The economic impact of a COVID-19 illness from the perspective of families seeking care in a private hospital in India.

Background: The Covid-19 pandemic had a tremendous impact that caused significant morbidity, mortality, and financial stress for families. Our study aimed to determine the Out-of-pocket expenses and economic impact of a Covid-19 illness for households where patients were admitted to a private hospital in India. Methodology: This was a cost-of-illness study from a tertiary care academic institute where adult patients diagnosed with COVID-19 from May 2020 to June 2021 were included. Patients with an admission of less than one day or who had any form of insurance were excluded. The clinical and financial details were obtained from the hospital information system and a cross-sectional survey. This was stratified across three clinical severity levels and two epidemiological waves. Results: The final analysis included 4445 patients, with 73 % admitted in Wave 1 and 99 patients interviewed. For patients with severity levels 1, 2 and 3, the median admission days were 7, 8 and 13 days respectively. The total cost of illness (general category) was $934 (₹69,010), $1507 (₹111,403) and $3611 (₹266,930) and the direct medical cost constituted 66%, 77% and 91% of the total cost for each level respectively. Factors associated with higher admission costs were higher age groups, male gender, oxygen use, ICU care, private admission, increased duration of hospital stay and Wave 2. The median annual household income was $3247 (₹240,000) and 36% of families had to rely on more than one financial coping strategies, loans with interest being the commonest one. The lockdown period affected employment and reduced income for a considerable proportion of households. Conclusion: A Covid admission of higher severity was a significant financial burden on families. The study reaffirms the need for collaborative and sustainable health financing systems to protect populations from hardships.$-US Dollar; ₹- Indian Rupees.

The relationship between online class environments and economic burden and mental health among university students during the COVID-19 pandemic

This study examined the relationship between online class environments and the economic burden and mental health among university students at the onset of the COVID-19 pandemic. The survey participants were 909 undergraduate students, and graduate students in Hokkaido who responded to the first wave of the two-wave panel survey. The survey was conducted from July to September 2020. This study used K6 and GAD-7 as indicators of mental health. The results showed that students with both a high economic burden and a high burden of on-demand online classes after the onset of the COVID-19 pandemic had a high probability of exceeding the cutoff points (indicating severe depression and anxiety) for K6 (above 13 points) and GAD-7 (above 10 points). The number of live online classes predicted lower depression. The discussion focused on the characteristics of online classes and discussed why they were associated with mental health and how to reduce the sense of burden in classes. In addition, we pointed out the importance of economic support for university students, since economic burdens were related to mental health. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

COVID-19 in real world: Survival and medical costs of hospitalized patients in Brazil´s first wave.

OBJECTIVE: To evaluate survival and direct medical costs of patients admitted in private hospitals with COVID-19 during the first wave. METHODS: A retrospective, observational study analyzing survival and the economic data retrieved on hospitalized patients with COVID-19. Data from March 2020 to December 2020. The direct cost of hospitalization was estimated using the microcosting method with each individual hospitalization. RESULTS: 342 cases were evaluated. Median age of 61.0 (95% CI 57.0‒65.0). 194 (56.7%) were men. The mortality rate was higher in the female sex (p = 0.0037), ICU (p < 0.001), mechanical ventilation (p<0.001) and elderly groups. 143 (41.8%) patients were admitted to the ICU (95% CI 36.6%-47.1%), of which 60 (41.9%) required MV (95% CI 34.0%-50.0%). Global LOS presented median of 6.7 days (95% CI 6.0-7.2). Mean costs were US$ 7,060,00 (95% CI 5,300.94-8,819,00) for each patient. Mean cost for patients discharged alive and patients deceased was US$ 5,475.53 (95% CI 3,692.91-7,258.14) and US$ 12,955.19 (95% CI 8,106.61-17,803.76), respectively (p < 0.001). CONCLUSIONS: Patients admitted with COVID-19 in these private hospitals point to great economic impact, mainly in the elderly and high-risk patients. It is key to better understand such costs in order to be prepared to make wise decisions during the current and future global health emergencies.

