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Purpose: Early detection of sight?threatening disorders by technological applications like teleophthalmology and prompt treatment can help decrease visual impairment. This study evaluated the role of teleophthalmology in underserved rural areas along with cost?saving estimates for the end user. Methods: A prospective, observational, cross?sectional hospital?based study was conducted over 3 months. First 1000 teleconsultations were included. None of the patients denied providing informed consent. The patients were consulted at the eight vision centers and three satellite centers of the hospital in the nearby rural and tribal regions closer to their residential places. These vision and satellite centers were connected to the base hospital like a hub and spoke model with a teleophthalmology network. Results: Cataract (n = 301, 30.1%) and refractive error (n = 290, 29%) were the most common diagnosis. 42.1% of patients were referred to base hospital for further evaluation. Thus, a total of 57.9% of patients were not required to visit the base hospital for initial consultation, saving time and money. Furthermore, 15.1% of patients were provided medical treatment at the vision center and satellite center, which helped in making teleophthalmology cost?saving for the patients. An average of Rs. 621/? were saved per patient for the community in our study. Conclusion: Networked teleophthalmology model can be an affordable and feasible tool for providing eye care delivery services in rural and tribal regions of Gujarat and the whole country, especially for the end user. Thus, it may be a workable model in ophthalmology practice with substantial cost saving to the community.
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OBJECTIVE To analyze the implementation of insulin centralized volume-based procurement policy （hereinafter referred to as “centralized procurement”） in our hospital and its effect on the use of insulin products in clinical. METHODS The manufacturer， specifications， usage， sales amount and agreed purchase volume of insulin products in our hospital before （July 4， 2021 to January 3， 2022） and after （July 4， 2022 to January 3， 2023） the centralized procurement were collected. The defined daily dose （DDD） method was used to calculate defined daily doses （DDDs）， defined daily cost （DDC）， the progress of procurement completion and actual cost saving. RESULTS After the centralized procurement， the number of insulin products had increased from 20 to 29 in our hospital； except for the Insulin degludec/aspart injection in our hospital’s original insulin catalog that had not been centrally purchased， all other existing varieties had been included in centralized procurement catalog. The use of Insulin aspart 30 injection produced by Novo Nordisk （China） Pharmaceutical Co.， Ltd. always ranked the first place in the list of usage and DDDs before and after the centralized procurement. The sales amount of Insulin glargine injection produced by Ganli Pharmaceutical Co.， Ltd. and Tonghua Dongbao Pharmaceutical Co.， Ltd. increased significantly due to the significant increase in usage. The centralized procurement of Degu insulin injection from Novo Nordisk （China） Pharmaceutical Co.， Ltd. had achieved a relatively high completion rate in our hospital’s original insulin catalog， while the completion rate for new varieties was low. After the centralized procurement， our hospital actually saved a total of 1 388 582.66 yuan in expenses. CONCLUSIONS After the centralized procurement， the selection and usage of insulin varieties in our hospital are reasonable， which saves patients’ insulin treatment costs， and reduces economic pressure on patients and society.
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In India, there is 62% out-of-pocket health expenditure per capita and only 15% are covered by health insurance. The use of generics can save a lot of money which can be used for other health issues. But lack of knowledge about cost effectiveness of generic medicines among various health-care professionals had led to a low rate of generic medicine prescription in India. This review aims to identify the barriers in adoption of generic prescribing in clinical practice in India. A systematic literature review was conducted using various healthcare databases such as PubMed and google scholar. The literature search using various combination of keywords retrieved 2360 articles. After excluding duplicates, articles in languages other than English and based on relevance to subject only 15 articles were selected. The barriers to generic prescribing identified from reported literature can be broadly classified based on stakeholders of healthcare setting such as physicians, patients, pharmacist and government policies. The major barriers to generic prescribing identified were negative perception of various stakeholders, lack of awareness of regulatory standards, maturity of health care system, vulnerability of patients, lack of standard guidelines in brand substitution, incentives and influence of drug advertisements. In Indian set up, studies on impact evaluation of generic prescription, emphasizing the quality and cost saving by their use in clinical practice should be conducted. This evidence will help to build the confidence of various stakeholders towards implementing generic prescribing in clinical practice.
