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1.
Soc Sci Med ; 259: 113171, 2020 08.
Article in English | MEDLINE | ID: mdl-32674847

ABSTRACT

Identifying ways to increase public spending on health is critical for the achievement of universal health coverage. While policymakers and donors often look at available options for increasing public spending for health in the medium-term, examining trends and drivers of past growth can help countries elucidate important lessons and to anticipate changes in the future. This note analyzes trends in inflation-adjusted per capita public spending for health vis-à-vis economic growth within and across a sample of 150 countries over the 2000-2017 period. Since 2000, per capita public spending for health across low- and middle-income countries has more than doubled. Less than one-fifth of this increase, however, resulted from a higher priority for health in government budgets. The remainder was largely due to conducive macroeconomic conditions such as economic growth and increases in total public spending. Furthermore, across most countries, a single time trend does not adequately capture the evolution either of economic growth or of per capita public spending on health. Instability in growth rates is large for both indicators, revealing distinct episodic patterns.


Subject(s)
Economic Development , Health Expenditures , Financing, Government , Humans , Income , Universal Health Insurance
2.
Int J STD AIDS ; 26(8): 549-55, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25085276

ABSTRACT

Free and anonymous screening centres (CDAG: Centres de Depistage Anononyme et Gratuit) are public facilities set up for HIV infection diagnosis in France. Some people visiting CDAG fail to return for test results and are not informed of their serology. This study aimed to assess factors associated with failure to return for HIV test results. Patients visiting the Fernand-Widal CDAG (Paris) for an HIV test in January-February 2011 were eligible to take part in the study. Data were collected with an anonymous self-administered questionnaire. Factors associated with failure to return were assessed using logistic regression models. Of the 710 participants (participation rate 88%), 46 patients failed to return. Not specifying birthplace and not living in the region of Paris were associated with failure to return. Those who perceived no risk of HIV infection and those who felt they were more at risk than other people were both statistically associated with failure to return. Self-perceived risk seemed to be of chief concern for failure to return for HIV test results and should be considered during pre-test counselling.


Subject(s)
Anonymous Testing , HIV Infections/diagnosis , Mass Screening/methods , Patient Acceptance of Health Care/statistics & numerical data , Treatment Refusal/statistics & numerical data , Adult , Ambulatory Care Facilities , Female , France , HIV Infections/prevention & control , Health Behavior , Health Knowledge, Attitudes, Practice , Health Services Accessibility/statistics & numerical data , Humans , Male , Mass Screening/statistics & numerical data , Middle Aged , Patient Dropouts/psychology , Patient Dropouts/statistics & numerical data , Socioeconomic Factors , Surveys and Questionnaires , Treatment Refusal/psychology , Young Adult
3.
Presse Med ; 41(1): e1-9, 2012 Jan.
Article in French | MEDLINE | ID: mdl-21802247

ABSTRACT

UNLABELLED: Unlike Anglo-Saxon countries, the rate of preventable readmissions is not a national quality indicator in France. In the context of the European research project Performance Assessment Tool for quality improvement in Hospitals (PATH), this pilot study provides a tool for health professionals to more easily identify preventable readmissions in order to analyze their causes. The objective of this work was to show the reliability of this tool. METHODS: We compared the rate of preventable readmissions occurring within 30 days, for a given disease, collected by analyzing medical reports (the gold standard rate of this study) to the rates of preventable readmissions occurring within 30 days, measured from algorithms using data from the French Programme of Medicalization of Information Systems (PMSI). The data were derived from PMSI data of the Lariboisiere-Fernand-Widal Hospital, a university hospital in Paris. RESULTS: The community-acquired pneumonia gold standard rate of preventable readmissions occurring within 30 days was 6.3 %. Five algorithmic tools were used and measured rates between 2.9 % and 7.9 %. The positive likelihood ratios of these tools range from 8 to 308. CONCLUSION: This work presents a tool aimed at the health professionals that takes into account the diversity and complexity of the causes of avoidable readmissions, resulting from the quality of medical practice, the variability of the organization of hospital pathways and the links with ambulatory care.


