Cost Containment Measures Research Articles

The Ariadne's thread in co-payment, primary health care usage and financial crisis: findings from Cyprus public health care sector

ObjectivesCyprus entered a prolonged financial recession in 2011 and by early 2013 it applied for an international bail-out agreement. This presupposed massive reforms in public governance. Health sector was considerably reformed and one of the measures was the introduction of co-payment for outpatient visits to public health care sector. The scope of this study is to assess the impact of financial crisis and co-payment to public outpatient visits in Nicosia urban and greater Nicosia region. Study designAn Interrupted time-series analysis. MethodsAll outpatient visits to public health care family doctor/general practitioners in Nicosia urban and greater Nicosia region from January 2011 until May of 2014 were registered and analysed. ResultsFinancial crisis did not alter outpatient visits. Introduction of co-payment led to a statistically significant decrease from the second month after its introduction (p = 0.048) (R2 = 0.329, Q = 23.75, p = 0.137). This decrease was consistent until the end of the observational period and it did not level off. ConclusionsFinancial crisis did not affect outpatient visits while co-payment can be considered as a potent cost containment measure during financial recession, by normalising utilisation of healthcare resources.

Generics: Are all immunosuppression agents created equally?

The Affordable Care Act initiated innumerable cost-containment measures, including promoting generic conversion from brand medications and directing the Food and Drug Administration to decrease requirements for generic approvals. Despite this mandate, few data existed on generic conversion of immunosuppressant medications with narrow therapeutic troughs. A retrospective analysis of our initial experience with generic tacrolimus (n = 39) was performed using a control cohort from our renal transplant database. A rejection and cost analysis was performed using a consecutive 2-year prior cohort (n = 159) as a control to determine the effect of generic conversion on tacrolimus a narrow therapeutic index immunosuppressant medication. During the first year after transplantation, the generic group had a greater drug variability (20% ± change in trough levels) that required more dosage adjustments (5.42 vs 3.59 drug dosage changes; P = .038) to obtain a stable dose, required increased number of intravenous magnesium infusions (4.95 vs 1.68 infusions; P = .001), and incurred a greater incidence of rejection (23.1% vs 10.2%; P = .024). A yearly institutional cost was evaluated against a negotiated $18,000/yearly central pharmacy cost savings compared with a $652,862 institutional cost to treat unanticipated rejections. Programmatic conversion from brand to generic tacrolimus resulted in increased drug variability, a greater incidence of magnesium wasting, and more episodes of rejection, leading to increases in institutional costs of care. This government-driven attempt at cost containment may be applicable to noncritical medications such as antibiotics and antihypertensives, but this policy should be reconsidered for narrow therapeutic index medications, such as tacrolimus and other immunosuppressant medications.

Potential Clinical and Economic Impact of Switching Branded Medications to Generics

Switching branded to generic medications has become a common cost-containment measure. Although this is an important objective for health care systems worldwide, the impact of this practice on patient outcomes needs to be carefully considered. We reviewed the literature summarizing the potential clinical and economic consequences of switching from branded to generic medications on patient outcomes. A literature search of peer-reviewed articles published 2003–2013 using key words of “generic switching” or “substitution” was conducted using PubMed, OvidSP, and ScienceDirect. Of 30 articles identified and reviewed, most were related to the diseases of the central nervous system, especially epilepsy. Based on our review, potential impacts of switching fell into 3 broad categories: patient attitudes and adherence, clinical and safety outcomes, and cost and resource utilization. Although in many cases generics may represent an appropriate alternative to branded products, this may not always be the case. Specifically, several studies suggested that switching may negatively impact medication adherence, whereas other studies found that generic switching was associated with poorer clinical outcomes and more adverse events. In some instances, switching accomplished cost savings but did so at increased total cost of care because of increased physician visits or hospitalizations. Although in many cases generics may represent an appropriate alternative, mandatory generic switching may lead to unintended consequences, especially in certain therapeutic areas. Although further study is warranted, based on our review, it may be medically justifiable for physicians and patients to retain the right to request the branded product in certain cases.

Can genomic medicine improve financial sustainability of health systems?

Recent years have seen increased use of genomic technologies in a variety of research and clinical settings. Genomic medicine is not a cost-containment measure per se, but is viewed as having the potential to bend the healthcare cost curve. Currently, it is unknown how systematic adoption of genomic medicine in clinical practice will impact healthcare costs. This article discusses the potential economic impact of genomic medicine and the challenges that lie ahead.

