Health Budget Research Articles

Current status of National Institutes of Health funding for thoracic surgeons in the United States: Beacon of hope or candle in the wind?

ObjectiveIncreasing forces threaten the viability of thoracic surgeon–initiated research, a core component of our academic mission. National Institutes of Health funding is a benchmark of research productivity and innovation. This study examined the current status of National Institutes of Health funding for thoracic surgeons. MethodsThoracic surgeon principal investigators on National Institutes of Health–funded grants during June 2010, June 2015, and June 2020 were identified using National Institutes of Health iSearchGrants (version 2.4). American Association of Medical Colleges data were used to identify all surgeons in the United States. Types and total costs of National Institutes of Health–funded grants were compared relative to other surgical specialties. ResultsA total of 61 of 4681 (1.3%), 63 of 4484 (1.4%), and 60 of 4497 (1.3%) thoracic surgeons were principal investigators on 79, 76, and 87 National Institutes of Health–funded grants in 2010, 2015, and 2020, respectively; these rates were higher than those for most other surgical specialties (P ≤ .0001). Total National Institutes of Health costs for Thoracic Surgeon–initiated grants increased 57% from 2010 to 2020, outpacing the 33% increase in total National Institutes of Health budget. Numbers and types of grants varied among cardiovascular, transplant, and oncology subgroups. Although the majority of grants and costs were cardiovascular related, increased National Institutes of Health expenditures primarily were due to funding for transplant and oncology grants. Per-capita costs were highest for transplant-related grants during both years. Percentages of R01-to-total costs were constant at 55%. Rates and levels of funding for female versus male thoracic surgeons were comparable. Awards to 5 surgeons accounted for 33% of National Institutes of Health costs for thoracic surgeon principal investigators in 2020; a similar phenomenon was observed for 2010 and 2015. ConclusionsLong-term structural changes must be implemented to more effectively nurture the next generation of thoracic surgeon scientists.

Handling of Household Waste That Impact on Environmental Pollution in Kupang City Review Based on Law Number 18 of 2008 Regarding Waste Management

Various efforts were taken by creating a healthy environment for the community. Related to this, Indonesia already has Law No. 18 of 2008 concerning Waste Management. Until now, waste management in Indonesia is still using the old paradigm: collect-transport-dispose. In Kupang City, East Nusa Tenggara, the management of household waste is still not optimal, especially with the lack of public understanding and awareness about the impact of waste that is not managed properly and correctly. There are still many people who throw household waste carelessly at certain points around the edge of the road and this creates an unfavorable view and smells that interfere with breathing in the surrounding environment. Thus, this problem must provide a response from various parties not only by the government and citizens (public), the private sector but also between governments (Kupang City Government and NTT Provincial Government). This can be seen in the lack of synergy between the government's movements and policies in dealing with waste in Kupang City. Handling the waste problem is closely related to environmental problems. If the environmental conditions are clean and healthy, the community will have an impact on public health and environmental pollution. If the community is healthy, the health budget will also be reduced. In this regard, based on Law Number 18 of 2008 concerning Waste Management, concrete steps to be applied in the implementation of waste management must start from the ministry to the RT level and change people's behavior by throwing garbage not in random places. must be removed. In addition, waste management must be carried out jointly by the government, the community and the private sector by helping to prepare waste transportation facilities because the waste transportation facilities belonging to the government of Kupang City are also limited in number to transport waste in various parts of Kupang City where the amount of waste is very large. The role of the private sector is to help the government by preparing garbage bins or helping to educate the public about the importance of maintaining cleanliness.

