Cost Of Medical Services Research Articles

Оценка конкурентной среды на рынке медицинских услуг: взгляд потребителей

The article presents the assessment of the competitive environment in the market of medical services (on the example of Krasnodar region) using the main criteria of consumer behaviour, such as the degree of public satisfaction with the level of prices for medical services, the quality and accessibility of health services; identified the main factors affecting consumer choice of medical organization; provided direction to improve the situation on the market of medical services.
 The purpose of the study is to assess the state of the competitive environment in the medical services market using the main criteria of consumer behavior (for example, in the Krasnodar region).
 The achievement of the research goal predetermined the formulation and consistent solution of the following interrelated tasks:
  analyze the state of the competitive environment in the medical services market of the Krasnodar territory; 
  determine the factors that influence the consumer's choice of primary care organizations; the level of consumer satisfaction with the availability of primary care organizations, the quality and cost of medical services;
  based on the results of the study, assess the state of the competitive environment in the medical services market of the Krasnodar territory.
 When compiling a review of literature sources on the research topic, the method of content analysis was used. Analytical results of assessing the state of the competitive environment in the medical services market of the Krasnodar territory were obtained using statistical and sociological research methods – a survey and survey of medical services consumers.
 The results obtained during the research will be useful in the development of strategic documents and initiatives to create a favorable competitive environment in the medical services market of the Krasnodar region.

The medical organization of primary care: competitiveness and reputation

The article investigated the state of the competitive environment on the market of medical services of the Krasnodar territory, which included socio-economic indicators needed to understand current market conditions such as the number of medical organizations of primary care and health manpower; the volume of paid medical services, rendered to population of the region and individual costs for medical services; the investment performance of the industry, the possibility of participation of private medical organizations in the implementation of the Territorial program of obligatory medical insurance. The author's interpretation reveals the concept of «business reputation of a primary-level medical organization». It is proved that the «business reputation» on the Internet or online reputation has become a strategic tool for ensuring the competitive advantages of a primary - level medical organization. The content analysis of Internet resources conducted in the study showed that the online reputation of a primary care organization is primarily patient reviews (negative and positive), and online reputation management in the Internet is continuous work with patient reviews, the process of communicating with the audience, publishing information materials, etc. Monitoring popular sites on this topic prodoctorov.ru and Yandex. Search and analysis of patient reviews of medical organizations in Sochi allowed the authors to assess the online reputation of primary care organizations. In conclusion, the article presents an algorithm for managing online reputation on the Internet to ensure the competitiveness of primary care organizations.

A real-world study evaluating the relative vaccine effectiveness of a cell-based quadrivalent influenza vaccine compared to egg-based quadrivalent influenza vaccine in the US during the 2017–18 influenza season

BackgroundCell-based influenza vaccine manufacturing reduces egg adaptations that can decrease vaccine effectiveness. We evaluated the relative vaccine effectiveness (rVE) of cell-based quadrivalent influenza vaccine (QIVc) compared to standard-dose egg-based quadrivalent influenza vaccines (QIVe-SD) against influenza-related and serious respiratory events among subjects 4–64 years of age during the 2017–18 influenza season. MethodsA retrospective cohort analysis was conducted using administrative claims data in the US (IQVIA PharMetrics Plus® database). Subjects vaccinated with QIVc or QIVe-SD from 8/2017–1/2018 were identified (date of vaccination termed the index date). Influenza-related hospitalizations/ER visits, all-cause hospitalizations and serious respiratory hospitalizations/ER visits were assessed post-vaccination. Inverse probability of treatment weighting (IPTW) and Poisson regression were used to evaluate the adjusted rVE of QIVc compared to QIVe-SD. In a subgroup analysis, rVE was assessed for several subgroups of interest (4–17, 18–64 and 50–64 years, and subjects with ≥1 high-risk condition). In a secondary economic analysis, annualized all-cause costs over the follow-up were compared using propensity score matching (PSM) and generalized estimating equation (GEE) models. ResultsThe study sample comprised 555,538 QIVc recipients and 2,528,524 QIVe-SD recipients. Prior to adjustment, QIVc subjects were older and had higher total costs in the 6-months pre-index. Following IPTW-adjustment and Poisson regression, QIVc was more effective in reducing influenza-related hospitalizations/ER visits, all-cause hospitalizations, and hospitalizations/ER visits related to asthma/COPD/bronchial events and other respiratory events compared to QIVe-SD. Similar trends were generally observed in the subgroup analysis. Following PSM adjustment and GEE regression, QIVe-SD was associated with significantly higher annualized all-cause total costs compared to QIVc, driven by higher costs for outpatient medical services and inpatient hospitalizations. ConclusionsAfter adjustment for confounders and selection bias, QIVc reduced influenza-related hospitalizations/ER visits, all-cause hospitalizations, and serious respiratory hospitalizations/ER visits compared to QIVe-SD. QIVc was associated with significantly lower all-cause total costs.

