Health Expenditure Research Articles

A comprehensive analysis of the impact of greenhouse gases, energy usage, institutional quality and globalization on health: A case study of selected developing nations

AbstractThis study inspects the health consequences of greenhouse gases, energy use, institutional quality and globalization for the 23 developing economies. Utilizing panel data from 2000 to 2022, various estimation techniques, including static models (pooled, fixed and random), the two‐step systemGeneralized Methods of Moments (GMM and Panel Auto Regressive Distributive Model (PARDL), are applied to investigate the short‐ and long‐term effects of greenhouse gases, energy use, institutional quality and globalization on health. Panel causality tests, Fully Modified Ordinary Least Squares (FMOLS) and Dynamic Ordinary Least Squares (DOLS) are employed to ensure robustness and causal linkage among variables. The results confirmed a positive association between health and its lag value. Institutional quality negatively influences health expenditure, while greenhouse gases, energy use and globalization exhibit an increasing effect on health expenditure. Life expectancy, institutional quality, energy use and globalization have favourable effects, while greenhouse gases negatively affect health outcomes. In Model 1, energy usage and health expenditures have two‐way causality, and green house gases and energy use in Model 2 have a bi‐directional causal linkage. All variables exhibit unidirectional causality, except globalization and institutional quality, as shown by the Dumitrescu and Hurlin causality test. The study complements the literature by stating that institutional quality is the key instrument for managing the negative consequences of the recent increase in globalization and energy use and their detrimental impact on health in developing economies.

Analysis of readmission and hospitalization expenditures of patients with ischemic stroke suffering from different comorbidities

BackgroundThe comorbidities of ischemic stroke (IS) are increasing worldwide. This study aimed to quantitatively assess the effect of different types of comorbidity on readmission and hospitalization expenditures of patients with IS. MethodsA retrospective observational study was conducted from the basic insurance claims database of a large city in China, between January 1, 2018, and May 31, 2022. We identified patients with IS aged 18 years and over, who experienced the first episode of IS and had one-year follow-up records. This study divided eighteen different comorbid conditions into two categories (concordant comorbidity and discordant comorbidity) and the IS patients were further categorized into four groups. Multivariable logistic regression models and generalized linear models with log-link and gamma distribution were to estimate the effect of different comorbidity groups on one-year readmission rates and annual hospitalization expenditures. ResultsIn total, 99,649 adult patients with IS were identified. Approximately 94.0 % of patients with IS had at least one comorbidity, and 63.8 % reported concordant comorbidity only. Patients with IS had a readmission rate of 26.7 %, and the mean of annual hospitalization expenditure and annual hospitalization out-of-pocket expenditure (OOPE) were 28086.6 Chinese Yuan (CNY) and 8267.3 CNY, respectively. After adjustment for covariates, the concordant comorbidity-only group had the highest readmission rate, annual hospitalization expenditure, and OOPE compared with the other groups, furthermore, these results increased as the number of comorbidity increased and had statistically significant positive associations. ConclusionsThe readmission and annual hospitalization expenditures of patients with IS were associated with different comorbidities. Concordant comorbidity increased hospital readmission risk and health expenditures. To better manage the comorbidities of patients with IS, especially concordant comorbidities, it is necessary to establish a routine care strategy specifically for comorbid conditions.

Does vertical integration increase the costs for primary care inpatients? Evidence from a national pilot programme in China

