Cost Of Services Research Articles

Return on Investment of Enhanced Behavioral Health Services.

Employer-sponsored benefit programs aim to increase access to behavioral health care, which may help contain health care costs. However, research has either focused solely on clinical outcomes or demonstrated reductions in medical claims without accounting for the costs of behavioral health services, leaving the financial return on investment unknown. To determine whether a clinically effective employer-sponsored behavioral health benefit is associated with net medical cost savings. This retrospective cohort study included participants eligible for an employer-sponsored behavioral health benefit between November 1, 2019, and May 31, 2023. Eligibility criteria included having a behavioral health diagnosis and, in the program group, attending at least 1 behavioral health appointment. Program users were matched to nonusers on medical risk scores, behavioral health diagnoses, date of diagnosis, age, sex, and employer. Participants were followed up for 1 year before and after the benefit launch. A digital platform screened individuals for common behavioral health conditions and provided access to video and in-person psychotherapy, medication management, care navigation, and self-guided digital content. Primary outcomes were per member per month (PMPM) medical spending, inclusive of all medical claims and program costs. A difference-in-differences analysis was used to compare changes in net medical spending between groups from the year before and up to 1 year after an index mental health diagnosis. This study included 13 990 participants: 4907 of 4949 (99.1%) eligible program group members were matched to 9083 control participants. Their mean (SD) age was 37 (13.2) years, and most participants (65.5%) were female. Costs decreased in the program group relative to the control group, with a net difference-in-differences of -$164 PMPM (95% CI, -$228 to -$100 PMPM), corresponding to savings of $1070 per participant in the first program year and a return on investment of 1.9 times the costs (ie, every $100 invested reduced medical claims costs by $190). Behavioral health costs in the program group increased relative to the control group but were more than offset by decreases in physical health care costs. Savings were larger for participants with higher medical risk. In this cohort study, every $100 invested in an employer-sponsored behavioral health program with fast access to psychotherapy and medication management was associated with a reduction in medical claims costs by $190. These findings suggest that expanding access to behavioral health care may be a financially viable cost-reduction strategy for health care buyers.

ASSESSMENT OF THE ACCESSIBILITY OF THE POPULATION OF ALMATY TO FREE DENTAL CARE

Background: Oral health is an important component of overall health and well-being. The ever-increasing cost of dental services makes it inaccessible to most of the population. The purpose of the study: to study the accessibility of the adult population in free dental medical care. Materials and methods: A cross-sectional study was conducted with the participation of 115 respondents who were interviewed using the author’s questionnaire «Patient satisfaction with the work of the dental service” and examined by a dentist to identify oral diseases. The main group consisted of people of retirement age who could receive dental care at the expense of the Republican budget – 36 people, the control group included people younger than retirement age (63 years for men, 61 years for women) — 79 people. Results: The survey showed that most patients go to the dentist only for urgent need, with a preventive purpose only 5% of the main group and 14% of the control group. None of the patients had an income below the subsistence level per family member, however, most patients in both groups need free dental care (87% of the main group and 80% of the control group), the main reason for rare visits to the dentist is financial constraints. Conclusions: Even though the respondents did not have an income below the subsistence level, most of them needed free dental care.

Health and social care use, costs, and satisfaction among key workers accessing Resilience Hub support during the COVID-19 pandemic.

Key workers are vulnerable to adverse mental health. To ensure service sustainability during COVID-19, Resilience Hubs were established across England offering outreach, screening, and mental health support. This evaluation aimed to describe wider service use, associated costs, and satisfaction among Hub clients (key workers) accessing Hub support. Clients accessing support across four Hubs were invited to complete a service use questionnaire, between 5 and 8 months post referral, collecting satisfaction, wider service use and cost data. Exploratory linear regression assessed the relationship between demographic variables and service use. Most Hub clients reported Hub contact post referral (219/299, 73.2%), with many accessing mental health support (171/299, 57.2%) or on waitlists (34/299, 11.4%). Satisfaction was high, with median helpfulness rated 92 (out of 100), and many stating that Hubs either fully (148/299, 49.5%) or partially (54/299, 18.1%) met their needs. Mental health support accounted for most service use, with higher total service use and costs when including Hub services (£514 versus £213). Key workers have complex needs. Hub services helped clients to access support, with high reported satisfaction indicating that Hubs met clients needs. Further research is required to assess how service use varies according to occupation or demographic characteristics, and whether Hubs are clinically and cost-effective.

