Impact of Cardiovascular Disease on Health Insurance Coverage and Healthcare Use under Economic Stress: The National Health and Nutrition Examination Survey, 2003–2012

OBJECTIVES: Cardiovascular disease (CVD) has a substantial financial impact on healthcare systems in the US. This study aimed to examine the impact of CVD on health insurance coverage and health service use under economic stress as indicated by the Great Recession in the US (December 2007–June 2009). METHODS: Data of 26,483 adults aged ≥ 20 years from the 2003–2012 National Health and Nutrition Examination Survey were analyzed. There were 9,479 adults assigned to the group “before the Great Recession” (2003–2006), 5,674 adults assigned to “during the Great Recession” (2007–2008), and 11,330 adults assigned to “after the Great Recession” (2009–2012). RESULTS: Patients with CVD from low-income families were more likely to have health insurance during the recession (OR:1.57, 95% CI: 1.01,2.45). Those participants without CVD, who were from low-income families or < 65 years, were more likely to use the emergency room rather than primary care facilities to gain access to routine healthcare (p < 0.05). Patients with CVD from high-income families were also more likely to use the emergency room (p < 0.05). Patients with CVD but not those without CVD, who reported a high family income or were ≥ 65 years old, were less likely to use mental health services during the recession than before the recession. CONCLUSION: Effective strategies need to be developed to promote primary care use among the general adult American population. In addition, use of mental health services among patients with CVD needs to be improved when financial stress occurs.

Effect Evaluation of PBM Pilots in Wuhu City of Anhui Province from the Perspective of Patients / 中国药房

OBJECTIVE： To evaluate the effects of Pharmacy Benefit Management （PBM） model on drug compliance， health outcomes， economic burden and satisfaction of patients in Wuhu city of Anhui province. METHODS： In cross-sectional study， the questionnaires were designed according to the National Health Service Survey. Through cluster sampling and convenient sampling， the questionnaire survey （including subjective evaluation） was conducted among hypertensive patients who participated in or did not participate in the PBM program in pilot area of Wuhu city. Descriptive analysis was used to analyze the general characteristics of the two groups. The Propensity Score Matching （PSM） was used to approximately randomize the included data to balance the baseline characteristics. Univariate linear regression or Logistic regression analysis were used to evaluate the relationship of whether to join PBM or not with drug compliance，QALY， hospitalization probability，monthly average drug cost for chronic diseases and monthly self-paid drug cost for chronic diseases， etc. RESULTS： A total of 755 valid questionnaires were collected， including 405 in the PBM group and 350 in the non-participating group. There was statistical significance in patient’s gender， age， education degree， nature of household registration， type of medical insurance or usual visited medical institutions （P＜0.05）. About 95％ patients （405 cases） satisfied with PBM program. 281 cases of PBM group and 193 cases of non-participating group were included through PSM. Results of regression analysis showed that lower one level at least of medication compliance in PBM group was 0.49 times as that in the non-participating group； the hospitalization probability in PBM group was 0.56 times as that in the non-participating group （P＜0.05）. There was no statistical significance of difference in control of blood pressure QALY， monthly average drug cost for chronic diseases and monthly self-paid drug cost for chronic diseases between two groups （P＞0.05）. CONCLUSIONS： The implementation of PBM model in pilot areas can improve drug compliance and reduce hospitalization rate of patients. The most patients are highly satisfied. However， the effects of PBM on patients’ control of blood pressure， QALY and medical expense are not obvious， and its long-term effect needs more follow-up studies to verify.

Carga financiera familiar asociada al cuidado del niño con cáncer / Family financial burden associated with caring for a child with cancer

Introducción: El cáncer es una de las principales causas de muerte en niños en todo el mundo, y la incidencia tiende a aumentar con el tiempo. La demora en la remisión de un paciente, la iniciación tardía o suspensión del tratamiento pueden significar la diferencia entre la vida y la muerte, situación que está relacionada con los gastos financieros generados por la enfermedad del niño los cuales son solventados por las familias. Objetivo. Determinar la carga financiera familiar asociada al cuidado del niño con cáncer. Materiales y métodos: Estudio descriptivo con abordaje cuantitativo. Su muestra la constituyeron 50 familias de niños con cáncer vinculadas a la Fundación Traspasando Fronteras. El estudio contó con el aval del comité de ética de la Facultad de Enfermería de la Universidad Nacional de Colombia. Los datos se obtuvieron a través de la Encuesta Familiar "Costo financiero del cuidado de la Enfermedad crónica". El análisis se realizó a través de la metodología Caracol. Resultados: Las fuentes de carga financiera que presentan los cuidadores de niños con cáncer son en su orden: transporte con un ángulo de 28.5°; comunicación , con un ángulo de 26.3°; salud con un ángulo de 20.8°; vivienda, con un ángulo de 19.7° y alimentos, con un ángulo de 17,4°.Algunas de las fuentes de soporte económico con los que cuentan las familias para el cuidado del niño con Cáncer son: ingresos mensuales por salario de uno de los padres, apoyo económico de otros miembros de la familia, apoyo de la Fundación Traspasando Fronteras, préstamos, venta de inmuebles. Al calificar el nivel de preocupación que les genera la carga financiera, el 58% de las familias calificó 4, es decir, un nivel de carga alta, el 38% califico 3, un nivel medio, solo el 4% calificó 2, un nivel bajo. Conclusiones: Las familias de los niños con cáncer tienen una alta carga financiera asociada al cuidado del niño, la principal fuente de carga son los gastos en transporte. Las familias buscan apoyo en familiares y en la fundación, sin embargo este no es suficiente y deben optar por el endeudamiento.