Assessing the impact of DRGs on patient care and professional practice in Switzerland (IDoC) - a potential model for monitoring and evaluating healthcare reform.

The starting point of the interdisciplinary project "Assessing the impact of diagnosis related groups (DRGs) on patient care and professional practice" (IDoC) was the lack of a systematic ethical assessment for the introduction of cost containment measures in healthcare. Our aim was to contribute to the methodological and empirical basis of such an assessment. Five sub-groups conducted separate but related research within the fields of biomedical ethics, law, nursing sciences and health services, applying a number of complementary methodological approaches. The individual research projects were framed within an overall ethical matrix. Workshops and bilateral meetings were held to identify and elaborate joint research themes. Four common, ethically relevant themes emerged in the results of the studies across sub-groups: (1.) the quality and safety of patient care, (2.) the state of professional practice of physicians and nurses, (3.) changes in incentives structure, (4.) vulnerable groups and access to healthcare services. Furthermore, much-needed data for future comparative research has been collected and some early insights into the potential impact of DRGs are outlined. Based on the joint results we developed preliminary recommendations related to conceptual analysis, methodological refinement, monitoring and implementation.

Health services financing and delivery: analysis of policy options for Dubai, United Arab Emirates.

IntroductionA national health account (NHA) provides a systematic approach to mapping the flow of health sector funds within a specified health system over a defined time period. This article attempts to present a profile of health system financing in Dubai, United Arab Emirates using data from NHAs, and to compare the functional structures of financing schemes in Dubai with schemes in Qatar and selected member countries of the Organization for Economic Cooperation and Development (OECD).MethodsThe author analyzed secondary data published in NHAs of Dubai and Qatar and data collected by the OECD countries and publicly available from Eurostat (Statistical Office of the European Union) of 25 OECD countries for comparative analysis. All health financing indicators used were as defined in the international System of Health Accounts (SHA).ResultsIn Dubai, spending on inpatient care was the highest-costing component, with 30% of current health expenditures (CHE). Spending on outpatient care was the second highest-costing component and accounted for about 23% of the CHE. Household spending accounted for about 22% of CHE (equivalent to US$187 per capita), compared to an average of 20% of CHE of OECD countries. Dubai spent 0.02% of CHE on long-term care, compared to an average of 11% of CHE of OECD countries. Dubai spent about 6% of CHE on prevention and public health services, compared to an average of 3.2% of CHE of OECD countries.ConclusionThe findings point to potential opportunities for growth and improvement in several health policy issues in Dubai, including increasing focus and funding of preventive services; shifting from inpatient care to day surgery, outpatient, and home-based services and strengthening long-term care; and introducing cost-containment measures for pharmaceuticals. More investment in the translation of NHA data into policy is suggested for future researchers.

Financial austerity measures and their effects as perceived in daily practice by Italian nurses from 2010 to 2011: A longitudinal study.

Abstract Most western economies have in recent years been experiencing one of the longest and deepest economic recessions since the Great Depression. During a recession health-care expenditures are often among the first to be cut. However, what is occurring in daily practice from the point of view of care has not been documented to date. Describing the cost containment interventions undertaken and their effects as perceived in daily practice by Italian nurses was the aim of the study. A longitudinal study design was adopted from 2010 to 2011 involving 1,001 nurses each year. In the 2-year period taken into consideration, participants reported a significant increase in the number of cost containment measures adopted by their health-care organisations. The effects of these cost containment measures have been perceived by nurses especially in terms of (1) increased stress levels, (2) increased number of patients with social problems, and (3) increased nursing workloads. In addition, greater difficulties in finding clinical placement for nursing students and fewer resources devoted to nursing professional development were reported, indicating that some cost containment measures will have long-term effects. The economic crisis seems to affect mainly the most vulnerable groups of society. Innovative solutions for the need to reduce the costs of National Health Services do not seem to emerge from the findings.

Making cuts to Medicare: the views of patients, physicians, and the public.