Multi-channel price and service level competition with the impact of coordination contracts

Abstract In this paper, we consider a two-echelon supply chain model with a single manufacturer and multiple retailers handling a single product. The demand at the retailers’ end is dependent on the retail price and service level of the retailer. The retailers compete with each other over the retail price and the service level. At first, we study the centralized and the decentralized systems, and then try to coordinate the decentralized system with several contracts. We use the service cost sharing contract, retail fixed markup (RFM) contract and RFM plus service cost sharing contract in our model. Our study establishes that among the aforementioned contracts, the RFM strategy yields the most profit and come out as the most beneficial for all parties involved. Finally, we validate the proposed model with a numerical example. Through sensitivity analysis, we illustrate the impact of different model parameters on the optimal decisions.

Users' Perspectives of Direct-to-Consumer Telemedicine Services: Survey Study.

Commercially run direct-to-consumer (DTC) telemedicine services are on the rise in countries such as Australia and the United States. These include DTC services that are web-based, largely asynchronous, and offer targeted treatment pathways for specific health issues (eg, weight loss or sexual function). It has been argued that DTC telemedicine improves access to health care and promotes patient empowerment. Despite research examining quality and safety issues, little is known about users' reasons for accessing DTC telemedicine services or their perceptions of them. In this study, we aimed to examine the perspectives of Australian users accessing DTC telemedicine services, including the reasons for use, perceived benefits, and concerns, in addition to their usage and interaction with traditional general practice services. A web-based cross-sectional survey including questions on demographics, published and validated scales, and author-developed closed- and open-response questions was administered via REDCap in 2023 to Australian adults accessing DTC telemedicine services. Among the 151 respondents, most (136/151, 90.1%) had seen a general practitioner (GP) in the previous 12 months and were somewhat or very satisfied (118/136, 86.8%) with the care, just over half found it easy to get an appointment with their GP (76/151, 50.3%), and a quarter found it difficult (38/151, 25.2%). Among the 136 respondents who had seen a GP, more than half either "never" (55/136, 40.4%) or "rarely" (23/136, 16.9%) discussed the information and treatment received from DTC telemedicine service with their GP. The majority of respondents were using a DTC telemedicine service offering prescription skin care (92/151, 60.9%), had received treatment in the previous 6 months (123/151, 81.5%), and had self-initiated care (128/151, 84.8%). The most frequently cited reasons for using DTC telemedicine were related to convenience (97/121, 80.2%) and flexibility (71/121, 58.7%), while approximately a third of the sample selected that it was difficult to see traditional health care provider in their preferred time frame (44/121, 36.4%) and that the use of DTC telemedicine allowed them to gain access to services otherwise unavailable through traditional health care (39/121, 32.2%). Most participants felt "more in control" (106/128, 82.9%) and "in charge" of their health concern (102/130, 78.5%) when using DTC telemedicine services, in addition to having "more correct knowledge" (92/128, 71.9%) and "feeling better informed as a patient" (94/131, 71.8%). "Costs of services" (40/115, 34.8%) and "privacy" (31/115, 27%) were the most frequently reported concerns with using digital health care technologies such as DTC telemedicine. We report that most users perceive DTC telemedicine services as offering ease of access and convenience, and that their use contributes to a greater sense of empowerment over their health. Concerns were related to data privacy and the costs of utilizing the services. Responses suggest that DTC telemedicine may be tapping into a previously unmet need, rather than complementing traditional health care provided by a GP.