Medical and social aspects of health security in the formation of public health

Introduction. Monitoring of the health status of the population as a whole, assessment and analysis of the leading determinants of health, including genetic, behavioral, anthropogenic, biophysiological factors, represent one of the global functions of public health, focused on health protection and provision of medical services. To date, health disorders are primarily related to lifestyle and are always a collection of individual personalized health data. Unhealthy diet and low physical activity are risk factors for the development of a number of chronic non-communicable diseases, primarily cardiovascular, metabolic, in particular type 2 diabetes mellitus and some types of cancer. These risk factors lead to early disability, a decrease in the quality and life expectancy of people, disability, as well as the health budget and the economy. So, if on average only 3 % of the health budget is spent on disease prevention programs, then about 7 % of the budget in the EU countries is spent on the treatment of obesity and turns into 2.8 % of world GDP. In this regard, the implementation of early preventive measures is characterized by favorable and positive results.
 Purpose. Analyzes the role of unhealthy diet and low physical activity as key risk factors for cardiovascular and metabolic diseases, especially in the population of patients with type 2 diabetes mellitus.
 Methods and materials. The characteristics of the presented studies included in the article cover international experience and analysis of the pilot study conducted on a population sample of patients with type 2 diabetes mellitus. To assess the economic costs associated with unhealthy diet and low physical activity, a general approach was used based on the analysis of individual diseases, in particular, type 2 diabetes mellitus, using population attributive fractions, regression method.
 Results. Based on the data obtained, it follows that patients with an unhealthy diet and low physical activity, burdened with overweight or obesity, have a high five-year risk of developing new cases of type 2 diabetes and cardiovascular complications. This includes early disability and the economic costs of providing medical care. Using the example of a number of European countries and its own results, this study is focused on assessing the economic damage that is associated with unhealthy diet and low physical activity among the population, regardless of the region of residence and the metropolis.

Service-, needs-, and quality-based hospital capacity planning – The evolution of a revolution in Switzerland

Most developed countries spend a large amount of their health budget on hospital capacities and inpatient services. However, those capacities and services are often not comprehensively planned what leads to vague service delivery steering and non-need driven hospital facilities. Switzerland is different as the planning procedure was completely reformed in 2012 and is further refined in 2021/2022. The Canton of Zurich, the frontrunner in Switzerland, has made a comprehensive update of its hospital capacity planning model for acute, psychiatric, and rehabilitative care. The result of this model is the hospital list. This list includes all hospitals which fulfill predefined quality, efficiency, and need requirements. Hospitals on the list receive a mandate to provide inpatient treatments for specific and selected service groups (n = 196), clustered in three areas (acute care, psychiatry, rehabilitation). The underlying health care policy process is transparent and is characterized by a high participation of all relevant actors. The building blocks of the planning model are a classification system of service groups, different quality and efficiency requirements attached to these groups, and an analysis of current and future need for health care. Hospitals which are willing to perform services must apply and demonstrate that the requirements are fulfilled. The canton then decides needs-based which hospital can deliver which services.

Health budgeting and governance responses to COVID-19 in Latin America and the Caribbean: Lessons for improving health systems’ resilience

This paper analyses the budgetary and health governance responses to the COVID-19 pandemic in Latin American and Caribbean (LAC) countries during 2020 and 2021 to identify good practices which could support countries improve the resilience of their health financing systems for future crises.

Defining Pooled' Place-Based' Budgets for Health and Social Care: A Scoping Review.

Introduction:Current descriptions of pooled budgets in the literature pose challenges to good quality evaluation of their contribution to integrated care. Addressing this gap is increasingly important given the shift from early models of integrated care targeting segments of the population, to more recent approaches that aim to target ‘places’, broader geographically defined populations. This review draws on the current international evidence to describe practical examples of pooled health and social care budgets, highlighting specific place-based approaches.Methods:We initially conducted a scoping review, a systematic database search (‘Medline’, ‘Embase’, ‘Econ Lit’ and ‘Google Scholar’) complemented by further snowballing for academic and ‘grey literature’ publications (1995 – 2020). Results were analysed thematically according to budget characteristics and macro-environment, with additional specific case studies.Results:Thirty-six primary studies were included, describing ten broad models of pooled budgets across seven countries. Most budgets targeted specific sub-populations rather than an entire geographically defined population. Specific budget structures varied and were generally under-described. The closest place-based models were for small populations and implemented in a national health system, or insurance-based with natural geographical boundaries.Conclusion:Despite their increasing relevance in the current political debate, pooled place-based budgets are still at an early stage of implementation and research. Adequate description is required for future meta-analysis of effectiveness on outcomes.

