Cost Of Health Care Services Research Articles

Biomedical Manufacturing: A Review of the Emerging Research and Applications

Abstract Biomedical manufacturing, which has seen rapid growth over the past decade, is an emerging research area for the manufacturing community. This growth trajectory is exemplified and coupled with a broadening scope of applications with biomedical manufacturing technology, including advancements in the safety, quality, cost, efficiency, and speed of healthcare service and research. The goal of this topical review is to offer a comprehensive survey of the current state-of-the-art in biomedical manufacturing and to summarize existing opportunities and challenges as a basis to guide future research activities in this emerging area. This article categorizes the key manufacturing process types that are currently being leveraged for the biomedical field of use, including machining, joining, additive manufacturing, and micro-/multi-scale manufacturing. For each of these manufacturing processes, notable applications are cited and discussed to provide insights and perspectives into how manufacturing processes can play an integral role in creating new and more sophisticated healthcare services and products.

Income level and healthcare utilization in Calabar Metropolis of Cross River State, Nigeria

Throughout the world, socio-economic status differentials of individuals have a lot of influence on privileges and opportunities enjoyed by society members. The different social and economic positions of individuals and income levels oftentimes hinder them from effective use of health care facilities. It is against this background, that the study was designed to investigate income differentials and its influence on utilization of healthcare services among the people of Calabar Metropolis in Cross River State, Nigeria. Relevant body of literature were reviewed and survey design method was adopted. The instruments used were the questionnaire, interview and Focus Group Discussions (FGD). A sample of 360 respondents was selected using a multi-stage sampling procedure for the study. Data was presented using simple percentage calculation while Chi-Square and ANOVA statistical tool was used to test and ascertain the relationship between income level and healthcare services usage at 0.05 level of significance. Findings of the study revealed that level of income and occupational status of individual influence health care service utilization among people in Calabar Metropolis. At the end of the study, several recommendations were made among which were a general improvement of socio-economic status of the people in areas of availability and compulsory education, employment opportunities as well as equitable distribution of income and minimizing cost of health care services for effective and equal utilization.

Healthcare services use and costs for a cohort of high needs elderly diabetic patients

Abstract Background The worldwide prevalence of diabetes mellitus is increasing, which especially involves people aged >65 years. A recent study also found that almost 75% of adults with diabetes have two or more comorbid conditions. The aim of the study was to investigate the impact of comorbidities on health care service use and health care costs of an elderly diabetes cohort with high health care needs (HHCN), based on real-world data. Methods For the purposes of the present study, people with a diagnosis of diabetes, residing in the area served by the ex-ULSS4-Veneto LHU, and characterized as having HHCN, corresponding to ACG-RUBs 4 and 5 were considered. The comorbidities was assessed using clinical diagnoses that the ACG System assigns to single patients by combining different information flows. The presence of correlation between comorbidity classes and total annual health care costs and use was tested with Spearman Test. Moreover, the association between above mentioned variables was tested with a appropriate regression, adjusting for age and sex. Results Mean overall cost and drug cost ranged respectively from 6284 euro, 525 euro in a patient with only 1 comorbidity to 10752 euro and 1764 euro for a patient with more than 8 comorbidities. The study shows that all measures of health care services use (as emergency care accesses; number of outpatients visits; number of inpatients admissions) have a statistically significant correlation with comorbidities class. However, multivariate analyses revealed that no different use in hospitalization was associated with comorbidity class. A significant correlation was also detected among costs variables (total annual costs and pharmacy costs) and comorbidity classes. Conclusions The increase in total healthcare services use and costs due to the increased number of comorbidities was seen mainly for primary care services, highlighting the need of primary care to be strengthen in an ageing and multi-morbid population. Key messages Overall cost and drug cost for patients with more than 8 comorbidities are respectively almost doubled and more than threefold greater than those with only one comorbidities. The study revealed an increase in primary care services, suggesting an implementation of these services giving the aging population and the increase prevalence of comorbid diabetic patients worldwide.

