Proportion Of Expenditure Research Articles

Budgetary Tracking of Food and Nutrition Security Funding in selected Sahel and West Africa regions from 2017-2019.

The longer-term trend towards decreasing foreign assistance has aroused great interest in tracking of domestic funding given that more than half of the anticipated additional funding for nutrition is expected from domestic sources. Given the limited trend analysis of nutrition budgets across developing countries, this review aimed to examine trends in nutrition financing as a proxy of national commitment for nutrition. We explored the program-based budget allocations and expenditure from 2017-2019 in the Chad republic, Gambia and Ghana for food and nutrition security (FNS) activities in various sectors. The total annual allocations for FNS activities from 2017-2019 in the Chad republic, Gambia and Ghana were €24,796,501, €155,416,112, and €3,299,472,194 of which 93.5%, 15.7% and 100% respectively of allocated funded were expended. The proportion of FNS allocations and expenditure was <5% of the gross domestic product across the three countries. Three-quarters (the Chad republic and Gambia) and one-quarter (Ghana) of all FNS activities were nutrition friendly as compared to being nutrition-specific/sensitive. Of the nutrition-specific/sensitive activities, about 9 in 10 were nutrition-sensitive. The main thematic areas of FNS activities were agriculture/food systems, health, education, water, sanitation and hygiene. There were significant resource gaps in FNS budget allocations and expenditure across the three countries making it difficult to establish a consistent domestic funding trend. Resource mobilization plans to bridge budget implementation gaps for domestic funding are urgently needed to scale-up government commitments toward the attainment of the sustainable development goals in these countries.

National Trends in Healthcare Expenditures for the Management of Skin Cancer in the United States.

Malignant melanoma and keratinocyte carcinomas account for a substantial proportion of healthcare expenditures in the United States. To estimate trends in the economic burden of skin cancer in the United States between 1996 and 2016. The Disease Expenditure Project and Global Burden of Disease databases were used to estimate annual total costs and population-standardized rates of change for skin cancer-related healthcare spending. Skin cancer expenditures totaled $23.4 billion in 2016, of which $1.4 billion (95% CI: $1.3-$1.6 billion) was melanoma-related and $22 billion (95% CI: $18-$28 billion) was keratinocyte carcinoma-related. Most spending on skin cancer management occurred in ambulatory care settings [60.7% (95% CI: 57.7%-64.3%) for melanoma and 87.8% (95% CI: 87.2%-88.2%) for keratinocyte carcinoma]. Pharmaceutical costs for melanoma have increased since 2010 to $365 million (95% CI: $327-$416 million), which represents 26.1% (95% CI: 22.6%-29.3%) of total melanoma expenditure. Skin cancer management in the United States is costly. Expenditures have increased substantially since 1996 without signs of plateauing in recent years.

Cost effectiveness and return on investment analysis for surgical care in a conflict-affected region of Sudan.

The delivery of healthcare in conflict-affected regions places tremendous strains to health systems, and the economic value of surgical care in conflict settings remains poorly understood. Our aims were to evaluate the cost-effectiveness, societal economic benefits, and return on investment (ROI) for surgical care in a conflict-affected region in Sudan. We conducted a retrospective study of surgical care from January to December 2022 at the Mother of Mercy-Gidel Hospital (MMH) in the Nuba Mountains of Sudan, a semi-autonomous region characterized by chronic and cyclical conflict. We collected data on all patients undergoing surgical procedures (n = 3016), including age, condition, and procedure. We used the MMH budget and financial statements to measure direct medical and non-medical expenditures (costs) for care. We estimated the proportion of expenditures for surgical care through a survey of surgical vs non-surgical beds. The benefits of care were calculated as averted disability-adjusted life-years (DALYa) based on predicted outcomes for the most common 81% of procedures, and then extrapolated to the overall cohort. We calculated the average cost-effectiveness ratio (CER) of care. The societal economic benefits of surgical care were modeled using a human capital approach, and we performed a ROI analysis. Uncertainty was estimated using sensitivity analysis. We found that the CER for all surgical care was $72.54/DALYa. This CER is far less than the gross domestic product per capita in the comparator economy of South Sudan ($585), qualifying it as very cost-effective by World Health Organization standards. The total societal economic impact of surgical care was $9,124,686, yielding a greater than 14:1 ROI ratio. Sensitivity analysis confirmed confidence in all output models. Surgical care in this conflict-affected region of Sudan is very cost-effective, provides substantial societal economic benefits, and a high return on investment.