Subject(s)
Community-Acquired Infections/prevention & control , Continuity of Patient Care/standards , Patient Readmission/statistics & numerical data , Pneumonia/prevention & control , Quality Indicators, Health Care , Quality of Health Care , Aged , Algorithms , Community-Acquired Infections/epidemiology , Community-Acquired Infections/therapy , Community-Acquired Infections/transmission , Continuity of Patient Care/statistics & numerical data , Female , Forecasting , France , Hospitals, University , Humans , Male , Paris , Pilot Projects , Pneumonia/epidemiology , Pneumonia/therapy , Predictive Value of Tests , Quality Indicators, Health Care/standards , Quality Indicators, Health Care/statistics & numerical data , Quality of Health Care/statistics & numerical data , Reproducibility of Results
4.
Sante Publique ; 23(5): 401-12, 2011.
Article in French | MEDLINE | ID: mdl-22177706

ABSTRACT

The services of general interest provided by hospitals, such as free HIV clinics, have been funded since 2005 by a lump sum covering all costs. The allocation of the budget was initially determined based on historical and declarative data. However, the French Ministry of Health (MoH) recently outlined new rules for determining the allocation of financial resources and contracting hospitals for each type of services of general interest provided. The aim of this study was to estimate the annual cost of a public free anonymous HIV-testing center and to assess the budgetary implications of new financing systems. Three financing options were compared: the historic block grant; a mixed system recommended by the MoH associating a lump sum covering the recurring costs of an average center and a variable part based on the type and volume of services provided; and a fee-for-services system. For the purposes of this retrospective study, the costs and activity data of the HIV testing clinic of a public hospital located in the North of Paris were obtained for 2007. The costs were analyzed from the perspective of the hospital. The total cost was estimated at 555,698 euros. Personnel costs accounted for 31% of the total costs, while laboratory expenses accounted for 36% of the total costs. While the estimated deficit was 292,553 euros under the historic system, the financial balance of the clinic was found to be positive under a fee-for-services system. The budget allocated to the HIV clinic under the system recommended by the MoH covers most of the current expenses of the HIV clinic while meeting the requirements of free confidential care.


Subject(s)
Anonymous Testing/economics , HIV Infections/diagnosis , Outpatient Clinics, Hospital/economics , Costs and Cost Analysis , Financing, Government/methods , France , Humans , Retrospective Studies
5.
Breast Cancer Res Treat ; 126(3): 729-38, 2011 Apr.
Article in English | MEDLINE | ID: mdl-20872242

ABSTRACT

Breast cancer (BC) survivors are at increased risk of second cancers. Obesity is commonly recognized as a risk factor of BC in postmenopausal period and a prognosis factor in BC regardless of menopausal status. Our aim was to study whether overweight BC survivors were at increased risk of contralateral BC (CBC). Our population was a large cohort of women followed since a first BC without distant spread and/or synchronous CBC. Body mass index (BMI) was assessed at diagnosis time. Binary codings of BMI were used to oppose overweight and obese patients to the others. Survival analyses were used including Cox models. Assumed hypothesis of proportional hazards was explored using graphical methods, Schoenfeld residuals and time-dependant covariates. In case of non-proportional hazards, survival models were computed over time periods. Over 15,000 patients were included in our study. Incidence of CBC was 8.8 (8.3-9.3)/1000 person-years and increased during follow-up. A significant time-dependent association between overweight and CBC was observed. After 10 years of follow-up, we found a significant increased hazard of CBC among patients with a BMI above 25 kg/m(2): the adjusted hazard ratio was 1.50(1.21-1.86), P = 0.001. After 10 years of follow-up, our study found a poorer prognosis among overweight BC survivors regarding CBC events. While benefits from diet habits and weight control may be expected during the long-term follow-up, they have yet to be established using randomized clinical trials.


