Health Care Rationing Research Articles

Efficient and Fair Healthcare Rationing

The rationing of healthcare resources has emerged as an important issue, which has been discussed by medical experts, policy-makers, and the general public. We consider a rationing problem where medical units are to be allocated to patients. Each unit is reserved for one of several categories, and each category has a priority ranking over the patients. We present a class of allocation rules that respect the priorities, comply with the eligibility requirements, allocate the largest feasible number of units, and do not penalize agents for rising in the priority ranking of a category. The rules characterize all possible allocations that satisfy the first three properties and are polynomial-time computable.

Guidance for unbiased predictive information for healthcare decision-making and equity (GUIDE): considerations when race may be a prognostic factor.

Clinical prediction models (CPMs) are tools that compute the risk of an outcome given a set of patient characteristics and are routinely used to inform patients, guide treatment decision-making, and resource allocation. Although much hope has been placed on CPMs to mitigate human biases, CPMs may potentially contribute to racial disparities in decision-making and resource allocation. While some policymakers, professional organizations, and scholars have called for eliminating race as a variable from CPMs, others raise concerns that excluding race may exacerbate healthcare disparities and this controversy remains unresolved. The Guidance for Unbiased predictive Information for healthcare Decision-making and Equity (GUIDE) provides expert guidelines for model developers and health system administrators on the transparent use of race in CPMs and mitigation of algorithmic bias across contexts developed through a 5-round, modified Delphi process from a diverse 14-person technical expert panel (TEP). Deliberations affirmed that race is a social construct and that the goals of prediction are distinct from those of causal inference, and emphasized: the importance of decisional context (e.g., shared decision-making versus healthcare rationing); the conflicting nature of different anti-discrimination principles (e.g., anticlassification versus antisubordination principles); and the importance of identifying and balancing trade-offs in achieving equity-related goals with race-aware versus race-unaware CPMs for conditions where racial identity is prognostically informative. The GUIDE, comprising 31 key items in the development and use of CPMs in healthcare, outlines foundational principles, distinguishes between bias and fairness, and offers guidance for examining subgroup invalidity and using race as a variable in CPMs. This GUIDE presents a living document that supports appraisal and reporting of bias in CPMs to support best practice in CPM development and use.

Impact of organizational culture on healthcare supply chain resilience in Jordan: Moderating role of technology integration

This study aims to investigate the impact of organizational culture (i.e., rational, hierarchical, and group) on healthcare supply chain resilience (SCR) in Jordan. This paper further examines the moderating role of technology integration on the relationship between organizational culture and healthcare SCR. Cross-sectional research was conducted, and participants were recruited from different hospitals in Jordan. An electronic survey was employed to collect the responses from 304 participants, including senior professionals designated as doctors, nurses, ray technicians, physical therapists, procurement officers, pharmacists, and lab technicians with more than three years of work experience. There was no statistically significant influence of rational culture on healthcare SCR (p-value = 0.156) and an adverse impact of hierarchical culture on healthcare SCR (p-value = 0.030). Group culture had a statistically significant impact on healthcare SCR (p-value = 0.007). Technology integration had an influential moderating influence on the association between rational culture and healthcare SCR (p-value = 0.042) and the association between hierarchical culture and healthcare SCR (p-value = 0.0129). However, technology integration had no moderating influence on the association between group culture and healthcare SCR (p-value = 0.331). The analysis revealed that group culture has an influential impact on healthcare SCR, while hierarchical culture has a negative impact on healthcare SCR. Moreover, technological integration was observed to improve the beneficial influence of rational culture and the negative effects of hierarchical culture on healthcare SCR. However, the technology integration was not observed to moderate the relationship between group culture and healthcare SCR. Acknowledgment The author acknowledges all the associated personnel who, in any reference, contributed to the completion of this study.

Identifying determinants of spatial agglomeration of healthcare resources by using spatial econometric methods: a longitudinal study in China.