Food security analysis of shrimp farmer households based on the proportion of food expenditure and energy consumption in Purworejo Regency

Abstract Purworejo Regency ranked among the lowest five in the Central Java province’s GRDP acquisition in 2023. It is crucial to understand the micro-food security of Purworejo Regency’s shrimp farming households to boost food consumption in terms of quality and quantity. This study aimed to (1) examine the household income, (2) examine the ratio of food expenditure to household expenditure, (3) examine the energy consumption level based on food consumption from expenditure, and (4) examine the state of food security of shrimp farm fishermen households based on the ratio of food expenditure and energy consumption. This study was conducted in Purworejo Regency with 65 shrimp farmers’ household samples. According to the findings, shrimp farmers spent 28% of their total household expenses on food, which is included in the low category. Based on daily food expenditure, shrimp farming households consumed an average of 1,920.69 kcal, or 86.03% of the daily ECL, placing them in the medium category for overall energy consumption. The shrimp farming households in Purworejo Regency make up 56.92% of the food security, 4.62% of the food vulnerable, 36.92% of less food security, and 1.54% of food insecurity.

Rural financial institutions, access to credit and production inputs of rural households

This paper studies the impact of rural financial institutions on farmers' production input from the perspective of rural bank branch adjustment and rural household credit access. Based on the data of rural bank outlets and China Household Income Survey (CHIP) in 293 prefecture-level cities in China from 2013 to 2018, the results show that rural financial outlets have a significant positive impact on farmers' production input, and each unit increase in the number of bank outlets will increase farmers' production input by 0.24 units, and the proportion of consumer expenditure will decrease by 0.071 units. The number of bank outlets has significant heterogeneity of household head and region on the production input of farmers, and the bank outlets have a greater impact on the production input of farmers with high education level. The increase in the number of bank outlets in the eastern region can significantly increase the production input of farmers, but the increase in the number of bank outlets in the central and western regions will reduce the production input of farmers. The mechanism analysis shows that the increase of branches of rural financial institutions improves farmers' access to credit, which is an important channel affecting farmers' production input. This study provides a reference for the reform of rural financial institutions and the revitalization of rural industries in China.

PERAN OVERLAPPING GENERATIONS MODEL DALAM MENINGKATKAN KONSUMSI KESEHATAN RUMAH TANGGA

A decline in household consumption expenditure on health may indicate a decline in households' ability to prevent health problems and treat illnesses. The proportion of household expenditure on health consumption is very small compared to the proportion of non-health consumption. Spending on health is still not a top priority for households compared to other expenditure components. One approach to understanding intergenerational health consumption is to use the Overlapping Generations (OLG) Model. The research objective is to analyse the factors that influence health consumption with the OLG model approach. Based on the test results using FDGMM and SYSGMM analysis, the previous year's health consumption, income, savings, labour, inflation, and Government Health Insurance (JKN) affect household health consumption. Keywords: Household, OLG Model, Health Consumption, Income, Saving, Labour, Inflation, Government Health Insurance

The Analysis of Whether India Views China as a Military Security Threat from a Quantitative Perspective

China is a neighboring major country of India. Many scholars have consistently emphasized in their papers that India regards China as its biggest military threat. If this viewpoint is fair, then India’s military defense will inevitably be influenced by China. In other words, the military defense of China and India should be highly correlated. National defense and military can be measured by two indicators: weapon throughput and the proportion of military expenditure to domestic GDP. According to the dimensionless operation and entropy weight method in quantitative analysis, the weights of two indicators can be obtained and their correlation can be analyzed. After quantitative analysis, there is a weak correlation between the military defense of China and India. So, it can be concluded that India does not fully consider China as the main military threat.

