Primary Health Care Costs Research Articles

Exploring the Efficacy of Selected Allografts in Chronic Wound Healing: Evidence from Murine Models and Clinical Data for a Proposed Treatment Algorithm.

Significance: Chronic wounds can lead to poor outcomes for patients, with risks, including amputation and death. In the United States, chronic wounds affect 2.5% of the population and cost up to $28 billion per year in primary health care costs. Recent Advances: Allograft tissues (dermal, amnion, and amnion/chorion) have shown efficacy in improving healing of chronic, recalcitrant wounds in human patients, as evidenced by multiple clinical trials. Their mechanisms of actions have been relatively understudied, until recently. Research in murine models has shown that dermal allografts promote reepithelialization, amnion allografts promote granulation tissue formation and angiogenesis, and amnion/chorion allografts support all stages of wound healing. These findings confirm their effectiveness and illuminate their therapeutic mechanisms. Critical Issues: Despite the promise of allografts in chronic wound care, a gap exists in understanding which allografts are most effective during each wound healing stage. The variable efficacy among each type of allograft suggests a mechanistic approach toward a proposed clinical treatment algorithm, based on wound characteristics and patient's needs, may be beneficial. Future Directions: Recent advances in allografts provide a framework for further investigations into patient-specific allograft selection. This requires additional research to identify which allografts support the best outcomes during each stage of wound healing and in which wound types. Longitudinal human studies investigating the long-term impacts of allografts, particularly in the remodeling phase, are also essential to developing a deeper understanding of their role in sustained wound repair and recovery.

Burden of metabolic syndrome on primary healthcare costs among older adults: A cross-sectional study.

The impact of metabolic syndrome (MetS) on healthcare costs remains unclear in the literature. To determine the impact of MetS on primary healthcare costs of adults, as well as to identify the impact of physical activity and other covariates on this phenomenon. This cross-sectional study was conducted in the city of Presidente Prudente, State of São Paulo/Brazil, in 2016. The sample comprised 159 older adults (> 50 years) of both sexes (110 women) who were identified from their medical records in the Brazilian National Health Service. Healthcare costs (US$) were assessed through medical records and divided into medical consultations, medications, laboratory tests, and total costs. MetS was assessed using medical records. The Brazilian National Health Service spent more on consultations (US$ 22.75 versus US$ 19.39; + 17.3%) and medication (US$ 19.65 versus US$ 8.32; + 136.1%) among adults with MetS than among those without MetS, but the costs for laboratory tests were similar (P = 0.343). Total costs were 53.9% higher in adults with MetS than in those without the diagnosis of the disease (P = 0.001). Regarding total costs, there was an increase of US$ 38.97 when five components of MetS were present (P = 0.015), representing an increase of approximately 700%, even after adjusting for sex, age, and physical activity. In conclusion, the presence of the MetS is responsible for increasing primary care costs among older adults, especially in those related to medicines.

An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria.

The availability of quality primary health care (PHC) services in Nigeria is limited. The PHC system faces significant challenges and the improvement and expansion of PHC services is constrained by low government spending on health, especially on PHC. Out-of-pocket (OOP) expenditures dominate health spending in Nigeria and the reliance on OOP payments leads to financial burdens on the poorest and most vulnerable populations. To address these challenges, the Nigerian government has implemented several legislative and policy reforms, including the National Health Insurance Authority (NHIA) Act enacted in 2022 to make health insurance mandatory for all Nigerian citizens and residents. Our study aimed to determine the costs of providing PHC services at public health facilities in Kaduna and Kano, Nigeria. We compared the actual PHC service delivery costs to the normative costs of delivering the Minimum Service Package (MSP) in the two states. We collected primary data from 50 health facilities (25 per state), including PHC facilities-health posts, health clinics, health centers-and general hospitals. Data on facility-level recurrent costs were collected retrospectively for 2019 to estimate economic costs from the provider's perspective. Statewide actual costs were estimated by extrapolating the PHC cost estimates at sampled health facilities, while normative costs were derived using standard treatment protocols (STPs) and the populations requiring PHC services in each state. We found that average actual PHC costs per capita at PHC facilities-where most PHC services should be provided according to government guidelines-ranged from US$ 18.9 to US$ 28 in Kaduna and US$ 15.9 to US$ 20.4 in Kano, depending on the estimation methods used. When also considering the costs of PHC services provided at general hospitals-where approximately a third of PHC services are delivered in both states-the actual per capita costs of PHC services ranged from US$ 20 to US$ 30.6 in Kaduna and US$ 17.8 to US$ 22 in Kano. All estimates of actual PHC costs per capita were markedly lower than the normative per capita costs of delivering quality PHC services to all those who need them, projected at US$ 44.9 in Kaduna and US$ 49.5 in Kano. Bridging this resource gap would require significant increases in expenditures on PHC in both states. These results can provide useful information for ongoing discussions on the implementation of the NHIA Act including the refinement of provider payment strategies to ensure that PHC providers are remunerated fairly and that they are incentivized to provide quality PHC services.

