Medical Fees Research Articles

The effectiveness and safety of precision cardiac anesthesia in patients undergoing cardiac surgery

Objective To investigate the effectiveness and safety of precision cardiac anesthesia. Methods A total of eighty subjects[New York Heart Association(NYHA) grades Ⅰ-Ⅳ] undergoing selective cardiac surgery were enrolled. They were randomly divided into two groups (n=40): a precision cardiac anesthesia group (group P) and a conventional cardiac anesthesia group (group C). Group P was primarily administrated with a low-dose of sufentanil, in combination with target - controlled infusion to accurately adjust the blood concentration of anesthetics as well as bispectral index to monitor anesthesia depth. The aim of this protocol of precision cardiac anesthesia was to achieve the rationalization of anesthetic use. The timing of tracheal extubation following cardiac surgery was determined by pre- and intra-operative individual general condition in group P. Routine dosage sufentanil was traditionally administrated in group C, and patients were transferred to intensive care unit (ICU) with tracheal intubation after surgery. All patients′ data were recorded including baseline characteristics, intraoperative sufentanil dosage, cases with cardiopulmonary bypass(CPB), operation time, lowest temperature, duration of mechanical ventilation, poor events, ICU length of stay, post - operative hospitalization stay and cost of hospital care. Results The total amount of sufentanil used intra-operatively was significantly less in group P than that in group C (P<0.05). The number of patients developing pneumonia after surgery in group C was revealed to be significantly greater than that in group P (P<0.05). Compared to group C, patients in group P had significantly decreased length of mechanical ventilation, ICU stay and post - operative hospital stay (P<0.05). Both total hospital expenditure and medical examination fee were significantly less in group P (P<0.05). Conclusions Precision cardiac anesthesia is of effectiveness and safety in adults undergoing cardiac surgery. It can reduce ICU and post-operative hospitalization stay. It is beneficial to cut the cost of health care, so as to improve efficiency of medical resources. Key words: Cardiac surgery; Precision cardiac anesthesia; Fast track

Impact of China’s healthcare price reforms on traditional Chinese medicine public hospitals in Beijing: an interrupted time-series study

ObjectiveTo evaluate the 2017 implementation of China’s 2009 healthcare price reforms on Beijing’s secondary and tertiary traditional Chinese medicine (TCM) hospitals.DesignWe employed a panel-interrupted time-series model with hospital fixed effects...

Treatment for human visceral leishmaniasis: a cost-effectiveness analysis for Brazil.

To estimate the cost-effectiveness of strategies for the treatment of VL in Brazil. Cost-effectiveness study comparing three therapeutic options: meglumine antimoniate (MA), liposomal amphotericin B (LAMB) and a combination of LAMB plus MA (LAMB plus MA), from public health system and societal perspectives. An analytical decision-making model was used to compare strategies for the following outcomes: early therapeutic failure avoided at 30days, days of hospitalisation avoided and VL cure at 180days. The efficacy and safety parameters of the drugs came from a randomised, open-label trial and the cost data came from a cost-of-illness study, both carried out in Brazil. For all outcomes analysed, the LAMB strategy was more effective. The MA strategy was inferior to the LAMB plus MA strategy for the outcomes early therapeutic failure avoided and cure. When only LAMB and MA were compared from a societal perspective, a cost of US$ 278.56 was estimated for each additional early therapeutic failure avoided, a cost of US$ 26.88 for each additional day of hospitalisation avoided and a cost of US$ 89.88 for each additional case of cured VL, for the LAMB strategy vs. MA. In Brazil, the LAMB strategy proved to be cost-effective for treating VL, considering a GDP per capita as the willingness-to-pay threshold, for all of the outcomes analysed in comparison to MA.

Limited effects of the comprehensive pricing healthcare reform in China

ObjectivesTo evaluate the effects of China's very recent comprehensive pricing healthcare reform, taking the patients' perspective. Study designTwo survey studies were conducted using the same protocol in Beijing in July 2017 and 2018, respectively. MethodsThe same questionnaire was used and contains two sections, with the first on demographic and personal information and the second on various assessments of the reform. ResultsFindings different from those in the government-led evaluations were made. Specifically, the majority of the patients thought the level of medical service fee and cost of medicine still high, and experienced no change or an increase in overall medical cost. The overall assessment of the reform was not sufficiently positive. Multiple problems in healthcare were identified. Development from 2017 to 2018 was not significantly positive. ConclusionsPatients' assessments of the reform were not as positive as those made in the government-led evaluations. In extending the reform to the whole country, the government and healthcare providers may need to further tune the reform to better serve the public.