Healthcare resources are necessary for individuals to maintain their health. The Chinese government has implemented policies to optimize the allocation of healthcare resources and achieve the goal of equality in healthcare for the Chinese people since the implementation of the new medical reform in 2009. Given that no study has investigated regional differences from the perspective of healthcare resource agglomeration, this study aimed to investigate China's healthcare agglomeration from 2009 to 2017 in China and identify its determinants to provide theoretical evidence for the government to develop and implement scientific and rational healthcare policies. The study was conducted using 2009-2017 data to analyze health-resource agglomeration on institutions, beds, and workforce in China. An agglomeration index was applied to evaluate the degree of regional differences in healthcare resource allocation, and spatial econometric models were constructed to identify determinants of the spatial agglomeration of healthcare resources. From 2009 to 2017, all the agglomeration indexes of healthcare exhibited a downward trend except for the number of institutions in China. Population density (PD), government health expenditures (GHE), urban resident's disposable income (URDI), geographical location (GL), and urbanization level (UL) all had positive significant effects on the agglomeration of beds, whereas both per capita health expenditures (PCHE), number of college students (NCS), and maternal mortality rate (MMR) had significant negative effects on the agglomeration of institutions, beds, and the workforce. In addition, population density (PD) and per capita gross domestic product (PCGDP) in one province had negative spatial spillover effects on the agglomeration of beds and the workforce in neighboring provinces. However, MMR had a positive spatial spillover effect on the agglomeration of beds and the workforce in those regions. The agglomeration of healthcare resources was observed to remain at an ideal level in China from 2009 to 2017. According to the significant determinants, some corresponding targeted measures for the Chinese government and other developing countries should be fully developed to balance regional disparities in the agglomeration of healthcare resources across administrative regions.

Management of paediatric surgical patients during the COVID-19 pandemic: Our challenges

Purpose: Here we describe the challenges and procedures adopted to ensure safe paediatric surgery services during the COVID-19 pandemic at the paediatric surgery department in non-Covid-19 wing of Dhaka Medical College Hospital-1. Materials and Methods: Design: Retrospective study. Setting: Department of paediatric surgery in non-Covid- 19 wing of Dhaka Medical CollegeHospital-1, a tertiary care academic medical center in Dhaka, Bangladesh. Participants and duration: All patients who were admitted in the department of paediatric surgery in Dhaka Medical College Hospital-1 from March 1 through June 30, 2020. Methods: We identified patients with or without a rRTSARS- CoV-2 PCR receiving care at the department of paediatric surgery. The healthcare professionals were trained to clean, disinfect, use of PPEs, and other wastes were disposed of as per waste management protocols. Data collection & analysis: Patient data were manually abstracted from the medical record for evaluation. Responses were analysed using Microsoft Excels & SPSS, and presented as categorical data and percentages. Main outcome measures: We describe patient characteristics including demographics, presenting symptoms, type of treatment (Surgery vs Non Surgery), outcomes (morbidity & mortality), hospital stay, and distance travelled for treatment. Results: A total of 320 paediatric surgical patients were included in this study, among all patients about 66.87% patients were male child and 79.06% patients required surgeries. There were 5 patients with confirmed COVID- 19, who were transferred to the Covid-Surgical unit. During this period, there were 4 (1.25%) children who died due to non-COVID related causes. In surgical group only 24(7.5%) patients developed postoperative complications. Length of hospital stay of 44 (13.75%) of non-surgical patients were less than 72 hours, whereas 141 (40.06%) of surgical patients were more than 72 hours. Majority of patients of both groups travelled more than 100 km distance for treatment. Conclusions: This corona crisis has provided an opening for rational health care and formulating global policies. So that in future such pandemics can be tackled more carefully and consistently with advancing knowledge and better preparation. Journal of Paediatric Surgeons of Bangladesh (2019) Vol. 10 (1 & 2): 15-21

Bounded rationality in healthcare: unraveling the psychological factors behind patient satisfaction in China.