Barriers and facilitators to maternal healthcare in East Africa: a systematic review and qualitative synthesis of perspectives from women, their families, healthcare providers, and key stakeholders

BackgroundIn East Africa, women face significant challenges accessing maternal healthcare during pregnancy, childbirth, and the postnatal period. While several studies have examined barriers and facilitators to maternal care, there is no comprehensive review reflecting the various perspectives of women, their families, healthcare providers, and key stakeholders. We systematically reviewed qualitative literature on maternal healthcare in East Africa, synthesizing insights from multiple perspectives and exploring barriers and facilitators across socioecological levels.MethodsA qualitative evidence synthesis focused on studies from East Africa published between January 2015 and June 2024. We searched electronic databases, including PubMed, Embase, Scopus, Cochrane, Web of Science, and ProQuest, and used citation tracking to find additional references. Eligible studies were critically appraised using the Critical Appraisal Skills Program, and a thematic synthesis was performed to identify barriers and facilitators.ResultsOf the 3181 records identified, 81 studies (63 qualitative and 18 mixed method) met the inclusion criteria, representing 4816 individuals from six East African countries. This review identified barriers at various levels: individual barriers included a lack of awareness and knowledge, fear of being treated poorly, and financial constraints; interpersonal barriers comprised limited family support, communication challenges, and a lack of decision-making autonomy; health facility barriers included poor quality of healthcare, poor infrastructure, limited medical supplies, provider shortages, abusive behaviors from healthcare providers, lack of transportation, and high service costs; community-level barriers involved socio-cultural norms, societal stigma, and gender-based disparities; and policy-level barriers included poor focus on maternal health, a lack of male accompaniment policies, and conflicts. Key facilitators identified included improved healthcare understanding and women's self-efficacy at the individual level, family support and positive social influences at the interpersonal level, high-quality services, reliable transportation, compassionate care, and health education at the health facility level, community initiatives, gender equality, and maternity waiting homes at the community level, as well as free maternity services and health extension programs at the policy level.ConclusionThe synthesis identified key barriers and facilitators to the maternal healthcare in East African countries, ranging from individual to policy levels. We recommend that future initiatives focus on addressing these barriers while enhancing facilitators across individual, interpersonal, health facility, community, and policy levels through woman-centered, evidence-based strategies. Moreover, fostering collaboration among governments, healthcare providers, and communities is essential for improving access to the maternal continuum of care.

Interpreting unit costs of PrEP services by effective use

Interpreting unit costs of PrEP services by effective use

Who's Really Footing the Bill? Sex and Ethnicity Disparities in the Cost of Diabetic Foot Ulcer-Related Amputations in a Major Healthcare System.

Diabetic foot ulcers (DFU)-related amputations are associated with enormous expenditures. Understanding why amputation services are more expensive for certain patients is crucial for reforming healthcare expenditure and insurance practices. This analysis examined differences in cost of DFU-related amputations services in patients insured by HealthFirst, a Medicaid-managed insurance company. Data from HealthFirst were collected for patients admitted for DFU-related amputation between 2021-2023. Demographics and laboratory values were extracted from the electronic health record. Demographics, laboratory values, total costs, and paid amounts were analyzed. Clinical variables were tested as predictors of expenditure levels through bivariate analysis. In our cohort of 140 patients, 65.3% of patients were male, with a mean age of 60.6 (S.D. 12) years, diagnosis of type 2 diabetes (96.3%) and ethnically Hispanic-Latino (56.1%). Common comorbidities were chronic kidney disease (57.9%) and hypertension (86.2%). DFU- related amputation charges were higher for Hispanic-Latino individuals, RR 1.97 (CI 1.04, 3.71), and those with chronic kidney disease, RR 1.36 (CI 1.0, 1.86) and moderately associated with female sex. Serum glucose, RR 1 (1.0 -1.0), body mass index, RR 0.98 (0.96-1.0), and Hemoglobin A1c, RR 1.01 (CI 0.93-1.09) were not found to be associated with higher cost. Overall, Hispanic-Latino individuals, persons with chronic kidney disease, and women incurred higher DFU related charges, highlighting the need for heightened DFU prevention in these populations. Level of Clinical Evidence: Retrospective cohort study= 2 or 3.

Stigma and patient work: Understanding cumulative inequities for gay and bisexual men in accessing HIV healthcare services.

