Medical Care Expenses Research Articles

Improvement of the management system of the pharmaceutical service of the health care institution

When providing medical care, harm to patients' health associated with the use of drugs occurs in 10-40% of cases. The issue of ensuring safety in the field of health care is a global problem. The relevance of the problem of improving the quality of pharmaceutical care and estimating the costs of medical care requires research. The purpose of the work is the formation of principles for improving pharmaceutical management in a health care institution by monitoring and analyzing prescription errors at all stages of drug use. The study was conducted on the basis of LLC "Endotechnomed", surgical clinic "Garvis" in the period 01.09.2019-29.02.2024 and was approved by the commission on biomedical ethics. The bibliographic method and retrospective analysis were used. In the study, the level of errors in appointment lists was calculated, their dynamics and relationship with the costs of medical care for the corresponding period were analyzed. The method of increasing the interval was used, and statistical significance was checked using the non-parametric Mann-Whitney test. The non-parametric method of Spearman's rank correlation is used to determine the characteristics of the relationship between the level of errors in appointment lists and the amount of drug costs for one patient. Statistical processing of the results was carried out using the methods of descriptive and analytical statistics using the integrated Jupyter Notebook development environment. A value of p<0.05 was considered statistically significant when testing all statistical hypotheses. The level of errors over 4.5 years significantly (p<0.002) decreased by 78.44% compared to the initial value (from 139.62‰ to 30.10‰), which was at the global level (10%). These indicators confirm the results of research by Chinese scientists, who prove that properly organized work in an inpatient medical institution can reduce the frequency of errors when prescribing drugs from 6.94% to 1.96%. A statistically significant negative rank correlation of average strength was observed between the amount of expenses for medical care of one patient and the level of errors in prescribing medicines for the considered period (r= -0.49; 95% CI (-0.67)–(-0.26); p<0.001), which contradicts the generally accepted notion and, according to the authors, is related to the uniqueness of the situation during the considered period (first the pandemic, then the war). Therefore, it can be concluded that the introduction of new approaches to control the prescription of medicines led to a significant (p<0.002) reduction in the level of errors in appointment lists over 4.5 years by 78.44% compared to the initial value; the higher level of errors in appointment lists corresponds to lower costs for medical care, which is a consequence of the unstable situation on the drug market during the pandemic and the war in Ukraine; the improvement of pharmaceutical service management processes was directed to the following areas of work: planning, control, implementation and functioning of the information system, personnel management, performance evaluation, involvement of interested parties for the formation and implementation of decisions.

Analyses of Osteogenesis Imperfecta in South Korea Using the Nationwide Health Insurance Service Claim Data: A Propensity Score-Matched Study.

Osteogenesis imperfecta (OI) is the most common inherited form of bone fragility and includes a heterogeneous group of genetic disorders that most commonly result from defects associated with type I collagen. Although genetic analyses have been developed, nationwide research on the incidence and associated fractures in OI is lacking. This study aimed to investigate the patterns of OI prevalence, incidence, fracture rate, etc. in South Korea using National Health Insurance Service (NHIS) claims data. We found 1596 patients newly diagnosed with OI between March 2002 and February 2020. We evaluated the incidence, prevalence, and history of fractures, fracture site, prescription of anti-osteoporosis drugs, etc. To compare medical costs, fracture rates, and scoliosis rates, we created a control group comprising patients without OI using 1:1 propensity score matching. The prevalence of OI increased slightly each year, with an annual incidence of 20.20 per 100,000 live births. Mean fracture frequency in OI patients was 17 (2-32) times per patient and the most frequent fracture site was the lower leg. A total of 21.4% patients were prescribed anti-osteoporosis drugs, and the most popular drug was pamidronate. After 1:1 propensity score matching, in terms of scoliosis, OI patients had a 3.91 times higher prevalence of scoliosis than in healthy patients which was statistically significant. The sum of medical care expenses for patients with OI was 3.5 times higher than that for patients without OI. We identified nationwide trends in OI occurrence, fractures, and medication use. This study also highlighted the real-world data of scoliosis and medical costs compared to the control group.

