Investment In Health Care Research Articles

Old-Age Inequality with Longevity Extension from Preventive Healthcare

We analyze whether endogenizing preventive healthcare investment in the lifetime portfolio affects the utility inequality of the elderly. To assess inequality, we exploited the coefficient of variation of the value function for the representative agent. Comparing the inequality of two simple cases with or without a choice of preventive cost reveals how the optimal choice of healthcare prevention affects inequality. The longevity extension from optimal prevention increases both inter- and intra-country welfare inequality among the elderly, mainly due to the adjusted pricing of financial assets. Calibrated results show that prevention endogenization increases the coefficient of variations by 6.9% for 24 OECD countries and by 3.9% for the elderly in the US.

Health production: analysis of doctors’ health actions in the More Doctors program

OBJECTIVE Analyze the health actions carried out by the Cuban cooperated physicians and their relationship with socioeconomic characteristics of the municipalities, contained in the first supervision visit report, in 2015. METHODS This is a quantitative research that used secondary data from the reports of the 1st supervision visit of the "More Doctors Program". The dependent variables were the health actions, and the independent variables were the type of municipality, Human Development Index (HDI), Investment in Primary Health Care (PHC), health center coverage, rural population, and total population. Multiple correspondence analysis was used to identify the latent variable, related to the profile of the professional with respect to the actions/procedures carried out to which the characteristics of the municipalities were associated through frequency analysis. RESULTS Three profiles of professionals were obtained, who have their practices associated with the professional training, consolidating as a determining factor for carrying out actions compatible with the actual needs of the population. Such findings were associated with the socioeconomic variables, with emphasis on funding, health center infrastructure, and coverage. CONCLUSIONS From the observed results, we suggest strategies to expand the scope of the practices carried out in Primary Health Care, from the perspective of training and continuing education of health professionals, and the focus on the everyday life of the service being of paramount importance.

“Too soon?, too soon?” or the dilemma of reopening centralist countries in the times of COVID-19

Conforme pasa el tiempo, cada país debe enfrentar lo desconocido en cuanto al equilibrio entre las medidas de distancia social y la reapertura de la economía de manera segura. Algunos países son ventanas al futuro, pero las experiencias de nuestros vecinos son las más adecuadas para anticipar algunos aspectos de nuestra realidad en unas pocas semanas. Algunas áreas más afectadas en los Estados Unidos, donde las disparidades sociales explican la enorme brecha interracial de mortalidad por COVID-19, son claros ejemplos de cómo la desigualdad puede dividir las trayectorias de diferentes grupos de población en un mismo país. Además, las horripilantes imágenes de Guayas (Ecuador), Manaos (Brasil) o Loreto (Perú) mostraron al mundo las consecuencias de años de bajas inversiones en salud cuando una pandemia golpea las áreas más vulnerables.

Healthcare and Welfare Policy Efficiency in 34 Developing Countries in Asia.

The healthcare and welfare policies of nations, as well as the amount of investments put into these areas, vary across countries. Investments in healthcare and welfare have been increasing worldwide which brings the question of assessing the efficiency of these investments. There are, however, difficulties in evaluating the effectiveness of such investments due to differences in countries’ economic development levels and due to the differences in data definition issues. There are only a limited number of studies in the literature that employ consistent and comparable indicators across countries. This study evaluates the healthcare investment efficiency and health competitiveness efficiency of 34 developing countries in Asia using a two-stage dynamic data envelopment analysis approach. Furthermore, we employ a broader measure of indicators on national healthcare and welfare policies and outcomes, in addition to the investment data on healthcare and welfare expenditures. Our findings indicate that the establishment of an investment environment with a consolidated approach and management is an important factor that increases the efficiency of investments in healthcare and welfare sectors. A consistent delivery of the national policy strategy is also crucial for reaching the medium-and long-term targets for each country. For example, if a country establishes healthcare and welfare policies that focus on improving its indicators with low efficiencies, the output will be improved and a better return on investment will be ensured in a long-term perspective.

Innovation Lessons From the COVID-19 Pandemic

On December 31, 2019, Chinese authorities reported the first case of what would become known as coronavirus disease 2019 (COVID-19) to the World Health Organization, which declared a Public Health Emergency of International Concern 1 month later.1 At the time of this publication, the virus has spread to all 6 World Health Organization regions, infecting several million people and killing more than 280,000 worldwide, with numbers that continue to grow.2 To stem pandemic-related deaths and prevent health care systems from being overwhelmed with sick patients, governments responded by limiting travel, closing schools, issuing stay-at-home orders, making emergency investments in health care, scaling testing, and using data and technology to trace contacts.

