The authors describe part of the results of a comparative clinico-economic analysis of the functioning of two models of organizational forms of psychiatric services with special reference to Moscow and Kaluga. The purpose of the given research fragment was to make a comparative analysis of expenditures on schizophrenic patients depending on the system of psychiatric services organization on the whole and between different types of services; to specify approaches to optimization of their functioning with the use of a clinico-economic approach. Based on a comparative investigation of the representative groups of schizophrenic patients (386 patients of a mental health center in Moscow and 531 patients of the Kaluga regional psychiatric hospital No. 1), it has been established that as a result of the proper organization and financing of psychiatric services in Kaluga, the "direct" expenditures on one schizophrenic patient per year could be 20% as reduced and the losses of the national income could be lowered more than 2-fold. It should necessarily be mentioned that the financing of extra hospital services in Kaluga exceeded that in Moscow more than 3-fold, reaching about 20.3% of all the expenditures on schizophrenic patients. Apparently, the organizational and financial experience gained in Kaluga with the design of the common complex and many-staged system of psychiatric services may turn fairly instrumental in elaborating approaches to optimization of the functioning of psychiatric services.
Using the POPULIS framework, this project estimated health care expenditures across the entire population of Manitoba for inpatient and outpatient hospital utilization, physician visits, mental health inpatient, and nursing home utilization.
This estimated expenditure information was then used to compare per capita expenditures relative to premature mortality rates across the various areas of Manitoba.
Considerable variation in health care expenditures was found, with those areas having high premature mortality rates also having higher health care expenditures.
Dental services use by two cohorts under the universal dental plan for the elderly in Alberta, Canada, was examined.
Two birth cohorts 65 to 69 years old at entry who used the plan from 1978 to 1979 (n = 17,816) or from 1985 to 1986 (n = 27,474) were analyzed over 6 successive years for differences in dental services use and costs.
The 1985/86 cohort received 24% more visits per patient than the 1978/79 cohort. Their inflation-adjusted expenditures increased by 19% mainly as a result of increases in denturists' expenditures (33%) (dentists' expenditures increased just 4% because of lower plan fee increases). The 1985/86 cohort received relatively many more periodontal and fewer denture services. Annual attendance over 6 consecutive years was high, especially for the 1985/86 cohort and dentists' patients; 55% of the 1985/86 cohort who used dentists did so in 5 or all 6 years.
Differences in plan expenditures per patient between the birth cohorts and dentists and denturists, along with the high continuity of care for dentists' patients, have important implications for planning and administering dental plans for the elderly. The large expenditure decreases for removable dentures and the large increases for periodontal services to the 1985/86 cohort are noteworthy.
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Cites: Am J Public Health. 1989 Jan;79(1):47-512783297
Cites: J Am Dent Assoc. 1990 Jun;120(6):665-82112567
Cites: J Can Dent Assoc. 1994 May;60(5):403-68004517
Cites: J Public Health Dent. 1992 Fall;52(5):259-631404070
Long-term health care planning is presently not based on the needs of the population at the local level in Finland but rather, it is based on retroactive economic values and already realised budget in hospital and primary health care. The existing health care structure and its health care practices continue to guide the supply of services. While we have the most extensive databases on primary health care and hospital services, such tools are not used in the broadest possible sense in the present health care planning at the local level. Simple and informative indicators available to health care planners and decision-makers from databases at the local level were used to appraise the use of health care services. Statistical profiles of health care clients were classified by age groups within the health authority area (population of 13,000) of Paimio-Sauvo in south-western Finland with the intent to explain utilisation of primary health care services, their coverage, and repeat visits as well as groups not using those services. Physicians recorded reasons for each patient visit with the ICD-10 categories. In the case municipalities, primary health care services provided 100% coverage to children of 0-6 years of age and more than 70% coverage to other groups. Most primary health care expenditures were assessed for people 65 years or older in 2000. As an example of a municipality, hospital and primary health care expenditures within Paimio varied from 24 to 30.4% of the total obligations for the last 10 years.
In 2011, 88% of all unintentional injury fatalities occurred in home and leisure environments in Sweden, while transportation fatalities accounted for 10% and work/school injuries for 2%. The corresponding proportions among non-fatal injuries were 75, 12 and 13%, respectively. However, 83% of the national governmental expenditure on unintentional injury prevention in 2011 was allocated to transportation safety, 7% to home and leisure, and 10% to the work sector including schools. Likewise, around 85% of the governmental research budget aimed for unintentional injury research was allocated to the transportation sector, 9% to home and leisure environments, and 6% to the work and school sector. Our results reveal a striking lack of correspondence between problem profile and governmental countermeasures.
