Use, cost, and digital divide in online public health care: lessons from Denmark

2019 ◽  
Vol 13 (2) ◽  
pp. 197-211 ◽  
Author(s):  
Kim Normann Andersen ◽  
Jeppe Agger Nielsen ◽  
Soonhee Kim
Keyword(s):  
Health Care ◽  
Digital Divide ◽  
Health Care Costs ◽  
Online Communication ◽  
Population Data ◽  
Public Health Care ◽  
Content Type ◽  
Health Related ◽  
Use Of The Internet ◽  
Care Costs

Purpose The purpose of this paper is to enhance the knowledge about the use of online communication between patients and health-care professionals in public health care. The study explores digital divide gaps and the impacts of online communication on the overall costs of health care. Design/methodology/approach This study focuses on online health care in Denmark. The authors rely on population data from 3,500 e-visits (e-mail consultations) between patients and general practitioners (GPs) from 2009 to 2015. Additionally, they include survey data on the use of the internet to search for health-related information. Findings The analysis of the Danish data reveals a rapid uptake in the use of the internet to search for health-related information and a three-fold increase in e-visits from 2009 to 2015. The results show that the digital divide gaps exist also in the online health-care communication. Further, the study findings suggest that enforced supply of online communication between GPs and patients does not alleviate the costs. Rather, the number of visits to GPs has not been decreased significantly and health-care costs showing a marginal increase. Research limitations/implications Further data should be collected and analyzed to explore the impacts of other institutional factors and population cohort on the digital divide and healthcare costs. Also, it is difficult to estimate whether the increased use of online health care in the long run lead to lowering overall health-care costs. While the internal validity of the study is high due to the use of population data, the external validity is lower as the study results are based on the data collected in Denmark only. Practical implications The study offers important input for practice. First, leaders in government might reconsider how they can control the health-care costs when opening online channels for communication between patients and doctors. Second, concerns about digital divide issues remains, but the study suggests that the uptake of e-visits does not widen the socio-economic, gender or age gaps. For health policy concern, this is encouraging news to lead to an increasing push of online communication. Social implications The dynamics of online health-care communication may lead to mixed results and unexpected impacts on overall health-care costs. Originality/value The paper offers new insights in the impacts of mandatory supply of digital services. The Danish push-strategy has led to an enforced supply of e-visits and a rapid growing use of the online health care without widening digital divide but at the risk of potential increasing the overall costs.

Cost-effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints

2006 ◽  
Vol 22 (1) ◽  
pp. 76-83 ◽  
Author(s):  
Jacques J. X. R. Geraets ◽  
Mariëlle E. J. B. Goossens ◽  
Camiel P. C. de Bruijn ◽  
Imelda J. M. de Groot ◽  
Albère J. S. Köke ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Treatment Period ◽  
Health Care Costs ◽  
Daily Activities ◽  
Graded Exercise Therapy ◽  
Graded Exercise ◽  
Health Related ◽  
Care Costs

Objectives:The present study evaluated the cost-effectiveness of a behavioral graded exercise therapy (GET) program compared with usual care (UC) in terms of the performance of daily activities by patients with chronic shoulder complaints in primary care.Methods:A total of 176 patients were randomly assigned either to GET (n=87) or to UC (n=89). Clinical outcomes (main complaints, shoulder disability [SDQ] and generic health-related quality of life [EQ-5D], and costs [intervention costs, direct health care costs, direct non–health-related costs, and indirect costs]) were assessed during the 12-week treatment period and at 52 weeks of follow-up.Results:Results showed that GET was more effective than UC in restoring daily activities as assessed by the main complaints instrument after the 12-week treatment period (p=.049; mean difference, 7.5; confidence interval [CI], 0.0–15.0). These effects lasted for at least 52 weeks (p=.025; mean difference 9.2; CI, 1.2–17.3). No statistically significant differences were found on the SDQ or EQ5D. GET significantly reduced direct health care costs (p=.000) and direct non–health care costs (p=.029). Nevertheless, total costs during the 1-year follow-up period were significantly higher (p=.001; GET=€530 versus UC=€377) due to the higher costs of the intervention. Incremental cost-effectiveness ratios for the main complaints (0–100), SDQ (0–100), and EQ-5D (−1.0–1.0) were €17, €74, and €5,278 per unit of improvement, respectively.Conclusions:GET proved to be more effective in the short- and long-term and reduces direct health care costs and direct non–health care costs but is associated with higher costs of the intervention itself.

scholarly journals Cerebral palsy in Canada, 2011-2031: results of a microsimulation modelling study of epidemiological and cost impacts

2020 ◽  
Vol 40 (2) ◽  
pp. 25-37
Author(s):  
Nana Amankwah ◽  
Maryam Oskoui ◽  
Rochelle Garner ◽  
Christina Bancej ◽  
Douglas G. Manuel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Cerebral Palsy ◽  
Health Care Costs ◽  
Health Related Quality ◽  
Incidence And Mortality ◽  
Related Quality ◽  
Health Related ◽  
Care Costs