ObjectiveTo assess the impact of vertical integration (VI) within County-Level Integrated Health Organisations (CIHOs) on the costs of primary care inpatients.MethodsThis study assessed Xishui, a national pilot county for CIHOs, using inpatient claims data. The treatment group comprised 10,118 inpatients from 5 vertically integrated township health centres (THCs), while the control group consisted of 21,165 inpatients from 19 non-vertically integrated THCs. The periods from July 2020 to December 2021 and January 2022 to December 2022 were defined as pre- and post-policy intervention, respectively. The primary outcome variables were total health expenditures (THS), out-of-pocket (OOP) expenditures, and the proportion of OOP expenditures. Propensity score matching was employed to align inpatient demographics and disease characteristics between the groups, followed by a difference-in-differences analysis to evaluate the outcomes.FindingsVI significantly increased THS (β = 0.1337, p < 0.01) and OOP expenditures per case (β = 0.1661, p < 0.001), but the increase in the proportion of OOP expenditures per case was not significant (β = 0.0029, p > 0.05). For the basic medical insurance for urban and rural residents, THS per case (β = 0.1343, p < 0.01) and OOP expenditures (β = 0.1714, p < 0.001) significantly increased. For the basic medical insurance system for employees, THS per case also increased significantly (β = 0.1238, p < 0.01), but the change in OOP expenditure proportion per case was not significant (β = 0.1020, p > 0.05). The THS per case led by Xishui County People’s Hospital, the leading county medical sub-centre (CMSC), significantly increased (β = 0.1753, p < 0.01), whereas the increase led by Xishui County Traditional Chinese Medicine Hospital was not significant (β = 0.0742, p > 0.05). Increases in OOP expenditures per case were significant in CMSCs led by the People’s Hospital and the Traditional Chinese Medicine Hospital (β = 0.1782, p < 0.01 and β = 0.0757, p < 0.05, respectively).ConclusionVI significantly increased THS and OOP expenditures for primary care inpatients. However, VI could exacerbate economic disparities in disease burden across different insurance categories.

Impact of Government-Funded Health Insurance on Out-of-Pocket Expenditure and Quality of Hospital-Based Care in Indian States of Madhya Pradesh and Maharashtra.

With its clear focus on financial protection, government-funded health insurance (GFHI) stands out among the strategies for universal health coverage (UHC) implemented by low-to-middle income countries globally. Since 2018, India has implemented a GFHI programme called the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which covers 500 million individuals. The current study aims to evaluate the performance of GFHI in meeting its key objectives of improving access, quality and financial protection for hospital-based care in two large central Indian states: Madhya Pradesh and Maharashtra. The study measures access in terms of utilisation of inpatient care. Financial protection was measured in terms of catastrophic health expenditure which was defined as the incidence of out-of-pocket expenditure (OOPE) above thresholds of 10% and 25% of annual household expenditure. Patient-satisfaction with care was taken as an indicator of quality. A household survey was conducted in 2023, covering a multi-stage sample of 11,569 and 12,384 individuals in Madhya Pradesh and Maharashtra, respectively. Multi-variate analyses were conducted to find the effect of GFHI-enrolment on the desired outcomes. The instrumental variable method was applied to address potential endogeneity in insurance enrolment. Additionally, propensity score matching was done to ensure robustness. Around 71% and 63% of surveyed individuals were enrolled under GFHI in Madhya Pradesh and Maharashtra, respectively. The hospitalisation rate did not differ much between the GFHI-enrolled and non-enrolled population. The average OOPE on hospitalisation was similar for the GFHI-enrolled and non-enrolled patients. The OOPE and catastrophic health expenditure in private hospitals remained very high, irrespective of GFHI enrolment. The pattern was similar in both states. Multi-variate adjusted models showed that GFHI had no significant effect on utilisation, quality, OOPE and catastrophic health expenditure. The above results were confirmed by propensity score matching. Coverage by GFHI enrolment was ineffective in improving access, quality or financial protection for inpatient hospital care despite 5 years of implementation of the programme. Long-standing supply-side gaps and poor regulation of private providers continue to hamper the effectiveness of GFHI in India.

Exploring The Implementation Challenges Faced By Healthcare Providers In Delivering Services Under Ayushman Bharat -Arogya Karnataka Health Scheme In Bengaluru, Karnataka-A Qualitative Study

