Health Care Rationing: Can we Afford to Ignore Euthanasia?

1997 ◽  
Vol 10 (1-2) ◽  
pp. 32-41 ◽  
Author(s):  
P. R. Ward
Keyword(s):  
Health Care ◽  
Hospice Care ◽  
Cost Savings ◽  
Patient Choice ◽  
Voluntary Euthanasia ◽  
Health Care Rationing ◽  
Do Not Resuscitate ◽  
Potential Cost ◽  
Medical Care Costs ◽  
Wide Range

Explicit rationing decisions are being made to encompass a wide range of health care issues. Voluntary euthanasia has largely been excluded from this debate due to, in my view, the emotive nature of the issue. Euthanasia is an issue in which economists have been largely excluded and in which ethicists and philosophers dominate. It is the purpose of this paper to review the economic and ethical literature on euthanasia and to discuss their compatibility within the debate on euthanasia. The potential cost savings by the use of advance directives, do-not-resuscitate orders, and futile care withdrawal are then reviewed, as are the potential cost savings created by hospice care. As a conclusion, the ethical and economic arguments are then balanced to assess their compatibility. It is the contention of this paper that reducing medical care costs near the end of life should not be a taboo subject, and that rationing decisions could focus on an exploration of this area and the approaches to it, which are ethically justifiable and economically worthwhile. The introduction of a policy of voluntary euthanasia could have a large impact on the rationing of health care resources whilst also promoting patient choice and an arena for a more dignified death.

Consumer Prices for Surgical Management of End-Stage Hallux Rigidus

2019 ◽  
Vol 13 (4) ◽  
pp. 276-280
Author(s):  
Niall A. Smyth ◽  
Vaishnavi Krishnan ◽  
Johnathon R. McCormick ◽  
Jonathan R. Kaplan ◽  
Amiethab A. Aiyer
Keyword(s):  
Health Care ◽  
Hallux Rigidus ◽  
Treatment Modalities ◽  
Potential Cost ◽  
First Metatarsophalangeal Joint ◽  
Consumer Prices ◽  
Wide Range ◽  
Significant Difference ◽  
The Mean ◽  
End Stage

Background. Hallux rigidus is the most prevalent arthritic condition of the foot. Treatment of end-stage disease traditionally consists of a first metatarsophalangeal joint (MTPJ) arthrodesis; however, the use of a synthetic cartilage implant is becoming more common. With the high prevalence of disease and implementation of new treatment modalities, health care consumers should be aware of the costs associated with management. The purpose of this study was to determine access to the cost and variability in price of first MTPJ arthrodesis and synthetic cartilage implantation. Methods. Forty academic centers were contacted using a standardized patient script. The patient was a 59-year-old female who had failed conservative treatment of hallux rigidus. Each institution was contacted up to 3 times in an attempt to obtain a full bundled operative quote for a first MTPJ arthrodesis and synthetic cartilage implantation. Results. Twenty centers (50%) provided a quote for first MTPJ arthrodesis and 15 centers (38%) provided a quote for synthetic cartilage implantation. Only 14 centers (35%) were able to provide a quote for both procedures. The mean bundled price for MTPJ arthrodesis was $21 767 (range $8417 to $39 265). The mean bundled price for synthetic cartilage implantation was $21 546 (range $4903 to $74 145). There was no statistically significant difference between the bundled price for first MTPJ arthrodesis and synthetic cartilage implantation. Conclusions. There was limited availability of consumer prices for first MTPJ arthrodesis and synthetic implantation, thus impeding health care consumers’ decision making. There was a wide range of quotes for both procedures, indicating potential cost savings. Levels of Evidence: IV, basic science

scholarly journals Group Medical Visits and Clinician Wellbeing

2020 ◽  
Vol 9 ◽  
pp. 216495612097397
Author(s):  
Ariana Thompson-Lastad ◽  
Paula Gardiner
Keyword(s):  
Health Care ◽  
Care Delivery ◽  
Cost Savings ◽  
Models Of Care ◽  
Group Medical Visits ◽  
Integrative Health ◽  
Medical Visits ◽  
Integrative Health Care ◽  
Wide Range ◽  
Clinical Benefits

