Total Health Expenditure Research Articles

Economic Evaluation of an Integrated Care Program Compared to Conventional Care for Patients With Chronic Kidney Disease in Rural Communities of Thailand

IntroductionAn integrated care program for chronic kidney disease in Thailand has shown its effectiveness in delaying the decline in kidney function, as evidenced by the ESCORT-1 randomized control trial and the ESCORT-2 prospective cohort study. Designed for sustainability within the primary healthcare system, the program optimizes the use of the existing workforce by fostering collaboration among local multidisciplinary care teams and community care networks. MethodsA Markov model with a lifetime horizon was used to conduct a cost-utility analysis from a societal perspective. Individual participant level data from ESCORT studies, national registries, and relevant literature were used to estimate model parameters. A budget impact analysis from the payer’s perspective was also assessed over a five-year period. ResultsThe integrated care program yielded a dominant result with 1.84 QALYs gained with “less” lifetime cost, resulting in a negative incremental cost-effectiveness ratio. Probabilistic analysis showed that the intervention being cost-effective almost 100% of the time at the local willingness-to-pay threshold. The intervention maximized cost-effectiveness when delivered as early as possible, both in terms of age and stage. The budget impact analysis estimated that the introduction of the intervention could save about 7% of the Thai government's total health expenditure or 205 billion Thai-Baht ($5.9 billion) over five years with cost savings beginning from the third year onwards. ConclusionThe integrated care program for CKD offers potential benefits and cost savings for patients, caregivers, and payers. Future efforts should focus on the screening and implementation processes across various regions and healthcare settings.

Health financing analysis in the implementation of minimum service standards in Lumajang Regency

Background: Health financing in Lumajang is still far from the target. Therefore, a study focused on the implementation of minimum service standards (MSS) in the health sector is needed. Despite the government emphasis on MSS health, disparities in service access and health conditions persist.Objective: To provide insights into the effectiveness of health financing, serving as a foundation for policy recommendations to enhance the efficiency and effectiveness of health fund allocation in Lumajang Regency.Methods: The study employed a quantitative approach, utilising district health accounts (DHA) and cost and benefit analysis (CBA). The budget allocation for different MSS health services was also investigated. The analysis involved examining the spending proportion relative to total health expenditure. The study design used a qualitative descriptive method. The data source was obtained from the budget realisation report for the MSS health sub-activities at the Community Health Center (CHC) and the Lumajang Health Office. Data analysis was performed by an integration of DHA and CBA approaches. We performed mapping costs and benefits analysis and calculated the sensitivity of financing to whether it is economically profitable and provides leverage for achieving MSS performance indicator targets. Results: The realisation of local original revenue in the health sector tended to fall below targets. Central transfer funds dominated the funding sources in CHC. The highest health budget allocation of MSS was received by maternal health services, while other services only received a proportion relative to a decrease in total health expenditure.Conclusion: In Lumajang Regency, analysis of the costs and benefits of regional health financing to fulfil MSS health showed that the benefit-cost ratio (BCR) value was > 1, meaning that health financing for MSS in the District Health Sector was profitable, so it should be used as a regional priority program in overcoming regional health problems.