Do Infrared Thermometers Hold Promise for an Effective Early Warning System for Emerging Respiratory Infectious Diseases?

BACKGROUND: Major respiratory infectious diseases, such as influenza, SARS-CoV, and SARS-CoV-2, have caused historic global pandemics with severe disease and economic burdens. Early warning and timely intervention are key to suppress such outbreaks. OBJECTIVE: We propose a theoretical framework for a community-based early warning (EWS) system that will proactively detect temperature abnormalities in the community based on a collective network of infrared thermometer-enabled smartphone devices. METHODS: We developed a framework for a community-based EWS and demonstrated its operation with a schematic flowchart. We emphasize the potential feasibility of the EWS and potential obstacles. RESULTS: Overall, the framework uses advanced artificial intelligence (AI) technology on cloud computing platforms to identify the probability of an outbreak in a timely manner. It hinges on the detection of geospatial temperature abnormalities in the community based on mass data collection, cloud-based computing and analysis, decision-making, and feedback. The EWS may be feasible for implementation considering its public acceptance, technical practicality, and value for money. However, it is important that the proposed framework work in parallel or in combination with other early warning mechanisms due to a relatively long initial model training process. CONCLUSIONS: The framework, if implemented, may provide an important tool for important decisions for early prevention and control of respiratory diseases for health stakeholders.

Rekindling Hope for Remission: Current Impact of Diabetes for Our World's Future Health and Economy.

The individual and societal burdens of living with a chronic disease are a global issue. Diabetes directly increases health care costs to manage the disease and the associated complications and indirectly increases the economic burden through long-term complications that hinder the productivity of humans worldwide. Thus, it is crucial to have accurate information on diabetes-related costs and the geographic and global economic impact when planning interventions and future strategies. Health care systems must work with government agencies to plan national-level pre diabetes and diabetes strategies and policies. Public health services must focus on diabetes screening prevention and remission.

Remdesivir-related cost-effectiveness and cost and resource use evidence in COVID-19: a systematic review.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has been a global health emergency since December 2019, leading to millions of deaths worldwide and placing significant pressures, including economic burden, on individual patients and healthcare systems. As of February 2022, remdesivir is the only US Food and Drug Administration (FDA)-approved treatment for severe COVID-19. This systematic literature review (SLR) aimed to summarise economic evaluations, and cost and resource use (CRU) evidence related to remdesivir during the COVID-19 pandemic. METHODS: Searches of MEDLINE, Embase the International Health Technology Assessment (HTA) database, reference lists, congresses and grey literature were performed in May 2021. Articles were reviewed for relevance against pre-specified criteria by two independent reviewers and study quality was assessed using published checklists. RESULTS: Eight studies reported resource use and five reported costs related to remdesivir. Over time, the prescription rate of remdesivir increased and time from disease onset to remdesivir initiation decreased. Remdesivir was associated with a 6% to 21.3% decrease in bed occupancy. Cost estimates for remdesivir ranged widely, from $10 to $780 for a 10-day course. In three out of four included economic evaluations, remdesivir treatment scenarios were cost-effective, ranging from ~ 8 to ~ 23% of the willingness-to-pay threshold for the respective country. CONCLUSIONS: Economic evidence relating to remdesivir should be interpreted with consideration of the broader clinical context, including patients' characteristics and the timing of its administration. Nonetheless, remdesivir remains an important option for physicians in aiming to provide optimal care and relieve pressure on healthcare systems through shifting phases of the pandemic.

The methodological quality of economic evaluations of measles outbreaks: A systematic review of cost-of-illness studies.