6.P. Scientific session: Economic evaluation of health impacts for better decision choices

Abstract The strategy of Health in All Policies (HiAP) pursues to analyse the wider determinants of health affected by the decision-making process of traditionally non-health sectors, seeking to enhance population health benefits while avoiding health inequalities. This usually involves the use of health impact assessment (HIA) or health lens analysis to any policy, program, plan or project (PPPP), preferably prior to its implementation. On the other hand, decision-makers from a wide range of public and private sectors also demand a better insight of the meaning of the health impacts quantified under HIA. Assuming the (ubiquitous) situation of limited resources and budgets, decisions need to be based on cost effectiveness criteria and, whenever possible, direct and indirect health costs should be part of the impact assessment. Economic appraisal attempts to define whether a proposal makes a net contribution to social welfare, quantifying and valuing changes to individuals’ utility from the societal perspective, taking into account the impact of health on the individual, their family, employers, healthcare providers and the state. This approach can incorporate different components of the welfare costs of illness, including direct medical and paid care expenses, indirect lost opportunity costs such as productivity and the value of informal care time, as well as a value that monetises the disutility or pain and suffering associated with disease. The range of methods and estimated benefits can make it challenging to identify a best practice approach. The present session aims to address certain methodological aspects related to the economic evaluation of health impacts, which still generate some controversy and debate, with particular emphasis on the following topics: • Approaches for synthesizing evidence on health impact pathways and economic evaluation of health impacts for a better decision choice; • Health metrics: influence on the conclusions of economic analysis within HIA; • Sources of metrics used for economic analysis; • Uncertainties inherent to economic valuation of health outcomes: how to deal with it. Key messages • The economic analysis of health impacts can help prioritizing aspects with the greatest impact on population health, facilitating a more effective use of human and economic resources. • The economic analysis within HIA can improve decision-making but requires careful consideration of health metrics, sourcing of data, and management of uncertainties.

Resolving sustainable development conflicts caused by vinyl leakage accidents in the USA: From the perspective of graph model under fuzzy preferences with self-confidence

On February 3, 2023, a railroad accident led to the release and combustion of 115,580 gallons of vinyl chloride monomer in East Palestine, Ohio, USA. The large leakage and long-time combustion of vinyl chloride monomer harmed the stability of local sustainable ecosystems and the health of residents, as the burning produced deadly toxins, triggering dissatisfaction from residents and environmental protection organizations. With the COVID-19 pandemic still unfolding globally, decision makers (DMs) in vinyl chloride leakage accidents must consider the existing environmental health uncertainty, potentially leading to uncertainty in their preference cognitive. Thus, this paper proposes a novel fuzzy preference with a self-confidence structure of the graph model for conflict resolution (GMCR) to resolve the sustainable development conflicts caused by the vinyl chloride leakage accident in Ohio. Fully considering the uncertainty of option choice by DMs and the different levels of confidence in DMs’ preference selection, four different fuzzy stability definitions of self-confidence are defined in GMCR. The analysis results suggest the following: (1) During conflicts, the US Norfolk Southern Corp should assume corporate responsibility by setting up a health monitoring system for residents in Ohio; the company should pay for the medical examinations and related care expenses for residents within the scope of the vinyl chloride leakage accident. (2) The negotiation of all stakeholders in conflicts can promote reconciliation. Finally, the analysis process and results of this study can provide guidance to government departments for properly handling major accidents and appeasing affected residents.

Maxillofacial defects following road traffic accidents should be included in the disability spectrum.

In India, 21.20% of annual road traffic accidents (RTA) result in maxillofacial injuries, with most victims being young adults aged 18-45 years. Such RTAs cause personal losses to individuals and families and adversely impact the country's health system facilities. These losses result from the expenses for medical care, lost wages for individuals who are rendered unable to work, and lost productivity for family members who must miss work or school in order to care for the injured. Most nations lose 3% of their gross domestic product to road accidents. RTA injuries, often associated with severe morbidity, cause functional impairments and have immense psychological impact. Rehabilitating these patients and their future treatment needs constitute an economic burden to themselves and their families, more so in a developing country like India, where a majority of the population cannot afford the treatment costs and lack health insurance coverage. These injuries therefore, as defined by the International Classification of Functioning, Disability and Health 2001, fall within the ambit of impairment and disability. However, Indian law does not identify maxillofacial injuries and the ensuing trauma as disabilities. Addressing this could be an important step towards improvement in the care and compensation provided to survivors of such life changing accidents.