Introduction The objective of our study was to present model-based estimates and projections on current and future health and economic impacts of cerebral palsy in Canada over a 20-year time horizon (2011–2031). Methods We used Statistics Canada’s Population Health Model (POHEM)–Neurological to simulate individuals’ disease states, risk factors and health determinants and to describe and project health outcomes, including disease incidence, prevalence, life expectancy, health-adjusted life expectancy, health-related quality of life and health care costs over the life cycle of Canadians. Cerebral palsy cases were identified from British Columbia’s health administrative data sources. A population-based cohort was then used to generate the incidence and mortality rates, enabling the projection of future incidence and mortality rates. A utility-based measure (Health Utilities Index Mark 3) was also included in the model to reflect various states of functional health to allow projections of health-related quality of life. Finally, we estimated caregiving parameters and health care costs from Canadian national surveys and health administrative data and included them as model parameters to assess the health and economic impact of cerebral palsy. Results Although the overall crude incidence rate of cerebral palsy is projected to remain stable, newly diagnosed cases of cerebral palsy will rise from approximately 1800 in 2011 to nearly 2200 in 2031. In addition, the number of people with the condition is expected to increase from more than 75 000 in 2011 to more than 94 000 in 2031. Direct health care costs in constant 2010 Canadian dollars were about $11 700 for children with cerebral palsy aged 1–4 years versus about $600 for those without the condition. In addition, people with cerebral palsy tend to have longer periods in poorer health-related quality of life. Conclusion Individuals with cerebral palsy will continue to face challenges related to an ongoing need for specialized medical care and a rising need for supportive services. Our study offers important insights into future costs and impacts associated with cerebral palsy and provides valuable information that could be used to develop targeted health programs and strategies for Canadians living with this condition.

scholarly journals 衛生保健體制改革: 理性與現實的選擇

1999 ◽  
Vol 2 (1) ◽  
pp. 5-26
Author(s):  
Zhizheng DU
Keyword(s):  
Public Health ◽  
Health Care ◽  
Medical Care ◽  
Small Group ◽  
Health Care Reform ◽  
Health Care Costs ◽  
High Technology ◽  
Public Health Care ◽  
Basic Health ◽  
Care Costs

LANGUAGE NOTE | Document text in Chinese; abstract also in English.衛生保健制度改革之艱難，主要在於要在諸多因素發展勢頭的相互硑撞中維持衛生保健工作的良性發展。衛生保健改革目標的設定，應當着眼於現實，但又必須顧及長遠。為此，它應當是首先有利於為更多的人群提供最基本的保健服務，同時又 能有力地控制保健費用的增長，有利於控制疾病的發生。只着眼於開源或節流，或者只強調衛生服務組織自身的營運，都可能使衛生保健產生更多的麻煩。多方位的雙層或多層的體制是使衞生保健工作適應各方需要的理想構思，它包含多種雙層或多種多層的內涵。在衛生資源有限的情況下，配給是保證為更多的人群提供保健的有效措施，救援則是其重要的補充。現行的醫療服務體系與為最廣大的人群提供基本的醫療保健服務不適應，也與抑制醫療費用上漲的要求不適應，必需有較大力度的改革。衛生保健改革的選擇，必須是道德的，同時又是理性而現實的。Health care costs soar and become unbearable everywhere in the world. This is not only a problem faced by developed Western countries. It is also a difficult issue for the third world countries such as China. China's health care system needs reform. On the one hand, a great number of people have not been covered by any basic health insurance. On the other hand, however, critical care medicine in high-technology hospitals in urban areas consumes tremendous public health care resources for a very small group of patients. This essay argues that China should appropriately establish multiple goals for its health care reform, based on ethical and reasonable deliberations on China's actual health care situation.First, rationing is crucial in containing health care costs. Public health care resources are limited. It is impossible to satisfy all medical needs for all people at all times. This is especially the case for mainland China, where public resources that can be invested in medical care are scarce. An appropriate goal of China's health care reform should be to provide basic, not luxury, health care for the people. Some luxury medical procedures must be left to individuals for purchase through their own resources.Second, a basic level of health care must be ensured to most people, even if it is impossible to ensure to everyone. It is important for everyone to understand that providing the best care for everyone is practically impossible. The best a government can do is to provide some level of basic care. However, the goal here must be the basic health of all or most people, rather than total care for a small group of people.Third, an appropriate pattern of China's health care should be prevention-oriented and ordinary-treatment-oriented, rather than high-technology-medicine-oriented. Since the early 1980s, many hospitals have relied on high-technology medicine to deal with diseases and to earn more income for themselves at the same time. But high-technology medicine is not panacea, though it is extremely costly. Inexpensive medical prevention is often more effective than high-technology medical procedures.Finally, a rule of rescue should be established in society. Society ought to provide some help for those who need special expensive medical care (such as organ transplantation) and are not able to afford it. The rule of rescue guides our efforts in this direction. Society should organize and establish special foundations to help people in this regard.DOWNLOAD HISTORY | This article has been downloaded 21 times in Digital Commons before migrating into this platform.

