Cost Containment Research Articles

The Effects of Cost Containment and Price Policies on Pharmaceutical Expenditure in South Korea.

Policy-makers have proposed and implemented various cost-containment policies for drug prices and quantities to regulate rising pharmaceutical spending. Our study focused on a major change in pricing policy and several incentive schemes for curbing pharmaceutical expenditure growth during the 2010s in Korea. We constructed the longitudinal dataset from 2008-2017 for 12 904 clinics to track the prescriber behavior before and after the implemented policies. Applying an interrupted time series model, we analyzed changes in trends in overall monthly drug expenditure and antibiotic drug expenditure per prescription for outpatient claims diagnosed with three major diseases before and after the policies' implementation. Significant price reductions and incentives for more efficient drug prescriptions resulted in an immediate decrease in monthly drug expenditures in clinics. However, we found attenuated effects over the long run. The top-spending clinics showed the highest rate of increase in drug costs. Future policy interventions can maximize their effects by targeting high-spending providers.

The pilot of a new patient classification-based payment system in China: The impact on costs, length of stay and quality

With the urgent need to regulate provider behaviors, China developed a novel patient classification with global budget payment system, expecting to achieve both easy implementation and cost containment. The new system, called “diagnosis-intervention packet (DIP)” payment, is based on a deterministic patient classification approach, which groups patients according to the combination of principal diagnosis ICD-10 (International Classification of Diseases, 10th Revision) codes and procedure ICD-9-CM3 (International Classification of Diseases, 9th Revision, Clinical Modification) codes and links each group to relative historical costs market-wide. This study investigated the impact of the DIP-based payment on inpatient costs, length of stay, and quality of care in the largest DIP pilot city of China. In 2018, the city changed from the “fixed rate per admission with a cap on annual total compensation” policy to DIP with global budget for all insured inpatients. A difference-in-differences approach was employed to identify changes in outcome variables before and after the DIP policy among insured relative to uninsured patients. We found an average of 8.5% (p = 0.000) increase in inpatient costs per case (as intended), trivial changes in length of stay, and a 3.6% (p = 0.046) reduction in postoperative complication rate in response to DIP adoption among patients with high severity. Our findings suggested that the DIP-based payment helped regulate provider behaviors when treating high-risk patients. And the new payment has the potential for rapid rollout in resource-limited areas where lack a uniform coding practice or high-quality historical data.

The impact of routine post-anesthesia care unit extubation for pediatric surgical patients on safety and operating room efficiency

PurposeMaximizing operating room (OR) efficiency is essential for hospital cost containment and effective patient throughput. Little data is available regarding the safety and efficacy of extubation of children in the post-anesthesia care unit (PACU) by a nurse rather than in the OR. We sought to evaluate the impact of a long-standing practice of PACU extubation upon airway complications and OR efficiency. MethodsThe records of 1930 children who underwent inguinal hernia repair, laparoscopic appendectomy or pyloromyotomy at a children's hospital between July, 2018 and June, 2020 were reviewed. Extubations were performed in the OR only when the PACU was inadequately staffed or during the early months of the Covid-19 pandemic. Cases in which there was a deep extubation, a PACU hold was in effect or a patient went directly to an inpatient unit from the OR were excluded. Intra- and post-operative time metrics were recorded and emergency airway interventions were assessed. Results1747 operations were evaluated. Time from the end of the procedure to leaving the OR ranged from 4.1 to 4.8 min when extubation was done in the PACU and was 6–9 min less than with OR extubation. (see table). There were 23 airway events (1.5% of all cases) after PACU extubation that necessitated only brief bag-mask ventilation. There were no cases of re-intubation. ConclusionsIn a large population of children undergoing diverse surgical procedures, post-anesthesia care unit extubation was safe and resulted in rapid transfer of patients from the operating room after completion of their operation. Time saved because of shorter operating room times reduces hospital costs and can allow for increased throughput. Extubation in the post-anesthesia care unit may not only be as safe as operating room extubation, but may result in fewer serious airway events as patients may be less likely to have their endotracheal tube removed prematurely. Level of evidenceTreatment Study, Level III

Dialysis and Total Health Care Costs in the United States and Worldwide: The Financial Impact of a Single-Payer Dominant System in the US.