Hypertension Hindrance: Unraveling the Impact on Bangladesh’s Economic Development

"In Bangladesh, hypertension, sometimes referred to as hypertension, has become a serious public health concern that is having a considerable negative impact on the nation’s ability to prosper economically. Bangladesh’s expanding economy has advanced significantly in many areas during the past few decades. Concerns have been expressed concerning the influence of hypertension on the nation’s overall wellbeing due to its rising prevalence. This study examines the complex nature of Bangladesh’s hypertension epidemic, considering both economic and medical factors. This study mainly based on secondary data, using the narrative review paper as a guide, observed at the epidemiological trends of hypertension in Bangladesh, emphasizing its upward tendency across all age groups and socio-economic classes. After that, saw at the financial effects of hypertension, including the direct expenses of medical care and treatment as well as the indirect costs of decreased productivity and higher mortality. This financial burden may impede a nation’s efforts to achieve sustainable development. Additionally, investigate the determinants of hypertension in Bangladesh, taking into consideration dietary practices, genetic predisposition, lifestyle factors, and access to medical treatment. The important factors influencing the prevalence of hypertension are also explored, including socio-economic inequalities and urban-rural divisions. Designing successful interventions and policies requires an understanding of these drivers. Finally, communicated about possible methods for lowering the prevalence of hypertension in Bangladesh, highlighting the need of early detection, prevention, and health promotion. The study’s findings indicated that Bangladesh’s economic progress is hampered by hypertension. As we support expanding economic development, the importance of governmental policies, healthcare infrastructure, and public awareness campaigns in tackling these developing health concerns was taken into consideration. The study will underline how urgent it is to address high blood pressure as a significant impediment to Bangladesh’s economic development. This study intends to offer insights that help guide evidence-based policies and initiatives to enhance the country’s economic and health well-being by thoroughly examining the sources and effects of this understanding"

Association of oral frailty with medical expenditure in older Japanese adults: The study of late-stage older adults in Tottori (START Tottori).

This study aimed to determine the association between annual medical expenses and oral frailty in later-stage older adults (aged ≥ 75 years). No studies have investigated the association between medical costs and oral frailty, which would elucidate the association between oral frailty and the deterioration of mental and overall physical function. In this cross-sectional study, 2190 adults (860 men and 1330 women aged 75-94 years) covered by the Medical System for the Elderly and residing in Tottori Prefecture, Japan, between April 2016 and March 2019, were included. Participants were classified into three groups: healthy, pre-orally frail or orally frail, based on dental health screening findings. The medical and dental expenses over the years, number of days of consultations and comorbidities were obtained from the Japanese Health Insurance Claims Database. The number of days of medical and dental consultations and annual medical expenses for outpatient care differed among the three study groups. A significant association was observed between oral frailty and high annual expenses for outpatient medical and dental care. Oral frailty was associated with higher medical expenses in participants with poor masticatory function. Higher and lower dental expenses were associated with subjective poor masticatory function and subjective impairment of swallowing function respectively. Medical and dental expenses for orally frail older adults are high, indicating that oral frailty may be related to the occurrence and severity of diseases other than oral health issues. Future studies should examine the mechanism by which oral weakness affects physical and mental functions.