Research on health expenditure in Kazakhstan

Objective To understand and study Kazakhstan's resource planning and budget allocation in the field of health care through data related to Kazakhstan's health expenditure, to ensure the sustainable development of the health field between China and Kazakhstan, and to promote the medical and health undertakings among countries along the Belt and Road Initiative. Learn from each other's strengths and complement each other's weaknesses to promote cooperation. Methods Using the literature review method and comparative method, the per capita health expenditure in Kazakhstan and the other five Central Asian countries and China from 2001 to 2021 was compared with the proportion of GDP per capita, the proportion of self-pay expenditure in per capita health expenditure, and the total government health expenditure in the country. The proportion of GDP, per capita health expenditure and its proportion to per capita GDP, and the average actual growth average of per capita government health transfer expenditure and self-pay expenditure are compared with each other's medical and health security systems, health expenditures, national health levels and health resources. Results From 2001 to 2021, Kazakhstan's per capita health expenditure accounted for per capita GDP fluctuated between 2% and 4%, while other countries had growth trends of varying degrees. China's growth trend was relatively stable; Kazakhstan's per capita out- of -pocket health expenditure grew on average. The value is the lowest, only 1.05%, and the growth of government health transfer expenditures is at a medium level; the proportion of Kazakhstan's self-pay expenditures in per capita health expenditures and the proportion of total government health expenditures in GDP are also at a medium level. Conclusion (a) Kazakhstan's medical and health security system has certain effectiveness, and China's medical and health security system also has its advantages. There is a need for in-depth cooperation and development between China and Kazakhstan. (b)Kazakhstan needs to maintain a low proportion of per capita health expenditure in per capita GDP. The low growth rate of self-pay health expenditure and the low proportion of self-pay expenditure in per capita health expenditure are conducive to maintaining social equity and social welfare levels. (c)It is necessary for Kazakhstan to increase investment in the health field, promote medical research and innovation, and deepen cooperation in the medical and health field with countries along the "Belt and Road".

Trends in household out-of-pocket health expenditures and their underlying determinants: explaining variations within African regional economic communities from countries panel data

BackgroundThe persistently high out-of-pocket health spending (OOPHE) in Africa raise significant concern about the prospect of reaching SDG health targets and UHC. The study examines the convergence hypothesis of OOPHE in 40 African countries from 2000 to 2019.MethodsWe exploit the logt\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\ ext{log }}t$$\\end{document}, club clustering, and merging methods on a panel of dataset obtained from the World Development Indicators, the World Governance Indicators, and the World Health Organization. Then, we employ the multilevel linear mixed effect model to examine whether countries' macro-level characteristics affect the disparities in OOPHE in the African regional economic communities (RECs).ResultsThe results show evidence of full panel divergence, indicating persistent disparities in OOPHE over time. However, we found three convergence clubs and a divergent group for the OOPHE per capita and as a share of the total health expenditure. The results also show that convergence does not only occur among countries affiliated with the same regional economic grouping, suggesting disparities within the regional groupings. The findings reveal that countries' improved access to sanitation and quality of governance, increased childhood DPT immunization coverage, increased share of the elderly population, life expectancy at birth, external health expenditure per capita, and ICT (information and communication technology) significantly affect within-regional groupings’ disparities in OOPHE per capita. The results also show that an increasing countries’ share of elderly and younger populations, access to basic sanitation, ICT, trade GDP per capita, life expectancy at birth, childhood DPT immunization coverage, and antiretroviral therapy coverage have significant impacts on the share of OOPHE to total health expenditure within the regional groupings.ConclusionTherefore, there is a need to develop policies that vary across the convergence clubs. These countries should increase their health services coverage, adopt planned urbanization, and coordinate trade and ICT access policies. Policymakers should consider hidden costs associated with access to childhood immunization services that may lead to catastrophic health spending.

Health and economic burden avoided due to air pollution reduction during the COVID-19 Lockdown: Portugal case study

Since the onset of the COVID-19 pandemic, strict mobility measures and lockdown periods were implemented globally to curtail the spread of the virus. Thus, this study aimed to estimate the health and economic burden avoided due to the air pollution reduction during the COVID-19 lockdown in Portugal. PM10, NO2, and O3 hourly concentrations were obtained from Portugal's 68 air quality monitoring stations for the 2020 lockdown and historical (2015–2019) periods to estimate the avoided premature deaths, avoided asthma-related morbidity and avoided hospital admissions due to respiratory diseases, and related avoided costs. Overall, a higher number of avoided premature deaths was estimated, especially related to short-term NO2 exposure (less 30 %). Moreover, the highest avoided morbidity effects were estimated for the short-term NO2 exposure on hospital admissions due to respiratory diseases (57 % of avoided admissions). Economically, €48.3 million were avoided from the averted NO2-related premature deaths, and up to 0.1 % of the total health expenditure was saved due to the avoided new asthma cases in children aged 5–19 years old. In sum, the air pollution reduction during the 2020 lockdown relative to the historical period led to human health gains and related avoided economic costs.