Analysis of medical expenses of inpatients with diabetes: China's Eastern, Central, and Western regions (2013–2015)

ObjectiveWith the continuing rise in the global incidence of diabetes, the prevention of diabetes and control of associated medical expenses has become a public health issue worldwide. This study aims to identify the medical expenses of patients with diabetes in different regions of China and examine the differences in inpatient medical expenses and the impacts of them on these patients. Study designThis study is a longitudinal analysis of medical expenses for inpatients with diabetes for different years; horizontal analysis of medical expenses among different regions; and literature review. MethodsData were derived from China's Medical Insurance Department database. We selected inpatients with diabetes in the eastern, central, and western regions of China for the period 2013–2015 and randomly selected data through systematic sampling. ResultsAmong the 4150 patients with diabetes considered in this study, the patients' medical expenses were found to differ significantly across regions, years, ages, medical insurance types, medical institution levels, total medical expenses, medical insurance fund payments, and out-of-pocket (OOP) expenses. In addition, there were significant differences in total medical expenses for male and female patients. Furthermore, medical insurance type, patients' age, medical institution level, and year significantly influenced total medical expenses. ConclusionsInpatients with diabetes in different regions exhibited significant differences in total medical expenses, medical insurance fund payments, and OOP expenses. China should invest more in chronic disease treatment in its central and western regions, narrow the regional differences in medical expenses, and endeavor to ensure equity in the availability and cost of medical services. Moreover, patients with diabetes must be encouraged to access primary care to reduce their medical expenses.

The Quality of Higher Medical Education: Students’ Perceptions and Assessments

Introduction. The medical education system requires modernization and adaptation to the needs of modern society. The dissatisfaction of the population with the low professional competence of doctors at the rising cost of medical services requires new principles for tuning the educational system of medical workers. The topical question is whether the medical education system should be changed with the account of not only teachers’ vision but students’ requests as well. The purpose of the article is to reveal the perceptions of students of medical universities in Russia about quality medical education, to identify the attitudes to the existing forms and methods of learning, expectations from the a dministration and teaching staff. Materials and Methods. The research design is based on a combination of quantitative and qualitative methods. A survey of 3 249 students representing 45 universities subordinate to the Ministry of Healthcare of Russia was conducted. To increase the reliability of the results and the interpretation of quantitative data at the second stage, the interviews with students, clinical residents and graduate students of medical institutions of higher learning were conducted. Results. The article defines the dependence of assessing the quality of education on attitudes toward academic mobility: the higher students evaluate the experience of participating in academic mobility, the higher they assess the quality of Russian medical education. Russian medical education, possessing institutional autonomy, which allows for modernization of the content and methods of implementing educational programs, comes across restrictions caused by oversupply of students to the universities in the situation of undersupply of facilities, and the underdevelopment of norms regulating the participation of medical students in medical activities. Discussion and Conclusion. The results can be used by university leadership in determining the directions of development of educational activities with a focus on student-centered learning in order to increase students’ motivation and commitment to quality education.

