scholarly journals Necessity under construction – societal weighing rationality in the appraisal of health care technologies

2020 ◽  
pp. 1-16
Author(s):  
Tineke Kleinhout-Vliek ◽  
Antoinette de Bont ◽  
Bert Boer
Keyword(s):  
Health Care ◽  
Scientific Evidence ◽  
Appraisal Committee ◽  
Policy Makers ◽  
National Health Care ◽  
Two Phases ◽  
Set Up ◽  
Under Construction ◽  
The Cost ◽  
Patient Representative

Abstract Health care coverage decisions may employ many different considerations, which are brought together across two phases. The assessment phase examines the available scientific evidence, such as the cost-effectiveness, of the technology. The appraisal then contextualises this evidence to arrive at an (advised) coverage decision, but little is known about how this is done. In the Netherlands, the appraisal is set up to achieve a societal weighing and is the primary place where need- and solidarity-related (‘necessity’) argumentations are used. To elucidate how the Dutch appraisal committee ‘constructs necessity’, we analysed observations and recordings of two appraisal committee meetings at the National Health Care Institute, the corresponding documents (five), and interviews with committee members and policy makers (13 interviewees in 12 interviews), with attention to specific necessity argumentations. The Dutch appraisal committee constructs necessity in four phases: (1) allowing explicit criteria to steer the process; (2) allowing patient (representative) contributions to challenge the process; (3) bringing new argumentations in from outside and weaving them together; and (4) formulating recommendations to societal stakeholders. We argue that in these ways, the appraisal committee achieves societal weighing rationality, as the committee actively uses argumentations from society and embeds the decision outcome in society.

The Nursery of Life

2030 ◽  
2010 ◽  
Author(s):  
Rutger van Santen ◽  
Djan Khoe ◽  
Bram Vermeer
Keyword(s):  
Health Care ◽  
New Technology ◽  
Medical Knowledge ◽  
Human Beings ◽  
Slowing Down ◽  
Cost Of Health Care ◽  
Precise Diagnosis ◽  
Set Up ◽  
The Cost ◽  
Prompt Diagnosis

Human beings are much more complex than any technology we could devise today. How many machines are good for 80 or 90 years of service? Our immune system—set up at birth—is able to repel diseases that don’t even exist yet. Most viruses that proliferate 50 years after we were born can be defeated just as easily as maladies that have been dogging humans for generations. Effective health care means that—in most regions of the planet—we are living longer and longer. All the same, human beings are not perfect: We get sick and we wear out over time. In the wealthier regions, we spend a great deal of money trying to get as close as possible to a 100-year span. Our greatest task is to bring a long and healthy life within the reach of as many people as possible. New technology is required to hold down the cost of health care, to nip outbreaks of disease in the bud, and to ease discomfort in our old age. Scientists believe that substantial benefits can be gained by identifying abnormalities earlier. A cancerous growth measuring just a few millimeters is still relatively harmless, and an infection caught in its early stages won’t leave any scars. Although techniques for accurately diagnosing incipient abnormalities can often be very expensive, prompt diagnosis generally means that treatment will be easier, cheaper, and more likely to succeed. Thus, we can end up saving money despite the need for expensive equipment. To adequately fight the outbreak of diseases in the future, our technology must be able to respond more rapidly. This could pose a particular challenge because there is also a trend at present toward superspecialization, which is fragmenting medical knowledge and slowing down responses. Take the science of ophthalmology in which the various specializations focus on extremely specific parts of the eye. This is fine once a precise diagnosis has been made, but it could be a significant problem if the patient consults the wrong doctor at the outset. The way we currently approach diagnosis needs to change.

scholarly journals Policy makers’ perceptions and attitudes regarding incorporation of traditional healers into the national health care delivery system

Curationis ◽  
2008 ◽  
Vol 31 (4) ◽  
Author(s):  
MG Pinkoane
Keyword(s):  
Health Care ◽  
Delivery System ◽  
Health Care Delivery ◽  
National Health ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Traditional Healers ◽  
Policy Makers ◽  
National Health Care ◽  
Perceptions And Attitudes

Based on mixed perceptions which were both negative and positive the policy makers have not been vocal about the process to incorporate traditional healers into the National Health Care Delivery System of South Africa. Negative views were related to the denial that traditional healing does provide a cure and the positive views were identified in the passing of policies from 1994. These policies passed initiated recognition of the existence of traditional healers, but failed to address the important aspect of incorporating the traditional healers into the National Health Care Delivery System. It is these mixed perceptions as well as lack of appropriate policy to facilitate incorporation of traditional healers that urged the researcher to explore the perceptions and attitudes of policy makers regarding this incorporation process, as well as their views on how it should be achieved.