Cancer-related expenditures are increasing health care costs. Determining how patients with cancer, oncologists, and the general public view Medicare spending and whether they would support cost-containment measures is important to identifying acceptable approaches to reducing health care expenditures. Patients with cancer treated at an academic medical center, a random national sample of oncologists, and the general public were surveyed between July 2012 and March 2013 about causes of high health care costs and proposed cost-control measures. Three hundred twenty-six patients (response rate, 72%), 250 oncologists (response rate, 55%), and 891 members of the general public (response rate, 50%) completed surveys. The majority thought Medicare spending was a moderate or big problem (75.8% of patients; 97.2% of oncologists; 75.3% of the general public) and thought Medicare could spend less without causing harm (65.6% of patients; 74.0% of oncologists; 69.7% of the general public). There was broad consensus that drug and insurance companies' profits added to costs, although physicians, hospitals, and patients were also perceived as sharing responsibility. More than 75% of respondents supported enabling Medicare to refuse reimbursement for more expensive treatment if less costly, equally effective treatment was available. Respondents generally favored means testing Medicare cost sharing but, except for oncologists, resisted the idea of an independent oversight panel. All groups opposed annual ceilings on Medicare spending per patient. The majority of respondents view Medicare costs as a substantial problem and that all players in the system, including providers, contribute to high costs. Most thought Medicare could spend less without causing harm. Overall, respondents strongly favored not paying for more expensive treatments when cheaper ones are equally effective.

A cost/benefit analysis of self-care initiatives in the European Union: who gains, who loses?

European health systems have increasingly come under pressure to implement cost-containment measures while simultaneously maintaining or even enhancing high-quality health care. In the field of medication of minor ailments, a promising approach to achieve this is initiatives promoting patient involvement (i.e. self-care). Therefore, the aim of the study was to analyse potential costs and benefits related to self-care oriented health systems in the European Union. A cost/benefit analysis (CBA) was conducted covering modified access to prescription medicines, extended range of authorized prescribers and internet/telephone information portals. Costs and benefits were calculated for selected initiatives: minor ailment schemes (MAS), non-medical prescribing (NMP) and NHS Choices in England. The CBA covered four perspectives: patient, provider (physician, pharmacist), system and society. A standard costing approach was used to facilitate transferability of results. In all studied initiatives, patients benefit from time savings due to avoided physician visits, compensating for occasionally higher out-of-pocket payments for medicines. Physicians are confronted with a negative benefit due to loss of income, which corresponds to a positive effect at the system level. If the initiatives' costs do not provide for additional remuneration for pharmacists, increased time for consultations will lead to a negative benefit for pharmacists. In order to gain a positive societal net benefit, participation rates (in terms of patients with minor ailments refraining from a GP consultation due to an initiative) of 27.5% for MAS and 4.4% for NHS Choices are required. For NMP costs at providers' (i.e. pharmacists') levels are too high for a positive societal net benefit. Self-care initiatives based on modified access schemes and information portals may lead to a societal benefit, whereas the mere extension of prescribing authority does not do so. As actual cost components of the initiatives (e.g. provider remuneration) and pharmaceutical reimbursement policies (e.g. prescriptions fees) are likely to affect savings and costs, these have to be considered when implementing a policy.

Community Pharmacists’ Strategies in Greece: An Assessment of the Policy Environment and the Mapping of Key Players

The aim of the study was to form and assess the pharmacists’ strategies in Greece, by analyzing the policy environment and identifying the role of the key players-stakeholders. For collecting and organizing important information about the pharmacists’ policy, the PolicyMaker’s computerized version of political mapping was used, serving as a database for assessments of the policy’s content, the major players, the power and policy positions of key players, the interests of different players, and the networks and coalitions that connect the players. As the research findings show, the initially expected impact of the pharmacists’ policy proved to be very optimistic in most of the implemented strategies, as the majority of the strategies have worsened or minimized their success ratio throughout the time in study. Concluding, either the initially set strategies were at the wrong direction or the actions taken to implement them were inappropriate. Moreover, one can suggest that the shifting ability in both the position and the power of the most key players were over-estimated, while they under-estimated the impact of troika-constitutions meddling in the pharmaceutical policymaking and in the health sector cost-containment measures imposing.

Reforming private drug coverage in Canada: Inefficient drug benefit design and the barriers to change in unionized settings

Prescription drugs are the highest single cost component for employees’ benefits packages in Canada. While industry literature considers cost-containment for prescription drug costs to be a priority for insurers and employers, the implementation of cost-containment measures for private drug plans in Canada remains more of a myth than a reality. Through 18 semi-structured phone interviews conducted with experts from private sector companies, unions, insurers and plan advisors, this study explores the reasons behind this incapacity to implement cost-containment measures by examining how private sector employers negotiate drug benefit design in unionized settings. Respondents were asked questions on how employee benefits are negotiated; the relationships between the players who influence drug benefit design; the role of these players’ strategies in influencing plan design; the broad system that underpins drug benefit design; and the potential for a universal pharmacare program in Canada. The study shows that there is consensus about the need to educate employees and employers, more collaboration and data-sharing between these two sets of players, and for external intervention from government to help transform established norms in terms of private drug plan design.