Household Health Care Expenditure and Utilization of Health Care Services: A Study in Dibrugarh District of Assam

Indian health care system is a complex one with the existence of high out of pocket health expenditure, low spending on health sector and also high cost of medical services etc. Increasing cost of medical services has become a serious concern over the years, heavy amounts of medical expenses creates financial pressure on households and the situation become more worse when they do not have any kind of financial protection and an even source of income. The aim of the present study was to investigate the utilisation and expenditure on health care services at household level. This study was conducted among 225 households of Dibrugarh district of Assam. There were 719 reported illness cases during the reference period, out of which 85.2% cases were treated at medical institutions, 9.3% cases were not treated due to financial constraints. The coverage of health insurance was found to be very low, only 12.45% households had any kind of health insurance. In the absence of any kind of financial support from any sources, some households had to borrow for medical expenditure. Expenditure per illness cases was highest in private hospital; sample households incurred average monthly expenditure of 11.35% of their income on health care. Regression analysis revealed that income, place of residence and educational qualification of the head of the household were the significant determinants of household health care expenditure. It is necessary for the government to improve health infrastructure, spending on health sector must be increase along with. Expansion of health insurance coverage particularly in rural and remote areas is much needed so that people can understand the benefits of being enrolled in health insurance.

Analysis of direct economic burden of occupational asthma

Objective: To analyze the direct economic burden of occupational asthma patients and provide economic basis for the government to rationally allocate health resources. Methods: In September 2019, colleted the case data of 53 patients diagnosed with occupational asthma who were hospitalized in our hospital from December 2008 to December 2018, and analyze the impact of gender, age, diagnosis time, ducation level, allergen type to the length of stay, hospitalization cost, medical technology diagnosis and treatment costs, western medicine costs, average daily hospitalization costs and other indicators. Results: The average length of hospitalization for occupational asthma patients was (38.7±8.1) days, and the average hospitalization cost was 14743 yuan, of which medical technology diagnosis and treatment costs, western medicine costs, and comprehensive medical service costs accounted for the top three, 42.5% (331977/781369) , 32.0% (249942/781369) , 19.6% (153268/781369) respectively. Hospitalization days for occupational asthma patients has decreased significantly in 2014-2018 (P<0.05) . There were no significant differences in hospitalization costs, medical technology diagnosis and treatment costs, western medicine costs, and average daily hospitalization costs for occupational asthma patients caused by different allergens (isocyanates, persulfates and phthalic anhydrides) (P>0.05) . Hospitalization days, hospitalization costs, medical technology diagnosis and treatment costs, western medicine costs, and average daily hospitalization costs of patients with moderate occupational asthma were significantly higher than those of mild patients (P<0.05) . Conclusion: Early detection of occupational asthma patients and early intervention can reduce the economic burden on patients and society.

Analysis of the Competitive Advantages of Kazakhstan Medical Services in Terms of Attracting Foreign Patients

Aim. To analyse the current state of the medical services market in Nur-Sultan (Kazakhstan) in terms of providing medical care to foreign patients.Materials and methods. The dynamics of medical tourism in Nur-Sultan was identified using the method of retrospective analysis. The main clinics providing medical tourism services in the capital city of Kazakhstan were characterised in terms of their advantages over competitor centres.Results. A prerequisite for the development of medical tourism in a certain country is the development of the whole country as a tourist destination. The recognition of a country as a safe destination by international tourism rankings contributes to the confidence of medical tourists in the quality of the services provided. The following advantages of Nur-Sultan determining its potential as a medical tourism destination were identified: access to modern medical technologies and new facilities; a large number of medical institutions accredited by the Joint Commission International (JCI); a wide range of medical directions; a convenient geographical location; reasonable costs of medical services; security and political stability; the lack of a language barrier for patients from the Commonwealth of Independent States (CIS).Conclusions. The capital city of Kazakhstan demonstrates a growing trend in the number of medical tourists. The largest number of tourists is currently from the CIS countries: Uzbekistan, Kyrgyzstan and Russia. It can be considered that, under a proper governmental policy, Kazakhstan’s potential as a medical tourism destination will be realised in the nearest future.