Significance Statement In the United States, dialysis provision is an example of a robust, single-payer dominant system with cost containment. When compared with the cost of dialysis in other countries, Medicare dialysis costs in the United States as a function of overall health care expenditures are approximately $60,000 per patient less than expected, likely due to substantial cost containment imposed by Medicare as the dominant payer.

Routine in-person post-operative follow-up for uncomplicated laparoscopic appendectomy does not change management.

IntroductionEliminating points in the continuum of care that do not change management is a safe strategy for cost containment and workflow efficiency in health systems. As a process improvement initiative, we sought to identify whether routine, outpatient follow-up changes management in laparoscopic appendectomy in a military hospital.MethodsWe performed a retrospective chart review of adult patients undergoing laparoscopic appendectomy during a one-year period. The primary outcome was identification of a change in management during routine in person follow-up. Secondary outcomes included location of patient presentation with a post-operative event (clinic, emergency department, primary care provider), and if those visits changed management. Events were defined as any deviation from the typical post-operative course within 6 weeks of surgery, including abnormal specimen pathology.ResultsOne-hundred and seventy-six appendectomies were performed over one year, and 148 patients met inclusion criteria (median age = 27, 66.9% male). Perforation was identified in 10.1% of patients. Seventeen-point-five percent of patients had a post-operative event, of which persistent pain was the most common. Only 2.0% of all patients saw a change in management at their routine in person follow-up appointment. Eighty percent of patients with any post-operative events sought care outside of their routine in person follow up appointments. No variable was independently associated with a change in management.ConclusionRoutine in-person clinical follow-up for laparoscopic appendectomy almost never changes management. Perforated appendicitis may be an indication for in-person follow-up. Considering a telemedicine model for post-operative follow-up of laparoscopic appendectomy patients will provide a safe and effective alternative to in-person clinic visits, while saving patients time and allowing providers the clinic freedom to prioritize more urgent and new patients.