Patient work refers to the quotidian labour undertaken by individuals to manage health, often unrecognised by health systems. This article argues that anticipated and received stigma and inclusivity labour comprise additional forms of patient work specific to minority populations. We draw on a case study of gay and bisexual men's experiences accessing healthcare services related to HIV prevention and testing in New South Wales (NSW), Australia's most populous state. Although new HIV diagnoses have reduced in NSW, these declines have not been uniformly observed. This study aimed to understand experiences of stigma related to accessing healthcare amongst two priority populations identified in the state's HIV strategy: gay and bisexual men who are young or who are living in regional and outer metropolitan suburbs. We interviewed 32 participants in 2023, recruited via social media advertisements and email invitations, and analysed data thematically. Our findings emphasise how disclosure of sexual orientation and/or HIV status operates as a form of inclusivity labour, in which patients look for cues from health providers that disclosure will be safe and respected. Other forms of patient work required to navigate access to HIV prevention services included finding appropriate providers likely to prescribe HIV pre-exposure prophylaxis (PrEP) and managing service refusal from general practitioners. Patient work appeared to also be compounded by intersecting issues of anticipated and vicarious stigma, unavailability of sexual health services in regional areas, long waiting times, and increased costs of healthcare services. Although experiences of enacted stigma in healthcare were infrequently reported, interview accounts suggested that participants undertook extensive patient work to minimise or avoid stigmatising encounters with health providers. Focusing on patient work in the context of stigma illuminates the labour of underserved populations required to access safe and culturally competent healthcare services (including HIV prevention and testing), suggesting areas of unmet need from health systems.

Colorectal cancer legal and administrative burden support (COLLABS): A pilot clinical trial.

TPS307 Background: Patients with colorectal cancer often have health-related social needs (e.g. food insecurity, housing instability, employment loss). Failure to adequately address these is associated with financial hardship, worse quality-of-life, psychosocial distress, lower rates of treatment receipt, and worse survival. Cancer clinical care teams often lack the resources, knowledge, and processes to resolve these issues, many of which are actually legal in nature. Engagement with legal teams—medical-legal partnerships—can screen for, prevent, and resolve health-related social needs, as well as address related legal issues such as insurance denials, employment rights and protections, disability benefits, debt management, and estate planning. Cancer Legal Care (CLC) is a nonprofit providing free legal services to persons affected by cancer in MN. Past CLC clients have indicated a preference for proactive connection to CLC to prevent crises and overcome barriers to access such as concerns regarding perceived costs of legal services. Methods: This is a single-arm, pilot study to evaluate the feasibility, acceptability, and preliminary efficacy of proactive and free legal care support for patients with colorectal cancer at the University of Minnesota. The enrollment goal is 20 patients and the trial duration is 6 months. Inclusion criteria include English-speaking adults with advanced stage colorectal cancer and estimated life expectancy of >6 months. There is no requirement for baseline health-related social need(s) or time from diagnosis. After participants complete baseline surveys, we will connect them to a CLC attorney for an initial “legal care checkup”— the timing and method of connection (in-person, video visit, or phone call) is based on patient preference. Patients can bring up self-identified or active issues themselves, while CLC will also screen for needs. CLC will provide any required legal services and engage with the cancer care team as needed. CLC will follow-up with participants at 3 and 6 months, though services may continue after the study period off trial. Participants will complete surveys at baseline, 3 months, and 6 months. Surveys will assess patient-reported outcomes on financial toxicity, quality-of-life, comfort levels with accessing cancer care, status of health-related social and legal needs, perceived stress, life mastery and engagement, relationship with CLC contact, and acceptability of the intervention. The primary outcomes are feasibility (rates of initial engagement, continued engagement, and intervention completion; feasible if >50% on each metric) and acceptability. We will conduct exit qualitative interviews. We will collect sociodemographics, rates of treatment adherence/ completion, legal services provided, outcome of legal issues, and monetary savings or recovery for patients. Enrollment opened August 2024 and we have enrolled 15/20 participants. Clinical trial information: NCT06475664 .

Prevalence of obesity-related multimorbidity and its health care costs among adults in the United States.

