Skip header and navigation

Refine By

316 records – page 1 of 32.

A 10 year asthma programme in Finland: major change for the better.

https://arctichealth.org/en/permalink/ahliterature168103
Source
Thorax. 2006 Aug;61(8):663-70
Publication Type
Article
Date
Aug-2006
Author
T. Haahtela
L E Tuomisto
A. Pietinalho
T. Klaukka
M. Erhola
M. Kaila
M M Nieminen
E. Kontula
L A Laitinen
Author Affiliation
Skin and Allergy Hospital, Helsinki University Central Hospital, P O Box 160, FIN-00029 HUS, Finland. tari.haahtela@hus.fi
Source
Thorax. 2006 Aug;61(8):663-70
Date
Aug-2006
Language
English
Publication Type
Article
Keywords
Adult
Anti-Asthmatic Agents - therapeutic use
Asthma - economics - epidemiology - therapy
Child
Communication
Cost of Illness
Disabled Persons
Emergency Treatment - statistics & numerical data
Finland - epidemiology
Health Promotion - economics - organization & administration - trends
Hospitalization - statistics & numerical data
Humans
Incidence
Insurance, Disability - economics
Interprofessional Relations
National Health Programs - economics - trends
Pharmaceutical Services - standards
Primary Health Care
Program Evaluation
Smoking - epidemiology
Abstract
A National Asthma Programme was undertaken in Finland from 1994 to 2004 to improve asthma care and prevent an increase in costs. The main goal was to lessen the burden of asthma to individuals and society.
The action programme focused on implementation of new knowledge, especially for primary care. The main premise underpinning the campaign was that asthma is an inflammatory disease and requires anti-inflammatory treatment from the outset. The key for implementation was an effective network of asthma-responsible professionals and development of a post hoc evaluation strategy. In 1997 Finnish pharmacies were included in the Pharmacy Programme and in 2002 a Childhood Asthma mini-Programme was launched.
The incidence of asthma is still increasing, but the burden of asthma has decreased considerably. The number of hospital days has fallen by 54% from 110 000 in 1993 to 51 000 in 2003, 69% in relation to the number of asthmatics (n = 135 363 and 207 757, respectively), with the trend still downwards. In 1993, 7212 patients of working age (9% of 80 133 asthmatics) received a disability pension from the Social Insurance Institution compared with 1741 in 2003 (1.5% of 116 067 asthmatics). The absolute decrease was 76%, and 83% in relation to the number of asthmatics. The increase in the cost of asthma (compensation for disability, drugs, hospital care, and outpatient doctor visits) ended: in 1993 the costs were 218 million euro which had fallen to 213.5 million euro in 2003. Costs per patient per year have decreased 36% (from 1611 euro to 1031 euro).
It is possible to reduce the morbidity of asthma and its impact on individuals as well as on society. Improvements would have taken place without the programme, but not of this magnitude.
Notes
Cites: Eur Respir J. 1999 Aug;14(2):288-9410515403
Cites: BMJ. 1996 Mar 23;312(7033):762-68605467
Cites: Allergy. 2005 Mar;60(3):283-9215679712
Cites: N Engl J Med. 2005 Apr 14;352(15):1519-2815829533
Cites: BMJ. 2005 May 21;330(7501):1186-715849204
Cites: Thorax. 2005 Jul;60(7):545-815994260
Cites: Eur Respir J. 2000 Feb;15(2):235-710706483
Cites: Respir Med. 2000 Apr;94(4):299-32710845429
Cites: CMAJ. 1999 Nov 30;161(11 Suppl):S1-6110906907
Cites: Pediatr Allergy Immunol. 2000 Nov;11(4):236-4011110578
Cites: Eur Respir J. 2000 Nov;16(5):802-711153575
Cites: Am J Respir Crit Care Med. 2001 Aug 15;164(4):565-811520716
Cites: Thorax. 2001 Oct;56(10):806-1411562522
Cites: J Allergy Clin Immunol. 2001 Nov;108(5 Suppl):S147-33411707753
Cites: Eur Respir J. 2002 Aug;20(2):397-40212212973
Cites: Thorax. 2003 Feb;58 Suppl 1:i1-9412653493
Cites: Int J Tuberc Lung Dis. 2003 Jun;7(6):592-812797704
Cites: J Allergy Clin Immunol. 2004 Jul;114(1):40-715241342
Cites: Scand J Public Health. 2004;32(4):310-615370772
Cites: Am Rev Respir Dis. 1985 Apr;131(4):599-6063994155
Cites: N Engl J Med. 1991 Aug 8;325(6):388-922062329
Cites: N Engl J Med. 1994 Sep 15;331(11):700-58058076
Cites: Qual Health Care. 1994 Mar;3(1):45-5210136260
Cites: BMJ. 1996 Mar 23;312(7033):748-528605463
Cites: Eur Respir J. 2004 Nov;24(5):734-915516665
PubMed ID
16877690 View in PubMed
Less detail

