Identifying healthcare cost drivers in Palestine

We examine the relationship between national health expenditure and its drivers to help inform resource allocation policy decisions in Palestine. We forecast health expenditures from the financing agency perspective, and examine Granger-Causality relationships to assess implied causality between health spending and exogenous variables, using estimates of vector autoregressions. We forecast national health expenditure to be US$1.45 billion in 2015 and grow at 7% annually through 2020. This is due to expected increases in government health expenditure, and household spending, at 5% and 7%, respectively, compared to 2014. The proportion of household spending on health services is expected to increase, while the government proportion is expected to decrease over the long run due to budget constraints. Population growth, ageing and changes in chronic disease patterns contribute significantly as drivers of the increase in healthcare costs. Our results suggest a need to review and modify the current health insurance scheme.

The Role of Information and Communications Technology (ICT) in Enhancing Service Sector Productivity in Palestine

This article discusses the productivity of the Information and Communication Technology (ICT) sector using cross-sectional data from 793 service firms in Palestine. The authors have examined the impact of ICT growth on service sector productivity in Palestine using a set of indicators for ICT including internet usage, e-commerce, networks, websites, and use of “smart” phones. They find that using ICT (mainly Internet) in commerce (e-commerce) is one of the most important levers of labor productivity among service firms. Service firms that are less ICT-intensive are less productive than more ICT-intensive firms; moreover, the use of mobile phones for services other than send-and-receive calls, highly improves the labor productivity of service firms. Conversely, using a website and computer network does not positively affect the labor productivity. Regarding geographical differences in labor productivity, the analysis shows that firms in Jerusalem are characterized by higher productivity than firms in the West Bank, while firms in Gaza have a lower productivity compared to firms in the West Bank.

A cost analysis of kidney replacement therapy options in Palestine

This study provides a cost analysis of kidney replacement therapy options in Palestine. It informs evidence-based resource allocation decisions for government-funded kidney disease services where transplant donors are limited, and some of the common modalities, i.e., peritoneal dialysis (PD) and home hemodialysis (HD), are not widely available due to shortages of qualified staff, specialists, and centers to follow the patient cases, provide training, make home visits, or provide educational programs for patients. The average cost of kidney transplant was US$16,277 for the first year; the estimated cost of HD per patient averaged US$16,085 per year--nearly as much as a transplant. Consistent with prior literature and experience, while live, related kidney donors are scarce, we found that kidney transplant was more adequate and less expensive than HD. These results have direct resource allocation implications for government-funded kidney disease services under Palestinian Ministry of Health. Our findings strongly suggest that investing in sufficient qualified staff, equipment, and clinical infrastructure to replace HD services with transplantation whenever medically indicated and suitable kidney donors are available, as well as deploying PD programs and Home HD programs, will result in major overall cost savings. Our results provide a better understanding of the costs of kidney disease and will help to inform Ministry of Health and related policy makers as they develop short- and long-term strategies for the population, in terms of both cost savings and enhanced quality of life.

A cost effectiveness analysis of salt reduction policies to reduce coronary heart disease in four Eastern Mediterranean countries

Background

Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey.

Methods and Findings

Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey.

Conclusion

Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives.

Cost-volume-profit analysis and expected benefit of health services: a study of cardiac catheterization services

AIM

Academic research investigating health care costs in the Palestinian region is limited. Therefore, this study examines the costs of the cardiac catheterization unit of one of the largest hospitals in Palestine. We focus on costs of a cardiac catheterization unit and the increasing number of deaths over the past decade in the region due to cardiovascular diseases (CVDs).

METHODS

We employ cost-volume-profit (CVP) analysis to determine the unit's break-even point (BEP), and investigate expected benefits (EBs) of Palestinian government subsidies to the unit.

RESULTS

Findings indicate variable costs represent 56 percent of the hospital's total costs. Based on the three functions of the cardiac catheterization unit, results also indicate that the number of patients receiving services exceed the break-even point in each function, despite the unit receiving a government subsidy.

CONCLUSIONS

Our findings, although based on one hospital, will permit hospital management to realize the importance of unit costs in order to make informed financial decisions. The use of break-even analysis will allow area managers to plan minimum production capacity for the organization. The economic benefits for patients and the government from the unit may encourage government officials to focus efforts on increasing future subsidies to the hospital.

Increased serum mitogenic activity for arterial smooth muscle cells associated with relaxation and low educational level in human subjects with high but not low hostility traits: implications for atherogenesis

Proliferation of arterial smooth muscle cells (aSMC) is a key component of atherogenesis. A sample of 225 volunteers, aged 21-65 years, was exposed to "frustration," "harassment," or "relaxation," after completing the 50-item Hostility subscale of the Minnesota Multiphasic Personality Inventory (MMPI). Whole blood was measured before and after exposure for platelet-derived growth factor (PDGF), and sera were evaluated for total and HDL cholesterol concentrations and PDGF-independent mitogenic activity (SMA). Blood pressure and pulse rate were also evaluated. Analyses of SMA (i.e., serum independent of PDGF) revealed an increase in mitogenic effect for cultured human aSMC when hostility was treated as a dichotomous modifier. Among high-hostility subjects, surprisingly, those in the relaxed group and those with a lower educational level were found to have a significant mitogen response; no significant effects were observed for the low-hostility groups. The data suggest that endogenous stresses may occur in high-hostility individuals when "relaxed," to influence proliferation of arterial smooth muscle cells, as a contribution to atherogenesis. In individuals with lower educational levels and higher hostility scores, lifestyle changes may play a role.

Control of human vascular smooth muscle cell proliferation by sera derived from 'experimentally stressed' individuals

Recently we reported that individuals with high scores in standardized hostility evaluation tests, when placed in a environment, may have an association with increases in a blood-borne mitogenic substance(s) for arterial smooth muscle cells. To further investigate the molecular basis for such an association, PDS [plasma derived serum with platelet derived growth factor (PDGF) removed] from individuals showing the greatest differential pre/post-stress mitogenic activity, were tested for ability to modulate changes in the steady state of the c-myc mRNA in cultured VSMC (vascular smooth muscle cells) by Northern blot analysis. Post-stress PDS resulted in a significant increase in c-myc mRNA, when compared with pre-stress PDS of the same individual. These results give further experimental support for the notion that stress (even in the form of transient, episodic psychological challenges) may affect the cardiovascular system via rapid elicited rises in serum mitogenic activity for VSMC.

The anti-proliferative effects of nicotinamide and 3-aminobenzamide on human smooth muscle cells in vitro

The proliferation of cultured human arterial smooth muscle cells (HASMC) was suppressed by nicotinamide and its analogue, 3-aminobenzamide, in a concentration-dependent manner, based on cell count and [3H]thymidine incorporation into DNA. The addition of 10 and 15 mM nicotinamide, or 6 mM 3-aminobenzamide, to HASMC, for 96 h, resulted in a 19.3%, 44% and 41.5% reduction of cell growth and inhibition of DNA synthesis. Since c-myc protooncogene expression has previously been correlated with cell proliferation, the steady state level of its mRNA was determined in control and treated HSMC by Northern analysis, following a 1 h treatment with the respective chemicals. Whereas c-myc mRNA was suppressed by nicotinamide in proportion to its ability to reduce HASMC growth, down regulation of c-myc by 3-aminobenzamide was much less than the observed antiproliferative effect. These results suggest that the growth regulatory properties of nicotinamide and 3-aminobenzamide in HASMC are probably unrelated to their activity in controlling c-myc gene expression.