Rising Health Costs Research Articles

Government Procurement Defence Under GATT 1994 Article III:8(a): A Critical Review of the Turkey-Pharmaceutical Products Dispute

This article critically reviews the Turkey-Pharmaceutical Products Dispute, focusing on the question of whether Turkey’s drug insurance reimbursement scheme can be regarded as government procurement, which would allow Turkey’s drug production localization policy to be exempt from national treatment obligation. Both the panel (on the account that there was no ownership by the government) and the arbitrators (on the account that there was insufficient control of pharmaceutical products subject to the dispute), ruled against Turkey’s government procurement defence. In contrast, this article argues that given rising health costs and repeated global pandemics which compel governments to build up sufficient national production capability of health products to facilitate timely supply of medical products, it would be desirable to take a broad approach towards interpreting the scope of Article III:8(a) with respect to the pharmaceutical sector, granting greater policy space for member governments. pharmaceuticals, government procurement, national treatment, Article III:8(a) derogation, drug insurance reimbursement, domestic localization policy, health policy, Turkey

State of Knowledge on the Acquisition, Diversity, Interspecies Attribution and Spread of Antimicrobial Resistance between Humans, Animals and the Environment: A Systematic Review.

Resistance to antibiotics is considered one of the most urgent global public health concerns. It has considerable impacts on health and the economy, being responsible for the failure to treat infectious diseases, higher morbidity and mortality rates, and rising health costs. In spite of the joint research efforts between different humans, animals and the environment, the key directions and dynamics of the spread of antimicrobial resistance (AMR) still remain unclear. The aim of this systematic review is to examine the current knowledge of AMR acquisition, diversity and the interspecies spread of disease between humans, animals and the environment. Using a systematic literature review, based on a One Health approach, we examined articles investigating AMR bacteria acquisition, diversity, and the interspecies spread between humans, animals and the environment. Water was the environmental sector most often represented. Samples were derived from 51 defined animal species and/or their products A large majority of studies investigated clinical samples of the human population. A large variety of 15 different bacteria genera in three phyla (Proteobacteria, Firmicutes and Actinobacteria) were investigated. The majority of the publications compared the prevalence of pheno- and/or genotypic antibiotic resistance within the different compartments. There is evidence for a certain host or compartment specificity, regarding the occurrence of ARGs/AMR bacteria. This could indicate the rather limited AMR spread between different compartments. Altogether, there remains a very fragmented and incomplete understanding of AMR acquisition, diversity, and the interspecies spread between humans, animals and the environment. Stringent One Health epidemiological study designs are necessary for elucidating the principal routes and dynamics of the spread of AMR bacteria between humans, animals and the environment. This knowledge is an important prerequisite to develop effective public health measures to tackle the alarming AMR situation.

Innovation in the healthcare industry

The COVID-19 pandemic challenged, transformed and still transforming the healthcare industry, besides there is an increasing pressure on healthcare. The main influencing factors are: technological developments, increasing societal expectations, the amount of health data to be recovered, rising health costs and aging population. The solution lies in healthcare innovations. In fact, the impact of COVID-19 has accelerated the research, development and innovation activities in the healthcare sector, which will hopefully have long-term positive effects. After briefly exploring the concept of innovation in the literature, the study focuses on the outstanding role of corporate innovation, which accounts for about two-thirds of Europe's economic growth in recent decades. The overall performance of the innovation system of the European Union member states is presented, with a special focus on the Hungarian innovation performance, which plays a key role for health industry innovations in improving the overall innovation performance. It is considered the characteristics of the health industry from an economic point of view. The definition and areas of the health industry, the statistics of Hungarian research and development and innovation (R & D & I) applicable to this field, the significance and measurability of innovation in the health industry are presented, and the main barriers and drivers of health industry development are mentioned. The main features of the innovation and development of the studied area are highlighted. Overall, it has been concluded that R&D expenditures on the healthcare industry play a significant role in Hungary, which represents a serious opportunity to handle these challenges. Health industry developments have a huge potential for innovation, which greatly affects the competitiveness of the state at both corporate and industry levels.