Effect of physical activity counselling on the number of contacts in primary healthcare, specialised healthcare and the related healthcare costs among patients with type 2 diabetes: a register-based evaluation study

IntroductionThis study evaluated the effect of physical activity (PA) counselling on the number of contacts and related costs in primary healthcare (PHC) and specialised healthcare (SHC) among patients with type...

Health system barriers to accessing care for children with weight issues in New Zealand: An interview-based study.

To identify barriers created and maintained by the health system affecting engagement in a family-based multidisciplinary healthy lifestyle programme for children and adolescents in New Zealand. We conducted 64 semi-structured interviews with participants of the programme (n = 71) with varying levels of engagement, including those who declined contact after their referral. Half the interviews were with families with Māori children, allowing for appropriate representation. Interviews were analysed using thematic analysis. Five health system factors affecting engagement were identified: the national policy environment, funding constraints, lack of coordination between services, difficulty navigating the health system, and the cost of primary health care. Engaging with a health system that creates and maintains substantial barriers to accessing services is difficult, affecting programme engagement, even where service-level barriers have been minimised. Lack of access remains a crucial barrier to improved health outcomes for children and their families experiencing childhood obesity in New Zealand. There is a need for comprehensive approaches that are accompanied by a clear implementation strategy and coordinated across sectors.

Disruption of microbial cell morphology by Buxus macowanii

BackgroundMicrobial infections are one of the major causes of death globally. This is attributed to the rising costs of primary healthcare and its inaccessibility especially in developing countries. Moreover, there has been an increase in microbial strains that have reduced susceptibility to antimicrobial drugs. Research on the antimicrobial properties of medicinal plants, which could address these problems, has become more important as they present fewer side effects when compared to the antibiotics currently in use. This study evaluated the antimicrobial properties of a methanolic extract from Buxus macowanii in order to assess its potential in the development of novel antimicrobial drugs.MethodsAntimicrobial activity of the extract was evaluated using the broth microdilution method. The effects of B. macowanii on the morphology of B. cereus were observed using Scanning and Transmission electron microscopy. Chemical profiling of the plant extract was performed using the GCMS.ResultsThe extract showed antimicrobial activity against all the microbial species used. Microscopic examination of the cells of B. cereus cells treated with Buxus macowanii showed some changes in morphology such as damage of the cell wall, swelling of the cells and incomplete cell division that eventually resulted in cell death. Neophytadiene, an antimicrobial compound was detected in the extract using GCMS.ConclusionThe morphological disruptions of the cell wall of Bacillus cereus explain the antimicrobial properties of B. macowanii and indicate its possible application in the development of natural antimicrobial drugs.

Recurrent costs in primary health care in Ethiopia: facility and disease specific unit costs and their components in government primary hospitals and health centers