Patient satisfaction is a crucial metric to gauge the quality of medical services, but the psychological factors influencing patient satisfaction remain insufficiently explored. This study examines these psychological factors by applying the theory of bounded rationality to 1,442 inpatients in Hangzhou, China, whose data were collected using a questionnaire. One-way ANOVA, correlation analysis, and hierarchical regression were used to analyze patient satisfaction and its associated factors. Additionally, the path analysis of the structural equation model revealed the mechanisms behind the key psychological factors that influenced patient satisfaction. Medical risk perception, the social cognition of the medical environment, and social desirability bias had significant positive impacts on patient satisfaction. By contrast, negative emotions had a significant negative impact on patient satisfaction. Notably, patients' negative emotions had both a suppressive effect and a positive moderating effect on the relationship between medical risk perception and patient satisfaction. Similarly, social desirability bias had a suppressive effect on the correlation between the social cognition of the medical environment and patient satisfaction, albeit with a negative moderating effect. These results suggest that when evaluating and improving patient satisfaction, accounting only for the factors that directly influence medical service quality is insufficient, as the indirect and moderating effects of patients' negative emotions and the social cognition of the medical environment must also be considered. Medical service providers should thus address patients' negative emotions, establish good doctor-patient relationships, optimize service environments, provide managers with medical risk education and training on negative emotions, and prioritize patient-centered care. Additionally, the government and relevant health departments should optimize medical policies, enhance fairness and accessibility, and create a positive social cognitive environment through public education and awareness campaigns.

External reference pricing for medicines in Ukraine: latest trends

Compared to the previous year, the share of healthcare expenditure in the state budget of Ukraine has decreased, which is associated with increased funding for the security and defense sector. In terms of gross domestic product, healthcare spending has reduced to 2.8 %, which corresponds to the figures for 2019. These circumstances indicate the importance of proper budget utilization, including effectively regulating medicine prices. One of the key elements of rational healthcare budget usage is the development and implementation of external reference pricing (ERP). A well-formulated and implemented ERP policy for pharmaceuticals contributes to improving patient access to essential medicines (EMs). The aim of this study is to analyze the current status of ERP implementation in Ukraine and provide recommendations for improving this policy. Materials and methods. During the research process, an analysis of the ERP’s current regulatory framework was conducted, and ERP implementation in Ukraine was assessed according to adherence to the 14 best practice principles of ERP proposed by Sullivan, Kanavos & Kalo in 2015. Results. In Ukraine, ERP has been introduced for medicines from the National Essential Medicine Lists (NEML) and the “Affordable Medicines” program. The Ministry of Health (MoH) of Ukraine has approved a Register of marginal wholesale prices for medicines purchased with state budget funds and subject to price regulation. Currently, the register includes 1239 medicinal products, of which 1233 are from NEML and 6 have undergone Health Technology Assessment (HTA). Approximately 58 % of medicines have a set price through ERP, 24 % are regulated by internal reference pricing (IRP), and nearly 18 % have declared prices. This indicates a lack of uniformity in approaches to price regulation for medicines and requires further improvements. According to the latest update of the Register of medicines for reimbursement under the state medical guarantees program, there are 486 medicines, including 72 insulins and 21 immunosuppressive medicines (184 medicines are provided with co-payment). Different approaches, including different reference countries and price calculation algorithms, are applied for the price regulation of medicines in NEML and the “Affordable Medicines” program. An assessment of the implementation of the ERP system in Ukraine based on the 14 best practice principles of ERP proposed by Sullivan, Kanavos & Kalo in 2015 showed that the current policy does not adhere to all principles. Conclusions. The analysis revealed different approaches to pricing for medicines NEML and the “Affordable Medicines” program, indicating the need for harmonizing pricing policies for different lists. The adoption of a unified positive list can contribute to improving pricing policies and efficient resource utilization. Collecting, disseminating, and exchanging data on drug prices is crucial to support transparency in pricing and its control. Regular monitoring of prices in the market will help ensure compliance with pricing policies and take appropriate measures in case of violations. The implementation of a unified pricing regulation policy for medicines in Ukraine is an important step towards European integration and compliance with international standards.

Reproducing differential racialisation: social triage in migrant mental health services in England

