Higher Health Expenditures Research Articles

Mental Health Utilization and Expenditures for Children Pre–Post Firearm Injury

Mental Health Utilization and Expenditures for Children Pre–Post Firearm Injury

Factors Influencing Utilization of Preventive Health Services in Primary Health Care in the Republic of Serbia.

The use of preventive health services is a long-term health investment due to its potential to help individuals to take care of their health. This study aimed to explore the availability and performance of health services in primary health care (PHC) in the domain of general practice (GP), pediatrics, and gynecology, as well as to analyze the influence of sociodemographic and health determinants on the utilization of preventive health services. This descriptive study used data from the National Health Insurance Fund and the Statistical Office of the Republic of Serbia for 2015 and included 149 independent PHC units. The relationship between the utilization of preventive services and sociodemographic and health characteristics of the population was analyzed by bivariate and multivariate linear regression models. The higher health expenditure per capita and noncommunicable diseases mortality rate were, the more preventive health services were provided by a chosen GP. Children with a higher completion rate of primary school (p = 0.024), higher health expenditure (p = 0.017), and higher life expectancy at birth (p = 0.041) had more preventive health services. The fertility rate was positively associated with the number of preventive health services per 1000 women (p = 0.033). Our findings should serve as a starting point for where efforts should be made to achieve better health outcomes.

Abstract P88: Risk of Stroke in Hospitalized SARS-Cov-2 Infected Patients a Multinational Population-Based Study

The goal of this study was to better depict the short-term risk of stroke and its associated factors among SARS-CoV-2 hospitalized patients. Data Source: This multicenter, multinational observational study includes hospitalized SARS-CoV-2 patients from North and South America (United States, Canada, and Brazil), Europe (Greece, Italy, Finland, and Turkey), Asia (Lebanon, Iran, and India), and Oceania (New Zealand). Main Outcomes and Measures: The outcome was the risk of subsequent stroke (ischemic stroke, intracranial hemorrhage, cerebral venous/sinus thrombosis). The counts and clinical characteristics including laboratory findings and imaging of the patients with and without a subsequent stroke were recorded according to a predefined study protocol. Data Extraction and Synthesis: Quality, risk of bias, and heterogeneity assessments were conducted according to ROBINS-E and Cochrane Q-test. The risk of subsequent stroke was estimated through meta-analyses with random effect models. Binary logistic regression was used to determine the associated factors with the outcome measure. The study was reported according to the STROBE, MOOSE, and EQUATOR guidelines. Results: We received data from 18,311 hospitalized SARS-CoV-2 patients from 77 tertiary centers in 46 regions of 11 countries until May 1 st , 2020. A total of 17,799 patients were included in meta-analyses. Among them, 156(0.9%) patients had a stroke—123(79%) ischemic stroke, 27(17%) intracerebral/subarachnoid hemorrhage, and 6(4%) cerebral sinus thrombosis. Subsequent stroke risks calculated with meta-analyses, under low to moderate heterogeneity, were 0.5% among all centers in all countries, and 0.7% among countries with higher health expenditures. The need for mechanical ventilation (OR: 1.9, 95% CI:1.1-3.5, p = 0.03) and the presence of ischemic heart disease (OR: 2.5, 95% CI:1.4-4.7, p =0·006) were predictive of stroke. Conclusion and Relevance: The results of this multi-national study on hospitalized patients with SARS-CoV-2 infection indicated an overall stroke risk of 0.5% (pooled risk: 0.9%). The need for mechanical ventilation and the history of ischemic heart disease are the independent predictors of stroke among SARS-CoV-2 patients.

Abstract P81: SARS-CoV-2 and Stroke Characteristics a Report From the Multinational COVID-19 Stroke Study Group