Abstract 300: Long-Term Survival, Quality of Life and Health Care Costs in the Survivors of Pre-Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Hao Y Lin ◽  
Zui S Yen ◽  
Chih H Lin ◽  
Chih W Yang ◽  
Ming J Hsieh ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Survival Time ◽  
Health Care Costs ◽  
Health Related Quality ◽  
Post Discharge ◽  
Related Quality ◽  
Health Related ◽  
Care Costs

Background: Understanding the prognosis of out-of-hospital cardiac arrest (OHCA) patients is vital to informing resuscitation and advanced care planning decisions. However, short-term outcomes such as survival to hospital discharge do not account for post-arrest quality of life and medical costs. Objective: To investigate the survival time, long-term health-related quality of life, and health care costs of OHCA survivors. Methods: We conducted a prospective cohort study of all adult OHCA survivors of cardiac origin between 1 August 2016 and 31 December 2017 in a tertiary medical center in Taiwan. Chinese version of EuroQol-5D-5L (EQ-5D-5L) was used for measuring health-related quality of life at 1 month, 6 month and 1 year post-discharge. Survival and health care costs data were collected. Descriptive statistics and Wilcoxon Signed-Ranks Test were used for data analysis. Results: During the study period, 30 of 163 (18.4%) OHCA of presumed cardiac origin survived to hospital discharge. The mean age for the survivors was 59 years. Most survivors were male (83.3%), and received bystander cardiopulmonary resuscitation (73.3%) and defibrillation (86.7%) in the prehospital settings. Of 30 survivors, 23 patients were cerebral performance category score (CPC) of 1 or 2 and 7 were CPC of 3 or 4. The median hospital stay and estimated median survival time for CPC 1-2 and CPC 3-4 were 17 days, 8.8 years and 34 days, 0.4 years, respectively. The mean EQ-5D-5L visual analogue scale score and index score (utility) for 13 CPC 1-2 survivors followed at 6 month post discharge were 75.58 ± 13.31 and 0.856 ± 0.125, respectively, and were significantly higher than the scores (65.38 ± 15.47, 0.689 ± 0.114) at 1 month. The median health care costs of the index admission and 6 month post-discharge for CPC 1-2 survivors were NT$ 655,866 and NT$ 46,550, respectively. Conclusion: The survival time and health related quality of life for OHCA survivors with good neurologic outcome is good and improves over time. It pays to save those lives.

The future of workplace wellness programs

2017 ◽  
Vol 16 (1) ◽  
pp. 2-6 ◽  
Author(s):  
Sam Ho
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Wellness Programs ◽  
Employee Health ◽  
Workplace Wellness ◽  
Employee Communication ◽  
Content Type ◽  
Workplace Wellness Programs ◽  
Manage Health Care ◽  
Care Costs

Purpose A comprehensive look at how technology, health plan design and employee communication can improve workplace wellness programs. Design/methodology/approach There are numerous ways for employers to enhance their workplace wellness programs, helping to improve employee health and more effectively manage health-care costs. Findings There are numerous ways for employers to enhance their workplace wellness programs, helping to improve employee health and more effectively manage health-care costs. Originality/value The paper is original to Strategic HR Review.

scholarly journals Health Care Services Utilization and Health-Related Quality of Life of Syrian Refugees with Post-Traumatic Stress Symptoms in Germany (the Sanadak Trial)

2021 ◽  
Vol 18 (7) ◽  
pp. 3408
Author(s):  
Thomas Grochtdreis ◽  
Susanne Röhr ◽  
Franziska U. Jung ◽  
Michaela Nagl ◽  
Anna Renner ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Health Care Services ◽  
Current Treatment ◽  
Syrian Refugees ◽  
Post Traumatic Stress ◽  
Care Services ◽  
Related Quality ◽  
Health Related ◽  
Care Costs

Refugees who have fled from the ongoing civil war in Syria that arrived in Germany often develop post-traumatic stress symptoms (PTSS). The aim of this study was to determine health care services utilization (HCSU), health care costs and health-related quality of life (HrQoL) of Syrian refugees with mild to moderate PTSS without current treatment in Germany. The study was based on the baseline sample of a randomized controlled trial of a self-help app for Syrian refugees with PTSS (n = 133). HCSU and HrQoL based on the EQ-5D-5L and its visual analogue scale (EQ-VAS) were assessed with standardized interviews. Annual health care costs were calculated using extrapolated four-month HCSU and standardized unit costs. Associations between health care costs, HrQoL and PTSS severity were examined using generalized linear models. Overall, 85.0% of the sample utilized health care services within four months. The mean total annual health care costs were EUR 1920 per person. PTSS severity was not associated with health care costs. The EQ-5D-5L index score and the EQ-VAS score was 0.82 and 73.6, respectively. For Syrian refugees with higher PTSS severity, the EQ-5D-5L index score was lower (−0.17; p < 0.001). The HCSU and the resulting health care costs of Syrian refugees with mild to moderate PTSS without current treatment are low and those with a higher PTSS severity had a lower HrQoL.

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