Growth Of Health Care Costs Research Articles

Understanding of sarcopenia: from definition to therapeutic strategies.

Sarcopenia refers to the gradual loss of skeletal muscle mass and function along with aging and is a social burden due to growing healthcare cost associated with a super-aging society. Therefore, researchers have established guidelines and tests to diagnose sarcopenia. Several studies have been conducted actively to reveal the cause of sarcopenia and find an economic therapy to improve the quality of life in elderly individuals. Sarcopenia is caused by multiple factors such as reduced regenerative capacity, imbalance in protein turnover, alteration of fat and fibrotic composition in muscle, increased reactive oxygen species, dysfunction of mitochondria and increased inflammation. Based on these mechanisms, nonpharmacological and pharmacological strategies have been developed to prevent and treat sarcopenia. Although several studies are currently in progress, no treatment is available yet. This review presents the definition of sarcopenia and summarizes recent understanding on the detailed mechanisms, diagnostic criteria, and strategies for prevention and treatment.

The budgetary and Insurance Model of Healthcare Funding in Russia

This paper aims to investigate the essence and method of building a financial model of healthcare in Russia. The author applies methods such as analysis and synthesis, statistical data processing, systemic and structural approaches. This article is an analysis of the basics of building a budgetary and insurance model: cost allocation (various types of medical care, individual costs) by funding sources; system of inter-budgetary relations; the structure of expenditures of the budgetary system of the Russian Federation on healthcare in 2019. The study presents the financial model of the compulsory medical insurance (СMI) system and defines the role of insurance and private medical organizations in the CMI system. The mechanism of financing state (public) healthcare institutions is shown. The procedure for financing medical organizations according to the territorial program is considered (as illustrated by the example of the Irkutsk region). The article analyzes the methodology for calculating the cost of the territorial program and identifies the problems associated with it. The author pays special attention to organizations that do not carry out activities in the field of compulsory medical insurance, outlining the specifics of financing and legal regulation, and arguing the reasons for excluding a number of diseases from the compulsory medical insurance program. The paper examines the content of the new law on the CHI reform, which provides for direct financing from the budget of the Federal CHI Fund of federal institutions providing specialized medical care. The author highlights the main problems of the building of the budgetary and insurance healthcare funding model such as congestion, inconsistency, cost intensity. The author concluded that it is necessary to revise the organization of the healthcare system and mechanisms for its financial support. The outstripping growth in healthcare costs, on the one hand, and inadequate funding of medical institutions, on the other, lead to a constant search for a compromise between equity and cost-effectiveness. Based on this, the author substantiated the goals and determined the directions for further research, such as reducing transaction costs, changing the motivation of participants, identifying cost growth factors and the possibility of eliminating them.

Investor-owned Health Care: The Hidden Blight on America's "System".

Investor ownership of US health care has grown exponentially in the past 50 years through ever closer ties with Wall Street corporate interests. More recently, private equity firms have accelerated this process, invariably with harmful impacts on access to affordable care, its quality, and profiteering, with little accountability. These impacts are fueled by several concurrent trends: (1) increasing privatization, (2) consolidation and mergers, (3) increasing bureaucracy and waste, and (4) profiteering that may bleed into outright fraud. This article traces the uncontrolled growth of health care costs and prices in recent decades, together with documented examples across the health care delivery system whereby profit-driven, investor-owned interests have compromised patient care. These include hospitals, emergency care, nursing homes, mental health, and practices of such specialities as obstetrics-gynecology and ophthalmology. These practices have compromised patient care in the midst of a pandemic and economic downturn, as reflected by markers of a system needing reform. A larger role of government is called for, together with the advantages of Medicare for All in establishing health care as a human right, not a privilege based on ability to pay.

Can Sever Acute Malnourished children be effectively rehabilitated physically, biochemically and developmentally at nutritional rehabilitation centers: A follow up study from Ujjain.