OBJECTIVES: To identify the main cost components included in the economic evaluations of measles outbreaks, their items and cost drivers, and evaluate the quality of costing methodology, analyzing the key features that may affect the validity of these studies in countries with different income levels. METHODS: We systematically searched multiple databases EMBASE, MEDLINE (via PubMed), Biblioteca Virtual em Saúde do Ministério da Saúde (BVS MS), NHS Economic Evaluation Database (NHS EED) and NHS Health Technology Assessment (NHS HTA) (via The Centre for Reviews and Dissemination Library - CRD), and EconLit, SCOPUS, and Web of Science, selecting cost analysis and cost of illness studies (COI) of measles outbreaks. Two independent reviewers screened articles for relevance and extracted the data. The quality of costing methods was assessed using a guide to critical evaluation of COI studies. We performed a qualitative narrative synthesis. RESULTS: Twenty-two studies were reviewed. Most studies evaluated outbreaks that occurred from 2011 to 2013 and 2017 to 2019. Total costs varied from $40,147 to $39.3 million. Per case cost varied from $168 to $49,439. The main drivers of measles outbreak costs were outbreak response, personnel, and productivity losses. Most studies (20/22) did not report the costing methodology adopted, the degree of disaggregation used in the identification and measurement of resource and costs components and the method for the valuation of resource and cost components. CONCLUSIONS: The quality of the costing methodology, its transparency and accuracy are essential to the validity of these studies results and their potential use to allocate public health resources in the most efficient manner and to inform measles outbreak control strategies, with rapid and effective response.

Economic burden of the novel coronavirus infection: a systematic review

Background. The sudden emergence and rapid spread of the novel coronavirus infection (COVID-19) caused tremendous burden on the health care system including the economic one. In this regard, many questions concerning the prioritization of funding for various restrictive and preventive procedures have arisen;also the introduction of various intervention methods for monitoring and timely treatment of post-COVID consequences became an urgent problem. These challenges actualized the development of pharmacoeconomic methods that improve the quality of decisions making in such extreme conditions. Objective(s): to systematize available studies on the assessment of the global economic burden of the novel coronavirus infection. Material and methods. A feature of the proposed review design was the highlighting of the observed shortcomings and areas in which scientists make additions to the assessment methods taking into account the chronology of the pandemic determining changes in the information field. Therefore, an analysis was made of 80 studies published in 2020-2022 and dedicated to the assessment and forecast of the global economic burden of COVID-19. The main inclusion criteria for the studies was the estimation of COVID-19 global burden. The search was carried out in PubMed/MEDLINE, Web of Science, Scopus, and eLibrary databases. Using a predefined data collection form, two reviewers independently extracted information characterizing the studies. Results. An analysis of the publications showed a fairly wide variety of studies in the field of the COVID-19 burden, including those determined by the difference in observation objects, analysis methods, factors taken into account, etc. Scientists actively use international (73.8%) and national (90%) databases, and surveys (57.5%). Predominantly, the estimates involve the calculation of quality-adjusted life years lost (QALY) (66.3%), 37.6% of the studies are based on the results of constructing scenario models, 28.8% consume algorithms of epidemiological SIR (susceptible, infected, or recovered) models, and 66.3% provide for cost assessment. As part of the estimated economic burden, the loss of productivity (26.3% of publications), the introduction of vaccination (32.5%), comorbidity (25%), post-COVID complications (17.5%) are considered. Conclusion. A significant interest of the world scientific community in assessing the COVID-19 global burden is observed, determined by the search for the most effective study methods. Further investigations in this area should focus on detailing within the estimated economic burden of losses associated with post-COVID-19 complications, including their various combinations, as well as on the analysis of the correlation and mutual compensation of effects from various types of treatment, with a deeper study of indirect losses. The results of this work will be also useful in conducting similar studies, including for determining their design and applying modern mathematical modeling tools. Copyright © 2022 Obstetrics, Gynecology and Reproduction. All rights reserved.

Spatial effects of air pollution on the economic burden of disease: implications of health and environment crisis in a post-COVID-19 world.