PD51-02 SOCIAL DETERMINANTS OF HEALTH ASSOCIATED WITH INCREASED READMISSIONS TO NON-INDEX HOSPITALS

You have accessJournal of UrologyBladder Cancer: Invasive III (PD51)1 Sep 2021PD51-02 SOCIAL DETERMINANTS OF HEALTH ASSOCIATED WITH INCREASED READMISSIONS TO NON-INDEX HOSPITALS Valentina Grajales, Jonathan Y. Lin, Adam J. Sharbaugh, Michelle Yu, Dan Pelzman, Zhaojun Sun, Maria M. Pere, Jonathan G. Yabes, Benjamin J. Davies, Lindsay M. Sabik, and Bruce L. Jacobs Valentina GrajalesValentina Grajales More articles by this author , Jonathan Y. LinJonathan Y. Lin More articles by this author , Adam J. SharbaughAdam J. Sharbaugh More articles by this author , Michelle YuMichelle Yu More articles by this author , Dan PelzmanDan Pelzman More articles by this author , Zhaojun SunZhaojun Sun More articles by this author , Maria M. PereMaria M. Pere More articles by this author , Jonathan G. YabesJonathan G. Yabes More articles by this author , Benjamin J. DaviesBenjamin J. Davies More articles by this author , Lindsay M. SabikLindsay M. Sabik More articles by this author , and Bruce L. JacobsBruce L. Jacobs More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002078.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy is associated with one of the highest readmission rates of any surgery, hovering around 25%. Readmissions occur both at the hospital at which patients received their surgery (index readmission) and at other hospitals (non-index readmission). Non-index readmissions have been associated with worse outcomes. We sought to examine characteristics associated with being readmitted to a non-index hospital. METHODS: Using the Pennsylvania Cancer Registry linked to the Pennsylvania Health Care Cost Containment Council database, we identified all patients with non-metastatic muscle-invasive bladder cancer between 2010-2016 who were treated with radical cystectomy. The primary outcome was readmission to an index versus non-index hospital. We fit a multivariable logistic regression model to assess predictors of being readmitted to a non-index hospital, adjusting for several patient demographic and clinical characteristics. Area Deprivation Index (ADI) was used as a surrogate for socioeconomic status and reported as quartiles. The 4th quartile represents the lowest socioeconomic status. Urban, large town and rural residence was defined using the Rural-Urban Commuting Area codes. RESULTS: We identified 2,113 patients with muscle-invasive bladder cancer who underwent radical cystectomy. Of those, 517 (24.5%) patients were readmitted within 30 days. Non-index readmissions accounted for 86 (4%) of these patients. Patients who had higher comorbidity burden, positive N stage and rural residence were significantly associated with higher non-index readmissions. On multivariable analysis, high comorbidity index (odds ratio [OR] 3.22) and rural residence (OR 4.28) were independent predictors of non-index readmissions (all p<0.05). CONCLUSIONS: Rural residence and high comorbidity burden were predictors of readmissions to non-index hospitals after radical cystectomy while insurance and socioeconomic status were not. Metastatic disease was also associated with increased non-index readmissions. Development of policy initiatives may help assess disparities in rural residence and healthcare access. Source of Funding: Valentina Grajales, MD, MS was supported in part by the 2020 Urology Care Foundation Residency Research Award Program and The Kahlert FoundationBruce L. Jacobs, MD MPH is supported in part by the Shadyside Hospital Foundation © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e905-e905 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Valentina Grajales More articles by this author Jonathan Y. Lin More articles by this author Adam J. Sharbaugh More articles by this author Michelle Yu More articles by this author Dan Pelzman More articles by this author Zhaojun Sun More articles by this author Maria M. Pere More articles by this author Jonathan G. Yabes More articles by this author Benjamin J. Davies More articles by this author Lindsay M. Sabik More articles by this author Bruce L. Jacobs More articles by this author Expand All Advertisement Loading ...

Trends in Medicare Part B Payments and Utilization for Imaging Services Between 2009 and 2019

BackgroundIn 2019, the total National Healthcare Expenditure (NHE) reached $3.8 trillion, or nearly 20% of the total Gross Domestic Product. This represents a 4-fold increase in its Gross Domestic Product share since 1960. Given the magnitude and growth of such expenditures, healthcare cost containment is central to the country's financial sustainability. Moreover, as Medicare represents nearly 20% of the total NHE, it is a primary target for piloting, implementing and scaling initiatives that reduce expenditures. ObjectiveTo assess trends in Medicare Physician Fee Schedule for Service (Part B) payments and utilization for Imaging relative to other services from 2009 through 2019. Materials and methodsWe conducted a retrospective observational study of annual expenditures and utilization of imaging services using data from Centers for Medicare and Medicaid Services Medicare Part B. Data was grouped according to the Berenson-Eggers Type of Service Classification. The values were adjusted for inflation and we calculated the annual changes and the compound annual growth rates and the price elasticity of supply. ResultsFor the 10-year period, Imaging represented on average 8% of the total Medicare Part B expenditures, an equivalent of 1.4% of total Medicare expenditures or 0.05% of the NHE. While NHE, overall Medicare and overall Part B had positive growth rates of total expenditures, Imaging did not. Moreover, Imaging had the most negative CAGR compared to all other categories, including Drugs, Procedures, Evaluation and Management and Durable Medical Equipment. ConclusionImaging did not contribute to the increase in Medicare Part B expenditures, and it might have been disproportionately affected by cost containment policies.

Economic burden of enhanced practices of duodenoscopes reprocessing and surveillance: balancing risk and cost containment.