Conducting rapid research to aid the design of a health systems governance intervention in the Somali Region of Ethiopia.

IntroductionThe rapid research described in this chapter was conducted as an assignment for a UN agency in Ethiopia's Somali Region. The agency's aim was support the implementation of an interim citizen engagement intervention, with a view of supporting of the Ethiopian Government's Citizen Score Card at primary healthcare facilities and hospitals in future. Many health facilities in Somali Region struggle with budget shortages related to ineffective budget planning and budget execution at woreda health office levels. In this context, an intervention to first improve budget accountability, through the implementation of citizen audits, was proposed.MethodologyThe rapid study focused on five woredas (districts) within Somali Region, where interviews were conducted with the heads of woreda health offices. In the same five woredas, directors of healthcare facilities were interviewed and offices and healthcare facilities were observed. The framework of assessment and analysis was based on health systems literature on fragile and conflict affected states guided the questions for the health authorities and health facility management.FindingsThe research yielded five distinct mini case studies covering woreda health office planning and budgeting capacity and support (or lack thereof), and related impressions of challenges regarding healthcare delivery at health facilities in the same five woredas.ResultsThe findings demonstrated that the capacity for healthcare planning and budgeting Somali Region at woreda level varied significantly and that little guidance was available from regional level health authorities. Frontline health services clearly suffered from budget shortages as a result.ConclusionThe research provided an evidence base for the delay of the roll-out of the Community Scorecard implementation across Somali Region. In a context whereby health facilities remain under-resourced due to budgeting constraints, a citizen-service provider-focused accountability intervention would have been of limited utility. The rapid case study research, conducted by condensing the usual case study research process, allowed for the production of evidence that was “robust enough” to demonstrate heterogeneity and challenges regarding budgeting quality across the five research sites. This evidence clearly transcended the hitherto anecdotal evidence that woreda-level health budget planning remains an area that faces significant shortcomings.

Projected Return on Investment From Implementation of a Lifestyle Intervention to Reduce Adverse Pregnancy Outcomes

Structured antenatal diet and physical activity interventions have been shown to be associated with reduced adverse pregnancy outcomes and recommended to be routinely offered to all pregnant women. The health cost implications of population-level implementation are unclear. To estimate the budget impact associated with integrating structured diet and physical activity interventions into routine antenatal care. This economic evaluation was conducted from the perspective of Australian health funders. An open-source decision-tree model was constructed to compare the projected budget outcomes of implementing lifestyle intervention vs usual care. Scenario, deterministic, and probabilistic sensitivity analysis were completed. The study setting was Australian health services, and the study population was all Australian women projected to give birth in the years 2022 to 2026 (approximately 330 000 per year). Structured diet and physical activity intervention provided by trained health professionals, integrated into routine antenatal care. Comparator was usual care, which currently in Australia does not include routine structured lifestyle interventions. Return on investment (ROI) ratio for lifestyle intervention (cost of intervention divided by cost savings attributable to reduced maternal and infant adverse events) from the perspective of Australian health care funders. Adverse events were obtained from a published meta-analysis and population data. Costs were estimated from aggregate trial data and clinical pathways and valued at the year incurred. Intervention offered an ROI ratio of 4.75 over the 5-year program; hence every Australian dollar spent on implementation produced an estimated return of A$4.75. The projected total 5-year intervention cost was A$205 million ($151 million), with cost offsets (from reduced incidence of adverse pregnancy outcomes) of A$1022 million ($755 million), and health budget savings of A$807 million (95% CI, A$129 million to A$1639 million) ($596 million [95% CI, $95 million to $1211 million]); 93.3% of the 10 000 iterations were within cost saving, and results were robust to scenario and sensitivity analyses. This economic evaluation found that providing access to structured diet and physical activity lifestyle interventions for all pregnant Australian women was estimated to provide strong return on investment for health funders. The open-source model developed can be used by other jurisdictions and health services to explore cost implications of implementation within their patient population.