The pharmacoeconomic analysis of olaparib (Linparza®) application for the supporting therapy of patients with BRCA-mutated platinum-sensitive recurrent ovarian cancer

Among women, one of the common localizations of malignant tumors is ovarian cancer (OC). Two genes have been identified, and their mutations lead to hereditary forms of breast and ovarian cancer – BRCA1 and BRCA2. Women with BRCA-associated OC respond better to targeted drugs and have better survival rates against specific treatments. Targeted drugs for the treatment of BRCA-mutated OC are specific inhibitors of enzymes of the group poly- (ADP-ribose) polymerase (PARP). Currently, the only PARP inhibitor registered in Ukraine is olaparib (Linparza® drug, AstraZeneca, United Kingdom).Aim. To assess the economic feasibility of the targeted olaparib therapy (Linparza® drug) for patients with BRCA mutated platinum-sensitive recurrent ovarian cancer (BRCA-MPS ROC) from the standpoint of the Ukrainian healthcare system.Materials and methods. Determination of treatment outcomes and associated costs was performed using Markov analytical modeling based on the results of a randomized multicenter, open-label phase II clinical trial D0810C0019-Study 19. The model time horizon is 15 years. Clinical efficacy and safety of olaparib and placebo (WW strategy) were compared as the supportive therapy for patients with BRCA-MPS ROC. Based on the results of Markov simulation the methods of “cost-effectiveness” and “cost-utility” were used. Years of the saved life (LYG) were used as a criterion of efficiency. The QALY index was used as a criterion of utility. The cost of direct medical expenses, which structure was determined in accordance with the current Protocol, was taken into account. The cost of medical treatment was determined according to the register of the Ministry of Health of Ukraine as of 7.08.2019. The cost of medical services was determined according to the available price lists. The cost of correction of side effects of the chemotherapy was also considered. Discounting was determined at the level of 5 % annually. The sensitivity analysis of the results was performed on the price and dose of olaparib and the observation horizon.Results. According to the simulation, the average life expectancy of patients with BRCA mutated platinum-sensitive recurrent ovarian cancer when using olaparib (Linparza® drug) as a supportive antitumor therapy is 4.8 LYG compared to 2.56 LYG in the WW strategy group. The olaparib supportive care strategy provides the patient with 3.61 years of quality of life compared to 1.87 years in the WW group. Thus, the use of olaparib provides the patient with an additional 2.24 years of life and 1.74 additional QALY. The total costs for the simulated period in the group of olaparib averaged 1893410.7 UAH, and in the WW group – 47466.9 UAH. The incremental coefficients of ICER (cost of 1 additional year of life) and ICUR (cost of 1 additional year of quality life) amounted to 824564,4 UAH, and 1063162.2 UAH, respectively.Conclusions. The pharmacoeconomic analysis based on Markov modeling and cost-effectiveness and cost-utility calculations has shown that olaparib (Linparza® drug) is highly effective in the treatment of BRCA-mutated platinum-sensitive recurrent ovarian cancer; it almost doubles the patients’ survival without recurrence. At the same time, olaparib is an expensive drug. The transition of half of the patients with BRCA-mutated platinum-sensitive recurrent ovarian cancer from the “watch-and-wait” strategy to the treatment with olaparib requires an additional annual cost of 10,548,250.3 UAH.

Insights on Hysteroscopic Procedures and Their Place in Romanian Gynecologic Practice-The Experience of Two Medical Units.

Hysteroscopy has known an increasing use in Romania over the last decade, succeeding to mark an impact on lowering the costs of medical services. The strategy of this study was to present the experience of two Romanian medical units with different experiences using inpatient regimen hysteroscopy, and to further compare it with current worldwide tendencies. Strong points in our practice were sought, as well as components that require improvement. Overall, abnormal uterine bleeding stands for most hospital case presentations in our study group; hysteroscopy had the highest accuracy and positive predictive value in identifying uterine myomas: 91.03% and 100%, respectively; for endometrial polyps, statistical analysis showed the highest sensitivity: 100%, with 83.89% specificity and a 77.64% positive predictive value. The applicability of hysteroscopy was further described for infertility cases and isthmocele repair.