Objective and Design: We conducted a multinational observational study on features of consecutive acute ischemic stroke (AIS), intracranial hemorrhage (ICH), and cerebral venous or sinus thrombosis (CVST) among SARS-CoV-2 infected patients. Main Outcome Measures: We investigated the association of demographics, clinical data, geographical regions, and countries’ health expenditure among AIS patients with the risk of large vessel occlusion (LVO), stroke severity as measured by National Institute of Health stroke scale (NIHSS), and stroke subtype as measured by the TOAST criteria. Additionally, we applied unsupervised machine learning algorithms to uncover possible similarities among stroke patients. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least one eligible stroke patient. Out of 432 patients included, 323(74.8%) had AIS, 91(21.1%) ICH, and 18(4.2%) CVST. Among 23 patients with subarachnoid hemorrhage, 16(69.5%) had no evidence of aneurysm. A total of 183(42.4%) patients were women, 104(24.1%) patients were younger than 55 years, and 105(24.4%) patients had no identifiable vascular risk factors. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144(37.8%) presented to the hospital with chief complaints of stroke-related symptoms, with asymptomatic or undiagnosed SARS-CoV-2 infection. Among AIS patients 44.5% had LVO; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median NIHSS (8[3-17], versus 11[5-17]; p=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; p<0.001) in countries with middle to high-health expenditure when compared to countries with lower health expenditure. The unsupervised machine learning identified 4 subgroups, with a relatively large group with no or limited comorbidities. Conclusions and Relevance: We observed a relatively high number of young, and asymptomatic SARS-CoV-2 infections among stroke patients. Traditional vascular risk factors were absent among a relatively large cohort of patients. The stroke severity was lower and rate of mechanical thrombectomy was higher among countries with middle to high-health expenditure.

Chemical Constituents and their Antioxidant, Anti-Inflammatory and Anti-Acetylcholinesterase Activities from Pholidota cantonensis.

Alzheimer's disease (AD) has the third highest health expenditures after heart disease and cancer. It has emerged as a serious global health issue. The discovery of new drugs to prevent and treat AD is of utmost importance. Pholidota cantonensis is an edible medicinal plant consumed in China. It is widely used in traditional Chinese medicine to treat various diseases. P. cantonensis has been reported to have antioxidant, anti-inflammatory, antitumor and antibacterial activities. Among these properties, its potent antioxidant activity has attracted our attention, since oxidative stress is one of the important pathological mechanisms involved in AD. This study aimed to isolate the compounds from the active extract and evaluate their bioactivities. Fifteen compounds, including one new compound, were obtained. The isolates were tested for 2,2'-diphenyl-1-picrylhydrazyl (DPPH)/2,2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radical scavenging activities, anti-acetylcholinesterase (anti-AChE) activities and inhibitory effects on nitrogen monoxide (NO) release in the BV-2 cells. Compounds 1, 2, 4, 6, 8, and 13-15 exhibited two kinds of AD-associated bioactivities. More importantly, compound 13 showed more potent NO inhibitory activity (IC50 = 0.72 ± 0.08μM) than the positive control quercetin (IC50 = 12.94 ± 0.08μM). Compound 13 also had a higher inhibitory rate (99.59 ± 0.43%) on AChE than that of the positive control galantamine (78.32 ± 1.16%) at the concentrate of 50μg/mL. Our studies provide new insights into this plant in terms of its potential in the development of new multi-target anti-Alzheimer's disease (anti-AD) drugs.

Socioeconomic indicators and economic investments influence oral cancer mortality in Latin America

BackgroundIt is necessary to recognize the influence of socioeconomic factors on oral cancer indicators in Latin American countries. This study aimed to analyze the influence of socioeconomic indicators and economical investments on oral cancer mortality rates in Latin American countries.MethodsThis cross-sectional study considered the age-standardized mortality rate (ASR) of oral cancer within the period 2000–2015. The oral cancer mortality rate (for both sexes and age groups 40–59 and 60 years old or more), socioeconomic aspects (Gini Inequality Index, unemployment rate and Gross Domestic Product (GDP) per capita) and investments in different sectors (%GDP invested in health per capita and by the government, %GDP invested in education by the government and %GDP invested in research and development) were considered. Tweedie multivariate regression was used to estimate the effect of independent variables on the mortality rate of oral cancer, considering p < 0.05.ResultsThis study showed that being male and aged 60 or over (PR = 14.7) was associated with higher mortality rate for oral cancer. In addition, greater inequality (PR = 1.05), higher health expenditure per capita (PR =1.09) and greater investment in research and development (PR = 1.81) were associated with a higher mortality rate from oral cancer.ConclusionSocioeconomic factors and economical investments influence the mortality rate of oral cancer in Latin American countries. This emphasizes oral cancer is a socioeconomic-mediated disease.

