PHP42 THE ANNUAL HEALTH CARE EXPENDITURES PER CAPITA IN BRAZIL: A COMPARISON BETWEEN THE PUBLIC AND THE PRIVATE HEALTH CARE SYSTEMS

BACKGROUND Caring for individuals with chronic conditions is labor intensive, requiring ongoing appointments, treatments, and support. The growing number of individuals with chronic conditions makes this support model unsustainably burdensome on health care systems globally. Mobile health technologies are increasingly being used throughout health care to facilitate communication, track disease, and provide educational support to patients. Such technologies show promise, yet they are not being used to their full extent within US health care systems. OBJECTIVE The purpose of this study was to examine the use of staff and costs of a remote monitoring care model in persons with and without a chronic condition. METHODS At Dartmouth-Hitchcock Health, 2894 employees volunteered to monitor their health, transmit data for analysis, and communicate digitally with a care team. Volunteers received Bluetooth-connected consumer-grade devices that were paired to a mobile phone app that facilitated digital communication with nursing and health behavior change staff. Health data were collected and automatically analyzed, and behavioral support communications were generated based on those analyses. Care support staff were automatically alerted according to purpose-developed algorithms. In a subgroup of participants and matched controls, we used difference-in-difference techniques to examine changes in per capita expenditures. RESULTS Participants averaged 41 years of age; 72.70% (2104/2894) were female and 12.99% (376/2894) had at least one chronic condition. On average each month, participants submitted 23 vital sign measurements, engaged in 1.96 conversations, and received 0.25 automated messages. Persons with chronic conditions accounted for 39.74% (8587/21,607) of all staff conversations, with higher per capita conversation rates for all shifts compared to those without chronic conditions (P<.001). Additionally, persons with chronic conditions engaged nursing staff more than those without chronic conditions (1.40 and 0.19 per capita conversations, respectively, P<.001). When compared to the same period in the prior year, per capita health care expenditures for persons with chronic conditions dropped by 15% (P=.06) more than did those for matched controls. CONCLUSIONS The technology-based chronic condition management care model was frequently used and demonstrated potential for cost savings among participants with chronic conditions. While further studies are necessary, this model appears to be a promising solution to efficiently provide patients with personalized care, when and where they need it.

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Diagnostic Delay of Inflammatory Bowel Disease Is Significantly Higher in Public versus Private Health Care System in Mexican Patients

Inflammatory Intestinal Diseases ◽

10.1159/000520522 ◽

2021 ◽

pp. 1-9

Author(s):

Jesús K. Yamamoto-Furusho ◽

Norma N. Parra-Holguín

Keyword(s):

Health Care ◽

Health Care System ◽

Associated Factors ◽

Health Care Systems ◽

Diagnostic Delay ◽

Private Health Care ◽

The Public ◽

Care Systems ◽

Inflammatory Bowel ◽

Care System

Introduction: Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn’s disease (CD) characterized by a fluctuating course with periods of clinical activity and remission. No previous studies have demonstrated the frequency of delay at diagnosis and its associated factors in Mexico and Latin America. The aim of this study was to evaluate diagnostic delay of IBD in the last 4 decades in 2 different health care systems (public vs. private) and its associated factors. Methods: This is a cohort study that included 1,056 patients with a confirmed diagnosis of IBD from public and private health care systems. The diagnostic delay was defined as time >1 year from the onset of symptoms to the confirmed diagnosis for patients with UC and 2 years for patients with CD. Statistical analysis was performed with the SPSS v.24 program. A value of p ≤ 0.05 was taken as significant. Results: The delay at diagnosis decreased significantly by 24.9% in the last 4 decades. The factors associated with the diagnostic delay were proctitis in UC, clinical course >2 relapses per year and IBD surgeries for CD. We found a delay at diagnosis in 35.2% of IBD patients in the public versus 16.9% in the private health care system (p = 0.00001). Conclusions: We found a significant diagnosis delay of IBD in 35.2% from the public health care system versus 16.9% in the private health care system.