Background:Under-nutrition has got serious and lasting impact on health, development, society and economy. It may result in poor growth, development of child and can cause increase mortality, morbidity, health care cost, low productivity and economic growth. Nutritional rehabilitation is one of key intervention to address the under nutrition. It is questionable that nutritional intervention has potential to improve multiple domains.Methods:Follow up study evaluated the multi-domain impact of nutritional interventions on 204 admitted Severe Acute Malnutrition (SAM) children. Data was analyzed with SPSS version 20.Results:Significant positive changes were observed in physical, biochemical, developmental domains. Macnemar, paired t- test, co relation, z test were applied for data analysis.Conclusion:Nutritional intervention was found to be effective in improving selected physical, biochemical and developmental parameters. After discharge rate of improvement in anthropometric parameters was less. Actual quantification of recovery especially in biochemical and developmental parameters due to nutritional intervention is difficult.

The Bloody Board Game: A Game-Based Approach for Learning High-Value Care Principles in the Setting of Anemia Diagnosis.

IntroductionWith growing health care costs, high-value care is an increasingly important subject for medical training. Many resident and medical student curricula have incorporated lectures-based material about this topic. However, practical-type experiences are needed to refine critical-thinking skills essential for high-value care.MethodsTo provide such practical experiences, we developed an instructional game for resident-level education that incorporated cost-constraint-based approaches in the workup of anemia. To play the game, teams of learners were given patients with anemia of unknown cause. To pay for their diagnostic tests of choice, teams earned money by correctly answering internal medicine resident-level anemia questions. The first team to successfully work up and diagnose three patients won.ResultsResident learners had very positive reviews of our game. As a team, groups of residents across all levels were able to develop cost-effective strategies for diagnosis. Our game also served as a resource for anemia education. Residents on average felt the game enhanced their ability to apply medical knowledge and clinical reasoning (M = 4.7 out of 5, where 5 = strongly agree), as well as high-value care (4.6), and should remain in the program for the high-value care curriculum (4.9).DiscussionGame-based learning provides a fun, orthogonal approach to learning critical-thinking skills used during anemia diagnostic patient workups. Although we did not quantify change in diagnostic test ordering, according to resident-learners, our high-value care game improved their ability to integrate cost-effective strategies into their practice of medicine.

Antibiotic resistance and persistence-Implications for human health and treatment perspectives.

Antimicrobial resistance (AMR) and persistence are associated with an elevated risk of treatment failure and relapsing infections. They are thus important drivers of increased morbidity and mortality rates resulting in growing healthcare costs. Antibiotic resistance is readily identifiable with standard microbiological assays, and the threat imposed by antibiotic resistance has been well recognized. Measures aiming to reduce resistance development and spreading of resistant bacteria are being enforced. However, the phenomenon of bacteria surviving antibiotic exposure despite being fully susceptible, so-called antibiotic persistence, is still largely underestimated. In contrast to antibiotic resistance, antibiotic persistence is difficult to measure and therefore often missed, potentially leading to treatment failures. In this review, we focus on bacterial mechanisms allowing evasion of antibiotic killing and discuss their implications on human health. We describe the relationship between antibiotic persistence and bacterial heterogeneity and discuss recent studies that link bacterial persistence and tolerance with the evolution of antibiotic resistance. Finally, we review persister detection methods, novel strategies aiming at eradicating bacterial persisters and the latest advances in the development of new antibiotics.

Machine Learning and the Pursuit of High-Value Health Care

The United States faces unsustainable growth in health care costs despite limited return on this investment in the form of health outcomes, prompting efforts to improve the value of health care. Artificial intelligence has the potential to enable high-value decision-making from the perspectives of the patient, clinician, and health system, but it also could worsen value. This article assesses these opportunities and challenges, separates reality from hype, and proposes policy approaches for contemporary artificial intelligence — specifically, machine learning — to contribute to rather than detract from high-value care. The conclusion is that it is critical to consider value — in particular, the cost component — in all machine-learning work and to let humans and algorithms each do what they do best.

The Role of Activities of Daily Living Independence in Post-Acute-Care Rehabilitation Service Needs in the Elderly Abdominal-Surgery Population

Abstract Date Presented 03/28/20 More than half of all surgical patients are age 65 and older, and research suggests that a majority of these patients will require post-acute-care rehabilitation services (PAC). Despite growing healthcare costs, characteristics influencing PAC needs in the elderly abdominal-surgery population are not well studied. This project aims to describe discharge trends, as well as factors related to requiring placement at a skilled-nursing facility in the elderly abdominal-surgery population. Primary Author and Speaker: Erika Dobson Contributing Authors: Hailey Zanette, Rebecca Julian

Variations in Health Care Utilization Patterns Among Inflammatory Bowel Disease Patients at Risk for High Medical Service Utilization Enrolled in High Deductible Health Plans.