PCN116 HEALTHCARE RESOURCE UTILIZATION AND COSTS OF METASTATIC HEAD AND NECK CANCER PATIENTS IN A U.S. CLAIMS DATABASE FROM 2014 TO 2018

To describe all-cause and cancer-related healthcare resource utilization and costs of pharmacy and medical services recorded in the Truven MarketScan® database from January 1, 2014 until September 30, 2018, and estimate the average cost of one unit or episode of selected medical services. A retrospective cohort design was used. Patients who had qualifying diagnoses of head and neck cancer and metastatic cancer, and continuous enrollment for 12 months prior and 1 month following, were included. Patients were stratified by length of follow-up. Demographic information, healthcare resource utilization, and costs (total, payer, and patient) were reported descriptively. 1,483 patients with metastatic head and neck cancer were included in this analysis with a median follow-up of 7.36 months. In the sub-population analysis of patients with newly diagnosed metastatic head and neck cancer and up to 15 months of follow-up (N=976), the most common all-cause resources used during the follow-up period were office/clinic visits (931 patients, 95%), outpatient hospital visits (958, 98%), and inpatient hospital visits (573, 59%). Furthermore, in this sub-population, all-cause median costs for all settings in the follow-up were as follows: $16,712.67/month total payment, $368.97/month paid by patient, and $16,291.23/month paid by payer. Finally, the average all-cause visit unit cost total payment in the follow-up of the most commonly used resources were $508.45 for office/clinic, and $2,812.49 for outpatient hospital. With the advent of immuno-oncologic (I-O) agents, treatment options available to patients for recurrent or metastatic squamous cell carcinoma of the head and neck have expanded. There have been few evaluations of changes in economic burden since I-O availability. This study provides additional evidence to inform healthcare resource utilization and costs in patients with metastatic head and neck cancer.

The hospital-substituting technologies: condition and strategic tasks of their development

The program of state guarantees of free medical care of citizens for 2019 and up to 2020-2021 plans to reduce volume of inpatient medical care through development of hospital-replacing technologies. The economic feasibility of hospital-replacing technologies is in significantly lower cost of medical services in a day hospital as compared with twenty-four hours hospital (UPC). However, the existing legislative framework and the lack of proactive financial mechanisms do not stimulate development of hospital-replacing technologies. The purpose of study is to analyze reporting data and results of SWOT analysis of rating of factors affecting introduction of day hospitals, On the basis of analysis the strategic objectives of development of hospital-replacing technologies are formed. The study applied statistical analysis, direct observation, sociological survey, SWOT analysis. The analysis was applied to data from forms of Federal statistical observation No. 14 and industrial statistical monitoring No. 14 for 2009-2018. Based on results of SWOT analysis, experts were interviewed by the heads of health care authorities and medical organizations regarding development of strategy of medical care of children with disabilities. The expert survey was carried out with health care managers in Moscow, the Moscow oblast, Orenburg, Chelyabinsk, Samara, Ivanovo, Ryazan oblasts and the Republic of North Ossetia-Alania. The analysis established that in 2018 the number of medical care organizations increased up to 6495, including medical institutions providing outpatient medical care (41.4%) and in-patient medical care (58.6 %). The analysis demonstrated that percentage of treated patients in day hospitals out of the total number of hospitalized patients (in hospitals was 29,1% in 2018, while in 2009 this percentage was significantly lower - 15,6%, which indicates the intensification of the use of the bed fund of the UPC, which to some extent is associated with increased development of hospital-replacing technologies. The results of SWOT analysis demonstrated that the strategic objectives of development of hospital-replacing technologies should be targeted to develop financial stability of health care, active position of the heads managers of health care institutions and medical organizations and introduction of innovations if needed. It is necessary to develop modern management methods, rational application of health care resources, implementation of economic incentives in all components of health care system, ensure functioning of the system, including effective contract.

Impact of Behavioral Health Homes on Cost and Utilization Outcomes.