The Growth Of Private Equity Investment In Health Care: Perspectives From Ophthalmology.

The growth of private equity investment in health care has dramatically changed the landscape of health care delivery over the past decade. Private equity firms are rapidly acquiring physician practices, with ophthalmology practices being one of the most frequently acquired types. We present perspectives from thirty-five semistructured interviews conducted with a wide range of knowledgeable people on private equity investment in physician practices, with a specific focus on ophthalmology. Acquisition by a private equity firm can be an attractive option for physicians, particularly older ones. However, interviewees had starkly conflicting perspectives on the likely impact of private equity acquisitions on the cost, quality, and use of medical care.

Why were the UK and USA unprepared for the COVID-19 pandemic? The systemic weaknesses of neoliberalism: a comparison between the UK, USA, Germany, and South Korea

Pandemics historically have killed as many people as the wars that have beset this world, yet the resources committed to pandemic prevention and response are a fraction of the resources we commit to security. This paper examines the COVID-19 pandemic of 2020 by analysing the preparedness and responses of the UK, the USA, Germany, and South Korea. We will evidence that the UK and USA lacked the levels of preparedness that global health reports indicated, and that their responses were diametrically opposite of those of Germany and South Korea. We argue that decades of deregulation and privatization due to neoliberal, free-market economics by the UK and USA led to the Great Recession of 2008. This, in turn, led to economic collapse and austerity (increased neoliberalism), which negatively impacted investment in healthcare in the UK and USA. This resulted in very different levels of preparedness and responses by the four countries under the microscope.

Macroeconomic Development and Dramatic Increase in Stroke Burden in Rural China: A 25-Year Population-Based Study.

Low socioeconomic status is associated with a high stroke risk. However, few studies have quantitatively assessed the relationship between stroke burden and national economic development indicators. We explored the quantitative association between macroeconomic development and stroke burden in rural China. In this population-based, prospective study (1992–2016), we collected data on annual registrations of stroke events and deaths in Tianjin, China. Economic development over the period was represented by gross domestic product annually adjusted for purchasing power parity (PPP-aGDP) and per capita net income (PCNI) of rural residents in China. We assessed the association of first-ever stroke incidence with PPP-aGDP and PCNI. During the 25-year study period, there were 1,185 stroke events and 362,296 person years of surveillance. First-ever stroke incidence increased by an average of 10.7% per 1,000 USD increase in overall PPP-aGDP and by 12.0% per 1,000 Yuan increase in PCNI; respectively, the mean increases were 9.6 and 10.8% in men and 13.0 and 14.4% in women (all, P < 0.001). These same changes in PPP-aGDP and PCNI also resulted in increases in the incidence of ischemic stroke (12.6 and 14.3%, respectively; P < 0.05), and intracerebral hemorrhage (both, 6.2%; P < 0.05). Similarly, in men, the age of onset of intracerebral hemorrhage decreased by 0.96-years (P = 0.002) for each 1,000 USD increase in PPP-aGDP and by 1.08-years (P = 0.003) for each 1,000 Yuan increase in PCNI. Macroeconomic development was positively associated with stroke incidence in rural China. Thus, enhancing health-care investments is crucial for containing the stroke burden during this remarkable economic development in China. Our findings could guide other developing countries with information regarding the timely control of stroke risk factors and reductions in stroke burden during the initial stages of economic development.

The burden of disease in Saudi Arabia 1990–2017: results from the Global Burden of Disease Study 2017

