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Optimizing health care in developing countries

Issues in Science and Technology 1994年第2期11卷 42-42页

作者： Saxenian, H. Population Health and Nutrition Department World Bank.

LDCs could provide quality health care to a large segment of their populations by concentrating public spending on a specified package of highly cost-effective public health and clinical services. Two criteria that are crucial for developing this package--the cost effectiveness of interventions and the burden of disease--are examined.

关键词：数据收集发展中国家/经济学筹资政府卫生经费支出/统计学和数值数据健康计划/经济学贫困

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A comparison of dental care expenditures and office-based medical care expenditures, 1987

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 1999年第5期130卷 659-666页

作者： Manski, RJ Moeller, JF Maas, WR Univ Maryland Sch Dent Dept Oral Hlth Care Delivery Baltimore MD 21201 USA US Dept HHS Agcy Hlth Care Policy & Res Rockville MD 20852 USA

Background. This article compares national estimates of utilization of and expenditures for dental care and office-based medical care. The comparison includes respondents in several socioeconomic and demographic categories. Methods. The focus of the analyses is on dental care and office-based medical care utilization during 1987. Specifically, the authors provide national estimates for numbers of dental and office-based medical visits made, expenditures for and sources of payment for each of several socioeconomic and demographic categories using household survey data from the 1987 National Medical Expenditure Survey, or NMES. Results. Data show that out-of-pocket expenditures are greater for dental care than for office-based medical care;that few Medicaid dollars are spent on dental care;that insurance is an important component of dental and office-based medical care;and that dentists provide greater amounts of unreimbursed care than do their office-based physician counterparts. Conclusions. NMES data show that dental care expenditures are considerable, almost as large as expenditures for office-based medical care, and are a significant component of all nonhospital health care expenditures for noninstitutionalized Americans. Practice Implications. U.S. dentists provide a significant amount of care. By understanding these analyses, practitioners will be better positioned to provide care and to better meet the dental needs of all Americans.

关键词：数据收集牙科保健服务/经济学牙科保健服务/统计学和数值数据卫生经费支出/统计学和数值数据诊室就医/经济学诊室就医/统计学和数值数据偿还途径/经济学偿还途径/统计学和数值数据社会经济因素美国青少年成年人女(雌)性人类男(雄)性中年人

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Direct costs of ankylosing spondylitis and its determinants:: an analysis among three European countries

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ANNALS OF THE RHEUMATIC DISEASES 2003年第8期62卷 732-740页

作者： Boonen, A van der Heijde, D Landewé, R Guillemin, F Rutten-van Mölken, M Dougados, M Mielants, H de Vlam, K van der Tempel, H Boesen, S Spoorenberg, A Schouten, H van der Linden, S Univ Hosp Dept Internal Med Div Rheumatol NL-6202 AZ Maastricht Netherlands Univ Hosp Dept Clin Epidemiol & Eval Nancy France Erasmus Univ Inst Med Technol Assessment Rotterdam Netherlands Univ Paris 05 Dept Rheumatol Hop Cochin Paris France Ghent Univ Hosp Dept Rheumatol B-9000 Ghent Belgium Maasland Ziekenhuis Sittard Sittard Netherlands Univ Maastricht Fac Hlth Sci Maastricht Netherlands Univ Maastricht Dept Methodol & Stat Maastricht Netherlands

Objective: To assess direct costs associated with ankylosing spondylitis (AS). To determine which variables, including country, predict costs. Methods: 216 patients with AS from the Netherlands, France, and Belgium participated in a two year observational study and filled in bimonthly economic questionnaires. Disease related healthcare resource use was measured and direct costs were calculated from a societal perspective (true cost estimates) and from a financial perspective (country-specific tariffs). Predictors of costs were assessed using Cox's regression analysis. Results: 209 patients provided sufficient data for cost analysis. Mean annual societal direct costs for each patient were E2640, of which 82% were direct healthcare costs. In univariate analysis costs were higher in the Netherlands than in Belgium, but this difference disappeared after adjusting for baseline differences in patients' characteristics among countries. Longer disease duration, lower education, worse physical function, and higher disease activity were predictors of costs. Mean annual direct costs from a financial perspective were E2122, E1402, and E941 per patient in the Netherlands, France, and Belgium, respectively. For each country, costs from a financial perspective were significantly lower than costs from a societal perspective. Conclusion: Direct costs for AS are substantial in three European countries but not significantly different after adjusting for baseline characteristics among countries. Worse physical function and higher disease activity are important determinants of costs, suggesting better disease control might reduce the costs of AS. The difference in costs from a societal and financial perspective emphasises the importance of an economic analysis.

