Assessing social protection influence on health status in the European Union

Introduction

Health status and access to healthcare services are crucial factors that directly impact the well-being of individuals and societies. In the European Union (EU), social protection measures are significant in supporting citizens' health and providing access to healthcare resources.

Methods

This study investigates the relationship between social protection and health status in EU countries. We collected data from Eurostat on the EU member states' health status, healthcare expenditure, and social protection expenditure. The paper used structural equation modeling (SEM) and cluster analysis to analyze the complex interplay among these variables.

Results

Findings revealed a strong positive correlation between EU countries' social protection expenditure and healthcare status. Higher social protection spending was associated with improved access to healthcare services and facilities. Moreover, the analysis showed that countries with higher social protection expenditure tended to exhibit better overall health status indicators among their populations.

Discussion

The results suggest that adequate social protection expenditure positively influences health status in the European Union. By investing in robust social protection programs, governments can enhance citizens' access to healthcare services and resources, ultimately leading to improved health outcomes. These findings underscore the importance of prioritizing social protection policies to address health disparities and promote public health in the EU.

Drivers of healthcare expenditure growth in West Africa: A panel data investigation

Per capita health expenditure in West African countries appears to have assumed a growing trend over the years. This may not be unconnected with the critical role played by health in economic growth, sustainable development and human capital formation. This study analysed drivers of healthcare expenditure in West Africa, using panel data analysis. Random Effects estimating technique was preferred to pooled Ordinary Least Squares and Fixed Effects techniques based on Hausman and Breusch-Pagan Lagrangian multiplier tests. Data employed were sourced from World Bank's world development indicators. The findings indicated that number of people using at least basic sanitation services, incidence of tuberculosis, malaria incidence, and per capita GDP, significantly increased healthcare expenditure in West Africa within the study period. Infant and under-five mortality (UFM) rates raised healthcare expenditure but insignificantly in the sub-region. The study recommends the need to reduce malaria and tuberculosis incidences as well as UFM rate in West Africa through appropriate policy enactment. Such policies should include adequate investment in education, increased per capita income, development of malaria vaccines, maintenance of hygienic environment and free treatment of tuberculosis patients.

Exploring the Evolution of Statin Pricing in Australia: Observations of Price Disclosure Effects on Pharmaceutical Benefits Scheme Expenditure

OBJECTIVES

The high cardiovascular disease burden globally and in Australia necessitates attention on statin expenditure, the primary pharmacological intervention for cardiovascular disease risk factors. The Pharmaceutical Benefits Scheme (PBS) subsidies approved statins for Australians. Managing PBS government expenditure occurs through price control strategies of statutory price decreases upon first generic entry and price disclosure. This study investigates the impact price control measures had on statin price evolution and government expenditure between 2010 and 2022.

METHODS

Prescription and pricing data were obtained from Services Australia Medicare Statistics, and price reduction strategies from the PBS. Summary statistics compared and described statin price, prescription, number of brands, market share, and government expenditure to atorvastatin, fluvastatin, pravastatin, rosuvastatin, and simvastatin price control timelines.

RESULTS

Statin prices exposed to price control measures decreased irrespective of dosage and correlated with reductions in government expenditure, with a comparison of 2010 and 2022 showing annual statin expenditure declined by AU$833.5 million (83.25%) whereas prescriptions reduced by 3.0 million (15.7%). Effects of price disclosure on atorvastatin and rosuvastatin market share suggest industry-prompted price reductions may arise from market share loss, whereas reasons external to pricing prompted rosuvastatin to gain market share.

CONCLUSIONS

Limited publications on contemporary effects of statin price control measures exist. This investigation found these measures reduced government expenditure for statins by AU$949.1 million, with the price reduction correlating with price control measures. In addition to affirming price control mechanisms remain effective in contemporary times, this investigation provides data for key insights into the Australian statin industry.

Food Insecurity, Healthcare Utilization, and Healthcare Expenditures: A Longitudinal Cohort Study

Objective: This study examines the longitudinal association between household food insecurity and healthcare utilization and expenditure. Methods: A multi-wave longitudinal cohort study was conducted using the 2008-2019 and 2021 waves of the Korean Welfare Panel Study. The baseline data included participants aged ≥19 years with valid responses to the food insecurity and healthcare questionnaires in the 2008 wave (n = 12,166). Healthcare outcomes encompassed outpatient visits, inpatient admissions, days hospitalized, and personal healthcare expenditure. Random effects Poisson and linear regressions were estimated. Results: Severe food insecurity was associated with a higher incidence rate of outpatient visits (IRR, 1.14; 95% CI, 1.12-1.17), days of hospitalization (IRR, 1.18; 95% CI, 1.13-1.22), and inpatient admissions (IRR, 1.40; 95% CI, 1.18-1.65). Moderate food insecurity was associated with 10.4% (β = -0.11; 95% CI, -0.14 to -0.07) or 238,276 KRW reductions in personal healthcare expenditures in the subsequent year. Conclusion: Household food insecurity was linked to increased healthcare utilization and reduced personal healthcare expenditure among Korean adults. Our findings present opportunities to identify target populations for healthcare policies and interventions.

Multimorbidity clusters and associated health care cost among patients attending psychiatric clinics in Odisha, India

Introduction

There is a dearth of data on common multimorbidity clusters and the healthcare costs for individuals with mental health disorders. This study aimed to identify clinically meaningful physical-mental multimorbidity clusters, frequently occurring clusters of conditions, and healthcare utilization patterns and expenditure among patients attending a psychiatric outpatient clinic.

Materials and Methods

Data were collected in the psychiatric outpatient department among patients aged 18 years and above in February-July 2019 (n = 500); follow-up data on non-communicable disease incidence were collected after 18 months. For analysis, morbidity clusters were defined using two approaches: 1) agglomerative hierarchical clustering method to identify clusters of diseases; and 2) non-hierarchical cluster k mean analysis to identify clusters of patients. Self-reported healthcare costs in these clusters were also calculated.

Result

Two disease clusters were identified: using the 1st approach were; 1) hypertension, diabetes, and mood disorder; 2) Neurotic, stress-related, and somatoform disorders, and acid peptic disease. Three clusters of patients identified using the 2nd approach were identified: 1) those with mood disorders and cardiometabolic, musculoskeletal, and thyroid diseases; 2) those with neurotic, substance use, and organic mental disorders, cancer, and epilepsy; and 3) those with Schizophrenia. Patients in Cluster 1 were taking more than six medicines and had more hospital visits. Within 18 months, 41 participants developed either one or two chronic conditions, most commonly diabetes, hypertension, or thyroid disease.

Conclusion

Cardiometabolic diseases are most commonly clustered with mood disorders. There is a need for blood pressure and sugar measurement in psychiatric clinics and mood disorder screening in cardiac, endocrinology, and primary care clinics.

Appropriateness of laboratory expenditure for primary health care facilities across South Africa

BACKGROUND

Primary health care (PHC) services have been prioritised from a cost-containment perspective. To manage expenditure, facility managers use the Laboratory Handbook that indicates the Essential Laboratory List (ELL) tests.

AIM

The aim of this study was to analyse PHC laboratory expenditure to assess the impact of the ELL in South Africa.

SETTING

We reported ELL compliance at the national, provincial and health district levels.

METHODS

A retrospective cross-sectional study was used to analyse data for the 2019 calendar year. The unique tariff code descriptions were used to develop a lookup table to identify ELL compliant testing. Researchers analysed data for the human immunodeficiency virus (HIV) conditional grant tests and by facility for the bottom two districts.

RESULTS

There were 356 497 tests (1.3%) that were not ELL compliant that equated to an expenditure of $2.4 million. Essential Laboratory List compliance ranged from 97.9% to 99.2% for clinics, community healthcare centres and community day centres. The provincial ELL compliance ranged from 97.6% for the Western Cape to 99.9% for the Mpumalanga province. The average cost per ELL test was $7.92. At the district level, ELL compliance ranged from 93.4% for Central Karoo to 100% for Ehlanzeni.

CONCLUSIONS

High levels of ELL compliance have been demonstrated from the national to the health district level, demonstrating the value of the ELL.Contribution: This study provides data for quality improvement initiatives at primary care facilities.