Abstract In England, coverage for treatment of post-traumatic stress disorder (PTSD), a health condition that disproportionately affects forced migrants, is universal, in principle provided free of charge to all. Yet, multiple informal access barriers typically arise and informal systems of social triage may emerge. Using intersectional analysis, this study asks what political and moral rationalities inform social triage in the NHS. It is particularly attentive to how and why a supposedly universal service reproduces differential racialisation, in which multiple and co-existing populations are stratified and ranked as more or less belonging to a nation. Fieldwork was conducted in two waves, in 2015-2016 and in 2019-2021. It included six months of participant observation in an NGO; 21 semi-structured interviews with health professionals across 16 different NHS and NGO service providers, purposively sampled until saturation was reached; six interviews with mental health commissioners and national policymakers; and analysis of grey literature. Transcripts and fieldnotes were analysed inductively to identify themes using NvivoR1. Results were validated by interviewees. Despite being covered, undocumented migrants and asylum seekers were systematically excluded from NHS PTSD services, through social triage. People with refugee status were prioritised. Mental health care providers consciously and subconsciously reproduced differential racialisation, which generated health inequality. This was facilitated by: austerity; omitting immigration status in measurement of health inequality; securitisation of mental health services and minoritised Muslim populations; and bifurcated activism in which the forced migrant sector was disconnected from established struggles to combat racism in mental health care. Policies extending coverage to undocumented migrants and asylum seekers must be accompanied by extra monitoring, as well as financial, political and social support to service providers. Key messages • Health professionals informally, but systematically, reproduce differential racialisation in the rationing of health care through practices such as obfuscation and silencing critique. • Informal systems of social triage erode universal health coverage. This is exacerbated in contexts of austerity, where health professionals use their discretion to ration limited resources.

Fair Allocation of Vaccines, Ventilators and Antiviral Treatments: Leaving No Ethical Value Behind in Healthcare Rationing

A priority system has traditionally been the protocol of choice for the allocation of scarce life-saving resources during public health emergencies. COVID-19 revealed the limitations of this allocation rule. Many argue that priority systems abandon ethical values, such as equity, by discriminating against disadvantaged communities. We show that a restrictive feature of the traditional priority system largely drives these limitations. Following minimalist market design, an institution design paradigm that integrates research and policy efforts, we formulate pandemic allocation of scarce life-saving resources as a new application of market design. Interfering only with the restrictive feature of the priority system to address its shortcomings, we formulate a reserve system as an alternative allocation rule. Our theoretical analysis develops a general theory of reserve design. We relate our analysis to debates during COVID-19 and describe the impact of our paper on policy and practice. This paper was accepted by Axel Ockenfels, behavioral economics and decision analysis.

Public preferences to trade-off gains in total health for health equality: Discrepancies between an abstract scenario versus the real-world scenario presented by COVID-19

Policymakers must ration healthcare. This necessity became salient during the COVID-19 pandemic. Some policymakers took that opportunity to reduce inequality of health outcomes at the expense of overall health gains. There is a literature that seeks to quantify the optimal trade-off between efficiency and equality in health outcomes: economists employ surveys to quantify the public’s preferred level of equity/efficiency trade-off. An odd result from these studies is that a non-trivial subsample of respondents choose to “level down” i.e., they choose as though an additional year of life delivers negative utility to society if it accrues to the most privileged. In an experiment of US and UK respondents ( n = 495), we compare equity/efficiency trade-offs across an abstract scenario along the lines of that presented in previous surveys versus a COVID-19 scenario, where it is made explicit that healthcare rationing is a real and current necessity occasioned by the pandemic. We find that preference for “levelling down” is reduced in the COVID-19 scenario relative to the abstract scenario. This result implies that, at least in the context of the COVID-19 pandemic, previous results have overestimated the public’s willingness to sacrifice overall gains in population health in order to reduce inequality of health outcomes.

Rationing in healthcare-a scoping review.

Healthcare rationing has been the subject of numerous debates and concerns in the field of health economics in recent years. It is a concept which refers to the allocation of scarce healthcare resources and involves the use of different approaches to the delivery of health services and patient care. Regardless of the approach used, healthcare rationing fundamentally involves withholding potentially beneficial programs and/or treatments from certain people. As the demands placed on health services continue to rise and with that significant increases to the cost, healthcare rationing has become increasingly popular and is deemed necessary for the delivery of affordable, patient-care services. However, public discourse on this issue has largely been centered on ethical considerations with less focus on economic rationality. Establishing the economic rationality of healthcare rationing is essential in healthcare decision-making and consideration of its adoption by healthcare authorities and organizations. This scoping review of seven articles demonstrates that the economic rationality of healthcare rationing is the scarcity of healthcare resources amidst increased demand and costs. Therefore, supply, demand, and benefits are at the core of healthcare rationing practices and influence decisions on its suitability. Given the increased costs of care and resource scarcity, healthcare rationing is a suitable practice towards ensuring healthcare resources are allocated to people in a rational, equitable, and cost-effective manner. The rising costs and demands for care place significant pressure on healthcare authorities to identify suitable strategies for the allocation of healthcare resources. Healthcare rationing as a priority-setting strategy would support healthcare authorities identify mechanisms to allocate scarce resources in a cost-effective manner. When used in the context of a priority-setting approach, healthcare rationing helps healthcare organizations and practitioners to ensure that patient populations achieve maximum benefits at reasonable costs. It represents a fair allocation of healthcare resources to all populations, especially in low-income settings.