2020 healthcare management in Canada: a new model home next door.

https://arctichealth.org/en/permalink/ahliterature184152
Source
Healthc Manage Forum. 2003;16(1):6-10, 44-9
Publication Type
Article
Date
2003
Author
D Wayne Taylor
Author Affiliation
Michael G. DeGroote School of Business, McMaster University.
Source
Healthc Manage Forum. 2003;16(1):6-10, 44-9
Date
2003
Language
English
French
Publication Type
Article
Keywords
Canada
Cost Sharing
Efficiency
Employment - statistics & numerical data - trends
Health Care Reform
Health Expenditures - trends
Health Services Needs and Demand - trends
Humans
Models, organizational
National Health Programs - economics - organization & administration - trends
Politics
Population Dynamics
Social Change
Social Values
Taxes - trends
Abstract
The Commission on the Future of Health Care in Canada asked whether Medicare is sustainable in its present form. Well, Medicare is not sustainable for at least six reasons. Given a long list of factors, such as Canada's changing dependency ratio, the phenomenon of diminishing returns from increased taxation, competing provincial expenditure needs, low labour and technological productivity in government-funded healthcare, the expectations held by baby boomers, and the evolving value sets of Canadians--Medicare will impoverish Canada within the next couple of decades if not seriously recast. As distasteful as parallel private-pay, private-choice healthcare may be to some policy makers and providers who grew up in the 1960s, the reality of the 2020s will dictate its necessity as a pragmatic solution to a systemic problem.
PubMed ID
12908160 View in PubMed
Less detail

AARN applauds Romanow Report. Urges all levels of government to work together to improve health care.

https://arctichealth.org/en/permalink/ahliterature186148
Source
Alta RN. 2003 Jan;59(1):1, 4-5
Publication Type
Article
Date
Jan-2003

Access to care, health status, and health disparities in the United States and Canada: results of a cross-national population-based survey.

