Hospital Fees Research Articles

The healthcare system costs of hip fracture care in South Africa.

We estimated direct healthcare costs of hip fracture (HF) management in the South African (SA) public healthcare system. We conducted a micro-costing study to estimate costs per patient treated for HF in five regional public sector hospitals in KwaZulu-Natal (KZN), SA. Two hundred consecutive, consenting patients presenting with a fragility HF were prospectively enrolled. Resources used including staff time, consumables, laboratory investigations, radiographs, operating theatre time, surgical implants, medicines, and inpatient days were collected from presentation to discharge. Counts of resources used were multiplied by unit costs, estimated from the KZN Department of Health hospital fees manual 2019/2020, in local currency (South African Rand, ZAR), and converted to 2020 US$ prices. Generalized linear models estimated total covariate-adjusted costs and cost predictors. The mean unadjusted cost for HF management was US$6935 (95% CI; US$6401-7620) [ZAR114,179 (95% CI; ZAR105,468-125,335)]. The major cost driver was orthopaedics/surgical ward costs US$5904 (95% CI; 5408-6535), contributing to 85% of total cost. The covariate-adjusted cost for HF management was US$6922 (95% CI; US$6743-7118) [ZAR113,976 (95% CI; ZAR111,031-117,197)]. After covariate adjustment, total costs were higher in patients operated under general anaesthesia [US$7251 (95% CI; US$6506-7901)] compared to surgery under spinal anaesthesia US$6880 (95% CI; US$6685-7092) and no surgery US$7032 (95% CI; US$6454-7651). Healthcare costs following a HF are high relative to the gross domestic product per capita and per capita spending on health in SA. As the population ages, this significant economic burden to the health system will increase.

Trends of Urolithiasis in China: A National Study Based on Hospitalized Patients from 2013 to 2018

Introduction: The aim of this study was to explore the chronological trends in clinical features and utilization of healthcare resources for hospitalized patients with urolithiasis in China. Methods: Patients with urolithiasis were extracted from the Hospital Quality Monitoring System, a national database of hospitalized patients in China, based on the International Classification of Diseases, Tenth Revision, codes. Variables including demographic characteristics, comorbidities, treatment modalities for urolithiasis, length of hospital stay, and expenditures were collected and analyzed. Results: Among 79.8 million hospitalized patients, 3.5 million were diagnosed with urolithiasis with an increasing trend (from 3.0% in 2013 to 4.0% in 2018). Most of these patients had upper urinary tract calculi (76.6% in 2013 and 81.7% in 2018). Middle-aged patients (46–65 years) constituted the largest proportion with a stable trend (from 46.9% in 2013 to 48.8% in 2018), while the proportion of older patients (>65 years) showed an increasing trend (from 23.7% in 2013 to 27.4% in 2018). The percentages of gout/hyperuricemia, hypertension, diabetes, and cardiovascular disease among the hospitalized patients with urolithiasis increased steadily, with the sharpest increases in patients from rural areas. Overall, 656,952 patients (18.9%) received surgical interventions for urolithiasis. The proportions of ureteroscopy and extracorporeal shockwave lithotripsy increased steadily during the 6-year study period, with simultaneous decreases in open surgery and percutaneous nephrolithotomy. The median length of hospital stay decreased from 10 days to 8 days. The cost of urolithiasis intervention accounted for 2.0% of the total hospitalization fee in 2013 and increased to 2.7% in 2018. Conclusions: The analysis showed an increasing trend in the percentage of hospitalized patients with urolithiasis, accompanied by an increased percentage of the total hospitalization fee for urolithiasis intervention during the 6-year study period. Based on the increasing trends in the proportion of older patients (>65 years) and percentages of metabolic comorbidities among patients with urolithiasis, an increased burden of urolithiasis on the healthcare system in China is anticipated.

