Use Of Scarce Health Resources Research Articles

Mandatory health insurance for the informal sector in Tanzania-has it worked anywhere!

Many countries in sub-Saharan Africa are struggling to expand voluntary health insurance schemes to raise finances toward achieving universal health coverage. With more than three-quarters of the population without any insurance, the government of Tanzania has unsuccessfully tried to pass a Bill proposing a mandatory, nationwide scheme to cover the large and diverse informal sector. The Bill proposed an annual premium of ∼150 USD for a household of six or 65 USD per person. Studies in Tanzania and Kenya have shown that the majority of people in the informal sector are unwilling and unable to pay premiums as low as 4 USD, mostly due to poverty. Mandatory health insurance for the informal sector is not common in this region, mostly because it is difficult to enforce. Successful insurance schemes have included significant subsidies from tax revenues. Tanzania should not seek to raise funds for health through an unenforceable insurance scheme but rather should consider a largely tax-funded scheme for the informal sector. Contributions through low-cost voluntary schemes can enhance social contracts, reduce out-of-pocket expenditure, and promote efficient utilization. In addition, progressive health taxes should be imposed on harmful products (tobacco, alcohol, sugary drinks, etc.) to raise more funds while addressing the increasing burden of non-communicable diseases. Furthermore, efficiency in the use of scarce health resources should be promoted through realistic prioritization of public services, the use of Health Technology Assessment, and strategic purchasing.

Algorithmic legitimacy in clinical decision-making

Machine learning algorithms are expected to improve referral decisions. In this article I discuss the legitimacy of deferring referral decisions in primary care to recommendations from such algorithms. The standard justification for introducing algorithmic decision procedures to make referral decisions is that they are more accurate than the available practitioners. The improvement in accuracy will ensure more efficient use of scarce health resources and improve patient care. In this article I introduce a proceduralist framework for discussing the legitimacy of algorithmic referral decisions and I argue that in the context of referral decisions the legitimacy of an algorithmic decision procedure can be fully accounted for in terms of the instrumental values of accuracy and fairness. I end by considering how my discussion of procedural algorithmic legitimacy relates to the debate on algorithmic fairness.

How the West Controls Pharmaceutical Prices: Lessons for Malaysia

Drug price in Malaysia has increased substantially over the years. Malaysian policymakers may learn from the Western countries on how to control pharmaceutical spending. We conducted a review to assess the pharmaceutical strategies adopted in Western countries to curb pharmaceutical pricing and compared it with the current Malaysian system. The study found that the European countries adopted a regulated pharmaceutical market. In this regulated market, the price of the drugs will be determined using external reference pricing. The reimbursement and pricing of the drugs are also based on a set of guidelines rather than arbitrary nature. Additionally, the health technology assessment in the European countries utilised rating systems to categorise the added therapeutic benefit of the drugs. This rating system will add more information for price negotiation between the government and pharmaceutical manufacturers. Furthermore, cost-effectiveness analysis is also being incorporated into the decision-making process to ascertain the optimal use of scarce health resources. On top of that, pooled procurement system has been established in order to benefit from the higher volume purchasing. These measures may help Malaysia to ensure that the pharmaceutical spending remain sustainable and that Malaysians, will continue to have access toward a high-quality and affordable healthcare in the future.

Assess the Prevalence for Needs of Breast Cancer Survivors' in the Oncology Ward at a Selected Tertiary Care Hospital