Myeloid Ptpn2 Deficiency in Mice Causes Functional Iron Deficiency

Background: Anemia is the most prevalent extraintestinal complication of inflammatory bowel disease (IBD) and is associated with the manifestation of Crohn’s disease. Anemia significantly reduces the quality of life, increases hospitalization visits, and increases medical care expenses of IBD patients. Iron deficiency is the leading cause of anemia in IBD; however, the physiological mechanisms involved are still poorly understood. Macrophages significantly contribute to iron homeostasis by mechanisms including iron recycling by phagocytosing senescent erythrocytes and damaged cells, and nurturing erythropoiesis in the bone marrow. In this study, we investigated the role of the IBD candidate gene, protein tyrosine phosphatase non-receptor type 2 ( PTPN2), in regulating macrophage iron homeostasis. Methods: Myeloid cell-specific knockout mice ( Ptpn2LysMCre) and control littermates ( Ptpn2fl/fl) were analyzed for serum iron content and liver and spleen non-heme iron. Duodenal epithelial cell (DEC) proteins were assayed by Western blotting. Localization of the brush border ferrous iron transporter, DMT1, and the coupled ferrous iron absorption driver, NHE3, in duodenal tissue was determined by immunohistochemistry (IHC). Gene expression profiles of macrophages were analyzed by Nanostring. Results: Ptpn2LysMCre mice had reduced serum iron ( p<0.0001; n=12) and reduced spleen non-heme iron (p=0.0017; n=6), whereas liver non-heme iron was unaltered (n=6), indicating iron deficiency in select tissues. DMT1 (n=8) and NHE3 (n=5) protein expression in DECs was unaltered and IHC confirmed the unaltered localization of DMT1 and NHE3 (n=6) in the duodenal epithelium of Ptpn2LysMCre mice, suggesting the reduction in serum iron was not due to an impairment in intestinal non-heme iron uptake. Nanostring analyses revealed that the gene expression of the iron transporter Dmt1, iron exporter Fpn, and iron importer Tfr1 were significantly downregulated (p<0.05; n=5) in macrophages from Ptpn2LysMCre mice, indicating an iron sequestering phenotype. Conclusions: Loss of myeloid Ptpn2 in mice causes functional iron deficiency. These findings indicate a major role of myeloid PTPN2 in regulating systemic iron homeostasis. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Transitional Medicine of Intractable Primary Dyslipidemias in Japan

Transitional medicine refers to the seamless continuity of medical care for patients with childhood-onset diseases as they grow into adulthood. The transition of care must be seamless in medical treatment as the patients grow and in other medical aids such as subsidies for medical expenses in the health care system. Inappropriate transitional care, either medical or social, directly causes poorer prognosis for many early-onset diseases, including primary dyslipidemia caused by genetic abnormalities. Many primary dyslipidemias are designated as intractable diseases in the Japanese health care system for specific medical aids, as having no curative treatment and requiring enormous treatment costs for lipid management and prevention of complications. However, there are problems in transitional medicine for primary dyslipidemia in Japan. As for the medical treatment system, the diagnosis rate remains low due to the shortage of specialists, their insufficient link with generalists and other field specialists, and poor linkage between pediatricians and physicians for adults. In the medical care system, there is a mismatch of diagnostic criteria of primary dyslipidemias between children and adults for medical care expense subsidization, as between The Program for the Specific Pediatric Chronic Diseases and the Program for Designated Adult Intractable Diseases. This could lead some patients subsidized in their childhood to no longer be under the coverage of the aids after transition. This review intends to describe these issues in transitional medicine of primary dyslipidemia in Japan as a part of the efforts to resolve the problems by the Committee on Primary Dyslipidemia under the Research Program on Rare and Intractable Disease of the Ministry of Health, Labour and Welfare of Japan.

The impact of retirement on health: Empirical evidence from the change in public pensionable age in Japan

The balance between maintaining and enhancing the health, quality of life, and healthy life expectancy of the elderly and their corresponding social costs, including medical and long-term care expenses, is an important policy issue in the context of Japan’s super-aging society. In this paper, we employ individual panel data from the four waves of the Japanese Study of Aging and Retirement to examine how retirement from the labor market affects the health of elderly males. Numerous empirical studies have shown mixed results concerning the causal effect of retirement on health through diverse and complex mechanisms. However, we present several new insights by focusing on the policy change in 2000 of raising the pensionable age for the earnings-related public pension system which completely eliminates pension income after the statutory retirement age for particular cohorts. Our fixed-effects instrumental variable estimation shows that retirement significantly improves oral function and mental health, but it also makes male retirees more susceptible to lifestyle-related diseases. Supplemental results further suggest that a significant increase in dental care utilization would help improve post-retirement oral function.