Multimorbidity healthcare expenditure in Belgium: a 4-year analysis (COMORB study)

BackgroundThe complex management of health needs in multimorbid patients, alongside limited cost data, presents challenges in developing cost-effective patient-care pathways. We estimated the costs of managing 171 dyads and 969 triads in Belgium, taking into account the influence of morbidity interactions on costs.MethodsWe followed a retrospective longitudinal study design, using the linked Belgian Health Interview Survey 2018 and the administrative claim database 2017–2020 hosted by the Intermutualistic Agency. We included people aged 15 and older, who had complete profiles (N = 9753). Applying a system costing perspective, the average annual direct cost per person per dyad/triad was presented in 2022 Euro and comprised mainly direct medical costs. We developed mixed models to analyse the impact of single chronic conditions, dyads and triads on healthcare costs, considering two-/three-way interactions within dyads/triads, key cost determinants and clustering at the household level.ResultsPeople with multimorbidity constituted nearly half of the study population and their total healthcare cost constituted around three quarters of the healthcare cost of the study population. The most common dyad, arthropathies + dorsopathies, with a 14% prevalence rate, accounted for 11% of the total national health expenditure. The most frequent triad, arthropathies + dorsopathies + hypertension, with a 5% prevalence rate, contributed 5%. The average annual direct costs per person with dyad and triad were €3515 (95% CI 3093–3937) and €4592 (95% CI 3920–5264), respectively. Dyads and triads associated with cancer, diabetes, chronic fatigue, and genitourinary problems incurred the highest costs. In most cases, the cost associated with multimorbidity was lower or not substantially different from the combined cost of the same conditions observed in separate patients.ConclusionPrevalent morbidity combinations, rather than high-cost ones, made a greater contribution to total national health expenditure. Our study contributes to the sparse evidence on this topic globally and in Europe, with the aim of improving cost-effective care for patients with diverse needs.

Trends in out-of-pocket health expenditure inequality in Turkey under comprehensive health reforms

The success of Turkey's inclusive health policies has served as a strategic tool for building progressivity and improving social welfare. The objective of this study is to examine the inequality trend in out of pocket (OOP) health expenditures in Turkey. Data from the Turkish Statistical Institute's Household Budget Survey conducted in 2015 and 2019 were used to measure inequalities in OOP total health, pharmaceutical and hospital expenditure variables across socioeconomic status. Decomposition analysis was conducted to identify the factors contributing to inequalities. The study findings demonstrate that OOP health expenditure is higher among the poor in Turkey. Evidence suggests that in Turkey inequalities in OOP health expenditures continue to persist. The results show that OOP health, pharmaceutical, and hospital expenditures increased from 2015 to 2019. The inequality index and curve approaches reveal that the pro-rich distribution of OOP health expenditures is remarkable from 2015 to 2019. The burden of OOP pharmaceutical and hospital services expenditures stands on the shoulders of poor households. Progressive universalism is essential to achieve poverty alleviation strategies and reduce inequality for egalitarian development.

Empirical Analysis of Human Capital Development and Poverty Reduction in Nigeria (1981-2022)