Background and study aims Recent outbreaks attributed to contaminated duodenoscopes have led to the development of enhanced surveillance and reprocessing techniques (enhanced-SRT) aimed at minimizing cross-contamination. Common enhanced-SRT include double high-level disinfection (HLD), ethylene oxide (EtO) gas sterilization, and culture-based monitoring of reprocessed scopes. Adoption of these methods adds to the operational costs and we aimed to assess its economic impact to an institution. Methods We compared the estimated costs of three enhanced-SRT versus single-HLD using data from two institutions. We examined the cost of capital measured as scope inventory and frequency of scope use per unit time, the constituent reprocessing costs required on a per-cycle basis, and labor & staffing needs. The economic impact attributable to enhanced-SRT was defined as the difference between the total cost of enhanced-SRT and single HLD. Results Compared to single HLD, adoption of double HLD increased the costs approximately by 47 % ($80 vs $118). Similarly, culture and quarantine and EtO sterilization increased costs by 160 % and 270 %, respectively ($80 vs $208 and $296). Enhanced-SRT introduced significant scope downtime due to prolonged techniques, necessitating a 3.4-fold increase in the number of scopes needed to maintain procedural volume. The additional annual budget required to implement enhanced-SRT approached $406,000 per year in high-volume centers. Conclusions While enhanced-SRT may reduce patient risk of exposure to contaminated duodenoscopes, it significantly increases the cost of performing ERCP. Future innovation should focus on approaches that can ensure patient safety while maintaining the ability to perform ERCP in a cost-effective manner.

Unbalanced Treatment Costs of Breast Cancer in China: Implications From the Direct Costs of Inpatient and Outpatient Care in Liaoning Province.

The increasing incidence of breast cancer and its financial burden highlights the need for controlling treatment costs. This study aimed to assess the direct costs of inpatient and outpatient care for breast cancer patients in Liaoning Province to provide a policy reference for cost containment. Based on the System of Health Accounts 2011 (SHA 2011), systematic data collection was conducted via multistage stratified cluster random sampling. A total of 1160 health institutions, including 83 hospitals, 16 public health institutions, 120 primary health institutions, and 941 outpatient institutions were enrolled in 2017. A database was established containing 20 035 patient-level medical records from the information system of these institutions. Curative care expenditure (CCE)was calculated, and generalized linear modeling was performed to determine cost-related factors. In 2017, the CCE for breast cancer was approximately CNY 830.19 million (US$122.96 million) in Liaoning province (0.7% of the total health expenditure and 9.9% of cancer-related healthcare costs). Inpatient care costs were estimated to be CNY 617.27 million (US$91.42 million), accounting for 74.4% of the CCE for breast cancer, almost three times as large as outpatient costs (25.6%). The average inpatient and outpatient costs for breast cancer were estimated to be CNY 12 108 (US$1793) and CNY 829 (US$123) per visit. Medication cost was the main cost driver, which comprised 84.0% of the average outpatient cost and 37.2% of the mean inpatient cost. Breast cancer imposes a large economic burden on patients and the social health insurance system. Results show an irrational cost pattern of inpatient and outpatient services, with patients relying excessively on inpatient services for treatment. Promoting outpatient care whenever relevant is conducive to cost containment and rational utilization of resources.

EDITORIAL COMMENT

Operating rooms have an immense financial impact to their individual hospitals’ bottom line and therefore to the entire national health care system. In fact, surgical care is responsible for approximately one third of all health care spending in the United States (3). In our more cost conscious contemporary medical paradigm, maximizing operating room and perioperative efficiency is necessary to deliver high-quality, lower cost care. Reducing daily variation in care delivery also has the potential to improve clinical outcomes, decrease complications and provide down-stream cost containment for health systems.

The impacts of multiple healthcare reforms on catastrophic health spending for poor households in China