SummaryBackgroundAvailability of data to assess the population health and provision and quality of health care in Saudi Arabia has been lacking. In 2010, Saudi Arabia began a major investment and transformation programme in the health-care sector. Here we assess the impact of this investment era on mortality, health loss, risk factors, and health-care services in the country.MethodsWe used results of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to describe the levels and temporal patterns in deaths, health loss, risk factors, and health-care access and quality in the Saudi Arabian population during 1990–2010 (before the health-care investments and reform) and 2010–17 (during health-care investments and reform). We also compared patterns in health outcomes between these periods with those in the north Africa and the Middle East GBD region and the Gulf Cooperation Council countries.FindingsAge-standardised mortality in Saudi Arabia decreased from 1990 to 2010 (annualised rate of change of −0·58%), and this decrease was further accelerated from 2010 to 2017 (–2·20%). The north Africa and the Middle East GBD region also had decreases in mortality during these periods, but for 2010–17 the decrease was not as low as in Saudi Arabia (–1·29%). Transport injuries decreased from third ranked cause of disability-adjusted life-years in 2010 to fifth ranked cause in 2017 in Saudi Arabia, below cardiovascular diseases (ranked first) and musculoskeletal disorders (ranked second). Years lived with disability (YLDs) due to mental disorders, substance use disorders, neoplasms, and neurological disorders consistently increased over the periods 1990–2010 and 2010–17. Between 1990 and 2017, attributable YLDs due to metabolic, behavioural, and environmental or occupational risk factors remained almost unchanged in Saudi Arabia, with high body-mass index, high fasting plasma glucose concentration, and drug use increasing across all age groups. Health-care Access and Quality (HAQ) Index levels increased in Saudi Arabia during this period with similar patterns to the rest of the Gulf Cooperation Council countries and the north Africa and the Middle East GBD region.InterpretationDecreases in mortality continued at greater rates in Saudi Arabia during the period of 2010–17 than in 1990–2010. HAQ Index levels have also improved. Public health policy makers in Saudi Arabia need to increase efforts to address preventable risk factors that are major contributors to the burden of ill health and disability.FundingBill & Melinda Gates Foundation.

Accountable care organizations are increasingly led by physician groups rather than hospital systems.

Because hospitals and health systems sponsored the majority of new accountable care organizations (ACOs) from 2010 to 2015, they influenced priorities and strategies of the policies designed to drive ACO adoption. In recent years, however, the majority of new ACOs have been sponsored by physician groups. This shift means that policies need to be developed with the characteristic strengths and weaknesses of physician-led ACOs in mind. Using data from the Leavitt Partners ACO database, we analyzed the types of providers becoming ACOs over time to look at their numbers and market potential. Because the market potential for further growth of physician group-led ACOs is much stronger than for hospital- or health system-led ACOs, policy makers need to create programs and policies that facilitate physician-led ACOs' success by helping them develop the capacity to take on risk, finance investments in high-value healthcare, and partner with other organizations to provide the full spectrum of care.

Overutilization of Endoscopic Surveillance in Barrett's Esophagus: The Perils of Too Much of a Good Thing.

A cost-utility analysis in the current issue of AJG examines the ramifications of the overuse of surveillance endoscopy in Barrett's esophagus (BE). This study suggests that excess surveillance is expensive, increasing costs by 50% or more, with only nominal increases in quality-adjusted life expectancy. This study joins a growing literature of cost-utility analyses that suggest that more is not likely better when it comes to surveillance endoscopy. Given the plentiful literature showing overutilization of surveillance endoscopy in BE, the authors argue for a focus on the quality of endoscopy rather than increased frequency of surveillance to improve returns on our healthcare investment.

Dependence of Demographic Indicators upon Government Expenditure on Health: A Study of the Indian States

Investment in health care is becoming more and more significant day by day because of an economicenvironment where resources are extremely scarce. As a result, there is a growing interest among economistsin applying the economic skills to the health issue. As government health services are primarily meant forcatering to the needs of the under served population, it will continue to play a significant role as a serviceprovider. Hence, there is an urgent need to understand how demographic indicators vary in response tothe changes in government health care expenditure or alternatively what effect does public health careexpenditure have upon the demographic indicators (measured in terms of health outcomes).

Association of the Meaningful Use Electronic Health Record Incentive Program With Health Information Technology Venture Capital Funding

Although the Health Information Technology for Economic and Clinical Health (HITECH) Act has accelerated electronic health record (EHR) adoption since its passage, clinician satisfaction with EHRs remains low, and the association of HITECH with health care information technology (IT) entrepreneurship has remained largely unstudied. To determine whether the passage of the HITECH Act was associated with an increase in key measures of health care IT entrepreneurship. This economic evaluation of venture capital (VC) activity in the US from 2000 to 2019 examined funding trends in health care IT, EHR-related companies, and all VC investments before and after the passage of HITECH. A difference-in-differences analysis compared investments in health care IT companies with those of companies in 3 categories: general health care (non-IT), IT (non-health care), and all US VC transactions. Data were analyzed from September 2018 to August 2019. Venture capital funding received by US companies before and after the HITECH Act. Venture capital investment in health care IT companies and the proportion of those investments going to seed-stage companies, a proxy for very early-stage entrepreneurship and innovation. The data included 70 982 investments, of which 9425 (13.3%) were seed stage, 10 706 (15.1%) were early stage, and 50 851 (71.6%) were growth stage. After passage of the HITECH Act, investment in both health care IT companies and EHR-related companies increased at a rate much faster (13.0% and 11.4%, respectively) than VC as a whole (6.9%). In addition, the proportion of investments going to seed-stage health care IT companies increased compared with both overall VC investments and non-IT health care investments. Health care IT companies saw increased probabilities of transactions being seed-stage of 5.1% (SE, 2.2%; 95% CI, 0.8% to 9.3%; P = .02) compared with the entire sample of VC transactions and 13.6% (SE, 1.9%; 95% CI, 9.9% to 17.2%; P < .001) compared with non-IT health care VC transactions. Health care IT had essentially 0 increased probability of a transaction being seed stage compared with IT companies outside health care (-0.8% probability; SE, 2.4%; 95% CI, -5.4% to 3.9%; P = .75). Although widespread clinician dissatisfaction with EHR systems remains a challenge, the HITECH Act's incentive program may have catalyzed early-stage entrepreneurship in health care IT, suggesting an important role for incentives in promoting innovation.