https://arctichealth.org/en/permalink/ahliterature169088
Source
Am J Public Health. 2006 Jul;96(7):1300-7
Publication Type
Article
Date
Jul-2006
Author
Karen E Lasser
David U Himmelstein
Steffie Woolhandler
Author Affiliation
Department of Medicine, The Cambridge Health Alliance and Harvard Medical School, Cambridge, Mass, USA. klasser@challiance.org
Source
Am J Public Health. 2006 Jul;96(7):1300-7
Date
Jul-2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada - epidemiology
Delivery of Health Care - economics - standards - utilization
Emigration and Immigration
Ethnic Groups
Female
Health Services Accessibility - economics - statistics & numerical data
Health services needs and demand - economics - statistics & numerical data
Health Status Indicators
Humans
Income
Life expectancy
Logistic Models
Male
Middle Aged
Multivariate Analysis
National Health Programs - economics - standards - utilization
Patient Satisfaction - ethnology
Quality of Health Care
Socioeconomic Factors
United States - epidemiology
Universal Coverage
Abstract
We compared health status, access to care, and utilization of medical services in the United States and Canada and compared disparities according to race, income, and immigrant status.
We analyzed population-based data on 3505 Canadian and 5183 US adults from the Joint Canada/US Survey of Health. Controlling for gender, age, income, race, and immigrant status, we used logistic regression to analyze country as a predictor of access to care, quality of care, and satisfaction with care and as a predictor of disparities in these measures.
In multivariate analyses, US respondents (compared with Canadians) were less likely to have a regular doctor, more likely to have unmet health needs, and more likely to forgo needed medicines. Disparities on the basis of race, income, and immigrant status were present in both countries but were more extreme in the United States.
United States residents are less able to access care than are Canadians. Universal coverage appears to reduce most disparities in access to care.
Notes
Cites: BMJ. 2000 Apr 1;320(7239):898-90210741994
Cites: Health Aff (Millwood). 1999 May-Jun;18(3):206-1610388217
Cites: Health Aff (Millwood). 2002 May-Jun;21(3):182-9112025982
Cites: Health Rep. 2002;13(2):23-3412743954
Cites: JAMA. 2004 Mar 3;291(9):1100-714996779
Cites: Health Aff (Millwood). 2004 May-Jun;23(3):89-9915160806
Cites: N Engl J Med. 2004 Sep 9;351(11):1137-4215356313
Cites: Health Aff (Millwood). 1990 Summer;9(2):185-922365256
Cites: JAMA. 1994 Aug 17;272(7):530-48046807
Cites: Am J Public Health. 1996 Apr;86(4):520-48604782
Cites: Health Rep. 1996 Spring;7(4):33-45, 37-508679956
Cites: Health Rep. 1996 Summer;8(1):25-32 (Eng); 25-33 (Fre)8844178
Cites: Stat Methods Med Res. 1996 Sep;5(3):311-298931198
Cites: Health Rep. 1996 Winter;8(3):29-38(Eng); 31-41(Fre)9085119
Cites: Am J Public Health. 1997 Jul;87(7):1156-639240106
Cites: Health Rep. 1995;7(2):25-32(Eng); 29-37(Fre)9395439
Cites: J Gen Intern Med. 1998 Feb;13(2):77-859502366
Cites: Ann Intern Med. 1998 Sep 1;129(5):406-119735069
Cites: Ann Intern Med. 1998 Sep 1;129(5):412-69735070
Cites: JAMA. 2000 Apr 26;283(16):2152-710791509
PubMed ID
16735628 View in PubMed
Less detail

Achievements and challenges of medicare in Canada: Are we there yet? Are we on course?

https://arctichealth.org/en/permalink/ahliterature173211
Source
Int J Health Serv. 2005;35(3):443-63
Publication Type
Article
Date
2005
Author
Stephen Birch
Amiram Gafni
Author Affiliation
Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada. birch@mcmaster.ca
Source
Int J Health Serv. 2005;35(3):443-63
Date
2005
Language
English
Publication Type
Article
Keywords
Canada
Health Expenditures - legislation & jurisprudence - statistics & numerical data
Health Policy
Health Services Accessibility
Health services needs and demand
Humans
National Health Programs - economics - utilization
Needs Assessment
Policy Making
Poverty
Program Evaluation
Universal Coverage
Abstract
Health care policy in Canada is based on providing public funding for medically necessary physician and hospital-based services free at the point of delivery ("first-dollar public funding"). Studies consistently show that the introduction of public funding to support the provision of health care services free at the point of delivery is associated with increases in the proportionate share of services used by the poor and in population distributions of services that are independent of income. Claims about the success of Canada's health care policy tend to be based on these findings, without reference to medical necessity. This article adopts a needs-based perspective to reviewing the distribution of health care services. Despite the removal of user prices, significant barriers remain to services being distributed in accordance with need-the objective of needs-based access to services remains elusive. The increased fiscal pressures imposed on health care in the 1990s, together with the failure of health care policy to encompass the changing nature of health care delivery, seem to represent further departures from policy objectives. In addition, there is evidence of increasing public dissatisfaction with the performance of the system. A return to modest increases in public funding in the new millennium has not been sufficient to arrest these trends. Widespread support for first-dollar public funding needs to be accompanied by greater attention to the scope of the legislation and the adoption of a needs-based focus among health care policymakers.
PubMed ID
16119569 View in PubMed
Less detail

Adherence to statin therapy under drug cost sharing in patients with and without acute myocardial infarction: a population-based natural experiment.