Direct healthcare cost of pediatric systemic lupus erythematosus in the Philippines

Background

Pediatric rheumatic diseases are chronic illnesses that pose a huge economic burden to children and their families; one of the most common is pediatric systemic lupus erythematosus (pSLE). The direct cost of pSLE has been studied in other countries. In the Philippines, this was only studied in the adult population. This study aimed to determine the direct cost of pSLE in the Philippines and its cost predictors.

Methods

A total of 100 pSLE patients were seen from November 2017 to January 2018 at the University of Santo Tomas. Informed consent and assent forms were obtained. A total of 79 patients met the inclusion criteria and parents were asked to answer a questionnaire. Data were tabulated and were subjected to statistical analysis. Cost predictors were estimated using a stepwise log linear regression.

Results

A total of 79 pediatric SLE patients, with a mean age of 14.68 ± 3.24 years, 89.9% of which were females, with a mean disease duration of 36.08 ± 23.54 months, were included in this study. A total of 65.82% had lupus nephritis and 49.37% were in flare. The mean annual direct cost for pediatric SLE patient was 162,764.81 PHP (USD 3,047.23). Majority of the expense was for medications. Regression analysis showed that the predictors of increased cost in doctor's fee in clinic visits (p-value 0.000) and IV infusion (p-value 0.01) were the higher combined income of the parents.

Conclusion

This is a preliminary study on the mean annual direct cost of pediatric SLE patients in a single center in the Philippines. Pediatric SLE patients with nephritis and other target organ damage were seen to increase the cost up to 2-3.5×. Patients in flare also had a higher cost of up to 1.6×. The overall cost driver of this study was the parent's or caregivers combined income. Further analysis showed that cost drivers in the subcategories include the age, sex and parent's/caregiver's educational attainment.

The relationship between hope, medical expenditure and survival among advanced cancer patients

Introduction

Among those with advanced illness, higher levels of hope may offer physiological benefits. Yet, greater levels of hope may also encourage aggressive treatments. Therefore, higher levels of hope may lead to greater healthcare utilization, higher expenditure, and longer survival. We test these hypotheses among patients with advanced cancer.

Methods

A secondary data analysis from a cross-sectional survey of 195 advanced cancer patients with high mortality risk linked to subsequent healthcare utilization (outpatient, day surgeries, non-emergency admissions), health expenditures, and death records. The survey collected data on hope, measured generally by the Herth Hope Index (HHI) and more narrowly by two questions on illness-related hope. Generalized linear regression and Cox models were used to test our hypotheses.

Results

142 (78%) survey participants died during the period of analysis, with close to half (46%) doing so within a year of the survey. Contrary to expectation, HHI scores did not have a significant association with healthcare utilization, expenditure or survival. Yet, illness-related hope, defined as those who expected to live at least 2 years, as opposed to the likely prognosis of 1 year or less as determined by the primary treating oncologist, had 6.6 more planned hospital encounters (95% CI 0.90 to 12.30) in the 12-months following the survey and 41% lower mortality risk (hazard ratio: 0.59, 95% CI 0.36 to 0.99) compared to those who were less optimistic. Secondary analysis among decedents showed that patients who believed that the primary intent of their treatment is curative, had higher total expenditure (S$30,712; 95% CI S$3,143 to S$58,282) in the last 12 months of life than those who did not have this belief.

Conclusion

We find no evidence of a relationship between a general measure of hope and healthcare utilization, expenditure, or survival among advanced cancer patients. However, greater illness-related hope is positively associated with these outcomes.

Effectiveness of interventions to contain out-of-pocket-expenditure in lower-middle income countries: A systematic review and synthesis

The extant literature on myriad interventional strategies to contain the adverse financial impacts of soaring out-of-pocket expenditures commands systematic auditing and knowledge synthesis. The purpose of this study is to answer these specific questions. What are the interventions present in lower-middle-income countries? How effective are those interventions in reducing the household's out-of-pocket expenditure? Are the studies suffering from any methodological bias? The imprints for this systematic review are obtained from Scopus, PubMed, Web of Science, ProQuest and CINAHL. These manuscripts are identified in full compliance with PRISMA guidelines. The documents identified have undergone quality assessment checks using the 'Effective Public Health Practice Project'. The review identified Interventions that are found to reduce out-of-pocket expenditure are patient educational programs, a combination of financial assistance, healthcare facility quality upgrade measures, and early disease detection strategies. However, these reductions represented marginal changes in the total health expenditure of patients. The role of non-health insurance interventions and the combination of health insurance and non-health insurance measures are highlighted. This review concludes by emphasising the need for further research to fill the knowledge gap by building on the suggestions put forward.

Real-world cost of care and site of care in patients with multiple sclerosis initiating infused disease-modifying therapies

AIM

Evaluate the real-world costs over 2 years and costs by site of care for ocrelizumab (OCR), natalizumab (NTZ), and alemtuzumab (ATZ) in patients with multiple sclerosis (MS).

METHODS

This retrospective study used HealthCore Integrated Research Database and included continuously enrolled adults with MS initiating OCR, NTZ, and ATZ between April 2017 and July 2019 (i.e., patient identification period). Annual total cost of care (pharmacy and medical costs) was evaluated for the first- and second- year of follow-up, further stratified by site of care. Costs were measured using health plan allowed amount and adjusted to 2019 US dollars. Sensitivity analyses were conducted in patients who completed yearly dosing schedule according to Food and Drug Administration approved prescribing information.

RESULTS

Overall, 1058, 166, and 46 patients were included in OCR, NTZ, and ATZ cohorts, respectively. Mean (standard deviation [SD]) total cost of care during first- and second-year follow-up were $125,597 ($72,274) and $109,618 ($75,085) for OCR, $117,033 ($57,102) and $106,626 ($54,872) for NTZ, and $179,809 ($97,530) and $108,636 ($77,973) for ATZ. Infusible drug cost was the main driver in all three cohorts accounting for >78% of the total costs. Annual total cost of care increased substantially after patients started/switched to infusible DMTs. Across site of care, hospital outpatient infusion was common (OCR 58%, NTZ 37%, ATZ 49%) and expensive followed by physician office infusion (OCR 28%, NTZ 40%, ATZ 16%); home infusion was the least common (<10%) and least expensive.

LIMITATIONS

The results were limited to commercially insured patients (specifically those with Anthem-affiliated health plans).

CONCLUSIONS

Real-world costs increased after patients started/switched to infusible DMTs. Drug cost is the main driver for the total costs, which varied substantially by site of care. Controlling drug cost markups and using home setting for infusion can reduce costs in the treatment of MS patients.

Impact of Coronavirus Disease COVID-19 on the Relationship between Healthcare Expenditures and Sustainable Economic Growth

The coronavirus disease (COVID-19) pandemic led to a catastrophic burden on the healthcare system and increased expenditures for the supporting medical infrastructure. It also had dramatic socioeconomic consequences. The purpose of this study is to identify the empirical patterns of healthcare expenditures' influence on sustainable economic growth in the pandemic and pre-pandemic periods. Fulfilment of the research task involves the implementation of two empirical blocks: (1) development of a Sustainable Economic Growth Index based on public health, environmental, social, and economic indicators using principal component analysis, ranking, Fishburne approach, and additive convolution; (2) modelling the impact of different kinds of healthcare expenditures (current, capital, general government, private, out-of-pocket) on the index using panel data regression modelling (random-effects GLS regression). Regression results in the pre-pandemic period show that the growth of capital, government, and private healthcare expenditures positively influence sustainable economic growth. In 2020-2021, healthcare expenditures did not statistically significantly influence sustainable economic growth. Consequently, more stable conditions allowed capital healthcare expenditures to boost economic growth, while an excessive healthcare expenditure burden damaged economic stability during the COVID-19 pandemic. In the pre-pandemic period, public and private healthcare expenditures ensured sustainable economic growth; out-of-pocket healthcare expenditures dominantly contributed to the pandemic period.