关键词：抗风湿药/经济学比利时患病代价直接服务费用/统计学和数值数据药费支出随访研究法国卫生经费支出/统计学和数值数据卫生服务/统计学和数值数据荷兰前瞻性研究疾病严重程度指数脊柱炎强直性/经济学脊柱炎强直性/治疗统计学(主题) 青少年成年人老年人女(雌)性人类男(雄)性中年人

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Public hospital resource allocations in El Salvador: accounting for the case mix of patients

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HEALTH POLICY AND PLANNING 1998年第3期13卷 296-310页

作者： Fiedler, JL Schmidt, RM Wight, JB Univ Richmond Richmond VA 23173 USA

National hospitals in developing countries command a disproportionate share of medical care budgets, justified on the grounds that they have a more difficult patient case mix and higher occupancy rates than decentralized district hospitals or clinics. This paper empirically tests the hypothesis by developing direct measures of the severity of patient illness, hospital case-mix and a resource intensity index for each of El Salvador's public hospitals. Based on an analysis of inpatient care staffing requirements, national hospitals are found to receive funding far in excess of what case-mix and case-load considerations would warrant. The findings suggest that significant system-wide efficiency gains can be realized by allocating hospital budgets on the bases of performance-related criteria which incorporate the case-mix approach developed here.

关键词：病床利用率/统计学和数值数据预算诊断相关患者组/分类诊断相关患者组/统计学和数值数据效率组织萨尔瓦多/流行病学卫生经费支出/统计学和数值数据卫生资源/分类卫生资源/利用卫生服务研究医院公立/经济学医院公立/组织和管理医院公立/利用年患病率人员配备和时间安排/统计学和数值数据疾病严重程度指数人类

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National Health Accounts development: lessons from Thailand

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HEALTH POLICY AND PLANNING 1999年第4期14卷 342-353页

作者： Tangcharoensathien, V Laixuthai, A Vasavit, J Tantigate, NA Prajuabmoh-Ruffolo, W Vimolkit, D Lertiendumrong, J Hlth Syst Res Inst Nonthaburi 11000 Thailand Chulalongkorn Univ Bangkok 10330 Thailand

National Health Accounts (NHA) are an important tool to demonstrate how a country's health resources are spent, on what services, and who pays for them. NHA are used by policy-makers for monitoring health expenditure patterns;policy instruments to re-orientate the pattern can then be further introduced. The National Economic and Social Development Board (NESDB) of Thailand produces aggregate health expenditure data but its estimation methods have several limitations. This has led to the research and development of an NHA prototype in 1994, through an agreed definition of health expenditure and methodology, in consultation with peer and other stakeholders. This is an initiative by local researchers without external support, with an emphasis on putting the system into place. It involves two steps: firstly, the flow of funds from ultimate sources of finance to financing agencies;and secondly, the use of funds by financing agencies. Five ultimate sources and 12 financing agencies (seven public and five private) were identified. Use of consumption expenditures was listed under four main categories and 32 sub-categories. Using 1994 figures, we estimated a total health expenditure of 128 305.11 million Baht;84.07% consumption and 15.93% capital formation. Of total consumption expenditure, 36.14% was spent on purchasing care from public providers, with 32.35% on private providers, 5.93% on administration and 9.65% on all other public health programmes. Public sources of finance were responsible for 48.79% and private 51.21% of the total 1994 health expenditure. Total health expenditure accounted for 3.56% of GDP (consumption expenditure at 3.00% of GDP and capital formation at 0.57% of GDP). The NESDB consumption expenditure estimate in 1994 was 180 516 million Baht or 5.01% of GDP, of which private sources were dominant (82.17%) and public sources played a minor role (17.83%). The discrepancy of consumption expenditure between the two estimates is 2.01% of GDP There is als

关键词：数据收集/方法卫生保健公平提供卫生经费支出/统计学和数值数据健康计划/方法卫生服务研究/方法泰国人类

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Researching the public/private mix in health care in a Thai urban area: methodological approaches