This study examined the impact of human capital development on poverty reduction in Nigeria covering the period 1981-20222. Data for the research were annual times series data on total education expenditures, total health expenditures, and inflation extracted from the Central Bank of Nigeria Statistical Bulletin 2020 and poverty rate, out-of-pocket expenditures, and human development index collected from World Development indicators. The methodology adopted in the study is linear regression with the application of the Ordinary Least Squares (OLS) technique. Other diagnostic tests which include unit-root test, autocorrelation, and normality test were carried out in the study. The major findings of the study were that total education expenditures (TOEDXP) have a positive and insignificant contribution to poverty reduction in Nigeria, total health expenditures (TOHEXP) have a positive and insignificant contribution to poverty reduction in Nigeria, and out-of-pocket expenditures (OOPE) have a positive and insignificant contribution to poverty reduction in Nigeria. It is therefore the recommendation of the study that the government should also increase its expenditure on health and education. It is a fact that health is wealth and therefore, there is a need to provide a good environment, health facilities, an increased rate of doctor to patient ratio, health workers motivation and increased remuneration amongst others and also government should increase its expenditure on education as this would improve the standard of living of the citizens.

Economic Burden of Healthcare Utilisation by Older Persons Living in the Community in Malaysia

Objective: The aim of the study is to estimate the economic burden of healthcare utilisation by older persons in Malaysia at a national scale. The specific objectives are to: (1) identify the healthcare utilisation behaviour of older persons; (2) estimate the direct and indirect healthcare costs at the community setting, and (3) estimate the economic burden of healthcare utilisation by older persons. Methods: The survey utilised multi-stage random sampling techniques to recruit a total of 2,274 elderly respondents aged 60 years and above. The economic burden of healthcare utilisation by an older person was estimated using multiple sources of data, namely administrative cost and healthcare cost from both institutional and community settings. Results: The prevalence of outpatient and inpatient care was 60.5% and 5.6%, respectively. Older persons generally chose government facilities for both inpatient and outpatient services. The average direct cost for outpatient and inpatient care were RM 141.24 and RM 2,527, respectively. The average indirect costs for outpatient and inpatient care were RM 31.44 and RM 524.07, respectively. The economic burden of healthcare utilisation by an older person was estimated at RM 3,807,481,491, which represent 0.34% of the total GDP in 2014 or 8% of the total health expenditure in the same year. By 2040, the burden is projected to reach a staggering RM 21 billion, or around 1.08% of the total GDP. The economic burden of healthcare utilisation by older persons is expected to increase as Malaysia is moving towards an aged nation by 2045. Conclusion: The utilization of outpatient care for older persons was estimated at 60% and most of the sought-after services were heavily subsidized government facilities. This study highlights the needs for the government to embark on preventive health and comprehensive education to decrease the prevalence and severity of non-communicable diseases (NCDs) among both the future aged and existing elderly in Malaysia. Alternatively, health care reform may be timely to ease the burden of healthcare utilisation by an even bigger percentage of older persons, once we become an aged nation.

Proyección de la carga clínica y económica de la enfermedad renal crónica entre 2022 y 2027 en España: resultados del proyecto Inside CKD

Background and objectiveChronic kidney disease (CKD) is a growing health problem affecting between 10% and 15% of the Spanish population. The lack of updated projections of the evolution of the disease burden hinders the development of evidence-based health policies and interventions to optimize the management of the disease and prevent its progression. The aim of this study is to project the evolution of the clinical and economic burden of CKD in Spain between 2022 and 2027. Materials and methodsInside CKD uses a validated microsimulation approach to project the burden of CKD. The projection is based on a virtual population according to Spanish demographics, literature, national data registries and clinical expert opinion. Costs associated with CKD management, renal replacement therapy (RRT), cardiovascular complications and arterial comorbidities were included. ResultsIn Spain, an absolute increase in the prevalence of CKD of 1% (from 10.7% to 11.7%) is expected between 2022 and 2027, corresponding to an increase from 5.14 million to 5.68 million patients in 2027. However, only one third of CKD patients would be diagnosed. Of these diagnosed patients, 3.9% will require RRT in 2027, an increase of 14.7% from 2022. A total of 654,281 accumulated deaths are expected in patients with CKD diagnosed between 2022 and 2027. The economic burden of diagnosed CKD is expected to increase by 13.8% to 4.89 billion euros in 2027, representing 5.56% of total Spanish public health expenditure in 2027 (compared to 4.88% in 2022), of which 42.5% will be allocated to RRT (2.4% of public health expenditure). ConclusionsThe Inside CKD project highlights the growing clinical, economic and social burden of CKD in Spain expected by 2027. Progression to more advanced stages with the need for RRT and associated complications represent a small proportion of the total CKD population, but contribute significantly to overall costs.