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Clinical pharmacists in intensive care units are involved in patient safety, technical guidance and cost saving with rational use of medicines. This study aimed to estimate the cost saving of clinical pharmacist interventions in pediatric intensive care units (PICU). This was a retrospective, observational study. Savings were measured for three months based on (1) Clinical pharmacist interventions from prescription analysis, (2) Individualized doses of four antibiotics, (3) Comparison of drugs dispensing systems before and after the decentralization of pharmacy services. The main outcome is costs saving with strategic planning of medication use based on local reality. A number of 73 clinical pharmacist interventions were made, from which 13 allowed the calculation of economic impact, saving US$ 633.38/year. Cost saving from individualized doses of four antibiotics was US$ 8,754.46/year. The decentralization of pharmacy services saved US$ 28,770.52/year. The evaluated interventions were successful. Clinical pharmacist interventions, individualized antimicrobials doses and decentralization of pharmacy services reduce costs in the hospital.
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Mediation AnalysisABSTRACT
Objective To analyze the impact of “4+7” City Drug Centralized Procurement Program on the utilization of cardiovascular medicines, and to provide a reference for optimizing the policy of generic medicines as substitutes for original medicines. Methods Eleven drugs, both generic and original were selected for treatment of cardiovascular diseases in an outpatient clinic of a tertiary hospital in Shanghai. The proportion of use of generic drugs and original drug, ratio of used amount, daily cost ratio, and potential cost savings rate of replacement of original drug by generic drug were analyzed before the “4+7” (2018.04.01-2018.09.30) and after the “4+7” (2019.04.01-2019.09.30). Results After the “4+7”, the proportion of the original research drug used decreased from 84.32% to 58.12%, and the ratio of amount of used money decreased from 86.02% to 78.16%; the proportion of generic medicines used increased from 15.68% to 41.88%, and the ratio of amount used increased from 13.98% to 21.84%; the daily cost ratio of generic medicine to original medicine decreased from 0.87 to 0.39. Under the same condition, the potential cost savings of replacing the original drug with generic drugs before and after the “4+7” were RMB 3.703 million and RMB 3.399 million, respectively, and the cost saving rate was 35% and 61%, respectively. Conclusion The “4+7” City Drug Centralized Procurement Program significantly increase the use of cardiovascular generic drugs and significantly reduce the cost of drugs; however, it has a small impact on the quantity and amount of generic drugs used. There is still a significant potential for cost saving. It is recommended to further increase the publicity of the policy on the substitution of original drug by generic, expedite the consistency evaluation process of generic drugs and take measures to avoid the widening of the price gap between original drugs and generics.
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OBJECTIVE： To provide evidence support for the economic benefits of generic drugs as substitutes for original drugs， and to provide suggestions for promoting the use of generic drugs. METHODS： Twelve kinds of drugs with both original and generic versions for treating hypertension and diabetes were selected from a tertiary public hospital in Jiangsu province. The proportion of usage quantity， the ratio of amount， price ratio were analyzed quarterly during 2017-2018. RESULTS： From the first quarter of 2017 to the fourth quarter of 2018， the ratio of quantity of original drugs increased from 24.53％ to 39.12％， while that of generic drugs decreased from 75.47％ to 60.88％； the ratio of amount of original drugs increased from 39.45％ to 61.47％， while that of generic drugs decreased from 60.55％ to 38.53％； the price ratio of generic drug to original drug decreased from 0.50 to 0.40. With the same efficacy， the cost of generic drugs replacing original drugs in 2018 could save 622，100 yuan， and the cost savings rate could be 47.65％. CONCLUSIONS： Drug expenditure could be reduced by substituting original drug with generics， but the useage quantity and amount ratio of generic drug in this hospital is gradually declining. So， in order to save drug experditure， it is necessary to speed up the process of conformity evaluation and clinical equivalence study of generic drugs， increase the education and publicity of generic prescriptions and rational use， so as to improve doctors’ and patients’ recognition of the quality and efficacy of generic drugs， cooperate with the centralized procurement policy to encourage the purchase and use of generic drugs.