There is strong evidence for clinical benefits of group medical visits (GMVs) (also known as shared medical appointments) for prenatal care, diabetes, chronic pain, and a wide range of other conditions. GMVs can increase access to integrative care while providing additional benefits including increased clinician-patient contact time, cost savings, and support with prevention and self-management of chronic conditions. During the COVID-19 pandemic, many clinical sites are experimenting with new models of care delivery including virtual GMVs using telehealth. Little research has focused on which clinicians offer this type of care, how the GMV approach affects the ways they practice, and their job satisfaction. Workplace-based interventions have been shown to decrease burnout in individual physicians. We argue that more research is needed to understand if GMVs should be considered among these workplace-based interventions, given their potential benefits to clinician wellbeing. GMVs can benefit clinician wellbeing in multiple ways, including: (1) Extended time with patients; (2) Increased ability to provide team-based care; (3) Understanding patients’ social context and addressing social determinants of health. GMVs can be implemented in a variety of settings in many different ways depending on institutional context, patient needs and clinician preferences. We suggest that GMV programs with adequate institutional support may be beneficial for preventing burnout and improving retention among clinicians and health care teams more broadly, including in integrative health care. Just as group support benefits patients struggling with loneliness and social isolation, GMVs can help address these and other concerns in overwhelmed clinicians.

scholarly journals A unique partnership between a health system’s insurance plan and the Integrative Medicine Department benefits patients and helps control costs

2016 ◽  
Vol 5 (4) ◽  
pp. 61
Author(s):  
Maureen M Anderson ◽  
Karen Armstrong ◽  
Katherine Nori Janosz ◽  
Michael Tocco ◽  
Nancy A DeVore ◽  
...  
Keyword(s):  
Health Care ◽  
Integrative Medicine ◽  
Health Care Costs ◽  
Treatment Options ◽  
Cost Savings ◽  
Clinical Results ◽  
Insurance Plan ◽  
Effective Care ◽  
Wide Range ◽  
Care Costs

Health care costs continue to increase, affecting patients and insurance providers. Complementary health approaches are increasingly used to augment traditional medicine, and integrative medicine (IM) incorporates these complementary approaches into traditional patient care. The IM Department was established in our institution in 2004 and now offers a wide range of services to patients. Our institution offers health care coverage to all benefit-eligible hospital personnel and their eligible dependents. The use of IM has had a surprising and beneficial effect on the health care costs of this small, self-insured health plan. We found that the coverage of certain IM modalities for specific conditions had positive clinical results and resulted in significant cost savings to the insurance plan. At the same time, this partnership supports patients by providing appropriate and effective care, and we have seen success in terms of patient recovery and patient satisfaction. Here, we present the history of the relationship between the insurance plan and the IM Department, how the coverage of IM modalities has expanded, and the current practice at our institution. We demonstrate that this innovative relationship has benefitted patients and resulted in cost-savings for the insurance provider. Therefore, this partnership will continue to expand, thus providing patients with a wide range of treatment options and effective care.

scholarly journals Direct electrochemical production of pseudo-binary Ti–Fe alloys from mixtures of synthetic rutile and iron(III) oxide

2020 ◽  
Vol 55 (33) ◽  
pp. 15988-16001
Author(s):  
Simon J. Graham ◽  
Lyndsey L. Benson ◽  
Martin Jackson
Keyword(s):  
Intermetallic Phase ◽  
Cost Savings ◽  
Strengthening Effect ◽  
Potential Cost ◽  
Oxide Mixture ◽  
Synthetic Rutile ◽  
Β Phase ◽  
Α Phase ◽  
Wide Range ◽  
Fe Alloys