The unmet needs of breast cancer survivors are not being addressed as the number of survivors continues to climb.
 Aim and Objective: To determine the prevalence of post-treatment unmet needs and association between unmet needs of breast cancer survivors with selected demographic variables. A descriptive research study was conducted in a tertiary care hospital's oncology outpatient clinic and wards.
 Materials and Methods: Data was gathered in two sections: I – baseline data, and section II – Modified needs assessment questionnaire. 35 needs were categorized as physical, emotional, family, spiritual, practical routine, and sexual relationship needs, with ‘Yes’ scored as ‘1’ and ‘No’ scored as ‘0’. Data was collected for one month. Data tabulation and analysis was done.
 Results: The majority of BCS had a monthly income of Rs.3000- 10000/- (50.8%) and menopause had occurred in 54 (45%) of the women under the age of 45. Majority 65 (78%) did not have health insurance, whereas 42 (35%) had it. Majority 108 (90.33%) breast cancer survivors had high level of needs, whereas 12 (10%) had moderate level of needs. High physical needs reported by 87 (72.50 %) and 32 (26.67%) moderate physical needs. All 100% BCS reported high emotional need. Whereas 2(1.67%) less need, 14(11.67%) moderate, 56 (46.67%) high needs and 48 (40%) very high reported family and spiritual need and 39 (32.5 %) BCS reported moderate level of practical needs. Participants 14(11.67%) less needs, 39 (32.50%) moderate, 22(18.33%) high and very high 8(6.67%) reported practical needs. 100% of breast cancer survivors (BCS) reported physical includes Hot flashes, a change in appetite or eating pattern. High emotional needs followed by physical needs. Family and spiritual requirements of BCS were found to be strongly related to age, P 0.036. Age, education, occupation, income, stage of cancer, and health insurance are not associated with the overall and physical needs of breast cancer survivors (p > 0.05).
 Conclusion: Breast cancer survivors' needs are more prevalent and have an impact on quality of life, prognosis, and recovery of clients. Real, appropriate assessment of breast cancer survivors needs is an important steps in development of need base intervention to improve quality of life. As a result, health care providers should address the needs of BCS patients as soon as possible in order to make better use of scarce health resources.

Is bed turnover rate a good metric for hospital scale efficiency? A measure of resource utilization rate for hospitals in Southeast Nigeria

BackgroundNigeria health sector, like that of other sub-Saharan African countries, increasingly faces critical resource constraints. Thus, there is need to seek for ways of improving efficient use of scarce health resources. The aim of this study was to determine resource utilization rate of teaching hospitals in Southeast Nigeria as a means of estimating their efficiency.MethodsThe study is a longitudinal cross sectional study. It applied ratio indicators and Pabon Lasso model using data on the number of hospital bed, number of inpatients and total inpatient-days from purposefully selected teaching hospitals in Southeast Nigeria to measure efficiency over a period of 6 years (2011–2011).ResultsThe hospitals’ mean bed occupancy rate was as low as 42.14%, far below standard benchmark of 80–85%. The mean average length of stay was as high as 8.15 days and observed mean bed turnover was 21.27 patients/bed/year. These findings portrayed high level of inefficiency in Nigeria teaching hospitals, which was further illustrated by Pabon Lasso graph, with only 10–20% of the hospital-years located within or near the efficient zone or quadrant.ConclusionThe study was able to show that health ratio indicators such as hospital bed turnover rate (BTR) and bed occupancy rate (BOR), as well as patients’ average length of stay (ALS) can be used as tools for assessing hospital performance or its efficiency in resource utilization. Thus, in low and middle income countries where medical record keeping may be inadequate or poor, ratio indicators used alone or with Pabon Lasso graph/chart could be an optional metrics for hospital efficiency.

Depression Screening and Health Outcomes in Children and Adolescents: A Systematic Review.

Depression screening among children and adolescents is controversial. In 2009, the United States Preventive Services Task Force first recommended routine depression screening for adolescents, and this recommendation was reiterated in 2016. However, no randomized controlled trials (RCTs) of screening were identified in the original 2009 systematic review or in an updated review through February 2015. The objective of this systematic review was to provide a current evaluation to determine whether there is evidence from RCTs that depression screening in childhood and adolescence improves depression outcomes. Data sources included the MEDLINE, MEDLINE In-Process, EMBASE, PsycINFO, Cochrane CENTRAL and LILACS databases searched February 2, 2017. Eligible studies had to be RCTs that compared depression outcomes between children or adolescents aged 6 to 18 years who underwent depression screening and those who did not. Of 552 unique title/abstracts, none received full-text review. No RCTs that investigated the effects of screening on depression outcomes in children or adolescents were identified. There is no direct RCT evidence that supports depression screening among children and adolescents. Groups that consider recommending screening should carefully consider potential harms, as well as the use of scarce health resources, that would occur with the implementation of screening programs.

Problematic alcohol and other substance use among patients presenting to emergency services in South Africa: Who is ready for change?