Research on financial risk early warning system model based on second-order blockchain differential equation

A financial risk early warning system (FREWS) is a disclosure and tracking mechanism that provides advance notice of potential issues, hazards, and potentials that might affect the business’s finances. Some elderly individuals living alone may experience financial difficulties, which may hinder their ability to pay for appropriate medical care, property maintenance, and other essential expenses. Financial difficulties can add tension and diminish their quality of life. Financial results, investment risk, and possible insolvencies may all be detected by implementing early warning systems. Management might use the window of opportunity provided by early warning systems to avert or lessen the impact of possible issues. Almost all FREWS rely on some financial statement analysis. Financial measures are combined with the EWS, accounting information, to determine the firm’s success in its field. Organizational success depends on effective financial oversight, which is at the heart of each business. Studying the enhancement of early warning capacities is relevant because there are no adequate risk evaluation methods to generate realistic estimates. To minimize the FREWS, this research provides a systemic model based on a second-order block chain differential equation (SBDE). China’s systemic financial liabilities have also been quantified using the expected investment returns of 64 selected financial enterprises in China between February 2006 and September 2020 as the datasets. The financial risk warning approach is compared and analyzed primarily using analytical and comparative techniques. The suggested method is 96% accurate in experiments. Consequently, the proposed algorithm compares favorably to others regarding both computing efficacy and precision and has strong predictability.

Challenges in the diagnosis and management of SLE in India

Management of Systemic lupus erythematosus is challenging due to its varied manifestations, relapses and problems associated with immunosuppressive therapy. This challenge is compounded in resource limited countries due to additional factors such as poor access to health care, limited income, out of pocket expenses for medical care and lack of financial independence of women. In the current review some of these issues have been highlighted in context of India, the most populous country of the world with current annual per capita income of around 2000 dollars.

Can the OSA patient be managed within an ERAS protocol? A narrative review

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder among surgical patients and is associated with an increased risk of perioperative cardiopulmonary complications leading to increased health expenses. Therefore, preoperative OSA screening should be instituted to inform patients of their increased perioperative risk and measures can be taken in to decrease this risk. Meanwhile ERAS (Enhanced recovery after surgery) guidelines are becoming standard of care and being widely implemented. The purpose of these recovery programs is to standardize medical care, enhance outcomes and decrease health care expenses using evidence-based protocols. According to the current evidence it is unclear if OSA patients could benefit from these protocols. The first part of this narrative review states the current evidence on OSA definition, classification, pathophysiology and risk factors, postoperative complications, endotypes and their relevance for the anesthesiologist. The second part investigated the feasibility of ERAS measures within the OSA-population. Preoperatively there are many parallels to be drawn between the ERAS measures and Society of Anesthesia and Sleep Medicine (SASM) guidelines on OSA management: Risk stratification by OSA-screening, information counselling on the increased perioperative risk and optimization of preoperative health conditions by initiation of CPAP-therapy. Perioperatively the use short acting anesthetics allows for both early mobilization and avoid postoperative respiratory compromise by sustained drug effect. ERAS measures to maintain the patient in the zone of normovolaemia are advantageous for OSA patients as excessive fluid administration can worsen OSA. The use of multimodal analgesia sparing opioids might be the most important element beneficial for OSA patients they are more prone to develop opioid induced respiratory depression (OIRD). As OSA patients are at risk for venous thromboembolism appropriate thromboprophylaxis should be applied. Postoperatively OSA patients should be closely monitored in the prevention of OIRD. In conclusion many ERAS measures seem to be applicable or of benefit for OSA patients. However, large prospective randomized controlled trials are needed to evaluate if these patients can be managed within an ERAS protocol.

Coronary heart disease risk factors among academic workers based on the Jakarta Cardiovascular Score: A cross-sectional study.