Employee Job Satisfaction in Health Care Industry in a Private Multi-Speciality Organization

Employee job satisfaction is essential to face the dynamic and ever-increasing challenges of maintaining productivity of the organization by keeping their workforce constantly engaged and motivated. In the present era of globalization, the varied and changing demands of consumers are putting consistent pressure on the employers to satisfy their needs and to be competitive in the business. Furthermore, environmental pressures, rising health costs and various needs of the workforce also pose a challenge for the management. This could be overcome by creating a work environment that maintains employee job satisfaction as well as motivates people towards exceptional performance at the workplace achieving work-life balance.

Drivers and Barriers Toward Healthy and Environmentally Sustainable Eating in Switzerland: Linking Impacts to Intentions and Practices

Food consumption is among the activities with the most significant environmental impacts, and furthermore contributes to rising health costs. We explored the factors that foster or hinder healthy and sustainable eating in Switzerland. Based on an online household survey with 620 respondents, we first determined the disability adjusted life years and greenhouse gas impacts associated with individuals' dietary habits to measure healthy and environmentally sustainable eating. We then relate the nutritional health and environmental impacts to individual's intentions, and explore what interpersonal and societal factors foster or hinder healthy and sustainable eating. Results suggest that intentions for healthy eating are stronger than intentions to eat environmentally sustainable and that intentions for healthy eating transmit better into behavior than intentions for environmentally sustainable eating. Males and females had similar intentions but males showed substantially higher dietary related health impacts with 12 min of healthy life lost per day and 14% higher carbon footprint than females. Furthermore, vegan and vegetarian diets yielded very high nutritional health benefits of >23 min of healthy life gained per person and day, mostly realized through the reduced intake in processed and red meat and increased consumption of nuts, wholegrain, and to a lesser extent in fruits and vegetables. Meatless diets show concurrent high reductions in the carbon footprint of −42% for vegetarians and −67% for vegan. A key obstacle to healthier and more environmentally sustainable eating is that people do not recognize the high nutritional and environmental co benefits of vegetarian and vegan diets. This suggests that policies promoting healthy eating can target factors affecting intentions, while measures targeting environmentally sustainable eating should aim at overcoming the intention behavior gap, by informing on e.g. the importance of reducing meat consumption toward environmental sustainability.

Developing indicators and measures of high-quality for Australian general practice.

Rising health costs and health inequity are major challenges in Australia, as internationally. Strong primary health care is well evidenced to address these challenges. Primary Health Networks (PHNs) work with general practices to collect data and support quality improvement; however, there is no consensus regarding what defines high quality. This paper describes the development of an evidence-based suite of indicators and measures of high-quality general practice for the Australian context. We reviewed the literature to develop a suitable framework and revise quality assurance measures currently in use, then reviewed these in three workshops with general practitioners, practice managers, nurses, consumers and PHN staff in western Sydney. We used a descriptive qualitative research approach to analyse the data. A total of 125 evidence-based indicators were agreed to be relevant, and 80 were deemed both relevant and feasible. These were arranged across a framework based on the Quadruple Aim, and include structure, process and outcome measures. The agreed suite of indicators and measures will be further validated in collaboration with PHNs across Australia. This work has the potential to inform health systems innovation both nationally and internationally.

AGING POPULATION TREND IN THE STATE OF PERAK, MALAYSIA

Malaysia will be one of the old countries by 2030. Aging population occurs when the percentage of the elderly population exceeds the percentage of the young population in an area, state or country. In Malaysia, 6.73 percent of Malaysia's population is comprised of people who are mostly in the age of 65 years and above. However, the year 2020 has shown that the state of Perak has become an old state. The percentage contribution from the population aged 65 years and above is higher in Perak, than Malaysia, with the percentage of 11.9 percent of elderly population in 2020. The main objective in this writing is to analyze the aging trends of the population in Perak and to examine the issues and effects of aging population. This study has used secondary data collection methods, namely data from the Department of Statistics Malaysia (JPM), United Nations and other related articles. Perak has become the third eldely state, after Johor and Selangor in 2020. However, due to this escalation, several issues have arisen such as the needs for financial resources to accommodate the elderly, rising health costs of the elderly and labor shortages. Thus, this situation will cause some serious effects on the national economy and also directly on the individuals.