Many developing nations witness systemic healthcare reforms where the expansion of health financing mechanisms and reforms of the service delivery system are being rolled out simultaneously. Yet, poorly coordinated reforms and negative interactions between multiple policies may offset synergies and undermine intended reform outcomes. This study examines how multiple healthcare reforms affect catastrophic health spending of low-income households in China. We characterize two broad types of health policy reforms: expansion- and constraint-oriented policies in the domains of financing, services delivery, and pharmaceuticals introduced since 2009. We adopt an innovative methodology by matching macro-level policy text data collected using big data techniques with micro-level health expenditure data drawn from a nationally representative survey. Employing a linear probability analysis and controlling for household and year fixed effects, we find that more expansion-oriented policies, especially in the domain of financing, increased the incidence of catastrophic health spending of poor households. In contrast, constraint-oriented policies, particularly in the domain of health services delivery, lead to a lower incidence of catastrophic health spending. This type of policy is thus better able to mitigate the positive relationship between expansion-oriented policies and the incidence of catastrophic health spending. This study suggests that while the expansion of benefit package in the domain of financing is indeed a decisive move towards universal health coverage, the essential financial protection of the poor cannot be achieved without strong and coordinated supply-side reforms towards cost containment. Health policy makers must take a strategic view of the complex interactions of multiple policy interventions in both financing and service delivery domains.

Outpatient paediatric hand surgery: strategy in healthcare implementation and cost-efficient manner.

The increasingly cost of health care is a relevant problem as well as prolonged waiting time for admission also in emergencies. Effective cost containment measures and expenditure controls are needed to achieve and maintain clinical and organizational appropriateness. Outpatient management has proven to be the most useful method for lower-cost treatment in less severe pathologies, requiring surgery without hospitalization. The current study provided to evaluate how this model was successfully applied also to the paediatric population in hand surgery. Methods. A retrospective cohort study of 645 patients from 8 to 18years (mean age 14.9) was performed in children treated in outpatient setting from 2015 to 2019. The direct costs were evaluated as well as the mean waiting time for surgery, comparing the data with the previous five-year period. The mean reduction in waiting time for children emergencies was 57% (from 72 to 31h) due to the Outpatient setting into a dedicated Day-Surgery Service organizational model. The visual graphed data showed a general clear growing trend towards outpatient surgery in adults and children. The overall effect was a 29.2% of reduction in spending between expected and achieved costs, recovering resources toward the increasing technology and innovation expenditures. Outpatient paediatric hand surgery was an effective and attractive option which leaded to decreased individual and social costs, with increased clinical and organizational appropriateness. Thus, reduced delay in treatment and provided benefits for children and familiars.

Time modifier billing code - an interrupted time series analysis

Time modifier billing code: Interrupted time series analysis. Terrence McDonald, Brendan Cord Lethebe, Alistair McGuire, Lee Green Background: Alberta has the highest percentage of fee-for-service Family Physicians in Canada at over 80%. In 2019 as part of a cost containment strategy, the Alberta government proposed a policy change to eliminate the most used fee code that compensates family physicians for extended visit times (16-25 minutes). Optimal length for patient visit times varies throughout the world and countries with health systems that place emphasis on relational continuity demonstrate a trend towards longer appointment times. In Canada, the relationship between visit length and outcomes is not known. Implementation: What would be the likely consequences of eliminating the extended visit code? We examined this question using two different observational methods, to improve confidence in our findings: a retrospective longitudinal cohort (time series) around the time the code was introduced in 2009, and a cross-sectional cohort at current time. We explored the usage patterns of that fee code, its association with the outcomes of emergency department visits and hospitalizations, along with physician billings. Results: We found rates of emergency department visits decreased after the time-modifier code was implemented starting in 2010. This effect was maintained in the years that followed. A similar but less pronounced effect was observed in the hospitalization rates. The cross-sectional analysis had to include an interaction term because family physicians selectively extend visits for patients at risk, but when that is accounted for, the same effect is observed as in longitudinal results. The code was not used ubiquitously among primary care providers, especially in rural areas. Female physicians used it more often. Users use it for an average of 40% of 03.03A office visits. Non-users of the code earned more income than their user-colleagues. Conclusion: We believe our findings will fill an important gap in informing the importance of an extended time service billing code in a fee-for-service system in reducing ED visits and hospitalizations. Advice and Lessons Learned: The fee-for-service time-modifier code, introduced in 2009, resulted in reduced ED visits and hospitalizations. It is likely that discontinuing the code would result in increased ED and hospital utilization, costing much more than removing the code would save. Usage of the time-modifier code was not uniform among primary care. Users of the code had different practice patterns and provider demographics. Our next step is to model the uptake of the code by primary care providers and explore the health system utilization and down-stream costs between users and non-users of the code.