Medical and economic burden of delirium on hospitalization outcomes of acute respiratory failure: A retrospective national cohort

Although delirium in patients with acute respiratory failure (ARF) may evolve in any hospital setting, previous studies on the impact of delirium on ARF were restricted to those in the intensive care unit (ICU). The data about the impact of delirium on ARF hospitalizations outside of the ICU is limited. Therefore, we conducted the first national study to examine the effect-magnitude of delirium on ARF in all hospital settings, that is, in the ICU as well as on the general medical floor. We searched the 2016 and 2017 National Inpatient Sample databases for ARF hospitalizations and created "Delirium" and "No delirium" groups. The outcomes of interest were mortality, endotracheal intubation, length of stay (LOS), and hospitalization costs. We also aimed to explore any potential demographic, racial, or healthcare disparities that may be associated with the diagnosis of delirium among ARF patients. Multivariable logistic regression was used to control for demographics and comorbidities. Delirium was present in 12.7% of the sample. Racial disparities among African Americans were also significant. Delirious patients had more comorbidities, higher mortality, and intubation rates (17.5% and 9.2% vs 10.6% and 6.1% in the "No delirium" group [P < .001], respectively). Delirious patients had a longer LOS and higher hospitalization costs (5.9 days and $15,395 USD vs 3.7 days and $9393 USD in "No delirium" [P < .001], respectively). Delirium was associated with worse mortality (adjusted odds ratio 1.49, confidence interval [CI] = 1.41, 1.57), higher intubation rates (adjusted odds ratio 1.46, CI = 1.36, 1.56), prolonged LOS (adjusted mean ratio 1.40, CI = 1.37, 1.42), and increased hospitalization costs (adjusted mean ratio 1.49, CI = 1.46, 1.52). A racial disparity in the diagnosis of delirium among African Americans hospitalized with ARF was noted in our sample. Patients in small, non-teaching hospitals were diagnosed with delirium less frequently compared to large, urban, teaching centers. Delirium predicts worse mortality and morbidity for ARF patients, regardless of bed placement and severity of the respiratory failure.

Resiliency of healthcare expenditure to income shock: Evidence from dynamic heterogeneous panels

Using the World Bank data over the period of 1960-2019, this study aims at estimating the resiliency of health expenditures against gross domestic product (GDP). Long-run and short-run elasticities are calculated using the type of panel time series methods that are exclusively designed for dynamic heterogeneous panels: Mean Group, Pooled Mean Group, and Dynamic Fixed Effects estimators. These methods permit better estimations of elasticity with considerable heterogeneity across the 177 countries included in this study. Along with a standard elasticity estimation, this study estimates country-specific long-run and short-run elasticities along with error correction components. The study finds that the long-run elasticity of income is very close to unity, but short-run coefficients are insignificant for most nations. In addition, most countries revert to long-run equilibrium reasonably quickly if there is shock as the error correction coefficients are negative and, in many cases, very close to one. While for most developed countries, the short-run elasticities are lower in comparison with the short-run elasticities of developing countries indicating that many developing countries may face a larger decrease in health expenditure with the forecasted decline in income due to impending economic recession. Therefore, although this study is not directly intended to capture the post-COVID-19 effects, the study estimates may project the potential responses in health expenditure across countries due to potential income shocks.

How does digital infrastructure affect residents' healthcare expenditures? Evidence from Chinese microdata

Healthcare expenditure is only one of the heavy burdens that families face in developing countries. Current research mainly focuses on analyzing the effects of financial policy. There is a lack of studies that examine the understanding and assessment of the impact of digital infrastructure on this issue. In this study, we used the Broadband China policy as a quasi-natural experiment to explore the impact of digital infrastructure on residents' healthcare expenditures in China. Using the differences-in-differences (DID) model and micro-survey data, we found that digital infrastructure has a positive impact on reducing the burden of healthcare expenditure in China. Our findings indicate that residents in cities can save up to 18.8% on healthcare expenses following large-scale digital infrastructure construction. Through mechanism analysis, we found that digital infrastructure reduces residents' healthcare expenditures by improving both commercial insurance availability and the healthcare efficiency of residents. In addition, the effects of digital infrastructure on reducing healthcare expenditure are more pronounced among middle-aged individuals, those with low levels of education, and those with low incomes, which indicates this digital construction wave helps bridge the social gap between the poor and the rich. This study provides compelling evidence of the positive impact of digital society construction on social health and wellbeing.

Healthcare expenditure of intravitreal anti-vascular endothelial growth factor inhibitors compared with dexamethasone implant for diabetic macular oedema

PURPOSE

The aim of this study was to estimate the 1-year costs associated with treating diabetic macular oedema (DME) patients using current intravitreal anti-vascular endothelial growth factor (anti-VEGF) biologics compared with the dexamethasone implant.

METHODS

We conducted a descriptive cost-evaluation analysis using data from Oslo University Hospital and literature to compare three different intravitreal drugs for DME: bevacizumab, aflibercept and dexamethasone. Stratification of patients into 'Naive' or 'Switch' group was based on treatment history. We estimated the costs from healthcare and 'extended' healthcare perspectives. Sensitivity analysis evaluated the impact of various parameters.

RESULTS

The average injections per patient per year for the Naive group (bevacizumab), Switch group (aflibercept) and dexamethasone were 9.5, 9.1 and 3.0 respectively. From a healthcare perspective, the 1-year costs for the Naive group were 15% lower (bevacizumab, €3619), and for the Switch group, 23% higher (aflibercept, €5226) compared with dexamethasone (€4252). The 'extended' healthcare perspective showed the cost per patient per year for bevacizumab remained nominally lower in the Naive group, while dexamethasone remained lower for the Switch group (€5116 for dexamethasone, compared to €4987 for bevacizumab and €6537 for aflibercept).

CONCLUSIONS

From a primary healthcare perspective, the dexamethasone as a first-line DME treatment may increase economic costs in settings where bevacizumab is used off-label. Treating resistant DMEwith dexamethasone may reduce the costs and treatment burden compared with switching to aflibercept.

A two-stage super learner for healthcare expenditures

Objective

To improve the estimation of healthcare expenditures by introducing a novel method that is well-suited to situations where data exhibit strong skewness and zero-inflation.

Data Sources

Simulations, and two real-world datasets: the 2016-2017 Medical Expenditure Panel Survey (MEPS); the Back Pain Outcomes using Longitudinal Data (BOLD).

Study Design

Super learner is an ensemble machine learning approach that can combine several algorithms to improve estimation. We propose a two-stage super learner that is well suited for healthcare expenditure data by separately estimating the probability of any healthcare expenditure and the mean amount of healthcare expenditure conditional on having healthcare expenditures. These estimates can then be combined to yield a single estimate of expenditures for each observation. The analytical strategy can flexibly incorporate a range of individual estimation approaches for each stage of estimation, including both regression-based approaches and machine learning algorithms such as random forests. We compare the performance of the two-stage super learner with a one-stage super learner, and with multiple individual algorithms for estimation of healthcare cost under a broad range of data settings in simulated and real data. The predictive performance was compared using Mean Squared Error and R².

Conclusions

Our results indicate that the two-stage super learner has better performance compared with a one-stage super learner and individual algorithms, for healthcare cost estimation under a wide variety of settings in simulations and in empirical analyses. The improvement of the two-stage super learner over the one-stage super learner was particularly evident in settings when zero-inflation is high.

Healthcare Expenditures among the Elderly in China: The Role of Catastrophic Medical Insurance

China has been piloting the catastrophic medical insurance (CMI) program since 2012 and rolled it out nationally in 2016 to reduce the incidence of catastrophic health expenditure among Chinese residents. Few studies have been conducted to determine its effect on healthcare expenditures, particularly among the elderly. The purpose of this study is to examine the effect of CMI on healthcare expenditures among China's elderly population. The data for this study were derived from 4 waves of the Chinese Longitudinal Healthy Longevity Survey, which included 344 and 1199 individuals in the treatment and control groups, respectively. To examine the effect of CMI on healthcare expenditures among the elderly, we used difference-in-differences and fixed-effects models. Additionally, a heterogeneity analysis was used to examine the differences in the impact of CMI on different groups. Finally, we confirmed the robustness of the results using robustness and placebo tests. CMI increased total health and out-of-pocket expenditures significantly, as well as inpatient and corresponding out-of-pocket expenditures. The reassults of the heterogeneity analysis indicated that CMI had a greater impact on elderly residents of rural areas. Economic burden protection has been enhanced for low-income groups and patients with serious diseases over the last two years. Our research indicated that CMI can promote the use of inpatient medical services for the elderly to a certain extent. Targeted measures such as expanding the CMI compensation list, establishing a more precise compensation scheme, and specific diseases associated with high healthcare expenditures can be considered in the practice of CMI implementation.