High-deductible health plans (HDHPs) are increasing in prevalence as a cost control device for slowing health care cost growth by reducing nonessential medical service utilization. High cost-sharing associated with HDHPs can lead to significant financial distress and worse disease outcomes. We hypothesize that chronic disease patients are delaying or foregoing necessary medical care due to health care costs. A retrospective cohort analysis of IBD patients at risk for high medical service utilization with continuous enrollment in either an HDHP or THP from 2009 to 2016 were identified using the MarketScan database. Health care costs were compared between insurance plan groups by Kruskal-Wallis test. Temporal trends in office visits, colonoscopies, emergency department (ED) visits, and hospitalizations were evaluated using additive decomposition time series analysis. Of 605,862 patients with a diagnosis of IBD, we identified 13,052 eligible patients. Annual out-of-pocket costs were higher in the HDHP group (n = 524) than the THP group (n = 12,458) ($2870 vs $1,864; P < 0.001) without any difference in total health care expenses ($23,029 vs $23,794; P = 0.583). Enrollment in an HDHP influenced colonoscopy, ED visit, and hospitalization utilization timing. Colonoscopies peaked in the fourth quarter, ED visits peaked in the first quarter, and hospitalizations peaked in the third and fourth quarter. High-deductible health plan enrollment does not change the cost of care; however, it shifts health care costs onto patients and changes the timing of the care they receive. High-deductible health plans are incentivizing delays in obtaining health care with a potential to cause worse disease outcomes and financial distress. Further evaluation is warranted.

Financial Hardship, Healthcare Utilization, and Health Among U.S. Cancer Survivors

This study examined associations of both medical and nonmedical financial hardships with healthcare utilization and self-rated health among cancer survivors. The National Health Interview Survey (2013-2017) was used to identify cancer survivors (aged 18-64 years: n=4,939; aged ≥65 years: n=6,972). A total of 4 levels of medical financial hardship intensities were created with measures from material, psychological, and behavioral domains. A total of 5 levels of nonmedical financial hardship intensities were created with measures in food insecurity and worry about other economic needs (e.g., housing expenses). Generalized ordinal logistic regression examined associations between medical and nonmedical financial hardship intensities and emergency department visits, use of preventive services and cancer screenings, and self-rated health. All analyses were performed in 2019. In adjusted analyses, cancer survivors with higher medical financial hardship intensity (Level 4 vs Level 1; aged 18-64 years: 42% vs 26.2%, p<0.001; aged ≥65 years: 37.6% vs 24.3%, p=0.001) and higher nonmedical financial hardship intensity (Level 5 vs Level 1; aged 18-64 years: 37.2% vs 27.9%, p=0.011) had more emergency department visits. Moreover, cancer survivors with higher medical financial hardship intensity had lower influenza vaccine (Level 4 vs Level 1; aged 18-64 years: 45.6% vs 52.5%, p=0.036; aged ≥65 years: 64.6% vs 75.6%, p=0.008) and lower breast cancer screening levels (Level 4 vs Level 1; 46.8% vs 61.2%, p=0.001). Similar patterns were found between higher financial hardship intensities and worse self-rated health. Higher medical and nonmedical financial hardships are independently associated with more emergency department visits, lower receipt of some preventive services, and worse self-rated health in cancer survivors. With growing healthcare costs, unmet medical and nonmedical financial needs may worsen health disparities among cancer survivors.

Health Care Cost Growth Benchmarks in 5 States.

Health Care Cost Growth Benchmarks in 5 States.

RE-AIM Evaluation Plan for Washington State Innovation Models Project.

The State of Washington received a State Innovation Models (SIM) $65 million award from the federal Centers for Medicare & Medicaid Services to improve population health and quality of care and reduce the growth of health care costs in the entire state, which has over 7 million residents. SIM is a "complex intervention" that implements several interacting components in a complex, decentralized health system to achieve goals, which poses challenges for evaluation. Our purpose is to present the state-level evaluation methods for Washington's SIM, a 3-year intervention (2016-2018). We apply the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework to structure our evaluation. We create a conceptual model and a plan to use multiple and mixed methods to study SIM performance in the RE-AIM components from a statewide, population-based perspective.