The Safety Profile of Same-Day Outpatient Total Ankle Arthroplasty

There has been significant change in the health care policy in the United States in recent years with an increasing focus on health care costs and patient satisfaction. One strategy of cost containment is to transition outpatient surgery away from high cost hospital environments. Total ankle arthroplasty has begun the evolution to outpatient settings; however, there is limited published literature on the results of outpatient total ankle arthroplasty (TAA). The purpose of the present study was to review the safety profile of same day outpatient TAA at an ambulatory surgery center. A review of consecutive patients who underwent same day outpatient TAA for end-stage ankle arthritis with a minimum of 12 months' follow-up was performed. The primary outcomes assessed were the incidence of perioperative adverse medical events, hospital admissions related to the procedure, and postoperative complications (minor and major). Univariate analyses were performed. Fifty-one patients who underwent same-day TAA between June 2016 and July 2018 were included; mean follow-up was 20.7 months (± 7.6). The mean age at time of surgery was 56.5 years (± 7.2), with a mean body mass index of 30.4 (± 5.3). Overall, there were no perioperative adverse medical events or hospital admissions related to the procedure. Five minor complications (9.8%) and 7 major (13.7%) were recorded. Of the major complications, only 1 required TAA revision. Implant survivorship during the most recent follow-up was 98%. The present study suggests that TAA can be performed safely in an outpatient ambulatory setting. Additional comparative studies with larger TAA cohorts and patient reported outcomes are warranted.

Prise en compte des critères environnementaux dans la commande publique des produits de santé

Healthcare products (HP) have a significant carbon footprint that must be included by regulation in the facility's purchasing policy. A national overview of the inclusion of environmental criteria (EC) in the public procurement (PP) of HP in hospitals has been carried out. Thirty EC were identified in the literature. Two questionnaires were proposed: (i) for buyers that analyze the level of "importance" and "ease of application" for public tenders (PT), and (ii) for suppliers that declare their commitments and evidence. Six regional buyers and 28suppliers participated. Buyers recognize the "importance" of sustainable development (SD) but are more reticent about the "applicability" of EC in PT. The environmental rating remains low: on average 4.38 (0.25-10.00) % of the total rating. Only 12EC are integrated within some PT. Suppliers report a high and diversified commitment to SD: 18suppliers sent 474evidence. Buyers and suppliers converge on the optimization of primary packaging and the establishment of a minimum order or delivery group. Since the efficiency of PP is inevitable, EC that combines SD and savings should be prioritized. The integration of additional EC, simple and easily documented, allowing cost containment for both suppliers and buyers, is possible to promote sustainable purchasing.

Assessing Policy Challenges and Strategies Supporting Informal Caregivers in the European Union

ABSTRACT Cost containment and the preferences of older adults are important stimuli for encouraging the provision of informal care worldwide. Nevertheless, informal caregiving can have negative effects on caregiver’s health, wellbeing, and employment opportunities. Moreover, it is questionable whether informal caregivers can substantially contribute to meeting the increasing demand for care or serve as a substitute for formally provided services. This commentary assesses strategies to remediate the negative effects of caregiving and ultimately to improve informal caregiving and to support their critical role in European long-term care systems. Cash benefits are a particularly common method of supporting informal caregivers; paid and unpaid leave, and flexible work arrangements are the most prevalent measures to support family caregivers within labor market policy, specifically. Providing training and counseling services to individuals engaged in informal care is a strategy used to support caregivers at home. Disparities in the level of support provided to informal caregivers across the European Union need to be addressed. A lack of supporting policies increases the likelihood that caregivers experience negative physical and psychosocial health problems, as well as unemployment and impoverishment.

Recommendation for a Pilot MCDA Tool to Support the Value-Based Purchasing of Generic Medicines in the UAE.