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Objective:To forecast the reduce of medical direct expenses of China from 2016 to 2020,under the circumstances that some outpatients and inpatients of tertiary hospitals and secondary hospitals could be distributed to primary medical institutions.Methods:According to the number of outpatients,number of inpatients,medical expenses of outpatients per visit,and medical expenses of inpatients per visit in the first grade,second grade and third grade public hospitals from 2006 to 2015,the corresponding visit numbers and costs from 2016 to 2020 were forecasted based on liner regression model.The percentages of transferable patients out of all patients in different levels of institutions could be equal to 10％,20％ and 30％.The direct medical expense could be saved after the distribution were calculated.Results:If the trend of health service utilization from 2016 to 2020 were equal to the sample,the third grade hospitals would keep the fast increasing of outpatient expenses and patients.8％,16％ and 24％ of the total expenses would be saved if 10％,20％ and 30％ patients in third and second were led to the second and first grade medical institutions.Conclusion:It needed to slowdown the increasing trend of medical expenses,lead patients visit hospitals reasonably,strengthen the construction capacity of second grade medical and health institutions,meanwhile,the medical and health service system construction should adjust the distribution ratio.
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Objective:To forecast the reduce of medical direct expenses of China from 2016 to 2020,under the circumstances that some outpatients and inpatients of tertiary hospitals and secondary hospitals could be distributed to primary medical institutions.Methods:According to the number of outpatients,number of inpatients,medical expenses of outpatients per visit,and medical expenses of inpatients per visit in the first grade,second grade and third grade public hospitals from 2006 to 2015,the corresponding visit numbers and costs from 2016 to 2020 were forecasted based on liner regression model.The percentages of transferable patients out of all patients in different levels of institutions could be equal to 10％,20％ and 30％.The direct medical expense could be saved after the distribution were calculated.Results:If the trend of health service utilization from 2016 to 2020 were equal to the sample,the third grade hospitals would keep the fast increasing of outpatient expenses and patients.8％,16％ and 24％ of the total expenses would be saved if 10％,20％ and 30％ patients in third and second were led to the second and first grade medical institutions.Conclusion:It needed to slowdown the increasing trend of medical expenses,lead patients visit hospitals reasonably,strengthen the construction capacity of second grade medical and health institutions,meanwhile,the medical and health service system construction should adjust the distribution ratio.
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Objective: Implementation of effective control, tracking, analysis and evaluation to the hospital renovation and expansion cost and achieve the objectives of cost reduction and efficiency, environmental protection and energy saving. Methods:In practical work, insisting on the direction of cost control and environmental protection, executing accurate management, to improve energy using efficiency and reduce costs. Results:Study the means of hospital renovation and expansion project cost control and environmental protection and energy saving, improve funds usability. Conclusion:Lean management produce effectiveness, hospital renovation and expansion project cost control and environmental protection and energy conservation work can gradually get people's attention.
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RACIONAL: A execução de bypass gástrico laparoscópico em hospital universitário público tem sido difícil devido ao elevado custo dos grampeadores cirúrgicos que prejudica o treinamento de médicos residentes e tem motivado a busca por técnicas alternativas, de baixo custo, mantendo a eficácia. OBJETIVO: Apresentar a viabilidade de um método com menor uso de suturas mecânicas. MÉTODOS: Foram operados 63 pacientes em 2 hospitais universitários, sendo 12 homens e 51 mulheres (81 por cento), com média de 33,5 anos de idade e IMC médio de 43. Aplicou-se a seguinte padronização técnica: Secção da alça com bisturi elétrico a 50 cm do ângulo duodeno-jejunal, anastomose término-lateral, passagem da alça retrocólica e retrogástrica, confecção da parede lateral da bolsa gástrica com 1 carga azul de 45 e outra de 60 mm após a secção horizontal com bisturi elétrico, sutura do estômago excluso e anastomose gastrojejunal. As anastomoses foram manuais e contínuas com fio absorvível. RESULTADOS: O tempo operatório médio foi de 5,5 horas. As complicações precoces foram: fístula no ângulo de esôfago-gástrico (1,6 por cento), estenose (1,6 por cento) e fístula na anastomose gastrojejunal (1,6 por cento) e torção da anastomose intestinal (1,6 por cento). A estenose foi tratada por dilatação endoscópica e as outras complicações através de 3 re-operações (2 laparoscópicas e 1 laparotômica). O tempo de internação variou de 2 a 20 dias, com média de 4 dias, não havendo óbito. CONCLUSÃO: Este método é viável e com baixo custo operacional; todavia, é complexo e requer habilidade principalmente em suturas laparoscópicas.
