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BACKGROUND:Clinical use of vascular stents involves high medical costs,but it may also bring long-term benefits in reducing cardiovascular events and improving the quality of life in patients.Economics evaluation can help decision makers better understand the balance between the cost and benefit of treatment. OBJECTIVE:To analyze the related articles of health economics and discuss the hot spots in the study of the effect and problems of vascular stents in medical quality management. METHODS:The articles concerning health economics evaluation of vascular stents were retrieved from the core set of the Web of Science.The VOSviewer_1.6.19 software was used to make a visualization analysis of the annual publication volume,institutions,countries,keywords,etc.Finally,the research hot spots on the effects and problems of vascular stents were analyzed from the perspective of health economics and medical quality management. RESULTS AND CONCLUSION:(1)120 articles in English were finally included.In the past 10 years,the highest number of articles published in this field was in 2019,with 10 articles.The institution with the largest number of articles published was Harvard University in the United States with 20 articles,and the country with the largest number of articles published was the United States with 58 articles.(2)Keyword cluster analysis demonstrated that the cost-effectiveness analysis of bare metal stents and drug-eluting stents in coronary disease,the cost-effectiveness analysis of angioplasty stent intervention,and the effect of coronary stents in percutaneous coronary intervention are the research hot spots in the field of health economics evaluation of vascular stent research.(3)In the context of medical quality management,the paper further summarized the research hot spots on the therapeutic effect of vascular stents as follows:long-term effect of vascular stents,safety,drug release mechanism research,personalized therapy,restenosis problems,and stent insertion technology.(4)The results of highly cited literature analysis exhibited that drug-eluting stents release drugs to reduce the risk of vascular restenosis,and the restenosis rate is lower than that of bare metal stents,but the cost is usually higher.Biodegradable stents combine the advantages of bare metal stents and drug-eluting stents,that is,avoiding long-term stent existence and reducing the risk of restenosis,but their cost may be higher,and there may be some complications in the short term,and they are not widely used at present.(5)In addition to the direct stent cost,factors that need to be considered when comparing the cost-effectiveness of vascular stents include the risk and cost of stent re-intervention,the risk and cost of complications,the duration and cost of drug therapy,and the quality of life of patients.Therefore,while the initial cost of drug-eluting and biodegradable stents may be higher than bare metal stents,they may lead to better clinical outcomes in the long term,resulting in a more favorable cost effect.(6)Future research directions should focus on making personalized vascular stent treatment decisions,observing the long-term effect of stent treatment,the impact of the stent on patients'quality of life,formulating health policies,rational allocation of medical resources,and the establishment of long-term follow-up mechanisms.
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Objective:To acquire the implementation effect of the neonatal Phenylketonuria(PKU)Screening Project in Dong-guan,and evaluate its economic effectiveness,so as to provide references for the prevention and control policies of genetic defects in newborns.Methods:Choosing PKU children born in Dongguan from January 2012 to December 2021(excluding BH4 deficien-cy)as the subjects,conduct the cost-benefit and cost-effectiveness analysis on the prevention and treatment of PKU.The relevant data was gained from questionnaire surveys,statistical data,medical service prices of non-profit medical institutions in Dongguan,and relevant literature materials.Results:In the past 10 years,1 245 243 newboms were screened for PKU in Dongguan,the average screening rate is 93.32%.Among them,29 were diagnosed with PKU,with a positive rate of 1:42939.During continuous follow-up,23 cases were diagnosed.Among the 23 follow-up cases,only 1 had intelligence at the critical value,while the rest were normal.The total cost of screening is 29.728 7 million,and the total benefit is 14.239 9 million.The cost-effectiveness ratio is 102.51:1,the cost-benefit ratio is 1:4.79.Conclusion:Neonatal phenylketonuria(PKU)screening in Dongguan has significant social and economic benefits.It's necessary to continue and improve the screening work,especially the policy which can benefit the PKU's full life.
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Objective To investigate the current application of the EQ-5D in health economics research in the field of traditional Chinese medicine(TCM).Methods PubMed,Embase,CNKI,CBM and Wanfang databases were systematically searched.The clinical research literature in the field of TCM such as'Chinese medicine','tuina'and'acupuncture'containing EQ-5D analysis was included.The Excel spreadsheet was used for data extraction,and the extracted information including title,publication year,author,institution,country,conflicts of interest(declaration or involvement of enterprise),study type,participants,interventions,outcomes,research perspectives and measurement methods.The Quality of Health Economic Studies(QHES)was used to evaluate the methodological quality of the included literature.SPSS 18.0 software was used for descriptive analysis of the extracted data.Results A total of 52 articles were included,and the study design was mainly based on randomized controlled trials.The application of EQ-5D-5L was less than that of EQ-5D-3L.Most of the literature used utility value and quality-adjusted life years(QALYs)for cost-utility analysis(CUA).EQ-5D was widely used in the study of musculoskeletal diseases,and Chinese patent medicine and acupuncture were the most commonly used interventions.Chinese patent medicine was used in most systemic diseases,but it was mainly used in musculoskeletal system diseases,which was equivalent to the proportion of massage application.Acupuncture was the most widely used intervention in musculoskeletal diseases,followed by the application of pain diseases.According to the QHES evaluation criteria,the average score of the 37 articles with full text was 73.49.Among them,20 articles were of high quality,14 articles were of general quality,and 3 articles were of low quality.The quality of the research was generally acceptable,but there were problems such as unreasonable or unreported research time limit selection,research result interpretation,conflict of interest,research perspective,utility value and QALYs evaluation.No conflict of interest statement was made in all the studies involving enterprises.Conclusion The application of EQ-5D in the evaluation of health economics in TCM is less,and the quality of literature still needs to be improved.There is still much room for research and application of EQ-5D in this field.
