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Objective@#To understand the current situation regarding snack food consumption among grade 4 and grade 5 primary school students in agricultural and pastoral areas of Qinghai Province, China, and to provide a scientific basis for nutrition education and intervention strategies.@*Methods@#Multistage stratified cluster random sampling was employed. The research included 969 fourth and fifth grade students were selected from 10 primary schools in four counties and districts of three cities in Haidong City, Hainan Prefecture and Haixi Prefecture in Qinghai Province. The self report questionnaire method was used to investigate the current status regarding snack food consumption in this population.@*Results@#The proportion of students who consumed snack food at home, school and elsewhere were 98.2%, 88.5% and 75.4%, respectively. Male students reported a lower rate of snack consumption at school than female students ( χ 2=9.66). The fifth grade students reported a higher rate of snack consumption at home and other places than the fourth grade students ( χ 2=10.31, 6.77). The reported rate of snack consumption of students in the rural was higher than that in the county( χ 2=6.03,100.53, 24.77). The reported rate of snack consumption of boarding students at home was lower than that of non-boarding students ( χ 2=7.22), while the reported rate of snack consumption at school was higher than that of non-boarding students ( χ 2=9.04）（ P <0.01). The most popular snacks consumed at home included fruits and vegetables, cereals and nuts (76.9%, 67.2%, 63.7%), while the most popular snacks consumed at school were fruits and vegetables, cereals and candies (45.1%, 36.9%, 24.4%). The most popular snacks consumed in other settings included ice cream, candies and beverages(54.7%, 51.6%, 42.9%). The top three reasons for snacking were that snacks were regarded as delicious, healthy/nutritious and clean (76.9%, 65.5% and 59.0%, respectively).@*Conclusion@#Snacking is popular among students, although many snacks are unhealthy. Therefore, there is a need to improve food environments and nutrition education, so as to help students to choose healthy beverages and adopt healthy eating behaviors.
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Abstract@#Excessive intake of sugar-sweetened beverages among children and adolescents could increase the risks of adverse health outcomes, including dental caries and obesity. This study reviewed the consumption of sugar-sweetened beverages among children and adolescents in China and the international strategies to reduce the consumption of sugar-sweetened beverage. The aim of the study was to provide a reference for the introduction of relevant policies to control the intake of sugar-sweetened beverages in children and adolescents in China. In summary, measures including a tax on sugar-sweetened beverages, implementing front-of-pack labelling system, restricting marketing and publicity and education have been adopted to control the consumption of sugar-sweetened beverages in some countries, while public publicity and education have been adopted in China. It is suggested that comprehensive policies and measures should be adopted to control the intake of sugar-sweetened beverage among Chinese children.
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Objective@#To evaluate snack consumption and the influencing factors associated with student participation in the Nutrition Improvement Program, and to provide a scientific basis for improving the program.@*Methods@#Among the 50 monitoring counties that implemented the Compulsory Education Student Nutrition Improvement Program, two primary schools and two junior schools were randomly selected according to different food supply patterns (i.e., school, company, and mix). This study randomly selected one or two classes from each grade, which ranged from grade 3 to grade 9. A questionnaire, which addressed snack consumption and choice, was distributed to 27 374 students.@*Results@#The findings revealed that 14.0% of students from poor rural areas in central and western regions consumed snacks two or more times per day, and 21.6% of students spent 3 yuan or more on snacks each day. The top three choices of snacks included fruit and vegetables (50.6%), biscuits and bread (50.1%), and puffed food (40.0%). Students who had mothers who worked outside the home, parents who worked outside the home, who consumed corporate meals, and who had access to a small shop on campus were more likely to consume snacks one or more times per day(OR=1.35，1.19，1.11，1.51，P<0.05).@*Conclusion@#The phenomenon of snack consumption among primary and middle school students from poor rural areas in central and western regions is common, and the selection of unhealthy snacks was identified as a problem. A health education system with comprehensive support and guidance from individuals, families, schools, and society should be established to guide students to opt for healthier snacks.
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Objective@#This study aimed to examine the mediating effects of sleep quality in the association between beverages consumption and depressive symptoms in Chinese university students, and to provide a theoretical reference for preventing and reducing depression symptoms.@*Methods@#This school-based cross-sectional survey was carried out among 4 624 university students from 2 universities in Anhui and Jiangxi provinces of China. The patient health questionnaire-9 items (PHQ-9) was used to assess depressive symptoms. The Pittsburgh sleep quality index（PSQI） was used to assess sleep quality, and a self-reported dietary frequency questionnaire was used to measure beverages consumption. The quantile regression model was used to association analysis, and the latent variable mediation model was used to analyze the mediation effect.@*Results@#The positive rates of mild, moderate, moderate to severe and severe depression in 4 624 university students were 31.4%, 7.5%, 4.1% and 2.0%, respectively. There was a significant association between the beverages consumption score, the PSQI score, and the PHQ-9 score( P <0.01). The higher the quantile of the beverage consumption and PSQI score, the greater the regression coefficient ( β ), and a significant dose-response relationship was observed( P <0.01). In the latent variable mediation model of beverages consumption associated with depressive symptoms in Chinese university students, the mediating effect value of sleep quality was 0.12, and the ratio of mediating effect to total effect was 71.3%.@*Conclusion@#Our study demonstrates that poor sleep quality partially mediates the association between beverages consumption and depressive symptoms in Chinese university students.