The Impact of Cost Containment Reforms to the Pharmaceutical Benefits Scheme (Pbs) On Prescribing Volumes And Expenditure In Australia: 1992 To 2011.

Objectives: To investigate the impact of cost containment measures on PBS prescribing volumes and expenditure. Methods: Segmented linear regression models were used to analyse the time series data from Medicare Australia’s PBS Statistics. Seven measures and four new listing dates of statins were investigated. Results: Many of the cost containment measures were effective in containing costs. Conclusions: The safety net 20 days rule was estimated to be the most effective in reducing drugs utilisation and expenditure.

Price Comparison in the European Pharmaceutical Market.

CONTACT: Sandra Ressl, MA IPF Institute for Pharmaeconomic Research Wolfengasse 4/7 1010 Vienna, Austria Email: sr@ipf-ac.at Web: www.ipf-ac.at Objectives Due to rising healtcare costs, stricter governmental cost containment measures like international price comparison and external reference pricing, the European pharmaceutical markets will lead to future challenges in pricing. Despite of the external reference pricing the pharmaceutical prices vary across the European countries. Thus, the aim of the analysis was to draw a comprehensive picture of the pharmaceutical price levels and consumption (expenditure per capita – based on ex-factory prices per Standard Units) of pharmaceuticals in Europe.

Investment Aspects of Generic Drug Policies in Countries With Severe Resource Constraints.

BACKGROUND The objective of generic drugs policies can be defined as reduction in health care expenditure without compromising health outcomes. This definition is based on the disinvestment aspect of drug policies. However, in several countries the accessibility of patients to innovative drugs may be limited. Different cost-containment measures are applied by payers to reduce the utilization of expensive therapies by influencing different stakeholders, including a) prescibers: • volume limit for individual prescribers or health care institutions • second-line reimbursement only after the first-line therapy fails b) patients: • significant copayment c) manufacturers: • price-volume agreement

Pharmaceutical cost management in an ambulatory setting using a risk adjustment tool

BackgroundPharmaceutical expenditure is undergoing very high growth, and accounts for 30% of overall healthcare expenditure in Spain. In this paper we present a prediction model for primary health care pharmaceutical expenditure based on Clinical Risk Groups (CRG), a system that classifies individuals into mutually exclusive categories and assigns each person to a severity level if s/he has a chronic health condition. This model may be used to draw up budgets and control health spending.MethodsDescriptive study, cross-sectional. The study used a database of 4,700,000 population, with the following information: age, gender, assigned CRG group, chronic conditions and pharmaceutical expenditure. The predictive model for pharmaceutical expenditure was developed using CRG with 9 core groups and estimated by means of ordinary least squares (OLS). The weights obtained in the regression model were used to establish a case mix system to assign a prospective budget to health districts.ResultsThe risk adjustment tool proved to have an acceptable level of prediction (R2 ≥ 0.55) to explain pharmaceutical expenditure. Significant differences were observed between the predictive budget using the model developed and real spending in some health districts. For evaluation of pharmaceutical spending of pediatricians, other models have to be established.ConclusionThe model is a valid tool to implement rational measures of cost containment in pharmaceutical expenditure, though it requires specific weights to adjust and forecast budgets.

Financial austerity measures and their effects as perceived in daily practice by Italian nurses from 2010 to 2011: A longitudinal study

Most western economies have in recent years been experiencing one of the longest and deepest economic recessions since the Great Depression. During a recession health-care expenditures are often among the first to be cut. However, what is occurring in daily practice from the point of view of care has not been documented to date. Describing the cost containment interventions undertaken and their effects as perceived in daily practice by Italian nurses was the aim of the study. A longitudinal study design was adopted from 2010 to 2011 involving 1,001 nurses each year. In the 2-year period taken into consideration, participants reported a significant increase in the number of cost containment measures adopted by their health-care organisations. The effects of these cost containment measures have been perceived by nurses especially in terms of (1) increased stress levels, (2) increased number of patients with social problems, and (3) increased nursing workloads. In addition, greater difficulties in finding clinical placement for nursing students and fewer resources devoted to nursing professional development were reported, indicating that some cost containment measures will have longterm effects. The economic crisis seems to affect mainly the most vulnerable groups of society. Innovative solutions for the need to reduce the costs of National Health Services do not seem to emerge from the findings.