Which medical disciplines diagnose and treat melanoma in Europe in 2019? A survey of experts from melanoma centres in 27 European countries.

The incidence of melanoma is increasing. This places significant burden on societies to provide efficient cancer care. The European Cancer Organisation recently published the essential requirements for quality melanoma care. The present study is aimed for the first time to roughly estimate the extent to which these requirements have been met in Europe. A web-based survey of experts from melanoma centres in 27 European countries was conducted from 1 February to 1 August 2019. Data on diagnostic techniques, surgical and medical treatment, organization of cancer care and education were collected and correlated with national health and economic indicators and mortality-to-incidence ratio (MIR) as a surrogate for survival. Univariate linear regression analysis was performed to evaluate the correlations. SPSS software was used. Statistical significance was set at P<0.05. The MIR was lower in countries with a high health expenditure per capita and with a higher numbers of general practitioners (GPs) and surgeons (SURG) per million inhabitants. In these countries, GPs and dermatologists (DER) were involved in melanoma detection; high percentage of DER used dermatoscopy and were involved in the follow-up of all melanoma stages; both medical oncologists (ONC) and dermato-oncologists administered systemic treatments; and patients had better access to sentinel lymph node biopsy and were treated within multidisciplinary tumour boards. Based on these first estimates, the greater involvement of GPs in melanoma detection; the greater involvement of highly trained DER in dermatoscopy, dermatosurgery, follow-up and the systemic treatment of melanoma; and the provision of ongoing dermato-oncology training for pathologists, SURG, DER and ONC are necessary to provide an optimal melanoma care pathway. A comprehensive analysis of the melanoma care pathway based on clinical melanoma registries will be needed to more accurately evaluate these first insights.

Does Health Insurance Reduce Catastrophic Health Expenditure in Sudan?

High out of pocket (OOP) health expenditure has negative effects on households' budgets, pushing a considerable portion of the population below the poverty line, and potentially creating a financial catastrophe for the majority of the population in poor countries. Therefore, health insurance has been regarded as an important mechanism to protect people from the financial consequences of poor health and financing healthcare. However, in the context of developing countries, empirical findings on the impact of health insurance on incidence of high health expenditure are inconclusive. This study investigates the causal effect of health insurance on catastrophic health expenditures in Sudan. The analysis relies mainly on 2009 and 2014/2015 national household budget surveys. To control for possible endogeneity that may arise due to omitted variable bias and/or reverse causality, the study uses government and Zakat subsidies to instrument for health insurance across different localities. For the purpose of comparison and robustness check, the empirical model is estimated using three instrumental variable procedures: bivariate probit, IV-probit; and the two-stage least square (2SLS) model. The results indicate that for the 2014/2015 survey, health insurance has negative and significant effect on the catastrophic health expenditures, while for the 2009 survey I found that health insurance has no significant impact on catastrophic health spending. These outcomes hold for different catastrophic threshold levels, indicating that the role of health insurance in protecting households from the financial risk associated with health spending is improving over time. These findings also imply that the ongoing efforts to expand health coverage through Zakat and charitable institutions have a significant effect in mitigating catastrophic health expenditure. The study concludes with important policy implications given the pervasive issue of high out of pocket health expenditure in Sudan. Thus, policy makers should prioritize legislation and interventions to expand health insurance coverage further to protect households from financial vulnerability, as well as to improve health overall. In particular, enrollment of employees of the informal sector in health insurance is an urgent need. Moreover, charitable bodies such as Zakat and NGOs should prioritize health insurance coverage in their work. Furthermore, government subsidies to health insurance scheme should continue until achieving universal health coverage.

Lessons Learned from COVID-19 Pandemic Crisis to Reduce Mortality of Future Infectious Diseases in Society

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the strain of novel coronavirus that causes Coronavirus disease 2019 (COVID-19) that generates high number of infected cases and deaths worldwide. The fundamental question in this field of research is how countries can reduce fatality rates of COVID-19. This study confronts this question here by developing the first global analysis (based on more than 160 countries), which endeavors to analyze the socioeconomic sources of the reduction of mortality rates of COVID-19 in society. Results suggest that a low average fatality rate of COVID-19 is associated with countries having high level of current health expenditure expressed as a percentage of GDP, high domestic general government health expenditure per capita and a reduced exposure of population to days exceeding safe levels of particulate matter (PM2.5). These findings are important, very important to support an effective strategy to cope with future epidemics similar to COVID-19 that has to be based on high investments in health sector and environmental policy that reduces air pollution in order to be able to minimize fatality rates of future infectious diseases.