Introduction: Cancer is one of the leading causes of death in children worldwide, and the incidence tends to increase over time. Delay in referral, late initiation or discontinuation of treatment can mean the difference between life and death, a situation that is related to the financial expenses generated by the child's illnesses which are paid for by the families. Objective. Determine the family economic burden associated with the care of the child with cancer. Materials and methods: Descriptive study with a quantitative approach. Its sample was constituted by 50 families of children with cancer linked to the Trespassing Borders Foundation. The study was endorsed by the institutional ethics committee and signed the informed consent. The data were obtained through the "Financial Cost of Chronic Illness Care Survey". The analysis was performed through the Snail methodology. Results: The largest source of economic burden for caregivers of children with cancer is in their order: transport with an angle of 28.5, communication with an angle of 26.3, health with an angle of 20.8, housing with an angle of 19.7 and food with an angle of 17.4. Some of the sources of financial support for the families of children with cancer are monthly income for a parent's salary, financial support from other family members, support from the Trespassing Borders Foundation, loans, real estate selling. In assessing the level of concern generated by the economic burden, 58% of families rated 4, that is, a high burden level, 38% rated 3, an average level, only 4% rated 2. Conclusions: The families of children with cancer have a high financial burden associated with child care, the main source of burden are transportation costs. Families seek support in family and in the foundation; however this is not enough and should opt for indebtedness.

Economic burden among cardiovascular patients of middle-aged and elderly: An empirical analysis based on China Health and Retirement Longitudinal Survey data / 中国卫生政策研究

Objectives: China has observed an increasing prevalence of cardiovascular diseases among its population, which is putting heavy economic burden both on individuals and the whole society.Conducting a multi-angle study of cardiovascular patients with economic burden can help adjust the health care policy to reduce the economic burden of patients.Methods: Using the baseline data (2011) and follow-up data (2013) of the China Health and Retirement Longitudinal Survey, this study selected cardiovascular patients aged 45 and above to calculate their direct medical cost, direct non-medical cost as well as self-paid cost before and after reimbursement.The total cost and self-paid cost are both calculated, and gender difference and rural-urban difference are also analyzed.Results: The prevalence of cardiovascular disease among the population age 45 and above was 13.9% in 2013 and 12.1% in 2011, while the prevalence in women was higher than in men and urban areas higher than rural areas.The average annual total costs for individual patient before reimbursement in 2013 was lower than that in 2011, but contrary to the trend of self-pay costs.Urban patients had higher amount of direct medical cost, lower co-payment rate and lower non-medical cost such as transportation and accommodation than their rural counterpart.Both urban and rural patients self-paid more on outpatient services than inpatient services.Conclusion: Based on these analyses, this paper suggests that Chinese policy makers should look deeper into patient behaviors as well as their economic burden before revising the current health policy.More practices regarding to the unbalanced distribution of health resources between urban and rural areas are needed, in order to ensure patients living in remote areas could get access to appropriate treatment without paying heavy non-medical cost.

Application of real-time continuous glucose monitoring in outpatient management system for type 1 diabetes mellitus / 中华内分泌代谢杂志

Objective To evaluate the effect of continuous glucose monitoring system(CGMS) in improving the current status of type 1 diabetes mellitus(T1DM) control and reducing the economic burden of the patients.Methods One hundred and fifteen patients with T1DM were randomly assigned to the CGMS group and the self-monitoring of blood glucose(SMBG) group respectively.The patients in CGMS group were on 72 h CGMS every 6 months, while SMBG group only with SMBG to guide the insulin dose adjustment.The levels of blood glucose and the statistics of the number of hypoglycemia and diabetic ketoacidosis were taken as the main observational indexes every 6 months.The chronic complication and the statistics of the number of hospitalizations and the total cost of treatment were made as the secondary observational index every 12 months.Results 2 h postprandial plasma glucose(2hPG) and mean blood glucose(MBG) in the CGMS group were lower than those in the SMBG group [(10.7±1.9 vs 11.5±2.7) mmol/L, (9.7±0.5 vs 10.6±0.7) mmol/L, P<0.05] in the clinical follow-up visit after 6 months.The per capita number of hypoglycaemia in the CGMS group was lower than that in the SMBG group[(7.9±2.6 vs 9.2±3.4) times, P<0.05].In the outpatient follow-up re-visit to the patients after 6 months, fasting plasma glucose(FPG), 2hPG, MBG, and HbA1C of the patients in the CGMS group were lower than those in the SMBG group(t=4.71~9.75, P<0.05), the per capita numbers of hypoglycemia and DKA in the CGMS group were lower than those in the SMBG group(t=3.61~4.37, P<0.05).Conclusion The application of real-time continuous glucose monitoring in T1DM outpatient management may reduce the whole-day blood glucose of the patients, decrease the incidence risk of hypoglycemia, and improve the compliance of the treatment while without increasing the economic burden of the disease.