Ramification of healthcare expenditure on morbidity rates and life expectancy in the association of southeast asian nations countries: A dynamic panel threshold analysis

OBJECTIVE

This study has investigated the impact of healthcare expenditure on life expectancy and morbidity rates in the Association of Southeast Asian Nations to analyse whether health expenditure remains a critical component of improving health status and to determine the threshold value at which health strategy becomes cost-effective from 2000 to 2019.

METHODS

The techniques employed include the Dynamic Panel Threshold model advanced by Seo et al. (2019) to implement Seo and Shin's (2016) proposed first-differenced generalised method of moments (GMM) estimation. Furthermore, the dynamic system GMM and Pooled Ordinary Least Squares (OLS) techniques were also employed for robustness check.

RESULTS

The findings revealed that healthcare expenditure raises life expectancy and lowers the crude death rate, infant mortality rate, and maternal mortality rate. Therefore, healthcare expenditure is increasing life expectancy and reducing crude death rate, infant mortality rate, and maternal mortality rate. However, when disaggregating the impact, that of public healthcare expenditure is higher than that of private except in the case of infant mortality rate where that of private is higher. In addition, it found that the threshold value at which health strategy becomes cost-effective, thus the amount which the countries should spend for health status improvement is at least 6% and above of their Gross Domestic Product (GDP).

CONCLUSION

Healthcare expenditure is raising life expectancy and lowering the morbidity rate of the countries. Furthermore, the cost-effective level of the country's healthcare expenditure as a proportion of GDP is 6% and above.

Nexus Between Economic Efficiency, Healthcare, and Environmental Expenditures: A Perspective of BRI Countries

Public health and the environment are the most essential pillars, and play a vital role in the economy. In order to better public health, the economic and environmental atmosphere must be stable and clean, respectively. Thus, this paper emphasizes on nexus between economic, public health, and the environment. Therefore, the objective of this paper is whether healthcare and environmental expenditures affect economic efficiency and vice versa. So, this study evaluates the performance of the country's economic efficiency and investigates the effect of healthcare and environmental expenditures for 62 Belt and Road Initiative countries for the period from 1996 to 2020. Suitable input-output variables are employed under the framework of DEA-window and Malmquist Index Productivity, and Stochastic Frontier Analysis (SFA). In addition, this study estimates the relationship between economic efficiency, healthcare, and environmental expenditures by fixed and random effects models. Therefore, the analytical outcomes reveal that countries are economically efficient. On the contrary, SFA estimation concludes that countries are found to be inefficient, because higher variation is exists in efficiency change compared to technological efficiency change and total factor productivity change on average. In addition, it is worth notable that healthcare and environmental expenditures improve the country's economic efficiency. Furthermore, public health is also influenced by economic efficiency. Thus, this study suggests that countries should better utilize given resources and invest a specific portion of national income in order to improve economic efficiency.

Association between Economic Growth, Mortality, and Healthcare Spending in 31 High-Income Countries

This study aims to investigate the association between gross domestic product (GDP), mortality rate (MR) and current healthcare expenditure (CHE) in 31 high-income countries. We used panel data from 2000 to 2017 collected from WHO and OECD databases. The association between CHE, GDP and MR was investigated through a random-effects model. To control for reverse causality, we adopted a test of Granger causality. The model shows that the MR has a statistically significant and negative effect on CHE and that an increase in GDP is associated with an increase of CHE (p < 0.001). The Granger causality analysis shows that all the variables exhibit a bidirectional causality. We found a two-way relationship between GDP and CHE. Our analysis highlights the economic multiplier effect of CHE. In the debate on the optimal allocation of resources, this evidence should be taken into due consideration.

Utilization Trends of a Government-Sponsored Health Insurance Program in South India: 2014 to 2018

OBJECTIVES

To characterize the utilization trends associated with the Aarogyasri health insurance scheme in Andhra Pradesh, India.

METHODS

This is a retrospective cross-sectional study including participants enrolled in the Aarogyasri health insurance scheme, with recorded claims pertaining to inpatient care from quarter 3, 2014 through quarter 2, 2018. The main outcome measure, was annual utilization by service category, trended to characterize changes in the mean claim amount and the median length of stay. Mortality by service category was also trended. Mann-Kendall correlation was used to evaluate trends. Additionally, interdistrict migration for care in 2014 versus 2018 was examined to evaluate changes in access to care.

RESULTS

The distribution of claims by caste significantly shifted over time, with members of backward castes and scheduled tribes filing more claims, and members of other castes and scheduled castes filing fewer claims. The median age of patients significantly increased, rising from 44.0 years in 2014 to 46.0 years in 2018. The nominal mean claim amount in 2018 was 105.4% of the 2014 average, but the 2018 real mean claim amount was 90.3% of the 2014 average. The median length of stay significantly decreased from 5 to 4 days. Mortality rates after procedures significantly decreased from 2.4% to 2.1%. Interdistrict migration to access care remained high among beneficiaries from the districts YSR Kadapa and West Godaveri in 2014 and 2018.

CONCLUSIONS

Over time, the value delivered by Aarogyasri improved. More patients received care at lower real per claim cost, with a concurrent decline in mortality.

Assessing the impact of diversity and ageing population on health expenditure of United States

BACKGROUND

At the biological level, ageing results from a plodding decline in physical and mental capability, an emergent menace of malady, and eventually, fatality. Even though a few of the geriatric's health changes are hereditary, to a great extent is due to individual's physical and societal surroundings and their residence, locality, societies, gender, ethnicity or socio-economic status. The current debate is well popular by the relationship between increasing diversity and the ageing population with healthcare expenditure in the United States. Higher diversity in society and increasing ageing population have various socio-economic consequences. A good policy in this regard helpful to managed and get fruitful outcomes.

OBJECTIVE

This study aims to examine the direct effects of diversity and ageing population on healthcare spending. The assortment observed in geriatrics is not arbitrary. A huge portion emerges from individual's physical and social settings and the influence of these environs on their prospect and well-being demeanour.

METHOD

This study used the Bayesian-vector autoregressive model, impulse response analysis, and variance decomposition and data over the period 1990-2018 for empirical analysis of the United States.

RESULTS

The empirical findings indicate that diversity and ageing population are more persistent with health expenditure in the United States. This study concludes that an increase in diversity and ageing population will rely on the long-term healthcare facility.

CONCLUSION

The study suggests that cohesive society and effective health intervention might aid in curtailing expenditure pressure linked with elderly population. Furthermore, a recommendation of this study is a good opportunity for healthcare policymakers and further researches.

National sample surveys show poor households face catastrophic expenditure for oral healthcare services in India

Introduction:

Globally people pay out-of-pocket (OOP) to access Oral healthcare services. In India, there is limited evidence on estimates of OOP expenditure. We undertook an analysis of national sample survey data on household health care expenditure to understand the expenditure pattern for Oral healthcare services and the catastrophic burden.

Method:

The expenditure reported for Oral healthcare services from two surveys: 71^st round and 75^th round, published by National Sample Survey Office (NSSO) was extracted. Based on monthly household consumption expenditure three economic groups were made: poor, middle- and rich-income groups. The OOP expenditure pattern while accessing day-care services and hospitalization and in public and private sector and the catastrophic expenditure were analysed.

Results:

A total of 204 and 155 households from two national surveys reported to have accessed day-care Oral services respectively. The median OOP expenditure in public sector remained same at US $ 4 in both surveys. Over 35% of 78 households in 71^st round and 42% of 167 in 75^th round used public sector hospitalization services. The median expenditure of hospitalization doubled from US$ 58 (IQR 21–263) in 71^st round to US $ 125 (IQR 45-363) in 75^th round. Households from poor income groups spent seven times more for Oral healthcare services during the recent survey and faced catastrophic expenditure.

Conclusion:

The OOP expenditure for Oral healthcare has significant catastrophic household expenditure among the poor. There is a need to increase investment in public sector and insurance to protect poor against hospitalization expenditure in private sector.