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ABSTRACT BACKGROUND: The impact of metabolic syndrome (MetS) on healthcare costs remains unclear in the literature. OBJECTIVES: To determine the impact of MetS on primary healthcare costs of adults, as well as to identify the impact of physical activity and other covariates on this phenomenon. DESIGN AND SETTING: This cross-sectional study was conducted in the city of Presidente Prudente, State of São Paulo/Brazil, in 2016. METHODS: The sample comprised 159 older adults (> 50 years) of both sexes (110 women) who were identified from their medical records in the Brazilian National Health Service. Healthcare costs (US$) were assessed through medical records and divided into medical consultations, medications, laboratory tests, and total costs. MetS was assessed using medical records. RESULTS: The Brazilian National Health Service spent more on consultations (US$ 22.75 versus US$ 19.39; + 17.3%) and medication (US$ 19.65 versus US$ 8.32; + 136.1%) among adults with MetS than among those without MetS, but the costs for laboratory tests were similar (P = 0.343). Total costs were 53.9% higher in adults with MetS than in those without the diagnosis of the disease (P = 0.001). Regarding total costs, there was an increase of US$ 38.97 when five components of MetS were present (P = 0.015), representing an increase of approximately 700%, even after adjusting for sex, age, and physical activity. CONCLUSION: In conclusion, the presence of the MetS is responsible for increasing primary care costs among older adults, especially in those related to medicines.
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Antecedentes: El departamento del Cauca en Colombia es multiétnico, multicultural y biodiverso, también con grandes diferencias en bajo peso al nacer (BPN), mortalidad perinatal y mortalidad neonatal tardía entre municipios. Objetivo: Determinar la relación de costo-efectividad del control prenatal (CPN) cuando ha tenido buena calidad frente al que ha tenido calidad deficiente con respecto al BPN en el departamento del Cauca entre 2018 y 2020. Método: Evaluación económica con diseño epidemiológico de una cohorte histórica desde la perspectiva de la institución pagadora. Se calculó la razón incremental de costo-efectividad (RICE), análisis de sensibilidad e impacto presupuestal. Resultados: La incidencia de BPN fue del 8,3% (348/4182). La calidad deficiente en el CPN incrementó el riesgo de BPN (OR: 3,38; IC95%: 1,05-8,2) y la buena calidad tuvo una mejor relación de costo-efectividad (RICE: USD 2727,75), con posición dominante frente a la calidad deficiente (6,14 veces el PIB per cápita de ahorro) y con un impacto presupuestal de USD 2.904.392. Conclusiones: La buena calidad del CPN en el departamento del Cauca durante 2018-2020 fue costo-efectiva y dominante por ser de menor costo y mayor efectividad.
Background: The department of Cauca in Colombia is multiethnic, multicultural, and biodiverse, also with large differences in low birth weight (LBW), perinatal mortality, and late neonatal mortality among municipalities. Objective: To determine the cost-effectiveness relationship of antenatal care (ANC) when it has had good quality compared to that which has had poor quality with respect to low birth weight in the department of Cauca between 2018 and 2019. Method: Economic evaluation with epidemiological cohort design historical from the perspective of the payer institution. Incremental cost-effectiveness ratio (RICE), sensitivity analysis, and budgetary impact were calculated. Results: The incidence of LBW was 8.3% (348/4182). Poor quality in ANC increased the risk of LBW (OR: 3.38; CI95%: 1.05-8.2), good quality had a better cost-effectiveness ratio (RICE: USD 2727.75), with dominant position against poor quality (6.14 times the GDP/capita savings) with a budgetary impact of USD 2,904,392. Conclusions: The good quality of the ANC in the department of Cauca during 2018-2020 was cost-effective and dominant because it is lower cost and more effective.
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Humans , Female , Pregnancy , Infant, Newborn , Prenatal Care/economics , Infant, Low Birth Weight , Retrospective Studies , Health Care Costs , Cost-Benefit AnalysisABSTRACT
Objetivo: Identificar estudos sobre políticas públicas, ações de saúde e análises econômicas relacionados aos distúrbios de sono no Brasil e discutir os seus resultados para o sistema de saúde, gestores de políticas públicas e a sociedade. Métodos: Revisão integrativa da literatura nas bases de dados Lilacs (via BVS), SciELO e PubMed (via Medline), incluindo estudos publicados nos idiomas português, inglês e espanhol, entre os anos de 1960-2023; foram excluídos estudos que não apresentaram a perspectiva brasileira ou aqueles cuja versão integral não estava disponível (seja gratuitamente ou na versão paga). Resultados: A busca retornou 536 resultados, dos quais apenas dois atendiam aos critérios de inclusão e mais cinco trabalhos foram incluídos manualmente, após consulta com especialistas de sono (todos abordaram apneia obstrutiva do sono, sendo: um relato sobre alteração na legislação de trânsito focada em prevenção de acidentes por sonolência excessiva; uma revisão de escopo sobre análises de custo-efetividade do tratamento da doença com uso de CPAP; dois relatos sobre linha de cuidado em um município e outros três em Secretarias Estaduais de Saúde). Conclusões: A revisão integrativa encontrou poucas evidências acerca do tema e aponta para a necessidade de futuros estudos que visem a suprir essa lacuna científica e de que seja necessário o desenvolvimento de futura linha de cuidado que amplie o acesso ao tratamento de doenças do sono no Sistema Único de Saúde.