This study evaluated the impact of two behavioral health home (BHH) approaches, provider-supported care and self-directed care, on health care utilization and cost outcomes among adult Medicaid recipients with serious mental illness. Eleven community mental health provider sites were randomly assigned to one of the BHH approaches, which each site implemented over a 2-year period. In both approaches, staff were trained in wellness coaching to support patients' progress toward general health and wellness goals. Provider-supported sites employed a full-time on-site registered nurse, who provided consultation to patients and wellness coaches. Each approach had a consistently enrolled treatment group (combined N=859) with a matched comparison cohort that was identified for analysis. Approaches were compared with each other and with baseline, and differences between each approach and its comparison cohort were examined by using analysis of covariance to determine impact on total health care cost, prescription costs, and use and cost of general medical and behavioral health services. Relative to its comparison cohort, each approach achieved significant reductions in total cost (15% for provider-supported care and 26% for self-directed care) and increases in use of outpatient general medical services (43% for provider-supported care and 29% for self-directed care). Compared with self-directed care, provider-supported care resulted in approximately 28% lower use of general medical inpatient services and 26% lower related costs. BHH approaches in community mental health settings can produce health care savings and decrease use of inpatient health care.

Expectations from a private multi-speciality hospital: a moderated-mediation analysis

PurposeA highly competitive market incentivizes private healthcare providers to deliver high quality services. The purpose of this paper is to identify the perceived expectations of a new private multi-speciality hospital in a non-metro city. To this end, the paper develops a model using identified relevant factors.Design/methodology/approachA structured questionnaire was administered to 900 people. Exploratory factor analysis and confirmatory factor analysis were then applied to the data, and partial least square-structural equation modelling was used to test the moderated mediation model.FindingsWord-of-mouth and safety (WM) and access to the hospital and the cost of medical services are found to be important factors for the perceived expectations of the hospitals by medical facility and treatment at a hospital. High quality medical facilities can lead to improved perceived expectations of hospitals, mediated by positive WM. Levels of access to the hospital and the cost of services can significantly moderate the perceived expectations of a hospital, despite good medical facilities.Practical implicationsThe study has implications for policymakers and hospital authorities in the context of private sector multi-speciality hospitals in non-metro cities. It will help healthcare managers and service providers to better understand customer perceived expectations, and thereby develop effective strategies for customer service. Decision-makers are encouraged to focus on positive word-of-mouth and enhancement of customer safety to bring about favourable expectations of hospitals. Beyond merely having excellent medical facilities, hospitals that ensure ease of access to the hospital and keep costs low can achieve positive consumer expectations and satisfaction levels.Originality/valueThe paper makes three novel contributions as follows: the mere presence of high quality medical facilities and practices does not equate to positive expectations about the hospital among the patients; access to the hospital and the cost of its services are important in bringing about positive expectations among healthcare consumers; and WM can significantly moderate positive expectations of the hospital. The authors are not aware of any of these findings being previously reported.

Tyrosine Kinase Inhibitors and the Relationship With Adherence, Costs, and Health Care Utilization in Commercially Insured Patients With Newly Diagnosed Chronic Myeloid Leukemia: A Retrospective Claims-Based Study.

To examine the association among tyrosine kinase inhibitor (TKI) out-of-pocket costs, adherence, and health care costs and utilization in a large group of commercially insured patients with chronic myeloid leukemia (CML). Patients with CML aged 18 to 64 years were identified using IBM MarketScan Commercial Database between April 1, 2011 and December 31, 2014. Patients were required to be continuously enrolled 3 months before and 12 months after TKI (imatinib, dasatinib, or nilotinib) initiation. TKI adherence is estimated using the proportion of days covered (PDC), defined as the percentage of the PDC by the prescription fill during the 12-month study period (adherent patients have PDC ≥80%). Health care cost differences between adherent and nonadherent patients were estimated using generalized linear models. Health care utilization was compared using negative binomial regression models. All models were controlled for potential confounding factors. The study sample consisted of 863 patients, where 355 (41.1%) patients were classified as adherent. Over the study period, nonadherent patients incurred US$10,974 more in medical costs (P<0.001), and US$1663 more in non-TKI pharmacy costs (P<0.01). Adherent patients incurred US$28,184 more in TKI pharmacy costs (P<0.001) that resulted in US$18,305 more in overall total health care costs (P<0.001). Adherent patients, however, were estimated to be less likely to have all-cause hospitalizations (incidence rate ratio, 0.32; P<0.001), or CML-specific hospitalizations (incidence rate ratio, 0.31; P<0.01). Patients with CML with better adherence experienced fewer hospitalizations, resulting in medical service cost savings. These lower medical costs, however, were more than offset by higher TKI medication costs observed during the first year of TKI therapy.