Study on the Elderly Curative Care Expenditurefrom the Perspective of Direct Economic Burden of Disease / 中国卫生经济

Objective:To explore the curative care expenditure of the elderly(above 65 years old) in Jilin based on analyzing the economic burden of the elderly.Methods:Based on the System of Health Accounts 2011(SHA2011).it estimated the total curative care expenditure and constitute of the elderly in Jilin.Results:In 2014,the curative care expenditure of the elderly in Jilin reached to 12.85 billion yuan,which accounted for 26.26％ of curative care expenditure of the total population in Jilin.The per capita curative care expenditure of the elderly was 3.01 times of the per capita curative care expenditure of the 0-14 year-old group,2.87 times of the per capita curative care expenditure of the 15-64 year-old group and 2.39 times of the overall per capita curative care expenditure of residents in Jilin.From the perspective of service composition,the elderly treatment costs occurred more in the hospital with the increase in age.From the perspective of disease costs,the elderly treatment costs mainly occurred in the circulatory system diseases,respiratory diseases,cancer and other chronic diseases.The household out-of-pocket (OOP) accounted for 41.83％ in curative care financing for the elderly.Conclusion:The constitute of the curative expense of the elderly in Jilin province had significant characteristics,showed as heavy OOP burden.It needed to provide policy support.

Propuesta metodológica para el análisis económico del embarazo en la adolescencia en Cuba / Methodologic proposal for the economic analysis of pregnancy at adolescence in Cuba

El embarazo y parto en la adolescencia generan altos costos. Hasta el año 2006 la fecundidad adolescente en Cuba decreció. En los últimos años ha tendido a aumentar, lo que representa una alarma para la salud de este grupo de jóvenes. En Cuba se desarrollan proyectos destinados a mejorar las condiciones de salud de los adolescentes, entre los que se destaca el Programa Nacional de Atención Integral a la Salud de Adolescentes. La realización de análisis económico sobre el embarazo en la adolescencia en Cuba es una tarea pendiente que requiere de herramientas metodológicas que brinden información oportuna sobre sus consecuencias económicas. El propósito del trabajo es realizar una propuesta metodológica para identificar las implicaciones económicas del embarazo en la adolescencia en Cuba. Se hizo una revisión bibliográfica y documental utilizando el modelo BIG 6 como modelo de gestión de información para identificar estudios sobre salud sexual y reproductiva con énfasis en consecuencias económicas del embarazo en la adolescencia. Se complementó la información a partir de entrevistas a expertos en salud sexual y reproductiva y en análisis económico, quienes aportaron elementos para el diseño de la propuesta metodológica a realizar. Se obtuvo una propuesta metodológica para estudiar las consecuencias económicas del embarazo en la adolescencia con dos perspectivas, la macroeconómica y la microeconómica. Ambas perspectivas complementan información económica necesaria y útil para la asignación de recursos y toma de decisiones.

Sexual and reproductive health concerns man in its individual, economic and social dimensions. Pregnancy and child delivery in adolescents generate high costs. The fertility rate of adolescents decreased in Cuba until 2006, but in the last few years, there has been an increase that represents a warning about the health of this group of young people. Cuba is developing projects aimed at improving the health status of adolescents such as the National Program of Integrated Care to the Health of Adolescents. Making economic analysis of the pregnancy at adolescence in Cuba is a pending task. Methodological tools providing timely information on the economic consequences of pregnancy at adolescence are required. The objective of this paper was to submit a methodological proposal in order to identify the economic effects of pregnancy at adolescence in Cuba. A literature and document review was made with Big 6 model as the information management pattern, with a view to identifying the studies on sexual and reproductive health, emphasizing the economic consequences of pregnancy at adolescence. This information was supplemented with interviews to experts in sexual and reproductive health and in economic analysis, who contributed several elements for the design of the final methodological proposal for this type of study from the macroeconomic and the microeconomic perspectives. Both provide the necessary useful economic information to allocate resources and to make decisions.