BackgroundContinued investment, especially from domestic financing, is needed for Ethiopia to achieve universal health coverage and a sustainable health system over time. Understanding costs of providing health services will assist the government to mobilize adequate resources for health, and to understand future costs of changes in quality of care, service provision scope, and potential decline in external resources. This study assessed costs per unit of service output, “unit costs”, for government primary hospitals and health centers, and disease-specific services within each facility.MethodsQuantitative and qualitative data were collected from 25 primary hospitals and 47 health centers across eight of the eleven regions of Ethiopia for 2013/14, and 2014/15 and 2015/16 but only for primary hospitals, and supplemented by other related health and financial institutions records. A top-down costing approach was used to estimate unit costs for each facility by department – inpatient, outpatient, maternal and child health, and delivery. A mixed-method approach was used for the disease-specific unit costs exempt from fees.ResultsHealth center median unit cost was 146 Ethiopian birr (ETB) (17 PPP$, 2012), the Delivery department had the highest median unit cost (647 ETB; 76 PPP$, 2012) and Outpatient department (OPD) had the lowest (124 ETB; 14 PPP$, 2012). Primary hospital median unit cost was 339 ETB (40 PPP$, 2012), with Inpatient department having the highest median unit cost (1288 ETB; 151 PPP$, 2012), while OPD was the lowest (252 ETB; 29 PPP$, 2012). Drugs and pharmaceutical supplies accounted for most of the costs for both facilities. Among the exempted services offered, tuberculosis and antiretroviral treatment are the costliest with median unit costs from 1091 to 1536 ETB (128–180 PPP$, 2012), with drugs and supplies accounting for almost 90% of the costs.ConclusionsHigh unit costs of service provision could be indicative of underutilization of the primary health care system, coupled with inefficiencies associated with organization and delivery of health services. Data from this study are being used to assess efficiency and productivity among primary care facilities, facilitate premium setting for health insurance, and improve budgeting and allocating health resources for a more sustainable and effective primary health care system.

Primary Health Care in the World: Results of the 40-year Implementation of the Almaty Declaration (1978) and Future Development According to the Astana Declaration (2018)

The article presents the results of the development of primary health care from the aprovement of the Almaty Declaration in 1978 to the signing of the Astana Declaration of 2018. It is emphasized that despite the actions taken, the pace of development and strengthening of primary health care is unsatisfactory, which is confirmed by numerous reports. According to reports of World Health Organization 50% of the world’s population still partially or completely do not have access to basic medical services, including treatment and prevention of infectional and non-communicable diseases, reproductive health, protection of women and children’s health. Taken into accaunt the current situation, WHO held the Global Conference on Primary Health Care, where the reports from world leaders and ministries on this issue were represented. The article discribes the generalized results in the development of primary care in the world according to the submitted reports. It is emphasized that in some countries today, the levels, rates of development of PHC and its financing are insufficient. Patients are forced to pay for basic medical services from their own funds. The negative consequences of paying for services from one’s own funds are felt by more people than 15 years ago. About 925 million people spend more than 10% of the income on medical care, and 200 million spend more than 25% of their income on it. At the same time, indicators of impoverishment as a result of payment for medical care increased among all groups of the population, except the extremely poor. WHO sets one of the global health goals for all countries to increase the cost of primary health care by at least 1% of its gross domestic product .The specified goals, principles and objectives of the PHC that WHO sets for the future are detailed. The full text of the Astana Declaration 2018 is given. The role and participation of the World Association of Family Doctors (Wonca) and Ukraine are described. In general, primary health care has been and will be at the forefront of the world’s health systems priorities, its further development and strengthening is a priority task posed by the World Health Organization for all countries of the world, which will lead to the protection and strengthening of the health of all people, the formation of effective affordable health care for all.

Cost of implementing a community-based primary health care strengthening program: The case of the Ghana Essential Health Interventions Program in northern Ghana.

BackgroundThe absence of implementation cost data constrains deliberations on consigning resources to community-based health programs. This paper analyses the cost of implementing strategies for accelerating the expansion of a community-based primary health care program in northern Ghana. Known as the Ghana Essential Health Intervention Program (GEHIP), the project was an embedded implementation science program implemented to provide practical guidance for accelerating the expansion of community-based primary health care and introducing improvements in the range of services community workers can provide.MethodsCost data were systematically collected from intervention and non-intervention districts throughout the implementation period (2012–2014) from a provider perspective. The step-down allocation approach to costing was used while WHO health system blocks were adopted as cost centers. We computed cost without annualizing capital cost to represent financial cost and cost with annualizing capital cost to represent economic cost.ResultsThe per capita financial cost and economic cost of implementing GEHIP over a three-year period was $1.79, and $1.07 respectively. GEHIP comprised only 3.1% of total primary health care cost. Health service delivery comprised the largest component of cost (37.6%), human resources was 28.6%, medicines was 13.6%, leadership/governance was 12.8%, while health information comprised 7.5% of the economic cost of implementing GEHIP.ConclusionThe per capita cost of implementing the GEHIP program was low. GEHIP project investments had a catalytic effect that improved community-based health planning and services (CHPS) coverage and enhanced the efficient use of routine health system resources rather than expanding overall primary health care costs.

