Willingness to pay for primary health care at public facilities in the Western Cape Province, Cape Town, South Africa

BACKGROUND AND OBJECTIVES

As facilities are being prepared for the implementation of National Health Insurance (NHI) in South Africa, there is a pressing need to understand how the public equates the provision of health services at Primary Health Care (PHC) centres with monetary value. Accordingly, this exploratory study was designed to ascertain the willingness to pay (WTP) for public primary healthcare services in South Africa and to identify factors that influence the WTP.

METHODS

The study was conducted in Cape Town, South Africa, among 453 persons presenting at two public primary health care centres, namely Bothasig Community Day Centre (CDC) and Goodwood CDC. The study used the contingent valuation range methodology. Descriptive statistics, multiple logistic and tobit regression analyses were conducted to assess demographics, socio-economic, and health access factors that influence WTP.

RESULTS

Overall, 60% of participants were willing to pay for services offered at the PHC facilities. The average willingness to pay for all participants was 49.44 ZAR, with a median of 25 ZAR. The multiple logistic regression for grouped facilities showed unemployment, public transport, and the facility attended to be significant while public transport, facility visits, and facility attended were the only significant variables in the tobit model. There was less willingness to pay for those unemployed in comparison with students, those using public transport rather than walking, those frequenting the facilities more than first-time visitors and those attending Goodwood facility in comparison with Bothasig.

CONCLUSION

This study revealed factors related to the participants' WTP and to their willingness to contribute towards the health service, though at very low amounts. Understanding the economic value placed upon a service provided in a facility is essential in decision-making for quality care improvements, especially as the South African health system is making the facilities ready for NHI.

Healthcare resource utilization and costs in patients with myelodysplastic syndromes treated with hypomethylating agents: a SEER-Medicare analysis

AIMS

To describe healthcare resource utilization (HRU) and costs in patients with myelodysplastic syndromes (MDS) treated with hypomethylating agents (HMA) based on HMA-treatment response.

MATERIALS AND METHODS

SEER-Medicare data (January 2006-December 2016) were used to identify adults diagnosed with MDS (SEER: January 2009-December 2015) initiated on HMA (index date). HMA-treatment success (indicators: ≥7 HMA cycles, stem cell transplantation, and transfusion independence) or failure (indicators: acute myeloid leukemia [AML], AML-like treatment, and death) was determined using a claim-based algorithm. HRU and costs were assessed from the index date to 1-year post-index, overall and stratified by HMA-treatment success or failure. Among patients with HMA-treatment failure, HRU and costs were also assessed from failure to 1-year post-failure.

RESULTS

The study included 3,046 patients (mean age: 77.4 years; females: 36.8%). Rates of HMA-treatment success and failure were 44.4% and 76.2%, respectively (20.6% had HMA-treatment success then failure). Overall, patients had 15.2 inpatient admissions per-100-patients-per-month (median follow-up: 5.9 months). Patients with HMA-treatment success had 7.5 inpatient admissions per-100-patients-per-month (median follow-up: 12.0 months), while those with HMA-treatment failure had 20.4 and 35.3 admissions per-100-patients-per-month pre- and post-HMA-treatment failure, respectively (median follow-up: 4.3 and 1.8 months, pre- and post-HMA-treatment failure, respectively). Mean total healthcare costs were $12,494 per-patient-per-month overall, $8,069 per-patient-per-month among patients with HMA-treatment success, and $13,809 and $19,242 per-patient-per-month pre- and post-HMA-treatment failure, respectively. Outpatient costs (68.3%) were the main contributor of total healthcare costs overall, while inpatient costs (80.3%) were the main cost driver post-HMA-treatment failure.

LIMITATIONS

Without available laboratory test results, clinical indicators observed in claims were used to assess HMA-treatment response.

CONCLUSIONS

Over 75% of patients with MDS failed HMA-treatment within 6 months of initiation and were observed with more inpatient admissions than those with HMA-treatment success, translating into substantially higher healthcare costs. HMA-treatment failure results in an important economic burden in MDS patients.

Excess healthcare costs in patients with autosomal dominant polycystic kidney disease by renal dysfunction stage

AIM

To build upon previous outdated studies by comprehensively assessing the direct healthcare burden of autosomal dominant polycystic kidney disease (ADPKD).