Objective: To identify studies on public policies, health actions, and economic analyses related to sleep disorders in Brazil and discuss their results for public policy managers and society. Methods: Integrative literature review using Lilacs (via BVS), SciELO, and PubMed (via Medline) databases, including studies published in Portuguese, English, and Spanish languages, between years of 1960-2023; studies that did not present the Brazilian perspective or whose full version was not available were excluded (free or paid version). Results: The search returned 536 results, of which only two met the inclusion criteria, and five more studies were included manually after consulting sleep experts (all addressing obstructive sleep apnea, namely: a report on changes in traffic legislation focused on preventing accidents caused by excessive sleepiness; a scoping review on cost-effectiveness analysis of CPAP for sleep apnea treatment; two reports on care lines in one municipality and another three in State Secretariats). Conclusions: The integrative review found few evidences on the topic and points to the need for future studies aimed at filling this scientific gap and the development of a care line that expands access to sleep disorder treatment in Brazilian Public Health System.
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Public Health , Sleep Apnea, Obstructive , Sleep Disorders, Intrinsic , Health Care Economics and Organizations , Disorders of Excessive SomnolenceABSTRACT
INTRODUCCIÓN: Frente al fuerte incremento del gasto en salud, es necesario indagar si ha venido acompañado de aumentos proporcionales en la producción de atenciones de salud dirigidas a los beneficiarios del Fondo Nacional de Salud. MÉTODOS: En esta investigación observacional, descriptiva y longitudinal retrospectiva estimamos la eficiencia técnica del Sistema Nacional de Servicios de Salud a través del costo medio de producción y la productividad media del trabajo en el periodo de 2010 a 2019. RESULTADOS: Durante la década estudiada, la producción ha aumentado en torno al 6% anual; la dotación de trabajadores aumentó (mayormente en el estamento médico) 61%; el gasto en remuneraciones aumentó 106% real; el gasto en bienes y servicios de consumo ha aumentado 25% real; la eficiencia del gasto ha disminuido 21% y la productividad es el elemento menos dinámico del sistema con 0,6% de crecimiento medio anual. Tras sustraer el componente de exámenes diagnósticos, el escenario empeora. CONCLUSIONES: Los resultados muestran que el mayor gasto en salud no ha venido aparejado de aumentos proporcionales en producción, traduciéndose en una caída en la eficiencia del gasto sanitario y aumentos magros o caídas en productividad, según cómo se mida la producción. Esto hace que la estrategia de crecimiento del sector público dependa principalmente de aumentos en la dotación de trabajadores. Esta baja productividad constituye una limitante seria para mejorar el acceso de los beneficiarios del Fondo Nacional de Salud a las atenciones de salud y contribuye a incrementar las listas de espera. Especial atención debiera brindarse a los costos medios de producción y a la productividad media del trabajo en un escenario de menor dinamismo en el crecimiento del gasto público en salud y de reforma del sistema de salud.
INTRODUCTION: In view of the strong increase in health expenditure, it is necessary to investigate whether proportional increases in healthcare production for the beneficiaries of the National Health Fund have corresponded to this increase. METHODS: In this observational, descriptive, and retrospective longitudinal research, we estimate the technical efficiency of the National Health Services System through the average cost of production and average labor productivity in the period from 2010 to 2019. RESULTS: During the studied decade, production has increased by approximately 6% annually; the number of workers increased (mostly physicians) by 61%; spending on salaries increased by 106% in real terms; spending on consumer goods and services has increased by 25% in real terms; the efficiency of spending has decreased by 21%, and productivity is the least dynamic element of the system with an average annual growth rate of 0.6%. After subtracting the diagnostic tests component, this scenario worsens. CONCLUSIONS: The results show that higher health expenditure has not been matched by commensurate increases in output, translating into a fall in the efficiency of healthcare expenditure and meager increases or falls in productivity, depending on how the output is measured. This means that the public sector's growth strategy depends mainly on increases in the number of workers. This low productivity is a serious constraint to improving healthcare access for National Health Fund beneficiaries and contributes to increasing waiting lists. Special attention should be paid to average production costs and average labor productivity in a scenario of less dynamic growth in public health spending and health system reform.
