Health Care Financing Research Articles

The State of Medical Care for Adults With Intellectual and/or Developmental Disabilities.

For more than 2 decades, medical care for adults with intellectual and/or developmental disabilities (IDDs) has been difficult to access and has not substantially changed the persistently poor health status that is common in this population cohort. While there has been some progress in the development of models of care that are designed with and for adults with IDD, it has been slow and sporadic, with little data or analyses of efficacy or effectiveness. Very few medical schools and other health science professional education in the United States include curricular content on adults with IDD, resulting in health care practitioners being under or altogether unprepared to provide care to them. Public and private health care policy and financing are not responsive to the medical care needs and experiences of adults with IDD. More recently, the impact of the COVID-19 pandemic on adults with IDD was disproportionally more severe, with significantly higher rates of morbidity and mortality than on adults without IDD, having nothing to do with the presence of an IDD itself. This commentary reviews persistent barriers to accessible, responsive medical care for adults with IDD and reviews a number of health care models that have been developed since the turn of the 21st century. It also offers a brief review of Medicaid Managed Care as a potential policy and financing solution to long-standing financing and related obstacles to optimal medical care.

Medicare Enrollment and Spending Among Patients Initiating Dialysis After the Affordable Care Act

Medicare finances health care for most US patients with end-stage kidney disease (ESKD), regardless of age. Medicare enrollment may have slowed for patients with incident ESKD who gained access to new private insurance options with the 2014 passage of the Affordable Care Act (ACA) and introduction of the ACA Marketplace. To describe trends in public and private insurance coverage and dialysis spending among patients with incident ESKD from 2012 to 2017. This serial cross-sectional study included patients 18 to 64 years old in Colorado who were not enrolled in Medicare at dialysis initiation. Data analysis was conducted from May to August 2023. Introduction of the ACA Marketplace in 2014. Medicare, Medicaid, or private insurance enrollment in the first year after dialysis initiation, and dialysis spending by insurance type. Of 2005 patients included in the sample, 1416 (70.6%) were 45 to 64 years old, and 1259 (62.8%) were male. A lower proportion of patients with incident ESKD starting dialysis were newly enrolled in Medicare in the years following the ACA (361 of 713 [50.6%]) compared to 2 years prior (420 of 595 [70.6%]). Unadjusted rates of switching from Medicaid to Medicare 1 year after dialysis initiation decreased 14.3 percentage points over time (68.9% in 2012-2013 vs 58.3% and 54.6% in 2014-2015 and 2016-2017, respectively). Unadjusted rates of switching from private insurance to Medicare 1 year after dialysis initiation decreased by 22.3 percentage points (68.1% in 2012-2013 vs 52.2% and 45.8% in 2014-2015 and 2016-2017, respectively). Over the entire 2012 to 2017 period, quarterly dialysis spending in the first year of dialysis among patients with private insurance was higher than among those with Medicare coverage ($26 351-$29 781 vs $10 039-$12 741). This cross-sectional study demonstrates that lower Medicare enrollment rates over time among those initiating dialysis may be inducing higher social spending. This finding raises concerns about the effectiveness of Medicare policies and federal leverage to improve access, outcomes, and value of dialysis care.

Barriers and recommendations for the implementation of robot-assisted minimally invasive surgery in Africa.

Robotic surgery offers several advantages to the African setting, including shorter hospital stays, faster return to work, and increased overall productivity. However, its adoption has been limited by several factors. This review aims to present the barriers to implementation, and recommendations for integrating robotic surgery into the African healthcare system. Use of robotic surgery in Africa is primarily limited to Egypt and South Africa. Barriers faced by other countries were categorized into economic, infrastructural, systemic, and training-related. They include limited healthcare budgets, initial costs of robotic systems, patients' inability to afford robotic procedures, out-of-pocket healthcare financing, inadequate power supply, limited internet connectivity, poor healthcare leadership, and insufficient surgeon training facilities. Public-private partnerships, provision of loans and subsidies, introduction of cheaper robotic systems, and local manufacturing of robotic equipment will serve as cost-effective innovations. It is also important to improve healthcare financing and strengthen healthcare leadership across Africa. To address the lack of surgeon training facilities, remote assistance for surgeon training can be used to create a mentor-mentee relationship between robotic surgeons in any part of the world and surgical trainees in Africa to facilitate knowledge transfer. Prior investment in electricity and network infrastructure is however necessary. Establishment of fellowships to provide early exposure to robotic surgery should also be explored. AI-integrated robotic surgery can also enhance precision and safety, and provide tailored training tools for surgeons. Similar barriers to the adoption of surgical robotics are faced across Africa. By implementing the provided recommendations, robotic surgery can still be widely adopted in African settings, despite the delay.