Factors Influencing Urban Variations of Household’s Utilization of Public Primary Healthcare Facilities in Nakuru Town, Kenya

Utilization of public health care (PHC) facilities incorporates three major components including people, service and mode of transport linking them. The difference in components influencing the households' utilization of PHC facilities varies across the world. This paper investigates the factors influencing urban variations of households' utilization of public primary health care facilities. This study was carried out in Nakuru Town. The study adopted mixed method research that involved quantitative and qualitative approaches. These included: a descriptive cross-sectional household survey and a health facility evaluation survey. The results indicate that the major factors influencing households' utilization of public PHC facilities were cost of healthcare services (79.25%), availability of drugs within the public health care facilities (70.5%) and distance to health facility (68.75%). This paper shows that households in Nakuru town utilize public primary health care facilities for their medical services based on the physical conditions, financial conditions, health status and socio-economic characteristics. The paper thus recommends for the County Government of Nakuru to increase the number of public PHCs, improve the supply of essential drugs and also to use mobile clinics to reach the underserved areas within the town.

Plasma Treatment Limits Cutaneous Squamous Cell Carcinoma Development In Vitro and In Vivo.

Cutaneous squamous cell carcinoma (SCC) is the most prevalent cancer worldwide, increasing the cost of healthcare services and with a high rate of morbidity. Its etiology is linked to chronic ultraviolet (UV) exposure that leads to malignant transformation of keratinocytes. Invasive growth and metastasis are severe consequences of this process. Therapy-resistant and highly aggressive SCC is frequently fatal, exemplifying the need for novel treatment strategies. Cold physical plasma is a partially ionized gas, expelling therapeutic doses of reactive oxygen and nitrogen species that were investigated for their anticancer capacity against SCC in vitro and SCC-like lesions in vivo. Using the kINPen argon plasma jet, a selective growth-reducing action of plasma treatment was identified in two SCC cell lines in 2D and 3D cultures. In vivo, plasma treatment limited the progression of UVB-induced SSC-like skin lesions and dermal degeneration without compromising lesional or non-lesional skin. In lesional tissue, this was associated with a decrease in cell proliferation and the antioxidant transcription factor Nrf2 following plasma treatment, while catalase expression was increased. Analysis of skin adjacent to the lesions and determination of global antioxidant parameters confirmed the local but not systemic action of the plasma anticancer therapy in vivo.

Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons: Randomized Controlled Trial

ObjectivesFrailty increases the risks of hospitalization, institutionalization, and death. Our objective was to study the effects of home-based physical exercise on the number of days spent at home among pre-frail and frail persons, versus usual care. In addition, utilization and costs of health care and social services, cost-effectiveness, and health-related quality-of-life (HRQoL) were explored. DesignRandomized controlled trial, with year-long supervised exercise for 60 minutes twice a week versus usual care. Follow-up for 24 months after randomization. Setting and ParticipantsA sample of 299 home-dwelling persons in South Karelia, Finland. Main inclusion criteria: ≥65 years, meeting at least 1 of the frailty phenotype criteria, Mini-Mental State Examination score ≥17. MethodsPrimary outcome, days spent at home over 24 months, was calculated deducting days in inpatient care, in nursing homes, and days after death. HRQoL was assessed (15D questionnaire) at baseline and at 3, 6, and 12 months. Utilization data were retrieved from medical records. ResultsThe participants' mean age was 82.5 (SD 6.3), 75% were women, 61% were pre-frail and 39% frail. After 24 months, there was no difference between groups in days spent at home [incidence rate ratio 1.03; 95% confidence interval (CI) 0.98–1.09]. After 12 months, the costs per person-year were 1.60-fold in the exercise group (95% CI 1.23–1.98), and after 24 months, 1.23-fold (95% CI 0.95–1.50) versus usual care. Over 12 months, the exercise group gained 0.04 quality-adjusted life-years and maintained the baseline 15D level, while the score in the usual care group deteriorated (P for group <.001, time 0.002, interaction 0.004). Conclusions and ImplicationsPhysical exercise did not increase the number of days spent at home. Exercise prevented deterioration of HRQoL, and in the frail subgroup, all intervention costs were compensated with decreased utilization of other health care and social services over 24 months.