A multi-dimensional Sustainable Diet Index (SDI) for Ghanaian adults under transition: the RODAM Study

BackgroundThe sustainability of diets consumed by African populations under socio-economic transition remains to be determined. This study developed and characterized a multi-dimensional Sustainable Diet Index (SDI) reflecting healthfulness, climate-friendliness, sociocultural benefits, and financial affordability using individual-level data of adults in rural and urban Ghana and Ghanaian migrants in Europe to identify the role of living environment in dietary sustainability.MethodsWe used cross-sectional data from the multi-centre Research on Obesity and Diabetes among African Migrants Study (N = 3169; age range: 25–70 years). For the SDI construct (0–16 score points), we used the Diet Quality Index-International, food-related greenhouse gas emission, the ratio of natural to processed foods, and the proportion of food expenditure from income. In linear regression analyses, we estimated the adjusted ß-coefficients and 95% confidence intervals (CIs) for the differences in mean SDI across study sites (using rural Ghana as a reference), accounting for sociodemographic and lifestyle factors.ResultsThe overall mean SDI was 8.0 (95% CI: 7.9, 8.1). Participants in the highest SDI-quintile compared to lower quintiles were older, more often women, non-smokers, and alcohol abstainers. The highest mean SDI was seen in London (9.1; 95% CI: 8.9, 9.3), followed by rural Ghana (8.2; 95% CI: 8.0, 8.3), Amsterdam (7.9; 95% CI: 7.7, 8.1), Berlin (7.8; 95% CI: 7.6, 8.0), and urban Ghana (7.7; 95% CI: 7.5, 7.8). Compared to rural Ghana, the differences between study sites were attenuated after accounting for age, gender and energy intake. No further changes were observed after adjustment for lifestyle factors.ConclusionThe multi-dimensional SDI describes four dimensions of dietary sustainability in this Ghanaian population. Our findings suggest that living in Europe improved dietary sustainability, but the opposite seems true for urbanization in Ghana.

Analysis of the structure and trend prediction of China's total health expenditure.

In the context of rapid economic and social development, there has been a continuous intensification of population aging, transformation of disease patterns, and wide application of new medical technologies. As a result, health expenditures in various countries have sharply soared. How to utilize limited medical resources to maximize the improvement of health levels has become a hot and challenging issue related to the well-being of all humanity. The relevant indicators of total health expenditure play a crucial role in monitoring and evaluating the fairness of health financing and health security in the region. This study explores the changes in the main expenses that constitute China's total health expenditure and uses indicators related to health expenditure to observe the changes and future development trends of China's health expenditure. Based on this, the utilization of China's health expenditure is monitored to identify possible problems, and thereby targeted suggestions for promoting the development of China's health and wellness cause are put forward. Based on the comparison of previous literature, this paper analyzes the changes and future development trends in China's health expenditure by using the relevant indicators of China's health expenditure through the structural variation analysis method and the gray prediction model. The results show that the scale of government, social, and out-of-pocket health expenditures has continuously expanded, with social health expenditures becoming the main funding source for total health expenditures. The burden of medical expenditures on individuals has been further reduced. In the institutional method of total health expenditures, hospital expenditures account for about 60% of the total and are the main component. The expenditures of health administration and medical insurance management institutions are the main driving force behind the growth of total health expenditures. However, the proportion of health expenditures in China's GDP is relatively low, so more investment is needed in the healthcare sector, and the burden of individual medical expenses also needs to be continuously reduced. In the future, China should further increase its investment in the medical and health sector. Specifically, the government should persist in investing in fundamental medical and health services. Simultaneously, efforts should be made to establish a scientific cost control mechanism for pharmaceuticals and broaden financing channels for healthcare, such as accelerating the development of commercial health insurance.