Background: Ayushman Bharat-Arogya Karnataka (AB-ArK) is a flagship health insurance scheme of Karnataka started in Oct-2018. The integrated health assurance scheme of Ayushman Bharat-Arogya Karnataka is implemented by the State of Karnataka on an assurance/trust mode through the State Health Agency-Suvarna Arogya Suraksha Trust (SAST). AB-Ark is a Universal Health coverage scheme that provides a comprehensive healthcare to both Below Poverty Line (BPL) and Above Poverty Line (APL) families, covering a wide range of secondary and tertiary healthcare services. This scheme, part of the broader Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), seeks to offer financial protection against catastrophic health expenditures and improve access to quality healthcare services. Learning the experiences and insights from the scheme's implementers can enhance our understanding of how contextual factors impact a program's success. Therefore, it is crucial to examine the different contextual elements that can either support or obstruct the effective execution of a scheme. Objective: To understand the specific obstacles and barriers in effectively implementing the Ayushman Bharat Arogya Karnataka health scheme from a healthcare provider perspective. Methods: The study employed a qualitative approach involving 8 in-depth interviews. Interviews were audio recorded and were transcribed as per the reported verbatim. The transcripts were then analysed in Microsoft excel using thematic analysis for emerging patterns and insights leading to conclusions drawn from the analysis results. Results: Findings were depicted in broad themes and subthemes under individual, community, health system and policy levels. In brief, factors like infrastructure, patient load, awareness, affordability, quality of care and operational challenges were discussed. Conclusion: Study finding revealed various challenges faced by the health care provider, which needs to be addressed for the scheme’s long-term success and sustainability. Continuous monitoring, policy adjustments, and stakeholder engagement are essential to overcoming these hurdles and achieving the scheme's objectives.

The economic cost of direct smoking in South Korea

BackgroundSmoking not only causes negative health outcomes for individuals but also causes an economic burden to society. This study estimated the socioeconomic costs of direct smoking in South Korea in 2020. MethodsWe used the prevalence-based cost-of-illness approach to estimate the sum of the direct (medical, transportation, and caregiving) and indirect (productivity loss due to health service utilization and premature death) costs of 41 smoking-related diseases. We assumed that diseases with death-based hazard ratios greater than 1.0 were related to smoking and used them in cost estimation. ResultsThe socioeconomic cost of direct smoking in Korea was USD 10.9 billion in 2020, accounting for 0.67 % of the gross domestic product and 8.0 % of current health expenditures. The direct cost was USD 4,172 million and the indirect cost was USD 6,753 million. The cost of productivity loss due to premature death took up the largest amount of the total cost, accounting for 52.3 %. The amount attributed to males accounted for 90.4 % of the overall cost, totaling to USD 9,877 million. This is attributable to higher smoking rates and higher medical costs in men. Cancer costs accounted for 40.0 % of the total cost, causing the greatest burden of diseases. ConclusionDirect smoking imposed a harmful and heavy economic burden on South Korea. Our estimate provides the latest evidence on the financial burden of smoking and strengthens the case for strong tobacco control policies and interventions.

Managing the Historic Burden of Kernicterus Mortality in India.

Prevention of neonatal bilirubin injury exemplifies success of systems approach to avert adverse neonatal and childhood outcomes that rely on strategies including prenatal identification of Rhesus sensitization, universal maternal blood typing, risk assessment for neonatal extreme hyperbilirubinemia (EHB), unfettered access to safe, effective phototherapy, and application of patient safety principles. India's diverse landscape suggests varied real-time experiences of neonatal hyperbilirubinemia and consequent infant mortality rates (IMR). Utilizing Global Burden of Disease (GBD) database, the authors examined national and subnational trends, infant mortality timing, and the disease burden from hemolytic and perinatal jaundice over 30 y (1999 to 2019). They also assessed the correlation of EHB-IMR with socio-demographic index and health expenditure per capita, estimating economic losses from EHB-related infant mortality to guide policy decisions at national and state domains. From 1990 to 2019, India delivered 811,078,415 livebirths of which, 1,189,856 infant deaths were due to EHB. EHB-related deaths decreased from 57,773 in 1990 to 19,664 in 2019, a 60% reduction vs. 40% in overall IMR. Early (0-6 d), late (7-27 d), and post-neonatal (28-364 d) deaths accounted for 61%, 34%, and 5% of mortality, respectively. Uttar Pradesh and Bihar contributed to 38% of all EHB deaths. Economic analysis estimate losses between US $7.2 and 11.7 billion for the year 2019 secondary to EHB-related mortality. The present analysis reveals consistent declines across all states to reach current EHB-IMR of 0.8 per 1,000 live-births in India by 2019. Significant economic impact of lost human productivity highlight ongoing need for targeted life-saving public health strategies.