Costa Rica is one of the world's success stories in primary health care. During the past 20 years the country has experienced a demographic and epidemiological transition. However, during the 80's the economic recession severely affected the country. The social, economic, political and geographic contexts are important for the assessment of health policy. The longstanding democracy, investments in public education and health all contribute to the peace and stability. Assessment of health policy needs both a quantitative and qualitative approach. The policy-making process--how policies are made, translated into action and evaluated--is a research challenge. The national health policy 1986-1990 includes commitment to Health for All strategy; development of the National Health Care System; strengthening of the health care infrastructure; consolidation of health achievements and undertaking of new problems and approaches on integral care for the population; community participation in all health care system activities; and health care priorities. Important research issues are the relationship between the needs of the population and health policy development and the impacts of health policy on the health of the population. A comprehensive study of policy-making includes studies of policy content, process, output and evaluation of impacts (including economy of health policy), and analysis for policy, i.e. information for policy making, process and policy advocacy. Recent successful health policy issues are child health and HIV/AIDS, while water pollution and traffic accidents have been more problematic policy issues.
The extent to which better spending produces higher-quality care and better patient outcomes in a universal health care system with selective access to medical technology is unknown.
To assess whether acute care patients admitted to higher-spending hospitals have lower mortality and readmissions.
The study population comprised adults (>18 years) in Ontario, Canada, with a first admission for acute myocardial infarction (AMI) (n = 179,139), congestive heart failure (CHF) (n = 92,377), hip fracture (n = 90,046), or colon cancer (n = 26,195) during 1998-2008, with follow-up to 1 year. The exposure measure was the index hospital's end-of-life expenditure index for hospital, physician, and emergency department services.
The primary outcomes were 30-day and 1-year mortality and readmissions and major cardiac events (readmissions for AMI, angina, CHF, or death) for AMI and CHF.
Patients' baseline health status was similar across hospital expenditure groups. Patients admitted to hospitals in the highest- vs lowest-spending intensity terciles had lower rates of all adverse outcomes. In the highest- vs lowest-spending hospitals, respectively, the age- and sex-adjusted 30-day mortality rate was 12.7% vs 12.8% for AMI, 10.2% vs 12.4% for CHF, 7.7% vs 9.7% for hip fracture, and 3.3% vs 3.9% for CHF; fully adjusted relative 30-day mortality rates were 0.93 (95% CI, 0.89-0.98) for AMI, 0.81 (95% CI, 0.76-0.86) for CHF, 0.74 (95% CI, 0.68-0.80) for hip fracture, and 0.78 (95% CI, 0.66-0.91) for colon cancer. Results for 1-year mortality, readmissions, and major cardiac events were similar. Higher-spending hospitals had higher nursing staff ratios, and their patients received more inpatient medical specialist visits, interventional (AMI cohort) and medical (AMI and CHF cohorts) cardiac therapies, preoperative specialty care (colon cancer cohort), and postdischarge collaborative care with a cardiologist and primary care physician (AMI and CHF cohorts).
Among Ontario hospitals, higher spending intensity was associated with lower mortality, readmissions, and cardiac event rates.
Notes
Cites: N Engl J Med. 2009 Apr 2;360(14):1418-2819339721
Cites: Circulation. 2008 Dec 9;118(24):2596-64819001027
Cites: N Engl J Med. 2009 Oct 1;361(14):1368-7519797283
Cites: Med Care. 2010 Feb;48(2):157-6519927014
Cites: Med Care. 2010 Feb;48(2):125-3220057328
Cites: J Am Geriatr Soc. 2009 Nov;57(11):2046-5419793159
Cites: N Engl J Med. 2010 Feb 4;362(5):460-520054039
Cites: N Engl J Med. 2010 Feb 18;362(7):569-74; discussion 57420164482
Cites: N Engl J Med. 2010 Feb 18;362(7):569-73; discussion p 57420164483
Cites: Arch Intern Med. 2010 Feb 22;170(4):340-620177036
Cites: N Engl J Med. 2010 Mar 25;362(12):1110-820335587
Cites: Health Aff (Millwood). 2010 Aug;29(8):1523-3120679657
Cites: Circulation. 2010 Nov 2;122(18):1806-1420956211
Cites: Health Serv Res. 2010 Dec;45(6 Pt 2):1872-9220880043
Cites: Health Serv Res. 2010 Dec;45(6 Pt 2):1893-902; discussion 1908-1121108529
Cites: Ann Intern Med. 2011 Jan 18;154(2):94-10221242366
Cites: Ann Intern Med. 2011 Feb 1;154(3):160-721282695
Cites: N Engl J Med. 2011 Mar 17;364(11):1037-4521410372
Cites: Health Aff (Millwood). 2009 Jul-Aug;28(4):w566-7219460774
Cites: J Am Coll Cardiol. 2001 Mar 15;37(4):992-711263626
Cites: JAMA. 2001 Jun 27;285(24):3116-2211427140
Cites: N Engl J Med. 2002 May 16;346(20):1538-4412015393
Cites: N Engl J Med. 2002 May 30;346(22):1715-2212037152