BACKGROUND: Air pollution has been identified as related to the diseases of susceptible population, but the spatial heterogeneity of its economic burden and its determinants are rarely investigated. The issue is of great policy significance, especially after the epidemic of COVID-19, when human are facing the joint crisis of health and environment, and some areas is prone to falling into poverty. METHODS: The geographical detector was adopted to study the spatial distribution characteristics of the incidence of catastrophic health expenditure (ICHE) for older adults in 100 rural areas in China at the prefecture-city level. The health factors, sociological factors, policy factors and environmental factors and their interactions are identified. RESULTS: First, most health service factors had strong explanatory power for ICHE whether it interacts with air pollution. Second, 50 single-factor high-risk areas of ICHE were found in the study, but at the same time, there were 21 areas dominated by multiple factors. CONCLUSION: The different contributions and synergy among the factors constitute the complex mechanism of factors and catastrophic health expenditure. Moreover, during this process, air pollution aggravates the contribution of health service factors toward ICHE. In addition, the leading factors of ICHE are different among regions. At the end, this paper also puts forward some policy suggestions from the perspective of health and environment crisis in the post-COVID-19 world: environmental protection policies should be combined with the prevention of infectious diseases; advanced health investment is the most cost-effective policy for the inverse health sequences of air pollution and infectious diseases such as coronavirus disease 2019 (COVID-19); integrating environmental protection policy into healthy development policy, different regions take targeted measures to cope with the intertwined crisis.

Economic Burden of SARS-CoV-2 Patients with Multi-Morbidity: A Systematic Review Protocol.

Economic burden issues in SARS-CoV-2 patients with underlying co-morbidities are enormous resources for patient treatment and management. The uncertainty costs for clinical management render the healthcare system catatonic and incurs deficits in national annual budgets. This article focuses on systematic steps towards selecting and evaluating literature to uncover gaps and ways to help healthcare stakeholders optimize resources in treating and managing COVID-19 patients with multi-morbidity. A systematic review of all COVID-19 treatment procedures with co-morbidities or multi-morbidity for the period from 2019 to 2022 was conducted. The search includes studies describing treatment costs associated with multi- or co-morbidity cases for infected patients and, if concurrently reported, determining recurring expenses. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Galbraith plots and I2 statistics will be deployed to assess heterogeneity and to identify potential sources. A backward elimination process will be applied in the regression modelling procedure. Based on the number of studies retrieved and their sample size, the subgroup analysis will be stratified on participant disease category, associated total costs, and degree of freedom in cost estimation. These studies were registered in the PROSPERO registry (ID: CRD42022323071).

Hospital-related costs of sepsis around the world: A systematic review exploring the economic burden of sepsis.

AIM: The aim of this study was to examine the quality of manuscripts reporting sepsis health care costs and to provide an overview of hospital-related expenditures for sepsis in adult patients around the world. METHODS: We systematically searched the PubMed, EMBASE, Cochrane and Google Scholar to identify relevant studies between January 2010 and January 2022. We selected articles that provided costs and cost-effectiveness analyses, defined sepsis and described their cost calculation method. All costs were adjusted to 2020 US dollars. Medians and interquartile ranges (IQRs) for various costs of sepsis were calculated. The quality of economic studies was assessed using the Drummond 10-item checklist. RESULTS: Overall, 26 studies met our eligibility criteria. The mean total hospital costs per patient varied largely, between €1101 and €91,951. The median (IQR) of the total sepsis costs per country were €36,191 (€17,158 - €53,349), which equals €50 (€34 - €84) per capita annually. The relative amount of healthcare budget spent on sepsis was 2.65%, which equals 0.33% of the gross national product (GNP). CONCLUSION: While general sepsis costs are high, there is considerable variability between countries regarding the costs of sepsis. Further studies examining the impact on sepsis costs, especially on the general ward, can help justify, design and monitor initiatives on prevention, diagnosis, and treatment of this time-critical and potentially preventable disease.