Change in lifestyle leads to change in disease patterns from infectious diseases and malnutrition to degenerative diseases, such as coronary heart disease (CHD). The increasing prevalence of cardiovascular diseases among Indonesian workers and the general public will not only burden medical care expenses but also reduce work productivity, leading to more work-related injuries and work-related losses. The aim of this study was to determine the risk factors for CHD (age, sex, blood pressure, smoking, diabetes mellitus, body mass index, and weekly physical activity) and the CHD risk level among university workers. A cross-sectional study was conducted at workers at School of Medicine, Universitas Malikussaleh, Lhokseumawe, Indonesia. The risk level of CHD was calculated using Jakarta Cardiovascular Score and predicting model analyzed with multiple logistic regression model. Our data found that 58.2%, 25.5% and 16.3% of the university workers had low-, medium- and high-risk to have CHD. The final model indicted that the risk of heart disease was determined by gender, age, and the presence of hypertension and diabetes mellitus. Being male had odds ratio (OR) 30.84, aged >41 years old had OR 11.52, having hypertension had OR 4.87 and having diabetes mellitus had OR 13.99 for having high risk of CHD compared to female, those younger than 41 years old, having no hypertension and having no diabetes mellitus, respectively. In conclusion, our data suggests that more than 15% the respondents (university employees) have high risk of CHD and being male and older, and having hypertension and diabetes mellitus are associated with risk of CHD. Implantation of the preventive measures is therefore important to be implemented at the universities.

Futile care in Kirkuk teaching hospital burn unit.

Background; Futile care; a medical term applied when there is no reasonable hope of improvement or cure in spite of expense of medical or surgical care. Futile care decision governed by a variety of scoring systems to evaluate clinical situation and direct medical effort in respecting the patient requirement, surrogate allowance. Where and when the medical treatment being futile is another view must be sought for afflicted patient. 
 Materials & methods; This is a retrospective study about admitted patient over 7 years (since January 2012-until December 2018) were 2076 patient (total admission number) in Kirkuk teaching hospital burn unit, of them (1284 female, 762 male burns casualty) 74% of them are saved but (26%) 538 patient are dead out of total number of admission , (21%) 435 patient were with expected death, but (5%) 103 {(79 pediatric less than 12 years) and (24 patient age more than 56 years)} with un expected death the latter were succumbed to sepsis even with our best available rescue management.
 Result; This study on those (21%) 435 patients (with more than 55% BSAB. & mostly associated with inhalational injury) sex variation{23 male (25-55 years) , 412 female (13-45years)}most of them self-immolation; who are falls under the known guide lines {DNR=Do Not Resuscitate} comfort care applied to them, we depend on R-Baux score to predict the probability of death after burn injury was calculated for each patient by following formula:
 (TBSA + age + [17×R]). {R=1 if patient has inhalation injury and R=0 if not}.
 Aim; of our study is to evaluating our working in spite of our challenges in Iraq circumstances.
 we used different formulae to predict mortality in burn casualties to reach best results we could approach to it.
 Conclusion; our results show more increases in the mortality % than American and European studies because we have less facilities and limited resources.

PRESCRIPTION COST ANALYSIS IN PATIENTS OF TYPE 2 DM AND HYPERTENSION JOINING CHRONIC DISEASE MANAGEMENT PROGRAM (PROLANIS) AT PUSKESMAS AFTER THE IMPLEMENTATION OF NATIONAL HEALTH INSURANCE

To improve the status of public health and carry out social security programs in the health sector, the government started to implement the National Health Insurance. This program covers the participants’ medical care expenses using the capitation system applied in health centers as the First-Level Health Facilities. BPJS Kesehatan has allocated some budget in the form of a capitation rate to first-level health facilities for hypertension and type 2 diabetes mellitus patients after the implementation of National Health Insurance. This research was carried out in 4 health centers, namely Lamper Tengah Health Center, Mangkang Health Center, Mijen Health Center, and Karanganyar Health Center. The data were collected retrospectively from the medical records of 800 patients. The data were analyzed descriptively to determine the prescription cost and Spearman's rho test was used to find the factors that influence the prescription cost. It was revealed that the average prescription cost for type 2 DM patients was IDR 142,293, and for hypertensive patients was IDR 112,735. The prescribing pattern in patients covered by Prolanis program for type 2 DM patients is a combination of glimepiride, metformin with a drug price of IDR 20,670. Factors that have an influence on prescription costs are diagnosis p= 0.033, type of drug (p= 0.000) and drug item (p= 0.000). This study concludes that the factors to influence the drug costs of Prolanis patients at the health centers of Semarang City were the patient's diagnosis, the type of drug given, and the number of drug items given.