Breaking down the barriers: Understanding migrant workers' access to healthcare in Malaysia.

BackgroundMalaysia is widely credited to have achieved universal health coverage for citizens. However, the accessibility of healthcare services to migrant workers is questionable. Recently, medical fees for foreigners at public facilities were substantially increased. Mandatory health insurance only covers public hospital admissions and excludes undocumented migrants. This study explores barriers to healthcare access faced by documented and undocumented migrant workers in Malaysia.MethodsWe use qualitative data from 17 in-depth interviews conducted with key informants from civil society organisations, trade unions, academia, medical professionals, as well as migrant workers and their representatives. We interviewed doctors working in public hospitals and private clinics frequented by migrants. Data were analysed using thematic analysis.ResultsWe found that healthcare services in Malaysia are often inaccessible to migrant workers. Complex access barriers were identified, many beyond the control of the health sector. Major themes include affordability and financial constraints, the need for legal documents like valid passports and work permits, language barriers, discrimination and xenophobia, physical inaccessibility and employer-related barriers. Our study suggests that government mandated insurance for migrant workers is insufficient in view of the recent increase in medical fees. The perceived close working relationship between the ministries of health and immigration effectively excludes undocumented migrants from access to public healthcare facilities. Language barriers may affect the quality of care received by migrant workers, by inadvertently resulting in medical errors, while preventing them from giving truly informed consent.ConclusionsWe propose instituting migrant-friendly health services at public facilities. We also suggest implementing a comprehensive health insurance to enable healthcare access and financial risk protection for all migrant workers. Non-health sector solutions include the formation of a multi-stakeholder migration management body towards a comprehensive national policy on labour migration which includes health.

Exploratory qualitative study to understand the underlying motivations and strategies of the private for-profit healthcare sector in urban Bangladesh

ObjectivesThis paper explores the underlying motivations and strategies of formal small and medium-sized formal private for-profit sector hospitals and clinics in urban Bangladesh and their implications for quality and access.MethodsThis...

Cost-utility analysis of palonosetron in the antiemetic regimen for cisplatin-containing highly emetogenic chemotherapy in Japan

BackgroundAn antiemetic triplet regimen of 5-hydrotryptamine-3 receptor antagonist, dexamethasone, and aprepitant is the standard prophylaxis with highly emetogenic chemotherapy (HEC). A randomized phase III trial comparing palonosetron (PALO) versus granisetron (GRA) in the triplet antiemetic regimen (The TRIPLE study) showed the superiority of PALO over GRA for delayed-phase vomiting in patients receiving cisplatin-based HEC. However, economic efficiency evaluations including quality of life have not been done. The present study was a cost-utility analysis of PALO within the Japanese medical insurance system.MethodsThe data source was the results of the TRIPLE study. A decision tree was constructed to assess the incremental cost-effectiveness ratio (ICER) using quality-adjusted life years (QALYs) and the medical service fees and the drug price for 2018 from the perspective of the payer. A one-way sensitivity analysis and a probabilistic sensitivity analysis (PSA) were performed to assess the robustness of the model. A threshold analysis was performed to determine the cost-effective price of PALO.ResultsIn the base case, the estimated incremental effect of PALO addition was 0.000645 QALYs, the estimated incremental cost was 10,455 JPY (93.21 USD), and the ICER was 16,204,591 JPY QALY (144,465 USD/QALY). In the PSA, the probability of superior cost-effectiveness was 3.64%. In the threshold analysis, the acceptable price of PALO was estimated to be 7,743 JPY (69.03 USD).ConclusionsIf willingness-to-pay is taken as 5,000,000 JPY/QALY (44,575 USD/QALY), the antiemetic regimen using PALO for cisplatin-containing HEC was not cost-effective at this time. The cost of drugs, with the arrival of inexpensive generic drugs, will make a major contribution to its cost-effectiveness.

Effect of patient solicitation on mortality among patients receiving hemodialysis in Korea.

BackgroundThere is concern that overcompetition and illegal activities such as patient solicitation by some dialysis units may threaten patients’ health in Korea. Therefore, we investigated the effect of nephrologists’ patient-soliciting activity on hemodialysis practices and patients’ survival using the Korean Health Insurance Review and Assessment Service database.MethodsWe selected 19 soliciting hemodialysis facilities and matched them with 19 non-soliciting facilities located nearby to eliminate location bias. Soliciting behavior was defined as the reduction of medical fees or providing money to attract dialysis patients.ResultsA total of 2,231 incident dialysis patients were included and followed for a median of 37.2 months. Soliciting facilities had a lower percentage of nephrologists, a higher average daily number of hemodialysis patients per physician, and a higher number of hemodialysis patients per nurse compared with non-soliciting facilities. Survival analysis showed that the crude mortality was significantly higher in patients treated in soliciting facilities than in those treated in non-soliciting facilities, even after adjustment for the effects of many other independently predictive covariates.ConclusionsThis study demonstrated that in Korea, the overall mortality rate in incident dialysis patients was higher in those attending soliciting facilities than in those attending non-soliciting facilities.