Asymmetric Effect of Income on the Healthcare Expenditure in Türkiye

This paper examines the dynamics between income and health spending in Türkiye from 1988 to 2020, employing autoregressive distributed lag (ARDL) and nonlinear ARDL (NARDL) methodologies. One of the key findings of this study is the presence of an asymmetric relationship between variations in income and overall healthcare expenditure. This means that changes in income levels do not have uniform effects on health expenditure, and the direction of these effects depends on whether income is rising or falling. Interestingly, the research reveals that both increases and decreases in income lead to a rise in total health expenditure. However, the impact of income declines on health expenditure is more pronounced. In other words, when people experience a decrease in income, they tend to allocate a larger portion of their reduced resources to health-related expenses. This highlights the significant financial strain that income reductions can place on individuals and households when it comes to healthcare costs. This pattern of asymmetric effects also extends to government or compulsory health expenditures. When income falls, the government's role in funding health expenses becomes more prominent, as individuals rely more on public healthcare services during economic downturns. Furthermore, the study sheds light on the intriguing relationship between income shifts and voluntary or out-of-pocket health expenses. Positive income shifts are found to be associated with a reduction in voluntary health expenditure. This suggests that as people experience an improvement in their financial situation, they may opt for less costly or more efficient healthcare services, leading to a decrease in out-of-pocket expenses. Conversely, when income levels decrease, individuals may find themselves with limited options, potentially resorting to more expensive private healthcare services or bearing a greater burden of out-of-pocket expenses. This finding underscores the financial vulnerability that can accompany negative income shifts.

Public Versus Private Health Financing Transition in Low- and Middle-Income Countries: Exploring the Crowding-Out Effects

Healthcare financing is crucial for sustainable development and has been gaining attention, particularly since the COVID-19 pandemic. Although ample studies have explored the determinants of healthcare spending, the current study examines the determinants of health financing transition in 124 low- and middle-income countries (LMICs) for 19 years, from 2000 to 2018. The study first estimates the elasticity of health expenditure (i.e., government, private, and external) to per capita income, fiscal spending, age dependency, control of corruption, and time; second, it investigates crowding-out/in effects between domestic and external health financing. As the sample countries are heterogeneous in terms of development and universal health coverage (UHC) reform, our study employs a panel regression model with cluster-robust fixed effects and a bootstrapping quantile regression with fixed effects model to capture unobserved heterogeneity and produce robust estimates across quantile distributions. The results show that an increase in per capita government health expenditure (GHE) and per capita external health expenditure from foreign donors can reduce the share of out-of-pocket health expenditure to total health expenditure (OOPHE), thereby improving the health status and well-being of the people. The study also finds crowding-out effects of per capita external health financing on GHE in LIMCs. Interestingly, the results show that the control of corruption increases the per capita GHE in low-income countries. Thus, in low-income countries, improving governance would improve efficiency in fund utilization and strengthen the health system. Further, our study concludes that those countries that have passed UHC legislation are moving faster toward health financing transition by increasing public spending on health care. Healthcare policy in developing countries should prioritize (i) the adoption and implementation of UHC reform, (ii) alternative revenue mobilization strategy for financing public health care.