Wpływ migotania przedsionków na przebieg kliniczny i leczenie pacjentów z niewydolnością serca — dane z wieloośrodkowego rejestru

Introduction. When heart failure (HF) and atrial fibrillation (AF) afflict the same patient simultaneously, it becomes a challenge for cardiologists. This is not only due to the need to intensify preventive measures to reduce the prevalence of common aetiological factors, but also due to growing healthcare costs, particularly care costs for elderly patients at high risk of accumulated complications of both diseases. Our study was aimed at evaluating the concomitant incidence of AF on the natural history and treatment of Polish HF patients on the basis of data obtained in a multicentre registry study. Material and methods. In this study, the population subjected to retrospective analysis consisted of Polish patients included in the long-term ESC-HF registry study (N = 1,126). A comparative analysis of the study group (AF+) and the control group (AF−) was carried out. Results . No differences were observed in the rates of in-hospital deaths between the (AF+) and the (AF−) group: 2.9% versus 2.8%, [p = not significant (NS)]. The average duration of hospitalisation in the AF+ group was 9.8 ± 14.7 days compared to 8.8 ± 10.9 days in the AF− group (p = NS). In the AF+ group, compared to the AF− group, significantly higher frequencies were recorded for the following parameters: exacerbation of chronic HF as the cause of hospitalisation, intravenous diuretics usage during hospitalisation, electrical cardioversion, as well as in-hospital use of mineralocorticoid receptor antagonists, diuretics, digoxin, oral antithrombotic agents and amiodarone. Conclusions. In the population of HF patients requiring hospitalisation, the AF+ subgroup is characterised by poorer clinical condition (biventricular cardiac decompensation, lower systolic blood pressure, higher heart rate on admission, and more frequent use of intravenous diuretics). The concomitance of AF significantly impacts the natural history and treatment of HF patients.

Терапия системных заболеваний как фактор риска развития и прогрессирования глаукомы

The prevalence of multimorbidity defined as the presence of two or more chronic diseases increases with ageing. Multimorbidity which is associated with a decline in the quality of life and functional abilities results in the increase in the rate of various physiological disorders and hospital treatment and, therefore, growing healthcare costs. Glaucoma treatment, in particular, in elderly patients, is often accompanied by systemic comorbidities and the intake of multiple systemic drugs. Some systemic agents are known to affect the development of glaucoma (i.e., corticosteroids, some of cardiovascular drugs etc.). However, the data on the effect of systemic medications on the levels of intraocular pressure (IOP) and glaucoma progression remain controversial. Understanding the mechanisms of the effects of systemic medications on IOP levels is of crucial importance. Hence, well-designed prospective randomized controlled studies are required to evaluate these effects. This review paper summarizes published data on the effects of common systemic drugs on IOP levels as well as the risks of the development and progression of primary open-angle glaucoma.Keywords: glaucoma, systemic medications, risk factors, comorbidity, polypharmacy.For citation: Getmanova A.M., Brezhnev A.Yu., Kuroyedov A.V. et al. Systemic therapy a risk factor for glaucoma development and progression. Russian Journal of Clinical Ophthalmology. 2020;20(4):191–196. DOI: 10.32364/2311-7729-2020-20-4-191-196.

Integrating CBT and CFT within a case formulation approach to reduce depression and anxiety in an older adult with a complex mental and physical health history: a single case study