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Objective@#To explore the costs and other information of two different treatment plans for pediatric acute promyelocytic leukemia (APL): one is the traditional intravenous drip arsenic (arsenic trioxide) combined with chemotherapy treatment, and the other is a medication family treatment program based on oral arsenic (Realgar-Indigo naturalis formula), in order to provide a reference for the promotion of pediatric APL family treatment mode and the formulation of medical insurance policies.@*Methods@#The medical record homepage data and drug using of pediatric APL from 2010 to 2018 in Institute of Hematology & Blood Diseases Hospital of Chinese Academy of Medical Sciences & Peking Union Medical College were retrospectively analyzed, and the newly diagnosed pediatric patients (≤14 years old) with APL were included. The hospitalization expenses and hospitalization time of two treatment options were compared. One treatment option was Chinese children APL treatment plan 2010 (CCAPL 2010), which was based on intravenous drip arsenic trioxide. The other was Chinese Children Cancer Group APL treatment plan 2017 (CCCG-APL 2017), which was based on oral Realgar-Indigo naturalis formula.@*Results@#A total of 79 pediatric APL patients were included and grouped according to the treatment plans, 56 patients were treated with CCAPL 2010 plan, and 23 patients were treated with CCCG-APL 2017 plan. The median costs of one single pediatric APL patient in CCAPL 2010 plan was 167 700 yuan (95 800-386 600 yuan), and the median hospital stay time of one single pediatric APL patient was 102 days (14-157 days). The median costs of one single pediatric APL patient in CCCG-APL 2017 plan group was 118 700 yuan(50 800-270 600 yuan), and the median hospital stay time of one single pediatric APL patient was 37 days(5-96 days). The costs and hospital stay time of one single pediatric APL patient with CCCG-APL 2017 plan were remarkably less than those of one single pediatric APL patient with CCAPL 2010 plan (U = 178, P < 0.01; U = 66, P < 0.01).@*Conclusions@#The CCCG-APL 2017 plan simplifies the treatment plan compared with the CCAPL 2010 plan and significantly reduces the patient's medical expenses and shortens the hospitalization days. The CCCG-APL 2017 plan is suitable for family therapy and has good social and economic benefits, which is worthy of clinical promotion.
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Objective@#To study the consumption status of sports drinks in colleges and universitiesand its influencing factors,so as to provide the scientific basis for conducting nutrition education and making interventional measures.@*Methods@#2 610 college students from arts school, PE school and Chemistry and Environmental Science Institute of a university in Shangrao city, Jiangxi Province were randomly selected by random cluster sampling method to investigate the frequency and types of drinking beverages.@*Results@#In terms of gender, apart from lactic acid drinks, there was significant statistical significance in whether men and women regularly consumed beverages (fruit and vegetable juice drinks, χ2=24.20;Tea beverage, χ2=45.58;Carbonated beverage, χ2=57.27;Energy drink χ2=86.68, P<0.01).In addition to lactic acid drinks, there was statistically significant difference in whether the college regularly consumed beverages (fruit and vegetable juice drinks, χ2=54.72;Tea beverage, χ2=25.97;Carbonated beverages, χ2=46.64;Energy drinks χ2=74.81, P<0.01).In terms of family residence, only tea beverage (χ2=25.97) and carbonated beverage (χ2=46.64) had statistical significance（P<0.01）. In terms of monthly living expenses, all beverage types had statistical significance (milk beverage, χ2=11.69;Fruit and vegetable juice beverage, χ2=18.92;Tea beverage, χ2=20.09;Carbonated beverages,χ2=29.98;Energy drink χ2=17.71, P<0.01). Logistic regression analysis showed that apart from lactic beverages, male students were more likely to consume fruit and vegetable juice, tea beverage, carbonated drinks and functional drinks than female students(OR=1.60, 2.38, 2.50, 4.95, P<0.01); The students in PE school were more likely to consume lactic beverages and functional drinks than those in Arts school, while the students in Chemistry and environmental science institute were less likely to consume fruit and vegetable juice, tea beverage, carbonated drinks and functional drinks than those in Art school (OR=1.29, 2.19, 0.43, 0.50, 0.42, 0.42, P<0.05); The students who spent >1 500 yuan monthly were more likely to consume lactic beverages, fruit and vegetable juice, tea beverage, carbonated drinks than those spent <1000 yuan monthly, and they consumed more functional than those spent<1 000 yuan monthly(OR=1.68, 1.75, 1.73, 2.15, 1.69, P<0.05).@*Conclusion@#The students of different characters have different kinds of beverages. Therefore, health education should focus on male students who spend <1 500 monthly, and targeted measures should be taken to help college students build up a reasonable concept of beverage consumption so as to promote the formation of a scientific behavior of beverage consumption.