Decoupling of Elderly Healthcare Demand and Expenditure in China

This study examined the changing trajectory and factors that influenced the health and medical expenditure of the Chinese elderly population over the past two decades. Based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018, inferential and multiple linear regression models were constructed. The key finding is that China has experienced a decoupling of healthcare demand (HCD) and healthcare expenditure (HCE) since around 2014, when HCE began to decline despite the fact that HCD continued to rise. This is a promising sign, suggesting that the government's health insurance policy is working. Furthermore, participating in health insurance schemes can significantly reduce the elderly's HCD and HCE, demonstrating that health insurance can effectively affect the elderly's decision to seek medical treatment and improve their health condition. We also found that age, region, basic old-age insurance, and care by the government and institutions were significant factors that influenced the healthcare demand and expenditure of the elderly population.

Contemporary Incremental Healthcare Costs for Allergic Rhinitis in the United States

OBJECTIVES/HYPOTHESIS

Describe contemporary changes in healthcare expenditure and utilization associated with allergic rhinitis (AR) over the past decade.

STUDY DESIGN

Cross-sectional analysis.

METHODS

Patients reporting a diagnosis of AR were extracted from the 2018 Medical Expenditure Panel Survey and linked to the consolidated expenditures file. AR patients were then compared to non-AR patients to demonstrate differences in healthcare utilization for office visits, emergency facility visits, and prescriptions. In addition, differences in total healthcare costs, office-based costs, and prescription costs were calculated, using demographic- and comorbidity-adjusted multivariate models. Results were compared to those obtained in 2007.

RESULTS

In 2018, an estimated 1.94 ± 0.2 million adult patients reported AR (0.8% of the US population receiving medical care), a 90% decrease from the 17.8 ± 0.7 million patients seen in a formal healthcare setting for AR in 2007 (7.9%). AR patients still formally seen in 2018 had an average of 4.4 ± 1.3 more office visits (P = .001) and 9.7 ± 2.2 more prescription fills (P < .001) than non-AR patients. In contrast to the 2007 findings, there was no difference in total health care expenditure per person with AR per year. When comparing total healthcare expenditure between 2018 and 2007, there was a net decrease of $1,176 per person with AR per year (P < .01).

CONCLUSIONS

Patients reporting AR in a formal healthcare encounter fell significantly over the past decade, and per-person expenditure associated with an AR diagnosis also decreased significantly. The transition of nasal corticosteroids to over-the-counter was potentially a key driver behind these changes.

LEVEL OF EVIDENCE

3 Laryngoscope, 2021.

The Relationship Between "Protect People's Livelihood" and "Promote the Economy:" Provincial Evidence From China

This study focused on medical care in a single country (China) and in regions with different economic backgrounds and different economic development levels to determine the effect of healthcare expenditure on short- and long-term economic growth. The study supported some interesting conclusions: (1) For most areas of China, increasing healthcare expenditure has a negative impact on economic growth in the short term but promotes growth in the long run; (2) Under different levels of economic development within China, there is significant heterogeneity in the interaction between healthcare expenditure and economic growth; (3) The negative effects of healthcare expenditure on short-term economic growth are greater during periods of economic turbulence than during times of stability; and (4) Healthcare expenditure has a negative effect on underdeveloped areas through the accumulation of material capital, while in economically developed areas, this channel has the opposite effect. To improve the quality of medical and health protection and the quality of life and welfare, China needs to consider the development characteristics of different economic zones and establish a multilevel, systematic and diversified medical and health protection system.

Artificial Intelligence-Based Application Provides Accurate Medical Triage Advice When Compared to Consensus Decisions of Healthcare Providers

Accurate medical triage is essential for improving patient outcomes and efficient healthcare delivery. Patients increasingly rely on artificial intelligence (AI)-based applications to access healthcare information, including medical triage advice. We assessed the accuracy of triage decisions provided by an AI-based application. We presented 50 clinical vignettes to the AI-based application, seven emergency medicine providers, and five internal medicine physicians. We compared the triage decisions of the AI-based application to those of the individual providers as well as their consensus decisions. When compared to the human clinicians’ consensus triage decisions, the AI-based application performed equal or better than individual human clinicians.

Determinants of Antimicrobial Resistance among the Different European Countries: More than Human and Animal Antimicrobial Consumption

Although antimicrobial consumption is considered the main driver of antimicrobial resistance (AMR), other factors probably have a significant but less studied impact. The study’s goal was to assess AMR drivers across different European countries and quantify their possible contributions using the latest data available. Using the ESAC-Net (European Surveillance of Antimicrobial Consumption Network) database, the ESVAC (European Surveillance of Veterinary Antimicrobial Consumption) database and the OECD (Organisation for Economic Cooperation and Development) information, a dataset including 23 European countries was created. Associations between AMR and potential contributing factors were assessed using bivariate correlation and multiple linear regression models for multivariable analyses. Factors associated with the AMR rate among European countries were human ambulatory consumption of antibiotics and per capita expenditure on health, meaning that the higher human ambulatory consumption of antibiotics and the lower the per capita expenditure on health, the higher the AMR. Both variables together explain 74% of AMR variation. Private expenditure on health in terms of % GDP (Gross Domestic Profit) was positively related to a higher AMR rate. In conclusion, considering antibiotic consumption as the most important factor contributing to AMR may be a deviant focus, as resistance transmission may be paramount for AMR levels. Low per capita expenditure on health, probably a surrogate of worse healthcare conditions and a high level of resistance transmission, has a strong correlation with the AMR rate. Increasing public expenditure on healthcare, to strengthen infection control structures and processes interventions, seems relevant to tackle antimicrobial resistance at the European scale.

Analysis of the Household and Health Care System Expenditures in Bulgaria

Health care systems worldwide are experiencing tremendous financial pressure because of the introduction of new targeted health technologies and medicines. This study aims to analyze and compare public and household healthcare expenditures in Bulgaria during the period 2015-2019, as well as present the major cost-containment measures implied by the government and their probable influence on the overall health care cost. Regulatory analysis of the endorsed cost-containment measures, budget analysis of public and household health care expenditures, and their extrapolations were performed. The regulatory analysis reveals that a large number of measures are introduced and valid until January 2021, considering pharmaceuticals, medical devices, and negotiations between the National Health Insurance Fund (NHIF) and Marketing authorization holders (MAHs). NHIF costs due to pharmaceuticals, food supplements, and medical devices are rising from 2015 to 2019. The overall health expenditures average per household and the average per person also grow in this period. The cost extrapolation reveals that an increase in 3-year periods is expected. Despite the implementation of variety of cost-containment measures in Bulgaria, such as HTA, ERP, discounts, and annual negotiations, The National Health Insurance Fund's (NHIF) spending on pharmaceuticals continues to rise in recent years, and further increases are expected in the next 3 years. The average expenditure per household and per person also increased, which confirms the global trend of rising medicine and outpatient services value.

Does Education Mitigate the Effect of Population Aging on Health Expenditure? A Panel Data Study of Latin American Countries

Objective: To examine whether the effect of population aging on healthcare expenditures as a share of Gross Domestic Product (GDP) is attenuated in more educated countries. Method: The analysis is based on a dataset of 22 Latin American countries between 1995 and 2013. We estimate panel data models with country and time fixed effects, and control for potential nonlinear effects of population aging on health expenditure. Results: We find population aging increases health expenditure as a share of GDP in economies characterized by low levels of education, but this effect is mitigated in economies with higher levels of education. Results are driven by private health expenditures. Discussion: Results suggest population aging and education have a stronger influence on healthcare expenditures in less developed countries. This finding is important in a context in which the rapid growth of the aging population is likely to lead to significant costs in terms of health expenditures, but less so in more educated societies.

Economic Burden of Asthma-Chronic Obstructive Pulmonary Disease Overlap among Older Adults in the United States

The objective of this study is to estimate the excess economic burden of Asthma-COPD Overlap (ACO) among older adults in the United States. We used a cross-sectional study design with data from a nationally representative survey of Medicare beneficiaries (Medicare Current Beneficiary Survey) linked to Medicare fee-for-service claims. Older adults with ACO had higher average total healthcare expenditures ($45,532 vs. $12,743) and higher out-of-pocket spending burden (19% vs. 8.5%) compared to those with no-asthma no-COPD (NANC). Individuals with ACO also had almost two, and 1.5 times higher expenditures compared to individuals with asthma only and COPD only, respectively. Multivariable regression models indicated that the adjusted associations of ACO to economic burden remained positive and statistically significant. In comparison with NANC, nearly three-quarters of the excess total healthcare expenditures and 83% of the out-of-pocket spending burden of older adults with ACO were explained by differences in predisposing, enabling, need, personal healthcare practices, and external factors among the two groups. The higher number of unique medications and the increased incidence of fragmented care were the leading contributors to the excess economic burden among older adults with ACO comparing to NANC individuals. Interventions that reduce the number of medications and fragmented care have the potential to reduce the excess economic burden among older adults with ACO.