Design and Development of a Life Insurance Mobile Application for Young Adults

In this modern era, accidents could occur anywhere any time before prevention can be made. Life insurance could help lend a sum of money to reimburse the medical fees. But not everyone has life insurance, some people think that life insurance is a waste of money where they think people should save money at an early age and only pay when there is actual accident occur. This occurs in young adults too. Some young adults do not know the knowledge of life insurance. Therefore, this study is conducted to help young adults understand and provide the awareness of the importance of life insurance by creating a mobile application on Android Operating System using Android Studio. This system was created based on waterfall system development life cycle and evaluated using cooperative evaluation method. The mobile application can display and provide the knowledge of life insurance and calculate the suggested life insurance plan for the user. Five participants were randomly selected for cooperative evaluation. They are young adults age between 20 to 25 years old and have their own income. Out of those five participants, two of them like the mobile application while the other three participants suggested several improvements on the developed mobile application.

A Call to Action Against Rising Medical Student Tuition

There is growing concern among medical students regarding the unprecedented increases in medical school tuition fees, which has been far exceeding inflation. One consideration is how these increasing fees and resulting debt may be impacting student demographics, particularly with respect to socioeconomic status, as well the types of clinical careers that medical students are pursuing, given the lower average salaries earned by primary caregivers. This second point is concerning given the shortage of primary care physicians in Canada.

PGI4 COST-EFFECTIVENESS ANALYSIS OF VEDOLIZUMAB IN ANTI-TNF-NAÏVE PATIENTS WITH MODERATE-TO-SEVERELY ACTIVE ULCERATIVE COLITIS IN JAPAN

Anti-tumor necrosis factor (anti-TNF) biologic agents, adalimumab, golimumab, and infliximab, are standard of care in Japan for patients with moderate-to-severely active ulcerative colitis (UC). Vedolizumab, an antibody to gut-selective α4β7 integrin, was recently approved by Japan’s Ministry of Health, Labor, and Welfare, based on favorable results from a phase III study in Japanese patients; however, vedolizumab’s long-term clinical and economic outcomes versus other biologics in patients with UC are unknown in Japan. We assessed the cost-effectiveness of vedolizumab versus other biologics for the treatment of anti-TNF-naïve patients with moderate-to-severely active UC from the Japanese Public Payer perspective. A hybrid decision tree and Markov model was developed to predict the number of patients who achieve response and remission at the end of the treatment induction phase and sustain it during the treatment maintenance phase. Treatment-related adverse events, discontinuation, and surgery were also modeled. A systematic literature review and network meta-analysis were conducted to estimate the comparative efficacy of each treatment. Rates of surgery and utilities were obtained from scientific literature. Costs (in 2018 Japanese Yen) of treatment, surgery, and disease management were derived from the National Health Insurance drug price list and medical fee table and a commercial database (JMDC Inc., Tokyo). Clinical and economic outcomes were projected over lifetime and discounted at 2% annually. Vedolizumab yielded greater clinical benefits and quality-adjusted life-years (QALYs), and cost savings compared with golimumab. Compared with adalimumab and infliximab, vedolizumab yielded greater clinical benefits and QALYs at a higher cost; the incremental cost-effectiveness ratios were ¥4,711,806 and ¥3,865,266 per QALY gained, respectively. Deterministic and probabilistic sensitivity analyses confirmed the results were robust. With a willingness-to-pay threshold of ¥5,000,000 per QALY gained in Japan, vedolizumab is cost-effective versus other biologics for the treatment of anti-TNF-naïve patients with moderate-to-severely active UC in Japan.