Comorbidity in lung cancer patients and its association with medical service cost and treatment choice in China

BackgroundIt is evident that comorbidity exacerbate the complexity of the management of lung cancer, however, limited research has been conducted to investigate the impact of comorbidity on health service utilization and cost, as well as the treatment choice among lung cancer patients. We examined the association of comorbidity with medical service utilization, cost and treatment choice among lung cancer patients in China.MethodsWe used claims data from China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) between 2013 to 2016 and data from Hospital Information System (HIS) Database in Beijing Cancer Hospital (BCH). Elixhauser Comorbidity Index was used to assess comorbidity. Negative binomial regression, generalized linear model (GLM) with a gamma distribution and a log link, and logistic regression was applied to assess the associations between comorbidity and medical service utilization, cost and treatment choice, respectively.ResultsAmong 8655 patients with lung cancer, 31.3% of had at least one comorbid conditions. Having comorbidity was associated with increased number of annual outpatient visits (1.6, 95%CI: 1.3, 1.9) and inpatients admissions (0.8, 95%CI, 0.70, 0.90), increased outpatient (USD635.5, 95%CI: 490.3, 780.8) and inpatient expenditure (USD2 470.3, 95CI%: 1998.6, 2941.9), as well as increased possibility of choosing radio therapy (OR: 1.208, 95%CI:1.012–1.441) and chemotherapy (1.363, 1.196–1.554), and decreased possibility of choosing surgery (0.850, 0.730–0.989). The medical utilization and expenditure, the possibility of choosing radiotherapy increases, and the possibility of choosing surgery decreases with the increasing number of chronic conditions. There are variations in the association with medical service utilization and expenditure, and treatment choice among individuals with different types of comorbid conditions.ConclusionComorbidity among lung cancer patients restricts the potential treatment choices and poses an extra substantial health care burden. Our findings provide implications for both the clinical management and health service planning and financing for lung cancer patients.

Impacts of government supervision on hospitalization costs for inpatients with COPD

To address the remaining medical misconducts after the zero-makeup drug policy (ZMDP), e.g., over-examinations, China has given the priority to government supervision on medical institutions. This study evaluated the effect of government supervision on medical costs among inpatients with chronic obstructive pulmonary disease (COPD) in Sichuan province, the first province in China where the medical supervision was conducted.A linear interrupted time series (ITS) model was employed to analyze data about 72,113 inpatients from 32 hospitals. Monthly average medicine costs, diagnostic costs, and medical services costs, nursing costs from January 2015 to June 2018 were analyzed, respectively.The average hospitalization costs fell with a monthly trend of 42.90Yuan before the implementation of supervision (P < .001), and the declining trend remained with the more dramatic rate (−158.70Yuan, P < .001) after the government audit carried out. For western medicine costs, the monthly decreasing trend remained after the implementation of supervision (−66.44Yuan, P < .001); meanwhile, the monthly upward trend was changed into a downtrend trend for traditional Chinese medicine costs (−11.80Yuan, P = .009). Additionally, the increasing monthly trend in average diagnostics costs disappeared after government supervision, and was inversed to an insignificant decreasing trend at the rate of 26.18Yuan per month. Moreover, the previous upward trends were changed into downward trends for both medical service costs and nursing costs (P = .056, −44.71Yuan; P = .007, −11.17Yuan, respectively) after the supervision carried out.Our findings reveal that government supervision in Sichuan province was applicable to curb the growth of medical costs for inpatients with COPD, which may reflect its role in restraining physicians’ compensating behaviors after the ZMDP. The government medical supervision holds promise to dismiss medical misconducts in Sichuan province, the experience of which may offer implications for other regions of China as well as other low- and middle-income countries.

The Economic Determinants of the World Medical Tourism Industry Development

The paper considers the main types of medical tourism – diagnostic-therapeutic, health and beauty, and health resort treatment. It specifies the basic prerequisites for development of the international medical tourism industry – cost and quality of medical services, accreditation of medical institutions in compliance with international quality standards; development of medical tourism clusters.

Potential cost savings for selected non-pharmacological treatment strategies for patients with Alzheimer's disease in Finland.