Area-specific economic status should be regarded as a vital factor affecting the occurrence, development and outcome of cervical cancer

For patients with cervical cancer, despite the incidence and mortality rates have been declining in recent years, due to its huge population base, cervical cancer has always been a serious public health problem. Our research placed emphasis on the indices greatly associated with overall area-specific social economic status, making up for the defects of traditional research which only pay attention to the situation of some specific disease or patients’ individual social status. A total of 39160 women identified cervical cancer were concluded in our study from the Surveillance, Epidemiology, and End Results (SEER) 18 Program data between 1980 and 2014. With improving the area-specific social economic factors in recent years, the occurrence and prognosis of cervical cancer showed different variation patterns respectively. Some states like California and Georgia for their better economic status and more healthcare investment by local medical institution, population there showed a lower prevalence, incidence, more timely diagnosis, effective treatment, and better prognosis. According to our study, we aimed to give a scientific interpretation on how the area-specific social economic factors affect the disease situation at the macro level and help local medical institution make advisable decisions for controlling cervical cancer.

Does Private Equity Investment in Healthcare Benefit Patients? Evidence from Nursing Homes

The past two decades have seen a dramatic increase in private equity investment in healthcare, a sector in which intensive government subsidy and market frictions could lead high-powered for-profit incentives to be misaligned with the social goals of quality care at a reasonable cost. This paper studies the effects of private equity ownership on patient welfare and spending at nursing homes. With administrative patient-level data, we use a within-facility instrumental variables strategy to address both non-random targeting of facilities and non-random matching of patients into nursing homes. The estimates show that private equity ownership increases short-term mortality by 10%, which implies about 21,000 lives lost due to private equity ownership over our sample period. Private equity ownership also increases spending by 19%, the vast majority of which is billed to taxpayers. We observe several channels that help explain the increase in mortality: declines in patient-level health measures, such as worsening mobility and elevated use of anti-psychotic medications; declines in nurse availability per patient; and declines in compliance with federal and state standards of care.

More Doctors Program: health work process and socioeconomic indicators.

To analyze the working process of the professionals of the More Doctors Program and its relationship with socioeconomic indicators. It is a quantitative study, in which secondary data from supervision reports of PMM were used. The dependent variable was the quality of work processes in Primary Care facilities, and the independent ones were the type of municipality, education, Gini index, Primary Health Care investments, and health facilities coverage. Data were analyzed with multiple modeling based on Poisson regression with robust variance. 16,000 doctors within 3816 municipalities were analyzed. Variables related to the working process the remained significant in the final model were the investments in Primary Health Care and the health facilities coverage. The results expressed the equity principle, as those municipalities with more vulnerable conditions and with higher coverage are prone to perform more activities in their working process. The implementation of the More Doctors Program and hence the provision of doctors in deprived regions promoted the consolidation of three main aspects, namely the health working process, primary health care and equity, making it possible to carry out a health working process focused on PHC. This implies performing a greater number of activities that are inherent to PHC, which were not carried out due to the absence of doctors. The More Doctors Program fulfills its role in the combat of inequalities, particularly regarding more vulnerable municipalities.

Factors Associated with the Detection of Childhood and Adolescent Cancer in Primary Health Care: A Prospective Cross-Sectional Study.