Enablers for Allied Health Front-line Managers in Public Health Environments to Deliver Sustainable Patient Care

Background: Many allied health managers do not feel equipped to face the challenges of evolving business environments such as public hospitals The increasing demand on public hospitals due to chronicity of disease, an aging population and rising health costs will require managers to be resourceful, adaptable, influential and innovative The research on this topic is scarce with a lack of robust studies specific to allied health front-line managers working in public healthcare settings. Objectives: The review of the literature aims to identify enablers for front-line allied health managers to be more effective and better prepared for working in complex and challenging healthcare environments such as public hospitals. Method: Literature searches were performed using Scopus, PubMed, PsychINFO, CINAHL, ProQuest and Google Scholar databases for articles published between January 2000 and November 2019. Hand searching of reference lists of included papers also occurred. The included articles were studies containing cohorts of allied health professionals working in any healthcare setting that directly related to the study of management and/or leadership. Results: The literature findings on this topic were scarce, however review of the 22 studies that met the criteria identified nine potential enablers for allied health front-line managers. These included incorporating effective leadership styles, leadership attributes and characteristics for working in health, allied health structure, representation of allied health in contexts of influence, associations/network and organisational support, evidence-based and tailored allied health programs, measurable and robust feedback on performance and succession planning for the future. Conclusion: By identifying potential enablers, key strategies, resources and supports could be developed for allied health front-line managers working in complex settings such as public hospitals, which ultimately lead to improvements in patient safety, quality and experience. Implications for Practice: More research with front-line allied health managers in practice is required to explore and validate the identified enablers. Once validated, further studies to determine the strategies, resources, influences and supports that could be developed to support enacting them would be important. Providing the necessary enablers to allied health front-line managers would equip them to manage the increasing challenges facing public healthcare organisations that are required to be more sustainable while delivering quality care to patients.

Health Care Costs and Corporate Investment

Health care costs for U.S. employers have tripled in the past twenty years. By constructing a novel dataset of firm-specific health care expenses, I show that firms negatively adjust both capital expenditures and R&D expenses in response to changes in health care costs. I estimate that, on average, a 1% increase in health care costs is associated with a 0.7% decrease in total investment. The effects are greater for financially constrained firms, firms employing more high-skilled workers, and firms working with fewer insurers. Additional tests confirm that hiring fewer workers and reducing wages do not offset rising health costs enough to counteract this lower investment channel. Overall, my findings suggest that increasing health care costs limit firms’ ability to expand physically or through innovation.

Wearable electrochemical sensors for noninvasive monitoring of health—a perspective

Global problems today such as aging society and rising health costs have made preventive care and health monitoring increasingly important, so research on wearable electrochemical sensors for noninvasive monitoring of health has become very popular during the past several years. But the new technologies cannot be some dues ex machine who wrought changes overnight. Problems about fundamentals of electrochemistry under wearable conditions, software algorithms to treat signal artifacts in the real wearable detection, reliable sensors for prolonged wearable sensing in body fluid, platforms for tests of newly developed sensors, validation of test results, reproducible and standardized sampling methods, as well as clinical significance of wearable testing data still require to be addressed. The short review is not to include all important works recently published or reach any conclusion but to focus on the challenges as well as some of the promising approaches that help to overcome these challenges.

Cost identification analysis of general anesthesia.