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Trends in the kidney cancer mortality-to-incidence ratios according to health care expenditures of 56 countries

Scientific Reports ◽

10.1038/s41598-020-79367-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Wen-Wei Sung ◽

Po-Yun Ko ◽

Wen-Jung Chen ◽

Shao-Chuan Wang ◽

Sung-Lang Chen

Keyword(s):

Health Care ◽

Clinical Outcomes ◽

Kidney Cancer ◽

Health Care Disparities ◽

Health Care Systems ◽

Health Care Expenditures ◽

Incidence And Mortality ◽

Care Systems ◽

Per Capita ◽

Systemic Therapies

AbstractThe incidence and mortality rates in kidney cancer (KC) are increasing. However, the trends for mortality have varied among regions over the past decade, which may be due to the disparities in medical settings, such as the availability of frequent imaging examinations and effective systemic therapies. The availability of these two medical options has been proven to be positively correlated with a favorable prognosis in KC and may be more common in countries with better health care systems and greater expenditures. The delicate association between the trends in clinical outcomes in KC and health care disparities warrant detailed observation. We applied a delta-mortality-to-incidence ratio (δMIR) for KC to compare two years as an index for the improvement in clinical outcomes and the mortality-to-incidence ratio (MIR) of a single year to evaluate their association with the Human Development Index (HDI), current health expenditure (CHE) per capita, and CHE as a percentage of gross domestic product (CHE/GDP) by using linear regression analyses. A total of 56 countries were included based on data quality reports and missing data. We discovered that the HDI, CHE per capita, and CHE/GDP were negatively correlated with the MIRs for KC (p < 0.001, p < 0.001, and p < 0.001, respectively). No significant association was observed between the δMIRs and the HDI, CHE per capita, and CHE/GDP among the included countries, and only the CHE/GDP shows a trend toward significance. Interestingly, the δMIRs related with an increase in relative health care investment include δCHE per capita and δCHE/GDP.

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Modernization, Globalization, Trends, and Convergence in Health Expenditure in Latin America and the Caribbean

Sociology of Development ◽

10.1525/sod.2015.1.2.321 ◽

2015 ◽

Vol 1 (2) ◽

pp. 321-346 ◽

Cited By ~ 5

Author(s):

Shiri Noy ◽

Patricia A. McManus

Keyword(s):

Health Care ◽

Latin America ◽

Health Care Systems ◽

Health Care Financing ◽

Health Spending ◽

Modernization Theory ◽

The Public ◽

National Differences ◽

Care Systems ◽

Public Private Mix

Are health care systems converging in developing nations? We use the case of health care financing in Latin America between 1995 and 2009 to assess the predictions of modernization theory, competing strands of globalization theory, and accounts of persistent cross-national differences. As predicted by modernization theory, we find convergence in overall health spending. The public share of health spending increased over this time period, with no convergence in the public-private mix. The findings indicate robust heterogeneity of national health care systems and suggest that globalization fosters human investment health policies rather than neoliberal, “race to the bottom” cutbacks in public health expenditures.

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Health Care

10.1093/oso/9780198817055.003.0011 ◽

2018 ◽

Author(s):

Pierre Pestieau ◽

Mathieu Lefebvre

Keyword(s):

Health Care ◽

Technological Progress ◽

Health Care Systems ◽

Third Party ◽

Medical Expenditure ◽

Public Health Care ◽

The Public ◽

Common Features ◽

Care Systems

This chapter reviews the public health care systems as well as their challenges. It first shows how expenditure on health care has evolved in previous decades and deals with the reasons for the growth observed in almost every European country. It emphasizes the role of technological progress as a main explanatory factor of the increase in medical expenditure but also points to the challenges facing cost-containment policies. Especially, the main common features of health care systems in Europe, such as third-party payment, single provider approach and cost-based reimbursement are discussed. Finally the chapter shows that although inequalities in health exist in the population, health care systems are redistributive. Reforms are thus needed but the trade-off between budgetary efficiency and equity is difficult.