Perceiving the Consumer’s Desire and Transforming it into a Business Model : A Case Study of Morning Fresh, India’s No. 1 Hangover Cure & Detox Drink

An increasing number of Indians are drinking alcohol, but the latest study (“Alcohol Consumption in India,” 2022) shows that the country is experiencing a rise in smart drinking, limiting consumption within limits, and only on social occasions. The study conducted across three North Indian states found that there is now an increase in the number of people who drink at casual get-togethers, festivals, or social occasions; 54% of the respondents said that they drank at such events, while 44% admitted to responsibly following rules and regulations regarding alcohol consumption. According to recent research, the burden of alcohol in India costs the economy more than the Indian government’s whole health budget (Jyani et al., 2019). According to the findings of a study that was just recently published in the International Journal of Drug Policy, the economic loss that can be attributed to the negative effects of alcohol consumption accounts for approximately 1.45 percentage points of the total gross domestic product when tax receipts from the sale of alcohol are taken into account (GDP). To put this into perspective, the yearly expenditures of the government on health amount to around 1.1% of the GDP. According to the researchers’ projections, the whole social and economic cost of alcohol-related health disorders in 2050 would be more than the entire gross domestic product of India in 2018, which was INR 219.5 trillion. This development places one company at an advantage in further promoting responsible drinking among liquor drinkers. Looking at such a number of consumers with the social and health impact, the owner of Healthline Private Limited foresaw an opportunity not only to start an exponential revenue-generating product, but also to ameliorate the health problems in youngsters, thereby also limiting their habits’ ill effects on the society. The CEO of the company had a background of the F&B sector and was skilled in creative leadership, product innovation, and business development. This case examined how Healthline’s owners transformed an opportunity into a successful business model by introducing the most innovative and acceptable product, “Morning Fresh,” and underlined how crucial it is to understand customer desires. The case also emphasized the marketing strategies employed to capture the maximum possible market cap. I took the data from secondary sources and published resources (from 2014 to 2021) to analyze the complete case from different perspectives. I also explored how a consumer’s immediate needs and desires can be transformed into a successful business.

Definition of a tool to assess shared decision-making (SDM) on women with breast cancer: A value-based approach.

Background and AimsIn oncology, there is increasing talk of personalized treatment and shared decision‐making (SDM), especially when multiple treatment options are available with different outcomes depending on patient preference. The present study aimed to define the set of main dimensions and relative tools to assess the Value brought to patients from a Breast Cancer's Clinical pathway structured according to a dynamic SDM framework.MethodsStarting from our previous systematic review of the literature, a deep search of the main evidence‐based and already validated questionnaires was carried out. In the second phase, to corroborate this grid, a Delphi survey was conducted to assess each questionnaire identified for each dimension, against the following seven value‐based criteria: Clinical Benefit, Safety, Care Team Well Being, Patient Reported Outcomes Measures, Green Oncology, Impact on Health Budget, and Genomic Profile.ResultsThe resulting 7‐dimension questionnaire is composed of 72 questions. Of these, some quantitatively and objectively assess the evolution of the patient's disease state, whereas others aim to ask patients about their active involvement in decisions affecting them and to investigate whether they were free to explore their preferences. Furthermore, to frame the analyzed phenomenon at the right time, for each questionnaire section, the specific, evidence‐based timing of administration is indicated.ConclusionThe resulting questionnaire is validated in its entirety and it is composed of a set of questions and relative time point for data collections to assess the Value brought to patients undertaking a Breast Cancer's Clinical pathway, structured according to a dynamic SDM framework. It constitutes a quantitative instrument to integrate patient centeredness with a personalized perspective in the care management of women with breast cancer.

A unique hub-and-spoke model to optimize patient management in lymphoma using novel CAR-T cell therapy in Southeast and South Asia.