Background and Aims:Rising health costs are challenging anesthesiologists to search for cost-effective anesthetic techniques. We conducted a study to estimate variable cost per case and cost of drug wastage as percentage of total drug cost associated with different modalities of general anesthesia (GA).Material and Methods:This prospective study was carried out after approval by institutional ethical committee in 258 adult patients aged 18–60 years of either sex, American Society of Anesthesiologists physical status I or II, with a surgical duration of 1–4 hours, posted for elective surgery under GA with endotracheal intubation. At the end of surgery, total utilization of each drug, anesthetic gases, and consumables were noted and remaining drug was regarded as wastage. Cost was recorded as per maximum retail price for that particular brand in the market at start of study and total cost was calculated. For purpose of analysis, cases were divided into low flow sevoflurane, high flow sevoflurane, high flow isoflurane, low flow isoflurane, and total intravenous anesthesia (TIVA).Results:The mean variable cost was highest with TIVA (₹2713.82 ± 509.57) and lowest with low flow isoflurane (₹1981.62 ± 335.03; P < 0.001). Drug wastage was 13.1% overall, with highest in low sevoflurane group and lowest in TIVA.Conclusion:Low flow anesthesia with isoflurane is more cost-effective as compared to high flow techniques and TIVA even for short duration surgeries. Rational use of drugs and consumables and minimizing wastage can further reduce anesthesia costs.

Rates and patterns of uninsured cancer survivors before and after implementation of the Affordable Care Act, 2000-2017.

e18105 Background: Cancer survivors experience difficulties in maintaining healthcare coverage, however the reasons and risk factors for lack of insurance are poorly defined. We sought to assess self-reported reasons for not having insurance and to assess demographic and socioeconomic factors associated with non-insurance among cancer survivors, before and after implementation of the Affordable Care Act (ACA) in 2014. Methods: We used the National Health Interview Survey to identify adult participants (18-64 years) reporting a cancer diagnosis between 2000-2017. Multivariable logistic regression was used to define the association between demographic and socioeconomic variables and odds being uninsured. The prevalence of the most common self-reported reasons for not having insurance (unemployment, employment-related reason, family-related) were estimated, with AORs for each of the reasons defined by multivariable logistic regression. Results: Among 17,806 survey participants, 10.3% reported not having health insurance. Individuals surveyed in 2000-2013 had higher odds of not having insurance as compared to those surveyed in 2014-2017 (10.6% vs. 6.2%, AOR 1.75, 95% CI 1.49-2.08). Variables associated with higher odds of non-insurance throughout the entire study interval included younger age, annual family income below the poverty threshold, black race, Hispanic ethnicity, non-citizen status and current smoking (p &lt; 0.001 for all). After implementation of the ACA, increasing interval from cancer diagnosis and black race were no longer associated with not having insurance. The most commonly cited reason for not having insurance were cost followed by unemployment, both of which decreased after ACA implementation (cost: 49.6% vs. 37.6%, AOR 0.62, 95% CI 0.46-0.85; unemployment: 37.1% vs. 28.5%, AOR 0.62, 95% CI 0.45-0.87). Conclusions: The proportion of uninsured cancer survivors decreased after implementation of the ACA, however certain subgroups remain at greater risk of being uninsured. Cost remains the primary barrier to obtaining insurance, although more than half of cancer survivors reported other barriers to coverage. Given the growing number of cancer survivors in conjunction with rising health costs, efforts addressing barriers to insurance coverage are needed for this population.

Science and Challenges for Cuban Public Health in the 21st Century.

Cuba's public health outcomes are rooted in political and social phenomena that have favored achievement of health indicators well above expectations for an economy of its size. A less studied causal component of Cuba's development in health is the creation, from early in the 1960s, of scientific research capacity throughout the health system, including use of science to launch a domestic industry for manufacturing high-tech products. This component should play an even greater role in meeting Cuba's 21st century health challenges, especially the demographic and epidemiologi-cal transitions, increasing prevalence of chronic diseases, rapid emergence of a complex-product biotechnology pharmacopoeia, greater molecular stratification of diseases, rising health costs, and the need to maintain communicable diseases under control in a global context of climate change and more population mobility.Tackling these challenges will demand greater scientific influence in the health system, application of a scientific approach in all ac-tivities and at all levels, and integration with scientific endeavors of other sectors such as agriculture, industry and education. KEYWORDS Public health, science, health care costs, health workforce, chronic disease, biotechnology, immunology, aging, Cuba.