Overweight and obesity are associated with many obesity-related complications (ORCs) and drive increased health care costs. However, data on the impact of obesity severity on multimorbidity and the effect of multimorbidity on cost and health care resource utilization (HCRU) in people with overweight or obesity are limited. To determine in reference to obesity-related multimorbidity (1) if prevalence increases with higher levels of weight class, (2) if higher levels of weight class are associated with an increased risk of multimorbidity at an earlier age, and (3) how HCRU and health care costs are impacted, including if there is a beyond-additive effect on ORC-related costs. This retrospective cross-sectional study used linked electronic health records (EHRs) and insurance claims from Optum's de-identified Market Clarity Data. Costs were considered from January 1 to December 31, 2019. Patients continuously insured in 2018 and 2019 with at least 1 recorded body mass index (BMI) in 2019 were included. The presence of 17 prespecified ORCs was determined from the database based on the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes. ORC-related medical services costs were based on ICD-10-CM diagnosis codes in the primary position; pharmacy costs were based on National Drug Codes. Total health care costs were the sum of medical services and pharmacy costs. Weight classes were derived from the patients' median BMI in the EHR in 2019. The prevalence of multimorbidity increased with increasing weight levels (12.3% in overweight and 33.4% in class 3 obesity for ages 19-40years; 41.5% and 66.6% for ages 41-65years; and 70.6%-85.9% for age ≥65years). Ages for predicted 50% risk of having at least 2 ORCs were 59, 54, 49, and 43years among patients with overweight and obesity classes 1, 2, and 3, respectively. The mean effect of multimorbidity on ORC-related costs was beyond additive in those with obesity, such that the ORC-related costs were about $1,082 (151%), $1,696 (218%), and $2,433 (264%) for class 1, class 2, and class 3 obesity, respectively. This effect was not present for overweight, for which the cost was $310 (42%). Individuals with multimorbidity had higher odds of emergency department visits (odds ratio [OR] = 1.74; 95% CI = 1.73-1.76) and inpatient hospitalization (OR = 3.32; 95% CI = 3.27-3.38). The prevalence of obesity-related multimorbidity increased with increasing weight classes within age groups. Obesity-related multimorbidity presented at an earlier age with higher weight class, such that the predicted probability of having obesity-related multimorbidity was more than a decade younger in class 2 and class 3 obesity compared with overweight. It was associated with increased HCRU and higher-than-expected costs exceeding the sum for the ORCs. Early diagnosis and treatment of obesity may be needed to prevent or delay the onset of obesity-related multimorbidity and limit its associated health care costs.

The societal costs of avoidant personality disorder.

The study aims to estimate the societal costs of avoidant personality disorder (AvPD). Cross-sectional data on AvPD patients during 2017-2020 were retrieved from the quality register of the Norwegian Network for Personality Disorders. Cost estimations were based on a bottom-up approach, using a structured interview covering the 6-month period prior to initial assessment. Unit costs were retrieved from public records. The human capital approach was used to calculate productivity losses. Diagnoses were determined according to DSM-5 by semi-structured diagnostic interviews (SCID-5-PD). Mean societal costs were €19,378 for the total group (N = 410). The subgroup with a single diagnosis (n = 270) incurred €18,818, whereas the subgroup with at least one comorbid PD (n = 140) incurred €20,458. The difference between the two subgroups was not statistically significant. The largest cost component was productivity loss (69%), whereas health service costs constituted 31%. The main contributors to societal costs from the health service cost components were inpatient treatment (18%) and individual outpatient treatment (11%). In conclusion, societal costs for AvPD patients were high, on the same level as borderline PD, schizotypal PD, and schizophrenia, and higher than anxiety disorders, depression, and rheumatoid arthritis. In the future, development of effective AvPD treatment programs enhancing personality functioning and workforce participation is important in order reduce the cost of illness.

Increasing Access to Mental Health Supports for 18- to 25-Year-Old Indigenous Youth With the JoyPop Mobile Mental Health App: Study Protocol for a Randomized Controlled Trial.