Novel therapeutic options for cancer offer hope for patients and their families, particularly when the cancer has not responded to established treatment regimens. The CAR-T cell therapeutic approach has changed the treatment paradigm for relapsed or refractory lymphoma, extending the capacity of the patient's own T cells to detect and eliminate cancer cells through genetic modification of T-cell surface receptors. The process of establishing treatment centers and developing clinical expertize in this novel treatment strategy is complex. Time, resources, and a commitment to focusing health budgets on a new area are required. Currently, Singapore is the only country in southeast and south Asia with market authorization of the CAR-T product, tisagenlecleucel. Availability of CAR-T treatment across international borders provides patients in neighboring countries with choice in therapeutic options. This paper describes the unique hub-and-spoke cross-border collaboration developed between Singapore and its neighbors to provide access to CAR-T cell therapy for patients with relapsed or refractory lymphoma. To date in 2022, four patients have been included in the CAR-T treatment cross-border collaboration. Their stay in Singapore has been at least 2months' duration, including the pre-treatment evaluation, apheresis, CAR-T cell infusion and post-treatment monitoring. Patient support from referring and treating physicians, critical to the success of the undertaking, is characterized by early communication, patient selection, multi-disciplinary care, post-treatment monitoring, and attention to detail. The patient journey and the development and implementation of this unique collaboration are discussed.

Region-specific macro-indicators for palliative care development in the Eastern Mediterranean Region: a Delphi study.

The World Health Organization Office for the Eastern Mediterranean Region (WHO/EMRO), and the recently created palliative care experts network for the Eastern Mediterranean Region (EMR), decided to develop region-specific indicators for monitoring national palliative care development in the Region. To identify relevant and feasible macro-indicators for palliative care development for the EMR. Palliative care experts from the EMR were nominated and invited to complete a 2-round Delphi study to rate macro-indicators from previous studies and propose new ones based on the EMR regional characteristics. All indicators were assessed according to regional relevance (R) and feasibility (F). A content validity index (CVI) was calculated. Indicators with CVI ≥ 0.7/1, and scoring ≥ 7/9 for the R and F averages were selected. Twelve of the 22 countries in the Region were represented in the study. In the first round, 11 indicators were selected and 13 new ones proposed. In the second round, 15 indicators matched R, F and CVI criteria. Top-scored indicators were: existence of a current national palliative care strategy (R = 8, F = 8, CVI = 1); ratio of specialized services (for adults and children) in the country per population (R = 8, F = 7, CVI = 1); allocation of funds for palliative care in the national health budget by the Ministry of Health or equivalent government agency (R = 8, F = 6, CVI = 1); education for prequalification of doctors/nurses (R = 8, F = 8, CVI = 0.9); and availability of morphine and other strong opioids (R =8, F = 8, CVI= 0.9). A baseline set of 15 region-specific indicators for measuring the development of palliative care were validated by experts in the EMR.

Impact of the Price of Dialysis Treatment and the Prevalence in Dialysis on the Health Budget in Portugal

In Portugal, all expenses related to the replacement treatment of renal function in chronic kidney disease are supported through the budget of the Ministry of Health. The author, who limits the analysis to the modality of dialysis treatment, reviews the relative importance of the two factors that have the greatest influence on these expenses. The so-called comprehensive price (CP) which includes dialysis, medicines and diagnostic tests – and the number of patients undergoing treatment (prevalence). The CP with a very high initial value was progressively reduced, with these corrections contributing positively to a decrease in expenses. On the contrary, the prevalence of dialysis has always been increasing, mainly as a result of an extremely high incidence of new patients starting dialysis. The positive effect of decreasing CP it is not only completely nullified by the opposite effect resulting from the increase in prevalence, but it is even surpassed, with a significant increase in expenses. Everything seems to indicate that the high prevalence of dialysis represents the most important factor responsible for the high level of state expenditure in the treatment of chronic kidney disease in Portugal. In order to contain expenses, it will be necessary not only to correct the CP value again, but to analyze the cause, or causes, responsible for the very high levels of incidence/prevalence in dialysis that are observed in our country.