Impact of COVID-19 Pandemic on the Length of Hospital Stay in Hip Fracture Patients: A Single Centre Study.

Background Hip fracture is a debilitating injury, especially in older individuals, which is associated with significant morbidity and mortality. In recent decades, there has been a great focus on early rehabilitation and discharge after hip fractures. The aim of such efforts is to minimize the financial and clinical burden of this condition. We conducted our study during the COVID-19 pandemic and compared the length of hospital stay (LOS) in 2020 to the LOS in 2019. Additionally, we studied the factors which may impact the LOS, such as premorbid status according to established scoring systems, the type of fracture, an operation performed, and time to surgery. Methods We collected the data regarding the length of stay (in days) for all hip fracture patients admitted to our unit from 1st January 2019 until 31st December 2020. We then compared the mean LOS for both years using the t-test. We calculated the Nottingham Hip Fracture Score (NHFS) and American Society of Anaesthesiologists (ASA) scores for patients admitted in 2020 and calculated the correlation between increasing values of these scores and the LOS. We also compared the mean LOS for patients admitted in 2020 based on the type of fracture and type of management. We studied the correlation between the time to surgery and the LOS for patients admitted in 2020. Results Three hundred and eighty-eight patients were admitted with hip fractures in 2020, and 452 were admitted in 2019. LOS in 2020 was significantly lower (23.39 days) compared to 2019 (31.36 days) with p<0.01. While evaluating data from 2019, it was noted that there was a small positive correlation between LOS and NHFS (r=0.231, p<0.001) and LOS and ASA (r=0.18, p<0.001). The mean LOS for intracapsular fractures was noted to be lower than that of extracapsular fractures, but this was not statistically significant (p=0.17). An ANOVA test showed that the mean LOS for patients undergoing hemiarthroplasty, dynamic hip screws (DHS), and intramedullary nails (IMN) was significantly longer than for patients managed with total hip replacement or patients managed non-operatively (F=3.551, p<0.01). Conclusion Hip fracture patients admitted to our department were discharged quicker during the first year of the COVID-19 pandemic. The LOS for hip fractures increases with an increase in their NHFS or ASA scores. Extracapsular and intracapsular fractures lead to roughly the same periods of inpatient stay. Patients undergoing hemiarthroplasty, DHS, or IMN stay longer in the hospital compared to other treatment modalities.

Health impact assessment and evaluation of economic costs attributed to PM2.5 air pollution using BenMAP-CE.

Air pollution is considered the most prominent public health. Economically, air pollution imposes additional costs on governments. This study aimed to quantify health effects and associated economic values of reducing PM2.5 air pollution using BenMAP-CE in Qom in 2019. The air quality data were acquired from Qom Province Environmental Protection Agency, and the population data were collected from Qom Province Management and Planning Organization website. The number of deaths due to Stroke, Chronic Obstructive Pulmonary Disease, Lung Cancer, and Ischemic Heart Disease attributable to PM2.5 were estimated using BenMAP-CE based on two control scenarios, 2.4 and 10 µg/m3, known as scenarios I and II, respectively. The associated economic effect of premature deaths was assessed by value of a statistical life (VSL) approach. The annual average of PM2.5 concentration was found to be 16.32 µg/m3 (SD: 9.93). A total of 4694.5 and 2475.94 premature deaths in scenarios I and II were found to be attributable to PM2.5 in overall, respectively. The total associated cost was calculated to be 855.91 and 451.40 million USD in scenarios I and II, respectively. The total years of life lost due to PM2.5 exposure in 2019 was 158,657.06 and 78,351.51 in scenarios I and II, respectively. The results of both health and economic assessment indicate the importance of solving the air pollution problem in Qom, as well as other big cities in Iran. The elimination of limitations, such as insufficient local data, should be regarded in future studies.

The COVID-19 pandemic and the livelihood of a vulnerable population: Evidence from women street vendors in urban Vietnam.