Elements of Trust in Digital Health Systems: Scoping Review.

BackgroundInformation and communication technologies have long become prominent components of health systems. Rapid advances in digital technologies and data science over the last few years are predicted to have a vast impact on health care services, configuring a paradigm shift into what is now commonly referred to as digital health. Forecasted to curb rising health costs as well as to improve health system efficiency and safety, digital health success heavily relies on trust from professional end users, administrators, and patients. Yet, what counts as the building blocks of trust in digital health systems has so far remained underexplored.ObjectiveThe objective of this study was to analyze what relevant stakeholders consider as enablers and impediments of trust in digital health.MethodsWe performed a scoping review to map out trust in digital health. To identify relevant digital health studies, we searched 5 electronic databases. Using keywords and Medical Subject Headings, we targeted all relevant studies and set no boundaries for publication year to allow a broad range of studies to be identified. The studies were screened by 2 reviewers after which a predefined data extraction strategy was employed and relevant themes documented.ResultsOverall, 278 qualitative, quantitative, mixed-methods, and intervention studies in English, published between 1998 and 2017 and conducted in 40 countries were included in this review. Patients and health care professionals were the two most prominent stakeholders of trust in digital health; a third—health administrators—was substantially less prominent. Our analysis identified cross-cutting personal, institutional, and technological elements of trust that broadly cluster into 16 enablers (altruism, fair data access, ease of use, self-efficacy, sociodemographic factors, recommendation by other users, usefulness, customizable design features, interoperability, privacy, initial face-to-face contact, guidelines for standardized use, stakeholder engagement, improved communication, decreased workloads, and service provider reputation) and 10 impediments (excessive costs, limited accessibility, sociodemographic factors, fear of data exploitation, insufficient training, defective technology, poor information quality, inadequate publicity, time-consuming, and service provider reputation) to trust in digital health.ConclusionsTrust in digital health technologies and services depends on the interplay of a complex set of enablers and impediments. This study is a contribution to ongoing efforts to understand what determines trust in digital health according to different stakeholders. Therefore, it offers valuable points of reference for the implementation of innovative digital health services. Building on insights from this study, actionable metrics can be developed to assess the trustworthiness of digital technologies in health care.

Second Opinions in Psychiatry: A Review.

Background:Although second opinions are rather restricted to the surgical disciplines, they have become more and more important to the health system in the last 20 years. The demand has been triggered by rising health costs and the economization of the field. The Internet has also made a considerable contribution to the demand for patient-initiated second opinions. Given these developments, it is surprising that second opinions have not become more important in the field of psychiatry. This article highlights the special situation of second opinions in psychiatry, discusses possible barriers to the adoption of second opinions in psychiatry, and the potential for greater use of second opinions in this field.Objective:In psychiatry, second opinions have been neglected by the typical drivers of innovations in health care, including insurers and other commercial drivers as well as psychiatrists and patients themselves. This review identifies current barriers to widespread adoption of second opinions in psychiatric practice, discusses the benefits of second opinions that have been demonstrated in other disciplines, and outlines the potential gains to be realized through use of second opinions in psychiatry.Methods:Literature in the area was reviewed through a search of the main medical databases. This literature review was supported by in-depth interviews with health care personnel and insurers.Conclusions:Second opinions are rarely obtained in psychiatry and there is little literature on this subject. The stigmatization of psychiatric disorders and patients and the uniqueness of the patient-doctor relationship in psychiatry, especially in psychotherapeutic care, may pose considerable obstacles to the use of second opinions in this field. In addition, more stakeholders, such as social workers, government agencies and regulators, health care and disability insurers, and social security agencies, are involved in the mental health compared with the somatic health sector, which may make it more difficult to achieve a coordinated approach in psychiatric care. However, we have found no convincingly good reason why second opinions have not been at least discussed in psychiatry. Psychiatry could benefit from ongoing discussions concerning the outcomes of second opinions in other medical disciplines.