Analysis on the Rotary Inertial of the Primary Pump for China Advanced Research Reactor

2008 ◽  
Author(s):  
Jia Zhong ◽  
Wenxi Tian ◽  
Shengyao Jiang
Keyword(s):  
Research Reactor ◽  
Reactor Core ◽  
Physical Models ◽  
Rotary Inertia ◽  
Fortran Language ◽  
Set Up ◽  
Under Construction ◽  
The Cost ◽  
Residual Heat

The rotary inertia of the reactor’s primary pump is an important factor related to the reactor’s safety under some accidental conditions. If the rotary inertia of the primary pump is big, that the pump’s inertia time will be long and the coolant mass flow rate will decrease slowly. So it is helpful to remove the residual heat and enhance the safety of the reactor. On the other hand, a bigger rotary inertia increases the cost, and causes some other inconvenience. In this paper, our research object is China Advanced Research Reactor (CARR) which is under construction. Systemic mathematical and physical models were set up and a program was developed using FORTRAN language with GEAR numerical method to analyze the transient of CARR. The primary thermal-hydraulic parameters of the reactor core were obtained in case of loss of power accident under different rotary inertia of the pump. These parameters include the temperature of the coolant the clad and the fuel, the maximal quality of the reactor core and MDNBR, etc. On the basis of the calculate result, it can be found that when the rotary inertia of the pump is larger than 150 Kg·m2, all of the thermal parameters in loss of power accident meet the safety requirement. And if the rotary inertia of the pump is 450 Kg·m2 which is the design value of CARR, the delay shutdown time in loss of power accident must not exceed 20 seconds.

scholarly journals Nilotinib and Imatinib Utilization in Iran over 14 years

2021 ◽  
Author(s):  
Ava Mansouri ◽  
Kimia Hirbod ◽  
Maryam Taghizadeh-Ghehi ◽  
Aarefeh Jafarzadeh Kohneloo ◽  
Mohammad Solduzian ◽  
...  
Keyword(s):  
Kinase Inhibitors ◽  
Data Extraction ◽  
Insurance Coverage ◽  
Cost Effective ◽  
Insurance Companies ◽  
P Value ◽  
Policy Makers ◽  
Trend Assessment ◽  
Two Phases ◽  
The Cost

Background: Tyrosine Kinase Inhibitors (TKIs) are drugs of choice for Chronic Myeloid Leukemia (CML) treatment. CML healthcare costs greatly exceed of other haematological malignancies treatment mostly due to TKIs. There are several generic and brand preparations of imatinib and nilotinib, the only available TKIs, in Iran with different prices and varied insurance coverage. We have studied TKIs utilization and also investigate the effect of different insurance coverage on TKIs utilization in Iran. Methods: This was drug utilization study about Imatinib and Nilotinib over 14 years. It was conducted in two phases; data extraction from pharmaceutical wholesale data (2003-2017) for utilization trend assessment and registered data of prescriptions from Sizdah-Aban Pharmacy (2011-2014) for utilization trend and insurance coverage assessment such as; prescriptions frequency, number of TKIs, insurance companies and their cost coverage in each prescription. Results: Imatinib consumption increased significantly from 2003 to 2013. This trend stopped afterward. Nilotinib consumption had ascending trend. The trend line of years 2014 to 2017 was steeper and statistically significant (β=0.0014, p-value=0.02). The amount of nilotinib cost coverage by insurance companies increased significantly from 2011 to 2014 (p-value=0.04). The coverage of imatinib costs by insurance companies changed slightly during the study period that was not statistically significant. Frequency of prescriptions with full cost coverage doubled for nilotinib, while did not change remarkably for imatinib, from 2011 to 2014. Mean (SD) of imatinib and nilotinib counts per prescription was significantly higher in prescriptions for which 100% of the cost was covered. Conclusion: We found increasing trend in nilotinib utilization and observed some effects from nilotinib cost coverage by insurance on its consumption. This study made a clear picture for policy makers to monitor imatinib and nilotinib use appropriateness and design the proper cost-effective studies to make evidence-based decisions.

scholarly journals Selected facets of the fishing industry (early 1963)

2021 ◽  
Author(s):  
◽  
Ewen Bruce Macpherson McCann
Keyword(s):  
Economic Research ◽  
Export Trade ◽  
Commercial Fishery ◽  
Policy Makers ◽  
The Public ◽  
The Past ◽  
Intervention Price ◽  
Optimum Scale ◽  
Set Up ◽  
The Cost

<p>Consumer demand, retail distribution and the export trade are important aspects of the New Zealand Commercial Fishery which are outside the specific boundaries of this enquiry. It is a study in government intervention, price negotiation and supply. In analysing these three facets of the industry it was impossible to ignore the other three so they have been treated incidentally where a discussion of them was necessary to understand the central theme. There is scope for additional research into each of the above topics, perhaps more especially into administrative decision making when non economic objectives are involved and also into the optimum scale of plant given the cost conditions that apply to the industry. However, it is hoped that this essay goes part of the way towards meeting the need for fundamental economic research into an industry which periodically attracts the attention of the public, policy makers and Government. Parliament has set up three committees in the past twenty-six years to examine the industry.</p>