Identifying Influential Variables on Health Expenditure of the Organisation for Economic Co-Operation and Development (OECD) Countries.

Health expenditures of countries have an increasing trend in general and identifying variables affecting health expenditure is an important step toward budget planning for financial sustainability. This study aimed to examine the health expenditure of the Organisation for Economic Co-operation and Development (OECD) countries and identify influential variables. The data for the years 2000-2018 of OECD countries' current health expenditure (% of GDP) and economic, demographic, and health variables, considered to affect the health expenditure, to include in the analysis were extracted using the World Bank database (World Bank 2021). Data analys using Chi-Squared Automatic Interaction Detection (CHAID) decision tree technique. Fifteen variables in economic, demographic, and health categories are selected to build the CHAID decision tree. As a result of CHAID analysis, five variables are identified as influential on current health expenditure, which are gross domestic product per capita, life expectancy at birth, death rate, out-of-pocket expenditure, and fertility rate. Thirty-seven OECD countries are classified into eleven groups by the decision rules in terms of the current health expenditure. The high value of the correlation coefficient between the predicted values and the actual values of health expenditure of countries indicates good prediction performance. Moreover, the regression models built using the identified influential variables as explanatory variables give good forecast accuracy. As an effective tool, the CHAID decision tree technique provides a rule-based model in the form of a tree with nodes and branches, illustrating the splitting process graphically with identified variables and their cut-off points for classification and prediction.

Healthcare-seeking behavior and out-of-pocket payments in Erbil, Kurdistan Region of Iraq

BackgroundUnderstanding healthcare-seeking behavior and examining health expenditures can help determine possible barriers to accessing healthcare and direct more effective and inclusive healthcare systems. This study aimed to evaluate healthcare-seeking behavior and out-of-pocket healthcare expenditure in a sample of the population in Erbil, Iraq.MethodsWe conducted this cross-sectional study in Erbil, Kurdistan Region of Iraq, from October to December 2023. A convenience sample of 414 adults completed a self-administered online survey. The following data were collected: recent illness, sociodemographic characteristics, type of healthcare received, and cost of healthcare.ResultsThe most common health conditions reported were communicable diseases (16.3%), musculoskeletal problems (13.1%), and noncommunicable diseases (12.7%). Approximately 85% of patients with health conditions requiring care sought healthcare; most visited private clinics (46.3%) and private hospitals (18.6%). The median total out-of-pocket healthcare expenditure in US dollars was 117.3 (interquartile range (IQR) = 45.6–410.0). The median total cost was much greater for participants who first visited a private health facility (USD 135.5, IQR = 57.3-405.6) than those who first visited a public facility (USD 76.8, IQR = 16.1-459.7). Participants ≥ 60 years spent significantly more than those < 14 years (USD 332, 95% CI = 211–453, p < 0.001). Evermarried participants spent significantly more than unmarried (USD 97, 95% CI = 1 to 192, p = 0.047). Health expenditures were significantly greater for noncommunicable diseases than infectious diseases (USD 232, 95% CI = 96–368, p = 0.001). After adjusting for covariates, age ≥ 60 years was independently associated with higher spending (USD 305, 95% CI = 153–457, p < 0.001).ConclusionsMost participants sought care from formal health services, preferring the private sector. Seeking care from private facilities incurred significantly higher costs than seeking care from public ones, which suggests potential barriers to accessing healthcare, particularly affordability. The findings underscore the importance of evaluating existing healthcare policies to enhance effectiveness and identify areas for improvement. This study can help policymakers and healthcare providers design effective interventions, allocate resources efficiently, and improve healthcare delivery.