Abstract Combining the FFC-Cambridge process with field-assisted sintering technology (FAST) allows for the realisation of an alternative, entirely solid-state, production route for a wide range of metals and alloys. For titanium, this could provide a route to produce alloys at a lower cost compared to the conventional Kroll-based route. Use of synthetic rutile instead of high purity TiO2 offers further potential cost savings, with previous studies reporting on the reduction of this feedstock via the FFC-Cambridge process. In this study, mixtures of synthetic rutile and iron oxide (Fe2O3) powders were co-reduced using the FFC-Cambridge process, directly producing titanium alloy powders. The powders were subsequently consolidated using FAST to generate homogeneous, pseudo-binary Ti–Fe alloys containing up to 9 wt.% Fe. The oxide mixture, reduced powders and bulk alloys were fully characterised to determine the microstructure and chemistry evolution during processing. Increasing Fe content led to greater β phase stabilisation but no TiFe intermetallic phase was observed in any of the consolidated alloys. Microhardness testing was performed for preliminary assessment of mechanical properties, with values between 330–400 Hv. Maximum hardness was measured in the alloy containing 5.15 wt.% Fe, thought due to the strengthening effect of fine α phase precipitation within the β grains. At higher Fe contents, there was sufficient β stabilisation to prevent α phase transformation on cooling, leading to a reduction in hardness despite a general increase from solid solution strengthening.

scholarly journals Further potential savings attributable to maximum generic substitution of antidepressants in South Africa: A retrospective analysis of medical claims

2010 ◽  
Vol 15 (1) ◽  
Author(s):  
Elmarie Van der Westhuizen ◽  
Johanita R. Burger ◽  
Martie S. Lubbe ◽  
Jan H.P. Serfontein
Keyword(s):  
South Africa ◽  
Health Care ◽  
Statistical Analysis ◽  
Generic Substitution ◽  
Cost Savings ◽  
Potential Cost ◽  
Total Cost ◽  
Statistical Analysis System ◽  
Study Population ◽  
Analysis System

The main objective of the study was to calculate potential cost savings that could have been generated by maximum generic substitution of antidepressants within the private health care sector of South Africa from 2004 to 2006. Data on computerised medicine claims of patients receiving one or more antidepressants during three consecutive years (i.e. 2004, 2005 and 2006) were elicited from a South African pharmaceutical benefit management company. The total study population consisted of 292 071 items (N = 5 982 869) on 273 673 prescriptions (N = 5 213 765) at a total cost of R56 183 697.91(N = R1 346 210 929.00). A quantitative, retrospective drug utilisation review was conducted, and data were analysed using the Statistical Analysis System® programme. Potential cost savings were computed for criteria-eligible substances in the study population. Generic medicine constituted 58.7% (N = 292 071) of all antidepressants claimed, at a total cost of 28.2% (N = R1 346 210 929.00)of all incurred costs. With total substitution of the average price of all criteria-eligible innovators, a potential saving of 9.3% (N = R56 183 697.91) of the actual antidepressant cost over the study period was calculated. In developing countries with limited health care resources, generic medicines can be cost-saving treatment alternatives.OpsommingDie hoofmikpunt van hierdie studie was om die potensiële kostebesparing te bereken wat deur maksimale generiese vervanging van antidepressante in die Suid-Afrikaanse private gesondheidsorgsektor tussen 2004 en 2006 teweeggebring sou kon word. Data oor gerekenariseerde eise vir medisyne van pasiënte wat een of meer antidepressante gedurende die studietydperk ontvang het (d.i. 2004, 2005 en 2006) is van ʼn Suid-Afrikaanse maatskappy wat farmaseutiese voordele bestuur, verkry. Die totale studiepopulasie het bestaan uit 292 071 items (N = 5 982 869)van 273 673 voorskrifte (N = 5 213 765) teen ʼn totale koste van R56 183 697.91 (N = R1 346 210 929.00).’n Kwantitatiewe, retrospektiewe medisyneverbruiksontleding is gedoen en data is geanaliseer deur van die Statistical Analysis System®-pakket gebruik te maak. Potensiële kostebesparings is vir middels in die studiepopulasie wat aan die kriteria voldoen het, bereken. Generiese produkte het 58.7% (N = 292 071) van alle produkte wat voorgeskryf is, uitgemaak, teen ʼn totale koste van 28.2% (N= R1 346 210 929.00). Indien die gemiddelde prys van alle middels wat aan die kriteria vir vervanging voldoen het, met die prys vir generiese middels vervang word, is ʼn potensiële besparing van 9.3%(N = R56 183 697.91) van die werklike koste vir antidepressante gedurende die studietydperk moontlik. Generiese middels kan in ontwikkelende lande met beperkte gesondheidsorg-hulpbronne kostebesparende alternatiewe wees.