Offline: Towards a Pax Sinica?

One's immediate impression on meeting China's new Minister of Health, Ma Xiaowei, is his sense of humour. Laughter frequently punctuates his sentences. He discusses his love of Agatha Christie. Minister Ma has worked in the National Health Commission (Ministry of Health) for two decades. He knows the job and understands its enormous responsibilities. We met on what he pointed out was his 1-month anniversary in the role. Now is “a very critical period” for the health of the Chinese people. He identified two priorities. First, to improve accessibility to medical services. To meet this objective will require a high-performing primary health-care system, something China currently does not have. Second, to reduce the poverty-inducing health costs caused by expensive medicines. He would like to see closer collaboration between Chinese health experts and their international counterparts. And he welcomed independent external assessment of the progress of China's health reforms. He intends to accelerate the pace of those reforms. Time magazine last week named President Xi Jinping one of its “100 most influential people” in the world. It concluded its citation by arguing that, “Pax Americana is finished, and Xi will have a say in whatever comes next.” Today, there are escalating political and economic tensions between America and China. Yet last week signalled a modest but, in the difficult geopolitical circumstances, a not unimportant historic moment. Peng Gong, who heads the Department of Earth Systems Science at Tsinghua University in Beijing, led a team of 45 scientists in publishing a wholly Chinese-led Lancet Commission on unlocking the power of cities for a healthy China. The Commission set out the challenges for Chinese cities as the foundation for Xi's notion of an ecocivilisation: unprecedented expansion, an epidemic of non-communicable diseases, the threat of newly emerging infections, an ageing population, rising health costs, and growing health inequities. Although most policy makers accept that the health sector alone cannot solve these problems, there are few incentives for intersectoral collaboration. Peng and his team wrote a manifesto for urgent action not only by the Chinese Government but also by Chinese society. In line with President Xi's vision for a Healthy China 2030, health must be incorporated into every government policy. Greater public participation in producing healthy cities is needed. Some cities, such as Shanghai, are already putting health at the centre of their thinking. Fan Wu explained how Shanghai has seen life expectancy rise through multisectoral collaboration, community self-management, employer engagement, healthy schools, better care for the urban elderly, and tobacco-free policies. Ling Li put part of reason for the government's unusual focus on health down to President Xi's experience as a barefoot doctor early in his career. But part of the reason is also fear. In 2003, SARS shocked China out of what had been complacency concerning the state of its health system. Healthy China 2030, inaugurated in 2016, aims to achieve three goals. First, to improve population health. Second, to connect health to the country's broader socioeconomic development, emphasising the quality as well as the quantity of development. And third, to provide a platform for China to take a greater role in global health leadership. Foreign affairs specialists often talk about the Thucydides Trap. They mean the moment when one power threatens to displace another. When Athens rose, Sparta saw danger. War followed. Historians say that of 16 episodes of similar power transitions, 12 have ended in war. As America concedes power to China, is conflict inevitable? China interprets America's initiation of a trade dispute as proof that President Trump seeks to check China's rise. Writing in the China Daily last week, Huang Qunhui from the Chinese Academy of Social Sciences charged that the US, “wants to maintain its hegemony to deprive China's development rights.” President Xi has committed China to a new phase of “opening up”. That is certainly the policy of China's health community. The country's medical scientists crave global engagement. The Thucydides Trap is not inevitable. Indeed, there is every reason to believe that if the cooperative spirit of China's medical community could be replicated across China's Government, the future could be peaceful and productive. A new era of Pax Sinica.

Concordance of Motion Sensor and Clinician-Rated Fall Risk Scores in Older Adults.