Study on the impact of air pollution on residents' health expenditures in Guangdong, Hong Kong, and Macao Greater Bay Area

The Guangdong, Hong Kong, and Macao Greater Bay Area (GHMA) has experienced economic development and rapid growth of transportation infrastructure in recent years. However, the economic advancement is also accompanied by serious atmospheric pollution, which threatens the health of the residents, thus, it is of great significance to explore the impact of atmospheric pollution on the health expenditures of residents in the GHMA. The article establishes a spatial econometric model to study the impact of atmospheric pollution on residents' health expenditure in the GHMA based on panel data from 2014 to 2021, using nine prefectures in the GHMA as research objects. The results show that: (1) Atmospheric pollution in the GHMA has an obvious spatial agglomeration phenomenon and spatial spillover effect, and the impact of atmospheric pollution on the health of the residents is still very serious; (2) PM2.5 emissions are positively and significantly related to the actual health care cost per person, and the rise in air pollution is the main reason for the rise in public health spending; (3) Other factors also have different impacts on residents' health expenditures. Based on the above research, the article puts forward corresponding policy recommendations.

Assessment of the Indian Public Healthcare Delivery System and Its Comparison with Public Healthcare Delivery of Global Nations Based on Their Gross Domestic Products Potential as Criteria: A Comparative Study

Aim: The aim of this study is to analyze the Indian public healthcare delivery system and compare it with other countries based on their gross domestic product (GDP) classification. Materials and Methods: The study was conducted to assess the Indian healthcare delivery system and the GDP among global nations based on their GDP potential as criteria. The data from 24 high-, middle-, and low-income countries were gathered from the World Bank from year 2018 to 2021. The parameters included GDP, GDP per capita, total number of population, and healthcare delivery system. The data were collected from various electronic sources of the World Health Organization, the International Monetary Fund, and the US Census Bureau’s international data, National Health Profile 2021. The collected data were compiled and tabulated. The descriptive analysis was done using Microsoft Excel version 2016 and SPSS version 20. Results: India ranks in the high-income group based on the GDP, whereas when ranked based on GDP per capita, it drops down to the lower-middle-income group. This lag may be because of a larger population and lack of priority in public health delivery. In terms of overall expenditure, India spends US$63 million in total health expenditure, of which only US$20 million is spent by the government sector. On the other hand, the United States holds the highest rank with US$10,921 million of total health expenditure, of which US$5,552 million spent by the government sector and US$5,368 million by the private sector. Conclusion: The Indian healthcare delivery system is suffering from a shortage of public health workforce and infrastructure. In the last decade, India has seen remarkable economic development, particularly in terms of the GDP growth rate. Unfortunately, this progress does not accompany with the Indian healthcare delivery system. Still there is a shortage in public health workforce and infrastructure. India should prioritize the expenditure in healthcare delivery.

Pakistan’s path to universal health coverage: national and regional insights

BackgroundUniversal Health Coverage (UHC) is a common health policy objective outlined in the Sustainable Development Goals. With provincial governments taking the initiative, Pakistan has implemented and extended UHC program amid a complex public health landscape. In this context, we assess Pakistan’s progress toward achieving UHC at the national and subnational level.MethodsWe use data from the Demographic and Health Surveys and the Household Integrated Economic Survey to construct a UHC index at the national and subnational level for 2007, 2013, and 2018. Furthermore, we use Concentration Index (CI) and CI decomposition methodologies to assess the primary drivers of inequality in accessing medical services. Logistic regression and Sartori’s two-step model are applied to examine the key determinants of catastrophic health expenditure (CHE).ResultsOur analysis underscores Pakistan’s steady progress toward UHC, while revealing significant provincial disparities in UHC progress. Provinces with lower poverty rate achieve higher UHC index, which highlights the synergy of poverty alleviation and UHC expansion. Among the examined indicators, child immunization remains a key weakness that one third of the children are not fully vaccinated and one sixth of these not-fully-vaccinated children have never received any vaccination. Socioeconomic status emerges as a main contributor to disparities in accessing medical services, albeit with a declining trend over time. Household socioeconomic status is negatively correlated with CHE incidence, indicating that wealthier households are less susceptible to CHE. For individuals experiencing CHE, medicine expenditure takes the highest share of their health spending, registering a staggering 70% in 2018.ConclusionPakistan’s progress toward UHC aligns closely with its economic development trajectory and policy efforts in expanding UHC program. However, economic underdevelopment and provincial disparities persist as significant hurdles on Pakistan’s journey toward UHC. We suggest continued efforts in UHC program expansion with a focus on policy consistency and fiscal support, combined with targeted interventions to alleviate poverty in the underdeveloped provinces.