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Objective To explore the costs and other information of two different treatment plans for pediatric acute promyelocytic leukemia (APL): one is the traditional intravenous drip arsenic (arsenic trioxide) combined with chemotherapy treatment, and the other is a medication family treatment program based on oral arsenic (Realgar-Indigo naturalis formula), in order to provide a reference for the promotion of pediatric APL family treatment mode and the formulation of medical insurance policies. Methods The medical record homepage data and drug using of pediatric APL from 2010 to 2018 in Institute of Hematology & Blood Diseases Hospital of Chinese Academy of Medical Sciences & Peking Union Medical College were retrospectively analyzed, and the newly diagnosed pediatric patients (≤14 years old) with APL were included. The hospitalization expenses and hospitalization time of two treatment options were compared. One treatment option was Chinese children APL treatment plan 2010 (CCAPL 2010), which was based on intravenous drip arsenic trioxide. The other was Chinese Children Cancer Group APL treatment plan 2017 (CCCG-APL 2017), which was based on oral Realgar-Indigo naturalis formula. Results A total of 79 pediatric APL patients were included and grouped according to the treatment plans, 56 patients were treated with CCAPL 2010 plan, and 23 patients were treated with CCCG-APL 2017 plan. The median costs of one single pediatric APL patient in CCAPL 2010 plan was 167 700 yuan (95 800-386 600 yuan), and the median hospital stay time of one single pediatric APL patient was 102 days (14-157 days). The median costs of one single pediatric APL patient in CCCG-APL 2017 plan group was 118 700 yuan(50 800-270 600 yuan), and the median hospital stay time of one single pediatric APL patient was 37 days (5-96 days). The costs and hospital stay time of one single pediatric APL patient with CCCG-APL 2017 plan were remarkably less than those of one single pediatric APL patient with CCAPL 2010 plan (U ＝ 178, P < 0.01; U ＝ 66, P< 0.01). Conclusions The CCCG-APL 2017 plan simplifies the treatment plan compared with the CCAPL 2010 plan and significantly reduces the patient's medical expenses and shortens the hospitalization days. The CCCG-APL 2017 plan is suitable for family therapy and has good social and economic benefits, which is worthy of clinical promotion.
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A figura do perito nos processos judiciais é de suma importância, pois o esclarecimento em casos cujo assunto da lide ultrapassa o conhecimento do Juiz é indispensável para uma decisão devidamente fundamentada. A Lei 5.081/66, que regula o exercício da Odontologia no Brasil, diz ser a perícia nas mais diversas áreas, uma das competências do cirurgião-dentista. Nesse sentido, no âmbito trabalhista, a perícia judicial envolve casos dos chamados infortúnios do trabalho ou doenças relacionadas à atividade laborativa e quando estes processos demandam conhecimentos acerca da Odontologia, o cirurgião-dentista é o profissional mais indicado para elaborar o laudo pericial. O objetivo deste estudo foi levantar os procedimentos referentes ao credenciamento para atuação pericial junto aos Tribunais Regionais do Trabalho (TRTs) em suas 24 regiões, bem como questões referentes aos honorários quando no contexto da justiça gratuita. Por meio de pesquisa documental, buscou-se encontrar os procedimentos de cadastro como também os valores dos honorários, através de pesquisa nos sítios eletrônicos dos TRTs e contatos com suas ouvidorias. Concluiu-se que os TRTs possuem, em sua totalidade, procedimentos próprios para cadastros de peritos, sendo uma parte por meios eletrônicos e outra por meios físicos ou presenciais, regulados por intermédio de normativas específicas. Quanto aos honorários periciais, a maior parte dos TRTs segue a Resolução nº 66/2010, do Conselho Superior da Justiça do Trabalho (CSTJ), porém algumas regiões extrapolam os valores definidos e outras desfalcam o montante gratificado ao perito.