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Humans , Public Health , Health Expenditures , Chile , Retrospective Studies , Health Services AccessibilityABSTRACT
The aim of this study was to explore the optimal timing of holmium laser enucleation of the prostate (HoLEP) in patients presenting benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). A retrospective analysis was conducted based on the perioperative and postoperative outcome data of 1212 patients who underwent HoLEP in Shanghai Ninth People's Hospital (Shanghai, China) between January 2009 and December 2018. According to the preoperative International Prostate Symptom Score (IPSS), all patients whom we analyzed were divided into Group A (IPSS of 8-18) and Group B (IPSS of 19-35). Peri- and postoperative outcome data were obtained during the 1-year follow-up. IPSS changes were the main postoperative outcomes. The postoperative IPSS, quality of life, peak urinary flow rate, postvoid residual, and overactive bladder symptom score (OABSS) improved significantly. The IPSS improved further in the group with severe LUTS symptoms, but the postoperative IPSS was still higher than that in the moderate LUTS group. OABSSs showing moderate and severe cases after follow-up were more frequent in Group B (9.1%) than in Group A (5.2%) (P < 0.05). There were no significant intergroup differences in the intraoperative American Society of Anesthesiologists or hospitalization expense scores, and the medication costs, as well as the total costs, were significantly higher in Group B. In this retrospective study, HoLEP was an effective treatment for symptomatic BPH. For patients with LUTS, earlier surgery in patients with moderate severity may result in a marginally better 12-month IPSS than that in men with severe symptoms.
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Male , Humans , Retrospective Studies , Prostatic Hyperplasia/surgery , Follow-Up Studies , Holmium , Quality of Life , China , Treatment Outcome , Lower Urinary Tract Symptoms/surgery , Laser Therapy , Lasers, Solid-State/therapeutic useABSTRACT
Objective To evaluate the effect of clinical pharmacists participating in the treatment of hospitalized patients with diabetic foot by antibiotics management index and health economics index. Methods 40 hospitalized patients with diabetic foot of Wagner Grade 4 in the Endocrine Department of Air Force Medical Center from April to September 2017 were selected as control group, and 40 hospitalized patients with diabetic foot of Wagner Grade 4 in the Endocrine Department from April to September 2019 were selected as interventional group. No clinical pharmacists were involved in drug treatment of patients in the control group, while the clinical pharmacists in the interventional group participated in drug treatment, and implemented antimicrobial stewardship, medication reconciliation, pharmaceutical care and medication education. Antibiotics management indexes (use intensity of antibiotics, use rate of special class antibiotics) and health economics indexes (medicine expenses, hospitalization expenses) of the two groups were compared. Results The efficacy of the two groups was similar. The use intensity of antibiotics and use rate of special class antibiotics of the interventional group in which clinical pharmacists participated were significantly lower than the control group (P<0.01), so were the medicine expenses and hospitalization expenses (P<0.01). Conclusion Clinical pharmacists participating in the treatment of hospitalized patients with diabetic foot could reduce antibiotics administration index and health economics index, promote rational medicine use and save medical expenses.
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Resumo: Este artigo analisa o processo de transformação estrutural no mercado privado de serviços de saúde brasileiro a partir dos anos 2000, com ênfase na crescente participação de fundos financeiros e do capital estrangeiro no processo de expansão e consolidação do setor. A análise do movimento de ingresso do capital estrangeiro nos serviços e planos de saúde no Brasil foi desenvolvida a partir da construção de uma base dados com um total de 297 operações patrimoniais envolvendo empresas com atividades em serviços de saúde, inclusive operadoras de planos e seguros de saúde e administradoras de benefícios em saúde. A análise dessas operações evidencia que o afluxo de capital estrangeiro foi fundamental para viabilizar a centralização de capital em determinadas empresas e catalisar o processo de concentração e transformação estrutural do setor de serviços de saúde ao longo das últimas duas décadas. Conclui-se que o acirramento da disputa intercapitalista no mercado de serviços de saúde levou à emergência de grandes corporações no mercado e a novos modelos de negócio, com destaque especial para o surgimento de redes verticalizadas de atendimento (operação de planos, serviços hospitalares, ambulatoriais, de diagnóstico e tratamento e de atenção básica).
Abstract: This article analyzes the process of structural transformation within the Brazilian private health services market since the 2000s, with emphasis on the growing participation of financial funds and foreign capital in the process of expansion and consolidation of the sector. The analysis of the movement of foreign capital into health services and plans in Brazil was developed from the construction of a database with a total of 297 equity operations involving companies with activities in health services, including companies operating health plans and insurance and companies administering health benefits. The analysis of these operations shows that the influx of foreign capital was fundamental to enable the centralization of capital in certain companies and catalyze the process of concentration and structural transformation of the health services sector over the last two decades. We concluded that the intensification of the intercapitalist dispute within the health services market led to the emergence of large corporations and new business models, with special emphasis on the emergence of verticalized care networks (operation of plans, hospital services, outpatient services, diagnosis and treatment, and primary care).
Resumen: Este artículo analiza el proceso de transformación estructural en el mercado privado de servicios de salud brasileño, a partir de los años 2000, con énfasis en la creciente participación de fondos financieros y del capital extranjero en el proceso de expansión y consolidación del sector. El análisis del movimiento de ingreso del capital extranjero en los servicios y planes de salud en Brasil fue desarrollado a partir de la construcción de una base datos con un total de 297 operaciones de capital de empresas con actividades en servicios de salud; inclusive las empresas operadoras de planes y seguros de salud y las empresas administradoras de beneficios en salud. El análisis de esas operaciones muestra que la entrada de capital extranjero fue fundamental para viabilizar la centralización de capital en determinadas empresas y catalizar el proceso de concentración y transformación estructural del sector de servicios de salud a lo largo de las últimas dos décadas. La conclusión que el recrudecimiento de la disputa intercapitalista dentro del mercado de servicios de salud llevó a la emergencia de grandes corporaciones en el mercado y nuevos modelos de negocio, con destaque especial para surgimiento de redes verticalizadas de atención (operación de planes, servicios hospitalarios, ambulatorios, de diagnóstico y tratamiento y de atención básica).