The COVID-19 pandemic has caused enormous detrimental impacts on a global scale. Street vendors are one of the most heavily affected groups since they lack the skills and resources to overcome shocks. This study examines the economic burden facing this group during the pandemic and their coping strategies and mitigation mechanisms in response to these adverse effects. We utilized a mixed-methods approach, wherein 91 women vendors completed a survey questionnaire and 15 women vendors were interviewed. These vendors were found to experience a large reduction in business and consumption. The businesses of immigrant vendors suffered more adverse effects than those of local vendors. Also, the vendors selling in wet market areas incurred greater economic burdens than those selling near schools or recreation centers. The vendors lacked coping strategies to sustain their businesses and adopted various mitigation mechanisms to ensure essential consumption. This study highlights the need for urban social policies that can support this vulnerable group amid a pandemic. We also discuss policy implications for cities and economic development with a focus on street vendors.

A Maximization Model for Food Aid Distribution using Integer Linear Programming

The covid-19 pandemic has severely affected the economy of the Philippines. With 90% of the labor force being affected, hundreds of thousands of families turn to their respective local government units for assistance. LGUs have begun distributing food box assistance to every family under the Food Security Program to ease the economic burden. However, such a program having a vast number of recipients will require a large budget. This study presents the optimization of the content of the food packs used for food aid distribution through linear programming using Matlab. The study's goal is to maximize the nutritional content of the food pack while being under the constraint of a limited budget to ensure the best utilization of scarce resources. © 2021 IEEE.

Optimal timing and effectiveness of COVID-19 outbreak responses in China: a modelling study.

BACKGROUND: In January 2020, an outbreak of atypical pneumonia caused by a novel coronavirus, SARS-CoV-2, was reported in Wuhan, China. On Jan 23, 2020, the Chinese government instituted mitigation strategies to control spread. Most modeling studies have focused on projecting epidemiological outcomes throughout the pandemic. However, the impact and optimal timing of different mitigation approaches have not been well-studied. METHODS: We developed a mathematical model reflecting SARS-CoV-2 transmission dynamics in an age-stratified population. The model simulates health and economic outcomes from Dec 1, 2019 through Mar 31, 2020 for cities including Wuhan, Chongqing, Beijing, and Shanghai in China. We considered differences in timing and duration of three mitigation strategies in the early phase of the epidemic: city-wide quarantine on Wuhan, travel history screening and isolation of travelers from Wuhan to other Chinese cities, and general social distancing. RESULTS: Our model estimated that implementing all three mitigation strategies one week earlier would have averted 35% of deaths in Wuhan (50% in other cities) with a 7% increase in economic impacts (16-18% in other cities). One week's delay in mitigation strategy initiation was estimated to decrease economic cost by the same amount, but with 35% more deaths in Wuhan and more than 80% more deaths in the other cities. Of the three mitigation approaches, infections and deaths increased most rapidly if initiation of social distancing was delayed. Furthermore, social distancing of working-age adults was most critical to reducing COVID-19 outcomes versus social distancing among children and/or the elderly. CONCLUSIONS: Optimizing the timing of epidemic mitigation strategies is paramount and involves weighing trade-offs between preventing infections and deaths and incurring immense economic impacts. City-wide quarantine was not as effective as city-wide social distancing due to its much higher daily cost than social distancing. Under typical economic evaluation standards, the optimal timing for the full set of control measures would have been much later than Jan 23, 2020 (status quo).