Prevalence of household food insecurity and its association with food waste

BackgroundHousehold food waste significantly contributes to overall food waste. While the relationship between food security and food waste has been extensively studied at the macro level, there is a need for research focusing on the quantitative association between food security and food waste at the household level in developing countries, particularly in Southeast Asia. This study aims to estimate the prevalence of household food insecurity and household food waste and to examine the association between household food security and food waste using direct measurements.Subjects and methodsA total of 215 households in Bogor Regency, Indonesia, participated in this cross-sectional study. Food waste was measured using waste composition analysis and a 7-day diary. The Food Insecurity Experience Scale (FIES) questionnaire was used to assess household food security, while household income and the proportion of food expenditure were considered confounding factors. The association between food security and food waste was examined using Kendall tau-b and ordinal logistic regression.ResultsThe prevalence of household food insecurity was 18.6%, and the average household food waste was 77 kg/cap/year. Cereals, tubers, and their derivatives (especially rice) and vegetables were major contributors to edible waste, while fruits dominated inedible waste. A negative association was observed between food waste and household food security (edible FW: p = 0.044, r = -0.110; total FW: p = 0.038, r = -0.114), suggesting that household food waste decreases as the severity of food insecurity increases. However, after adjusting for household income, the proportion of food expenditure, and the education levels of spouses, this association became statistically insignificant (p > 0.05).ConclusionThere was no significant association between household food security status and food waste. Household income plays a significant role in determining the quantity of household food waste, as higher income is associated with increased food waste. Strategies to prevent and reduce food waste should focus on major contributors such as rice and vegetables, especially among families with higher food accessibility.

Does vertical integration increase the costs for primary care inpatients? Evidence from a national pilot programme in China

ObjectiveTo assess the impact of vertical integration (VI) within County-Level Integrated Health Organisations (CIHOs) on the costs of primary care inpatients.MethodsThis study assessed Xishui, a national pilot county for CIHOs, using inpatient claims data. The treatment group comprised 10,118 inpatients from 5 vertically integrated township health centres (THCs), while the control group consisted of 21,165 inpatients from 19 non-vertically integrated THCs. The periods from July 2020 to December 2021 and January 2022 to December 2022 were defined as pre- and post-policy intervention, respectively. The primary outcome variables were total health expenditures (THS), out-of-pocket (OOP) expenditures, and the proportion of OOP expenditures. Propensity score matching was employed to align inpatient demographics and disease characteristics between the groups, followed by a difference-in-differences analysis to evaluate the outcomes.FindingsVI significantly increased THS (β = 0.1337, p < 0.01) and OOP expenditures per case (β = 0.1661, p < 0.001), but the increase in the proportion of OOP expenditures per case was not significant (β = 0.0029, p > 0.05). For the basic medical insurance for urban and rural residents, THS per case (β = 0.1343, p < 0.01) and OOP expenditures (β = 0.1714, p < 0.001) significantly increased. For the basic medical insurance system for employees, THS per case also increased significantly (β = 0.1238, p < 0.01), but the change in OOP expenditure proportion per case was not significant (β = 0.1020, p > 0.05). The THS per case led by Xishui County People’s Hospital, the leading county medical sub-centre (CMSC), significantly increased (β = 0.1753, p < 0.01), whereas the increase led by Xishui County Traditional Chinese Medicine Hospital was not significant (β = 0.0742, p > 0.05). Increases in OOP expenditures per case were significant in CMSCs led by the People’s Hospital and the Traditional Chinese Medicine Hospital (β = 0.1782, p < 0.01 and β = 0.0757, p < 0.05, respectively).ConclusionVI significantly increased THS and OOP expenditures for primary care inpatients. However, VI could exacerbate economic disparities in disease burden across different insurance categories.

Trends in Public Drug Plan Expenditures for Patients With Crohn Disease and Ulcerative Colitis Initiating Targeted Immune Modulator Therapy

The objective of this analysis was to examine the changes in drug expenditures with the initiation of targeted immune modulator (TIM) treatment in patients diagnosed with Crohn disease (CD) and ulcerative colitis (UC). Patient cohorts for CD and UC were identified from hospitalizations in Canada. Expenditure data for TIMs with a Health Canada–approved indication for the treatment of CD or UC were extracted from all provincial drug plans (except Quebec) and Yukon from 2016 to 2021, and a descriptive analysis was performed to assess the expenditure patterns. Annual expenditures on TIMs for patients with CD increased each year from 2016 to 2019 before decreasing in 2020 and 2021, whereas expenditures on TIMs in UC increased each year, generally by a greater percentage than was observed in CD (peak percentage growth of 92.5% for UC versus 15.9% for CD in 2018). Expenditures associated with TIM initiation among patients with CD and UC were driven by infliximab and adalimumab, with the 2 drugs accounting for nearly all expenditures in both indications in 2016 and most expenditures in 2021. In both CD and UC, vedolizumab expenditures increased over time, as did the proportions of TIM expenditures on ustekinumab in CD and tofacitinib in UC, albeit to a lesser extent than vedolizumab.