The presence of an expert in legal proceedings is of the utmost importance, since most lawsuits demands a technical or scientifical elucidation, as this might surpass the knowledge of the Judge responsible for the case. The expert's role is indispensable for a correctly substantiated decision on the case. The Law 5.081/66, which regulates the practice of Dentistry in Brazil, embeds expertise in several legal fields as one of the dentist's skills. Among these fields, in the labor scope, the judicial expertise involves cases of so-called labor misfortunes or accidents, or labor-related diseases. When the aforementioned harm oral or dental structures and for that, call for odontological knowledge, the dentist is the most appropriate professional to produce a report for the Judge. The aim of this study was to bring forth the procedures involved in the accreditation of Brazilian dentists to the Regional Labor Courts (RLCs) in its 24 sub-divisions, as well as issues related to expert fees when the losing part is granted by free costs on legal proceedings. Through documentary research, we sought to find the registration procedures, coupled with the fees granted to the experts, via research in the Courts websites and contact with their ombudsmen. We conclude that the entirety of the RLCs have their own procedures for experts' accreditation, some by electronic means and others by physical means, all of them regulated by individual legal resolutions. Regarding the expert fees, most of the RLCs follow the Superior Council of Labor Justice Resolution 66/2010; however, some regions exceed the defined Resolution values while other ones pay lower amounts to the expert.
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Humans , Expert Testimony , Forensic Dentistry , Fees and Charges , Legislation, LaborABSTRACT
PURPOSE: This study was performed to suggest a realistic measure of charging for 119 emergency medical services (EMS) in Korea using Delphi study targeting emergency medical specialists. METHODS: The Delphi study was conducted four times targeting 24 emergency medical specialists. The first Delphi survey contained five categories as follows: Subjects of charging for 119 EMS, method of charging, strategy of implementation, utilization of fund, measure of quality improvement. In the second and third Delphi surveys, respondents were asked to indicate the level of importance with the questionnaire statements on a Likert scale, ranging from 0 to 5. The final consultation survey collected opinions on the system of charging for 119 EMS. RESULTS: The results from the first three Delphi surveys showed subjects of charging, method of charging, strategy of implementation, utilization of fund, and measure of quality improvement for 119 EMS. The fourth Delphi survey resulted in step 1 (classification of severity), step 2 (scene of accident), and step 3 (classification of severity at hospital). The classification of severity in steps 1 and 2 should be evaluated by first grade emergency medical technicians, and the classification of severity in step 3 should be evaluated by a person notified by the Ministry of Health and Welfare. Non-emergent patients should pay for the charge of 119 EMS to the hospital. CONCLUSION: Delphi study proposed charging for 119 EMS based on three levels of severity. This study suggests that charging for EMS can reduce unnecessary emergency calls and offer proper medical services to emergency patients.
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Humans , Classification , Delphi Technique , Emergencies , Emergency Medical Services , Emergency Medical Technicians , Fees and Charges , Financial Management , Korea , Methods , Quality Improvement , Specialization , Surveys and QuestionnairesABSTRACT
CONTEXT AND OBJECTIVE: Knowledge of socioeconomic impact of attempted suicide may sensitize managers regarding prevention strategies. There are no published data on this in Brazil. The aim here was to describe the direct and indirect costs of care of hospitalized cases of attempted suicide and compare these with the costs of acute coronary syndrome cases. DESIGN AND SETTING: Cost-of-illness study at a public university hospital in Brazil. METHOD: The costs of care of 17 patients hospitalized due to attempted suicide were compared with those of 17 acute coronary syndrome cases at the same hospital, over the same period. The direct costs were the summation of the hospital and out-of-hospital costs resulting from the event, determined from the medical records. The indirect costs were estimated through the human capital lost. The Mann-Whitney test and analysis of covariance (ANCOVA) with transformation adjusted for age were used for comparisons. RESULTS: The average costs per episode of attempted suicide were: direct cost, US$ 6168.65; indirect cost, US$ 688.08; and total cost, US$ 7163.75. Comparative analysis showed a difference between the indirect costs to family members, with significantly higher costs in the attempted suicide group (P = 0.0022). CONCLUSION: The cost of care relating to attempted suicide is high and the indirect cost to family members reinforces the idea that suicidal behavior not only affects the individual but also his social environment. .