Causal Inference and AI: Elevating Decision-Making in Uncertain Environments

Artificial intelligence (AI) has changed the way decisions are made in industries; however, its impact may be limited in situations with uncertainty where cause and effect relationships play a crucial role. While conventional AI models are good at spotting connections between variables they may struggle when it comes to predicting results in fields such as healthcare finance and self-driving vehicles where understanding causation is key. Causal inference an emerging area in AI goes beyond finding correlations and enables systems to make stronger and dependable decisions, in intricate settings. By incorporating reasoning into AI systems operations can enhance their predictive abilities by comprehending the fundamental mechanisms governing cause and effect connections This piece delves into the amalgamation of causal deduction in AI by examining its theoretical groundwork as well as practical implementations and the obstacles and advantages of merging causal understanding with machine learning. Through real life examples and new methodologies such as networks and counterfactual logic establishment this paper underscores how causal inference can enhance AIs decision making skills by rendering them more flexible and efficient, in ambiguous scenarios. Keywords: Artificial Intelligence, Causal Inference, Machine Learning, Decision-Making, Bayesian Networks, Counterfactual Reasoning, Uncertainty, High-Stakes Environments, Predictive Models, Causality.

Media bias in portrayals of mortality risks: Comparison of newspaper coverage to death rates

Chronic diseases are the leading cause of death in the United States, yet effective preventive measures receive minimal healthcare funding. This disparity may stem from public underestimation of these diseases’ impact and controllability, with distorted media coverage overemphasizing sensational risks and underemphasizing chronic illnesses. This study compares media coverage of mortality risks to objective measures of death rates to investigate such distortions. Data were collected on 14 mortality risks, including monthly US deaths from CDC Wonder and 823,406 relevant articles from major US newspapers via LexisNexis. Regression analyses and qualitative evaluations using natural language processing tools were performed. From 1999 to 2020, a significant disconnect was found between the deadliest risks and their media coverage. Media coverage fluctuations correlated with death rate changes, yet only 1.7–2.8% of the coverage was explained by these rates. Chronic illnesses were described neutrally as individual challenges, while sensational risks were depicted negatively as collective problems. These results illustrate how the media depict a skewed view of the risks facing the public, with disproportionate coverage of sensational risks while comparatively ignoring chronic diseases. Consumers may consequently come to a distorted understanding of the most threatening risks they face and how to combat them.

Review: Cost Effectiveness Analysis And Its Implementation Regarding Hypertension Treatment

Healthcare financing involves the management of various efforts to mobilize, allocate, and spend health funds to ensure the implementation of health development aimed at achieving the highest possible level of public health. Hypertension, a non-communicable disease (NCD) continues to evolve and poses a serious public health issue and leads to an increasing health financing burden. Health Social Security Agency (BPJS) indicated direct medical costs of hypertension IDR 3 trillion in 2017 and 2018. The variety of first-line antihypertensive combinations due to the numerous recommended first-line antihypertensive combinations in various guidelines highlights the importance of pharmacoeconomic studies to determine the most cost-effective combination. This review article aims to further discuss the implementation of the CEA method as a basis for treatment selection or decision-making regarding hypertension treatment. The nifedipine 60 mg and candesartan 32 mg combination is deemed the best, achieving a blood pressure reduction of 23,8/16,5 mmHg (p<0,01) compared to placebo and monotherapy reductions of 5,3/6,7 mmHg. Additionally, the nifedipine GITS - candesartan combination reduces vasodilator side effects incidence to 18,3% compared to 23,6% for nifedipine monotherapy, including a lower incidence of headaches (5,5% vs. 11%).

The Pandemic Era of COVID-19: Reflection on The Regional Government Budget Sustainability for The Optimism of National Economic Recovery

During the COVID-19 pandemic, many local governments experienced economic disruption as businesses closed or scaled back operations, unemployment rose, and government revenues decreased. This led to budget challenges for local governments as they worked to address the needs of their communities and support economic recovery efforts. Therefore, local governments should prioritize funding for healthcare, social services, economic recovery initiatives, and infrastructure projects in their budgets during the COVID-19 pandemic in order to support the national economy recovery and address the needs of their communities. The government decided that the village funds budget could be used for a wide range of things, such as giving money directly to the village's poor and working to combat the COVID-19 pandemic. The purpose of this study is to determine the extent to which local governments' budget structures prioritized managing the COVID-19 pandemic in the region to deal with consequences in the form of threats to the national economic system and financial system stability, with a particular emphasis on health spending, social safety nets, and economic recovery. The technique used qualitative research conducted through a document look at (desk studies). The data is sourced from secondary information in developmen t plans files, central government budgets, local government budgets, and amendments. The data was obtained through direct access to government websites, particularly the COVID-19 task force website, the Ministry of Finance website and the Ministry of Home Affairs website. The findings indicate that the COVID-19 pandemic in Indonesia has significantly impacted the country's economy and socio-economic situation since the second quarter of 2021. People's purchasing power is going down, unemployment is going up, and poverty will worsen. These are all current and future government problems. The implications and recommendations of the findings of this study are explained further.