Study on the influencing factors of the STR based on linear regression-take China as example

In recent years, the student-teacher ratio (STR) has received widespread attention in the field of education. By now, the STR has become an important indicator of education. This article first theoretically analyzes the relationship between the STR and the proportion of the school-age population in the middle school stage to the total population of the country, teacher gender ratio, the proportion of education expenditure in GDP, and GDP per capita, predicting that there is a positive correlation between STR and the proportion of school-age population in the total population, and there is a negative correlation between STR and the rate of women teacher, the proportion of education funds in GDP, and GDP per capita. Then this article establishes the regression equation of STR and the above variables through the data of secondary schools in China in the past 30 years. And it finds that there is a positive correlation between STR and the proportion of the school-age population in the middle school stage to the total population of the country, and there is a negative correlation between STR and the rate of women teachers, and GDP per capita, and there is no linear relation between STR and the proportion of education funds in GDP. Also, this article finds that proportion of the proportion of the school-age population in the middle school stage to the total population of the country, rate of women teachers and GDP per capita have collinearity relationship.

Trends and patterns of antibiotic using from 2014 to 2018 in stomatology hospitals of China.

To analyze trends of antibiotic consumption and expenditure in Chinese stomatology hospitals between 2014 and 2018 with a longitudinal study design, and show the impacts of the comprehensive policy on dental antibiotic use in China. Consumption was quantified as the number of daily defined doses (DDDs) and expenditure as the procurement costs, using medical institutions' drug procurement data from the Chinese Monitoring Network for Rational Use of Drugs. Descriptive statistics was employed and the compound annual growth rate (CAGR) was calculated to show the average annual growth rate. Between 2014 and 2018, overall antibiotic consumption increased from 842.6 thousand DDDs to 1376.7 thousand DDDs (p < 0.001) and expenditure increased from 11.6 million RMB to 20.9 million RMB (p < 0.001), where other β-lactam antibacterials accounted for the largest proportion of total consumption (37.1%-50.1%) and expenditure (52.9%-66.6%), and also increase the largest (CAGR = 18.4%, p < 0.001). The proportion of oral antibiotics was nearly 9 times of parenteral antibiotics in consumption (CAGR = 0.3%, p = 0.023) and only 2 times in expenditure (CAGR = -1.7%, p = 0.112). The non-restricted group accounted for more than 90% of consumption (CAGR = 0.6%, p < 0.001). In 2018, oral first-generation cephalosporins (22.8%), oral imidazole derivatives (22.3%), and oral second-generation cephalosporins (19.2%) were the most frequently used antibiotic classification, while parenteral second-generation cephalosporins were top one (19.8%) for expenditure. At chemical substance levels, the consumption of oral cefradine ranked top one (21.4%) and parenteral cefuroxime accounted for the largest proportion of expenditure (14.5%) in 2018. Oral cefradine, oral metronidazole, and oral cefaclor were the top three frequently consumed antibiotics throughout the five years. Despite the potential antibiotic overuse, the comprehensive antibiotic stewardship regulations of China got a satisfactory and better performance in dental practices. More effort is needed to establish more explicit guidelines to improve antibiotic stewardship, such as priority recommending amoxicillin and its derivatives for endodontic infections.