Psychological effects of COVID-19 phobia on industrial consumers: a case study in Turkey

Purpose This study aims to discover whether COVID-19 phobia has a positive and significant effect on the stress, depression and anxiety levels of industrial consumers in addition to reveal whether environmental awareness plays a mediating role between COVID-19 phobia and stress, depression and anxiety. Design/methodology/approach In this study, a quantitative method was used to reveal the role of anxiety, depression and stress (psychological effects) and environmental awareness caused by covid-19 phobia on industrial consumers. The universe of the study is small and medium-sized enterprises operating in the province of Sanliurfa, which is located in the southeast region of Turkey and the second largest city in the region, and are industrial customers. Questionnaire method was used in the study. In addition, data were collected from 406 people who agreed to participate in the study. In the study, in which intermediary and regulatory analyzes were made, the process macro program was used. Findings The results show that there is a medium relationship between COVID-19 phobia and environmental awareness;and COVID-19 phobia and stress, depression and anxiety. No relationship was found between environmental awareness and stress, depression and anxiety. COVID-19 phobia was found to have a positive and significant effect on environmental awareness and stress, depression and anxiety, while environmental awareness was found to have no effect on stress, depression and anxiety. Finally, environmental awareness was found to play a mediating role between COVID-19 phobia and stress, depression and anxiety. Research limitations/implications In this study, four hypotheses were developed. Of these hypotheses, three are for the simple effect and one for the mediation effect. Out of four hypotheses, three were supported. The most important inference obtained from the study was finding the mediation effect of environmental awareness between COVID-19 phobia and anxiety, depression and stress. Originality/value To the best of the authors' knowledge, no studies in the literature were made on the relationship among COVID-19 phobia, environmental awareness, stress, depression and anxiety. This study also examines the mediating effect of environmental awareness in the relationship between COVID-19 phobia and stress, depression and anxiety. The fact that the study is on the negative effects of the pandemic on one of the most affected occupational group also increases its original value.

Universal Health Insurance Coverage and the Economic Burden of Disease in Eastern China: A Pooled Cross-Sectional Analysis From the National Health Service Survey in Jiangsu Province.

China has achieved universal social health insurance coverage, but it is unclear whether this has alleviated the economic burden of disease for individuals. This was investigated in the present study by analyzing National Health Service Survey (2008-2018) data from Jiangsu province. Ordinary least squares and binary multivariate logistic regression of pooled cross-sectional data were carried out to evaluate the effect of universal health insurance coverage and other socioeconomic factors on the economic burden of disease. Total health expenses (THE) first increased and then decreased during the survey period while out-of-pocket health expenses (OOP) decreased except for urban residents, for whom OOP increased after 2013. Household catastrophic health expenditure (HCHE) was stable between 2008 and 2013 but increased after 2013. Social health insurance had a significant positive effect on the annual THE and OOP and a negative effect on HCHE, however, universal health insurance coverage could alleviated THE and the economic burden of disease on individuals (OOP) while it was insufficient to protect against the economic risk of diseases (HCHE), with greater benefits for urban as compared to rural residents. Other socioeconomic factors including age, marital status, education, income, and health status also influenced the economic burden of disease.

The Effect of COVID-19 on Cardiac Surgical Volume and its Associated Costs.

The COVID-19 pandemic significantly affected health care and in particular surgical volume. However, no data surrounding lost hospital revenue due to decreased cardiac surgical volume have been reported. The National Inpatient Sample database was used with decreases in cardiac surgery at a single center to generate a national estimate of decreased cardiac operative volume. Hospital charges and provided charge to cost ratios were used to create estimates of lost hospital revenue, adjusted for 2020 dollars. The COVID period was defined as January to May of 2020. A Gompertz function was used to model cardiac volume growth to pre-COVID levels. Single center cardiac case demographics were internally compared during January to May for 2019 and 2020 to create an estimate of volume reduction due to COVID. The maximum decrease in cardiac surgical volume was 28.3%. Cumulative case volume and hospital revenue loss during the COVID months as well as the recovery period totaled over 35 thousand cases and 2.5 billion dollars. Institutionally, patients during COVID months were younger, more frequently undergoing a CABG procedure, and had a longer length of stay. The pandemic caused a significant decrease in cardiac surgical volume and a subsequent decrease in hospital revenue. This data can be used to address the accumulated surgical backlog and programmatic changes for future occurrences.