Health Technology Assessment in Vietnam: Currant Situation and Future Direction

Health Technology Assessment (HTA) is defined as a multidisciplinary process involving a wide range of capacities that summarizes information about the characteristics, short- and long-term effects and/or impacts of health technologies and interventions (1) . HTA can also be understood as a method for assessing and analyzing medical, epidemiological, sociological, and economic aspects of health technologies and interventions (including drugs, vaccines, medical supplies, medical equipment, medical services, and public health interventions, etc.). HTA has been recognized by The World Health Organization (WHO) as a tool for successful progression toward universal health coverage (UHC) (2) . In Vietnam, given constraints in health budget, especially the shortage of health insurance fund, HTA has been being increasingly important. According to the statistics by Vietnam Social Security, drugs account for a huge portion of total health insurance expenditures, accounting for 61.6%, 41%, and 34% in 2010, 2016, and 2017. In this context, containing the drug costs and promoting efficient use the health insurance fund is considered as important task. In other words, HTA should be used as a tool for developing the list of drugs covered by health insurance, as well as payment conditions and rates.

The Effect of Increased Education and Health Budgets and Economic Growth on Poverty Levels During the 2007-2021 Period in South Sulawesi

The budget allocation made by the government in the education and health sectors as well as economic growth is not enough to reduce poverty. An increase in the budget for education, health, and economic growth will reduce poverty. If the budget allocation is not right on target, it will lead to poverty. This study aims to analyze the effect of increasing the budget for education, health, and economic growth on poverty levels in South Sulawesi. The type of data used in this study is secondary data and uses time series data from 2007 to 2021. This research uses the multiple linear regression model method. The results of this study indicate that the education budget and economic growth do not affect the poverty level of South Sulawesi Province, while the health budget affects the poverty level of South Sulawesi Province. Based on the results of this study, it is hoped that the South Sulawesi provincial government will be able to proportional the education and health budget to improve the welfare of the community, especially the lower middle class.

Implementasi Kebijakan Intervensi Gizi Spesifik sebagai Upaya Penanganan Stunting di Kabupaten Malang

This study explain the implementation of spesific nutrition intervention policy in attempt of stunting handling refer to Malang Regent Act No. 33 of 2018 about Stunting Prevention Efforts. A qualitative-descriptive approach used to describe the policy implementation according to A Model of The Policy Implementation Process by Donald Van Meter and Carl Van Horn. Amid of COVID-19 pandemic, several spesific nutrition activities were not carried out due to health budget refocusing. However, the proponent of implement agent such as nutritionist officer in Puskesmas and village tocologist are the key actors in pursuance of stunting integration action timeline. In adaption to this situation, home visits and appointments are made to reach a wider target group. The need for technical regulations as a continuity of Malang Regent Act No. 33 of 2018 to accomodate the handling of stunting through spesific nutrition intervention during the time of pandemic optimally.

A unique hub-and-spoke model to optimize patient management in lymphoma using novel chimeric antigen receptor-T cell therapy in Southeast and South Asia.

Novel therapeutic options for cancer offer hope for patients and their families, particularly when the cancer has not responded to established treatment regimens. The chimeric antigen receptor (CAR)-T cell therapeutic approach has changed the treatment paradigm for relapsed or refractory lymphoma, extending the capacity of the patient's own T cells to detect and eliminate cancer cells through genetic modification of T-cell surface receptors. The process of establishing treatment centers and developing clinical expertize in this novel treatment strategy is complex. Time, resources, and a commitment to focusing health budgets on a new area are required. Currently, Singapore is the only country in southeast and south Asia with market authorization of the CAR-T product, tisagenlecleucel. Availability of CAR-T treatment across international borders provides patients in neighboring countries with choice in therapeutic options. This paper describes the unique hub-and-spoke cross-border collaboration developed between Singapore and its neighbors to provide access to CAR-T cell therapy for patients with relapsed or refractory lymphoma. To date in 2022, four patients have been included in the CAR-T treatment cross-border collaboration. Their stay in Singapore has been about 2months' duration, including the pre-treatment evaluation, apheresis, CAR-T cell infusion and post-treatment monitoring. Patient support from referring and treating physicians, critical to the success of the undertaking, is characterized by early communication, patient selection, multi-disciplinary care, post-treatment monitoring, and attention to detail. The patient journey and the development and implementation of this unique collaboration are discussed.