Health taxes: missed opportunities for health and health-care financing

Health taxes: missed opportunities for health and health-care financing

From affordable to accessible: How the pharmaceutical industry transformed patient consumers into charity recipients

Recent changes in healthcare pricing and financing have resulted in patients paying more out of pocket for their healthcare. As a result, more patients with insurance are being priced out of essential or desired medications. Pharmaceutical companies have responded by offering financial assistance programs for patients. Medical sociologists have productively used the concept of consumerism to describe the effects of markets on the provision of healthcare. But in this current context where financial assistance programs are increasingly important for patients seeking prescription drugs, what are the implications for medical sociological theories of patient consumerism? I use medical and economic sociology theories to analyze pharmaceutical executive testimonies in 34 federal US Congressional hearing transcripts prices from 1959 to 2020. Congressional testimony offers an ideal window into how these executives justify their prices and describe the implications for patients downstream in the healthcare system. I find that executives initially justified prices as fair and drugs as cost-effective because medications were an affordable form of healthcare. However, as drug prices rose, executives abandoned affordability arguments and instead argued drugs were accessible to patients though pharmaceutical company run financial assistance programs. Findings contribute to medical sociology by theorizing a system of corporate charity as the next phase of the capitalist US healthcare system and demonstrates how elite market actors (re)define downstream categories of consumers.

Evaluating the implementation of the National Primary Health Care Development Agency (NPHCDA) gateway for the Basic Healthcare Provision Fund (BHCPF) across six Northern states in Nigeria

BackgroundThis evaluation research utilized both qualitative and quantitative methods to assess the implementation of the National Primary Health Care Development Agency (NPHCDA) gateway of the Basic Health Care Provision Fund (BHCPF) across six states in Northern Nigeria: Bauchi, Borno, Kaduna, Kano, Sokoto, and Yobe.MethodsThis was a mixed-method research that utilized longitudinal surveys and Key informant interviews to gather information about the implementation status of the BHCPF-NPHCDA gateway. Checklists were developed based on the BHCPF’s national guidelines to gather quantitative data, while simple open-ended questionnaires were used to collect qualitative data from the state BHCPF Program Implementation Unit (PIU) focal persons as key informants.ResultsThe result revealed that the NPHCDA had accredited these six states to use one Primary Health Care (PHC) facility in each political ward to implement the BHCPF. Factors that contributed to the success achieved in some states included the early completion of contingent start-up activities, well-established coordination structures, strong support from partners, and the availability of established financial management systems. However, the delays in the submission of quarterly business plans by the BHCPF facilities affected timely approval and fund disbursement. Other challenges included staff capacity gaps, inadequate human resources, and poor management and supervision from the state health agency teams.ConclusionThere was suboptimal implementation of the BHCPF in at least one thematic area across all states. Therefore, actions such as government commitment for improved coordination, continuous capacity building, effective monitoring and evaluation, and targeted supportive supervision using innovative approaches should be undertaken to improve the program’s implementation. In a broader setting, the insights from BHCPF implementation are valuable for LMICs, offering guidance on overcoming implementation challenges associated with PHC financing. This research provides a resource for enhancing healthcare financing strategies in similar contexts.

Approaches, enablers and barriers to govern the private sector in health in low- and middle-income countries: a scoping review

IntroductionThe private sector plays a substantial role in delivering and financing healthcare in low- and middle-income countries (LMICs). Supporting governments to govern the private sector effectively, and so improve outcomes...

Use of Prenatal Exome Sequencing: Opinion Statement of the French Federation of Human Genetics Working Group.