Use and Cost of Orthosis in Conservative Treatment of Acute Thoracolumbar Fractures: A Survey of European and North American Experts.

Survey study. Assess practices and opinions of spine specialists from Europe and North America on orthosis use in adult patients with acute thoracolumbar (TL) fractures. Evaluate cost of the devices. Although orthosis are traditionally used in conservative treatment of TL fractures, recent systematic reviews showed no benefit in patient's outcomes. A search for contact authors with publications on spine fractures from all European and North American countries was performed. An online questionnaire was sent on demographic data, practice setting, mean number of fractures treated, use of orthosis upon choice for conservative treatment, and average orthosis cost. Data was analyzed based in world regions, economic rank of the country, and health expenditure. We received 130 answers, from 28 European and five North American countries. Most responders had more than 9 years of practice and worked at a public hospital. 6.2% did not prescribe a brace in any patient with acute TL fractures conservatively treated and 11.5% brace all patients. In a scale from 1 to 5, 21 considered that there is no/low benefit (1) and 14 that bracing is essential (5), with a mean of 3.18. Europeans use orthosis less commonly than North Americans (P < 0.05). Orthosis mean cost was $611.4 ± 716.0, significantly higher in North America compared with Europe and in high income, when compared with upper middle income countries (both P < 0.05). Although hospital costs were not evaluated, orthosis is costlier when it involves admission of the patient (P < 0.05). An increase in orthosis cost associated with higher gross domestic product (GDP) per capita and higher health expenditure was found. More than 90% of spine specialists still use orthosis in conservative treatment of adult patients with acute TL fractures. Orthosis cost vary significantly between continents, and it is influenced by the country's economy.Level of Evidence: 4.

Risk factors, revascularization therapies and cardiovascular mortality in countries with middle and low public health expenditure

Abstract Background Studies from countries with high public health expenditure (PHE) have reported a decline of the rates of mortality from cardiovascular disease (CVD).Given that most mortality from CVD occurs in countries with low and middle PHE, there is a need for broader information on the relationship between variability in disease burden and outcomes in such countries. Purpose The aim of this study was to evaluate the relation among risk factors, revascularization therapies and short-term mortality from acute coronary syndromes (ACS) in patient admitted to hospitals in middle versus low PHE countries. Methods Data were derived from 18,704 patients admitted to 41 hospitals referring data to the ISACS-TC registry (NCT0128776). Patients were divided in two groups:low and middle PHE. Bosnia and Herzegovina,Croatia,Hungary,Italy,and Serbia have high PHE values, whereas Macedonia, Romania, Lithuania, Russian Federation, Kosovo,Moldova, and Montenegro, have low values. Main outcome measure was 30-day mortality. We used logistic-regression models to assess the effect of variables on the associations of interest. Results There were 18,704 patients admitted to hospital for an ACS. Of these patients, 45% were in the low PHE group and 55% in the middle PHE group. Patients in middle PHE group were older (64% vs 61%), had higher prevalence of traditional risk factors, namely hypertension (75% vs 66%), hypercholesterolemia (55% vs 31%), diabetes (28.58% vs 23.10%), and positive family history of coronary artery disease (45.66% vs 17.56) as compared with patients in the low PHE group.Furthermore, patients in the middle PHE group had more frequently history of prior ischemic heart disease and higher rate of ST segment elevation myocardial infarction (STEMI) as clinical presentation (63.91 vs 61.98). The crude 30-day mortality rate was 6.97% in the middle PHE and 5,82% in the low PHE group. After multivariable adjustment for comorbidities and treatment covariates, patients in the middle PHE group had a better outcome compared with those in the low PHE group (OR 0.64; 95% CI 0.45–0.93).As most patients presented to hospital with STEMI we performed separate analyses for such patients and stratified outcomes in function of time to hospital presentation from initial symptom onset. The odds of mortality were still lower in patients in the middle PHE group (OR 0.41; 95% CI 0.22–0.76) if they presented within 6 hours from symptom onset.In contrast there were no difference in outcomes between middle and low PHE groups (OR 0.69; 95% CI 0.34–1.44) in patients with delayed presentation.This held true even in patients undergoing primary percutaneous intervention (OR 1.02; 95% CI 0.43–2.39). Conclusions There are significant costs and infrastructure limitations that prohibit most countries with low PHE from having timely admission to hospital of patients with suspected ACS. Currently, many of the Eastern European countries are facing an enormous burden of mortality from CVD. Funding Acknowledgement Type of funding source: None