Adoption of Mobile health Insurance Systems in Africa: evidence from Cameroon

The cost of health care services remains central concerns in low- and middle-income countries (LMIC), especially in Africa. One of the major challenges they face is how to efficiently reduce out-of-pocket spending. Health insurance systems are either inexistent or inefficient in many of these countries. In an attempt to implement and improve these systems, several countries have implemented mobile-supported health insurance systems (MHIS). Unfortunately, most of these programs have not crossed the pilot phases because of low adoption rates. Thus, this study sought to investigate the factors that influence the adoption of MHIS in LMIC. Using 263 valid responses collected during a 3-month survey in Cameroon, we found that coping appraisal and technology appraisal are important for the adoption of MHIS in LMIC. Precisely, performance expectancy, self-efficacy, response efficacy, facilitating conditions, and perceived cost explain 57.7% of the variance in behavioral intention to adopt MHIS. This study is based on empirically tested factors founded on the protection motivation theory (PMT) and the unified theory of acceptance and use of technology (UTAUT). Our contributions target health economists, technologists, policymakers, managers, researchers, and anyone interested in understanding the behavior of health insurance service consumers in LMIC and the pressures insurers and governments face during MHIS programs. We discuss the implications of our findings and further research that could help further explain MHIS adoption in LMIC.

Recommendations to protect patients and health care practices from Medicare and Medicaid fraud

Fraud is defined as knowingly submitting, or causing to be submitted, false claims or making misrepresentations of a fact to obtain a federal health care payment for which no entitlement would otherwise exist. In today’s health care environment, Medicare and Medicaid fraud is not uncommon. The negative impact of fraud is vast because it diverts resources meant to care for patients in need to the benefit of fraudsters. Fraud increases the overall costs for vital health care services and can potentially be harmful to Medicare and Medicaid beneficiaries. The objectives of this commentary are to describe the types and trends of Medicare and Medicaid fraud that are committed, and provide recommendations to protect patients and health care practices. Specifically, this article identifies types of Medicare and Medicaid fraud at beneficiary (patient) and provider level, and it can be intentional or unintentional. This article also describes the 3 primary laws that prohibit fraud and gives fraud case examples relevant to each law, including the False Claims Act, Anti-Kickback Statute, and the Stark Law. We also discuss currently trending and emerging areas, including opioid and pharmacogenetic testing; both have experienced heavier and higher-profile instances of fraud in today’s health care landscape. Last, the article summarizes detection methods and recommendations for health care providers and patients to protect themselves against fraud. Recommended strategies to combat fraud are discussed at policy, practice, and grassroots levels. Health care practitioners, including pharmacists, can use these strategies to protect themselves and their patients from becoming victims of fraud or unknowingly committing fraud.

Healthcare service utilization and cost among transition-age youth with autism spectrum disorder and other special healthcare needs.

Youth with autism spectrum disorder often have complex medical needs. Disruptions of healthcare during the transition from pediatric to adult healthcare may put youth with autism spectrum disorder at higher risk of medical emergencies and high medical costs. To understand healthcare utilization during the transition years, we conducted a study among transition-age youth (14-25 years old) receiving healthcare at Kaiser Permanente Northern California during 2014-2015. We examined differences in healthcare utilization and costs among youth with autism spectrum disorder (n = 4123), attention deficit and hyperactivity disorder (n = 20,6015), diabetes mellitus (n = 2156), and general population controls (n = 20,615). Analyses were also stratified by age and sex. Youth with autism spectrum disorder had the highest utilization of outpatient primary care, mental health, and psychotropic medications and the lowest utilization of obstetrics/gynecology and urgent care. Costs for youth with autism spectrum disorder were higher than those for attention deficit and hyperactivity disorder and general population peers and lower than for diabetes mellitus. Healthcare utilization patterns varied by age. Transition-age youth with autism spectrum disorder generally used healthcare at higher rates relative to attention deficit and hyperactivity disorder and general population peers but at similar or lower rates than diabetes mellitus peers, indicating this group's complex combination of psychiatric and medical healthcare needs. The relatively high utilization of psychiatric services and low utilization of women's health services in transition-age youth with autism spectrum disorder may have implications for long-term health and warrants additional research.

Impact of Behavioral Health Comorbidities on Health Care Costs Among Japanese Patients With Cancer.

Little is known about how behavioral health (BH) conditions affect health care costs of patients with cancer in Japan. The purpose of this study is to evaluate the magnitude of general medical claims expenditures for individuals with cancer who use or do not use BH services in Japan. The study used a health insurance claims database for more than 3 million enrollees in Japan. All health plan enrollees (18 y or older) who had tumors without metastasis or metastatic solid tumors defined by the Charlson Comorbidity Index were included in the study (n= 20,260). Measurements included total claims expenditures for BH and medical services. The proportion of enrollees using BH services was 12.8%. BH service users accounted for 17.7% of total health service spending. Mean annual cost of total health care services were 1.5 times higher in BH users than those with no BH use, whereas the median was 1.8 times higher. Mean annual medical cost alone for BH users was 1.3 times higher than that for non-BH users, whereas the median was 1.5 times higher. The findings suggest the importance for the Japanese medical system to address BH needs of patients with cancer and introduce fiscal efficiencies to cancer care. Strategic implementation of effective integrated care services for patients with cancer should be considered in Japan.