7 Development of a leaflet to teach children to swallow tablets

2018 ◽  
Vol 103 (2) ◽  
pp. e2.47-e2
Author(s):  
Charlotte Mawson
Keyword(s):  
Cost Savings ◽  
European Medicines Agency ◽  
Multidisciplinary Teams ◽  
List Type ◽  
Potential Cost ◽  
Web Based ◽  
Patients Âgés ◽  
Number Of Patients ◽  
Wide Range ◽  
Patients Experience

AimIn paediatric pharmacy a wide range of medications are used, which are often not available in formulations suitable for children. We wanted to design a tool that would enhance our patients’ experience of medication taking as well as improving accessibility to medicines, palatability and ease of administration.MethodThe European Medicines Agency advises that ‘for chronic diseases, the acceptability of tablets in children may be improved by adequate training’.1 Among others a study has shown that almost half of two year olds could swallow a 3 mm tablet, increasing to 85% in 5 year olds.2A leaflet was suggested as the best way to teach our patients and their parents how to swallow tablets as it could be widely distributed. It was developed with a working group of paediatric clinical psychologists and a paediatric pharmacist. The leaflet aims to be encouraging and provide practical tips and advice. It offers seven different techniques for swallowing tablets which were adapted from web-based advice and previous cases. The leaflet was piloted in a small number of patients and they were given a questionnaire.ResultsTen questionnaires were returned, with patients’ ages ranging from 5 to 17. All the patients said that they would now be taking all or some of their medication as tablets. All of the techniques were tried by 2 or more patients and each technique was successful for at least 1 child. The most popular method was the ‘big gulp method’ which worked for 8 patients. This involves swirling the tablet around the mouth for 10 s with as much water as possible and then taking a large gulp until all the water and the tablet have gone.Positive feedback for the leaflet included ‘feels grown up being able to take a tablet’, taking tablets is ‘easier’ and ‘quicker’; one patient wished they had been given the leaflet sooner. Parents also fed back that ‘there was no longer a fight to take medicines’ and ‘it’s much easier for school to manage’.ConclusionThe findings have shown that this is a very successful and useful tool. It allows children and their families to take ownership of their medicine taking. To enable more patients to benefit, further engagement from multidisciplinary teams e.g. play specialists, is needed. In the long-term this leaflet could be used to proactively start patients on tablets rather than reactively, creating potential cost savings and a reduction in the use of unlicensed medicines and specials.ReferencesEuropean Medicines Agency. Guideline on pharmaceutical development of medicines for paediatric use2013. http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2013/07/WC500147002.pdf [Accessed: 28 July 2016].Thomson SA, Tuleu C, Wong ICK, et al. Minitablets: New modality to deliver medicines to preschool-aged children. Paediatrics2009;123(2):235–238.

Conserving Scarce Resources: Willingness of Health Insurance Enrollees to Choose Cheaper Options

2004 ◽  
Vol 32 (3) ◽  
pp. 496-499 ◽  
Author(s):  
Samia A. Hurst ◽  
J. Russell Teagarden ◽  
Elizabeth Garrett ◽  
Ezekiel J. Emanuel
Keyword(s):  
Health Care ◽  
Patient Choice ◽  
Health Care Rationing ◽  
Market Forces ◽  
Industrialized Countries ◽  
Scarce Resources ◽  
Technological Advances ◽  
Make Health Care ◽  
Care Rationing ◽  
Care Costs