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COVID-19, psychosocial issues, politics, and public mental health care

South African Journal of Psychology ◽

10.1177/00812463211015750 ◽

2021 ◽

Vol 51 (2) ◽

pp. 293-303

Author(s):

Anthony L Pillay ◽

Anne L Kramers-Olen

Keyword(s):

Mental Health ◽

South Africa ◽

Health Care ◽

Mental Health Care ◽

Health Care Systems ◽

Mental Health Policy ◽

Public Mental Health ◽

The Public ◽

Care Systems ◽

Public Mental Health Care

The COVID-19 pandemic heralded challenges that were both significant and unfamiliar, placing inordinate burdens on health care systems, economies, and the collective psyche of citizens. The pandemic underscored the tenuous intersections between public mental health care, politics, economics, and psychosocial capital. In South Africa, the inadequacies of the public health system have been laid bare, and the disproportionate privileges of the private health care system exposed. This article critically considers government responses to the COVID-19 pandemic, the psychosocial correlates of lockdown, politics, corruption, and public mental health policy in South Africa.

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Accountability for Rationing — Theory into Practice

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.2005.tb00534.x ◽

2005 ◽

Vol 33 (4) ◽

pp. 660-668 ◽

Cited By ~ 3

Author(s):

Christopher Newdick

Keyword(s):

Health Care ◽

National Health Service ◽

Health Service ◽

National Health ◽

Health Care Systems ◽

The Public ◽

Modern Health Care ◽

Concept Of Health ◽

Care Systems ◽

Health Need

Most now recognize the inevitability of rationing in modern health care systems. The elastic nature of the concept of “health need,” our natural human sympathy for those in distress, the increased range of conditions for which treatment is available, the “greying” of the population; all expand demand for care in ways that exceed the supply of resources to provide it. UK governments, however, have found this truth difficult to present and have not encouraged open and candid public debate about choices in health care. Indeed, successive governments have presented the opposite view, that “if you are ill or injured there will be a national health service there to help; and access to it will be based on need and need alone.” And they have been rightly criticized for misleading the public and then blaming clinical and managerial staffin the National Health Service (NHS) when expectations have been disappointed.

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Back to the Future: Principles on Resuming Outpatient Services in the COVID-19 Era

Otolaryngology ◽

10.1177/0194599820933597 ◽

2020 ◽

Vol 163 (4) ◽

pp. 705-706 ◽

Cited By ~ 1

Author(s):

Taher S. Valika ◽

Kathleen R. Billings

Keyword(s):

Health Care ◽

Outpatient Care ◽

Health Care Systems ◽

Lessons Learned ◽

Outpatient Services ◽

Drastic Reduction ◽

The Public ◽

Outpatient Visits ◽

The Future ◽

Care Systems

The rapidly changing health care climate related to coronavirus disease 2019 (COVID-19) has resulted in numerous changes to health care systems and in practices that protect both the public and the workers who serve in hospitals around the country. As a result, these past few months have seen a drastic reduction in outpatient visits. With phased reopening and appropriate guidance, health care systems are attempting to return to normal. The experiences and lessons learned are described, and we provide guiding principles to allow for a safe and effective return to outpatient care.

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Return to Normalcy? Principles on Resuming Surgical Services in the COVID-19 Era

OTO Open ◽

10.1177/2473974x20936658 ◽

2020 ◽

Vol 4 (2) ◽

pp. 2473974X2093665

Author(s):

Taher S. Valika ◽

Kathleen R. Billings

Keyword(s):

Health Care ◽

Patient Care ◽

Health Care Systems ◽

Lessons Learned ◽

Drastic Reduction ◽

The Public ◽

Surgical Services ◽

Outpatient Visits ◽

Care Systems ◽

Full Capacity

The rapidly changing health care climate related to coronavirus disease 2019 (COVID-19) has resulted in numerous changes to health care systems and in practices that protect both the public and the workers who serve in hospitals around the country. As a result, these past few months have seen a drastic reduction in outpatient visits and surgical volumes. With phased reopening and appropriate guidance, health care systems are attempting to return to normal. Our institution has had the unique opportunity to already return operations back to full capacity. The experiences and lessons learned are described, and we provide guiding principles to allow for a safe and effective return to patient care.

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