Hospitalized for poverty: orthopaedic discharge delays due to financial hardship in a tertiary hospital in Northern Tanzania

BackgroundMusculoskeletal injury contributes significantly to the burden of disease in Tanzania and other LMICs. For hospitals to cope financially with this burden, they often mandate that patients pay their entire hospital bill before leaving the hospital. This creates a phenomenon of patients who remain hospitalized solely due to financial hardship. This study aims to characterize the impact of this policy on patients and hospital systems in resource-limited settings.MethodsA mixed-methods study using retrospective medical record review and semi-structured interviews was conducted at a tertiary hospital in Moshi, Tanzania. Information regarding patient demographics, injury type, days spent in the ward after medical clearance for discharge, and hospital invoices were collected and analyzed for orthopaedic patients treated from November 2016 to June 2017.Results346 of the 867 orthopaedic patients (39.9%) treated during this time period were found to have spent additional days in the hospital due to their inability to pay their hospital bill. Of these patients, 72 patient charts were analyzed. These 72 patients spent an average of 9 additional days in the hospital due to financial hardship (range: 1–64 days; interquartile range: 2–10.5 days). They spent an average of 112,958 Tanzanian Shillings (TSH) to pay for services received following medical clearance for discharge, representing 12.3% of the average total bill (916,840 TSH). 646 hospital bed-days were spent on these 72 patients when they no longer clinically required hospitalization. 7 (9.7%) patients eloped from the hospital without paying and 24 (33.3%) received financial assistance from the hospital’s social welfare office.ConclusionsMany patients do not have the financial capacity to pay hospital fees prior to discharge. This reality has added significantly to these patients’ overall financial hardship and has taken hundreds of bed-days from other critically ill patients. This single-institution, cross-sectional study provides a deeper understanding of this phenomenon and highlights the need for changes in the healthcare payment structure in Tanzania and other comparable settings.

Unit cost analysis using the activity-based costing method at the dental and oral clinic, the oral and dental hospital of Andalas University, Indonesia

The assurance of hospital fee service (unit cost) is still calculated using conventional methods. Themethod is inappropriate because it produces inaccurate rates, providing distorted cost information, either undercosting or over costing, which results in errors in decision making and organizational continuity. Efforts to reducedistortion due to the use of this conventional method is to use a new approach that uses an activity basis, namely,Activity Based Costing, which can accurately measure the costs that come out of each activity to produce the correctrate for each type of service action in hospital. The study aims to analyze unit cost calculations using the activitybasedcostingmethodtosetnewratesandtoexplainpolicyproceduresforthelatestratesframeworkatthedentalandoral clinic of RSGM FKG UNAND. The type of research used is descriptive research with a mixed methodapproach that combines quantitative and qualitative methods. The goal is that data used in mixed method researchwill be more comprehensive, valid, reliable, and objective. The mathematical calculations, the quantitative methodcalculates unit cost with the activity-based costing method. The qualitative method analyzes information about feesetting procedures by conducting in-depth interviews. The quantitative research results obtained the unit cost valuefor services with the most visits, including composite fillings and IDR. 157.099.78, scaling is IDR.134,162.95, and rootcanal treatment is IDR.167,815.94. Results of qualitative research through in-depth interviews obtained that insetting the new rates through the structural levels that apply at Andalas University. The recent rate decisions at thedental and oral polyclinic services of RSGM FKG UNAND are in the discussion stage of the rectorate leadership.The new rates are based on unit cost calculations using the activity-based costing method plus a margin or expectedprofit.KEYWORDS: Activity-based costing, unit cost, rates, policy rates