Comparative Cost-utility Analysis Between Aprepitant- and Fosaprepitant-containing Regimens To Prevent Chemotherapy-induced Nausea and Vomiting in Patients Receiving Highly Emetogenic Chemotherapy in Japan

PurposeClinical trials have shown that the addition of aprepitant (APR) or a phosphorylated prodrug of aprepitant, fosaprepitant (FosAPR) as prophylactic antiemetic therapy consisting of a 5-hydrotryptamine-3 receptor antagonist and dexamethasone is effective in patients receiving highly emetogenic chemotherapy. These combination therapies have been commonly used in Japan. In the present study, we performed a cost-utility analysis of APR and FosAPR in the context of the Japanese medical insurance system, and economic efficiency was compared. MethodsData from randomized controlled trials that examined the efficacy of APR and FosAPR in the Japanese population were used. A decision tree was constructed to estimate the effectiveness of chemotherapy for 5 days from the day of the treatment and the cost associated with outpatient chemotherapy from the perspective of a payer. Health outcome was expressed in quality-adjusted life-years (QALYs), and costs were estimated based on medical fees and drug prices from 2018. An incremental cost-effectiveness ratio (ICER) was calculated for each regimen containing either APR or FosAPR. The robustness of the model was assessed using 1-way and probabilistic sensitivity analysis. FindingsThe base-case analysis estimated that the addition of APR or FosAPR would have incremental effects of 0.00166 and 0.00143 QALY and incremental costs of 8305 and 11,348 JPY (74 and 101 USD [1 USD = 112.17 JPY]), resulting in ICERs of 4,992,172 and 7,955,560 JPY/QALY (44,505 and 70,924 USD/QALY), respectively. Sensitivity analysis revealed that the probability of a complete response for delayed chemotherapy-induced nausea and vomiting had the most influence on the ICERs. Reductions in the drug costs of APR and FosAPR also had an effect on the ICERs. According to the probabilistic sensitivity analysis, APR and FosAPR were dominant in terms of cost-effectiveness in 48.7% and 8.55% of cases, respectively. ImplicationsThe ICER of outpatient prophylactic antiemetic therapy in patients receiving highly emetogenic chemotherapy was calculated in the context of the Japanese medical insurance system. Assuming the willingness-to-pay of 5,000,000 JPY/QALY based on the calculated ICER, our findings suggest that although the addition of APR is cost-effective, FosAPR is not cost-effective.

Diagnostic Behavior for Mild Cognitive Impairment in General and Neuropsychiatric Practices in Germany.

Little is known about the diagnostic methods currently used in routine care for patients with mild cognitive impairment (PwMCI). We estimated the frequency of diagnostic procedures in incident PwMCI compared to incident patients with dementia (PwD) in 2016-2017. The study is based on the Disease Analyzer database. After matching by age and sex, 4,700 PwMCI and 4,700 PwD were available. The diagnostic procedures were identified on the basis of the related medical fee schedule items. All diagnostic procedures were used more frequently in PwMCI than in PwD. The drafting of a practice-oriented MCI guideline is an important task for the future.

Variations in Medicaid Payment Rates for Radiation Oncology

Interstate variations in Medicaid reimbursements can be significant, and patients who live in states with low Medicaid reimbursements tend to have worse access to care. This analysis describes the extent of variations in Medicaid reimbursements for radiation oncology services across the United States. The Current Procedural Terminology codes billed for a course of whole breast radiation were identified for this study. Publicly available fee schedules were queried for all 50 states and Washington, DC, to determine the reimbursement for each service and the total reimbursement for the entire episode of care. The degree of interstate payment variation was quantified by computing the range, mean, standard deviation, and coefficient of variation. The cost of care for the entire episode of treatment was compared to the publicly available Kaiser Family Foundation (KFF) Medicaid-to-Medicare fee index to determine if the pattern of payment variation in medical services generally is predictive of the variation seen in radiation oncology specifically. Data were available for 48 states and Washington, DC. The total episode reimbursement (excluding image guidance for respiratory tracking) varied from $2945 to $15,218 (mean, $7233; standard deviation, $2248 or 31%). The correlation coefficient of the KFF index to the calculated entire episode of care for each state was 0.55. There is considerable variability in coverage and payments rates for radiation oncology services under Medicaid, and these variations track modestly with broader medical fees based on the KFF index. These variations may have implications for access to radiation oncology services that warrant further study.