Effects of periodontal management for patients with type 2 diabetes on healthcare expenditure, hospitalization and worsening of diabetes: an observational study using medical, dental and pharmacy claims data in Japan

AIMS

To investigate the effects of regular periodontal management for people with type 2 diabetes on total healthcare expenditure, hospitalization and the introduction of insulin.

MATERIALS AND METHODS

We collected data of individuals who were prescribed diabetes medications during the fiscal year 2015 from the claims database of a prefecture in Japan. We fitted generalized linear models that had sex, age, comorbidities and the status of periodontal management during the previous two years as predictors.

RESULTS

A total of 16,583 individuals were enrolled. The annual healthcare expenditure in the third year was 4% less (adjusted multiplier 0.96, 95% confidence interval [CI] 0.92-1.00) in the group receiving periodontal management every year. The adjusted odds ratio (aOR) for all-cause hospitalization was 0.90 (95% CI: 0.82-0.98). The aOR of introducing insulin in the third year for those who had not been prescribed insulin during the previous two years (n = 13,222) was 0.77 (95% CI: 0.64-0.92) in the group receiving periodontal management every year.

CONCLUSION

Regular periodontal management for diabetic people was associated with reduced healthcare expenditure, all-cause hospitalization and the introduction of insulin therapy.

Does Loneliness Have a Cost? A Population-Wide Study of the Association Between Loneliness and Healthcare Expenditure

Objectives: Loneliness has been associated with unhealthy behavior, poorer health, and increased morbidity. However, the costs of loneliness are poorly understood.

Methods: Multiple sources were combined into a dataset containing a nationally representative sample (n = 341,376) of Dutch adults (18+). The association between loneliness and total, general practitioner (GP), specialized, pharmaceutical, and mental healthcare expenditure was tested using Poisson and Zero-inflated negative binomial models, controlling for numerous potential confounders (i.e., demographic, socioeconomic, lifestyle-related factors, self-perceived health, and psychological distress), for four age groups.

Results: Controlling for demographic, socioeconomic, and lifestyle-related factors, loneliness was indirectly (via poorer health) associated with higher expenditure in all categories. In fully adjusted models, it showed a direct association with higher expenditure for GP and mental healthcare (0.5 and 11.1%, respectively). The association with mental healthcare expenditure was stronger in younger than in older adults (for ages 19–40, the contribution of loneliness represented 61.8% of the overall association).

Conclusion: Loneliness contributes to health expenditure both directly and indirectly, particularly in younger age groups. This implies a strong financial imperative to address this issue.

Cost of microvascular complications in people with diabetes from a public healthcare perspective: a retrospective database study in Brazil

AIM

To evaluate direct medical costs incurred by patients with diabetes in the periods before and after experiencing a microvascular complication from a Brazilian public healthcare system perspective.

MATERIALS AND METHODS

This was a retrospective, observational study using the Brazilian Unified Health System (DATASUS) database. Direct medical costs (hospitalization and outpatient) were extracted for patients with evidence of diabetes and a microvascular complication (January 2012-December 2018) and converted to 2019 US Dollars (USD). Length of hospital stays was also extracted. Mixed-effects logistic regression explored associations between demographic/clinical characteristics and incurrence of high direct medical costs (defined as the highest tertile of the annual costs ranked by median cost in the total population).

RESULTS

In total, 2,096 patients with diabetes experienced a microvascular complication and met study inclusion/exclusion criteria. Median [interquartile range] annual costs (USD/patient) were 176.3 [91.0; 481.2] at baseline, increasing to 1,678.5 [287.0; 6,908.4] and 5,172.4 [274.8; 7,395.9] in the first and second year after the complication, respectively. Median hospital stay was 2.0 and 3.0 days at baseline and in the first year, respectively. The odds of incurring high costs were substantially elevated in the first and second years (odds ratios of 69.9 and 84.7, respectively, vs. baseline, both p < .001).

LIMITATIONS

The DATASUS database covers secondary and tertiary care (not primary), adding selection bias to our sample. Additionally, our findings may not apply to the entire Brazilian population, as around 25% have some access to private healthcare.

CONCLUSIONS

This study demonstrates a large increase in costs, from the perspective of the Brazilian public healthcare system, in patients with diabetes after experiencing a microvascular complication compared with pre-complication costs. In addition to providing up-to-date cost estimates, our findings highlight the need to appraise the cost-effectiveness of evidence-based strategies that reduce the risk of diabetes-related microvascular complications in Brazilian patients.

Free prescriptions for low-income pensioners? The cost of returning to free-of-charge drugs in the Spanish National Health Service

This study estimated the impact of reducing a capped low coinsurance rate for outpatient medicines to nil for low-income pensioners and disabled individuals in the Valencian Community (Spain). This reduction was implemented in January 2016 as a regional reform which modified the national cost-sharing reform adopted in July 2012. The impact of this intervention on the number of monthly prescriptions dispensed between July 2012 and December 2018 was estimated using two different approaches of the synthetic control method, the classical method and the method based on Bayesian structural time series. The estimates from both methods were similar, showing significant overall increases of 6.34% and 6.70% [95% credible interval: 4.05, 9.47], respectively in the number of prescriptions dispensed in this region. These results are similar to those of the previous studies indicating that reducing price from a small amount to zero discontinuously boosts demand. This evidence indicates that the impact of this intervention on the budget of the regional health service is far greater than the amount of the subsidy in the public budget. These results are useful for making accurate budgetary projections for similar eliminations of charges for low-income pensioners in the Spanish National Health Service.

Death by austerity? The impact of cost containment on avoidable mortality in Italy

Does austerity in health care affect health and healthcare outcomes? We examine the intended and unintended effects of the Italian austerity policy Piano di Rientro aimed at containing the cost of the healthcare sector. Using an instrumental variable strategy that exploits the temporal and geographical variation induced by the policy rollout, we find that the policy was successful in alleviating deficits by reducing expenditure, mainly in the southern regions, but also resulted in a 3% rise in avoidable deaths among both men and women, a reduction in hospital capacity and a rise in south-to-north patient migration. These findings suggest that-even in a high-income country with relatively low avoidable mortality like Italy-spending cuts can hurt survival.

Tackling the cancer burden: the economic impact of primary prevention policies

Cancer is a noncommunicable disease (NCD) with increasing incidence and therefore constitutes a major public health issue. To reduce the health and economic burden of cancer, policy‐makers across the world have implemented a range of preventative interventions targeting risk factors with a known link to the disease. In this article, we examine the impact of six primary prevention interventions – related to physical inactivity, unhealthy diet or harmful alcohol use – on cancer‐related health outcomes and healthcare expenditure. Here, we used the OECD Strategic Public Health Planning for NCDs (SPHeP‐NCDs) model to quantify outcomes and costs for each intervention for years 2020–2050 across 37 countries. Results from the model indicate that all interventions could lead to a reduction in the number of new cancer cases, in particular those targeting harmful alcohol consumption. Introducing an alcohol tax, for instance, is estimated to reduce related cancer cases by 5619 a year or 174 193 by 2050. A breakdown of results by type of cancer revealed interventions had the largest impact on colorectal cancer with, on average, 41 140 cases avoided per intervention by 2050. In proportional terms, interventions had the greatest impact on new oesophageal and liver cancers. Findings from this article are designed to assist decision‐makers efficiently allocate limited resources to meet public health objectives.

Examining the UK Covid-19 mortality paradox: Pandemic preparedness, healthcare expenditure, and the nursing workforce

AIM

To examine the UK pandemic preparedness in light of health expenditure, nursing workforce, and mortality rates in and relation to nursing leadership.

BACKGROUND

The Global Health Security Index categorized the preparedness of 195 countries to face a biological threat on a variety of measures, producing an overall score. The United States of America and the United Kingdom were ranked 1st and 2nd most prepared in 2019.

