is that we should give bariatric surgery a high priority when allocating scarce resources in health care.
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Affiliation(s)
- Karl Persson
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Box 200, 405 30, Göthenburg, Sweden,
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Yang CH, Huang YTA, Hsueh YSA. Redistributive effects of the National Health Insurance on physicians in Taiwan: a natural experiment time series study. Int J Equity Health 2013; 12:13. [PMID: 23374629 PMCID: PMC3598464 DOI: 10.1186/1475-9276-12-13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 01/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have evaluated the effects of various health manpower policies but did not include full consideration of the effect of universal health insurance on physician re-distribution. This study examines the effects of implementing National Health Insurance (NHI) on the problem of geographic mal-distribution of health providers in Taiwan. METHODS Data on health providers and population between 1971 and 2001 are obtained from relevant governmental publications in Taiwan. Gini coefficients derived from the Lorenz curve are used under a spline regression model to examine the impact of the NHI on the geographic distribution of health providers. RESULTS The geographic distribution equality of the three key health providers has improved significantly after the implementation of NHI program. After accounting for the influences of other confounding factors, Gini coefficients of the three key providers have a net reduction of 1.248% for dentists, 0.365% for western medicine physicians, and 0.311% for Chinese medicine physicians. Overall, the absolute values of the three key providers' Gini coefficients also become close to one another. CONCLUSIONS This study found that NHI's offering universal health coverage to all citizens and with proper financial incentives have resulted in more equal geographic distributions among the key health care providers in Taiwan.
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Affiliation(s)
- Chiang-Hsing Yang
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yu-Tung A Huang
- Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| | - Ya-Seng A Hsueh
- Centre for Health Policy, Programs and Economics, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, 3053 Victoria, Australia
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