The Effect of Healthcare Expenditure on Maternal Mortality in Uganda

The maternal mortality rate in Uganda of 189 per 100,000 live births remains above the global target of 70 per 100,000. Evidence shows that the mode of healthcare expenditure impacts the provision of maternal healthcare services and reduction in maternal mortality. Understanding how healthcare expenditure impacts maternal health outcomes in Uganda is important for policy. Data from World Development Indicators for the period 1985-2019 were used to explore the effect of healthcare expenditure on maternal mortality using an auto-regressive distributed lag model. The findings showed that domestic government expenditure targeted on maternal health conditions significantly reduces maternal mortality. An increase in nurses was also associated with significant reductions in maternal mortality; hence, the government should increase investment in training and posting adequate nurses at public health facilities, where the majority of Ugandans seek care. Similarly, out-of-pocket health expenditure and total health expenditure per capita were both associated with a reduction in maternal deaths in the short-run. However, while out-of-pocket health expenditure is associated with a reduction in maternal mortality, it is inequitable. The Uganda National Health Insurance should ensure that financial risk protection for the poor is implemented to move towards universal health coverage.

The Effective Coverage of Maternal and Child Primary Health-Care-Services and its Relationship with Health-Expenditures: An Analysis at Sub-National-Level in Iran

Introduction: The primary health care (PHC) approach is widely acknowledged as a fundamental element in achieving universal health coverage (UHC) goals. Consequently, numerous countries have undertaken efforts to restructure their health systems based on PHC principles. This study aims to evaluate geographic disparities in essential maternal and child indicators provided at the PHC level, focusing on both crude and effective coverage. Additionally, it seeks to explore the association between effective coverage and health expenditures within the national and sub-national contexts of Iran.
 Methods: This research employed a secondary analysis approach to investigate the spatial distribution of maternal and child health (MCH) indicators in Iran's provinces, utilizing the latest available data from the 2010 Demographic Health Survey (DHS). To provide a comprehensive understanding of MCH indicators, the study calculated composite indicators, crude, and effective coverage. The provinces' situations were compared using the median cut-off method. Additionally, the study examined the association between coverage indicators and total health expenditure per-capita.
 Results: At the national level, the crude and the effective composite coverage were 89.56% and 77.22%, respectively. Also, the medians of composite crude and effective service coverage in the provinces were 90.25% and 77.62%, respectively. There was no significant difference between urban and rural areas.
 Conclusion: This study has revealed a notable difference between the crude and effective service coverage of the selected MCH indicators. While the coverage of maternal services was generally higher than that of child services, there were significant geographic disparities in the coverage of key indicators of MCH services across provinces. Despite the provision of free services in rural areas, their coverage was not higher than that of urban areas. These findings suggest that PHC services in Iran are still far from achieving the desired coverage and UHC goals. Policymakers and stakeholders need to focus on addressing the gaps in effective coverage and geographic disparities to improve access to essential maternal and child health services and achieve UHC in Iran.

Bexagliflozin as an Adjunct Therapy to Diet and Exercise to Improve Glycaemic Control in Adults with Type 2 Diabetes.

Type 2 diabetes (T2D) is one of the leading causes of morbidity and mortality worldwide. Currently, over 10.5% of the adult population has been diagnosed with T2D, and almost 12% of total health expenditure is spent exclusively on T2D management globally. Sodium-glucose cotransporter-2 inhibitors are a relatively new class of oral antidiabetic agents that act by inhibiting renal sodium and glucose reabsorption. Except for their glucose-l owering effects, they have been associated with a more significant weight loss and blood pressure reduction and a lower risk of hypoglycaemia than other commonly prescribed antidiabetic drugs. On 20 January 2023, bexagliflozin became the fifth orally administered sodium-glucose transporter 2 inhibitor to be approved by the US Food and Drug Administration for the treatment of T2D as an adjunct therapy to diet and exercise in the USA after dapagliflozin, canagliflozin, empagliflozin and ertugliflozin. This review aims to discuss the current evidence on the efficacy and safety of bexagliflozin, which provides an important alternative treatment option for patients with T2D.

Analysis of the Status Quo and Influencing Factors of Total Health Expenditure in Xinjiang Based on Principal Component Regression Method

Analysis of the Status Quo and Influencing Factors of Total Health Expenditure in Xinjiang Based on Principal Component Regression Method

Regional differences of individual and allocation efficiencies of health resources in China.