Transitional-aged youth have a high burden of mental health difficulties in Canada, with Indigenous youth, in particular, experiencing additional circumstances that challenge their well-being. Mobile health (mHealth) approaches hold promise for supporting individuals in areas with less access to services such as Northern Ontario. The primary objective of this study is to evaluate the effectiveness of the JoyPop app in increasing emotion regulation skills for Indigenous transitional-aged youth (aged 18-25 years) on a waitlist for mental health services when compared with usual practice (UP). The secondary objectives are to (1) evaluate the impact of the app on general mental health symptoms and treatment readiness and (2) evaluate whether using the app is associated with a reduction in the use (and therefore cost) of other services while one is waiting for mental health services. The study is a pragmatic, parallel-arm randomized controlled superiority trial design spanning a 4-week period. All participants will receive UP, which involves waitlist monitoring practices at the study site, which includes regular check-in phone calls to obtain any updates regarding functioning. Participants will be allocated to the intervention (JoyPop+UP) or control (UP) condition in a 1:1 ratio using stratified block randomization. Participants will complete self-report measures of emotion regulation (primary outcome), mental health, treatment readiness, and service use during 3 assessments (baseline, second [after 2 weeks], and third [after 4 weeks]). Descriptive statistics pertaining to baseline variables and app usage will be reported. Linear mixed modeling will be used to analyze change in outcomes over time as a function of condition assignment, while a cost-consequence analysis will be used to evaluate the association between app use and service use. Recruitment began September 1, 2023, and is ongoing. In total, 2 participants have completed the study. This study will assess whether the JoyPop app is effective for Indigenous transitional-aged youth on a waitlist for mental health services. Positive findings may support the integration of the app into mental health services as a waitlist management tool. ClinicalTrials.gov NCT05991154; https://clinicaltrials.gov/study/NCT05991154. DERR1-10.2196/64745.

IMPACT OF EXTERNAL DEBTS ON ECONOMIC GROWTH IN NIGERIA

The study examined the impact of external debts on economic growth in Nigeria. Annual time-series from 2001 to 2022, sourced from Central Bank of Nigeria, Nigerian Exchange Group and Securities Exchange Commission, are adopted. The data was subjected to linear regression analysis which was used to estimate the parameters of the model. The findings revealed that external debts services, debts services costs, and exchange rate fluctuations all have a negative relationship with economic growth. This highlights that higher burdens of external debt servicing and greater exchange rate volatility are associated with reduced economic growth. Thus, the study recommends that government should implement robust debt management strategies that prioritize sustainable debt levels and efficient servicing, The government should introduce policies aimed at stabilizing exchange rates to reduce volatility. Moreso, they diversify the economy, especially by promoting sectors less susceptible to external shock, to reduce dependence on external factors that could exacerbate debt and exchange rate vulnerabilities.

Comparison of diesel and petrol cars operational costs in the long term

The choice between diesel and petrol vehicles is often influenced by both initial purchase costs and long-term operational expenses, including fuel and maintenance. This paper presents a comprehensive cost analysis of various Indian car company variants, specifically examining the diesel and petrol models across different trims (NY2, NY3, X6, X8, X8 (O), BY5, and BY5L) over 1, 5, 10, and 15-year periods. Using a detailed financial model, this study accounts for initial vehicle cost, fuel consumption based on varying fuel prices, and routine maintenance costs. The research applies real-world data on fuel efficiency and prices, considering both minor and major servicing costs.

Extending product offers with product-related services: the value of configurators

A significant part of traditional manufacturing companies’ value propositions is provided through product-related services, such as transport, packaging, documentation, installation, and after-sales support. However, for many companies, it is challenging to manage such services. To address this issue, this paper investigates the usefulness of configurators in supporting this task. Specifically, product configurators are widely used in product development and sales processes in engineer-to-order (ETO) companies, where they have produced many benefits. To investigate the feasibility of product-related service configurators (PSCs) in manufacturing companies, this paper develops an approach to developing and implementing PSCs. The approach is tested in a case study to investigate its usefulness and the effects of applying PSCs. The study demonstrates the usefulness of the proposed approach and reveals three main types of benefits from PSCs: (1) increased product-related service cost transparency, (2) improved product-related service offerings based on customer characteristics, and (3) more standardised and structured product-related service specifications.

Genetic Services in Appalachia Conference Series.

This study examined the data generated as part of a seven-session webinar series that focused on genetics care provision in the medically underserved, rural Appalachian region and examined how these services have adapted to challenging practice environments. Barriers and facilitators to care in our region were considered. Data included a baseline survey of registrants, transcripts of sessions, and feedback about sessions. We analyzed data with a sequential and concurrent mixed methods approach. Registrants (n = 137) were disproportionately healthcare providers with genetic services expertise (37.2%). Approximately half (43.8%) of registrants were from KY, WV, and TN in the central Appalachian region. Our baseline survey found that the most noted barriers were the cost of services, lack of providers, and access to care. The most common facilitator was telehealth. Analysis of transcripts identified barriers that were consistent with those noted in the baseline survey, but additional support and network opportunities were discussed to allow for learning across services. Numerous barriers to service delivery were noted; however, despite challenges, participants identified opportunities and resources in the community. These insights will inform a research agenda aimed at advancing genetics services in rural Appalachia, addressing challenges, and leveraging assets for improved healthcare access and outcomes.