AbstractDepression and anxiety are major contributors to growing healthcare costs in the UK, particularly with an increasingly ageing population. However, identification of mental health needs in older adults has been overshadowed by a tendency to focus on physical health issues, despite the established co-morbidity of depression, anxiety and physical health conditions. When older adults seek psychological support, treatment options may vary and may be time limited, either because of protocol guidance or due to the resource constraints of psychology services. Time-limited treatment, common in many adult services, may not best meet the needs of older adults, whose physical, cognitive and emotional needs alter with age. It is, therefore, important to identify treatments that best meet the needs of older adults who seek psychological support, but who may arrive with complex mental and physical health histories. This paper aims to explore how a case formulation-driven approach that draws on the theoretical underpinnings of cognitive behavioural therapy (CBT) and compassion-focused therapy (CFT) can be used to reduce anxiety and depression in an older adult with a complex multi-morbid mental and physical health history. This study employs a single-case (A–B) experimental design [assessment (A), CBT and CFT intervention (B)] over 28 sessions. Results suggest the greatest reductions in depression and anxiety (as measured using PHQ-9 and GAD-7) occurred during the CFT phase of the intervention, although scores failed to drop below subclinical levels in any phase of the intervention. This case highlights the value of incorporating CFT with CBT in case formulation-driven interventions.Key learning aims(1)To consider the value of using case formulation approaches in older adult populations.(2)To demonstrate flexibility in balancing evidence-based interventions with service user needs by incorporating CBT and CFT to treat anxiety and depression in an older adult.(3)To present a clinical case to identify how assessment, formulation and treatment of anxiety and depression are adapted to best meet the needs of older adults with complex co-morbid mental and physical health conditions.(4)To appreciate the impact of contextual factors, such as austerity measures, on therapeutic work with individuals with long-standing mental and physical health difficulties.

Taking the CON out of Pennsylvania: Did hip/knee replacement patients benefit? A retrospective analysis

We analyze the effects of Certificate of Need (CON) laws on outcomes for hip and knee replacement procedures. Federal CON programs began in 1974 to stem rising health care costs by limiting hospital expansion and acquisition of equipment. The federal requirement for CON programs ended in 1987; however, 36 states and DC still maintain various forms of CON programs.In 1996, Pennsylvania (PA) let its CON law expire. We use data from the National Inpatient Survey from HCUP for the years 1993–1999 and examine four outcomes: hospital acquired infections, mortality, length of stay, and total charges. We use a difference-in-differences estimation method leveraging the expiration of PA's law to compare outcomes between patients in PA with patients in states that continued to have a CON law. We control for a number of covariates and pre-treatment trends in our analysis.We focus on hip and knee replacement surgeries — two procedures that have expanded greatly, have contributed increasingly to growing health care costs, and have not been well studied in the literature —for a population that includes Medicare beneficiaries and patients with other payment methods.Our results provide new evidence of the effects of CON (de)regulation. We find that the expiration of CON laws in PA increased length of stay within the patient population and reduced the probability of dying. The CON laws did not have statistically significant effects on hospital acquired infections or total charges.

Warning headache correlates survival rate in aneurysmal subarachnoid hemorrhage

BackgroundSevere headaches, projectile vomiting, focal neurological deficits and early onset seizure are regarded as early warning symptoms of subarachnoid hemorrhage (SAH). Earlier diagnosis based on such warning symptoms theoretically would improve the clinical prognosis. However, it is still not clear whether the prognosis is correlated with early warning symptoms. Here, we reviewed warning symptoms and other predictive factors in the emergency room (ER) setting and examined their correlations with mortality. MethodsNinety saccular aneurysmal SAH cases were reviewed in a single medical center between January 2011 and December 2013. We examined differences in mortality rate related to warning symptoms, SAH scales, onset-to-ER time, hydrocephalus, and aneurysm size, location, and complexity. Logistic regression analyses were performed to determine the correlations of warning symptoms and other predictive factors with mortality. Receiver operating characteristic (ROC) curve analysis was used to calculate the area the under curve (AUC) of SAH mortality prediction tools. ResultsWarning headache, projectile vomiting, the Hunt and Hess scale, Fisher scale, World Federation of Neurological Surgeons (WFNS) grading scale, and modified WFNS (m-WFNS) scale, body mass index, aneurysm complexity and hydrocephalus were significantly different between the survivors and the decedents. The warning headache and WFNS grade were strongly correlated with mortality. The rate of prognostic prediction improved from 90.4% to 94.6% when warning headache was additionally evaluated. ConclusionsWith growing healthcare costs and recognition of the value of palliative care, early identification via warning headache and a detailed clinical history review is necessary for cases of aSAH.