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RESUMEN Objetivo Analizar el efecto del envejecimiento de la población y las enfermedades no trasmisibles sobre las finanzas públicas, en Honduras, Nicaragua, Costa Rica, Chile y Uruguay. Materiales y Métodos Se realizó un estudio descriptivo de corte transversal no experimental. Se utilizaron datos de las variables gasto público en salud como porcentaje del producto interno bruto, esperanza de vida del nacer, tasa de mortalidad del menor de cinco años, tasa de mortalidad por enfermedades trasmisibles y tasa de mortalidad por enfermedades no trasmisibles, obtenidos del 2000 al 2016. Se aplicó un modelo econométrico de vectores autorregresivos bayesianos, que superó las diferentes pruebas para probar su robustez, estabilidad, ausencia de tendencias, especificidad y nivel de significancia menor del 5 %. Resultados La tasa de mortalidad por enfermedades no trasmisibles tuvo una mayor incidencia en los países de bajos ingresos, lo cual se atribuyó al acelerado envejecimiento de la población. Esta situación generará una mayor demanda en los presupuestos nacionales, los cuales son limitados en estos países para la atención en salud. Conclusiones Los hallazgos resaltan la importancia de orientar las políticas públicas de salud hacia la prevención de las enfermedades no trasmisibles, especialmente en los países con recursos limitados. Es fundamental la búsqueda del espacio fiscal para financiar las actividades para el abordaje de los factores de riesgo potencialmente modificables de las enfermedades no trasmisibles para garantizar el derecho a la salud y mejorar la calidad de vida de las personas de mayor edad.
ABSTRACT Objective This study aims to analyze the effect of population aging and non-communicable diseases on public finances in Honduras, Nicaragua, Costa Rica, Chile, and Uruguay. Materials and Methods A descriptive cross-sectional study was conducted using non-experimental data. Variables such as Public Health Expenditure as a percentage of Gross Domestic Product, Life Expectancy at Birth, Under-Five Mortality Rate, Mortality Rate from Communicable Diseases, and Mortality Rate from Non-Communicable Diseases were collected from 2000 to 2016. A Bayesian Vector Autoregressive (BVAR) econometric model was applied, which passed various tests to ensure its robustness, stability, absence of trends, specificity, and a significance level below 5 °%. Results The results indicated that the mortality rate from non-communicable diseases had a greater impact in low-income countries, which was attributed to accelerated population aging. This situation will result in a heightened demand for healthcare services, placing additional strain on the limited national budgets allocated for healthcare provision in these countries. Conclusions The findings highlight the importance of directing public health policies towards the prevention of non-communicable diseases, particularly in countries with limited resources. It is crucial to find fiscal space to finance activities aimed at addressing potentially modifiable risk factors for non-communicable diseases, to ensure the right to health and improve the quality of life for the elderly population.
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Purpose: Currently, there are an estimated 4.95 million blind persons and 70 million vision impaired persons in India, out of which 0.24 million are blind children. Early detection and treatment of the leading causes of blindness such as cataract are important in reducing the prevalence of blindness and vision impairment. There are significant developments in the field of blindness prevention, management, and control since the “Vision 2020: The right to sight” initiative. Very few studies have analyzed the cost of blindness at the population level. This study was undertaken to update the information on the economic burden of blindness and visual impairment in India based on the prevalence of blindness in India. We used secondary and publicly available data and a few assumptions for our estimations. Methods: We used gross national income (GNI), disability weights, and loss of productivity metrics to calculate the economic burden of blindness and vision impairment based on the “cost of illness” methodology. Results: The estimated net loss of GNI due to blindness in India is INR 845 billion (Int$ 38.4 billion), with a per capita loss of GNI per blind person of INR 170,624 (Int$ 7,756). The cumulative loss of GNI due to avoidable blindness in India is INR 11,778.6 billion (Int$ 535 billion). The cumulative loss of GNI due to blindness increased almost three times in the past two decades. The potential loss of productivity due to vision impairment is INR 646 billion (Int$ 29.4 billion). Conclusion: These estimates provide adequate information for budgetary allocation and will help advocate the need for accelerated adoption of all four strategies of integrated people?centered eye care (IPCEC). Early detection and treatment of blindness, especially among children, is very important in reducing the economic burden; thus, there is a need for integrating primary eye care horizontally with all levels of primary healthcare
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Introduction: Community pharmacy is a place under the direct supervision of the pharmacist where the prescription orders are compounded and dispensed. In India, there are limited studies published on the economic evaluation of community pharmacy. This study aimed to conduct a cost analysis of outpatient department prescriptions in the community pharmacies during the coronavirus disease-2019 pandemic on various parameters such as the total cost, average cost/prescriptions, age-wise cost, prescribers, drug class, pharmacy wise, route of administration, and diagnosis cost. Material and Methods: The analysis of total and average cost per prescription was conducted. The study was carried out for 6 months during. The number and type of drugs prescribed and the frequency and total cost of the prescriptions were noted. Statistical analysis was conducted for different demographics and various parameters. Results: A total of 1166 prescriptions were analyzed in the study. Out of 3704 drugs prescribed 99.9% were branded ones. The average number of drugs/prescriptions was 3.17. The predominance of male patients (60%) was seen. On the overall cost of prescriptions the statistical significance of the overall cost was established at (P < 0.00001). The sum of all the prescriptions accounted for ?.10, 86,504.65. The average cost/prescription was ?.931.82. Conclusion: The average total cost/prescription was found to be higher in our study. There is a need for further studies to be done in the field of community pharmacy
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RESUMO O objetivo deste artigo é o de analisar o financiamento federal do Sistema Único de Saúde (SUS) para o enfrentamento da pandemia da Covid-19 em 2020 e durante o primeiro quadrimestre de 2021 - períodos caracterizados como da primeira e da segunda ondas. Realizou-se pesquisa documental com levantamento de dados disponíveis em sítios eletrônicos oficiais. A pandemia se instalou no Brasil em fevereiro de 2020, no contexto do subfinanciamento crônico do SUS, que se aprofundou com o estrangulamento de dotações verificado a partir da Emenda Constitucional 95/2016, que definiu o teto das despesas primárias e o congelamento do piso federal do SUS até 2036, no mesmo valor do piso de 2017. Essa medida constitucional viabilizou o aprofundamento da política de austeridade fiscal pela via da redução das despesas primárias e da dívida pública em relação ao Produto Interno Bruto. Tais objetivos condicionaram também o financiamento federal para o combate à pandemia da Covid-19 em 2020 e 2021, cuja execução orçamentária e financeira pode ser caracterizada como reativa e retardatária. Essa forma de execução comprometeu o atendimento das necessidades de saúde da população, além de prejudicar a gestão do SUS nas esferas de governo subnacionais.