Research status and recommendation on chronic diseases multimorbidity in the elderly in China

As Chinas population ages, the management of multimorbidity in the elderly has become a significant public health issue. Understanding the current state of research on chronic disease multimorbidity among elderly Chinese is now an urgent priority. This review addresses the growing problem of multimorbidity in elderly Chinese, focusing on prevalence, disease patterns, risk factors, and demographic characteristics. Current research highlights the significant impact of lifestyle habits and socioeconomic factors on multimorbidity. It also explores the negative effects on health-related quality of life (HRQoL), longevity, depression, and catastrophic health expenditure (CHE). This study provides valuable insights for public health governance and the development of targeted interventions for managing chronic disease multimorbidity in elderly Chinese. However, existing studies lack unified standards and definitions in disease classification and multimorbidity, and differences in study design and statistical methods may also affect the generalizability of the results. Therefore, future research should pay more attention to the important area of multimorbidity in the elderly and should focus on prevention and comprehensive management policies.

The colonial labour question: Trade and social expenditure in interwar Africa

Access to education and health care are core development goals of the United Nations since its inception. Today, almost all countries have education and health systems in place. In former colonies, the historical roots of these systems can often be traced back to colonial times. In this article, we argue that spending on social services for the local population was seen as a necessary condition to expand the trade-based colonial economy especially in the initial stage of social services dating back to the interwar period. Using novel data on health and education expenditure in 35 former British and French African colonies during the height of their empires (1919–39), we show that trade volumes account for a large share in the variance of expenditure on education but not health services, and that present-day expenditures partly reflect these patterns. Our results suggest that similar mechanisms are at play within the two empires and differences between them are in degree rather than in kind.

Beyond Glucose Monitoring: Multianalyte Sensor Use in Diabetes.

The incidence, prevalence, mortality, and health expenditure associated with diabetes continue to grow, despite efforts. The use of multianalyte sensors, which detect glucose as well as key analytes such as ketones, lactate, insulin, uric acid, and electrolytes, may provide additional information to guide earlier identification and management of diabetes and its complications. We undertook a narrative review using a systematic approach in May 2023, with a bridge search undertaken in April 2024. Four biomedical databases were searched: MEDLINE (Ovid), Embase, Emcare, and Cochrane Library. Searches for gray literature were conducted on ClinicalTrials.gov, Google Scholar, and websites of relevant organizations. Included studies incorporated articles on multianalyte sensors in diabetes and single-analyte sensors proposing integration into multianalyte diabetes management, with no limits placed on publication date and study design. Data were screened and extracted using CovidenceTM software. Overall, 11 articles were included, of which 7 involved multianalyte sensors (involving glucose and other analytes) and 4 single-analyte sensors (measuring non-glucose substances for proposed future integration into multianalyte systems). Analytes examined were ketones (n = 3), lactate (n = 4), uric acid (n = 3), insulin (n = 1), and potassium (n = 1). Results demonstrated that in vitro and invivo measurements of multi- and single-analyte sensors accurately and reliably corresponded with human capillary and serum samples. While the literature on this topic is sparse, our review demonstrated that measurement of glucose and other analytes can be feasibly undertaken using multi- and single-analyte sensors. More studies in humans are needed to establish clinical utility in diabetes self-management and assist with technological improvements.