The case for more NHS funding: the inconsistent triad

British Journal of Healthcare ManagementVol. 29, No. 6 EditorialThe case for more NHS funding: the inconsistent triadSteve BojakowskiSteve BojakowskiCorrespondence to: Steve Bojakowski; E-mail Address: [email protected]GenSight Biologics SA, Paris, FranceSearch for more papers by this authorSteve BojakowskiPublished Online:13 Jun 2023https://doi.org/10.12968/bjhc.2023.0056AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Mackie JL. Inventing right and wrong. London: Penguin Books; 1977 Google ScholarOrganisation for Economic Cooperation and Development. Hospital beds (indicator). 2023a. https://doi.org/10.1787/0191328e-en (accessed on 17 May 2023) Google ScholarOrganisation for Economic Cooperation and Development. Gross domestic product (GDP) (indicator). 2023b. https://doi.org/10.1787/dc2f7aec-en (accessed on 17 May 2023) Google ScholarSeely A, Foster D. Health and social care levy. 2022. https://commonslibrary.parliament.uk/research-briefings/cdp-2021-0139/#:∼:text=In%20its%20Economic%20and%20Fiscal,%2F23%20to%202024%2F25. (accessed 17 May 2023) Google ScholarTidman Z, Carding N. Cost of government's promised ‘40 new hospitals’ revealed. 2023. https://www.hsj.co.uk/finance-and-efficiency/exclusive-cost-of-governments-promised-40-new-hospitals-revealed/7034583.article (accessed 17 May 2023) Google ScholarWeale A. Rationing of healthcare, a logical solution to an inconsistent trade. BMJ Volumes. 1998;316:410 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 June 2023Volume 29Issue 6ISSN (print): 1358-0574ISSN (online): 1759-7382 Metrics History Published online 13 June 2023 Published in print 2 June 2023 Information© MA Healthcare LimitedPDF download

Medical necessity, mental health, and justice

This paper examines the concept of medical necessity as it relates to mental health care rationing, arguing that the normal functioning model of medical necessity is insufficient because it fails to cohere with an important aim and function of mental health care, which is to provide support for individuals in abusive or otherwise difficult personal relationships.

Associations among socioeconomic status, multimorbidity of non-communicable diseases, and the risk of household catastrophic health expenditure in China: a population-based cohort study

BackgroundMultimorbidity of non-communicable diseases (NCDs) is increasingly prevalent among older adults around the world, leading a higher risk of household catastrophic health expenditure (CHE). As current powerful evidence was insufficient, we aimed to estimate the association between multimorbidity of NCDs and the risk of CHE in China.MethodsWe designed a cohort study using data investigated in 2011–2018 from the China Health and Retirement Longitudinal Study, which is a nationally-representative study covering 150 counties of 28 provinces in China. We used mean ± standard deviation (SD) and frequencies and percentages to describe baseline characteristics. Person χ2 test was employed to compare the differences of baseline characteristics between households with and without multimorbidity. Lorenz curve and concentration index were used to measure the socioeconomic inequalities of CHE incidence. Cox proportional hazards models were applied to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the association between multimorbidity and CHE.ResultsAmong 17,708 participants, 17,182 individuals were included for the descriptive analysis of the prevalence of multimorbidity in 2011, and 13,299 individuals (8029 households) met inclusion criteria and were included in the final analysis with a median of 83 (interquartile range: 25–84) person-months of follow-up. 45.1% (7752/17,182) individuals and 56.9% (4571/8029) households had multimorbidity at baseline. Participants with higher family economic level (aOR = 0.91, 95% CI: 0.86–0.97) had lower multimorbidity prevalence than those with lowest family economic level. 82.1% of participants with multimorbidity did not make use of outpatient care. The CHE incidence was more concentrated among participants with higher socioeconomic status (SES) with a concentration index of 0.059. The risk of CHE was 19% (aHR = 1.19, 95% CI: 1.16–1.22) higher for each additional NCD.ConclusionsApproximately half of middle-aged and older adults in China had multimorbidity, causing a 19% higher risk of CHE for each additional NCD. Early interventions for preventing multimorbidity among people with low SES could be intensified to protect older adults from financial hardship. In addition, concerted efforts are needed to increase patients’ rational healthcare utilization and strengthen current medical security for people with high SES to reduce economic disparities in CHE.