MATERIALS AND METHODS

Patients with ≥2 diagnoses for ADPKD (ADPKD cohort) were identified in the US fee-for-use IBM Truven Health Analytics MarketScan Commercial Claims and Encounters and IBM Truven Health Analytics MarketScan Medicare Supplemental databases (01 January 2015-31 December 2017) and matched (1:3) to controls without ADPKD (non-ADPKD cohort). The index date was the last calendar date followed by 12 months continuous enrollment (study period). Patients with ADPKD were stratified into one of seven mutually exclusive groups based on chronic kidney disease (CKD) stages (I-V), end-stage renal disease requiring renal replacement therapy (ESRD-RRT), and unknown stage.

RESULTS

During the 12-month study period, patients with ADPKD incurred significantly higher total healthcare costs than those without ADPKD (mean cost difference = $22,879 per patient per year [PPPY]; p < .001). Besides CKD stages I and II, total healthcare cost differences increased as patients progressed beyond CKD stage III, with the greatest difference observed among patients with ESRD-RRT. Total healthcare cost differences between cohorts were more pronounced in subgroups of patients with hypertension ($29,347) and with high risk of rapid progression ($39,976). Similar results were observed in the Medicare Supplemental population, with a total mean cost difference of $42,694 PPPY (p < .001); cost difference was also higher in the hypertension ($46,461 PPPY) and high risk of rapid progression ($45,708 PPPY) subgroups.

LIMITATIONS

Results may not be representative of the overall ADPKD US population; CKD stage was based on diagnosis and procedure codes; criteria used to identify ADPKD at risk of rapid progression did not rely on laboratory values; there may be billing inaccuracies and omissions in health insurance claims data.

CONCLUSIONS

This study demonstrated the substantial healthcare costs associated with ADPKD, which increased as patients progressed through more severe CKD stages.

Humanistic burden among caregivers of patients with Alzheimer's disease or dementia in Japan: a large-scale cross-sectional survey

AIMS

As the population in Japan is rapidly aging, the prevalence of dementia, particularly Alzheimer's Disease (AD), is expected to increase, resulting in a growing need for caregivers. This study aims to quantify and compare the humanistic burden of caregivers of AD/dementia patients with caregivers of patients with other conditions in Japan.

MATERIALS AND METHODS

This cross-sectional study used data from the 2018 Japan National Health and Wellness Survey (NHWS). Outcome measures included the Short-Form 12-item Health Survey (SF-12) for health-related quality-of-life (HRQoL), EuroQol 5-dimension scale (EQ-5D) for health states utilities, impact of health on productivity and activity, and evaluation of depression and anxiety. Multivariate analysis was used to compare across groups, with adjustment for potential confounding effects.

RESULTS

A total of 805 caregivers of AD/dementia patients, 1,099 other caregivers, and 27,137 non-caregivers were identified. Both AD/dementia caregivers and other caregivers had lower HRQoL and EQ-5D scores, higher total activity impairment, and more caregivers tended to experience anxiety than non-caregivers. There were no significant differences in the involvment in basic and instrumental activities of daily living (ADL) between AD/dementia caregivers and caregivers of other conditions. Notably, AD/dementia caregivers were more involved in making treatment decisions and finance management than other caregivers. Among AD/dementia caregivers caring for one patient, 395 patients lived in the community and 282 in an institution. AD/dementia caregivers whose patients lived in the community were more significantly involved in basic and instrumental ADL. Caregivers of patients with both AD/dementia and cancer had higher caregiving burden than caregivers of patients with either condition.

CONCLUSIONS

Caregivers of AD/dementia patients in Japan reportedly experienced significant humanistic burden which is associated with patients' living arrangements and the presence of an additional chronic condition. Therefore, provision of effective care/support is essential to relieve the burden experienced by the caregivers.

Survey of Preventable Disaster Deaths at Medical Institutions in Areas Affected by the Great East Japan Earthquake: Retrospective Survey of Medical Institutions in Miyagi Prefecture

Introduction In 2015, the authors reported the results of a preliminary investigation of preventable disaster deaths (PDDs) at medical institutions in areas affected by the Great East Japan Earthquake (2011). This initial survey considered only disaster base hospitals (DBHs) and hospitals that had experienced at least 20 patient deaths in Miyagi Prefecture (Japan); therefore, hospitals that experienced fewer than 20 patient deaths were not investigated. This was an additional study to the previous survey to better reflect PDD at hospitals across the entire prefecture.