Abstract 738: Long-term survivorship between gastrectomy and endoscopic resection for gastric cancer using a nationwide real-world database: 15 years of follow-up

Abstract Introduction: Nutritional deficiency and weight loss after gastrectomy are important detrimental factors for gastric cancer survivorship, which is avoided by endoscopic resection (ER). On the other hand, chronic metabolic or cardiovascular diseases in long term survivors may require appropriate weight reduction. The purpose of this study is to evaluate long term survival, cumulative incidence, and medical expenses of chronic diseases between gastric cancer survivors who underwent gastrectomy and ER using the Korean National Health Insurance (KNHI) database. Methods: Big data of patients treated by either gastrectomy or ER for gastric cancer were restructured from 2008 to 2015 through the KNHI database which covers the entire Korean population. Those who had other primary cancer within 3 years before the treatment, received chemotherapy or radiotherapy, or had gastric cancer as the cause of death in death certificates were excluded. After 2:1 propensity score matching by age, sex, Charlson Comorbidity Index, insurance premium quartiles, and year of treatment, gastrectomy and ER groups were compared for 15-year survival, and incidence of new chronic diseases including major adverse cardiovascular events (MACE). MACE-3 was defined as first occurrence of all-cause mortality, ischemic heart disease, and cerebrovascular events, and MACE-6 as MACE-3 plus heart failure, nephropathy, and atrial fibrillation. Results: After matching, 49,578 survivors for the gastrectomy group and 24,789 for the ER group were analyzed. The gastrectomy group showed significantly higher risk of death by respiratory diseases (HR 1.37, 95% CI 1.18 - 1.35, P < 0.0001) including pneumonia (HR 1.62, 95% CI 1.32 - 2.00, P < 0.0001), and external causes such as trauma (HR 1.38, 95% CI 1.16 - 1.63, P < 0.0001), but lower risk of death caused by other cancers (HR 0.85, 95% CI 0.77 - 0.95, P < 0.0001) especially obesity-related cancers including liver, bile duct, gallbladder, and pancreatic cancer. There was no difference in risk of death by other ICD-10 diseases between the two groups. Gastrectomy group showed significantly lower incidence of hypertension (HR 0.65), ischemic heart disease (HR 0.84), heart failure (HR 0.80), and cerebrovascular diseases (HR 0.79) than the ER group. The gastrectomy group had lower risk of MACE-3 (HR 0.86, 95% CI 0.83 - 0.89, P < 0.0001) and MACE-6 (HR 0.86, 95% CI 0.83 - 0.89, P < 0.0001). Conclusion: The gastrectomy group showed lower risk of MACE and obesity-related cancers with less medical care expenses for diabetes or hypertension, but had higher risk of death by pneumonia or external causes than the ER group in Korea. Citation Format: Hyeong-taek Woo, So Hyun Kang, Ji Yoon Baek, Mira Yoo, Duyeong Hwang, Eunju Lee, Young Suk Park, Sang-Hoon Ahn, Nayoung Kim, Dong Ho Lee, Hyung-Ho Kim, Aesun Shin, Yun-Suhk Suh. Long-term survivorship between gastrectomy and endoscopic resection for gastric cancer using a nationwide real-world database: 15 years of follow-up [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 738.