Factors contributing to home births among postpartum women in Manzini, Swaziland

Background/Aims Home births carry risks, especially in underdeveloped areas, including labour and childbirth complications and maternal and perinatal morbidity and mortality. Intrapartum care offered in healthcare facilities has fewer risks, as they employ skilled birth attendants and medical equipment. However, widespread provision of intrapartum care remains challenging in Swaziland. The incidence of avoidable intrapartum maternal and perinatal challenges could be reduced if more women gave birth accompanied by skilled birth attendants. The aim of this study was to explore and describe the factors associated with home birth in Swaziland, despite the practice being discouraged. Methods A qualitative design using convenient sampling was used. A total of 13 postpartum women took part in the study, who gave birth at home and brought their newborn babies to a well-baby clinic for immunisation 3 days after birth. Individual in-depth interviews were conducted and the data were subjected to thematic analysis. One theme was identified with associated subthemes. Results Personal factors formed the main theme describing the reasons for home birth. The subthemes were ignorance, silent labour, financial problems and access to a traditional birth attendant. Conclusions Enhanced health education during antenatal care on labour signs as well as reduced or abolished hospital fees for pregnant women and improved availability of ambulance services may help address women's reasons for choosing home birth. Encouraging women to give birth with a skilled birth attendant is important to reduce maternal and neonatal morbidity and mortality.

Trải nghiệm của người bệnh điều trị ngoại trú tại Khoa Khám Bệnh Đa Khoa, Viện Y Dược Học Dân Tộc năm 2021 và một số yếu tố ảnh hưởng

Objective: Describe the experience of outpatients at the Department of General Examination, Traditional Medicine Institute, Ho Chi Minh City in 2021 and analyze some factors affecting their experience. Methods: Applying cross-sectional design with quantitative and qualitative methods. Quantitative data were collected on 460 patients using self-completed questionnaires. There were 03 interview and 03 discussion meetings conducted after the preliminary quantitative results were available. Result: The percentage of patients with a positive overall experience is high with 84.79%, in which the rate of positive experiences is sorted from high to low according to the following groups of factors: medical examination and treatment services, health worker communication, utility service provision, hospital fees, waiting times, and procedures. 6 main factors are affecting the experience of outpatients: medical finance, human resources, information systems, pharmacy/drugs and equipment, and system administration. Conclusions: Outpatients have a positive experience at the Department of General Examination. Healthcare finance, human resources, information systems, pharmacy/drugs and equipment, and system administration were identified as factors affecting the experience. Keywords: outpatient, experience, outpatient experience

Trải nghiệm của người bệnh nội trú và một số yếu tố ảnh hưởng tại khoa ngoại chấn thương chỉnh hình – bỏng bệnh viện Đa khoa Thành phố Cần Thơ năm 2021

Policy makers and health managers around the world are increasingly interested in collecting patients’ experience data to capture information and issues that need to be improved to enhance the services quality, compete and retain customers. This study was conducted to describe the current situation and determine some factors affecting the experiences of inpatients treated at the Department of Orthopedic Surgery - Burns, Can Tho City General Hospital in 2021. This was a cross-sectional study, using both quantitative and qualitative approaches. Quantitative data was collected on 300 inpatients at the Department of Orthopedic Surgery - Burns, Can Tho City General Hospital. Qualitative data were collected through four in-depth interviews with managers, one group discussion with doctors, one group discussion with nurses and two group discussions with inpatients. The study results showed that the average score of the overall assessment of the inpatients’ experience was relatively positive with 8.54 (SD = ± 1.16). Regarding the patient’s experience at the time of admission, the doctors’ criterion explained the reason for admission that had the highest positive experience rate of 90.7%. With respect to the patients' experience on Facilities - Utilities, the criterion of Equipping hand sanitizer in the ward had the highest positive experience rate of 87.4%. The patients' experiences in terms of the attitude of medical staff, this criterion was perceived with a relatively high rate from 65.7% or more. With the patients' experiences with medical examination and treatment activities, the criterion that doctors informed and explained the reasons for performing procedures, surgery had the highest positive experience rate of 81.7%. Regarding the patients’ experiences with hospital fee payment, the criteria for supporting hospital fee payment for people with difficult circumstances had the lowest positive experience rate of 39%. Regarding the patients’ experiences before discharging from the hospital, 16.7% of patients reported that they have to wait for a long time to get discharge papers. 94.3% of the patients agreed that they plan to return to the hospital in the future if needed. Some factors affecting the patient’s experience can be divided into two groups: (1) positive effect factors: properly applying the medical examination and treatment procedures and regulations as prescribed by the Ministry of Health; reforming administrative procedures; having regulations and procedures to support patients with difficult; (2) negative effect factors: the long waiting time to perform the discharge procedure; the shortage of hospital beds. In conclusion, we proposed some recommendations: Develop a plan to adjust the process in order to reduce the waiting time for admission to the emergency department and the time to discharge from the hospital. Keywords: Experience of patients, inpatients, patients, Orthopedic Surgery – Burns.