Catastrophic health expenditure of inpatients in emerging economies: evidence from the Indian subcontinent

BackgroundCatastrophic health expenditures condensed the vital concern of households struggling with notable financial burdens emanating from elevated out-of-pocket healthcare expenditures. In this regard, this study investigated the nature and magnitude of inpatient healthcare expenditure in India. It also explored the incidence and determinants of inpatient catastrophic health expenditure.MethodologyThe study used the micro-level data collected in the 75th Round of the National Sample Survey on 93 925 households in India. Descriptive statistics were used to examine the nature, magnitude and incidence of inpatient healthcare expenditure. The heteroscedastic probit model was applied to explore the determinants of inpatient catastrophic healthcare expenditure.ResultsThe major part of inpatient healthcare expenditure was composed of bed charges and expenditure on medicines. Moreover, results suggested that Indian households spent 11% of their monthly consumption expenditure on inpatient healthcare and 28% of households were grappling with the complexity of financial burden due to elevated inpatient healthcare. Further, the study explored that bigger households and households having no latrine facilities and no proper waste disposal plans were more vulnerable to facing financial burdens in inpatient healthcare activity. Finally, the result of this study also ensure that households having toilets and safe drinking water facilities reduce the chance of facing catastrophic inpatient health expenditures.ConclusionsA significant portion of monthly consumption expenditure was spent on inpatient healthcare of households in India. It was also conveyed that inpatient healthcare expenditure was a severe burden for almost one fourth of households in India. Finally, it also clarified the influence of socio-economic conditions and sanitation status of households as having a strong bearing on their inpatient healthcare.

Exploring the return-on-investment for scaling screening and psychosocial treatment for women with common perinatal mental health problems in Malawi: Developing a cost-benefit-calculator tool.

This study sought to develop a user-friendly decision-making tool to explore country-specific estimates for costs and economic consequences of different options for scaling screening and psychosocial interventions for women with common perinatal mental health problems in Malawi. We developed a simple simulation model using a structure and parameter estimates that were established iteratively with experts, based on published trials, international databases and resources, statistical data, best practice guidance and intervention manuals. The model projects annual costs and returns to investment from 2022 to 2026. The study perspective is societal, including health expenditure and productivity losses. Outcomes in the form of health-related quality of life are measured in Disability Adjusted Life Years, which were converted into monetary values. Economic consequences include those that occur in the year in which the intervention takes place. Results suggest that the net benefit is relatively small at the beginning but increases over time as learning effects lead to a higher number of women being identified and receiving (cost‑)effective treatment. For a scenario in which screening is first provided by health professionals (such as midwives) and a second screening and the intervention are provided by trained and supervised volunteers to equal proportions in group and individual sessions, as well as in clinic versus community setting, total costs in 2022 amount to US$ 0.66 million and health benefits to US$ 0.36 million. Costs increase to US$ 1.03 million and health benefits to US$ 0.93 million in 2026. Net benefits increase from US$ 35,000 in 2022 to US$ 0.52 million in 2026, and return-on-investment ratios from 1.05 to 1.45. Results from sensitivity analysis suggest that positive net benefit results are highly sensitive to an increase in staff salaries. This study demonstrates the feasibility of developing an economic decision-making tool that can be used by local policy makers and influencers to inform investments in maternal mental health.

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) after four years of implementation – is it making an impact on quality of inpatient care and financial protection in India?

BackgroundIndia launched a national health insurance scheme named Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in 2018 as a key policy for universal health coverage. The ambitious scheme covers 100 million poor households. None of the studies have examined its impact on the quality of care. The existing studies on the impact of AB-PMJAY on financial protection have been limited to early experiences of its implementation. Since then, the government has improved the scheme’s design. The current study was aimed at evaluating the impact of AB-PMJAY on improving utilisation, quality, and financial protection for inpatient care after four years of its implementation.MethodsTwo annual waves of household surveys were conducted for years 2021 and 2022 in Chhattisgarh state. The surveys had a sample representative of the state’s population, covering around 15,000 individuals. Quality was measured in terms of patient satisfaction and length of stay. Financial protection was measured through indicators of catastrophic health expenditure at different thresholds. Multivariate adjusted models and propensity score matching were applied to examine the impacts of AB-PMJAY. In addition, the instrumental variable method was used to address the selection problem.ResultsEnrollment under AB-PMJAY was not associated with increased utilisation of inpatient care. Among individuals enrolled under AB-PMJAY who utilised private hospitals, the proportion incurring catastrophic health expenditure at the threshold of 10% of annual consumption expenditure was 78.1% and 70.9% in 2021 and 2022, respectively. The utilisation of private hospitals was associated with greater catastrophic expenditure irrespective of AB-PMJAY coverage. Enrollment under AB-PMJAY was not associated with reduced out-of-pocket expenditure or catastrophic health expenditure.ConclusionsAB-PMJAY has achieved a large coverage of the population but after four years of implementation and an evidence-based increase in reimbursement prices for hospitals, it has not made an impact on improving utilisation, quality, or financial protection. The private hospitals contracted under the scheme continued to overcharge patients, and purchasing was ineffective in regulating provider behaviour. Further research is recommended to assess the impact of publicly funded health insurance schemes on financial protection in other low- and middle-income countries.