Risk of stroke in hospitalized SARS-CoV-2 infected patients: A multinational study.

BackgroundThere is an increased attention to stroke following SARS-CoV-2. The goal of this study was to better depict the short-term risk of stroke and its associated factors among SARS-CoV-2 hospitalized patients.MethodsThis multicentre, multinational observational study includes hospitalized SARS-CoV-2 patients from North and South America (United States, Canada, and Brazil), Europe (Greece, Italy, Finland, and Turkey), Asia (Lebanon, Iran, and India), and Oceania (New Zealand). The outcome was the risk of subsequent stroke. Centres were included by non-probability sampling. The counts and clinical characteristics including laboratory findings and imaging of the patients with and without a subsequent stroke were recorded according to a predefined protocol. Quality, risk of bias, and heterogeneity assessments were conducted according to ROBINS-E and Cochrane Q-test. The risk of subsequent stroke was estimated through meta-analyses with random effect models. Bivariate logistic regression was used to determine the parameters with predictive outcome value. The study was reported according to the STROBE, MOOSE, and EQUATOR guidelines.FindingsWe received data from 26,175 hospitalized SARS-CoV-2 patients from 99 tertiary centres in 65 regions of 11 countries until May 1st, 2020. A total of 17,799 patients were included in meta-analyses. Among them, 156(0.9%) patients had a stroke—123(79%) ischaemic stroke, 27(17%) intracerebral/subarachnoid hemorrhage, and 6(4%) cerebral sinus thrombosis. Subsequent stroke risks calculated with meta-analyses, under low to moderate heterogeneity, were 0.5% among all centres in all countries, and 0.7% among countries with higher health expenditures. The need for mechanical ventilation (OR: 1.9, 95% CI:1.1–3.5, p = 0.03) and the presence of ischaemic heart disease (OR: 2.5, 95% CI:1.4–4.7, p = 0.006) were predictive of stroke.InterpretationThe results of this multi-national study on hospitalized patients with SARS-CoV-2 infection indicated an overall stroke risk of 0.5%(pooled risk: 0.9%). The need for mechanical ventilation and the history of ischaemic heart disease are the independent predictors of stroke among SARS-CoV-2 patients.FundingNone.

Cluster analysis application to identify groups of individuals with high health expenditures

We compare and demonstrate the effectiveness of two clustering methods with the main purpose of identifying characteristic profiles of high utilizers of health care. In this work, we use three sets of mutually independent longitudinal data that are nationally representative of the US adult working-age civilian non-institutionalized population. We compare k-means, a commonly used clustering method, with a k-medoids algorithm called Partitioning Around Medoids. We use one cohort of data to create clusters based on similar characteristics of individuals for both clustering methods. We examine these characteristic compositions of the highest three average total expenditure clusters from this cohort. We also examine the health expenditure distributions for this cohort over the following two years. We validate the approach by applying the centers of the clusters to two other cohorts of similar data. We form clusters based on demographic, economic, and health-related characteristics that are commonly used in studies of health care utilization. We demonstrate the consistency of our results across the three cohorts of data and across different types of health expenditures, such as office-based/outpatient and drug. Clusters can be formed with other more homogeneous data, such as Medicaid, Medicare, employer sponsored insurance, or individual private plans issued under the Affordable Care Act. This approach can be used to follow similar groups over time for other types of health outcomes.