METHOD

A cross-nation comparison of the top 36 countries ranked by Global Health Security Index score using a variety of online sources, including key data about each nation's expenditure on health and the nursing workforce, and compared these with mortality data for COVID-19.

RESULTS

The extent of a country's pandemic preparedness, expenditure on healthcare and magnitude of the nursing workforce does not appear to impact mortality rates at this stage of the pandemic which is something of a paradox.

CONCLUSION

It is important that arrangements for dealing with future global pandemics involve a range of agencies and experts in the field, including nurse leaders.

IMPLICATIONS FOR NURSING

To achieve the best outcomes for patients, nurse leaders should be involved in policy forums at all levels of government to ensure nurses can influence health policy.

Burden and cost of communicable, maternal, perinatal and nutrition deficiency diseases in India

BACKGROUND

Globally 36% of deaths and 42% of Disability Adjusted Life Years (DALYs) are due to communicable, maternal, perinatal and nutritional disorders (CMPND). We examined the state-wise disease burden and treatment cost for these diseases in India for 2017.

METHODS

DALYs for CMPND was obtained from National Disease Burden Estimate (NBE) Study and the expenditure was determined from the unit level records of persons who reported hospitalization for one or more CMPND in National Sample Survey (NSS)-75th Round.

RESULTS

The top conditions resulting in high DALYs for India were perinatal conditions and nutritional deficiency disorders. Odisha had the highest DALY rate, while Kerala had the lowest DALY rate for CMPNDs. The out-of-pocket expenditure (OOPE) was highest in Chattisgarh, while percentage of households pushed to CHE was highest in Uttar Pradesh for CMPND.

CONCLUSION

The public healthcare facilities need to be strengthened to facilitate patients with CMPND to undergo treatment that is timely, affordable and cost-effective. Efforts should be made for optimization of strategies aimed at primary and secondary prevention of CMPND and reduce OOPE for treatment of these diseases. In addition, advocacy spreading awareness will reduce the burden and treatment expenditure for CMPNDs in India.

The Effect of Population Aging on Healthcare Expenditure from a Healthcare Demand Perspective Among Different Age Groups: Evidence from Beijing City in the People's Republic of China

Background

With population aging (PA), the healthcare expenditure (HE) increases. The aim of this study is to analyze the HE of different age groups and the effect of age on HE among different age groups.

Methods

Combining PA and HE data, this study used the fixed effect model and parameter estimation method to evaluate the influence of different age groups on HE from 2008 to 2014.

Results

The age effect of HE for the population aged 65 or over was the most significant among the different age groups. Based on PA and HE data, HE per capita of the age group 65 years or over is 7.25 times as much as the population aged < 25 years, 1.61 times as much as the population aged 25~59 years, and 3.47 times as much as the population aged 60~64 years. Based on the result of the fixed effect model, HE per capita of the age group <25 years was 218.39 Yuan (CNY) (USD $31.2). HE per capita of the age group 25~59 years old increased to 1,548.62 Yuan (CNY) (USD $221.2). HE per capita of the 60~64 years age group will be 921.56 Yuan (CNY) (USD $131.7), 4.22 times as much as that of the age group < 25 years. HE per capita in the age group of 65 years or over is 2,538.88 Yuan (CNY) (USD $362.7), 11.63 times as much as that of the age group <25 years.

Conclusion

The results suggest that PA in China is intensifying. In order to control the rising of HE, the government should not only address the supply side such as reforming medical insurance payment, developing new technologies, but also focusing on solving the demand side such as improving the quality of healthcare services, solving environmental pollution, and improving the residents’ health.

Cost of macrovascular complications in people with diabetes from a public healthcare perspective: a retrospective database study in Brazil

Aims: To evaluate costs in patients with diabetes who experienced a macrovascular complication from a Brazilian public healthcare system perspective.Materials and methods: A retrospective, observational study that utilized the database of the Brazilian Unified Health System (DATASUS). Data for direct medical costs (hospitalization and outpatient) were extracted for patients with diabetes and a macrovascular complication (1 January 2012-31 December 2018) and converted to US Dollars (2019 USD). Mixed-effects logistic regression explored associations between demographic and clinical characteristics with the incurrence of high direct medical costs.Results: In total, 1,668 (0.2%) patients with diabetes met study inclusion criteria and experienced a macrovascular complication, either alone (N = 1,193) or together with a microvascular complication (N = 475). Median [95% CI] annual costs (USD/patient) were 130.5 [90.7; 264.2] at baseline, increasing to 334.0 [182.2; 923.5] in the first year after the complication. The odds of incurring high costs were significantly elevated in the first and second year (vs. baseline), and in patients who experienced a macrovascular and microvascular complication (vs. macrovascular alone) (all p < 0.001).Limitations: The DATASUS database does not cover primary care (it covers secondary and tertiary care), adding a selection bias to the sample. Additionally, our findings may not be representative of the entire Brazilian population given that approximately 75% of the population of Brazil depend exclusively on the SUS, while the remaining 25% have some access to private healthcare.Conclusions: This study has demonstrated higher medical costs from the perspective of the Brazilian public healthcare system in patients with diabetes after experiencing a macrovascular complication, either alone or in conjunction with a microvascular complication, in comparison with costs before the complication(s). In addition to providing up-to-date cost estimates, our findings highlight the need to implement strategies to reduce the cardiovascular risk in Brazilian patients with diabetes and drive cost savings.

Healthcare Capacity, Health Expenditure, and Civil Society as Predictors of COVID-19 Case Fatalities: A Global Analysis

Background: The rapid growth in cases of COVID-19 has challenged national healthcare capacity, testing systems at an advanced ICU, and public health infrastructure level. This global study evaluates the association between multi-factorial healthcare capacity and case fatality of COVID-19 patients by adjusting for demographic, health expenditure, population density, and prior burden of non-communicable disease. It also explores the impact of government relationships with civil society as a predictor of infection and mortality rates. Methods: Data were extracted from the Johns Hopkins University database, World Bank records and the National Civic Space Ratings 2020 database. This study used data from 86 countries which had at least 1,000 confirmed cases on 30th April 2020. Negative binomial regression model was used to assess the association between case fatality (a ratio of total number of confirmed deaths to total number of confirmed cases) and healthcare capacity index adjusting for other covariates. Findings: Regression analysis shows that greater healthcare capacity was related to lesser case-fatality [incidence rate ratio (IRR) 0.5811; 95% confidence interval (CI) 0.4727-0.7184; p < 0.001] with every additional unit increase in the healthcare capacity index associated with a 42% decrease in the case fatality. Health expenditure and civil society variables did not reach statistical significance but were positively associated with case fatalities. Interpretation: Based on preliminary data, this research suggests that building effective multidimensional healthcare capacity is the most promising means to mitigate future case fatalities. The data also suggests that government's ability to implement public health measures to a degree determines mortality outcomes.

Exploration of Influence of Socioeconomic Determinants on Mortality in the European Union

Economic performance measured through the gross domestic product indicator and the poverty rate varies across the whole European Union, together with the considerable income inequalities in the long-term. Economic growth may not bring a reduction in the health inequalities in the individual countries themselves. In order to eliminate health inequalities, the different types of policies implemented in the health, social and economic systems need to be explored in more detail. Mortality is explored through an indicator of the standardised mortality rate for both sexes explained by the several socioeconomic determinants, among which variables such as the variations of the gross domestic product per capita, the healthcare expenditures, the unemployment rate, and the healthcare system financing. Almost in all the described cases, these dimensions have negative impact. All the influences are expressed in a relative way in order to be suitably interpretable. The analysis is not comprehensive; nevertheless, it contains 18 regression models to cover as many aspects as it is possible. The Discussion section offers an evaluation of the obtained results according to the outcome of the other studies.

