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Simic R, Ratkovic N, Dragojevic Simic V, Savkovic Z, Jakovljevic M, Peric V, Pandrc M, Rancic N. Cost Analysis of Health Examination Screening Program for Ischemic Heart Disease in Active-Duty Military Personnel in the Middle-Income Country. Front Public Health 2021; 9:634778. [PMID: 33748069 PMCID: PMC7969704 DOI: 10.3389/fpubh.2021.634778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
Cardiovascular diseases, including ischemic heart disease, are the most common causes of morbidity and death in the world, including Serbia, as a middle-income European country. The aim of the study was to determine the costs of preventive examinations for ischemic heart disease in active-duty military personnel, as well as to assess whether this was justified from the point of view of the limited health resources allocated for the treatment of the Republic of Serbia population. This is a retrospective cost-preventive study which included 738 male active-duty military personnel, aged from 23 to 58. The costs of primary prevention of ischemic heart disease in this population were investigated. Out of 738 subjects examined, arterial hypertension was detected in 101 subjects (in 74 of them, arterial hypertension was registered for the first time, while 27 subjects were already subjected to pharmacotherapy for arterial hypertension). Average costs of all services during the periodic-health-examination screening program were €76.96 per subject. However, average costs of all services during the periodic-health-examination screening program for patients with newfound arterial hypertension and poorly regulated arterial hypertension were €767.54 per patient and €2,103.63 per patient, respectively. Since periodic-health-examination screening program in military personnel enabled not only discovery of patient with newfound arterial hypertension but also regular monitoring of those who are already on antihypertensive therapy, significant savings of €690.58 per patient and €2,026.67 per patient can be achieved, respectively. As financial resources for providing health care in Serbia, as a middle-income country, are limited, further efforts should be put on screening programs for ischemic heart disease due to possible significant savings.
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Affiliation(s)
- Radoje Simic
- Department for Plastic Surgery, Institute for Mother and Child Health Care of Serbia Dr. Vukan Cupic, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nenad Ratkovic
- Medical Faculty of the Military Medical Academy, University of Defence in Belgrade, Belgrade, Serbia.,Sector for Treatment, Military Medical Academy, Belgrade, Serbia
| | - Viktorija Dragojevic Simic
- Medical Faculty of the Military Medical Academy, University of Defence in Belgrade, Belgrade, Serbia.,Center for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
| | - Zorica Savkovic
- Faculty of Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| | - Mihajlo Jakovljevic
- Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan.,Department of Global Health Economics and Policy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Vitomir Peric
- Medical Faculty of the Military Medical Academy, University of Defence in Belgrade, Belgrade, Serbia
| | - Milena Pandrc
- Clinic for Cardiology, Military Medical Academy, Belgrade, Serbia
| | - Nemanja Rancic
- Medical Faculty of the Military Medical Academy, University of Defence in Belgrade, Belgrade, Serbia.,Center for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
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Stepovic M, Rancic N, Vekic B, Dragojevic-Simic V, Vekic S, Ratkovic N, Jakovljevic M. Gross Domestic Product and Health Expenditure Growth in Balkan and East European Countries-Three-Decade Horizon. Front Public Health 2020; 8:492. [PMID: 33042939 PMCID: PMC7522281 DOI: 10.3389/fpubh.2020.00492] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 07/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Dynamics of health care has changed over time along with development of the countries themselves. The aim of the study is to compare macroeconomic and health expenditure indicators of interest, such as total health expenditure (THE) as percentage of global domestic product, global domestic product per capita in US$, and private households' out-of-pocket payments of Balkan and Eastern European countries on health, as well as to assess their progress over the observed period. Methods: This research report represents a descriptive data analysis of indicators extracted from the European Health for All database. The data were analyzed using a linear trend and regression analysis to estimate the timeline changes. Results: Greece and Slovenia have the largest median values of global domestic product per capita throughout the whole period, and the largest increment trend was in Lithuania. Median value in out-of-pocket payment of THE was the highest in Albania and Ukraine, while the largest decrease in trend was noticed in Albania and Bosnia and Herzegovina. Bosnia and Herzegovina and Greece had the largest median value of THE as percentage of Gross Domestic Product (GDP) in the observed period, while regression trend analysis showed that Serbia had the largest increase. Most of the countries showed a significant correlation between observed indicators. Conclusion: Trends in the economy must be constantly monitored due to the fact that the population is aging and non-communicable diseases are multiplying, which requires innovations in medical treatment and pharmaceutical development.