Burden of Repeated Hospitalizations on Patients with Heart Failure: An Analysis of Administrative and Claims Data in Japan.

BackgroundRepeated hospitalization is a predictor of outcomes in heart failure, indicating the presence of symptoms, a deteriorated condition at pre-admission, and worsened prognosis.ObjectivesThe current database study aimed to understand the clinical and economic burden of repeated hospitalizations among patients with heart failure in Japan. The effect of repeated hospitalizations on the subsequent in-hospital mortality was the primary objective; economic burden of heart failure after discharge was investigated as a secondary outcome.MethodsBetween 2013 and 2018, administrative claims and discharge summary data of patients aged ≥ 20 years and diagnosed with heart failure were obtained from a Diagnosis Procedure Combination database maintained by Medical Data Vision. Hospitalization, mortality, and economic burden data were analyzed.ResultsThis study included 49,094 patients. The mean length of the first hospital stay was 22.9 days. The in-hospital mortality rate was approximately 10%, with one to five repeated hospitalizations. The time interval between repeated hospitalizations for heart failure decreased with an increasing number of hospitalizations. In-hospital mortality did not increase even with an increasing number of hospitalizations. The mean heart failure-related healthcare cost per patient was ¥564,281 ± 990,447 (US$5178 ± 9,088), 67.3% of which was hospitalization costs. Among hospitalization costs, other costs were high, mainly for basic hospitalization fees (71.7%; ¥233,146/person-year).ConclusionsRepeated hospitalization did not increase in-hospital mortality; however, it may shorten the intervals between heart failure-related hospitalizations, potentially caused by deterioration of the patient’s condition, and increase the clinical and economic burden on patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40801-022-00315-5.

The effects of different surgical positions (semi-sitting and lateral position) on the surgical outcomes of large vestibular schwannoma: study protocol for a randomized controlled trial

BackgroundThere is an ongoing discussion about the advantages and disadvantages of different surgical positions (semi-sitting and lateral position) for vestibular schwannoma surgery. Each position has its advantages, disadvantages, challenges, and risk profiles. The objectives of this study are to compare the effects of different surgical positions (semi-sitting and lateral position) on the outcomes of large vestibular schwannoma, primarily including effectiveness and safety.MethodsIn this single-centre, open, randomized controlled trial, we will recruit a total of 116 participants according to the inclusion and exclusion criteria who will be randomized to an experimental group or control group. Patients will undergo operations in semi-sitting and lateral positions. The primary endpoint will be the percentage of gross total resection. The secondary endpoints will include the facial nerve function, hearing preservation, surgical position placement time, time of operation (skin-to-skin surgical time), hospital stay, total hospitalization fee, and complications. The follow-up period will be at least 12 months, during which time patients will be evaluated both clinically and radiologically.DiscussionThis issue is still debated after 30 years since the first large comparative study was published in 1989, so the study will be useful. Therefore, more high-quality studies are required to compare clinical outcomes, complications, and other factors associated with these two positions.Trial registrationChinese Clinical Trial Registry ChiCTR1900027550. Registered on 17 November 2019