As the older adult population in the United States continues to grow, developing reliable, valid, and practical methods for identifying fall risk is a high priority. Falls are prevalent in older adults and contribute significantly to morbidity and mortality rates and rising health costs. Identifying at-risk older adults and intervening in a timely manner can reduce falls. Conventional fall risk assessment tools require a health professional trained in the use of each tool for administration and interpretation. Motion sensor technology, which uses three-dimensional cameras to measure patient movements, is promising for assessing older adults' fall risk because it could eliminate or reduce the need for provider oversight. The purpose of this study was to assess the concordance of fall risk scores as measured by a motion sensor device, the OmniVR Virtual Rehabilitation System, with clinician-rated fall risk scores in older adult outpatients undergoing physical rehabilitation. Three standardized fall risk assessments were administered by the OmniVR and by a clinician. Validity of the OmniVR was assessed by measuring the concordance between the two assessment methods. Stability of the OmniVR fall risk ratings was assessed by measuring test-retest reliability. The OmniVR scores showed high concordance with the clinician-rated scores and high stability over time, demonstrating comparability with provider measurements.

HEALTH PROMOTION OF THE ELDERLY IN BAN KRUAT DISTRICT BURIRAM PROVINCE

There is concern that the ageing of the population in Thailand will put unsustainable pressure on public spending, with particular concerns about rising health costs and the ability of the health system to serve the increasing numbers of older people needing care. Undoubtedly, ageing will present challenges to the health-care system given the larger number of older people, the fact that many health conditions and, associated disability become more common with age, and that older people are higher users of health services. This study analyses the key areas of challenge for the health system as it adapts to an ageing population. It then sets out ways Thailand’s health system needs to adjust to meet the issue of an ageing population. Specifically, the purpose of the study was to study health promotion for the elderly in Ban Kruat District Buriram Province, Thailand. The study area is in Ban Lahansai, Tambon Hin Lad, Amphur Ban Kruad, Buriram Province. The methodology used in this study is qualitative research. The sample group is specifically selected,consists of five elderly people aged more than 6 years old and 5 community leaders that reside in Ban Lahan Sai, Tambon Hin Lad, Amphur Ban Kruad, Buriram Province. The study uses Qualitative Methodology of Ethnographic, In-depth interview technique, note taking from focus group discussion and content analysis. This case study found that the current policies and practices of health promotion for the elderly in Thailand is not suitable for the elderly age group.

Editorial: Stopping Pancreatic Cyst Surveillance?

The management of patients with pancreatic cysts, especially presumed branch duct intraductal papillary mucinous neoplasms (BD-IPMNs), remains a challenge. BD-IPMNs carry a very low risk of malignancy and occur in predominantly older individuals who often die from causes not related to their pancreatic disease. The specific decision to stop surveillance of presumed low risk BD-IPMNs (those without either worrisome features (WF) or high risk stigmata (HRS)) is controversial, and needs to balance the real risk of malignancy or developing malignancy and IPMN-related mortality, with the patient's life expectancy, quality of life expectations, and mortality from non-pancreatic-related causes. With improved life expectancy, improved survival from non-pancreatic malignancies, rising health costs, and growing detection of ever smaller presumed BD-IPMNs, this issue is becoming ever more critical.

High Out-of-Pocket Medical Spending among the Poor and Elderly in Nine Developed Countries.

The design of health insurance, and the role out-of-pocket (OOP) payments play in it, is a key policy issue as rising health costs have encouraged greater cost-sharing measures. This paper compares the percentage of Americans spending large amounts OOP to meet their health needs with percentages in eight other developed countries. By disaggregating by age and income, the paper focuses on the poor and elderly populations within each. The study uses nationally representative household survey data made available through the Luxembourg Income Study. It includes nations with high, medium, and low levels of OOP spending. Households have high medical spending when their OOP expenditures exceed a threshold share of income. I calculate the share of each nation's population, as well as subpopulations within it, with high OOP expenditures. The United States is not alone in exposing large numbers of citizens to high OOP expenses. In six of the other eight countries, one-quarter or more of low-income citizens devoted at least 5 percent of their income to OOP expenses, and in all but two countries, more than 1 in 10 elderly citizens had high medical expenses. For some populations in the sample nations, health insurance does not provide adequate financial protection and likely contributes to inequities in health care delivery and outcomes.