The role of management function to the achievement of puskesmas indicator as a gatekeeper of national health guarantee in Bengkulu City

The financing of national health insurance for referral health services is amounted to 45.47 trillion, while the cost of primary health care is amounted to 11.5 trillion. The largest capitation cost was received by the Public Health Center 73.6% with the number of cases referred to the hospital as much as 11.9 million and non-specialist referral 1.54 million cases. Capitation policy based on service commitment fulfillment is a performance indicator in first-level health facility/FLHF (FKTP), so it can be measured periodically. Public Health Center as one of the government-owned in first level health facility that provides the most services for the national health insurance participants (JKN) should be sought controlling referral. The purpose of the study is to analyze the role of management function on the control of referral from Public Health Center in Bengkulu City.

A cost-benefit analysis of varicella vaccination in Aragón.

Varicella, a contagious and infectious disease that is usually benign in children, may become complicated among adults and vulnerable children and may even be life-threatening. There are effective vaccines. A retrospective study was conducted about costs and resulting hospitalizations related to this disease in the population of Aragón in the 2004-2014 period. Costs were compared to the expenses that would have been incurred if those people had received the vaccine and also to the expenses of vaccinating the 1-year-old population over the entire period. A cost-benefit analysis was done to assess the economic impact of varicella vaccination. Data for the 11-year period were provided by the Autonomous Community of Aragón (Spain) and included annual varicella incidence, hospital discharges of varicella cases, costs of primary health care visits and hospitalizations for each year, costs of each workday as per the minimum annual salary and of drugs used). Capitalized costs were estimated and compared to capitalized expenses of vaccination, and a sensitivity analysis was performed. A benefit-cost ratio of 1.6 was obtained considering that all children who had varicella had been vaccinated and had received a booster dose. A benefit-cost ratio of 1.24 was obtained considering that the vaccine had been administered to every 1-year-old individual at a price of EUR 28.59 per vaccine. Over the 11-year period, 53% of hospitalizations corresponded to children younger than 5 years old. Public campaigns for the immunization of children younger than 4 years old with 2 doses lead to cost savings and are cost-effective because the vaccine price results in a benefit-cost ratio greater than 1. A major reduction is expected in the number of hospitalizations among children aged 3-4 years.

Monitoring of Chronic Disease in the community: Australian Telehealth Study on Organisational Challenges and Economic Impact