Catastrophic health expenditure and associated factors among households of non community based health insurance districts, Ilubabor zone, Oromia regional state, southwest Ethiopia

BackgroundOut-of-pocket health expenditure is the proportion of total health expenditure that is paid by individuals and households at the time of health service. Hence, the objective of this study is to assess the incidence and intensity of catastrophic health expenditure and associated factors among households in non-community-based health insurance districts in the Ilubabor zone, Oromia National Regional State, Ethiopia.MethodA community-based cross-sectional study design was employed in the Ilubabor zone on non-community-based health insurance scheme districts from August 13 to September 2, 2020, and 633 households participated in the study. A multistage one cluster sampling method was used to select three districts out of seven districts. Data was collected by using a structured mix of open and close-ended pre -tested questionnaires by face-to-face interviewing. A micro-costing/bottom up approach was used for all household expenditure. After checking its completeness, all household consumption expenditure was done by mathematical analysis using Microsoft Excel. Binary and multiple logistic were done using 95%CI and significance was declared at P < 0.05.ResultsThe number of households that participated in the study was 633, with a response rate of 99.7%. Out of 633 households surveyed, 110 (17.4%) were in catastrophe, which exceeds 10% of total household expenditure. After medical care expenses, about 5% of the households moved downward from the middle poverty line to extreme poverty. Out-of-pocket payment AOR: 31.201: 95% CI (12.965–49.673), daily income less than 1.90 USD AOR: 2.081: 95% CI (1.010–3.670), living a medium distance from a health facility AOR: 6.219: 95% CI (1.632–15.418), and chronic disease AOR: 5.647: 95% CI (1.764–18.075.ConclusionIn this study, family size, average daily income, out of pocket payment and chronic diseases were statistically significant and independent predictors for household catastrophic health expenditure. Therefore, to overcome financial risk, the Federal Ministry of Health should develop different guidelines and modalities by considering household per capita and income to improve the enrolment of community-based health insurance. Also, the regional health bureau should improve their budget share of 10% to increase the coverage of poor households. Strengthening financial risk protection mechanisms, such as community-based health insurance, could help to improve healthcare equity and quality.

Justice in the provision of healthcare services – A stifled right in the private sector

Private medical aids are essentially non-profit organisations that aim to deliver speedy treatment and should prevent members from unexpected, out of pocket expenses for medical care. However, although the latest statistics show that 16.2% of individuals in South Africa were members of medical aid schemes, making the promise of private healthcare accessible to a small percentage of the population, they are not without their own unique set of challenges. The restrictions that exist within the private sector have a direct bearing on the types of healthcare services patients can access, which in turn impacts on the fundamental right to access healthcare. Using a recent High Court Case decision, this article seeks to explore whether there is justice in the provision of healthcare services, specifically within the private sector in South Africa.

Understanding the treatment burden of people with chronic conditions in Kenya: A cross-sectional analysis using the Patient Experience with Treatment and Self-Management (PETS) questionnaire.

In Kenya, non-communicable diseases (NCDs) are an increasingly important cause of morbidity and mortality, requiring both better access to health care services and self-care support. Evidence suggests that treatment burdens can negatively affect adherence to treatment and quality of life. In this study, we explored the treatment and self-management burden among people with NCDs in in two counties in Western Kenya. We conducted a cross-sectional survey of people newly diagnosed with diabetes and/or hypertension, using the Patient Experience with Treatment and Self-Management (PETS) instrument. A total of 301 people with diabetes and/or hypertension completed the survey (63% female, mean age = 57 years). They reported the highest treatment burdens in the domains of medical and health care expenses, monitoring health, exhaustion related to self-management, diet and exercise/physical therapy. Treatment burden scores differed by county, age, gender, education, income and number of chronic conditions. Younger respondents (<60 years) reported higher burden for medication side effects (p<0.05), diet (p<0.05), and medical appointments (p = 0.075). Those with no formal education or low income also reported higher burden for diet and for medical expenses. People with health insurance cover reported lower (albeit still comparatively high) burden for medical expenses compared to those without it. Our findings provide important insights for Kenya and similar settings where governments are working to achieve universal health coverage by highlighting the importance of financial protection not only to prevent the economic burden of seeking health care for chronic conditions but also to reduce the associated treatment burden.