Avaliação do desempenho das regiões de saúde do Estado do Rio de Janeiro

Este estudo tem como objetivo avaliar o desempenho dos indicadores despesas em saúde pública nas nove Regiões de Saúde do Estado do Rio de Janeiro. Para tanto, foram extraídos dados do Sistema de Informações sobre Orçamentos Públicos em Saúde (SIOPS), de domínio público, envolvendo as nove Regiões de Saúde do Estado do Rio de Janeiro, com periodicidade anual entre os anos de 2007 a 2016, ajustados pelo Índice Nacional de Preços ao Consumidor Amplo (IPCA). Em seguida, os dados foram analisados através de estatística descritiva e apresentados sob a forma de tabela e gráfico. Os dados evidenciaram que as regiões metropolitanas I e II vem mantendo suas despesas totais e por habitantes em declínio nos últimos anos. Em contrapartidas, as RS da Baixada Litorânea, Baía da Ilha Grande e Norte apresentam suas despesas crescente, sendo que está última, as diferenças atingem resultados considerados pronunciadamente elevadas. Estas RS usufruem de acréscimos em suas receitas de incentivos oriundos da produção de Petróleo e Gás ou incentivo tributário estadual ambiental. Considera-se que apesar das elevadas despesas em saúde das três RS em comparação com as duas RS metropolitanas, não se pode inferir que a qualidade dos processos de produção e produtos de saúde destes últimos são piores, pois os índices de desenvolvimento humanos são mais elevados nestas regiões de saúde do que nas RS de maiores despesas em saúde no período pesquisado.

Preventive healthcare policies in the US: solutions for disease management using Big Data Analytics

Data-driven healthcare policy discussions are gaining traction after the Covid-19 outbreak and ahead of the 2020 US presidential elections. The US has a hybrid healthcare structure; it is a system that does not provide universal coverage, albeit few years ago enacted a mandate (Affordable Care Act-ACA) that provides coverage for the majority of Americans. The US has the highest health expenditure per capita of all western and developed countries; however, most Americans don’t tap into the benefits of preventive healthcare. It is estimated that only 8% of Americans undergo routine preventive screenings. On a national level, very few states (15 out of the 50) have above-average preventive healthcare metrics. In literature, many studies focus on the cure of diseases (research areas such as drug discovery and disease prediction); whilst a minority have examined data-driven preventive measures—a matter that Americans and policy makers ought to place at the forefront of national issues. In this work, we present solutions for preventive practices and policies through Machine Learning (ML) methods. ML is morally neutral, it depends on the data that train the models; in this work, we make the case that Big Data is an imperative paradigm for healthcare. We examine disparities in clinical data for US patients by developing correlation and imputation methods for data completeness. Non-conventional patterns are identified. The data lifecycle followed is methodical and deliberate; 1000+ clinical, demographical, and laboratory variables are collected from the Centers for Disease Control and Prevention (CDC). Multiple statistical models are deployed (Pearson correlations, Cramer’s V, MICE, and ANOVA). Other unsupervised ML models are also examined (K-modes and K-prototypes for clustering). Through the results presented in the paper, pointers to preventive chronic disease tests are presented, and the models are tested and evaluated.

Biomarcadores en la demencia tipo alzheimer: sistema sanitario y edadismo

El envejecimiento de la población en España es una cuestión que no solamente atañe a la salud de la población y a Sanidad, sino que tiene importantes repercusiones en la economía, estructura familiar, sostenibilidad del sistema de pensiones, etc. Supone un elevado gasto sanitario, como ejemplo: el 52% del gasto de Atención Especializada se dedica a mayores de 65 años y los mayores de 70 años son los responsables del 40% del total del gasto sanitario. Los datos anteriormente expuestos denotan que el sistema sanitario no ha sabido adaptarse a la nueva situación social, aumentando el edadismo y responsabilidad de la sostenibilidad del sistema a la población anciana. Los biomarcadores de depósito amiloide y de neurodegeneración (obtenidos del líquido cefalorraquídeo: péptido Aß1-42 ylas proteínas Tau totaly Tau fosforilada), o bien por técnicas de neuroimagen (resonancia magnética(RM) o tomografía poremisión de positrones(PET con18F-fluorodesoxiglucosa PET-FDG). Los biomarcadores en sangre periférica aún no están estandarizados para el diagnóstico clínico. Por ello, la utilización de técnicas de imagen hiperespectral para la determinación de biomarcadores, así como la aplicación de estas técnicas en la clínica, favorecerán tanto el diagnóstico como el tratamiento de los pacientes con DTA.