Introduction : Commonwealth Scientific & Industrial Research Organisation (CSIRO) of Australia was tasked to lead a National Telehealth Trial for chronic disease in the community to investigate models of care, health service utilization and economic impact on the Australian health system. Chronic and aged care accounted for over 70% of Australia’s $155bn expenditure on healthcare during 2013–14, and is projected to dramatically increase into the future. Australia’s hospital-centric public health system is unnecessarily burdened by the management of chronic disease, which should occur in home and community settings. Telehealth services delivered through home Telemonitoring have been demonstrated to deliver cost effective, timely and improved access to quality care. They also reduce social dislocation and enhance the quality of life within communities and their sustainability by allowing chronically ill and aged members to stay in their homes and communities longer. The development of a robust business case and business models for large scale commercial deployment of Telehealth services based on solid economic evidence is essential if these services are to be scaled up nationally to have any impact on the escalating costs of health service delivery and the increasing deficit in clinical work force. Description of practice change : Trial was designed with the aim of demonstrating how Telehealth services for chronic disease management in the community can be deployed nationally in a range of hospital and community settings, by piloting services in six different locations across five Australian states with a range of health service provider’s, including a hospital, Local Health Districts, Medicare Locals and aged care organisation. The intervention was the provision of Telemonitoring equipment for the collection of vital signs and the administration of questionnaires. Control patients received normal care. In this trial we analysed and compared the performance, across four distinct groups with one hospital site, two community based services, two GP managed Medicare Local coordinated services and one Aged Care focused service. Key Findings : Based on a before and after control intervention (BACI) case matched design this trial evaluated health outcomes, impact of workplace culture and capacity for organizational change management. The project recruited 113 chronically ill patients with multiple co-morbidities and remotely monitored using Telehealth. These patients were compared with 174 patients acting as matched controls who were tracked for periods 6-18 months with at home telemonitoring of vital signs and clinical symptoms. Telehealth monitored patients’ demonstrated: a. Reduction in health services utilisation observed towards the later part of the trial (after 8-9 months) by reduced number of GP visits, specialist consultations, laboratory tests and procedures performed. b. Reduction in primary healthcare costs were demonstrated by the reduction of Medicare benefit costs by more than AUD600/year/patient and pharmaceutical dispensing cost by more than $300/year/patient at end of trial. c. Reduction in hospital length of stay by more than 7 days d. Reduction in rate of hospitalisations by 1 less event e. There were improved Quality of life metrics/Human factors /Useability and acceptability to patients and clinicians Highlights : At all trial sites the Telehealth technology was well accepted by patients. The key barriers were related to integration of Telemonitoring into existing models of care was at the services provider level. These barriers included the capacity to implement/participate in new programs within health organisations and one of our trial sites had to be decommissioned. Main highlight was the continuation of Telemonitoring at three sites post-trial, offering Telehealth as a mainstream service for chronic disease management of patients in their home. This is a big win from the trial where three health service providers have integrated Telehealth as an ongoing sustainable service for chronic disease management in the community. Conclusions : Telemonitoring can be deployed for management of chronic disease in the community as a cost effective alternative. From the experience throughout the trial has demonstrated that successful deployment of remote Telemonitoring of chronic disease requires the following success factors: − Importance of a new Clinical Care Coordination role to centrally coordinate optimal response to caregivers as demonstrated in this trial − Strong support and leadership from the health service management team and the formation of strong clinical governance for the service − Strong alignment of workplace culture and values with the objectives of Telemonitoring. This will often require the implementation of extensive training and education programs − A clear “ownership” and engagement not only with the patient, but with the patient’s carers who may include relatives, neighbours, community nurses and GPs. − Clear governance protocols and lines of communication between the clinical care coordinator and the patient’s care team, in particular the patient’s GP. − Support for Telemonitoring services through automated risk stratification protocols that can identify with high probability patients who are demonstrating an exacerbation of their condition and may require immediate attention to avoid an unnecessary hospitalisation.

Medical costs of asbestos-related diseases in Spain between 2004 and 2011.

The objective of this article was to estimate the medical costs derived from malignant ARD treatment in the Spanish National Health System (NHS) between 2004 and 2011. Estimation of direct healthcare costs was based on national primary data on the cost of specialized care for inpatients and outpatients treated at NHS hospitals and on national and regional secondary data on costs of primary healthcare and pharmaceutical prescriptions. A prevalence approach was used to estimate the overall burden of ARDs. Direct medical costs of 37,557 ARDs attended in Spanish NHS facilities in 2004–2011 were estimated at 464 million euros; specialist care accounted for 50.9% of total costs, primary healthcare 10.15%, and drug prescription 38.9%. The cost was 27.8-fold higher in males than in females. Bronchopulmonary cancers represented the greatest healthcare cost, 281 million euros. The cost of delivering healthcare to ARDs victims in Spain has a negative economic impact on the NHS due to the gross under-recognition of occupational victims under the Spanish National Insurance System.

Smoking increases use and costs of primary healthcare

Smoking increases use and costs of primary healthcare

Implementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta-analysis.