Europe Does It Better: Molecular Testing across a National Health Care System—The French Example

2013 ◽  
pp. 332-337 ◽  
Author(s):  
Frédérique Nowak ◽  
Fabien Calvo ◽  
Jean-Charles Soria
Keyword(s):  
Health Care ◽  
New Drugs ◽  
Molecular Testing ◽  
Tumor Biomarkers ◽  
National Network ◽  
National Health Care ◽  
Molecular Tests ◽  
Experimental Therapies ◽  
Set Up ◽  
French National Cancer Institute

Drug approvals for molecularly stratified tumor subgroups make molecular testing mandatory and require that molecular diagnostics be performed nationwide. To this end, the French National Cancer Institute (INCa) and the French Ministry of Health have set up a national network of 28 regional molecular genetics centers. Selective molecular tests are performed in these facilities. They are free of charge for all patients in their region, irrespective of the type of establishment in which they are receiving treatment. A specific program has also been implemented to anticipate the launch of new targeted therapies and to accelerate the time-to-access to new drugs and experimental therapies. The initiative has been operational for 5 years and has been successful in meeting its initial aims of uniform nationwide test provision and fast implementation of molecular tests for new tumor biomarkers.

Medizinisch-technischer Fortschritt und altersspezifische Gesundheitsausgaben / Medical Progress and Age-specific Expenditure on Health Care

2007 ◽  
Vol 227 (5-6) ◽  
Author(s):  
Walter Ried
Keyword(s):  
Health Care ◽  
Health Status ◽  
Survival Probability ◽  
Population Aging ◽  
Health Care Expenditure ◽  
Medical Progress ◽  
Set Up ◽  
The Cost ◽  
The Impact ◽  
Specific Expenditure

SummaryThis paper investigates the impact of population aging, driven by medical progress, upon agespecific expenditure on health care. In a model set up in discrete time, individuals at each age may catch a lethal disease which, upon receiving appropriate medical treatment, nevertheless involves a mortality risk. The incidence of lethal diseases, the associated survival probability conditional upon treatment, and health care expenditure conditional upon health status may all depend on an individual’s history of health status in the past.Medical progress is taken to involve an increase in the survival probability of a specified lethal disease. First, this produces a direct effect on age-specific health care expenditure to the extent that progress affects the cost of treatment of the disease. Second, indirect effects may also arise relating to individuals who, having survived the disease at some prior age, change the structure of individuals alive at current age. Specifically, these “new survivors” may influence age-specific expenditure either through changes in the incidence of lethal diseases or in the associated treatment cost. The sign of an indirect effect crucially depends on health care expenditure for “new survivors” relative to their peers.The analysis yields a number of general results with respect to the impact of medical progress on the age profile of health care expenditure. For example, both compression of morbidity and expansion of morbidity are hypotheses which relate to “new survivors” such that they fail to account for the total effect of progress on age-specific expenditure.

scholarly journals ANALISIS BIAYA KESEHATAN KEGIATAN PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT DI TINGKAT PUSKESMAS DALAM MENYUKSESKAN GERAKAN MASYARAKAT HIDUP SEHAT

2018 ◽  
Vol 21 (3) ◽  
pp. 163-171
Author(s):  
Astridya Paramita ◽  
Lusi Kristiana ◽  
A Yudi Kristanto
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Secondary Data ◽  
Community Empowerment ◽  
Minimum Standard ◽  
Unit Of Analysis ◽  
Average Percentage ◽  
Primary Health ◽  
Set Up ◽  
The Cost