The Cost of Health Care Services in Urban and Intercity Road Traffic Accidents

The article's abstract is no available.

Cost-effectiveness of a specialist smoking cessation package compared with standard smoking cessation services for people with severe mental illness in England: a trial-based economic evaluation from the SCIMITAR+ study.

To evaluate the cost-effectiveness of a specialist smoking cessation package for people with severe mental illness DESIGN: Incremental cost-effectiveness analysis was undertaken from the UK National Health Service and Personal Social Services perspective over a 12-month time horizon. Total costs, including smoking cessation, health-care and social services costs and quality-adjusted life years (QALYs), derived from the five-level EuroQol 5-dimension (EQ-5D-5L), collected from a randomized controlled trial, were used as outcome measures. The bootstrap technique was employed to assess the uncertainty. Sixteen primary care and 21 secondary care mental health sites in England. Adult smokers with bipolar affective disorder, schizoaffective disorder or schizophrenia and related illnesses (n=526). A bespoke smoking cessation (BSC) package for people with severe mental illness offered up to 12 individual sessions with a mental health smoking cessation practitioner versus usual care (UC). Of the participants who were randomized, 261 were in UC group and 265 were in BSC group. BSC intervention cost was estimated from the treatment log. Costs of UC, health-care and social services and EQ-5D-5L were collected at baseline, 6- and 12-month follow-ups. Incremental costs and incremental QLAYs were estimated using regression adjusting for respective baseline values and other baseline covariates. The mean total cost in the BSC group was £270 [95% confidence interval (CI)=-£1690 to £1424] lower than in the UC group, while the mean QALYs were 0.013 (95% CI=-0.008 to 0.045) higher, leading to BSC dominating UC (76% probability of cost-effective at £20 000/QALY). A bespoke smoking cessation package for people with severe mental illness is likely to be cost-effective over 12months compared with usual care provided by the UK's National Health Service and personal social services.

Healthcare use and costs in adult cancer patients with anxiety and depression.

Anxiety and depression are common in individuals with cancer and may impact healthcare service use and costs in this population. This study examined the effects of anxiety alone, depression alone, and comorbid anxiety and depressive disorder on healthcare use and costs among patients with cancer. This was a retrospective cohort analysis of administrative data of patients aged 18 or older with an International Classification of Diseases, Ninth Revision diagnosis of cancer. Key outcomes were any visit to emergency department (ED), any inpatient hospitalization, length of hospital stays, and annual healthcare costs 1 year from cancer diagnosis. A total of 13,426 patients were included. Relative to patients with neither anxiety nor depression, those with anxiety alone, depression alone, or comorbid anxiety and depression were more likely to experience an ED visit and be hospitalized. Length of hospital stays were also longer and annual healthcare costs were significantly higher in all three clinical groups. Cancer patients with anxiety and depression were at greater risk for ED visits and hospitalizations, experienced longer hospital stays, and accrued higher healthcare costs. Future researchers should determine whether screening and treating comorbid anxiety and depression may decrease healthcare utilization and improve turnover wellbeing among cancer patients.

SAT0576 THE PREVALENCE OF RHEUMATOID ARTHRITIS: A SYSTEMATIC REVIEW OF POPULATION-BASED STUDIES.