To compare the costs and monetary benefits of non-pharmacological interventions for patients with Alzheimer's disease in real-world settings. A systematic review was performed to determine the most effective treatment strategies for being able to stay at home for patients with Alzheimer's disease. Care-management, family support, and multidisciplinary rehabilitation were identified as effective interventions applicable in the Finnish healthcare setting. Data on medical and social service costs, and the costs of residential care for all patients newly diagnosed with Alzheimer's disease in 2 major cities in Finland were analysed in a 4-year follow-up study. The potential cost savings of the different treatment strategies were assessed. The annual cost increased from €9,481 to €28,400 (mean per patient) during the 4-year follow-up. Cost savings were achieved in care-management, family support programmes, and rehabil-itative cognitive and social activation if the patients' transition to long-term care was delayed by 2.8, 1.8 and 43.0 days, respectively. Care-management and informal caregiver support for patients with Alzheimer's disease may benefit patients and result in concurrent cost savings. Delaying the decline in cognitive and social functioning through rehabilitation is indicated for more severe phases of Alzheimer's disease, and the costs appear to be compensated by savings in the cost of long-term care.

УПРАВЛЕНЧЕСКИЙ УЧЕТ В СИСТЕМЕ УПРАВЛЕНИЯ МЕДИЦИНСКОЙ ОРГАНИЗАЦИЕЙ

The emergence and growth of the number of market-oriented organizations led to the introduction of management accounting into economic life. A well-established system of management accounting and reporting for managers of different levels is necessary for the highly effective work of a modern medical organization. At the same time, innovative approaches to management, the emergence of new forms of economic relationships, the constantly growing information needs of managers of the organization, the increase in the level of socialization and intellectualization of society have led to the emergence of new accounting objects. The allocation of management accounting in the system of economic accounting, along with accounting, statistical, operational and tax, is fixed at the legislative level. However, the organization determines the formation of this type of accounting to meet the information needs of management independently, which is also stipulated by law. The theoretical and methodological aspects of management accounting have been studied by many foreign and domestic scientists, but today the potential of accounting in the field of management of health care institutions, the essence of its system methodology, without understanding which the full use of its tools is complicated. There are no studies that would comprehensively cover the problems of management accounting in medical organizations in this area, which has determined the relevance and timeliness of this work. The article is devoted to the organization and management of accounting in medical organizations. The article substantiates the need to implement management accounting in the management system of a medical organization. The introduction of management accounting is considered as one of the factors for improving the efficiency of the medical organization’s management system. The article considers the classification of management accounting tools, outlines its range of tasks, taking into account the specifics of the medical organization, describes the conditions for effective management accounting in medical organizations, the problems of implementing and functioning of management accounting, the main approaches to the formation of the concept of modern management accounting for medical organizations. A management accounting system can be effective in healthcare institutions if it takes into account current trends in the industry and the economy as a whole. In the modern understanding of the term «management accounting», more and more emphasis is placed on the word «management», since the organization and methodology of this type of accounting is aimed at solving management tasks. The emergence and existence of management accounting is due to a specific goal-to help internal users make more informed decisions and is aimed at generating information for internal users to make management decisions. However, it is not regulated by generally accepted principles and is organized by the company independently. However, traditional approaches to the concept that the accounting system should include only internal information, and activities are considered as one main item of expenditure of the organization, are currently unacceptable. The system of domestic accounting should be focused not only on the production of services, but also on the market. At the same time, service-oriented thinking should change to patient-oriented thinking. Management accounting plays an important role in solving predictive tasks. The organization of management accounting in the healthcare industry provides for the need to take into account a number of factors that have a primary impact and are determined by the specifics of the activity. Each medical organization develops a management accounting system based on its own needs and work specifics. The cost of developing and further operating a management accounting system should not exceed the economic benefit of its implementation. The main approaches to forming the concept of modern management accounting for medical organizations are the introduction of new cost accounting systems and new approaches to calculating the cost of medical services provided. The experience of many medical organizations shows that the practical application of management accounting, unfortunately, has not yet received proper distribution, due to an unsolved range of problems. In modern conditions, this issue is extremely relevant and requires research.