Primary health care (Puskesmas) are the pioneer of GERMAS movement by health promotion and community empowerment activities (Promkes and PM). Financial support is one of the most important resources to managing activities. The object of this research is to provide information of costs and financial sources of Promkes and PM activities in Puskesmas. This research is a secondary data analysis of Health Cost Research for First Level Health Facility (RPK FKTP) 2015. The unit of analysis is puskesmas which organize Promkes and PM activities. There were 299 puskesmas in 2013 and 302 puskesmas in 2014. The data was analyze descriptively and comparing the amount and percentage of cost Promkes and PM activities in 2013/2014 along with financial resources by characteristics of Puskesmas. The results showed the average cost of organizing the Promkes and PM activities in 2014 is increasing, but the average percentage has decreased. In the period of 2013–2014, the average percentage to managing activities is 7,8%. The main financial source of the program is BOK. This condition occurs throughout the region. The cost of organizing the activities is directly proportional to the FCI category, but is inversely proportional to the IPKM category. Furthermore, in 2014 there is also an increased cost to organize activities in inpatient primary health care (Puskesmas rawat inap) and non-inpatient primary health care (Puskesmas non rawat inap). There is no minimum standard to regulate costing for program. It recommends to set up a minimum budget standard to takes account the categories of FCI and IPKM, arrange indicators to evaluate Promkes and PM activities to generate an ideal budget for Promkes and PM activities at puskesmas for succeeding the Germas movement. Abstrak Puskesmas menjadi ujung tombak keberhasilan GERMAS melalui kegiatan wajib promosi kesehatan dan pemberdayaan masyarakat (Promkes dan PM). Dukungan anggaran menjadi salah satu sumber daya penting penyelenggaraan kegiatan. Penelitian ini bertujuan memberi informasi besaran biaya dan sumber dana penyelenggaraan kegiatan Promkes dan PM di Puskesmas. Penelitian ini merupakan analisis lanjut data sekunder Riset Pembiayaan Kesehatan Fasilitas Kesehatan Tingkat Pertama (RPK FKTP) 2015. Unit analisis adalah puskesmas yang menyelenggarakan kegiatan Promkes dan PM yaitu 299 puskesmas di tahun 2013 dan 302 puskesmas di tahun 2014. Analisa data secara deskriptif dan komparasi terhadap besaran dan rerata persentase biaya tahun 2013/2014, sumber dana, dengan memperhatikan karakteristik Puskesmas. Hasil menginformasikan rerata biaya penyelenggaraan kegiatan Promkes dan PM tahun 2014 mengalami pertambahan, namun penurunan dalam rerata persentase biaya. Pada periode tahun 2013–2014, rerata persentase biaya penyelenggaraan adalah 7,8%. Bantuan Operasional Kesehatan (BOK) merupakan sumber dana utama. Tahun 2014 seluruh regional mengalami pertambahan biaya penyelenggaraan, namun penurunan dalam rata-rata persentase biaya. Besar anggaran penyelenggaraan kegiatan berbanding lurus dengan kategori FCI, namun berbanding terbalik dengan kategori IPKM. Tahun 2014, biaya penyelenggaraan kegiatan pada puskesmas non rawat inap dan puskesmas perairan atau di daerah terpencil bertambah. Belum ada peraturan standar minimal anggaran kegiatan Promkes dan PM. Disarankan perlu ditetapkan standar anggaran yang memperhatikan kategori IPKM dan FCI, penyusunan indikator keberhasilan kegiatan promkes dan PM untuk memperoleh besaran ideal anggaran kegiatan Promkes dan PM di Puskesmas demi keberhasilan GERMAS.  

scholarly journals Selected facets of the fishing industry (early 1963)

2021 ◽  
Author(s):  
◽  
Ewen Bruce Macpherson McCann
Keyword(s):  
Economic Research ◽  
Export Trade ◽  
Commercial Fishery ◽  
Policy Makers ◽  
The Public ◽  
The Past ◽  
Intervention Price ◽  
Optimum Scale ◽  
Set Up ◽  
The Cost

<p>Consumer demand, retail distribution and the export trade are important aspects of the New Zealand Commercial Fishery which are outside the specific boundaries of this enquiry. It is a study in government intervention, price negotiation and supply. In analysing these three facets of the industry it was impossible to ignore the other three so they have been treated incidentally where a discussion of them was necessary to understand the central theme. There is scope for additional research into each of the above topics, perhaps more especially into administrative decision making when non economic objectives are involved and also into the optimum scale of plant given the cost conditions that apply to the industry. However, it is hoped that this essay goes part of the way towards meeting the need for fundamental economic research into an industry which periodically attracts the attention of the public, policy makers and Government. Parliament has set up three committees in the past twenty-six years to examine the industry.</p>

scholarly journals Factors Affecting the Cost Effectiveness of Antibiotics

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Steven Simoens
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Antibiotic Treatment ◽  
Bacterial Infections ◽  
Guideline Implementation ◽  
Economic Evaluations ◽  
Policy Makers ◽  
Factors Affecting ◽  
The Cost ◽  
Care Costs

In an era of spiraling health care costs and limited resources, policy makers and health care payers are concerned about the cost effectiveness of antibiotics. The aim of this study is to draw on published economic evaluations with a view to identify and illustrate the factors affecting the cost effectiveness of antibiotic treatment of bacterial infections. The findings indicate that the cost effectiveness of antibiotics is influenced by factors relating to the characteristics and the use of antibiotics (i.e., diagnosis, comparative costs and comparative effectiveness, resistance, patient compliance with treatment, and treatment failure) and by external factors (i.e., funding source, clinical pharmacy interventions, and guideline implementation interventions). Physicians need to take into account these factors when prescribing an antibiotic and assess whether a specific antibiotic treatment adds sufficient value to justify its costs.

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