Studies that identify factors associated with intervention uptake are urgently needed in poorly resourced healthcare systems. This is important, as knowing who is likely to engage may lead to intervention targeting, which is an efficient use of scarce health resources. To identify patient characteristics that predict the acceptance of a brief intervention for substance use delivered in emergency departments (EDs). Patients presenting to three EDs were screened for substance use using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). All patients identified as at risk for substance use problems were offered a brief psychotherapy intervention focused on substance user education. Data were collected on patients' age, sex, presenting condition (injury/no injury), type of substance used, and severity of substance use. Logistic regression analysis was used to identify variables that predicted acceptance of the offer of a brief intervention. Being between the ages of 25 and 39 years increased the likelihood of accepting an offer of help compared with 18 - 24-year-olds. Polysubstance users were less likely to accept an offer of help than patients with problematic alcohol use only, while patients with higher ASSIST scores were more likely to accept an offer of help than those with lower scores. Findings suggest that more work is needed to understand the mechanisms underlying treatment acceptance. Brief interventions delivered in ED services in countries such as South Africa should target alcohol users with higher ASSIST scores in order to ensure the efficient use of scarce health resources.

Economic Outcomes Associated With Atypical Antipsychotics in Bipolar Disorder

Bipolar disorder is a serious condition that is costly to the health care system. Atypical antipsychotics are more expensive than conventional treatments. From a policy-making perspective, the additional cost must be justified by improved outcomes. The objective of this study was to conduct a systematic review to determine the relative costs and cost-effectiveness associated with atypical antipsychotics in bipolar disorder. We conducted a systematic review of the literature in PubMed and EMBASE from January 1985 through October 2005, including published studies and conference proceedings. Databases were searched using predefined terms. Studies were included if they were claims data analyses, trial-based economic evaluations, or cost-effectiveness analyses using models. Data were extracted using predefined tables. Fourteen studies were identified. Seven were medical claims database analyses, 4 were trial-based economic evaluations, and 3 were cost-effectiveness models. Eight of these studies were conference proceedings. The studies did not provide sufficient information to determine any ranking of interventions in terms of least to most costly in overall resource consumption or in terms of their relative cost-effectiveness. Where comparable, results tended to be inconsistent. There is a scarcity of economic studies in this field. A reference case outlining how to address the complex interplay between effectiveness, safety, adherence, and quality of life and their impact on resource use and costs is needed to contribute to improving the treatment of patients with bipolar disorder while making the best use of scarce health resources.

Modelo de perfil de morbilidad, características sociodemográficas y de saneamiento ambiental: Barrio El Rodeo de la localidad de San Cristóbal, Bogotá D.C.

Para la implementación del programa "Barrio Saludable" era importante determinar el perfil de morbilidad de los habitantes del barrio El Rodeo, sus necesidades fundamentales de saneamiento y sus características sociodemográficas, con el fin de establecer programas de salud, generar conductas de autoestima y autocuidado, promoviendo así la salud y evitando la aparición y el desenlace de patologías modificables, intervenibles y prevenibles, utilizando al máximo los escasos recursos de la salud.

Cost-Effectiveness: Seeking Value for Money in Lower Extremity Wound Management

This article discusses the different methods of evaluating cost in relation to the outcomes of treatment, and reviews the evidence of cost-effectiveness (CE) in the management of chronic leg ulceration. In essence, the CE argument revolves around the need to demonstrate outcomes of treatment in relation to particular levels of financial input by the health providers. High CE allows for either the same number of patients to be treated more efficiently (at a lower cost) or more patients to be treated for the same financial input. A review of medical and nursing databases (Medline, Embase, and Cinahl) identified studies of CE of dressing materials (n = 8), use of compression therapy (n = 4), and other treatments (n = 2). In addition, 5 research groups have undertaken studies to evaluate the relative CE of different systems of care. Overall conclusions are that modern wound dressings provide a more cost-effective alternative to saline gauze, whereas the evidence relating to the use of tissue-engineered skin is less clear. The use of compression bandaging is substantially more cost-effective when compared with a system of care where compression is not systematically offered. The systems that offer compression are not only cost-effective but also lead to reductions in absolute cost. The evaluation of CE is likely to become an ever-increasing part of wound care evaluation as we strive to achieve greater efficiency in the use of scarce health resources.