Current Status and Issues of Nursing for People with both Mental Illness and Diabetes:Toward Future Medical Fee Evaluation in the Revision of Medical Fees

Current Status and Issues of Nursing for People with both Mental Illness and Diabetes:Toward Future Medical Fee Evaluation in the Revision of Medical Fees

Incidence of Fall Accident in Suseong District of Daegu Metropolitan City, Republic of Korea

Background: Among the various types of injuries in the world, falls are one of the most important health problem related issues, especially for modern societies with aged populations. Korea, a country where industrialization and urbanization have made building structures and living spaces complex, has also been facing the emerging danger of falls. So, among the causes of death due to unintended injury accidents, falls are second reason of injury worldwide following traffic accidents. Falls are important causes in increase of morbidity rates, hospitalization rates, death rates and medical fees. Falls are not unfortunate accidents rather, they are preventable and predictable. Therefore, we needs to identify the incidence and causes of falls. Objectives The purposes of this study are to identify the incidence of fall accident in Suseong district of Daegu metropolitan city and to develop the evidence based fall accident program for Suseong district. Methods: In order to identify the incidence of falls of the citizens of Suseong district, authors analyzed the annual report on the causes of death statistics from the National Statistical Office and the injury data from Fire Station 119 Rescue Activity Daily Record. As well, in order to understand the current state of falls in households, an epidemiological survey was conducted to people from 1,977 households in Suseong district by home visited. The collected data were analyzed using SPSS WIN 17.0 based on the research objectives, and the frequency and percentages were investigated. Results: According to the data from the National Statistical Office, the death rate due to falls was 4.1 people (per 100,000 persons). In terms of age, elders aged 65 and over was the highest death rate with 17.0 out of 100,000 persons. In the injury transfer rate analyzed from rescue records of 119, accidents due to falls were highest with 2.3 cases out of 1,000 persons. In terms of age, elders aged 65 and over was the highest injury rate with 9.2 out of 1000 persons. After analyzing the injury causes of the citizens of Suseong district through household visits, the highest rate of falls was 43.7%, followed by traffic accidents (24.9%) and bump injuries (21.1%). Therefore, we were able to confirm once again that the fall prevention program is a very important program for improving the safety of citizens. Housework (29.4%) was the most common cause of falls. The most common places for falls were living rooms (22.6%), followed by restrooms and entrance. Conclusion: Mortality due to falls can be reduced through education, environmental improvements, and safety policies. It is necessary to conduct preventive education for elderly people who are vulnerable to falls, and to apply gymnastic exercises that can enhance balance and lower extremity muscle strength. In addition to, it is necessary to strengthen regulations on safety facilities at the senior community center. Therefore the government and related organizations should put fall prevention as the primary task and spread an effective evidence-based fall prevention program based on result of research.

Recognition Survey Among Outpatient Nurses on Medical Treatment Fees for Diabetes Nursing

Recognition Survey Among Outpatient Nurses on Medical Treatment Fees for Diabetes Nursing

Investigation of transition from pediatric to adult health care for patients with special health-care needs for neurological disease dating from childhood

We investigated the patients followed in our hospital's adult neurology department to evaluate issues during the transition from pediatric to adult health care for patients with special health-care needs for neurological diseases. There has been an increase in the number of transition patients, and they were often recommended for the transition by pediatricians. Many patients had complications such as epilepsy, and there were also patients with an intractable disease. Therefore, patients undergoing this transition need neurologists. The transition requires a long time, and there is a difference in the medical administrative fees between pediatric and adult health care. The Japanese Society of Neurology and related societies need to take measures to improve these health-care transitions.

Development of a Novel Home Based Multi-Scene Upper Limb Rehabilitation Training and Evaluation System for Post-Stroke Patients

Upper limb rehabilitation requires long-term, repetitive rehabilitation training and assessment. However, many patients cannot afford for heavy medical fees. It is necessary to design an effective, low-cost, and reasonable home rehabilitation and evaluation system. In this paper, we developed a novel home-based multi-scene upper limb rehabilitation training and evaluation system for post-stroke patients. Based on the Kinect sensor and the posture sensor, the multi-sensors fusion method was used to track the motion of the patients. Multiple virtual scenes were designed to encourage rehabilitation training of upper limbs and trunk. A rehabilitation evaluation method was proposed integrating Fugl-Meyer assessment (FMA) scale and upper limb reachable workspace relative surface area (RSA). Furthermore, an FMA-RSA assessment model was established to assess an upper limb motor function. Correlation-based dynamic time warping was used to solve the problem of inconsistent upper limb movement path in different patients. Two clinical trials were conducted. The experimental results show that the system is very friendly to the subjects. The rehabilitation assessment results by this system are highly correlated with the therapist's (the highest forecast accuracy was 92.7% in the 13th item). It also reveals that long-term rehabilitation training can improve the upper limb motor function of the patients statistically significant (p=0.02 <; 0.05). The system has the potential to become an effective home rehabilitation training and evaluation system.

A comparison of correction methods for medical fee revisions in health expenditure analyses using claims data

A comparison of correction methods for medical fee revisions in health expenditure analyses using claims data