The impact of the crisis on the migrant population: the Spanish case

Background The global financial crisis hit the Spanish economy badly, increasing sovereign debt and interest rates, reducing economic growth and increasing the budget deficit. GDP suffered a sharp slowdown in 2008, followed by a two-year long recession in 2009 and 2010. It was not until May 2010 that cost containment measures were established, including a reduction in the salaries of public employees. After introducing a further package of austerity …

The impact of cost-containment policies on health expenditure

Many governments have enacted health cost-containment policies in recent years, and many are currently considering further reform alternatives to tackle growing health spending and promote efficiency in the health system, particularly in light of projections regarding future cost pressures in this sector. The focus of this study is to assess the most robust empirical evidence on the public spending effects of health policy alternatives to contain excess cost growth in the system. A stylised theoretical framework of the relationships between potential cost-containment measures, economic incentives and quantities, and health expenditure is suggested. The developed framework provides structural guidance for reviewing the evidence on the cost-containment impacts of various reforms implemented in OECD countries in the last decades. The accumulated evidence indicates that there are various alternative policies in a government’s toolkit that can be combined to achieve better cost control in the health system, provided institutional aspects and policy interactions are carefully considered. JEL classification: I10, I18, H51. Keywords: Health financing, cost containment, provider payment, health system reform.

Evidence from the national health account: the case of Dubai.

IntroductionNational health accounts (NHAs) provide useful information to aid in understanding the health care financing system. This article aims to present a profile of health system financing in Dubai using data from the NHA. We also aim to compare the provider structure of financing schemes in Dubai with those of the State of Qatar and selected Organization for Economic Cooperation and Development (OECD) countries.MethodsThe author analyzed secondary data published in NHAs for Dubai and Qatar, and data collected by the OECD countries and publicly available from the Statistical Office of the European Union (Eurostat), for 25 OECD countries for comparative analysis. All health financing measures used are as defined in the international System of Health Accounts (SHA).ResultsIn Dubai, only 33% of current health expenditure (CHE) is funded by the government. However, the public sector is the main source of health funding in Qatar and most OECD countries, with an average of 79% and 72%, respectively. Households in Dubai spent about 22% of CHE, equivalent to an average US$187 per capita, ranking the highest among Gulf Cooperation Council (GCC) countries, and compared with 20% of CHE across OECD countries. Hospitals in Dubai accounted for 48% of CHE, which is much higher than Qatar (40%) and the OECD average (36%).ConclusionThe Dubai health care financing system differs substantially from that in OECD countries, as it is more private oriented. The findings point to several potential opportunities for growth and improvement. Policy areas that may be addressed using the information presented in this article are broad and include the following: shift from hospital care to ambulatory and day care, sustainability of health finance, shift the cost of health care to the private sector, introduce cost-containment measures, revise payment systems for health providers, and produce subnational accounts for non-communicable diseases. More investment in the translation of national health account data into policy is suggested for future researchers.

In ... and out: open access publishing in scientific journals.

Open access (OA) journals are a growing phenomenon largely of the past decade wherein readers can access the content of scientific journals without paying for a subscription. The costs are borne by authors (or their institutions) who pay a fee to be published, thus allowing readers to access, search, print, and cite the journals without cost. Although the OA model, in and of itself, need not diminish scientific rigor, selectivity, or peer review, the "author pays" model creates an inherent conflict of interest: it operates with the incentive on the part of the journal to publish more and reject less. This is coupled with cost containment measures that affect the journals' ability to engage experienced editors and professional staff to scrutinize data, data analyses, and author conflicts of interest. While some OA journals appear to be comparable to their print competitors, others are "predatory" and have no legitimacy at all. Two recent "scams"--one recently published in Science--highlight the urgency of addressing the issues raised by OA publication so that OA does not lose its credibility just as it begins to gather substantial momentum. High-quality journals develop their reputations over time, and OA outlets will be no exception. For this to occur, however, the OA audience will need to be satisfied that OA can deliver high-quality publications utilizing rigorous peer review, editing, and conflict of interest scrutiny. Academic tenure and promotion committees that review scholarly credentials are understandably skeptical of publications in unrecognized journals, and the large number of new OA outlets contributes to this urgency from their perspective as well.