https://arctichealth.org/en/permalink/ahliterature164224
Source
Circulation. 2007 Apr 24;115(16):2128-35
Publication Type
Article
Date
Apr-24-2007
Author
Sebastian Schneeweiss
Amanda R Patrick
Malcolm Maclure
Colin R Dormuth
Robert J Glynn
Author Affiliation
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120, USA. schneeweiss@post.harvard.edu
Source
Circulation. 2007 Apr 24;115(16):2128-35
Date
Apr-24-2007
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
British Columbia
Cohort Studies
Cost Sharing - economics - statistics & numerical data
Deductibles and Coinsurance - economics - statistics & numerical data
Drug Costs
Female
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - economics - therapeutic use
Insurance Coverage - economics - statistics & numerical data
Insurance, Pharmaceutical Services - classification - economics - statistics & numerical data
Male
Myocardial Infarction - drug therapy
National Health Programs - economics - statistics & numerical data
Patient Compliance - statistics & numerical data
Abstract
As medication spending grows, Medicare Part D will need to adapt its coverage policies according to emerging evidence from a variety of insurance policies. We sought to evaluate the consequences of copayment and coinsurance policies on the initiation of statin therapy after acute myocardial infarction and adherence to therapy in statin initiators using a natural experiment of all British Columbia residents aged 66 years and older.
Three consecutive cohorts that included all patients who began statin therapy during full drug coverage (2001), coverage with a $10 or $25 copay (2002), and coverage with a 25% coinsurance benefit (2003-2004) were followed up with linked healthcare utilization data (n=51,561). Follow-up of cohorts was 9 months after each policy change. Adherence to statin therapy was defined as > or = 80% of days covered. Relative to full-coverage policies, adherence to new statin therapy was significantly reduced, from 55.8% to 50.5%, under a fixed copayment policy (-5.4% points; 95% CI, -6.4% to -4.4%) and the subsequent coinsurance policy (-5.4% points; 95% CI, -6.3% to -4.4%). An uninterrupted increase in the proportion of patients initiating statin therapy after an acute myocardial infarction (1.7% points per quarter) was observed over the study period, similar to a Pennsylvania control population with full coverage. Sudden changes to full out-of-pocket spending, similar to Medicare's Part D "doughnut hole," almost doubled the risk of stopping statins (adjusted odds ratio, 1.94, 95% CI, 1.82 to 2.08).
Fixed patient copayment and coinsurance policies have negative effects on adherence to statin lipid-lowering drug therapy but not on their initiation after myocardial infarction.
PubMed ID
17420348 View in PubMed
Less detail

Alternative funding and delivery models: practice and prospects in Ontario.

https://arctichealth.org/en/permalink/ahliterature220892
Source
J Ambul Care Manage. 1993 Jul;16(3):19-29
Publication Type
Article
Date
Jul-1993

Ambulatory case mix funding systems in Canada.

https://arctichealth.org/en/permalink/ahliterature215824
Source
Healthc Manage Forum. 1994;7(2):21-8
Publication Type
Article
Date
1994
Author
P. Jacobs
J R Lave
E. Hall
C. Botz
Author Affiliation
Department of Health Services Adminisration, University of Alberta, Edmonton.
Source
Healthc Manage Forum. 1994;7(2):21-8
Date
1994
Language
English
Publication Type
Article
Keywords
Alberta
Ambulatory Care - classification - economics
Ambulatory Surgical Procedures - classification - economics
Canada
Day Care - classification - economics
Diagnosis-Related Groups - economics
Emergency Medical Services - economics - utilization
Humans
Insurance, Hospitalization - statistics & numerical data
National Health Programs - economics
Ontario
Outpatient Clinics, Hospital - economics - utilization
Outpatients - classification
Rate Setting and Review - methods
United States
Abstract
The implementation of inpatient case mix funding in Alberta and Ontario does not allow for adequate incentives to shift resources to an outpatient basis, where appropriate, or to provide outpatient care efficiently. This paper explores the prospects and problems of further extending case mix tools into this area. The availability of tools to characterize output for day surgery, special clinics and emergency care is surveyed. We conclude that case mix funding is desirable and feasible for ambulatory surgery; however, it is questionable for emergency care and special clinics. However, developments in this area in the United States will continue, and this will likely maintain an interest in Canada.
PubMed ID
10171879 View in PubMed
Less detail

316 records – page 1 of 32.