Introduction: In recent periods the United Arab Emirates (UAE) has strengthened economic measures in its pharmaceutical policy by promoting local manufacturing and facilitating the use of generic medicines. International examples indicate the importance of quality control elements in the implementation of cost containment policies. Multicriteria Decision Analysis (MCDA) is increasingly used in health care to facilitate health care decision based on multiple objectives. Our objective was to develop a pilot MCDA tool for repeated use to support the value-based purchasing of generic medicines in the UAE. Methods: An international evidence framework was adapted to UAE in a multistakeholder workshop organized by Dubai Health Authority. After validating the relevance of nine criteria in the local jurisdiction, participants decided the ranking and weight of each criterion by anonymous voting. Results: The top four criteria focused on quality elements starting with real-world clinical or economic outcomes (with 19.8% weight), followed by the quality assurance of manufacturing (17.3%), then evidence on the equivalence with the original product (14.8%), and drug formulation and stability (12.3%). The pharmaceutical acquisition cost criteria ranked fifth with 9.4% weight. The bottom four criteria, including reliability of drug supply, macroeconomic benefit, pharmacovigilance and added value services related to the product had similar weights in the range of 5.5–7.7%. Conclusion: Policy-makers in Dubai put high emphasis of value-based health care by incentivizing manufacturers of off-patent pharmaceuticals to generate additional scientific evidence compared to the mandatory minimum and acknowledging efforts to improve quality standards. The MCDA tool is considered suitable to improve the transparency and consistency of decision making in UAE for off-patent pharmaceuticals, and subsequently for other health technologies.

Change in health spending after implementation of a health transformation plan in Iran: an interrupted time series analysis

BackgroundHealth transformation plan (HTP) implemented in Iran since 2014 to improve accessibility and financial protection of patients. This study aimed to assess the impact of HTP on health spending in Iran.MethodsThis was a quasi-experimental design using Interrupted Time Series. All registered impatient records in Iran health insurance organization (IHIO) for the population of Mazandaran province (1,628,919 population in 2011), north of Iran from March 2010 to February 2019 were included. Data for three depended variables: hospitalization rate, average inpatient cost and inpatient expenditure per capita was extracted in 96 monthly observations. Segmented regression analysis was done in R version 3.6.1.ResultsHospitalization rate in 2010 was 6.6 in 1000 people and its level change was 0/799 immediately after HTP (P < 001). Post-reform level and trend changes for monthly average inpatient cost of registered admissions in IHIO were also significant (P < 001). IHIO inpatient expenditure per capita for 1,628,919 population in Mazandaran province was 24,436 Rials in 2011 and increased significantly immediately following HTP as 34,459 Rials (P < 001).ConclusionsThree important components of health spending including hospitalization rate, average inpatient cost and inpatient expenditure per capita were increased dramatically after HTP. Cost containment strategies and strengthening the preventive care initiatives is required to control the escalating trends of inpatient expenditure in Iran.

Testing cost containment of future healthcare with maintained or improved quality-The COSTCARES project.

BackgroundIncreasing healthcare costs need to be contained in order to maintain equality of access to care for all EU citizens. A cross‐disciplinary consortium of experts was supported by the EU FP7 research programme, to produce a roadmap on cost containment, while maintaining or improving the quality of healthcare. The roadmap comprises two drivers: person‐centred care and health promotion; five critical enablers also need to be addressed: information technology, quality measures, infrastructure, incentive systems, and contracting strategies.MethodIn order to develop and test the roadmap, a COST Action project was initiated: COST−CARES, with 28 participating countries. This paper provides an overview of evidence about the effects of each of the identified enablers. Intersections between the drivers and the enablers are identified as critical for the success of future cost containment, in tandem with maintained or improved quality in healthcare. This will require further exploration through testing.ConclusionCost containment of future healthcare, with maintained or improved quality, needs to be addressed through a concerted approach of testing key factors. We propose a framework for test lab design based on these drivers and enablers in different European countries.

CORR Insights®: Is There an Association Between Bundled Payments and "Cherry Picking" and "Lemon Dropping" in Orthopaedic Surgery? A Systematic Review.

CORR Insights®: Is There an Association Between Bundled Payments and "Cherry Picking" and "Lemon Dropping" in Orthopaedic Surgery? A Systematic Review.