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Affiliation(s)
- Milos Stepovic
- Faculty of Medical Science, University of Kragujevac, Kragujevac, Serbia
| | - Nemanja Rancic
- Centre for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
- Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Berislav Vekic
- Clinic for Surgery, University Hospital Center “Dr. Dragisa Misovic”, Belgrade, Serbia
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Viktorija Dragojevic-Simic
- Centre for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
- Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Stefan Vekic
- Faculty of Economics, University of Belgrade, Belgrade, Serbia
| | - Nenad Ratkovic
- Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia
- Treatment Sector, Military Medical Academy, Belgrade, Serbia
| | - Mihajlo Jakovljevic
- Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan
- The N.A.Semashko Public Health and Healthcare Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Global Health Economics and Policy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Pekez-Pavlisko T, Racic M, Kusmuk S. Medicine Availability and Prescribing Policy for Non-Communicable Diseases in the Western Balkan Countries. Front Public Health 2017; 5:295. [PMID: 29167787 PMCID: PMC5682312 DOI: 10.3389/fpubh.2017.00295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 10/24/2017] [Indexed: 01/13/2023] Open
Abstract
Background During the transition processes, the Western Balkan countries were affected by conflicts and transition-related changes. Life expectancy in these countries is lower, while the mortality from non-communicable diseases (NCDs) is higher in comparison with western and northern parts of Europe. The primary aim of this study was to analyze the treatment possibilities for the most common NCDs in the Western Balkan countries. The secondary aim was to understand and compare the policies regarding prescribing-related competencies of family physicians. Methods In June and July 2017, a document analysis was performed of national positive medicines lists, strategic documents, and clinical guidelines for the treatment of the most frequent NCDs; arterial hypertension, diabetes, hyperlipidemia, asthma, and chronic obstructive pulmonary disease (COPD). All text phrases that referred to medicines prescribing were extracted and sorted into following domains: medicine availability, prescribing policy, and medication prescribing-related competencies. Results Possibilities for treatment of arterial hypertension, diabetes, hyperlipidemia, asthma, and COPD vary across the Western Balkan countries. This variance is reflected in the number of registered medicines, number of parallels, and number of different combinations, as well as restrictions placed on family physicians in prescribing insulin, inhaled corticosteroids, statins and angiotensin II receptor blockers (ARBs), without consultant's recommendation. Conclusion Western Balkan countries are capable of providing essential medicines for the treatment of NCDs, with full or partial reimbursement. There are some exceptions, related to statins, newer generation of oral antidiabetic agents and some of the antihypertensive combinations. Prescribing-related competences of family physicians are limited. However, this practice is not compliant to the practices of family medicine, its principles and primary care structures, and may potentially result in increased health-care financial ramifications to both the system and patients due to frequent referrals to the specialists.
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Affiliation(s)
| | - Maja Racic
- Faculty of Medicine, Department for Primary Health Care and Public Health, University of East Sarajevo, East Sarajevo, Bosnia and Herzegovina
| | - Srebrenka Kusmuk
- Faculty of Medicine, Department for Primary Health Care and Public Health, University of East Sarajevo, East Sarajevo, Bosnia and Herzegovina
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Jiang Y, Wang Y, Li Y, Zhang Y, Zhao Y, Wang X, Ma C, Ma S. Inpatient Treatment for the Middle-aged and Elderly in Central China. Front Public Health 2017; 5:7. [PMID: 28210617 PMCID: PMC5288374 DOI: 10.3389/fpubh.2017.00007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/17/2017] [Indexed: 11/21/2022] Open
Abstract
Background Compared to outpatient treatment and self-treatment, inpatient treatment corresponds to more severe illness and poses more serious health and financial burden to patients. The goal of this study is to provide an updated and comprehensive description of the prevalence, characteristics, and cost of inpatient treatment for the middle-aged and elderly in Central China, which is highly populated, less-developed, and agriculture-dominating. Methods A survey was conducted in August 2013 in the Henan province. Data on 1,464 subjects were collected. Results Among the surveyed subjects, 582 had at least one episode of inpatient treatment. Subjects with different inpatient treatment status differ in the distributions of age, education, occupation, area, health insurance coverage, physical condition, and presence of chronic disease. The surveyed subjects had up to six inpatient treatments within 12 months. Different episodes have different characteristics. Age and the presence of chronic disease are significantly associated with the number of inpatient treatments. The utilization of grade III hospital for inpatient treatment is associated with gender, marital status, and per capita income. The total and out-of-pocket costs are associated with education, utilization of type III hospital, and insurance utilization. Conclusion This study has provided a comprehensive description of inpatient treatment for Central China, an area with low developmental and economic status. The observations may assist improving health conditions and disease treatment for this less-advantaged area.
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Affiliation(s)
- Yan Jiang
- Center for Applied Statistics, School of Statistics, Renmin University of China , Beijing , China
| | - Yu Wang
- Center for Applied Statistics, School of Statistics, Renmin University of China , Beijing , China
| | - Yang Li
- Center for Applied Statistics, School of Statistics, Renmin University of China , Beijing , China
| | - Yuming Zhang
- Center for Applied Statistics, School of Statistics, Renmin University of China , Beijing , China
| | - Yinjun Zhao
- School of Public Health, Yale University , New Haven, CT , USA
| | - Xiaojun Wang
- Center for Applied Statistics, School of Statistics, Renmin University of China , Beijing , China
| | - Chi Ma
- Ideological and Political Education Center, Beijing Institute of Petrochemical Technology , Beijing , China
| | - Shuangge Ma
- Center for Applied Statistics, School of Statistics, Renmin University of China, Beijing, China; School of Public Health, Yale University, New Haven, CT, USA
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