BACKGROUND: To perform laparoscopic gastric bypass in public university hospital has been difficult due to the high cost of the surgical staplers. This fact induced to look for different technical options, with low cost, maintaining the efficacy. AIM: To present the viability of a new method with the use of a low number of stapler devices. METHODS: Sixty three patients were operated in two university hospitals, 12 men and 51 women (81 percent), with mean age of 33.5y and average BMI of 43. The surgical technique used followed this sequence: loop section with electrical scalpel 50 cm of the duodenojejunal angle; termino-lateral anastomosis; retrogastric-retrocolic passage of the Roux limb; construction of the lateral wall of the pouch using 1 blue load of 45 and other of 60 mm after horizontal section with electrical scalpel; suture of the excluded stomach and gastrojejunal anastomosis. The anastomoses were hand-sewn made and a single-layer continuous absorble suture was performed. RESULTS: The average surgical time was 5.5 hours. The early complications were: fistula in the esophago-gastric angle (1.6 percent), stenosis (1.6 percent); fistula in the gastro-jejunal anastomosis (1.6 percent); obstruction of the intestinal anastomosis (1.6 percent). The stenosis was treated by endoscopic dilation. The remaining complications, with 3 re-operations (2 with laparoscopic and 1 with laparotomic approaches). The length of hospital stay was in average 4 days. CONCLUSION: This method is viable with low cost; however, it is complex and requires ability mainly in laparoscopic handsewn sutures.
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O presente estudo avaliou a assistência odontológica fornecida a cerca de 4 mil funcionários e dependentes de um hospital privado. A análise foi dividida em três momentos: (1) linha de base (controle): quando a assistência odontológica fornecida era terceirizada por uma empresa que operava com rede credenciada, (2) quando houve uma renegociação de preços com a prestadora original e (3) quando a assistência era feita por um serviço de odontologia próprio sem a intermediação de uma prestadora e com profissionais remunerados através de valores fixos. Foram coletados mensalmente dados econômicos e sobre o tipo e número de procedimentos realizados. A renegociação de preços reduziu os custos em cerca de 37 por cento em relação à linha de base, ao passo que o serviço próprio reduziu os custos em 50 por cento. A renegociação de preços provocou uma diminuição de 31 por cento no número de procedimentos realizados sem modificar o perfil da assistência, ao passo que o serviço próprio não causou diminuição na quantidade de serviços, mas modificou o padrão da assistência, pois se aumentaram os procedimentos relacionados com as causas das patologias e reduziram-se os procedimentos cirúrgico-restauradores.
The present study evaluated the dental care plan offered to 4,000 employees of a private hospital and their respective families. The analysis covered three stages: (1) baseline (control), when dental care was provided by an outsourced company with a network of dentists paid for services, (2) a renegotiation of costs with the original dental care provider, and (3) provision of dental care by the hospital itself, through directly hired dentists on regular salaries. Monthly economic and clinical data were collected for this research. The dental plan renegotiation reduced costs by 37 percent in relation to baseline, and the hospital's own dental service reduced costs by 50 percent. Renegotiation led to a 31 percent reduction in clinical procedures, without altering the dental care profile; the hospital's own dental service did not reduce the total number of clinical procedures, but modified the profile of dental care, since procedures related to the causes of diseases increased and surgical/restorative procedures decreased.