The Impact of Internet Usage and Knowledge-Intensive Activities on Households' Healthcare Expenditures

This paper examines the impact of the internet usage and knowledge intensive activities on households’ healthcare expenditures Similarly, the paper aims to recognize and understand, from a value-creation perspective, the correlation between: internet access of households (IA), individuals frequently using the internet (IU), individuals searching on internet for health-related information (HI), payments made by households for healthcare (PHH), expressed as euro per inhabitant and employment in knowledge-intensive activities (KIA). The approach utilized in the present study consists of two steps. First, a theoretical framework was conducted to determine the existing relationship between major variables. Next, the Vector Autoregressive (VAR) approach was applied in a case study at European level to prove the three hypothesis we consider. By analyzing the connection between the major variables, a positive and long- lasting impulse response function was revealed, followed by an ascending trend. This suggests that a self-multiplying effect is being generated; and it reasonable to assume that the more individuals use the Internet, the more electronic acquisitions occur. We can thus reasonably conclude that the improvement of the internet usage and knowledge intensive activities on households’ healthcare expenditures process is strongly dependent on people’s capability. Improving IU and KIA is the new reading key in the decision-making process in health system approach.

Analisi di minimizzazione dei costi di una strategia di test preventivo per le familiari di pazienti con carcinoma dell’ovaio BRCA mutato

Purpose:

This study aims to estimate the cost-minimization strategy of a preventive testing strategy destined to relatives of patients with BRCA mutated cancer versus a no test strategy in Italia.

Methods:

A BRCA testing pathway was designed by a panel of experts based on the MSTM Excel (2010) tool; the analysis was carried out considering the perspective of the Italian National Health Service. Two alternatives were considered: 1) preventive BRCA testing for relatives of patients affected by ovarian cancer carrying a BRCA1/BRCA2 mutation; 2) no test. Cost and effectiveness data, derived from literature and published sources validated by a Board of experts, were discounted using a discount factor equal to 3%. Probabilistic sensitivity analysis was performed.

Results:

Considering an average cost of therapy for breast and ovarian cancer major of €90,000.00 per case, the economic impact related to the preventive testing strategy are equal to –€17,814,767.25. The sensitivity analysis confirms these results in the totality of the simulations performed.

Conclusions:

Preventive genetic testing in relatives of patients affected by ovarian cancer is cost-effective and represents a sustainable cost for the National Healthcare System in Italia, also in the light of its reference values.

The association between medical spending and health status: A study of selected African countries

Background

The report from the World Health Organization (WHO) reveals that health spending worldwide remains highly unequal as more than 80% of the world's population live in low and middle-income countries but only account for about 20% of global health expenditure. Another report by the WHO on the state of health financing in Africa published in 2013 intimates that countries that are part of their member states are still on the average level in meeting set goals in financing key health projects.

Objective

The study set out to investigate the association between public and private spending and health status for eight selected African countries, namely Burundi, Eritrea, Ethiopia, Kenya, Rwanda, Sudan, Tanzania and Uganda. Health status indicators include the incidence of tuberculosis, mortality rates, maternal deaths and prevalence of HIV.

Methods

Descriptive statistics and pairwise correlation are used to assess the relationship between healthcare spending and health status. Random and fixed effect models are further employed to provide insights into the association between descriptive statistics and pairwise correlation. We used annual data from the year 2000 to 2014 obtained from world development indicators.

Results

The relationship between healthcare spending (public and private) and health status is statistically significant. Public healthcare expenditure has a higher association than private expenditure in reducing the mortality rate, tuberculosis and HIV for the average country in our sample. For example, an increase in public healthcare spending is negatively associated and statistically significant at 5% or better in reducing female mortality, male mortality, tuberculosis and HIV. Private healthcare spending is more impactful in the area of maternal deaths, where it is associated negatively and statistically significant at 1%. An increase in private healthcare spending is linked to a reduction in maternal deaths. We also compared the association between an increase in healthcare spending on males versus females and observed that public health expenditure impacts the health status of both sexes equally, however, private health expenditure provides a greater positive benefit to males. It is worth remembering that two goals of the United Nations agenda on sustainable development are gender equality and ensuring healthcare for all.

Conclusion

The findings of this research call for the selected African countries to pay more attention to public healthcare expenditure in order to improve health status, especially since private healthcare which provides access to healthcare facilities for some poor people leads to costs that are a burden. So, future research should focus on analyzing components of private healthcare spending such as direct household out-of-pocket spending, private insurance and direct service payments by private corporations as dependent variables to understand what form of private investment should be encouraged.

A Dynamic Relationship between Environmental Degradation, Healthcare Expenditure and Economic Growth in Wavelet Analysis: Empirical Evidence from Taiwan

This paper analyzes the co-movement and causal linkages between environmental pollution and healthcare expenditure, taking economic growth as a control variable by using wavelet analysis for Taiwan over the period 1995 Q1-2016 Q4. The results show that there exists co-movement and causality between environmental pollution and healthcare expenditure at different frequencies and times. The changes in the relationships of the two variables are observed in certain events such as the period of the expansion stage, the policy of environmental pollution, and the issue of the National Health Insurance Integrated Circuit card (NHI-IC) in Taiwan. In the short-term, positive causality runs from healthcare expenditure to environmental pollution before 2004, while negative causality runs from healthcare expenditure to environmental pollution before 2007 in the long-term. After adding economic growth as a control variable, positive causality runs from healthcare expenditure to environmental pollution in the period 2009-2011 in the short-term, while negative causality running from healthcare expenditure to environmental pollution is shown in 2008 in the long-term. The results indicate that "higher government health expenditure leading to higher demand for environment quality" exists in different sub-periods and the argument may concern the factor of economics in the long-term. The positive healthcare lead in the short-term may be based on economics in the expansion stage. Also, the issue of NHI-IC possibly affects the dynamic relationship between healthcare expenditure and environmental pollution without considering economics. Based on empirical analysis, certain policy and managerial implications are addressed for decision-makers at macroeconomic and microeconomic levels.

The economic cost of tobacco smoking and secondhand smoke in Greece: Musculoskeletal disorders the leading contributor to smoking-related morbidity

INTRODUCTION

The high proportion of the population in Greece that is active and passive smoking makes smoking the leading risk factor for death and disability. Tobacco use creates a high cost to society and yet relevant research for Greece is limited.

METHODS

The cost-of-illness approach is used to estimate the economic cost of smoking and, for the first time, of secondhand smoke (SHS) exposure in Greece. The analysis covers more health conditions, causally related to smoking, than those included in such studies.

RESULTS

Based on data from the Global Burden of Diseases Study 2017, total economic cost of tobacco smoking and SHS exposure is estimated to be €7.2 billion in 2017, which is equivalent to almost 4% of GDP in Greece. SHS exposure accounts for 8.9% of total cost. Direct cost of smoking is slightly less than indirect cost. Indirect cost is relatively higher for males. Musculoskeletal disorders and diabetes are found to comprise the greatest fraction of morbidity cost of smoking and SHS exposure, respectively. Cardiovascular diseases are found to be the main cause of mortality costs for both smoking and SHS exposure.

CONCLUSIONS

Total economic cost of tobacco smoking and SHS exposure in Greece is estimated to be more than double the revenue from tobacco taxes. Smoking imposes a heavy economic burden, underlining the need for efficient interventions, including effective implementation and enforcement of existing anti-tobacco policies.

Does participation in the community outreach for asthma care and healthy lifestyles (COACH) program alter subsequent use of hospital services for children discharged with asthma?

Introduction: Transition from hospital to home is a challenging time for children with asthma and their caregivers because of the high risk for reutilization of acute hospital services. Detecting effective quality improvement initiatives to reduce utilization of urgent services in children discharged with asthma is an important clinical and public health question. This study was designed to identify the role of a multimodal, nurse-driven, inpatient initiated Community Outreach for Asthma Care and Healthy lifestyles (COACH) program on subsequent use of hospital services for pediatric patients with asthma.Methods: We utilized comparative effectiveness design to identify the difference in recurrent emergency department (ED) visits and/or admissions within 12-months after discharge between patients with asthma who engaged in the COACH program (Intervention group) and those who did not (Comparison group). We used administrative databases of hospitals included in the Meridian Health system to identify the number of and time to asthma-related readmissions and ED re-attendances.Results: We found no difference in the rate or number of recurrent hospital-based services used within 12 months, but found a reduction in ED re-visitation and/or readmission within 30 days for COACH program participants prior to and after adjustment for age, race/ethnicity, insurance status, and clinical presentation (Odd Ratio 0.44, 95% Confidence Interval 0.20, 0.93).Conclusion: Participation in the COACH program decreases the likelihood for subsequent use of hospital services within a month of discharge for children with asthma. Enhanced post-discharge interactions with families may reduce long-term reuse of hospital-based services for COACH program participants.