Abstract CT145: Repeated radium-223-chloride versus rhenium-188-HEDP in patients with metastatic castration-resistant prostate cancer: RaRe study

Abstract Background: For patients with castration-resistant prostate cancer (CRPC) metastatic to bone, treatment with bone seeking radiopharmaceuticals is an important treatment option, both for pain palliation and improvement of survival. Radium-223-chloride (an alpha-emitter) has a proven survival benefit. Some small clinical studies suggest that rhenium-188-HEDP, a beta-emitter that is well-known for its effect on pain palliation, may have a beneficial effect on survival as well. A major advantage of rhenium-188-HEDP, compared to radium-223-chloride is the production on-site at a healthcare institute, resulting in rapidly availability and lower costs. Other advantages of rhenium-188-HEDP includes more favorable physical characteristics (shorter half-life and longer penetration depth) and being more patient-friendly (3 instead of 6 administrations) compared to radium-223-chloride. Despite some promising data in small randomized studies, the potential effect on patient survival of rhenium-188-HEDP needs to be established in a randomized phase III study. Methods: The RaRe trial is a multicenter, randomized, open-label, controlled phase III study comparing the efficacy of repeated treatment with radium-223-chloride and repeated treatment with rhenium-188-HEDP in patients with CRPC metastatic to bone. The aim of the trial is to include 402 participants who are randomized to one of the two treatment groups in a 1:1 ratio. The primary endpoint is overall survival (OS), and the secondary endpoints are pain response, quality of life (QoL), time to first occurrence of skeletal related event (SRE), prostate specific antigen (PSA) progression, total alkaline phosphatase (tALP) progression, and incremental cost-effectiveness. An interim analysis for futility will be performed after the inclusion of 90 patients in each treatment group. Discussion: In this randomized phase III trial we hypothesize that treatment with rhenium-188-HEDP results in an improved survival in patients with CRPC metastatic to bone as compared to the current standard treatment with radium-223-chloride. We also expect to demonstrate that treatment with rhenium-188-HEDP improves pain response and quality of life of CRPC patients. Results coming from this study may help to find a better treatment for CRPC patients, while reducing costs. In current times of exponential growth of healthcare costs, we believe that this study is meaningful from the perspective of cost-effectiveness. Clinicaltrials.gov identifier: NCT03458559. Registered 8 March 2018. Trial status: recruiting. Citation Format: Jessica C. Notohardjo, Esther W. Bouman-Wammes, Joyce M. van Dodewaard - de Jong, Haiko J. Bloemendal, Rogier Lange, Rob ter Heine, Henk M. Verheul, John M. de Klerk, Alfons J. van den Eertwegh. Repeated radium-223-chloride versus rhenium-188-HEDP in patients with metastatic castration-resistant prostate cancer: RaRe study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT145.

Length of Stay Beyond Medical Readiness in Neurosurgical Patients: A Prospective Analysis.

In an era of growing healthcare costs, there is increased pressure on medical care providers to discharge patients once they are medically fit. However, it is not uncommon for patients to stay beyond medical readiness (BMR). To analyze the frequency with which patients remain in the hospital BMR. A prospective cohort analysis utilizing a database maintained between 2014 and 2015 included 718 adults admitted to the neurosurgical service. The attending for admitted patients was asked on a daily basis as to whether the patient was medically cleared for discharge. Standard statistical analyses were performed. Of the 718 patients, 105 (14.6%) remained in the hospital BMR. Of the patients who presented with a spinal pathology, 17.8% had a length of stay (LOS)-BMR compared to 13.9% who presented with cerebrovascular pathologies and 14.8% who presented with a brain tumor. The average LOS-BMR was 1.8 d. Only 7.7% of patients who were discharged home had an LOS-BMR compared to 30.7% of patients who were discharged to a skilled nursing facility or rehabilitation center (P<.001). In logistic regression, a physical therapy consultation and discharge to a specialized nursing facility were both associated with a longer LOS (average 2.4 d longer, P<.001, and 6.2 d longer, P=.028, respectively). However, neither was associated with an LOS-BMR. LOS-BMR is an important process engineering concept within neurosurgery that represents a potential area for improvement to maximize limited healthcare resources. A sizeable portion of neurosurgical patients remained in the hospital BMR.

Healthcare Spending Overshoots a Threat to Sustainability

Growth in healthcare spending by provinces and territories has been accelerating over the last four years as governments continue to overshoot their budget targets, says a report from the C.D. Howe Institute. In “Healthcare Spending Overshoots a Threat to Sustainability,” author William B.P. Robson warns that, while governments are typically budgeting growth in healthcare budgets that should be fiscally sustainable, actual growth in healthcare costs is outrunning what Canada’s economy and tax base can support over the long run.