CONTEXTO E OBJETIVO: O conhecimento do impacto socioeconômico das tentativas de suicídio pode sensibilizar gestores para programas de prevenção. No Brasil, não há dados publicados a esse respeito. O objetivo foi descrever os custos direto e indireto dos cuidados com as tentativas de suicídio de pacientes internados no hospital de uma universidade pública, e compará-los aos custos de casos de síndrome coronariana aguda. TIPO DE ESTUDO E LOCAL: Estudo de custo de doença em hospital universitário público no Brasil. MÉTODO: Os custos dos cuidados de 17 pacientes hospitalizados por tentativas de suicídio foram comparados aos custos de 17 síndromes coronarianas agudas de pacientes internados no mesmo hospital, no mesmo período. Os custos diretos foram o somatório de custos hospitalares e extra-hospitalares decorrentes do evento, determinados por registro hospitalar. Os custos indiretos foram estimados através da perda de capital humano. Teste de Mann-Whitney e análise da covariância (ANCOVA) com transformação por idade foram utilizados para comparação. RESULTADOS: As médias de custos por episódio de tentativa de suicídio foram: custo direto individual, US$ 6168,65; custo indireto individual, US$ 688,08; e custo total, US$ 7163,75. A análise comparativa indica diferença entre os custos indiretos a familiares dos dois fenômenos, com custos significativamente mais elevados no grupo de tentativas de suicídio (P = 0,0022). CONCLUSÃO: O custo dos cuidados com tentativa de suicídio é elevado e o custo indireto a familiares reforça a ideia de que o comportamento suicida não afeta apenas o indivíduo, mas também seu ambiente social. .
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Adult , Female , Humans , Male , Middle Aged , Cost of Illness , Suicide, Attempted/economics , Acute Coronary Syndrome/economics , Age Factors , Brazil , Health Care Costs , Hospitalization/economics , Hospitals, General/economics , Psychiatric Status Rating Scales , Risk Factors , Sex Factors , Socioeconomic Factors , Statistics, NonparametricABSTRACT
Objective To investigate the factors of hospitalization expense in patients with type 2 diabetes mellitus undergoing non-emergency surgery.Methods A retrospective study included diabetic (109 cases) and control (162 cases) groups.Hospitalization expense and other observation indices were compared between two groups and subgroups.The factors that contribute to hospitalization expense were analyzed with multifactor regression analysis model.Results The median hospitalization expense was 12 014.74 yuan in the diabetic group,1.24 times than that in the control group (P =0.001).Diabetic group has higher American Society of Anesthesiologists (ASA) classification,longer wound healing time,higher postoperative infection rate,and longer hospital stay (P ＜ 0.01).Multifactor analysis revealed that the significant factors that influence the hospitalization expense were ASA classification (β =0.442,P =0.000),postoperative fasting plasma glucose (β =0.204,P =0.020),and postoperative infection (β =0.204,P =0.019).No significant difference was found in postoperative infection rate and hospitalization expense between two groups,when patients had received minimally invasive surgeries (P ＞ 0.05).Conclusions Type 2 diabetes patients have higher hospitalization expense;ASA classification,postoperative fasting plasma glucose,and postoperative infection are the main influence factors.Giving priority to minimally invasive surgeries and enhancing perioperative glucose control can help to reduce hospitalization expense in patients with type 2 diabetes mellitus.
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Objective To investigate the current application status of clinical laboratories in China, including:testing items, the testing amount of each item, total cost of each item and turnaround time ( TAT) of each item.The testing tem with larger proportion of testing amount required better quality control, more financial investment and policy making.Methods Except Tibet and Taiwan, 30 provinceswere included in this investigation.3 grade A tertiary hospitals, 3 tertiary hospitals and 3 secondary hospitals were randomly chosen from every province, and 270 hospitals were enrolled totally.The principals of clinical laboratories of chosen hospitals were contacted by each provincial center of clinical laboratories to complete the online questionnaire.The submitted data was checked by staff of our center and analyzed by Microsoft Excel 2007. The survey information included general information of the hospital, testing menu of the laboratory, test panels , annual test amount, cost, turnaround time, et al.Results All the hospitals enrolled in this investigation had submitted effective results (100%, 270/270).There were 628 single testing item collected in this survey:230 single items were in the field of clinical immunology, which made the biggest proportion (36.62%, 230/628 ); the total amount of testing of clinical chemistry had the biggest proportion (59.97%);the summary amount of the top 100 testing items exceeded 90% of the overall amount; the summary cost of the top 100 testing items exceeded 85% of the overall cost.Conclusions The information collected and analyzed after the survey of testing items of clinical laboratories in China could provide valuable reference information for quality control, financial investment and policy making.
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PURPOSE: This study compared in-hospital mortality within 30 days of admission, lengths of stay, and inpatient charges among patients with heart failure admitted to public and private hospitals in South Korea. MATERIALS AND METHODS: We obtained health insurance claims data for all heart failure inpatients nationwide between November 1, 2011 and May 31, 2012. These data were then matched with hospital-level data, and multi-level regression models were examined. A total of 8406 patients from 253 hospitals, including 31 public hospitals, were analyzed. RESULTS: The in-hospital mortality rate within 30 days of admission was 0.92% greater and the mean length of stay was 1.94 days longer at public hospitals than at private hospitals (mortality: 5.18% and 4.26%, respectively; LOS: 12.08 and 10.14 days, respectively). The inpatient charges were 11.4% lower per case and 24.5% lower per day at public hospitals than at private hospitals. After adjusting for patient- and hospital-level confounders, public hospitals had a 1.62-fold higher in-hospital mortality rate, a 16.5% longer length of stay, and an 11.7% higher inpatient charge per case than private hospitals, although the charges of private hospitals were greater in univariate analysis. CONCLUSION: We recommend that government agencies and policy makers continue to monitor quality of care, lengths of stay in the hospital, and expenditures according to type of hospital ownership to improve healthcare outcomes and reduce spending.