METHOD

Of the 147 hospitals in Miyagi Prefecture, the 14 DBHs and 82 non-DBHs that agreed to participate were included in an on-site survey. A database was created based on the medical records of 1,243 patient deaths that occurred between March 11, 2011 and April 1, 2011, followed by determination of their status as PDDs.

RESULTS

A total of 125 cases of PDD were identified among the patients surveyed. The rate of PDD was significantly higher at coastal hospitals than inland hospitals (17.3% versus 6.3%; P<.001). Preventable disaster deaths in non-DBHs were most numerous in facilities with few general beds, especially among patients hospitalized before the disaster in hospitals with fewer than 100 beds. Categorized by area, the most frequent causes of PDD were: insufficient medical resources, disrupted lifelines, delayed medical intervention, and deteriorated environmental conditions in homes and emergency shelters in coastal areas; and were delayed medical intervention and disrupted lifelines in inland areas. Categorized by hospital function, the most frequent causes were: delayed medical intervention, deteriorated environmental conditions in homes and emergency shelters, and insufficient medical resources at DBHs; while those at non-DBHs were disrupted lifelines, insufficient medical resources, delayed medical intervention, and lack of capacity for transport within the area.

CONCLUSION

Preventable disaster death at medical institutions in areas affected by the Great East Japan Earthquake occurred mainly at coastal hospitals with insufficient medical resources, disrupted lifelines, delayed medical intervention, and deteriorated environmental conditions in homes and emergency shelters constituting the main contributing factors. Preventing PDD, in addition to strengthening organizational support and functional enhancement of DBHs, calls for the development of business continuity plans (BCPs) for medical facilities in directly affected areas, including non-DBHs. Yamanouchi S , Sasaki H , Kondo H , Mase T , Otomo Y , Koido Y , Kushimoto S . Survey of preventable disaster deaths at medical institutions in areas affected by the Great East Japan Earthquake: retrospective survey of medical institutions in Miyagi Prefecture. Prehosp Disaster Med. 2017;32(5):515-522.

Development of Mass-casualty Life Support-CBRNE (MCLS-CBRNE) in Japan

This report outlines the need for the development of an advanced course in mass-casualty life support (MCLS) and introduces the course content. The current problems with education on disasters involving chemical agents, biological agents, radiation/nuclear attacks, or explosives (CBRNE) in Japan are presented. This newly developed "MCLS-CBRNE" program was created by a Ministry of Health, Labour, and Welfare (Tokyo, Japan) research group based on these circumstances. Modifications were then made after a trial course. Training opportunities for relevant organizations to learn how to act at a CBRNE disaster site currently are lacking. The developed course covers initial responses at a disaster site. This one-day training course comprises lectures, three tabletop simulations, and practical exercises in pre-decontamination triage and post-decontamination triage. With regard to field exercises conducted to date, related organizations have experienced difficulties in understanding each other and adapting their approaches. Tabletop simulations provide an opportunity for participants to learn how organizations working on-site, including fire, police, and medical personnel, act with differing goals and guiding principles. This course appears useful as a means for relevant organizations to understand the importance of developing common guidelines. The MCLS-CBRNE training is proposed to support CBRNE disaster control measures during future events. Anan H , Otomo Y , Kondo H , Homma M , Koido Y , Morino K , Oshiro K , Harikae K , Akasaka O . Development of mass-casualty life support-CBRNE (MCLS-CBRNE) in Japan. Prehosp Disaster Med. 2016;31(5):547-550.

Development and Verification of a Mobile Shelter Assessment System "Rapid Assessment System of Evacuation Center Condition Featuring Gonryo and Miyagi (RASECC-GM)" for Major Disasters