Background:Rheumatoid arthritis (RA) is a heterogeneous disease with unknown aetiology (1). The reported worldwide RA prevalence varies widely (2, 3), and it is unclear whether this is due to inconsistencies in defining populations or methodologies used to identify RA patients (3, 4). Accurate RA prevalence data are required to plan preventative, diagnostic, and management strategies to address raising health care service demands and costs associated with improved lifespan and level of disability (5, 6).Objectives:To estimate the prevalence of RA from international population-based studies and investigate the influence of prevalence definition, data sources, classification criteria and geographical area on RA prevalence.Methods:A systematic review of existing literature was performed using the Joanna Briggs Institute approach for the systematic review and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search of ProQuest, MEDLINE, Web of Science, and EMBASE was undertaken to include population-based studies investigating RA prevalence between 1980 and 2019.Results:Sixty published population-based studies met the inclusion criteria over the study period. The mean point-prevalence of RA was 0.56% (range 0.00% to 2.70%) between 1986 and 2014. The period-prevalence was 0.51% (range 0.05% to 1.9%) between 1955 and 2015. RA point- and period-prevalence was higher in urban settings than rural settings, (0.69% vs 0.48%) and (0.54% vs 0.25%), respectively. The mean point- and period-prevalence were 0.56% (SD=0.52) and 0.57% (SD=0.41) and were lower in sampling population studies than in larger population databases studies (0.60% (SD=0.27) and 0.44% (SD= 0.26)). The highest period-prevalence of RA was observed in linked databases (0.80%, SD=0.1) where RA diagnosis was validated by rheumatologists.Conclusion:The average point- and period-prevalence of RA were 51/10,000 and 56/10,000 respectively. The RA prevalence was higher in urban areas than rural areas, suggesting an impact of environmental differences. Population database studies were more consistent than sampling studies, and linked databases appeared to provide the best estimate of RA period-prevalence when rheumatologists clinically verified RA.Table 1.The top five countries for the highest and lowest prevalence of RA in recent global estimate between 1980 and 2019.Global prevalence of RATop five countriesPrevalence (%)Highest1-Cuba2.702-Finland1.903-Lesotho1.804-USA1.075-Lebanon1.00Lowest1-Nigeria0.002-Taiwan0.05Taiwan0.10Taiwan0.123-Thailand0.124-India0.155-Philippines0.17

MON-141 Healthcare Services Utilization and Costs Associated with the Management of Patients Living with Acromegaly

Background: Acromegaly (ACRO) is a rare, chronic growth hormone hypersecretory disorder associated with increased morbidity and mortality. Limited information is available on the utilization and costs of healthcare by patients with ACRO. Aims: To assess the impact of ACRO healthcare utilization and costs by locations of care (LoC). Methods: A US database of prescription (Rx) drug and medical claims from Jan 2010 to Apr 2019 was analyzed. Patients with an ACRO diagnosis (Dx) were identified based on claims with ICD-9/-10 codes 253.0x/E22.0. The 12-month study period followed each patient’s first ACRO Dx in the database (the index date). ACRO patients included in the study had ≥ 2 ACRO Dxs > 30 days apart, or 1 ACRO Dx plus either a pituitary adenoma Dx or a pituitary surgery or radiosurgery claim during the study period. Costs were adjusted using the medical and Rx cost Consumer Price Indexes (CPIs). Study subjects were 18–65 yr old and had continuous eligibility during the study period. Eligible ACRO patients were matched with 20 subjects who did not have ACRO. Outcomes by LoC included costs, services, and likelihood of use and were compared using separate two-part regression models (logistic followed by generalized linear) for each outcome, controlling for demographic and job-related variables, region, and Charlson comorbidity index (CCI) scores. The likelihood models only used logistic regression. Data are shown as likelihoods or mean ± standard error. Findings are significant at P < 0.05. Results: A total of 60 patients with ACRO and 1200 controls were compared. Compared with controls, patients with ACRO had a higher likelihood of using the physician’s office (100% vs 91%, P < 0.0001), inpatient (22% vs 3%, P < 0.0005), outpatient (89% vs 38%, P < 0.0001), laboratory (62% vs 31%, P < 0.0001), and “other” locations (e.g., ambulance and claims without a specific location code, 55% vs 23%, P < 0.0001). Services performed at each LoC were higher for patients with ACRO (P < 0.01, all except outpatient hospital). Total costs were higher for the ACRO cohort compared with controls ($25,770 vs $4,059, P < 0.05). Costs by LoC were consistently higher (all reported P < 0.001) for patients with ACRO compared to controls, with differences highest in the following settings: outpatient hospital/clinic ($9,611 ± $1,793 vs $1,355 ± $74), inpatient ($8,646 ± $2,388 vs $739 ± $115), physicians’ office ($4,762 ± $678 vs$1,301 ± $43), other ($2,001 ± $583 vs $367 ± $29), and laboratory ($508 ± $93 vs $66 ± $4). Neither the costs nor likelihoods of treatment in the emergency department were significantly different between cohorts. Conclusions: Compared with commercially insured people without ACRO, patients with ACRO had greater health care utilization, in all care locations, indicating a greater burden and higher costs of ACRO patients on the healthcare system.