Submandibular Gland Transplantation vs Minor Salivary Glands Transplantation for Treatment of Dry Eye: A Retrospective Cohort Study

To compare submandibular gland (SMG) transplantation with minor salivary gland (MSG) transplantation for the treatment of different dry eye diseases (DED). Retrospective clinical cohort study. A total of 73 refractory DED eyes were divided into 3 groups. Group A comprised 35 end-stage DED eyes that underwent SMG transplantation. Group B comprised 20 end-stage DED eyes with MSG transplantation. Group C comprised 18 non-end-stage DED eyes with MSG transplantation. Schirmer test (ST), tear break-up time (TBUT), corneal fluorescein staining (FL), and best-corrected visual acuity (BCVA) were measured before and after surgery. Hospital length of stay, length of operation, and hospital fee were significantly higher in group A than in group B or C. Eyes in group A showed the most severe DED disease, with preoperative ST, TBUT, FL, and BCVA of 0.36 mm per 5 minutes, 0.03 seconds, 10.97, and 0.11, respectively, which improved significantly to 20.23 mm per 5minutes, 1.74 seconds, 7.58, and 0.2 at >2-year follow-up. Group B had similar baseline data, and significant but limited improvement only in the ST (0.55 mm per 5 minutes to 3.79 mm per 5 minutes) and FL (11.10 to 9.58) after the operation. Group C had better baseline ST, TBUT, FL, and BCVA of 0.89 mm per 5min, 3.49 seconds, 1.83, and 0.81, respectively, which improved significantly (except for BCVA) to 9.35 mm per 5min, 9.08 s, 0.53, and 0.89 after MSG transplantation. SMG transplantation could be recommended to treat end-stage refractory DED. MSG transplantation may provide satisfying results for refractory DED with relatively less severe impairment of the eye.

Effects of a Medical Aid program on medical utilization patterns for low-income patients with affective disorder in Seoul.

Mental illness has been increasing globally and its global burden of disease has reached a significant level, and urban dwellers have more chances of having worse mental health status due to high population density, isolated social networks. In Korea's medical security system, Medical Aid (MA) program and National Health Insurance (NHI), patients covered by MA pay much smaller out-of-pocket payments for outpatient services because of exempt from hospitalization fees. However, as a result of focusing on improving access to medical services for the urban poor due to lower out-of-pocket payment, their healthcare costs have greatly increased, while their health management has thus far been inadequate. In light of the background, this study investigated the differences in patterns of medical utilization among affective disordered patients covered by the MA program and the NHI system respectively.Data used for this study were extracted from customized health information data from the National Health Insurance Service (NHIS). The data source used in this study, customized claims data from the NHIS, is census data, which strengthens the representativeness and reliability of the study results. A total of 6754 inpatients (MA: 3327 and NHI 20%: 3327) diagnosed with the affective disorder were retrieved by Propensity Scores Matching (PSM).The length of stay of MA beneficiaries was found to be longer than that of NHI enrollees. However, the rate of hospital emergency room visits by NHI enrollees was higher than that of MA beneficiaries.Overall, community-based interventions are required to prevent and treat mental health by providing primary medical care in the community, and linking with mental health centers. Such policies will ultimately improve the financial sustainability of medical security systems.

MISREPRESENTATION SEBAGAI FRAUD DALAM PERKARA KONTRAK ASURANSI YANG DILAKUKAN PENANGGUNG

Insurance companies in Indonesia are currently trapped in the stigma of seeking the highest premiums. Many agents do not work according to standards and do not explain in detail the insured party’s rights and obligations. This study aims to determine the meaning of misrepresentation and forms of misrepresentation made by the insurer in an insurance contract case based on court decisions. This normative juridical approach uses content analysis method. The results showed that the insurer failed to provide correct information about the importance of medical check-ups about life insurance, failed to explain the relationship between honesty in disclosing material circumstances with the risk of cancellation of the policy or the consequences of an insurance claim being rejected, failed to present the correct information to policyholders and gives the impression that insurance claims can be made easily, only with a photocopy of the receipt for payment of hospital fees, and the failed to present correct information that the policy can only be closed to other people if the prospective insured has a birth certificate and cannot be replaced by a statement only.