Screening and brief interventions (SBI) delivered in primary health care (PHC) are cost-effective in decreasing alcohol consumption; however, they are underused. This study aims to identify implementation strategies that focus on SBI uptake and measure impact on: (1) heavy drinking and (2) delivery of SBI in PHC. Meta-analysis was conducted of controlled trials of SBI implementation strategies in PHC to reduce heavy drinking. Key outcomes included alcohol consumption, screening, brief interventions and costs in PHC. Predictor measures concerned single versus multiple strategies, type of strategy, duration and physician-only input versus that including mid-level professionals. Standardized mean differences (SMD) were calculated to indicate the impact of implementation strategies on key outcomes. Effect sizes were aggregated using meta-regression models. The 29 included studies were of moderate methodological quality. Strategies had no overall impact on patients' reported alcohol consumption [SMD=0.07; 95% confidence interval (CI)=-0.02 to 0.16], despite improving screening (SMD=0.53; 95% CI=0.28-0.78) and brief intervention delivery (SMD=0.64;95% CI=0.27-1.02). Multi-faceted strategies, i.e. professional and/or organizational and/or patient-orientated strategies, seemed to have strongest effects on patients' alcohol consumption (P<0.05, compared with professional-orientated strategies alone). Regarding SBI delivery, combining professional with patient-orientated implementation strategies had the highest impact (P<0.05). Involving other staff besides physicians was beneficial for screening (P<0.05). To increase delivery of alcohol screening and brief interventions and decrease patients' alcohol consumption, implementation strategies should include a combination of patient-, professional- and organizational-orientated approaches and involve mid-level health professionals as well as physicians.

Towards a differentiated capitation system: relation between patient characteristics, contacts and costs.

A new payment system could curb primary health care costs. A differentiated capitation system based on patient characteristics could be the best mix for payment. To test the feasibility of such a system, we examined the number of contacts between patients and general practitioners (GPs), the related costs and the relationship with age, sex and comorbidity. A retrospective observational study included 29304 primary care patients in the Netherlands. Age, sex and comorbidity were related to number of contacts per patients per year and costs using a negative binomial regression analysis. Males, younger patients and patients with no comorbidities visit their GP least often. Medically unexplained physical symptoms, diabetes and severe back complaints generate the most contacts; diabetes is specifically related to higher costs. Several patient characteristics are related to the number of contacts patients have with their GP and the consecutive remuneration. This study can be used as an input to create a differentiated capitation system.

Characteristics and value of Aboriginal Community Controlled Health Organizations' primary health care and their financing needs: a protocol for systematic evidence reviews.

REVIEW OBJECTIVE AND QUESTIONS The objective of this comprehensive systematic review is to describe and assess the unique service characteristics, impact (experiences of meaningfulness and measures of effects) and costs of primary health care programs/services delivered by Aboriginal Community Controlled Health Organizations for Aboriginal and Torres Strait Islander people in Australia as well as the limitations of Aboriginal Community Controlled Health Organizations financing arrangements and options for enhancing them. The review questions are: 1.How do Aboriginal and Torres Strait Islander patients, their family members and primary health care providers experience or perceive: a) the characteristics (positive and negative) and meaningfulness/value of primary health care provided by Aboriginal Community Controlled Health Organizations: and b) the differences between the characteristics and meaningfulness/value of primary health care provided by Aboriginal Community Controlled Health Organizations and other Australian primary health care providers (including mainstream and state controlled Aboriginal Medical Services)? 2. What are effects of Aboriginal Community Controlled Health Organizations primary health care programs/services on: a) Aboriginal and Torres Strait Islander peoples’ access to primary health care; b) Social determinants of Aboriginal and Torres Strait Islander peoples’ health; and c) Aboriginal and Torres Strait Islander peoples’ health status? And how do these effects compare with those of other Australian primary health care providers? 3. How do costs of providing primary health care programs/services in the Aboriginal Community Controlled Health Organizations setting(s) differ from those of other Australian primary health care provider settings? 4. What are the perceived limitations of financing arrangements TRUNCATED AT 250 WORDS

Study of primary healthcare cost and budget prediction for community health centers

Objective To measure the costs of primary health services in the community for developing government compensation standard and prediction of budget in 2015. Methods Literature review and panel discussions were used to build the index database.A two-round Delphi expert consultation determined the work to do and steps for community healthcare standards.60 community health centers were sampled by stratified random sampling for survey, and the work hours, workload and service volume of respective services in 2013 were measured according to the service standards of primary care. Results The community primary care consists of the categories of outpatient services, nursing care, laboratory tests and drug management, totaling 20 services and 88 working procedures.The total work hours of primary healthcare service at 60 community health centers were 2 557 187.9 hours, which is adjusted to 2 959 215.1 hours based on workload coefficients.Based on the income standards of employees at the community health centers investigated, and the human cost price which was recommended by the experts, the total costs of primary healthcare of the 60 centers were 245 million, 248 million and 318 million respectively, and the average cost was 71.0 yuan, 71.8 yuan and 92.1 yuan per visit respectively.By such standards, the government should subsidize 38.9~60.0 yuan per visit to the centers.The total expenditure of primary healthcare of all communities in Shenzhen in 2015 was predicted to be 314 to 407 million, for which the government is expected to subsidize 1.68~2.58 billion. Conclusion The subsidies for community primary healthcare fall short as the cost per visit runs up in 2013 to 71.0 yuan per visit or more, far above the current subsidy of 32.1 yuan per person.The subsidy per visit should be made 50.0 yuan in 2015. Key words: Primary healthcare; Human cost; Unit cost; Work hours