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Aged , Female , Humans , Male , Middle Aged , Heart Failure/economics , Hospital Charges/statistics & numerical data , Hospital Mortality , Hospitalization/economics , Hospitals, Private/economics , Hospitals, Public/economics , Inpatients/statistics & numerical data , Length of Stay/economics , Logistic Models , Multivariate Analysis , Outcome Assessment, Health Care/economics , Patient Discharge/economics , Republic of Korea/epidemiology , Survival Analysis , Time FactorsABSTRACT
PURPOSE: This study compared in-hospital mortality within 30 days of admission, lengths of stay, and inpatient charges among patients with heart failure admitted to public and private hospitals in South Korea. MATERIALS AND METHODS: We obtained health insurance claims data for all heart failure inpatients nationwide between November 1, 2011 and May 31, 2012. These data were then matched with hospital-level data, and multi-level regression models were examined. A total of 8406 patients from 253 hospitals, including 31 public hospitals, were analyzed. RESULTS: The in-hospital mortality rate within 30 days of admission was 0.92% greater and the mean length of stay was 1.94 days longer at public hospitals than at private hospitals (mortality: 5.18% and 4.26%, respectively; LOS: 12.08 and 10.14 days, respectively). The inpatient charges were 11.4% lower per case and 24.5% lower per day at public hospitals than at private hospitals. After adjusting for patient- and hospital-level confounders, public hospitals had a 1.62-fold higher in-hospital mortality rate, a 16.5% longer length of stay, and an 11.7% higher inpatient charge per case than private hospitals, although the charges of private hospitals were greater in univariate analysis. CONCLUSION: We recommend that government agencies and policy makers continue to monitor quality of care, lengths of stay in the hospital, and expenditures according to type of hospital ownership to improve healthcare outcomes and reduce spending.
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Aged , Female , Humans , Male , Middle Aged , Heart Failure/economics , Hospital Charges/statistics & numerical data , Hospital Mortality , Hospitalization/economics , Hospitals, Private/economics , Hospitals, Public/economics , Inpatients/statistics & numerical data , Length of Stay/economics , Logistic Models , Multivariate Analysis , Outcome Assessment, Health Care/economics , Patient Discharge/economics , Republic of Korea/epidemiology , Survival Analysis , Time FactorsABSTRACT
PURPOSE: Aim of this study is to investigate the characteristics and performance of colorectal-anal specialty vs. general hospitals for South Korean inpatients with colorectal-anal diseases, and assesses the short-term designation effect of the government's specialty hospital. MATERIALS AND METHODS: Nationwide all colorectal-anal disease inpatient claims (n=292158) for 2010-2012 were used to investigate length of stay and inpatient charges for surgical and medical procedures in specialty vs. general hospitals. The patients' claim data were matched to hospital data, and multi-level linear mixed models to account for clustering of patients within hospitals were performed. RESULTS: Inpatient charges at colorectal-anal specialty hospitals were 27% greater per case and 92% greater per day than those at small general hospitals, but the average length of stay was 49% shorter. Colorectal-anal specialty hospitals had shorter length of stay and a higher inpatient charges per day for both surgical and medical procedures, but per case charges were not significantly different. A "specialty" designation effect also found that the colorectal-anal specialty hospitals may have consciously attempted to reduce their length of stay and inpatient charges. Both hospital and patient level factors had significant roles in determining length of stay and inpatient charges. CONCLUSION: Colorectal-anal specialty hospitals have shorter length of stay and higher inpatient charges per day than small general hospitals. A "specialty" designation by government influence performance and healthcare spending of hospitals as well. In order to maintain prosperous specialty hospital system, investigation into additional factors that affect performance, such as quality of care and patient satisfaction should be carried out.
