Years of life lost to COVID-19 in 49 countries: A gender- and life cycle-based analysis of the first two years of the pandemic

Unveiling the truth: is COVID-19 reimbursement in Colombia a flawed design? A cost-of-illness analysis for moderate, severe and critical infections

PURPOSE

This study examines the financial impact of the COVID-19 pandemic on the Colombian Health System, focusing on the adequacy of reimbursement rates for inpatient stays. The study, based on a cost of illness analysis, aims to evaluate the effectiveness of the reimbursement scheme and identify potential economic losses within the health system.

PATIENTS AND METHODS

The study protocol outlines the inclusion criteria for patients >18 years with confirmed COVID-19 infection and moderate to critical disease. Patients hospitalised between June 2020 and June 2021 for at least 24 hours were included. Exclusion criteria involved pregnant patients and those initially hospitalised for non-COVID-19.

RESULTS

The study included 781 patients contributing to 790 hospitalisations. Demographic and clinical characteristics were analysed, with critical illness being the most prevalent category (61%). The overall mortality rate was 20.3%, primarily observed in critically ill patients. In the general ward for moderate cases, the reimbursement rate saw a substantial increase from US$3237 in 2020 to US$6760 in 2021, surpassing median resource utilisation. However, for severe cases in the intermediate care unit, reimbursement rates decreased, indicating potential insufficiency in covering costs. In the intensive care unit for critical cases, despite improved reimbursement rates, median resource utilisation still exceeds the 2021 rate, suggesting financial insufficiency in reimbursement rates.

CONCLUSION

Our study underscores the inadequacies of the previous reimbursement system in addressing the varying resource utilisation and costs associated with COVID-19 inpatient care. Our analysis reveals substantial discrepancies between estimated costs and actual resource utilisation, particularly for severe and critical cases. We advocate for government flexibility in revising reimbursement baskets, supported by pilot studies to assess effectiveness. The use of real-world evidence forms a crucial basis for informed adjustments to reimbursement levels in preparation for future pandemics. This proactive approach ensures alignment between reimbursement policies and the actual costs associated.

Mechanism design for a fair and equitable approach to global vaccine distribution: The case of COVID-19

Vaccines are one of the most effective tools humanity has in the fight against pandemics. One of the major challenges of vaccine distribution is achieving fair and equitable allocation across the countries of the world, regardless of their economic wealth. The self-interested behaviour of high-income countries and the underutilisation of vaccines allocated to underprepared countries are some of the failures reported during COVID-19 vaccine roll-out. These shortcomings have motivated the need for a central market mechanism that takes into account the countries' vulnerability to COVID-19 and their readiness to distribute and administer their allocated vaccines. In this paper, we leverage game theory to study the problem of equitable global vaccine distribution and propose a fair market mechanism that aligns self-interested behaviour with optimal global objectives. First, we model the interaction between a central vaccine provider (e.g. COVAX) and a country reporting its demand as a two-player game, and discuss the Nash and mixed Nash equilibria of that game. Then, we propose a repeated auction mechanism with an artificial payment system for allocating vaccines among participating countries, where each auction round is based on a Vickrey-Clarke-Groves (VCG) mechanism. The proposed allocation mechanism aims at minimising deaths and incentivises the self-interested countries to report their demand truthfully. Compared with real-world COVAX allocation decisions, our results show that the proposed auction mechanism achieves more efficient outcomes that maximise the number of averted deaths. Pragmatic considerations are investigated and policy recommendations are discussed.