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HEALTH POLICY AND PLANNING 1998年第3期13卷 234-248页

作者： Pannarunothai, S Mills, A Univ London London Sch Hyg & Trop Med Hlth Policy Unit London WC1E 7HT England Buddhachinaraj Hosp Phitsanulok Thailand

The private health sector has been growing rapidly in many low and middle income countries, yet not enough is known about its sources of finance or characteristics of its users. Moreover, health care reform measures are leading to alterations in the mix of public and private finance and provision, increasing further the need for information. This paper presents and evaluates some research methods which can be used to collect information relevant to considering policies on the public/private mix. They comprise a household survey, a health diary and interview survey, a bed census, and a health resource survey. Each method is described as it was used in a study in a large urban setting in Thailand, and strengths and weaknesses of the methods are identified. The use of data to estimate the shares of public and private finance and provision, and particularly private sources of finance of public hospitals and public sources of finance for private hospitals, is demonstrated. Policy issues highlighted by the data are identified.

关键词：卫生保健改革卫生保健调查/方法卫生经费支出/统计学和数值数据医院私立/经济学医院私立/统计学和数值数据医院私立/利用医院公立/经济学医院公立/统计学和数值数据医院公立/利用收入/统计学和数值数据模型经济计量学私营部门/经济学私营部门/统计学和数值数据公共卫生管理/经济学公共卫生管理/统计学和数值数据社会经济因素泰国

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Out-of-pocket health care costs among older Americans

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JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES 2000年第1期55卷 S51-S62页

作者： Crystal, S Johnson, RW Harman, J Sambamoorthi, U Kumar, R Rutgers State Univ Inst Hlth Hlth Care Policy & Aging Res Div Aging New Brunswick NJ 08901 USA Urban Inst Washington DC 20037 USA

Objectives. Despite Medicare, elderly persons are exposed to substantial out-of-pocket health care cost burdens. As Medicare reform proposals are considered, it is important to determine the current size, distribution, and burden of these expenditures. Methods. Data From the 1995 Medicare Current Beneficiary Survey were used to analyze out-of-pocket expenditures and their burden in relation to income;the proportion of total health care expenditures paid out-of-pocket;and the role of pharmacy, hospital, physician, and other services in overall out-of-pocket spending. Results. Expenditures averaged 19.0% of income, for full-year Medicare beneficiaries alive during all of 1995. In bivariate analyses, higher-burden subgroups included those in poor health (28.5% of income), older than age 85 (22.4%), and with income in the lowest quintile (31.5%, despite Medicaid coverage for some). Those relying on fee-for-service Medicare only (23.0%) or with self-purchased supplemental insurance (25.5%) experienced more burden than those with employer-sponsored coverage or in HMOs. In multivariate analyses, functional impairment, number of medical conditions, self-perceived health and privately-purchased supplemental coverage were each associated with higher out-of-pocket burden, while HMO participation was associated with lower burden. Out-of-pecker expenditures averaged 15.2% of total health care expenditures with the proportion highest (22.6%) for those with no supplemental coverage. More than half of out-of-pocket payments for health care services were for prescription drugs and dental services. Discussion. Out-of-pocket cost burdens fall most heavily on those with chronic health conditions and without employer-subsidized supplemental coverage or Medicaid. Impact of Medicare reform proposals on these subgroups needs to be carefully evaluated.

关键词：患病代价筹资个人/经济学老年人身心健康评价卫生保健费用/统计学和数值数据卫生经费支出/统计学和数值数据收入 Medicaid/经济学 Medicare/经济学美国老年人老年人 80以上女(雌)性人类男(雄)性

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Declining payments for emergency department care, 1996-1998

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ANNALS OF EMERGENCY MEDICINE 2003年第3期41卷 299-308页

作者： Tsai, AC Tamayo-Sarver, JH Cydulka, RK Baker, DW Case Western Reserve Univ Dept Epidemiol & Biostat Sch Med Cleveland OH 44106 USA Metrohlth Med Ctr Dept Emergency Med Cleveland OH USA Northwestern Univ Feinberg Sch Med Div Gen Internal Med Dept Med Chicago IL 60611 USA