Does type of robotic platform make a difference in the final cost of robotic-assisted radical prostatectomy?

This study evaluates the difference of robot-assisted radical prostatectomy (RARP) costs in patients with similar preoperative characteristics operated on using the da Vinci® SP and Xi robotic platforms. We performed a retrospective analysis on 71 consecutive patients with prostate cancer who underwent RARP with the SP robot between June 2019 and April 2020. Propensity score (PS) matching was performed and 71 patients were selected from a cohort of 875 who underwent RARP with the Xi robot in the same period. We divided the total expense per surgery into the cost of disposable materials, robotic instruments (initial purchasing cost divided by the number of "lives"), and operative room costs. Only variable costs are included in this study, as fixed costs do not vary between procedures and are the same for both cohorts. Fixed costs include anesthesia, pathology, surgeon, and hospitalization fees. The median total cost for SP-RARP was $5586 ($5360-$5982) USD and $4875 ($4661-$5093) USDwith the XI for a median cost difference of $707 ($584-$832) (P < 0.001). The median cost of disposables for the SP was $1877 ($1588-$2193) USD and for the Xi $1527 ($1407-$1781) USD,P < 0.001. Non-disposable instruments cost per case (fixed cost) was $1610 and $1270 USD for the SP and Xi, respectively. The cost of radical prostatectomy in the SP cohort is higher than the Xi cohort. The greater price was primarily due to the increased cost of instruments and disposable materials. In our experience, the lack of GelPOINT and space maker is also crucial factors to decrease the SP total cost.

Impact of birth tourism on health care systems in Calgary, Alberta

BackgroundBirth tourism refers to non-resident women giving birth in a country outside of their own in order to obtain citizenship and/or healthcare for their newborns. We undertook a study to determine the extent of birth tourism in Calgary, the characteristics and rationale of this population, and the financial impact on the healthcare system.MethodsA retrospective analysis of 102 women identified through a Central Triage system as birth tourists who delivered in Calgary between July 2019 and November 2020 was performed. Primary outcome measures were mode of delivery, length of hospital stay, complications or readmissions within 6 weeks for mother or baby, and NICU stay for baby.ResultsBirth Tourists were most commonly from Nigeria (24.5%). 77% of Birth Tourists stated that their primary reason to deliver their baby in Canada was for newborn Canadian citizenship. The average time from arrival in Calgary to the EDD was 87 days. Nine babies required stay in the neonatal intensive care unit (NICU) and 3 required admission to a non NICU hospital ward in first 6 weeks of life, including 2 sets of twins. The overall amount owed to Alberta Health Services for hospital fees for this time period is approximately $694 000.00.ConclusionBirth Tourists remain a complex and poorly studied group. The process of Central Triage did help support providers in standardizing process and documentation while ensuring that communication was consistent. These findings provide preliminary data to guide targeted public health and policy interventions for this population.

Rotator Cuff Repair with Graft Augmentation Improves Function, Decreases Revisions, and Is Cost-Effective