A health economic evaluation of screening and treatment in patients with adolescent idiopathic scoliosis.

Summary of background dataAdolescent idiopathic scoliosis can progress and affect the health related quality of life of the patients. Research shows that screening is effective in early detection, which allows for bracing and reduced surgical rates, and may save costs, but is still controversial from a health economic perspective.Study designModel based cost minimisation analysis using hospital’s costs, administrative data, and market prices to estimate costs in screening, bracing and surgical treatment. Uncertainty was characterised by deterministic and probabilistic sensitivity analyses. Time horizon was 6 years from first screening at 11 years of age.ObjectiveTo compare estimated costs in screening and non-screening scenarios (reduced treatment rates of 90%, 80%, 70% of screening, and non-screening Norway 2012).MethodsData was based on screening and treatment costs in primary health care and in hospital care settings. Participants were 4000, 12-year old children screened in Norway, 115190 children screened in Hong Kong and 112 children treated for scoliosis in Norway in 2012. We assumed equivalent outcome of health related quality of life, and compared only relative costs in screening and non-screening settings. Incremental cost was defined as positive when a non-screening scenario was more expensive relative to screening.ResultsScreening per child was € 8.4 (95% CrI 6.6 to10.6), € 10350 (8690 to 12180) per patient braced, and € 45880 (39040 to 55400) per child operated. Incremental cost per child in non-screening scenario of 90% treatment rate was € 13.3 (1 to 27), increasing from € 1.3 (−8 to 11) to € 27.6 (14 to 44) as surgical rates relative to bracing increased from 40% to 80%. For the 80% treatment rate non-screening scenario, incremental cost was € 5.5 (−6 to 18) when screening all, and € 11.3 (2 to 22) when screening girls only. For the non-screening Norwegian scenario, incremental cost per child was € -0.1(−14 to 16). Bracing and surgery were the main cost drivers and contributed most to uncertainty.ConclusionsWith the assumptions applied in the present study, screening is cost saving when performed in girls only, and when it leads to reduced treatment rates. Cost of surgery was dominating in non-screening whilst cost of bracing was dominating in screening. The economic gain of screening increases when it leads to higher rates of bracing and reduced surgical rates.Electronic supplementary materialThe online version of this article (doi:10.1186/s13013-014-0021-8) contains supplementary material, which is available to authorized users.

Triggering Factors of Primary Care Costs in the Years Following Type 2 Diabetes Diagnosis in Mexico

Diabetes represents a high epidemiological and economic burden worldwide. The cost of diabetes care increases slowly during early years, but it accelerates once chronic complications set in. There is evidence that adequate control may delay the onset of complications. Management of diabetes falls almost exclusively into primary care services until chronic complications appear. Therefore, primary care is strategic for reducing the expedited growth of costs. The objective of this study was to identify predictors of primary care costs in patients without complications in the years following diabetes diagnosis. Direct medical costs for primary care were determined from the perspective of public health services provider. Information was obtained from medical records of 764 patients. Microcosting and average cost techniques were combined. A generalized linear regression model was developed including characteristics of patients and facilities. Primary health care costs for different patient profiles were estimated. The mean annual primary care cost was USD$465.1. Gender was the most important predictor followed by weight status, insulin use, respiratoty infections, glycemic control and dyslipidemia. A gap in costs was observed between genders; women make greater use of resources (42.1% on average). Such differences are reduced with obesity (18.1%), overweight (22.8%), respiratory infection (20.8%) and age >80 years (26.8%). Improving glycemic control shows increasing costs but at decreasing rates. Modifiable factors (glycemic control, weight status and comorbidities) drive primary care costs the first 10 years. Those factors had a larger effect in costs for males than in for females.