Study objective: We describe recent trends in payments from different payer classes and assess their relative importance to the financial solvency of emergency departments. Methods: We used Medical Expenditure Panel Survey data from 1996 and 1998. The unit of analysis was the ED visit. Primary outcome measures were ED charges and payments. The independent variable of interest was payer class, and therefore, we limited our analysis to those either uninsured or covered by Medicare, Medicaid, or private insurance. Results: From 1996 to 1998, a declining percentage of total charges were paid, from 60.3% to 53.0% (difference -7.3%;95% confidence interval [Cl] -11.3% to -3.5%). Although the percentage of total charges paid by Medicaid, Medicare, and the uninsured remained constant, the percentage of total charges paid by the privately insured declined from 75.1% to 63.4% (difference -11.7%;95% Cl -16.6% to -6.7%). Overall, adjusted mean ED charge increased from $695 to $798 (difference $103;95% Cl $61 to $146). Two payer classes experienced statistically significant increases in adjusted mean charge: the uninsured, from $544 to $740 (difference $196;95% Cl $62 to $330), and the privately insured, from $658 to $813 (difference $151;95% Cl $103 to $199). Although the adjusted mean payment rate for the uninsured remained stable, the adjusted mean payment rate for the privately insured declined from 77.7% to 65.7% (difference -12.0%;95% Cl -13.4% to -10.7%). Conclusion: The ability of EDs to provide emergency care to all regardless of ability to pay is increasingly threatened by declining overall payment rates. Cost shifting to fund care for the uninsured is an increasingly untenable financing strategy.

关键词：急诊室医院/经济学急诊室医院/发展趋势卫生经费支出/统计学和数值数据保险范围/经济学保险范围/统计学和数值数据 Medicaid/经济学 Medicaid/统计学和数值数据未参加医疗保险者/统计学和数值数据 Medicare/经济学 Medicare/统计学和数值数据美国/流行病学人类

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How good is the Dutch health-care system?

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ANNALS OF ONCOLOGY 2000年第11期11卷 1365-1366页

作者： [Anonymous]

How good is the Dutch health-care system? Annals of Oncology, Volume 11, Issue 11, 1 November 2000, Pages 1365–1366, https://***/10.1093/***.a010396 Published: 01 November 2000

关键词：预算欧洲预测卫生经费支出/统计学和数值数据卫生服务/经济学卫生服务/供应和分配预期寿命荷兰医师家庭/供应和分配转诊和会诊专业性职业人类

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Medicare expenditures on unsuccessful out-of-hospital resuscitations

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JOURNAL OF EMERGENCY MEDICINE 1999年第5期17卷 801-805页

作者： Suchard, JR Fenton, FR Powers, RD Hartford Hosp Dept EMS Trauma Hartford CT 06115 USA Univ Connecticut Sch Med Div Emergency Med Farmington CT USA

Numerous studies have shown the futility of continued emergency department (ED) resuscitative efforts for victims of out-of hospital cardiac arrest when prehospital resuscitation has failed. Nevertheless, these patients continue to arrive in the ED, where they create a strain on resources, To assess the economic cost of this, Medicare expenditures were determined for resuscitative efforts on victims of atraumatic, out-of-hospital cardiac arrest subsequently pronounced dead in the ED. Charts of patients pronounced dead in the ED of a 65,000-visit urban teaching hospital during 1995 were reviewed. Selected patients met the following criteria: 1) Medicare recipient age 65 or over;2) atraumatic, out-of-hospital arrest;3) transported to the ED by an EMS crew authorized to perform advanced cardiac life support interventions. A total of 105 cases were identified that met inclusion criteria and for which Medicare had claims on file corresponding to the date of death. Ambulance service payments ranged from $105-$391;mean = $263, Physician service payments ranged from $8-$106;mean = $65, Payments for Medicare Part A (hospital facility) ranged from $59-$1,025;mean = $436, The total Medicare reimbursement was $80,197, mean = $764, This annualizes to a national expenditure projection of $58 million. Failed out-of-hospital resuscitation for Medicare patients is associated with poor outcome and high cost. Termination of these efforts in the prehospital arena is unlikely to affect outcome, and would result in considerable cost savings on physician and hospital facility charges. Compassionate protocols that recognize these principles should be developed and Implemented. (C) 1999 Elsevier Science Inc.

关键词：救护车/经济学康涅狄格急救医疗服务/经济学卫生经费支出/统计学和数值数据心脏停搏/治疗保险医师工作 Medicare/利用医师复苏术/经济学治疗失败美国老年人人类

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