The purpose of this study is to evaluate the cost effectiveness of the use of extracellular matrix (ECM) augment at the time of primary rotator cuff repair utilizing a decision tree analysis. A decision tree model was created utilizing the existing literature for retear rates with and without dermal graft augmentation. Costs for rotator cuff repair (hospital and surgeon fees) were based on published studies and the cost for graft augmentation was based on institutional data. Utility measures were based upon EQ-5D (European Quality of Life 5 Dimension) scores to assess for improvement in quality adjusted life years (QALY) over a 10-year postoperative period with and without graft augmentation. Cost effectiveness was assessed using the incremental cost effectiveness ratio (ICER), or the incremental cost for per QALY with graft augmentation. Cost effectiveness is based on previous literature whereby an intervention is considered cost effective if the ICER is less than $50,000/QALY. On the basis of our decision tree analysis, total cost for rotator cuff tear without augmentation was $12,763, while the cost increased to $16,039 with ECM augmentation. With graft augmentation there was an improvement in 2.29 QALY, while there was an improvement of 2.05 without graft augmentation. The ICER of graft augmentation is $14,000/QALY, well below the cost effectiveness cut-off of $50,000/QALY. Sensitivity analysis showed the maximum cost of the ECM augment to be cost effective is $11,921. Graft augmentation does come with a significant upfront cost; however, on the basis of our decision-tree analysis, it may represent a cost-effective procedure. There is evidence to potentially consider more routine use in rotator cuff repairs, while being cost effective. Economic: Level IV: computer simulation model (Monte Carlo simulation, Markov model) with inputs derived from Level IV studies.

An implementation study of barriers to universal cervical length screening for preterm birth prevention at tertiary hospitals in Thailand

Objective: To identify healthcare managers’ perspectives on the barriers to implementing cervical length screening to prevent preterm births. Methods: In Phase I, 10 healthcare managers were interviewed. Phase II comprised questionnaire development and data validation. In Phase III, the questionnaire was administered to 40 participants, and responses were analyzed. Results: Their average related work experience was (21.0±7.2) years; 39 (97.5%) respondents also had healthcare management responsibilities at their respective hospitals. Most hospitals were reported to have enough obstetricians (31 cases, 77.5%) and to be able to accurately perform cervical length measurements (22 cases, 55.0%). However, no funding was allocated to universal cervical length screening (39 cases, 97.5%). Most respondents believed that implementing universal screening, as per Ministry of Public Health policies, would prevent preterm births (28 cases, 70.0%). Moreover, they suggested that hospital fees for cervical length measurements should be waived (34 cases, 85.0%). Three main perceived barriers to universal screening at tertiary hospitals were identified. They were heavy obstetrician workloads (20 cases, 50.0%); inadequate numbers of medical personnel (24 cases, 60.0%); not believing that the screening test could prevent preterm birth (8 cases, 20%) and lack of free drug support for preterm birth prevention in high-risk cases (29 cases, 72.5%). Conclusions: The main obstacles to universal cervical length screening are heavy staff workloads and inadequate government funding for ultrasound scanning and hormone therapy. The healthcare managers do not believe that the universal cervical length screening can help to reduce preterm birth.

Gánh nặng kinh tế từ phía người bệnh có thẻ bảo hiểm y tế và gia đình do điều trị ung thư phổi tại Bệnh viện K năm 2020

Objective: To estimate the economic burden from the perspective of health insusred patients and their families due to lung cancer treatment at Vietnam National Cancer Hospital, 2020. Methods: Cross-sectional study on 102 lung cancer patients who have been treated continously for at least 1 year at the Hospital. Results: The average economic burden from patients and their families due to lung cancer treatment at the Hospital in 2020 was VND 167.549 million, of which direct medical costs were VND 76.606 million (accounting for 45.7%), direct non-medical costs were VND 50.642 million (accounting for 30.2%) and indirect costs were VND 40.301 million (24.1%). Especially, costs of drugs and chemicals accounted for the highest proportion (75.8%). Although 100% of patients have health insurance, the cost of health insurance paid in hospital fees accounts for only 61%, the rest of the patients and households have to pay for themselves. Conclusions: The expansion of the list of medical examination and treatment techniques, drugs, chemicals and consumables within the scope of payment as well as payment conditions of the Health Insurance Fund in medical examination and treatment establishments, especially the list of specialized oncology in particular and lung cancer in general; At the same time, when medical staff exploit more financial situation of patients and households, along with flexibly using regimens and drugs suitable both professionally and economically, it would bring many benefits for the patients. Keywords: economic burden, lung cancer, health insurance

Access to Burn Care in Low- and Middle-Income Countries: An Assessment of Timeliness, Surgical Capacity, and Affordability in a Regional Referral Hospital in Tanzania.