Privacy preservation in e-health cloud: taxonomy, privacy requirements, feasibility analysis, and opportunities

Electronic health records (EHRs) are increasingly employed to maintain, store and share varied types of patient data. The data can also be utilized for various research purposes, such as clinical trials or epidemic control strategies. With the increasing cost and scarcity of healthcare services, healthcare organizations feel at ease in outsourcing these services to cloud-based EHRs. That serves as pay-as-you-go (PAYG) “e-health cloud” models to aid the healthcare organizations handling with existing and imminent demands yet restricting their costs. Technologies can host some risks; hence the privacy of information in these systems is of utmost importance. Regardless of its increased effectiveness and growing eagerness in its adoption, not much care is being employed to the privacy issues that might arise. Privacy preservation need to be reviewed about the changing privacy rules and legislations regarding sensitive personal data. Our work aims at answering three major questions: firstly, how privacy models and privacy techniques correlate with each other, secondly, how we can fix the privacy-utility-trade off by using different combinations of privacy models and privacy techniques and lastly, what are the most relevant privacy techniques that can be adapted to achieve privacy of EHR on cloud.

Maternal participation on preterm infants care reduces the cost of delivery of preterm neonatal healthcare services

BackgroundThailand, with an annual incidence rate of 12% ranks high in incidence of preterm birth. Preterm infants require specialized care which can be lengthy and costly both in terms of psychological and emotional stress and healthcare services. The rapid rise of cost of healthcare services is a major concern for Thai government and public. PurposeTo assess and compare the growth patterns and cost of delivery of healthcare services of 50 preterm infants who were randomly assigned to either the control arm or the Maternal Participation Program (MPP) arm of the study. Methods25 infants in the control arm and 25 infants in the MPP arm were followed up from the day of transfer to the neonatal ward until they were discharged from the hospital. Data on clinical parameters and cost of healthcare delivery were collected by reviewing medical charts and from institutional financial databases. The principle of intention-to-treat analysis was used to analyze the data using the SPSS package (Version 23). ResultsThe average hospital stay (53 days vs. 60, P = .427) and days of oxygen delivery (21 days vs. 45, P = .047) for infants in the MPP arm were shorter than the control. At discharge from hospital, growth velocity of infants in the control arm had caught up with the MPP arm. Overall costs of healthcare delivery services for the preterm infants in control arm were 1.75 times higher than those in the MPP arm, with the procedural services as the costliest. Costs of drugs and the other ancillary services for the control arm was about 3-fold higher than for the MPP arm. ConclusionThere were similar growth patterns and weight gain between the preterm infants in the control arm and the intervention arm. However, health care cost in preterm infants in the control arm was no statistically significant higher than those of the MPP arm. The difference of health care cost may arise from healthcare services and clinical interventions. Innovative and simple alternative strategy such as MPP can be an effective approach to curb the escalating cost of healthcare services.

Cost of Hypertension Illness and Associated Factors Among Patients Attending Hospitals in Southwest Shewa Zone, Oromia Regional State, Ethiopia.

BackgroundHypertension is a common vascular disease and the main risk factor for cardiovascular diseases. Since the incidence of hypertension is rising in Ethiopia, one may expect that the household’s cost of healthcare services related to the disease will increase in the near future. Yet the cost associated with the disease is not known. We aimed to estimate the total cost of hypertension illness and identify associated factors among patients attending hospitals in Southwest Shewa zone, Oromia regional state, Ethiopia.Patients and MethodsAn institution-based cross-sectional study design was employed to conduct the study from 13 August to 2 September 2018. All hypertensive patients aged 18 years and older who were on follow-up were eligible for this study. The total cost of hypertension illness was estimated by summing the direct and indirect costs. Bivariate and multivariate linear regression analyses were performed to identify factors associated with hypertension costs of illnesses.ResultsA total of 349 patients participated in the study. The mean monthly total cost of hypertension illness was US$ 22.3 (95% CI, 21.3–23.3). Direct and indirect costs constitute 51% and 49% of the total cost, respectively. The mean direct cost of hypertension illness per patient per month was US$ 11.39 (95% CI, 10.6–12.1). Out of these, drugs comprised higher cost (31%), followed by food (25%). The mean indirect cost per patient per month was US$ 10.89 (95% CI, 10.4–11.4). In this study, the primary educational status, family size (4–6 and >6), distance from hospital (≥10 km), the presence of a companion and stage of hypertension (stage two) of patients were identified as the predictors of the cost of hypertension illnesses.ConclusionThe cost of hypertension illness was very high when compared to the monthly income of households, exposing patients to catastrophic costs. Hence, the government should give due attention to protect patients from catastrophic health expenditures.