Prenatal whole exome sequencing (pES) is increasingly prescribed for fetuses with ultrasound anomalies. Starting from the local French prenatal medicine practice, healthcare system and legal landscape, we aimed to address the broad medical and ethical issues raised by the use of pES for women and couples as well as for prenatal care providers. The French Federation of Human Genetics established a working group composed of clinicians and biologists from all over France to discuss pES challenges. A literature review was also performed. We emphasize the importance of non-directive information that helps couples make a decision that is consistent with their personal values and ideas. We address the difficulty of obtaining informed consent that respects the couple's autonomy, despite the complexity of the information and regardless of their level of education and cultural background. We address whether variants of uncertain significance and unsolicited results should be reported. We emphasize the need for national harmonization of access to pES and the need for multidisciplinary meetings in complex situations. We point out that the specific French context of healthcare financing and the French law have a major influence on medical care organization and support for couples. The outcome of the working group is the development of 12 proposals. This opinion statement, dedicated to prenatal care providers worldwide although linked to the French context, will provide food for thought and assist them in understanding the complexity and implications of pES.

Willingness to Pay for Community-based Health Insurance: A Systematic Review and Analysis of Factors Influencing Participation and Implications for Healthcare Financing

Willingness to pay (WTP) for community-based health insurance (CBHI) is a crucial factor in understanding individuals’ attitudes and behaviours towards participating in insurance schemes. This article aims to examine the concept of WTP for CBHI and its implications for healthcare financing and accessibility. The research gives an organized and retrospective view of the antecedents, decisions and outcomes (ADO) of CBHI using a systematic review. The article also provides an overview of the theories, contexts and methods (TCM) employed to gain this understanding. The analysis concludes by identifying existing knowledge gaps and suggesting relevant ideas for future WTP and CBHI research. This article contributes to the existing body of knowledge on WTP for CBHI and provides insights for policymakers and researchers seeking to enhance the sustainability and effectiveness of CBHI programmes.

Simplifying acquisition of essential diagnostics: A comprehensive costing tool for anatomic pathology.

Histopathology is the core diagnostic tool for cancer in pathology laboratories around the world, but there are disparities in access to diagnostics globally. As recognition of the need for cancer care and treatment grows, especially in the wake of World Health Organization programs for cervical, breast, and pediatric cancers, policymakers and health care funders are seeking tools and processes that allow for the largest number of patients to receive a diagnosis at the lowest cost. As histopathology represents the most cost-effective diagnostic method by sheer number of tumor types and volume, understanding the detailed logistics and costs for histology as well as the impactful benefits of economies of scale (ie, larger volumes are less expensive per patient) and scope (ie, the multiple stains available after basic histology sectioning) is paramount to planning an effective publicly funded or government laboratory. Understanding the economic structure of a country's population along with the financial model of a histology laboratory also leads to a market understanding of private laboratories, which can provide services at a profit as well as pro bono services more cost-effectively than purely public laboratories. We have developed a comprehensive, scalable costing tool of a functioning histology laboratory that accounts for all feasible costs and variations in models of service. The tool allows for a standardized approach to selecting goods needed to provide histology services and serves as a guide for implementation of pathology services. Using the tool, laboratories can achieve self-sustainment and long-term financial health while incorporating a proportion of impoverished patients who cannot afford out-of-pocket expenses.

The role of big data in transforming financial management in U.S. healthcare: A conceptual framework

This paper explores the transformative role of big data in financial management within the U.S. healthcare sector, highlighting its capacity to address long-standing financial inefficiencies, enhance decision-making, and improve regulatory compliance. Big data technologies, such as predictive analytics and real-time financial reporting, provide healthcare institutions with the tools to forecast financial trends, optimize budgeting, and mitigate risks. Despite the significant benefits, the adoption of big data in healthcare finance faces challenges, including data privacy concerns, regulatory complexities, and technological limitations. The paper examines these barriers and enablers, offering strategic recommendations for healthcare institutions and policymakers to optimize the use of big data. By improving data governance, upgrading infrastructure, and fostering collaboration across departments, healthcare organizations can maximize the impact of big data on their financial operations. The review concludes with a call for continued policy support and financial incentives to encourage the broader adoption of big data in healthcare finance, ultimately promoting cost efficiency and operational resilience in the sector. Keywords: Big Data, Healthcare Financial Management, Predictive Analytics, Data Governance, Regulatory Compliance, Financial Decision-Making.

From strategic autonomy to strategic partnership: EU–India relations in health diplomacy

AbstractThe study examines the potential of the European Union (EU)–India cooperation in health diplomacy and the exchange of lessons learned by both actors. Particularly, the growing discourse on achieving strategic autonomy in health has not been adequately analysed in the existing literature, which is surprising given that both actors share this interest. This paper begins by contextualising the discourse of strategic autonomy in the European and Indian political discourse with a specific focus on achieving autonomy in health and subsequently argues for a transition from strategic autonomy to a strategic partnership by recognising the strategic interdependencies. A qualitative content analysis was used to analyse all 16 EU–India summits to locate health diplomacy in their relations and present recommendations for future cooperation. The shift from strategic autonomy to strategic partnership also necessitates a strategic vision towards shaping the EU–India cooperation. With the upcoming EU–India Summit in 2025, research and development, strengthening supply chains, harmonisation of regulations, and financing of healthcare are key areas that can be deliberated on to enhance the cooperation between the two global actors in healthcare.