This study investigates patients’ access to surgical care for burns in a low- and middle-income setting by studying timeliness, surgical capacity, and affordability. A survey was conducted in a regional referral hospital in Manyara, Tanzania. In total, 67 patients were included. To obtain information on burn victims in need of surgical care, irrespective of time lapsed from the burn injury, both patients with burn wounds and patients with contractures were included. Information provided by patients and/or caregivers was supplemented with data from patient files and interviews with hospital administration and physicians. In the burn wound group, 50% reached a facility within 24 hours after the injury. Referrals from other health facilities to the regional referral hospital were made within 3 weeks for 74% in this group. Of contracture patients, 74% had sought healthcare after the acute burn injury. Of the same group, only 4% had been treated with skin grafts beforehand, and 70% never received surgical care or a referral. Together, both groups indicated that lack of trust, surgical capacity, and referral timeliness were important factors negatively affecting patient access to surgical care. Accounting for hospital fees indicated patients routinely exceeded the catastrophic expenditure threshold. It was determined that healthcare for burn victims is without financial risk protection. We recommend strengthening burn care and reconstructive surgical programs in similar settings, using a more comprehensive health systems approach to identify and address both medical and socioeconomic factors that determine patient mortality and disability.

Cost of Cleft Team Care at an Academic Children’s Hospital

The financial burden of cleft-craniofacial team care is substantial, and high costs can hinder successful completion of team care. Collaboration with multiple stakeholders including providers, insurers, and patient guardians, as well as hospital administrators, is critical to increase patient retention and improve final clinical outcomes. At our cleft and craniofacial center, charges for a team care visit fall into one of three categories-hospital fees, professional fees, or external fees. There are four types of hospital fees depending on (1) whether the patient is new or returning, and (2) whether the patient saw ≤4 or ≥5 providers. To further elucidate the financial burden (out-of-pocket costs) directly borne by families of children with cleft lip and/or palate, we conducted a retrospective review of billing records of team care visits made between September 2019 and March 2020. Out-of-pocket costs for a single team care visit (on a commercial insurance plan) ranged from $4 to approximately $1220 and had a median (IQR) of $445 ($118, $749).

Investigating Perceptions of Patients on Healthcare Pricing Within The Private Healthcare Sector In Sri Lanka

Demand for private sector healthcare services in Sri Lanka is on the rise. This is very evident from the increase in the number of registered private healthcare institutions from 1990 to 2017. [1,2] With the increasing utilization of private sector healthcare services, various qualitative factors, and service-related issues associated with the healthcare delivery system have become common debates. A major concern, patients have expressed, is about the fees charged by doctors and hospitals. Principle aim of this study was to investigate the perceptions of patients on healthcare pricing within the private healthcare sector in Sri Lanka. The target population of the study was defined as Sri Lankans who have been inpatients in private hospitals within the past year. The focus districts were Colombo, Kandy, and Galle. These 3 districts represented nearly 60% of the total private sector bed capacity. From each district, three main private hospitals were selected. Over 700 patients were invited to participate, 246 surveys were completed, and 215 were retained as 31 had excessive missing and/or unclear data. In all 3 districts the majority of patients were either dissatisfied with or remained neutral (69%) on the hospital fees,(66%) on doctor’s fees,(74%) on the overall price they ended up paying,(76%) on whether they think the healthcare services they received are value for money. This study did not investigate the reasons or the factors that may affect the satisfaction or dissatisfaction of patients towards the fees they paid Multiple factors can affect patient’s perception on the fees they paid. With negative perception on the above it can be concluded that there is sufficient evidence to challenge private sector healthcare satisfaction level vs price/fees equilibrium in Sri Lanka.