Catastrophic Health Care Expenditure on Maternal Health Care in India: Evidence from National Level Data

Introduction: Catastrophic health expenditure is defined as payments for health services exceeding 40% ofhousehold disposable income after subsistence needs are met. Utilization of maternal health care serviceshas been recognized as a significant factor in influencing maternal and child mortality. India continuesto account for a quarter of all maternal and child deaths at the world level. The cost of health care iscomparatively higher in private sector than the public health facilities. Households using private inpatientservices are more likely to face catastrophic expenditure.Materials and Method: This paper has utilized the data collected by the National Sample SurveyOrganization (NSSO) during January-June, 2014. It is a cross sectional dataset available in public domain.The dataset provides information on Social Consumption and Health scenario of the population. To carry outthe research, descriptive statistics, bivariate and logistic regression analysis has been used.FINDINGSThe study shows that urban sector, primary educated and women belonging to poorest wealth quintilebear high catastrophic health expenditure than their other counterparts. Western and Southern region havelow percentage of women going for catastrophic expenditure on maternal health care. The likelihood ofcatastrophic health expenditure on maternal health care decreases with the increase in wealth quintile frompoorest to richest.Conclusion: Place of residence, educational status and wealth index plays an important role in determiningthe catastrophic health expenditure on maternal health care. Further research needs to be done in exploringthe factors that leads to inequity of the expenditure used in the utilization of maternal health care.

Impact of Out of Pocket Health Expenditure on Consumption Pattern of Below Poverty Line Households in India

Financial burden from health expenditure is a serious cause of concern for low-income and developing countries. Studies have shown that low public investment in health, lack of adequate safety net mechanisms and poor quality of public health system in these countries are few basic grounds for placing high financial burden on people. In order to make both ends meet during illness, poor people resort to various alternative means. One of the popular strategies adopted is to reduce or reallocate the consumption bundle, so as to meet the medical expenditure. The impact of out of pocket (OOP) health expenditure on the consumer expenditure has immediate and direct impact especially among the poor sections of the society. This article aims to study the impact of out of pocket health expenditure on the constituents of consumer expenditure and how the composition of consumer expenditure differs with the levels of out of pocket expenditure among different consumption quintiles. The study uses IHDS household level survey data for the year 2011–2012. A mean comparison test is carried out to check whether significant difference exists in the consumption bundles of households with and without medical expenditure. A system of Engel curves is estimated with seemingly unrelated regression equation (SURE) to study the impact of out of pocket medical expenses on the consumption bundle. The results show that there exists significant difference in the share of different consumption items in the consumption bundles of households with and without out of pocket expenditure. Despite having larger share for food expenditure, poor households tend to protect the consumption of food share in the bundle. Compensation for rise in medical expenses is reflected in the reduced share of non-food expenditure items like fuel, education, entertainment, clothing and footwear. With high share of out of pocket expenditure, poor households in the states with high public health expenditure mainly reduced their education expenditure whereas consumption of most of the non-food items were reduced by poor households in low public health expenditure states.

Heart failure disease management programs in Austria 2019 : Asystematic survey of the Heart Failure Working Group and the Working Group for Cardiological Assistance and Care Personnel of the Austrian Society of Cardiology.

SummaryHeart failure (HF) is common and is associated with high morbidity, mortality and high health expenditure. A multidisciplinary disease management plan (DMP) can reduce morbidity and mortality, save costs and improve the quality of life. In Austria, three HF-specific DMPs are currently in a project phase and four established DMPs are active. Although programs are widely heterogeneous with respect to their intervention type, they pursue the same interventional goal by supporting seamless care between inpatient and community care settings with a multidisciplinary team. This survey presents a systematic survey of the HF-specific DMPs in Austria. Disparities between programs are highlighted and discussed. The nationwide establishment of HF-specific DMPs that integrate primary care and cardiology services including a regulation of the remuneration of stakeholders and program infrastructure is needed to decrease the burden of HF for both the individual and society.

Envisioning a Better U.S. Health Care System for All: A Call to Action by the American College of Physicians.

Visual Abstract.Envisioning a Better U.S. Health Care System for All: A Call to Action by the American College of Physicians Visual Abstract. Envisioning a Better U.S. Health Care System for All: A...