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Adult , Aged , Female , Humans , Male , Middle Aged , Anus Diseases/economics , Colonic Diseases/economics , Efficiency, Organizational , Hospital Charges/statistics & numerical data , Hospitals, General/organization & administration , Hospitals, Special/organization & administration , Inpatients/statistics & numerical data , Length of Stay/economics , Outcome Assessment, Health Care/economics , Rectal Diseases/economics , Republic of KoreaABSTRACT
Objective: To analyze the expenditure of the Ministry of Health with osteoporosis treatment in the Brazilian Public Health System (SUS) in 2008-2010 triennium and estimate the influence of demographic, regional and disease related variables on average expenditure per procedures performed. Methods: A cross-sectional, descriptive and analytical study based on secondary data from DATASUS related to procedures for the elderly with a diagnosis of osteoporosis and related fractures. For the statistical analysis and multivariate model, Stata 11.0 was used. Results: According to the findings, 3,252,756 procedures related to the osteoporosis treatment among the elderly were carried out in Brazil during the 2008 - 2010 period, totalizing R$ 288,986,335.15. The age group that most had procedures was 60 - 69 years (46.3%); the population of 80 years or older showed the highest spending per procedure, around R$ 106 million in three years. The women were majority in terms of quantity (95.6%) and expense (76%) of procedures. The average cost per procedure showed a large gap between men and women, nearly 7 times (R$ 480.14 versus R$ 70.85, respectively). The ambulatory care procedures predominated in quantity (96.4%) and the hospital procedures predominated in resources (70.4%). It was found that there is no single standard for groups of procedures when these are analyzed separately. Conclusion: A disaggregated analysis of expenditure by procedures groups extracted from the SUS Management System of the Table of Procedures, Medicines, Orthotics, Prosthetics and Special Materials allowed a detailed overview of federal spending on the osteoporosis treatment in the elderly from Brazil. .
Objetivo: Analisar o dispêndio do Ministério da Saúde com o tratamento de osteoporose no Sistema Único de Saúde (SUS) no triênio 2008-2010 e estimar a influência de variáveis demográficas, regionais e associadas à doença nos gastos médios por procedimentos realizados. Métodos: Estudo transversal, descritivo e analítico com base em dados secundários do DATASUS relacionados a procedimentos para idosos com diagnóstico de osteoporose e de fraturas associadas. Para a análise estatística e para o modelo multivariado, foi utilizado o programa Stata 11.0. Resultados: Foram realizados 3.252.756 procedimentos relacionados ao tratamento de osteoporose em idosos do Brasil no triênio 2008 - 2010, que totalizaram R$ 288.986.335,15. A faixa etária de 60 - 69 anos (46,3%) foi a que mais realizou procedimentos, e a população de 80 ou mais anos foi a que apresentou maior gasto por procedimento, em torno de R$ 106 milhões no triênio. As mulheres foram majoritárias em termos de quantidade (95,6%) e de gastos (76%) com procedimentos. O gasto médio por procedimento apresentou uma grande disparidade entre homens e mulheres, de quase 7 vezes (R$ 480,14 versus R$ 70,85, respectivamente). Os procedimentos ambulatoriais predominaram em quantidade (96,4%) e os hospitalares, em recursos (70,4%). Verificou-se que não há um padrão único para os grupos de procedimentos, quando estes são analisados separadamente. Conclusão: A análise desagregada das despesas por grupos de procedimentos do Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos, Órtese, Prótese e Materiais Especiais do SUS permitiram uma visão mais detalhada dos gastos federais com o tratamento da osteoporose em idosos no Brasil. .
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Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Health Expenditures , Osteoporosis/economics , Osteoporosis/therapy , Brazil , Cross-Sectional Studies , Time FactorsABSTRACT
User fee removal has been put forward as an approach to increasing priority health service utilization, reducing impoverishment, and ultimately reducing maternal and neonatal mortality. However, user fees are a source of facility revenue in many low-income countries, often used for purchasing drugs and supplies and paying incentives to health workers. This paper reviews evidence on the effects of user fee exemptions on maternal health service utilization, service provision, and outcomes, including both supply-side and demand-side effects. We reviewed 19 peer-reviewed research articles addressing user fee exemptions and maternal health services or outcomes published since 1990. Studies were identified through a USAIDcommissioned call for evidence, key word search, and screening process. Teams of reviewers assigned criteria- based quality scores to each paper and prepared structured narrative reviews. The grade of the evidence was found to be relatively weak, mainly from short-term, non-controlled studies. The introduction of user fee exemptions appears to have resulted in increased rates of facility-based deliveries and caesarean sections in some contexts. Impacts on maternal and neonatal mortality have not been conclusively demonstrated; exemptions for delivery care may contribute to modest reductions in institutional maternal mortality but the evidence is very weak. User fee exemptions were found to have negative, neutral, or inconclusive effects on availability of inputs, provider motivation, and quality of services. The extent to which user fee revenue lost by facilities is replaced can directly affect service provision and may have unintended consequences for provider motivation. Few studies have looked at the equity effects of fee removal, despite clear evidence that fees disproportionately burden the poor. This review highlights potential and documented benefits (increased use of maternity services) as well as risks (decreased provider motivation and quality) of user fee exemption policies for maternal health services. Governments should link user fee exemption policies with the replacement of lost revenue for facilities as well as broader health system improvements, including facility upgrades, ensured supply of needed inputs, and improved human resources for health. Removing user fees may increase uptake but will not reduce mortality proportionally if the quality of facility-based care is poor. More rigorous evaluations of both demand- and supply-side effects of mature fee exemption programmes are needed.