Public financing in healthcare-The case of Kosovo in theory and practice

The man by nature tries and develops his activity for a better, richer and happier life, which in its essence means fulfilling diversified material, spiritual and cultural needs. Government, social-political communities or public legal entities, contemporary entities and institutions with forms of organization, with mechanism, and their instruments based on laws, must offer an organized life and opportunities for fulfilling general and common needs. Up to date, theoretical and practical knowledge shows that basic needs (security, education, healthcare, protection, jurisprudence, etc.) can be fulfilled more easily, faster, and more successfully, more rationally and continually, with higher quantity and quality with better and fairer organizing of the state and of the public legal entities of the institutions that respond to requests on realization of the new social and economic order of the world. The healthcare sector in Kosovo is financed mainly on income taxes, taxes, and co-payments, whereas out-of-pocket private payments are very high and include about 40% of costs for healthcare services. The budget for healthcare allocated by the government in the year 2015 was in total 163,760,703 million €, whereas the participation of budget for healthcare out of Kosovo’s total budget is 9.73., and 2,79% of GLP, that provided 90.72 € per citizen within one year! PHC is financed through transfers from the central budget to municipalities on specific grant form, on the amount 42,085,036 € that includes 28 % of the budget provided for healthcare. SHC and THC are financed by the Ministry, and it includes over 72% of the budget provided for healthcare. (PHC-primary healthcare, SHC-secondary healthcare, THC- tertiary healthcare).

A Mobile Phone-Based Telemonitoring Program for Heart Failure Patients After an Incidence of Acute Decompensation (Medly-AID): Protocol for a Randomized Controlled Trial.

BackgroundPatients with heart failure (HF) are at the highest risk for hospital readmissions during the first few weeks after discharge when patients are transitioning from hospital to home. Telemonitoring (TM) for HF management has been found to reduce mortality risk and hospital readmissions if implemented appropriately; however, the impact of TM targeted for patients recently discharged from hospital, for whom TM might have the biggest benefit, is still unknown. Medly, a mobile phone–based TM system that is currently being used as a standard of care for HF at a large Canadian hospital, may be an effective tool for the management of HF in patients recently discharged from hospital.ObjectiveThe objective of the Medly-After an Incidence of acute Decompensation (Medly-AID) trial is to determine the effect of Medly on the self-care and quality of life of patients with HF who have been recently discharged from hospital after an HF-related decompensation.MethodsA multisite multimethod randomized controlled trial (RCT) will be conducted at 2 academic hospitals and at least one community hospital to evaluate the impact of Medly-enabled HF management on the outcomes of patients with HF who had been hospitalized for HF-related decompensation and discharged during the 2 weeks before recruitment. The trial will include 144 participants with HF (74 in each control and intervention groups). Control patients will receive standard of care, whereas patients in the intervention group will receive standard of care and Medly. Specifically, patients in the intervention group will record daily weight, blood pressure, and heart rate and answer symptom-related questions via the Medly app. Medly will generate automated patient self-care messages such as to adjust diuretic medications, based on the rules-based algorithm personalized to the individual patient, and send real-time alerts to their health care providers as necessary. All patients will be followed for 3 months. Primary outcome measures are self-care and quality of life as measured through the validated questionnaires Self-Care of Heart Failure Index, EQ-5D-5L, and the Kansas City Cardiomyopathy Questionnaire-12. Secondary outcome measures for this study include cost of health care services used and health outcomes.ResultsPatient recruitment began in November 2018 at the Sunnybrook Health Sciences Centre, with a total of 35 participants recruited by July 30, 2019 (17 in the intervention group and 18 in the control group). The final analysis is expected to occur in the fall of 2020.ConclusionsThis RCT will be the first to assess the effectiveness of the Medly TM system for use following discharge from hospital after a HF-related decompensation.Trial RegistrationClinicalTrials.gov NCT03358303; https://clinicaltrials.gov/ct2/show/NCT03358303International Registered Report Identifier (IRRID)DERR1-10.2196/15753