Effect of retirement on medical reimbursement expenses—evidence from China

BackgroundMedical reimbursement in China is not for all diseases, and medical reimbursement expenses are not completely consistent with medical service demand, though the scope and proportion of medical reimbursement are gradually expanding. This study aimed to examine the effect of retirement on medical reimbursement expenses in urban China.MethodsThe effect of retirement on medical reimbursement expenses were estimated by using fuzzy regression discontinuity based on data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, and 2018. Its group heterogeneity by educational backgrounds and marital status, and underlying mechanisms were also explored.ResultsRetirement increased medical reimbursement expenses of outpatient significantly (P < 0.05).Low time cost and deteriorating health status after retirement were possible mechanisms in this association. Retirement increased the reimbursement expenses significantly among the older adults with more educational obtainment or being widowed/divorced.ConclusionThe above findings indicated that there was a positive association between retirement and medical reimbursement expenses. The scope and proportion of medical reimbursement should be incorporated into retirement policy for improving medical service accessibility and rational healthcare utilization of retired population.

Pitfalls of Healthcare Economics as Considered by Healthcare Professionals―Things They Should Know Before Discussing Healthcare Rationing in a Medical Setting

Medical care in Japan, which has achieved one of the world's longest life expectancies, is highly regarded globally, but national medical expenses continue to increase yearly. In the past, physicians focused mainly on doing what is best for the patient without considering any budget impact. However, physicians are now required to take into consideration health economic evaluations as well. As a result, physicians now consider medications not only from the standpoint of individual patients (micro perspective), but also from that of the public/society (macro perspective). This has led to a situation in which these two perspectives on the allocation of medical resources are easily confused. The purpose of this paper is to describe the situation outlined above, taking into account the current state of medical practice as well as key concepts in research ethics and medical economics. First, in terms of medical practice, as seen in the “Minds Manual for Clinical Practice Guideline Development 2020,” the introduction of health economic evaluation has forced healthcare professionals to think from a macro perspective when considering patient treatment. Second, in terms of the distinction between research and treatment, an important topic in research ethics, medical researchers need to think from a macro perspective when planning and conducting research, because they are required to consider the social benefits of the research. Consequently, the social benefit sought in research and the clinical benefit to individual patients/subjects, as well as the macro and micro perspectives relating to the allocation of medical resources, are intertwined in the eyes of researchers, placing them in a situation where conceptual confusion can readily occur. Finally, in terms of medical economics, the efficiency of production (micro level perspective) and efficiency of allocation (macro level perspective) are easily confused in medical practice when considering the cost-effectiveness of treatment. In view of the above, this paper discusses the importance of recognizing, as a preliminary step to further discussions on the issue of allocation of limited healthcare resources, that the decision-making body at the macro level must be the government rather than individual medical personnel, and that the decision-making body at the micro level must be individual medical personnel (and individual patients) rather than the government.

Urip iku urup (life is lit) by service to others: a qualitative study of frontline healthcare workers’ lived experiences providing patient care in Indonesia’s COVID-19-designated hospital

BackgroundWhile COVID-19 affects every walk of human life, it especially implicates healthcare workers at the forefront of the pandemic due to their vulnerable involvement in providing first-line treatment. This study presents the lived experiences of frontline healthcare workers serving in Indonesia’s COVID-19-designated hospital, one of the severely afflicted healthcare settings wherein resource challenges, public health crisis, and political constraints intersect as policy conundrums.MethodsUsing a qualitative exploratory-descriptive approach, this study drew on thirteen in-depth, semi-structured interviews with frontline healthcare workers who have experiences providing first-line COVID-19 patient care in the COVID-19 hospital. The data analysis commenced with the verbatim transcription of the interview data, which was then subjected to a systematic thematic analysis employing hermeneutic phenomenological principles.ResultsThe exploration of the participants’ accounts reveals eight interconnected themes: facing resource scarcity and resignation; experiencing service-induced burnout due to occupational workload; encountering fears of being infected and infecting others; engaging in positivity through social connectedness; having dilemmas over healthcare rationing; developing negative emotions during patient interactions; coping through spirituality and religiosity; and embodying a life of service.ConclusionManaging healthcare in resource-limited, crisis settings presents multifaceted challenges that exceed mere structural modifications, requiring prioritized public health investment to ensure optimal patient care. Therefore, healthcare policy development and implementation should equally emphasize the well-being of frontline healthcare workers to foster sustainable healthcare delivery and achieve improved patient outcomes.