ABSTRACT
In order to implement the spirit of the document awarded by the three ministries,promote the medical reform process of public hospital,promote the heahhy development of the laboratory medicine,this paper expounds the significance of the study and implementation of the file,and puts forward several ideas.
ABSTRACT
PURPOSE: The purpose of this study was to develop a resource-based relative value scale (RBRVS) and its conversion factor for advanced nursing practices carried out by critical care nurse practitioners (CCNP) in intensive care units. METHODS: The methodology was developed by calculating CCNP's RBRVS for 32 advanced nursing services based on CCNP's workload and time spent in the context of national health insurance. A cost analysis was performed to estimate the conversion factor of CCNP's RBRVS. The share of CCNP's contribution to fee-for-service in intensive care units was also analyzed. RESULTS: Calculation of the RBRVS of 32 advanced nursing practices showed a range of points from 100.0 to 1,181.4 and an average of 296.1 points. The relevant conversion factor for advanced nursing practices in CCNP were estimated at 37.3-48.4 won. The contribution rate of CCNP's advanced nursing practices in the relative value scale of the national health insurance was estimated at 0.1-31.3%. CONCLUSION: Measuring the economic value of advanced nursing services will be a basis for esta-blishing a reimbursement system for CCNP's practices and thus encourage a social demand for advanced nurse practitioners.
Subject(s)
Adult , Humans , Advanced Practice Nursing/economics , Costs and Cost Analysis , Intensive Care Units , National Health Programs , Nurse Practitioners/economics , Relative Value Scales , WorkloadABSTRACT
Objective: The objective of this study was to evaluate the cost-effectiveness ratios and the economic burden of oral care in the public health service from both the service and the society´s perspective. Method: Longitudinal data were collected from 7.825 patients treated by 13 dentists and two hygienists during one year. The completed treatment was considered the outcome. All costs were included, such as overhead, capital and operational costs. Two cost components were taken into account: cost opportunity and depreciation. Furthermore, the refresh rate of the initial capital was calculated and a sensitivity analysis was done. Results: From the perspective of service, the best cost-effectiveness ratios were for emergencies in all specialties ($10.99 to $12.98), followed by prevention, operative dentistry, endodontics and prosthesis. From the perspective of society, the best cost-effectiveness ratios were for emergencies in all specialties ($1.43 to $2.31), followed by endodontics, prevention, prosthesis and operative dentistry. Conclusion: Priority differs both from the perspective of service and of society. From the perspective of service, the costs for elective care, including prevention, were close to the costs seen in high-income countries. From the perspective of society, the cost-effectiveness ratios for prevention in a clinical setting were unfavorable to be recommended for low-income populations. The perspective of society is an essential approach for decision-makers who need to allocate their resources.
Objetivo: Avaliar a razão de custo-efetividade e o peso econômico dos cuidados com saúde bucal na área pública, sob a perspectiva do serviço odontológico e da sociedade. Métodos: Foram coletados dados de 7.825 pacientes tratados por 13 dentistas e 2 higienistas, durante o ano de 2004, em Sabará, Minas Gerais. O tratamento completado foi considerado como desfecho. Foram levantados custos de capital e custos operacionais. Dois componentes foram considerados: custo-oportunidade e depreciação. Além disso, foi calculada uma taxa de atualização do capital inicial e realizada uma análise de sensibilidade. Resultados: Sob a perspectiva do serviço odontológico a melhor razão de custo- efetividade foi a consulta de emergência em todas as especialidades ($10,99 para $12,98), seguida por prevenção, dentística, endodontia e prótese. Sob o ponto de vista da sociedade a melhor razão de custo-efetividade foi a consulta de emergência para todas as especialidades ($1,43 para $2,31), seguida de endodontia, prevenção, prótese e dentística. Conclusão: A prioridade difere dependendo da perspectiva da sociedade ou do serviço. Para o serviço, os custos dos cuidados eletivos, incluindo prevenção foram muito próximos dos custos de países de alta renda. Sob a perspectiva da sociedade, a razão de custo-efetividade para prevenção em ambiente clínico foi desfavorável para ser recomendado para uma população de baixa renda. A perspectiva da sociedade constitui-se numa abordagem essencial para tomadores de decisão que necessitam alocar seus recursos financeiros.