The existing health resources and services are difficult to meet the needs of rapid economic development and the aging population in China. This paper evaluates the regional differences of individual and allocation efficiencies of health resources in China to explore ways to change the current situation. The models of single-input single-output efficiency (SISOE), single-input multi-output efficiency (SIMOE), multi-input single-output efficiency (MISOE), and multi-input multi-output efficiency (MIMOE) were developed to calculate the individual and allocation efficiencies of health resources of China in this study. It was found that the efficiencies of the number of health institutions (NHI) in the eastern and western regions of China were relatively close, with values of 0.61 and 0.59, respectively, significantly higher than 0.49 in the middle region. The efficiencies of the number of health personnel (NHP) in the eastern, middle, and western regions were closer, with values of 0.77, 0.75, and 0.79, respectively. The efficiencies of the number of health institution beds (NHIB) in the eastern and western regions were very close, with values of 0.79 and 0.78, respectively, while that in the middle region was 0.72. The efficiencies of the total health expenditure (THE) were 0.72, 0.76, and 0.79 in the east, middle, and western regions, respectively. The efficiencies of the number of diagnosis and treatment persons (NDTP) were 0.81, 0.70, and 0.71 in the eastern, middle, and western regions, respectively, while the efficiencies of the number of inpatients (NI) were 0.75, 0.79, and 0.81, respectively. The efficiencies of the utilization rate of beds (URB) and the average days of hospitalization (ADH) in the three regions were below 0.51. The health resources allocation efficiencies (HRAEs) were 0.86, 0.83, and 0.87 in the eastern, middle, and western regions, respectively. There were obvious regional differences in HRAE in China with the situation of "Middle Collapse." The main direct reason for the low HRAE in the middle region was the lower efficiencies of NHI, NHIB, URB, and ADH. It revealed that there was relatively blind expansion of health institutions and beds with lower health service quality in the middle region. Governments should make strategic adjustments to public health resources and increase the investment in medical technology and manpower in the middle region. Hospitals in the eastern region should strengthen inter-regional medical and health technical cooperation with partners in the middle region by establishing a tele-medical network. The models of SISOE, SIMOE, MISOE, and MIMOE put forward in this study are simple, reasonable, and useful for resource efficiency analysis, which makes it convenient to adopt targeted measures to upgrade the efficiency of resource allocation. This study provides a new perspective and method to understand the mechanism of regional differences in China's health resource allocation efficiency.

Investment case for small and sick newborn care in Tanzania: systematic analyses

BackgroundSmall and sick newborn care (SSNC) is critical for national neonatal mortality reduction targets by 2030. Investment cases could inform implementation planning and enable coordinated resource mobilisation. We outline development of an investment case for Tanzania to estimate additional financing for scaling up SSNC to 80% of districts as part of health sector strategies to meet the country’s targets.MethodsWe followed five steps: (1) reviewed national targets, policies and guidelines; (2) modelled potential health benefits by increased coverage of SSNC using the Lives Saved Tool; (3) estimated setup and running costs using the Neonatal Device Planning and Costing Tool, applying two scenarios: (A) all new neonatal units and devices with optimal staffing, and (B) half new and half modifying, upgrading, or adding resources to existing neonatal units; (4) calculated budget impact and return on investment (ROI) and (5) identified potential financing opportunities.ResultsNeonatal mortality rate was forecast to fall from 20 to 13 per 1000 live births with scale-up of SSNC, superseding the government 2025 target of 15, and close to the 2030 Sustainable Development Goal 3.2 target of <12. At 85% endline coverage, estimated cumulative lives saved were 36,600 by 2025 and 80,000 by 2030. Total incremental costs were estimated at US$166 million for scenario A (US$112 million set up and US$54 million for running costs) and US$90 million for scenario B (US$65 million setup and US$25 million for running costs). Setup costs were driven by infrastructure (83%) and running costs by human resources (60%). Cost per capita was US$0.93 and the ROI is estimated to be between US$8–12 for every dollar invested.ConclusionsROI for SSNC is higher compared to other health investments, noting many deaths averted followed by full lifespan. This is conservative since disability averted is not included. Budget impact analysis estimated a required 2.3% increase in total government health expenditure per capita from US$40.62 in 2020, which is considered affordable, and the government has already allocated additional funding. Our proposed five-step SSNC investment case has potential for other countries wanting to accelerate progress.