Value of GLP-1 receptor agonists versus long-acting insulins for type 2 diabetes patients with and without established cardiovascular or chronic kidney diseases: A model-based cost-effectiveness analysis using real-world data

AimsTo evaluate the cost-effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1RAs) versus long-acting insulins (LAIs) in patients with type 2 diabetes (T2D) using real-world data. MethodsA Markov model was utilized to estimate healthcare costs (US$) and quality-adjusted life-years (QALYs) of receiving treatments over 10 years from the healthcare sector perspective. Model inputs were derived from the analyses of Taiwan’s National Health Insurance Research Database or published literature on Taiwanese T2D populations. Base-case analysis was performed for the overall study cohort and subgroup analyses were stratified by the presence or absence of established cardiovascular diseases (CVDs) or chronic kidney diseases (CKDs). ResultsOverall, using GLP-1RAs versus LAIs cost $6,053 per QALY gained. Results were robust across sensitivity and scenario analyses. Among patients with established CVDs and CKDs, GLP-1RA versus LAI therapy saved $673 (cost-saving) and cost $1,675 per QALY gained, respectively. Among patients without established CVDs and CKDs, GLP-1RA versus LAI therapy cost $9,093 and $7,659 per QALY gained, respectively. ConclusionsUsing GLP-1RAs versus LAIs for T2D patients represented good economic value in real-world practice. Pronounced economic benefits of GLP-1RA therapy among those with prior CVDs or CKDs support rational treatment decisions and optimal healthcare resource allocation for these patients.

The rationing of nursing care phenomenon in the light of scientific reports – definitions, system solutions, assessment methods – PART I

Rationing of nursing care is a widespread and growing phenomenon whose causes are multifaceted and whose consequences are serious. Nursing rationing is defined as withholding or failing to perform necessary nursing tasks due to insufficient time, staffing, and/or inadequate skills. Nursing rationing is also defined as omission, delay, or failure to complete, which qualifies as an error of omission. Unfinished nursing care has many negative consequences for patients, nurses, and organizations. The presented series of three papers aims to show many important aspects related to care rationing. This first part of the series of rationing of nursing care phenomenon will address definitions and concepts of rationing of nursing care, rationing of nursing care in the context of health care rationing, rationing of care versus omission of care or medical error, methods for assessing the rationing and the quality of nursing care, and main reasons for rationing of nursing care.

Abstract WMP59: Effect Of Radiographic Contrast Media Shortage On Stroke Evaluation In The United States

Background: We quantified the effect of nationwide contrast media shortage, initiated on April 19 th , 2002 after GE Healthcare rationing, on evaluation of acute ischemic stroke (AIS) patients. Methods: We analyzed the data on 41,926 AIS patients (46,157 studies) who underwent imaging processed with Viz.ai software at 185 hospitals in the United States from Feb 28, 2022 through July 11, 2022. We quantified the overall (and in various strata) percentage change in daily number of computed tomographic angiography (CTA) and perfusions (CTP) performed, and the change in proportion of patients with large arterial occlusion (LVO) identified and image quality (CTP quality warnings) before and after April 19 th . Results: The daily counts of unique patients who underwent CTA decreased (a 14% reduction) in April: from 2.099 studies (before April 19 th ) to 1.811 studies (after April 19 th ) per day per hospital (see Figure). The reduction was most prominent in comprehensive stroke centers and in sites that used GE contrast media (24% versus 12%). There was no change in the proportions of patients with LVO identified (8.69% versus 9.34%) and inadequate tests (5.86% versus 5.00%). Conclusions: There was a prominent reduction in CTA performed in the United States due to contrast media shortage. However, the proportion of patients with LVO identified was not affected.