Economic Costs Attributed to Diagnosed Diabetes in Each U.S. State and the District of Columbia: 2021.

To update state-specific estimates of diabetes-attributable costs in the U.S. and assess changes in spending from 2013 to 2021. We used an attributable fraction approach to estimate direct medical costs of diagnosed diabetes using the 2021 State Health Expenditure Accounts, the 2021 Behavioral Risk Factor Surveillance System, and the Centers for Medicare and Medicaid Services 2018-2019 Minimum Data Set. We estimated diabetes-attributable productivity losses from morbidity and mortality using the 2016-2021 National Health Interview Survey and the 2021 mortality data from the Centers for Disease Control and Prevention. Costs were adjusted to 2021 U.S. dollars. Total diabetes-attributable cost in 2021 was $640 billion ($335 billion in direct medical costs and $305 billion in indirect costs). The median state-level total diabetes-attributable cost was $8.2 billion (range $842 million to $81 billion). The median state-level per-person cost was $21,082, ranging from $17,452 to $37,090. Total diabetes-attributable cost increased by a median of 33% between 2013 and 2021, ranging from 16 to 68% across states. Medical costs increased by 50% overall (range 33-79%) and by 27% (range 15-41%) for per person with diabetes. Costs paid by Medicaid experienced the highest increase between 2013 and 2021 (median 153%; range 41-483%). State economic costs of diagnosed diabetes are substantial and increased over the last decade. These costs and their growth vary considerably across states. These findings may help state policy makers in developing evidenced-based public health interventions in their respective states to prevent and control the prevalence of diabetes.

Cost analysis of cardiac MRI for cardiac transplant surveillance

National health expenditures in the United States have risen steadily since 1960. While lifesaving therapies exist for acquired and congenital heart diseases, for some children heart transplantation is their only chance for a period of durable survival. Like many advanced therapies, however, heart transplantation confers a significant cost to families and the health care system at large. Current heart transplant health surveillance relies on frequent cardiac catheterization with endomyocardial biopsy (cath-EMB) as periodic assessment of graft health and detection of possible life-threatening acute rejection. Cardiac magnetic resonance imaging (MRI) has emerged as a diagnostic tool which can characterize the myocardium, providing insights into graft health and potentially acute/chronic graft rejection. The PEACE study (R01-HL164995-02) aims to systematically evaluate the potential for using cardiac MRI parametric mapping as a pre-cath-EMB screening tool to alleviate both patient anxiety and discomfort, as well as the financial burden of cath-EMB. The PEACE trial aims to establish definitive evidence and criteria for determining when cath EMB is needed. For a technique to be practical in the real world, though, it must also be cost effective.Therefore, the goal of this current research is to determine a minimal set of measurement properties (positive predictive value (PPV), etc.) that cardiac MRI must attain to be cost-effective. These data will guide the decision-making for the PEACE trial results. Consistent with the recent emphasis on “Value MRI,” we sought to understand the potential Medicare savings, through economic cost analysis modeling, if cardiac MRI is used for cardiac transplant surveillance rather than cath-EMB surveillance. At even the most pessimistic positive test rate for MRI considered, these modeling results suggest substantial Medicare cost savings when using cardiac MRI parametric mapping as a screening tool for detecting acute cardiac rejection. Longitudinal cost savings are notable too.