Abstract 15431: Barriers to Percutaneous Coronary Intervention in Sub Saharan Africa: A Call to Action

Introduction: Myocardial infarction incidence is rising in Sub-Saharan Africa (SSA). Currently, 80% of the world cardiovascular disease mortality burden is by low- and middle-income countries. SSA countries have limited access to trained interventional cardiologists and medical centers where Percutaneous Coronary Intervention (PCI) is performed. Methods: In this review, Google Scholar and PubMed were used to search literature on PCI in SSA. Selection criteria were manuscripts published between 2013-2023, written in English language, and addressed the hurdles with PCI. Results: Between April 2010 and March 2019, patients presenting to a PCI-capable center in Abidjan, Côte d’Ivoire had a median delay of 20 hours from onset of symptoms to admission. This was 53.2 hours in Senegal, 4.35 days in Burkina-Faso, and 6.6 days in Tanzania, while it was between 2.3 to 3.6 hours in South Africa. In terms of availability of PCI-capable centers in East and Central Africa; Kenya, Ethiopia Tanzania, and Uganda 5, 3, 2, and 1 center (s) respectively. In West Africa; Nigeria, Senegal, Ghana, Côte d’Ivoire and Cameroon had 6, 4, 2, 1, and 1 center(s), respectively. The average cost of an uncomplicated PCI of a single vessel occlusion costs up to $3500 (R65,000/1,612,000). In SSA, due to limited access to medical insurance, the proportion of direct out-of-pocket payments in total health expenditure remains above 40%. Conclusions: Minimizing ST-elevation Myocardial Infarction care and PCI delay should be a public health priority, as it a matter of public health interest and global health equity. There is a need for research into understanding better ways to improve access to STEMI care in Africa.

Treated versus self-reported prevalence of chronic pain and costs of patients' health services utilization: a population-based study of health administrative databases.

To compare treated to self-reported prevalence of chronic pain (CP) and to estimate health services utilization (HSU) costs of patients treated for CP in Alberta, Canada. Patients treated for CP were identified by the physician billing codes of health services for CP from the practitioner claims database in fiscal year 2021/22. The treated prevalence of CP (number of these patients divided by the population) was compared to the self-reported prevalence of CP previously estimated (doi:10.1371/journal.pone.0272638). Costs of patients' HSU included costs for general practitioner (GP), specialist, inpatient, emergency department, outpatient clinic services, and prescription drugs. The treated prevalence of CP was 6.0% (4.4% among males and 7.8% among females) which was 30% to 41% of the self-reported prevalence. The highest treated prevalence (7.2%) was found in the age group of 18-64years, followed by age groups of >64years (7.0%) and <18years (2.1%). The average cost per patient per year was $5096 ($5878 for males and $4652 for females), of which hospitalizations accounted for 65.0%, outpatient clinic visits 16.4%, ED visits 9.5%, prescription drugs 4.7%, GP visits 3.9%, and specialist visits 0.4%. The total cost of patients with CP for the health system was $1.37 billion (∼7% of total health expenditure), of which males accounted for 41.7% and females for 58.3%. Our findings suggest that the economic burden of CP is considerable and that many people with self-reported CP do not use the public healthcare services. This can be multifactorial, including lack of availability and accessibility of publicly funded services, people's lack of awareness of available services, lower utilization due to COVID-19 pandemic, and reliance on self-management, private services, and alternative treatments. Further studies are warranted to inform future policies and health system initiatives aiming to reduce the burden of CP and improve lives of people living with it.