Health care costs have been rising steadily in most industrialized countries. These increases are driven primarily by technological advances and, to a lesser degree, by aging of the population. Many factors make it unlikely that market forces alone will limit increases in the costs of health care. These unremitting increases make health care rationing appear both necessary and inevitable.One of the least controversial mechanisms for rationing could be to allow patients to make their own choices as to which kinds of care they would be willing to forgo. This is appealing because it preserves individual freedom of choice regarding health care in a way that other rationing mechanisms often do not. Rationing by patient choice, however, can only happen if patients recognize that resources are limited and need to be conserved, and are willing to forgo marginal benefits.

scholarly journals Incremental Cost of Prematurity by Week of Gestational Age

2019 ◽  
Vol 09 (01) ◽  
pp. e76-e83 ◽  
Author(s):  
Eileen Walsh ◽  
Sherian Li ◽  
Libby Black ◽  
Michael Kuzniewicz
Keyword(s):  
Health Care ◽  
Gestational Age ◽  
Cost Savings ◽  
Care Utilization ◽  
Potential Cost ◽  
Term Infants ◽  
Cross Sectional ◽  
Very Preterm Infants ◽  
Hospitalization Costs ◽  
Cost Differences

Objective This study was aimed to compare health care costs and utilization at birth through 1 year, between preterm and term infants, by week of gestation. Methods A cross-sectional study of infants born at ≥ 23 weeks of gestational age (GA) at Kaiser Permanente Northern California facilities between 2000 and 2011, using outcomes data from an internal neonatal registry and cost estimates from an internal cost management database. Adjusted models yielded estimates for cost differences for each GA group. Results Infants born at 25 to 37 weeks incur significantly higher birth hospitalization costs and experience significantly more health care utilization during the initial year of life, increasing progressively for each decreasing week of gestation, when compared with term infants. Among all very preterm infants (≤ 32 weeks), each 1-week decrease in GA is associated with incrementally higher rates of mortality and major morbidities. Conclusion We provide estimates of potential cost savings that could be attributable to interventions that delay or prevent preterm delivery. Cost differences were most extreme at the lower range of gestation (≤ 30 weeks); however, infants born moderately preterm (31–36 weeks) also contribute substantially to the burden, as they represent a higher proportion of total births.

scholarly journals Value of schizophrenia treatment II: Decision modelling for developing early detection and early intervention services in the Czech Republic

2018 ◽  
Vol 53 ◽  
pp. 116-122 ◽  
Author(s):  
Petr Winkler ◽  
Hana Marie Broulíková ◽  
Lucie Kondrátová ◽  
Martin Knapp ◽  
Paul Arteel ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Czech Republic ◽  
Early Intervention ◽  
Early Detection ◽  
Cost Savings ◽  
Potential Cost ◽  
The Czech Republic ◽  
Early Intervention Services ◽  
Intervention Services

Abstract:Background:Positive findings on early detection and early intervention services have been consistently reported from many different countries. The aim of this study, conducted within the European Brain Council project “The Value of Treatment”, was to estimate costs and the potential cost- savings associated with adopting these services within the context of the Czech mental health care reform.Methods:Czech epidemiological data, probabilities derived from meta-analyses, and data on costs of mental health services in the Czech Republic were used to populate a decision analytical model. From the health care and societal perspectives, costs associated with health care services and productivity lost were taken into account. One-way sensitivity analyses were conducted to explore the uncertainty around the key parameters.Results:It was estimated that annual costs associated with care as usual for people with the first episode of psychosis were as high as 46 million Euro in the Czech Republic 2016. These annual costs could be reduced by 25% if ED services were adopted, 33% if EI services were adopted, and 40% if both, ED and EI services, were adopted in the country. Cost-savings would be generated due to decreased hospitalisations and better employment outcomes in people with psychoses.Conclusions:Adopting early detection and early intervention services in mental health systems based on psychiatric hospitals and with limited access to acute and community care could generate considerable cost- savings. Although the results of this modelling study needs to be taken with caution, early detection and early intervention services are recommended for multi-centre pilot testing accompanied by full economic evaluation in the region of Central and Eastern Europe.

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