BackgroundThe treatment of childhood cancer has achieved important advances evidencing a significant increase in overall survival; however, the diagnosis of these cases still seems late. Among the main causes for the delay in diagnosis are the issues related to the health system and the first professional who performs the care. The objective of this study is to evaluate the knowledge of primary care physicians and nurses about the most common signs and symptoms of pediatric cancers, as well as the factors related to the obtained scores.MethodsThis is a prospective cross-sectional study, developed in municipalities in the northeastern region of Brazil. Fifty-one professionals (physicians and nurses) were interviewed through a questionnaire structured as a quiz game about knowledge, training and attitudes regarding the signs and symptoms of childhood cancer. Multiple linear regression analysis was used to evaluate the effect of professional characteristics on the number of correct answers on the implemented questionnaire on knowledge of childhood and adolescent cancer.ResultsIn the bivariate analysis, the results indicated that the type of employment relationship influences the number of correct answers in the questionnaire used. However, when adjusted for covariates, only the professional category, which means being a medical professional, showed a significant effect on the number of correct answers (β=−7.50, p=0.001).ConclusionThe type of employment relationship of medical professionals and nurses working in primary care had an influence on the number of correct answers for knowledge of childhood and adolescent cancer, but only the professional category (physician) was associated with the highest number when controlled by covariables, thereby justifying the need to improve the curricular training of nurses and greater investments in primary health care for continuing health education that includes infant and adolescent oncology.

Dengue Surveillance System in Brazil: A Qualitative Study in the Federal District.

Dengue’s increasing trends raise concerns over global health and pose a challenge to the Brazilian health system, highlighting the necessity of a strong surveillance system to reduce morbidity, mortality, and the economic burden of this disease. Although the Brazilian surveillance system reports more dengue cases than any other country, recent studies suggest that non-reported cases are the majority. The aim of the study is to explore the strengths and weaknesses of the Brazilian surveillance system, particularly looking at the functioning of data collection and reporting. This was done through qualitative semi-structured interviews with 17 experts in dengue surveillance, supported by quantitative data from the official notification system. To select the interviewees, purposive and theoretical sampling were used. Data were analyzed through thematic analysis. The research highlighted that a lack of human and technological resources in healthcare units and surveillance departments slows down the notification process and data analysis. Due to a lack of integration in the private sector, the surveillance system fails to detect the socioeconomic profile of the patients. Investments in public healthcare, human and technological resources for surveillance and better integration in the private healthcare system, and vector surveillance may improve dengue surveillance.

PUBLIC ADMINISTRATION AND LEGAL REGULATION EFFECTIVENESS IN THE FIELD OF HEALTH CARE IN THE CONTEXT OF SUSTAINABLE DEVELOPMENT

The purpose of the article is the study of health capital as the basis for the formation of human capital. The authors consider health capital as a new factor in economic growth in modern conditions. It is concluded that there is a high risk of a shortage of health capital due to high mortality, low fertility, and low life expectancy. There is also a shortage of investment in health care. The regional features of the development of the health capital of Ukraine in modern conditions are analyzed. The existence of regional differences in the formation of health capital is proved. The inconsistency of regional and national interests regarding the strategy of state regional policy is revealed. It is concluded that regional priorities should be such as to save and increase the health capital of health. The results of an integrated assessment made it possible to form a ranking of regions by indicators of health capital. The approaches proposed by the authors to ranking the regions make it possible to develop programs of priority measures to implement the strategic goal of healthcare. It is an increase in the quality and accessibility of medical care, drug provision, ensuring the sanitary and epidemiological safety of the country, and the prevention of infectious diseases among the population.

Macroeconomic Development and Dramatic Increase in Stroke Burden in Rural China: A 25-Year Population-Based Study

Background: To explore the quantitative association between macroeconomic development and stroke burden in rural China. Methods: In this population-based, prospective study (1992–2016), gross domestic product annually adjusted for purchasing power parity (PPP-aGDP) and per capita net income (PCNI) in rural China were collected to assess the association with first-ever stroke incidence over 25-year prospective study. Findings: During the 25-year study period, there were 1185 stroke events and 362,296 person-years of surveillance. First-ever stroke incidence increased by an average of 10·7% per 1000 USD increase in overall PPP-aGDP and by 12·0% per 1000 Yuan increase in PCNI; respectively. These same changes in PPP-aGDP and PCNI also resulted in increases in the first-ever stroke incidences across sex and stroke types. Similarly, in men, the age of onset of intracerebral hemorrhage decreased by 0·96 years for each 1000 USD increase in PPP-aGDP and by 1·08 years for each 1000 Yuan increase in PCNI. Interpretation: These findings suggested that enhancing health-care investments is crucial for containing the stroke burden during this remarkable economic development in China. Our findings imply the guiding function for other developing countries on the timely control of stroke risk factors and reductions in stroke burden during the initial stages of economic development. Funding Statement: The authors stated: None. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The study protocol was approved by the ethics committee of Tianjin Medical University General Hospital (TMUGH), and written informed consent was obtained from each participant.