Rationing in healthcare-a scoping review.

Healthcare rationing has been the subject of numerous debates and concerns in the field of health economics in recent years. It is a concept which refers to the allocation of scarce healthcare resources and involves the use of different approaches to the delivery of health services and patient care. Regardless of the approach used, healthcare rationing fundamentally involves withholding potentially beneficial programs and/or treatments from certain people. As the demands placed on health services continue to rise and with that significant increases to the cost, healthcare rationing has become increasingly popular and is deemed necessary for the delivery of affordable, patient-care services. However, public discourse on this issue has largely been centered on ethical considerations with less focus on economic rationality. Establishing the economic rationality of healthcare rationing is essential in healthcare decision-making and consideration of its adoption by healthcare authorities and organizations. This scoping review of seven articles demonstrates that the economic rationality of healthcare rationing is the scarcity of healthcare resources amidst increased demand and costs. Therefore, supply, demand, and benefits are at the core of healthcare rationing practices and influence decisions on its suitability. Given the increased costs of care and resource scarcity, healthcare rationing is a suitable practice towards ensuring healthcare resources are allocated to people in a rational, equitable, and cost-effective manner. The rising costs and demands for care place significant pressure on healthcare authorities to identify suitable strategies for the allocation of healthcare resources. Healthcare rationing as a priority-setting strategy would support healthcare authorities identify mechanisms to allocate scarce resources in a cost-effective manner. When used in the context of a priority-setting approach, healthcare rationing helps healthcare organizations and practitioners to ensure that patient populations achieve maximum benefits at reasonable costs. It represents a fair allocation of healthcare resources to all populations, especially in low-income settings.

COVID-19 Pandemic and Healthcare Communication: A Patient-Centric Evaluation of Treatment and Diagnostic Procedures in Poland.

BACKGROUND The COVID-19 pandemic necessitated swift and often abrupt changes in healthcare practices, significantly influencing treatment and diagnostic procedures. This study aimed to gauge patient perceptions regarding these changes and their overall impact on the treatment and diagnosis process (ITDP). MATERIAL AND METHODS In March 2022, we conducted a cross-sectional online survey among 1860 Polish residents (mean age: 48.82±16.57 years), who had accessed medical services within the preceding 24 months. We employed a binary logistic regression model to pinpoint independent factors contributing to a wholly negative perception of the pandemic's influence on the ITDP. RESULTS Around 64.3% of respondents perceived the ITDP during the pandemic negatively, with 20.8% reporting mixed impacts. Of 22 factors considered, 16 were significantly associated with ITDP perceptions in univariate analyses, and 8 qualified for the final multivariate model. The most potent predictors of negative ITDP perceptions included impeded communication with medical personnel due to the emphasis on COVID-19 (OR=2.82; 95% CI: 2.04-3.90) and worsening family financial circumstances during the pandemic (OR=2.03; 95% CI: 1.26-3.27). Other significant predictors comprised viewing remote services as a hindrance to medical communication, higher education, and use of self-funded private healthcare. CONCLUSIONS Our findings confirm that negative perceptions of the ITDP during the COVID-19 pandemic are associated with the remote delivery of medical services and communication challenges. These insights underscore the need to improve these domains for better healthcare delivery amid ongoing or future health crises.

Case report: Unusual patient with dermatomyositis associated with SARS-CoV-2 infection.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak is a major challenge for clinicians. SARS-CoV-2 infection results in coronavirus disease 2019 (COVID-19), and it is best known for its respiratory symptoms. It can also result in several extrapulmonary manifestations such as neurological complications potentially experienced during the course of COVID-19. The association of dermatomyositis (DM) with COVID-19 pathogenesis has not been well-studied. This study aimed to present a previously healthy 37-year-old man, a soldier by profession, with symptoms of DM on the 4th day from the onset of COVID-19. The patient presented DM symptoms with both skin and muscle manifestations. The patient suffered from cough, fever, and fatigue to begin with, and reverse-transcription polymerase chain reaction (RT-PCR) reported positive for SARS-CoV-2 infection. The laboratory findings showed, intra alia, elevated muscle enzymes CK 8253 U/l (N: <145 U/l), a positive test for myositis-specific autoantibodies (anti-Mi-2), electrodiagnostic tests exhibited features of myopathy, with the presence of muscle and skin symptoms. The patient improved with corticosteroids and immunosuppressive agent therapy. In summary, the association between COVID-19 and the development of multi-system autoimmune disorders such as DM remains unclear. Nevertheless, viral infections such as SARS-CoV-2 may likely serve as a trigger.

Comprehensive Cardiac Care: How Much Does It Cost?

The benefits of coordinating care between healthcare professionals and institutions are the main drivers behind reforms to the payment and delivery system for healthcare services. The purpose of this study was to analyse the costs incurred by the National Health Fund in Poland related to the comprehensive care model for patients after myocardial infarction (CCMI, in Polish: KOS-Zawal). METHODS: The analysis involved data from 1 October 2017 to 31 March 2020 for 263,619 patients who received treatment after a diagnosis of first or recurrent myocardial infarction as well as data for 26,457 patients treated during that period under the CCMI programme. RESULTS: The average costs of treating patients covered by the full scope of comprehensive care and cardiac rehabilitation under the programme (EUR 3113.74/person) were higher than the costs of treating patients outside of that programme (EUR 2238.08/person). At the same time, a survival analysis revealed a statistically significantly lower probability of death (p < 0.0001) in the group of patients covered by CCMI compared to the group not covered by the programme. CONCLUSIONS: The coordinated care programme introduced for patients after myocardial infarction is more expensive than the care for patients who do not participate in the programme. Patients covered by the programme were more often hospitalised, which might have been due to the good coordination between specialists and responses to sudden changes in patients' conditions.