Cites: N Engl J Med. 2002 Nov 21;347(21):1678-8612444183
Cites: Ann Intern Med. 2003 Feb 18;138(4):273-8712585825
Cites: Ann Intern Med. 2003 Feb 18;138(4):288-9812585826
Cites: Can J Cardiol. 2003 Mar 31;19(4):357-6412704479
Cites: Ann Intern Med. 2003 Oct 21;139(8):649-5714568853
Cites: JAMA. 2004 Mar 17;291(11):1358-6715026403
Cites: Stat Med. 1994 Nov 15;13(21):2233-477846422
Cites: Ann Intern Med. 1998 Jun 15;128(12 Pt 1):1010-209625664
Cites: Cancer. 2005 Feb 1;103(3):435-4115622523
Cites: J Bone Joint Surg Br. 2005 Mar;87(3):361-615773647
Cites: Circulation. 2006 Jan 24;113(3):333-516432064
Cites: Circulation. 2006 Jan 24;113(3):374-916432068
Cites: Circulation. 2006 Jan 24;113(3):380-716432069
Cites: Health Aff (Millwood). 2006 Mar-Apr;25(2):w34-4716464904
To compare the health costs of groups with and without psychiatric diagnoses (PDs) using 9 years of physician billing data.
A dataset containing registration data for all patients receiving public mental health service was constructed and subsequently matched, on age and sex, in a final patient to comparison patient ratio of 1:8, with health care users who did not receive treatment in the mental health system. Three groups emerged: a patient PD group-patients with psychiatric disorders treated in public mental health care (n = 76 677); a comparison patient PD group-comparison patients with PDs treated in physicians only (n = 277 627); and a patient- comparison patient non-PD group-patients (treated in specialized publicly funded care or by their physician) without PDs (n = 329 177). Examining over 42 million billing records for all of these patients, we compared the average number of visits and the average health only (nonpsychiatric) billing cost per each patient during the 9-year study period across the groups.
Among all health care users in the data, the health costs (Total Costs - Mental Health Costs) were greater on average for the patients with PD group ($3437) and the comparison patient PD group ($3265), compared with patient-comparison patient non-PD group ($1345). Forty-six percent of the comparison sample had a PD.
Having a mental health problem is related to greater health-related expenditures. This has important policy implications on how mental health resources are constructed and rationed within the health care system.
The aim of this study was to investigate attitudes to and experiences of dental care in a population, born 1942. The following items were studied: opinions of general and oral health, attitudes to and experiences of dental care, dental care habits, experiences of latest visit to a dentist, tobacco habits and use of various dental hygiene articles. A cross-sectional mail questionnaire was sent in 1992 to all 50-year-olds in two Swedish counties, Orebro and Ostergotland, totally 8888 persons; the response rate was 71%. Of the population 89%, indicated good health. Satisfaction with dental care was high, 94%. 26% stated attendance to a dentist twice or more per year, and 64% at least once a year. As to expenses, 78% paid less than 1000 SEK the last year. Concerning the latest visit, 38% reported painless treatment, 37% no inconvenience, and 55% good care. The duration of the latest visit included on an average 27 min in travel time, 7 min in waiting time and 27 min in treatment time. Information about oral hygiene was given to 29% and about cost for treatment to 47% of the interviewed. There were 28% daily smokers. Snuff was daily used by 10% of the males. Toothbrushing twice a day with fluoride toothpaste seemed to be the standard oral hygiene procedure and was reported by 80% of the respondents.
Centre for Health Services and Policy Research, Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada. morgan@chspr.ubc.ca
Prescription drug expenditures in North America have nearly doubled in the past 5 years, creating intense pressure for all public and private benefits managers and policymakers.
The objective of this study was to describe age-specific drug expenditure trends from 1996 to 2002 for the Canadian province of British Columbia.
This study shows changes in expenditures per capita quantified for 5 age categories: residents aged 0 to 19, 20 to 44, 45 to 64, 65 to 84, and 85 and older. The cost impacts of 7 determinants of prescription drug expenditures are quantified.
This study describes population-based, patient-specific pharmaceutical data showing the type, quantity, and cost of every prescription drug purchased by virtually all residents of British Columbia.
Population-wide expenditures per capita grew at a rate of 11.6% per annum. Growth was primarily driven by the selection of more costly drugs per course of treatment and increases in the number concomitant treatments received per patient. Population aging did not have a major impact on expenditures. However, expenditure per capita grew most rapid among residents aged 45 to 64, the cohort that expended most over the period. The aging of this demographic cohort may threaten the financial viability of age-based drug benefit programs.