Public health and budgetary impact of 20-valent pneumococcal conjugate vaccine for adults in England

ABSTRACT Background Despite use of 23-valent pneumococcal polysaccharide vaccine (PPV23) in England, disease burden among at-risk adults remains high. We evaluated the public health and budgetary impact of 20-valent pneumococcal conjugate vaccine (PCV20) compared to the current adult pneumococcal vaccination program. Methods Five-year outcomes and costs of invasive pneumococcal disease (IPD) and community-acquired pneumonia (CAP) among adults aged 65–99 years and adults aged 18–64 years with underlying conditions in England were projected using a deterministic cohort model. Hypothetical vaccination with PCV20 versus PPV23 was compared from the National Health Service (NHS) perspective. Results Replacing PPV23 with PCV20 would prevent 785 IPD hospitalizations, 11,751 CAP hospitalizations, and 1,414 deaths over 5 years, and would reduce medical care costs by £48.5 M. With vaccination costs higher by £107.2 M, projected net budgetary impact is £58.7 M. The budgetary impact would be greatest in year 1 (£26.3 M), and would decrease over time (to £1.6 M by year 5). The average budget increase (£11.7 M/year) represents <0.01% of the Department of Health and Social Care total budget and <3% of the vaccine budget. Conclusions Use of PCV20 among adults currently eligible for PPV23 in England would substantially reduce the burden of pneumococcal disease, with modest budgetary impact.

Environmental considerations in the selection of medical staplers: A comparative life cycle assessment

It is estimated that the health care industry produces 8% of the total United States’ carbon dioxide emissions. This is in line global with other OECD countries, where the health care industries comprise between 3% and 8% of national carbon dioxide emissions. However, only 0.03% of the $29 billion US National Institutes of Health budget is granted to research focused on increasing sustainability in the healthcare industry. Due to the positive feedback system of the environmental impacts due to healthcare creating more challenges that affect human health, such as global warming the environmental impacts of medicine must be considered more holistically. One area that requires significant attention is the use of disposable medical supplies and their implications for sustainability. Disposable medical materials were first introduced for the purpose of infection control, convenience, and cost-savings. However, tradeoffs exist with respect to the indirect costs to society from the environmental impacts that are produced from the use of disposable materials. This study utilized life cycle assessment (LCA) to analyze two single use staplers at different price points. These staplers are primarily comprised of metal and plastic components. The more expensive and complex stapler was found to have a greater environmental impact across all of the impact categories analyzed when compared to the less costly and complex single use stapler due to having a greater mass. Dematerializing the single use staplers has the potential to reduce the environmental impacts, however, a durability and use tradeoff must be considered.

Analysis of Public Health Centre Financing using the District Health Account (DHA) Model in Karangasem District, Bali, Indonesia

Background and purpose: Health financing aspects of the public health centres (PHC) may influence the achievement of PHC’s programs and its minimum service standards (SPM). The District Health Account (DHA) is a model used to describe and evaluate health financing at the PHC level. The purpose of this study was to analyze health financing mechanism from both the government and national health insurance in the Karangasem District using the DHA Model. Methods: This study was an evaluation research with a case study approach using the DHA Model. Evaluations were carried out at two PHC, Manggis II PHC and Abang I PHC, between March and April 2018. Data were collected from the Karangasem District Health Office and the PHCs. These include PHC realization data, report on program achievements and SPM. The research instrument used for the data collection and analysis was the DHA extraction form and pivot table which includes information on cost sources, financing managers, service providers, functions, programs, types of activities, budget lines, levels of activities and beneficiaries. Results: We found the source of budget in both PHC was dominated by the district budget (APBD) and the national budget (APBN). The institutions which manage the budget and provide service were predominantly the Health Office and PHC. The most frequent financing functions was for governance and administration, while the largest types of activities covered was the indirect activities. Budget spending for operational costs was higher than for maintenance and investment. Realization of the activity for community program efforts (UKM) and prevention program (UKP) was lower than for the capacity building program. Conclusion: The DHA model was able to identify patterns of health budget allocation by health agencies. The use of the DHA model to analyze health financing should be adopted routinely in order to provide evaluation reports for health agencies at the district level.