Can digital transformation curtail carbon emissions? Evidence from a quasi-natural experiment

Digital infrastructure construction (DIC) is a crucial component of digital transformation, yet its impact on the sustainable development of cities remains uncertain. To address this question, this study employs the Difference-in-Differences (DID) model to evaluate the effects of a typical DIC policy, the Broadband China Pilot (BBCP) policy. The research sample covers data from Chinese cities from 2009 to 2019. The DID estimation demonstrates that the BBCP policy effectively decreased carbon emissions (COE). Robustness tests, such as parallel trend tests, placebo tests, propensity score matching DID, and local projection DID, all confirm the negative impact of the BBCP policy on COE. Heterogeneity analysis reveals that the BBCP policy has a greater mitigation effect on COE in non-resource cities. The BBCP policy has a stronger effect on reducing the COE in cities with a higher proportion of green funds or lower fiscal expenditures. Further analysis indicates that the BBCP policy significantly improves low-carbon ecological efficiency and reduces COE intensity. The results of the mechanism analysis reveal that the BBCP policy lowers COE by enhancing the industrial structure and promoting green technological progress. The study provides policy recommendations in the realm of DIC for developing countries to achieve digital transformation and low COE development concurrently. This research can assist governments in better considering how to implement DIC policies to construct ecologically sustainable cities with low COE.

Analysis of Sources and Diversification of Farmers' Household Income Around PT Jembayan Muara Bara, Tenggarong Seberang Sub-district, Indonesia

Most farming households depend entirely on sources of income from the agricultural sector, especially on-farm farming, this has the potential for quite a high risk of crop failure which results in a decrease in household income. Diversification of sources of income is aimed at creating wider employment opportunities, improving the economy in the agricultural and rural sectors, as well as developing services and service activities through linkages between agriculture and rural and non-agricultural sectors. The problem in realizing food security today is that the population continues to increase but rice production tends to decrease, thus affecting farmers' income in spending to meet basic needs, namely food. This study was conducted to find out the sources of income earned and the proportion of food expenditure of farmer households around PT Jembayan Muara Bara in Tenggarong Seberang subdistrict., Kutai Kartanegara Regency. This research was conducted in Mulawarman, Buana Jaya, Suka Maju, and Bukit Pariaman Villages, Tenggarong Seberang subdistrict. It rans from July 2023 to March 2024. Site selection is done by Purposive Sampling. Sampling using the method (Non Proportional Random Sampling) The number of samples is equalized in each village taking 25 families per village so that the total number of samples is 100 families. The types of data collected are primary data and secondary data. Data collection techniques with observation, and interviews. The results showed that sources of income in the study area, apart from farming activities, namely by working as mining employees, traders, builders, stone diggers, masseurs, farm workers, RT heads, Honorary, and civil servants; The average total family income per month ranges from IDR 2,500,000.00 to IDR 8,800,000.00. The average per capita income per month ranges from IDR 910,152.00 to IDR 1,362,339.00, while the distribution of income per sample capita per month is between IDR 416,667.00 to IDR 2,500,000.00; and the proportion of food expenditure by farmer households ranges from 50.72% - 54.51%, while the proportion of non-food expenditure by farmer households ranges from 45.45 - 49.25%.

Impact of health spending on hospitalization rates in Baltic countries: a comparative analysis

IntroductionThis study examines the association between healthcare indicators and hospitalization rates in three high-income European countries, namely Estonia, Latvia, and Lithuania, from 2015 to 2020.MethodWe used a sex-stratified generalized additive model (GAM) to investigate the impact of select healthcare indicators on hospitalization rates, adjusted by general economic status—i.e., gross domestic product (GDP) per capita.ResultsOur findings indicate a consistent decline in hospitalization rates over time for all three countries. The proportion of health expenditure spent on hospitals, the number of physicians and nurses, and hospital beds were not statistically significantly associated with hospitalization rates. However, changes in the number of employed medical doctors per 10,000 population were statistically significantly associated with changes of hospitalization rates in the same direction, with the effect being stronger for males. Additionally, higher GDP per capita was associated with increased hospitalization rates for both males and females in all three countries and in all models.ConclusionsThe relationship between healthcare spending and declining hospitalization rates was not statistically significant, suggesting that the healthcare systems may be shifting towards primary care, outpatient care, and on prevention efforts.