Learning From Ervin's Care: Ethics, Health Care Finance, and Human Connection.

A 70-year-old man with complex multimorbidity and intellectual disability was my patient for the last 5 years of his life. He taught me important lessons about the challenges of practicing medicine as a primary care physician. He embodied all the complexities of multimorbidity, the ways in which clinical decision making can be fraught with uncertainties and tradeoffs. He raised difficult ethical questions for his care team, questions about how to respect the dignity of patients who lack decisional capacity and who do not have surrogate decision makers. The gaps in his care revealed shortcomings of the US health care system, but his care in his final years also showed some of the bright spots in coordinated, team-based care. Most importantly, caring for this patient taught me about the rewards of the human connections that primary care physicians establish with their patients.

Pain control post total knee replacement in patients given local infiltrative analgesia combined with adductor canal block compared to either modality alone: a systematic review and meta-analysis

ObjectivesOptimising postoperative pain following knee replacement is important for patients, healthcare professionals and healthcare funders. Adductor canal blocks (ACB) are widely used but there is uncertainty about their efficacy when...

The in-patient substituting technologies in maxillofacial surgery: characteristics of organization and ways of further development

The social economic crisis and international sanctions significantly affected health care system that requires implementation of new organizational approaches with medical, social and economic benefits. Currently, up to 80% of budgetary funds for health care are spent on in-patient care, although 20-50% of patients could be effectively treated in less expensive short-stay hospitals. The purpose of the study is to assess efficiency of specialized care in maxillofacial surgery in conditions of short-stay hospitals. In maxillofacial surgery, implementation of in-patient substitution technologies is justified that ensure availability of minimally invasive surgeries and reduction of treatment time. The analysis of data of 2,022 patients hospitalized in the Maxillofacial Hospital for War Veterans of the Moscow Health Department from January 1 to December 31 2023 demonstrated that 1,518 patients (65.37%) were treated in the 24-hour in-patient department and 504 patients (34.63%) in the short-stay in-patient department. Among them, 738 males (36.3%) and 1,284 females (63.7%), average age of patients was 42.5 ± 17.82 years. In the 24-hour in-patient department, females accounted for 62.85% and males 37.15%. In short-stay in-patient department, females accounted for 65.48%, males for 34.52%. The average stay in 24-hour hospital was 5.6 bed days and in short-stay hospital - 6-8 hours. The economic efficiency of short-stay hospitals was demonstrated in significant savings of medications and services. The level of patient satisfaction is higher in short-stay hospital (8.4 points versus 8.1 points in 24-hour hospital). The development of short-stay hospitals in maxillofacial surgery contributes into improving of quality and accessibility of medical care, modernizing medical infrastructure and optimizing budget expenditures.

Respiratory Diagnoses Year-Round: Unraveling the Multifaceted Pediatric Infection Cycles.

The aim of the study is to analyze the annual cycle of pediatric medically attended respiratory illnesses. Data on 141 million pediatric respiratory visits from the years 2010-2019 were obtained from the Polish National Healthcare Fund. To identify underlying patterns and trends within the aggregated data, techniques like seasonal-trend decomposition using LOESS (STL) and principal component analysis (PCA) were applied. A strongly recurring pattern was observed. Following the annual minimum in late summer, there was a sudden surge in upper respiratory infections in early September. Subsequently, overall visits declined gradually, while the share of lower respiratory infections increased, particularly during the influenza peaks from January to March. Afterwards, visits declined steadily, with an additional peak of tonsillopharyngitis noted in midsummer. Dimensionality reduction of diagnoses implied the existence of two major groups of co-occurring diagnoses, the proportions of which change over the year: one smaller but more severe, peaking during the influenza season, and the second dominating with lower severity. Age differences in diagnoses were observed, with babies showing upper respiratory infections likely diagnosed with the common cold rather than a more specific upper respiratory infection. While enhancing surveillance strategies is indeed a desirable long-term goal, it is worth noting that despite the variability observed in the onset of the influenza season, the infection cycles generally follow a relatively fixed pattern. This consistency provides a foundation for effective planning and underscores the potential for proactive measures to mitigate the impact of seasonal outbreaks.