STRATEGIC MANAGEMENT OF THE UNIVERSITY'S ECONOMIC SUSTAINABILITY

The article is devoted to the strategic management of universities' economic sustainability in the context of digital transformations. The study examines the main approaches to ensuring the economic sustainability of higher education institutions, which are particularly relevant in the era of globalization and technological change. The impact of digitalization on university management processes is analyzed, focusing on the integration of advanced technologies, resource optimization, and increased financial efficiency. The role of digital tools in reducing the costs of educational services, improving management processes, and enhancing the competitiveness of universities is explored. A comprehensive model of strategic management of economic sustainability is proposed, encompassing financial flow assessment, cost management, investment analysis in digital technologies, and their integration into university development strategies. The model aims to enhance resilience to economic challenges, ensure stability, and increase competitiveness in the educational services market.

A Markov decision optimization of medical service resources for two-class patient queues in emergency departments via particle swarm optimization algorithm

In the modern healthcare system, the rational allocation of emergency department (ED) resources is crucial for enhancing emergency response efficiency, ensuring patient safety, and improving the quality of medical services. This paper focuses on the issue of ED resource allocation and designs a priority sorting system for ED patients. The system classifies patients into two queues: urgent and routine. Considering different service rates, a multi-server preemptive priority queueing model and a multi-server non-preemptive priority queueing model are constructed. Additionally, the number of beds, K, is introduced as the capacity of the urgent queue. By comprehensively considering the costs associated with patient waiting time, the cost of rejecting the most critical patients, and the total costs of beds and servers, a mixed-integer programming model was constructed with the objective of minimizing the total cost. The particle swarm optimization algorithm was applied to determine the optimal number of servers, service rate, and number of beds. Compared with the model proposed by Alipour-Vaezi et al., our model significantly improves patient waiting times and queue lengths using the same data set: the waiting time decreased by 74.44%, by 5.79%, and by 1.13%; the queue length decreased by 78% and by 3.33%. Our model effectively reduces patient waiting times and queue lengths while controlling costs, identifies the optimal number of beds, and achieves optimized resource allocation. Finally, we conducted a sensitivity analysis and provided some valuable management insights.

Burden of Vitiligo in Canada: Retrospective Analysis of a Canadian Public Claims Database.

Vitiligo is an autoimmune disease resulting in skin depigmentation. Treatment options are limited. To examine disease burden and healthcare resource utilization (HCRU) among patients with vitiligo in Québec, Canada. In this retrospective study, data were obtained from the Régie de l'Assurance Maladie du Québec (RAMQ) databases for 125,000 random individuals from January 2010 to December 2019. The International Classification of Diseases, Ninth Revision (ICD-9) diagnostic code [709.x (other skin disorders)] with vitiligo-related treatment was used to identify patients with vitiligo. Patient characteristics and treatments, including treatment type, episodes (treatments used without discontinuation), and sequences (treatment episodes ≥30 days), were assessed. Annualized HCRU and costs (2021 adjusted) included all-cause hospitalization, emergency department visits, outpatient visits, and medications among patients with vitiligo (n = 113) and age- and sex-matched non-vitiligo controls (n = 339). Of patients with vitiligo (mean age, 50.0 years; 68.1% female) identified using ICD-9 code 709.x with vitiligo-related treatment, 36.3% received ≥4 treatment episodes. Treatment patterns were heterogeneous, with 43 different sequences reported. Annualized mean outpatient visits (16.1 vs 5.5) and all-cause outpatient service costs per patient were significantly higher in the vitiligo versus the control group (CAN$1037 vs CAN$523; P < .01). Total all-cause services costs were higher for patients with vitiligo in the year after versus before diagnosis (CAN$3679 vs CAN$2085; P = .04). Vitiligo is associated with significant burden and HCRU among patients in Québec, Canada, who were identified by ICD-9 code 709.x plus vitiligo-related treatment. Measurement of true vitiligo burden remains challenging.