Social Expenditures in Odisha: Populism Versus Human Capital Formation

This article examines the level, composition and trends of social expenditures at the subnational level in India using the secondary data of Odisha from 1990–91 to 2016–17 due to the low level of economic development in the state. The level of social expenditures of Odisha is better than those of the 14 major states of the country. However, it is not sufficient for the development of the state due to its declining trend and a small proportion of capital account social expenditures. Regarding the composition of social expenditures, a substantial proportion is incurred on populism rather than human capital formation. Social expenditures deviate from human capital formation to populism with time. Further emphasis is shifted towards economic services from social expenditures in the total expenditures. The ruling party used the strategy of populism to win seats in the state legislature keeping in mind the high proportion of the poor, illiterates and poor farmers in the state, where a direct relationship exists between human capital formation and winning seats in the legislature. To ensure economic development, the state should strive to improve its human capital formation and refrain from populist measures.

THE EPIDEMIOLOGY AND ECONOMIC IMPACT OF ACCIDENT COMPENSATION CORPORATION (ACC)-FUNDED PRIMARY TOTAL KNEE AND TOTAL HIP ARTHROPLASTY IN AOTEAROA

IntroductionIndividuals with significant hip and knee trauma receive total knee (TKA) and total hip arthroplasty (THA) as definitive end-stage procedures. In Aotearoa, injury-related costs, including workers compensation, may be funded by ACC. With a steady increase of arthroplasty procedures in Aotearoa, we aim to understand the magnitude and characteristics of such procedures to inform future healthcare strategies.MethodThis is a longitudinal collaborative study from 1st January 2000 to 31st December 2020, using ACC and New Zealand Joint Registry databases. Total cost was subcategorised into social and medical cost for analysis.ResultsACC funded 10179 TKA and 5611 THA, amounting to 918 million New Zealand Dollars. Most clients were between 55 and 65 years of age at time of surgery, with greater representation by Male sex and European prioritised ethnicity. Māori and Pacific peoples represent less than 10% of the study population.ACC identified requiring more than 182 days of workers’ compensation as a significant marker for needing additional supports. Risk of this was 21% for TKA and 11% for THA, with risk factors being younger age (RR 0.96), Male sex (TKA RR 1.12, THA RR 1.23), and heavy work-types (TKA RR 1.50, THA RR 1.57).DiscussionSupporting individuals with post-traumatic lower limb arthroplasty is costly. Workers’ compensation contributes to a significant proportion of social expenditure. Risk factors for increased cost utilisation can be used to highlight vulnerable clients and target interventions.ConclusionsThis is one of few nationwide studies investigating the healthcare cost of post-traumatic lower limb arthroplasty. We need to focus on injury prevention, targeted treatment, and rehabilitation protocols to improve recovery and reduce time off work. These findings would be of interest to multiple stakeholders.

An analysis of financial hardship faced by patients with First Episode Psychosis, and their families, in an Indian setting

BackgroundThe economic burden of psychotic disorders is not well documented in LMICs like India, due to several bottlenecks present in Indian healthcare system like lack of adequate resources, low budget for mental health services and inequity in accessibility of treatment. Hence, a large proportion of health expenditure is paid out of pocket by the households. ObjectiveTo evaluate the direct and indirect costs incurred by patients with First Episode Psychosis and their families in a North Indian setting. MethodDirect and Indirect costs were estimated for 87 patients diagnosed at AIIMS, New Delhi with first-episode psychosis (nonaffective) in the first- and sixth month following diagnosis, and the six months before diagnosis, using a bespoke questionnaire. Indirect costs were valued using the Human Capital Approach. ResultsMean total costs in month one were INR 7991 ($107.5). Indirect costs were 78.3% of this total. Productivity losses was a major component of the indirect cost. Transportation was a key component of direct costs. Costs fell substantially at six months (INR 2732, Indirect Costs 61%). Respondents incurred substantial costs pre-diagnosis, related to formal and informal care seeking and loss of income. ConclusionFamilies suffered substantial productivity loss. Care models and financial protection that address this could substantially reduce the financial burden of mental illness. Measures to address disruption to work and education during FEP are likely to have significant long-term benefits. Families also suffered prolonged income loss pre-diagnosis, highlighting the benefits of early and effective diagnosis.