Introduction There were 5,385 deceased and 710 missing in the Ishinomaki medical zone following the Great East Japan Earthquake that occurred in Japan on March 11, 2011. The Ishinomaki Zone Joint Relief Team (IZJRT) was formed to unify the relief teams of all organizations joining in support of the Ishinomaki area. The IZJRT expanded relief activity as they continued to manually collect and analyze assessments of essential information for maintaining health in all 328 shelters using a paper-type survey. However, the IZJRT spent an enormous amount of time and effort entering and analyzing these data because the work was vastly complex. Therefore, an assessment system must be developed that can tabulate shelter assessment data correctly and efficiently. The objective of this report was to describe the development and verification of a system to rapidly assess evacuation centers in preparation for the next major disaster. Report Based on experiences with the complex work during the disaster, software called the "Rapid Assessment System of Evacuation Center Condition featuring Gonryo and Miyagi" (RASECC-GM) was developed to enter, tabulate, and manage the shelter assessment data. Further, a verification test was conducted during a large-scale Self-Defense Force (SDF) training exercise to confirm its feasibility, usability, and accuracy. The RASECC-GM comprises three screens: (1) the "Data Entry screen," allowing for quick entry on tablet devices of 19 assessment items, including shelter administrator, living and sanitary conditions, and a tally of the injured and sick; (2) the "Relief Team/Shelter Management screen," for registering information on relief teams and shelters; and (3) the "Data Tabulation screen," which allows tabulation of the data entered for each shelter, as well as viewing and sorting from a disaster headquarters' computer. During the verification test, data of mock shelters entered online were tabulated quickly and accurately on a mock disaster headquarters' computer. Likewise, data entered offline also were tabulated quickly on the mock disaster headquarters' computer when the tablet device was moved into an online environment.

CONCLUSIONS

The RASECC-GM, a system for rapidly assessing the condition of evacuation centers, was developed. Tests verify that users of the system would be able to easily, quickly, and accurately assess vast quantities of data from multiple shelters in a major disaster and immediately manage the inputted data at the disaster headquarters. Ishii T , Nakayama M , Abe M , Takayama S , Kamei T , Abe Y , Yamadera J , Amito K , Morino K . Development and verification of a mobile shelter assessment system "Rapid Assessment System of Evacuation Center Condition featuring Gonryo and Miyagi (RASECC-GM)" for major disasters. Prehosp Disaster Med. 2016;31(5):539-546.

Survey of preventable disaster death at medical institutions in areas affected by the Great East Japan Earthquake: a retrospective preliminary investigation of medical institutions in Miyagi Prefecture

PROBLEM

The 2011, magnitude (M) 9, Great East Japan Earthquake and massive tsunami caused widespread devastation and left approximately 18,500 people dead or missing. The incidence of preventable disaster death (PDD) during the Great East Japan Earthquake remains to be clarified; the present study investigated PDD at medical institutions in areas affected by the Great East Japan Earthquake in order to improve disaster medical systems.

METHODS

A total of 25 hospitals in Miyagi Prefecture (Japan) that were disaster base hospitals (DBHs), or had at least 20 patient deaths between March 11, 2011 and April 1, 2011, were selected to participate based on the results of a previous study. A database was created using the medical records of all patient deaths (n=868), and PDD was determined from discussion with 10 disaster health care professionals.

RESULTS

A total of 102 cases of PDD were identified at the participating hospitals. The rate of PDD was higher at coastal hospitals compared to inland hospitals (62/327, 19.0% vs 40/541, 7.4%; P<.01). No difference was observed in overall PDD rates between DBHs and general hospitals (GHs); however, when analysis was limited to cases with an in-hospital cause of PDD, the PDD rate was higher at GHs compared to DBHs (24/316, 7.6% vs 21/552, 3.8%; P<.05). The most common causes of PDD were: insufficient medical resources, delayed medical intervention, disrupted lifelines, deteriorated environmental conditions in homes and emergency shelters at coastal hospitals, and delayed medical intervention at inland hospitals. Meanwhile, investigation of PDD causes based on type of medical institution demonstrated that, while delayed medical intervention and deteriorated environmental conditions in homes and emergency shelters were the most common causes at DBHs, insufficient medical resources and disrupted lifelines were prevalent causes at GHs.

CONCLUSION

Preventable disaster death at medical institutions in areas affected by the Great East Japan Earthquake occurred mainly at coastal hospitals. Insufficient resources (at GHs), environmental factors (at coastal hospitals), and delayed medical intervention (at all hospitals) constituted the major potential contributing factors. Further investigation of all medical institutions in Miyagi Prefecture, including those with fewer than 20 patient deaths, is required in order to obtain a complete picture of the details of PDD at medical institutions in the disaster area.