ABSTRACT The purpose of this article is to analyze the federal funding of the Unified Health System (SUS) to fight the COVID-19 pandemic in 2020 and during the first four months of 2021 - periods characterized as the first and second waves. Documentary research was carried out, with data available on official websites. The pandemic took hold in Brazil in February 2020, in the context of the chronic underfunding of SUS, which deepened with the strangulation of appropriations verified from the Constitutional Amendment 95/2016, which defined the ceiling on primary expenditure and the freezing of the federal floor of SUS until 2036, at the same value as the 2017 floor. This constitutional measure made it possible to deepen the fiscal austerity policy by reducing primary expenditure and public debt in relation to the Gross Domestic Product. These goals also conditioned federal funding to combat the COVID-19 pandemic in 2020 and 2021, whose budget and financial execution can be characterized as reactive and delayed. This form of execution compromised meeting the health needs of the population, in addition to harming the management of SUS in subnational government spheres.
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RESUMEN Introducción. La enfermedad isquémica del corazón (EIC) es actualmente un problema de salud pública en el Perú, y su tratamiento tiende a ser muy costoso para el sistema de salud. Objetivo. Establecer los patrones de costos de atención de las EIC en el Instituto Nacional Cardiovascular (INCOR) de la Seguridad Social en Salud del Perú (EsSalud). Métodos. Se utilizaron las bases de datos de atenciones, cirugías, egresos y valor bruto de la producción del INCOR de la población diagnosticada y atendida con EIC en el año 2019 (879 pacientes). Se estimaron los costos de las atenciones mediante costeo basado en actividad; se utilizó un modelo econométrico para establecer los determinantes de los costos, y con el método de distancia euclidiana se formaron "clústeres" con características similares para establecer patrones de costos. Resultados. El costo de atención de EIC más alto fue de 148 567 soles (US$ 44 830) para un paciente con 40 días de estancia. Fueron principales determinantes del costo de la atención la estancia hospitalaria y el número de ingresos al establecimiento. Se identificó que los "clúster" que tuvieron un costo mayor, fueron pacientes con edad de 70 y 72 años como mediana, con altos número de días de estancia y con alguna cirugía de alta complejidad. Conclusión. Los patrones de costos de la atención de la EIC estuvieron asociados a la estancia y los reingresos al establecimiento de salud. Los "clústers" con mayor costo estuvieron relacionados a la edad y complejidad de la cirugía.
ABSTRACT Introduction. Ischemic heart disease (IHD) is currently a public health problem in Peru, and its treatment tends to be very expensive for the health system. Goal. Establish the patterns of care costs of the EIC in the National Cardiovascular Institute (INCOR) of the Social Security in Health of Peru (EsSalud). Methods. The databases of care, surgeries, discharges and gross value of INCOR production of the population diagnosed and treated with IHD in 2019 (879 patients) were used. Costs of care were estimated using activity-based costing; an econometric model was used to establish the determinants of costs, and with the Euclidean distance method, "clusters" with similar characteristics were formed to establish cost patterns. Results. The highest cost of EIC care was 148 567 soles (US$ 44 830) for a patient with a 40-day stay. The main determinants of the cost of care were the hospital stay and the number of admissions to the establishment. It was identified that the "clusters" that had a higher cost were patients with a median age of 70 and 72 years, with a high number of days of stay and with some highly complex surgery. Conclusion. Cost patterns for IHD care were associated with length of stay and readmissions to the health facility. The "clusters" with the highest cost were related to age and complexity of the surgery.