Subject(s)
Breast Neoplasms/diagnosis , Neoplasms, Second Primary/diagnosis , Obesity/complications , Adolescent , Adult , Aged , Aged, 80 and over , Body Mass Index , Breast Neoplasms/pathology , Breast Neoplasms/secondary , Cohort Studies , Female , Follow-Up Studies , Humans , Middle Aged , Neoplasms, Second Primary/pathology , Obesity/pathology , Overweight , Prognosis , Proportional Hazards Models , Risk , Time Factors
7.
Gastroenterol Clin Biol ; 31(12): 1098-103, 2007 Dec.
Article in English | MEDLINE | ID: mdl-18176365

ABSTRACT

OBJECTIVES: The aim of this prospective epidemiological study was to determine the incidence of inflammatory bowel diseases (IBD) in Corsica using the same methodology as that of the EPIMAD registry. METHODS: Between January 1st, 2002 and December 31, 2003, all gastroenterologists in Corsica (N=19) enrolled patients consulting for the first time with clinical symptoms compatible with IBD. Each case was reviewed by another expert gastroenterologist to assign a diagnosis of definite, probable, possible Crohn's disease (CD), ulcerative colitis (UC) or unclassified/able chronic colitis. RESULT: Eighty-one new cases were recorded, including seventy-one diagnoses of IBD (definite and probable cases), with 20 (28%) CD, 49 (69%) UC and 2 (3%) unclassifiable chronic colitis. The age-adjusted incidence (per 105 inhabitants/year) was 4.05 for CD and 9.5 for UC. The female/male ratio and median age at time of diagnosis were 1.3 and 29 years for CD and 0.63 and 44 years for UC, respectively. The median time from symptom onset to diagnosis was five months for both diseases. CONCLUSION: In Corsica, the observed incidence of CD is close to that observed in other metropolitan French regions. These data are contrary to the north-south gradient reported for this disease. Our figure of 9.5/10(5) for UC in Corsica is two-fold higher than reported in other metropolitan French regions. Genetic and/or environmental factors may explain these findings.


Subject(s)
Inflammatory Bowel Diseases/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Chronic Disease , Cohort Studies , Colitis/epidemiology , Colitis, Ulcerative/epidemiology , Colonoscopy/statistics & numerical data , Crohn Disease/epidemiology , Epidemiologic Studies , Female , France/epidemiology , Humans , Incidence , Male , Middle Aged , Prospective Studies , Registries , Rural Health/statistics & numerical data , Time Factors , Urban Health/statistics & numerical data
8.
Presse Med ; 34(5): 353-7, 2005 Mar 12.
Article in French | MEDLINE | ID: mdl-15859568

ABSTRACT

OBJECTIVES: Analysis of the tuberculosis cases reported in France in patients treated with infliximab since its marketing approval, assessment of the effect of changes in the summary of product characteristics and national guidelines. METHODS: Based on tuberculosis reports from the national post-marketing adverse drug reaction databank of the manufacturer from January 1, 2000 through June 30, 2003, and records from the national multicenter retrospective survey on opportunistic infections with anti-TNFalpha, we analyzed all cases of tuberculosis and the impact of the changes made in December 2000 in the summary of product characteristics and the guidelines on the prevention and management of tuberculosis in patients treated with infliximab published in February 2002. RESULTS: 56 cases of tuberculosis were reported: the median interval before diagnosis was 12 weeks with a median of 3 infusions. The presence of Koch bacilli was confirmed in 32 patients; 29 patients had extrapulmonary or disseminated forms of tuberculosis. The tuberculosis rate among patients treated with infliximab was greater than among the general population and differed significantly by period (p < 0.005). CONCLUSION: Tuberculosis can occur within the first 12 weeks of treatment with infliximab. Information for practitioners must be continued, together with surveillance of the tuberculosis cases in France.


Subject(s)
Antibodies, Monoclonal/adverse effects , Antirheumatic Agents/adverse effects , Gastrointestinal Agents/adverse effects , Tuberculosis/etiology , Adolescent , Adult , Adverse Drug Reaction Reporting Systems , Aged , Aged, 80 and over , Arthritis, Rheumatoid/drug therapy , Child , Crohn Disease/drug therapy , Female , France/epidemiology , Health Surveys , Humans , Infliximab , Male , Middle Aged , Tuberculosis/epidemiology
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