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Objetivo Evaluar el impacto del embarazo en mujeres con una alta carga de enfermedad, especialmente con enfermedades crónicas no transmisibles (ECNT) en los costos de una aseguradora de salud. Materiales y Métodos Estudio de costos retrospectivos realizado en Famisanar EPS entre 2016 y 2018. Utilizamos múltiples modelos de regresión lineal para evaluar; los costos generales se calcularon para cada paciente. La perspectiva de la aseguradora fue considerada para el análisis. Resultados El universo de estudio estuvo conformado por 458 249 mujeres en edad fértil afiliadas a Famisanar EPS entre los 15 y 49 años, de las cuales 24 030 (5,2%) mujeres tienen alguna relación con el ECNT. De ellas, 2454 (10,2%) fueron al parto y cesárea. Habíamos determinado los costos del embarazo en mujeres sanas en USD 200,41 y el embarazo en mujeres con ECNT USD 519,95 (97,5%) en términos de los costos de las complicaciones en la atención de gestación. Mediante la regresión multinomial, comparamos los embarazos de ECNT con los otros grupos de mujeres. No observamos diferencias significativas en zona e ingresos, observamos diferencias significativas en la edad. Conclusión El ECNT preexistente en mujeres embarazadas puede conducir al uso de recursos adicionales en el sistema de salud. El ECNT en la sociedad representa una carga severa para un sistema de salud debido a los altos costos, especialmente cuando se habla de mujeres que tienen un ECNT y están embarazadas.
Objetive Evaluate the impact of pregnancy on women with a high disease burden, especially with Chronic Non-Communicable Diseases (CNCD) in the costs of a health insurer. Materials and Methods Retrospective costing study conducted at Famisanar EPS between 2016 and 2018. We used multiple linear regression models to evaluate; the overall costs were calculated for each patient. The insurer's perspective was taken into account for the analysis. Results The study universe was made up of 458 249 women of childbearing age affiliated to Famisanar EPS between 15 and 49 years, of which 24 030 (5.2%) women have some relationship with the CNCD, of these, 2 454 (10.2%) went to childbirth and caesarean section. We had determined the costs of pregnancy healthy's women in USD 200.41 and pregnancy CNCD's women USD 519.95 (97.5%) in terms of the costs for the complication's gestation care. Using multinomial regression, we compared the pregnancy with CNCD with the other groups of women. We did not observe any significant differences in ingress and zone. However, we observe signicant differences in the age. Conclusion Pre-existing CNCD in pregnant women can lead to the use of additional resources in the health system. CNCD in society represent a severe burden for a health system due to high costs and especially when talking about women who have an CNCD and are in pregnant. The study also indicates that female infertility treatments are important for cost containment in health systems.
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In times of great socio-sanitary conjunctures, such as these, to identify the influence of nursing in the complex dynamics of the health economy and health management becomes vital. Objective: To determine the implications of nursing on health economics as seen in the literature. Methodology: To integrative a review of the literature, in OVID, Pubmed, Clinikal Key, Scielo databases, published in the 2000 - 2018 period in English, Portuguese, and Spanish languages, following the recommendations of the SALSA review method and adjusted to modified PRISMA requirements. Of a total of 26 retrieved articles, 18 were eligible for review, after applying the inclusion and exclusion criteria. The data were summarized using a narrative-qualitative-descriptive synthesis. Results: 44% of the publications were made between 2005 and 2009; 78% were made in the United States; 56% were obtained from PUBMED; and 44% are of quantitative design. The categorical analysis shows a clear tendency to reveal the economic cost related to the impact of the nursing professional's work in various areas, rather than considerations of quality of care or effectiveness of the work. Conclusion: Links were observed between nursing actions and health economics in three main aspects: quality of care, costs, and effectiveness.
En momentos de grandes coyunturas socio sanitarias actuales, se vuelve vital identificar la influencia de enfermería en las dinámicas complejas de la economía de la salud y la gestión sanitaria. Objetivo: Determinar las implicancias evidenciadas en la literatura que enfermería posee en la economía de la salud. Metodología: Revisión integrativa de la literatura, en bases de datos OVID, Pubmed, Clinikal Key, Scielo publicados entre 2000 - 2018 en idiomas inglés, portugues y español, siguiendo las recomendaciones del método SALSA de revisión y ajustada a requerimientos PRISMA modificado. De un total de 26 artículos recuperados, 18 fueron elegibles para revisión, luego de aplicar los criterios inclusión y exclusión. Los datos fueron resumidos mediante síntesis narrativa-cualitativa- descriptiva. Resultados: Un 44% de las publicaciones se realizaron entre 2005 al 2009; el 78% fueron hechas en Estados Unidos; un 56% se obtuvieron de PUBMED y el 44% son de diseño cuantitativo. El análisis categorial muestra una clara tendencia por relevar el costo económico relacionado al impacto del trabajo del profesional de enfermería en diversas áreas del quehacer, más que consideraciones de calidad del cuidado o efectividad del trabajo. Conclusión: Se observaron vinculaciones entre el actuar de enfermería y la economía de la salud, en tres aristas principales: calidad de atención, costos y efectividad.
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Objective: This study aims at identifying the payment methods existing in the Unified Health System referring to federal transfers to Primary Health Care (PHC) and Specialized Health Care. Methods: A quantitative and analytical study was carried out, developed in three stages: survey of all types of transfers from the Union; classification of each transfer category according to the types of payment methods and measurement of the participation of each payment methods, according to the financing components analyzed, in relation to the net values transferred. Results: Federal transfers were classified into seven payment methods. For PHC, in 2020, approximately R$ 21.7 billion was calculated, including resources destined for the pandemic, and R$ 20.9 billion without considering resources to face the COVID-19 pandemic. More than 50% of the amounts used were classified as capitation, in both cases. For specialized health care, in 2019, around R$ 48.5 billion were calculated, and in 2020 more than R$ 49.2 billion. For the two years, more than 70% of the funds were allocated to fee for service. Conclusions: This study allowed for an expansion in knowledge about the allocation of resources referring to transfers from the Union to states, the Federal District and municipalities. As the payment methods are related to productivity, access and quality of the health service, knowing and identifying the most appropriate payment methods for each situation contributes to the achievement of the goals and to the mitigation of eventual losses of efficiency in the healthcare systems.
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Objetivo: Este estudo tem por objetivo identificar os modelos de pagamento existentes no Sistema Único de Saúde referentes aos repasses federais para a Atenção Primária à Saúde (APS) e a Atenção Especializada à Saúde. Métodos: Foi realizado um estudo quantitativo e analítico, desenvolvido em três etapas: levantamento de todos os tipos de repasse da União; classificação de cada categoria de repasse segundo os tipos de modelos de pagamentos; e mensuração da participação de cada modelo de pagamento, de acordo com os componentes de financiamento analisados, em relação aos valores líquidos repassados. Resultados: Os repasses federais foram classificados em sete modelos de pagamentos. Para a APS, em 2020, foram apurados R$ 21,7 bilhões, aproximadamente, incluindo os recursos destinados para a pandemia, e R$ 20,9 bilhões, sem considerar os recursos para enfrentamento da pandemia de COVID-19. Mais de 50% dos valores empregados foram classificados como capitação, em ambos os casos. Para a Atenção Especializada à Saúde, em 2019, foram computados em torno de R$ 48,5 bilhões e, em 2020, acima de R$ 49,2 bilhões. Para os dois anos, mais de 70% dos recursos foram destinados a pagamentos por procedimento. Conclusões: Este estudo permitiu a ampliação do conhecimento sobre a alocação dos recursos referentes aos repasses da União para estados, Distrito Federal e municípios. Como os modelos de pagamentos estão relacionados com a produtividade, acesso e qualidade do serviço de saúde, conhecer as formas de pagamento e identificar a mais adequada para cada situação contribui para o alcance das metas e para a mitigação de eventuais perdas de eficiência nos sistemas de saúde.
Objective: This study aims at identifying the payment methods existing in the Unified Health System referring to federal transfers to Primary Health Care (PHC) and Specialized Health Care. Methods: A quantitative and analytical study was carried out, developed in three stages: survey of all types of transfers from the Union; classification of each transfer category according to the types of payment methods and measurement of the participation of each payment methods, according to the financing components analyzed, in relation to the net values transferred. Results: Federal transfers were classified into seven payment methods. For PHC, in 2020, approximately R$ 21.7 billion was calculated, including resources destined for the pandemic, and R$ 20.9 billion without considering resources to face the COVID-19 pandemic. More than 50% of the amounts used were classified as capitation, in both cases. For specialized health care, in 2019, around R$ 48.5 billion were calculated, and in 2020 more than R$ 49.2 billion. For the two years, more than 70% of the funds were allocated to fee for service. Conclusions: This study allowed for an expansion in knowledge about the allocation of resources referring to transfers from the Union to states, the Federal District and municipalities. As the payment methods are related to productivity, access and quality of the health service, knowing and identifying the most appropriate payment methods for each situation contributes to the achievement of the goals and to the mitigation of eventual losses of efficiency in the healthcare systems.
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Unified Health System , Prospective Payment System , Health Care Economics and Organizations , Healthcare FinancingABSTRACT
Resumen Introducción: El mercurio circula por el aire; persiste en suelos, sedimentos y agua, y causa efectos en la salud humana. Las mujeres en edad fértil y los neonatos son la población más vulnerable. Objetivo: Analizar las evidencias sobre la carga de enfermedad ocasionada por la exposición a mercurio, así como el impacto económico sobre el sistema de salud. Metodología: Revisión de alcance de la literatura, de las bases de datos PUBMED y EPISTEMONIKOS, búsqueda manual de documentos técnicos de entidades oficiales de diferentes continentes. Resultados: Se identificaron 311 registros en bases de datos y 4 en búsqueda manual en entidades oficiales; 19 artículos fueron incluidos. Discusión: Predomina la afectación del desarrollo neurológico y cognitivo en niños de madres expuestas y lactantes. Los costos se midieron por la pérdida del coeficiente intelectual. Conclusión: Efectos en salud por la exposición a metilmercurio se traducen en gastos para la sociedad y los sistemas de salud.
Abstract Introduction: Mercury circulates through the air, persists in soils, sediments and water, and can affect human health. Women of childbearing age and newborns are the most vulnerable population. Objective: To analyze the evidence on the burden of disease caused by mercury exposure, as well as the economic impact on the health system. Methodology: Review of the literature, PUBMED and EPISTEMONIKOS databases, manual search of technical documents of official entities from different continents. Results: A total of 311 records were identified in databases and four in manual searches from official entities; 19 articles were included. Discussion: Neurological and cognitive development in children of exposed mothers and infants are more predominant. Costs were measured by IQ loss. Conclusion: Health effects of methylmercury exposure translate into costs for society and health systems.