Indonesia-based Study of the Clinical and Cost-saving Benefits of Subcutaneous Allergen Immunotherapy for Children with Allergic Rhinitis in Private Practice

Mapping Intimacies ◽

10.20944/preprints202106.0354.v1 ◽

2021 ◽

Author(s):

Anang Endaryanto ◽

Ricardo Adrian Nugraha

Keyword(s):

Health Care ◽

Allergic Rhinitis ◽

Health Care System ◽

Cost Savings ◽

Public Health Care ◽

Subcutaneous Immunotherapy ◽

Private Health Care ◽

Medication Score ◽

Allergy Treatment ◽

Care System

Background. Until now, cost of allergy treatment in insured public health care system and non-insured self-financing private health care system in Indonesia has not been well documented and published, as well as the cost of allergy treatment with subcutaneous immunotherapy. Objective. To evaluate the clinical and cost benefits of allergic rhinitis treatment in children with subcutaneous immunotherapy in non-insured self-financing private health care system. Methods. A retrospective cohort study conducted from 2015 until 2020, compared clinical improvement and health care costs over 18 months in newly diagnosed AR children who received SCIT versus matched AR control subjects who did not receive SCIT, with each group consisting of 1,098 subjects Results. Decrease of sp-HDM-IgE level (kU/ml) from 20.5 + 8.75 kU/ml to 12.1 + 3.07 kU/ml had been observed in the SCIT group. To reduce the symptom score of allergic rhinitis by 1.0 with SCIT it costs IDR 21,753,062.7 per child, for non SCIT it costs IDR 104,147,878.0 per child. Meanwhile, to reduce the medication score (MS) by 1.0 with SCIT it costs Rp. 17,024,138.8 while with non SCIT it costs Rp. 104,147,878.0. Meanwhile, to lower combination symptoms and medication score (CSMS) by 1.0, with SCIT it costs IDR 9,550,126.6, while with non SCIT it costs IDR 52,073,938.9. Conclusion. In conclusion, this first Indonesia-based study demonstrates substantial health care cost savings associated with SCIT for children with AR in an uninsured private health care system and provides strong evidence for the clinical benefits and cost-savings benefits of AR treatment in children.

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Blurring the boundaries between public and private health care services as an alternative explanation for the emergence of black medicine: the Israeli case

Health Economics Policy and Law ◽

10.1017/s1744133114000383 ◽

2014 ◽

Vol 10 (3) ◽

pp. 293-310 ◽

Cited By ~ 3

Author(s):

Dani Filc ◽

Nissim Cohen

Keyword(s):

Health Care ◽

Health Care System ◽

Health Care Services ◽

Qualitative Methodology ◽

Health Care Systems ◽

Public Health Care ◽

Private Health Care ◽

Public And Private ◽

Care Services ◽

Care System

AbstractBlack medicine represents the most problematic configuration of informal payments for health care. According to the accepted economic explanations, we would not expect to find black medicine in a system with a developed private service. Using Israel as a case study, we suggest an alternative yet a complimentary explanation for the emergence of black medicine in public health care systems – even though citizens do have the formal option to use private channels. We claim that when regulation is weak and political culture is based on ‘do it yourself’ strategies, which meant to solve immediate problems, blurring the boundaries between public and private health care services may only reduce public trust and in turn, contribute to the emergence of black medicine. We used a combined quantitative and qualitative methodology to support our claim. Statistical analysis of the results suggested that the only variable significantly associated with the use of black medicine was trust in the health care system. The higher the respondents’ level of trust in the health care system, the lower the rate of the use of black medicine. Qualitatively, interviewee emphasized the relation between the blurred boundaries between public and private health care and the use of black medicine.

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Access to Spine Care: A Tale of Two Cities

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s031716710000888x ◽

2008 ◽

Vol 35 (3) ◽

pp. 308-313 ◽

Cited By ~ 7

Author(s):

R. John Hurlbert ◽

Ralph Mobbs ◽

Charles Teo

Keyword(s):

Health Care ◽

Health Care System ◽

Spinal Surgery ◽

Public Health Care ◽

Wait List ◽

Private Health Care ◽

The Public ◽

Spine Care ◽

Sydney Australia ◽

Care System

ABSTRACT:Introduction:As governments struggle with increasing demand for accountability within the Canadian Health Care System and set wait-time standards, it is important to objectify data to allow a true understanding of present limitations and to facilitate comparisons to other systems. The purpose of this study was to compare wait list times for a cohort of patients requiring spinal surgery in Calgary, Alberta to a similar cohort in Sydney, Australia.Methods:From January 1 until June 30, 2006 all outpatients admitted for spinal surgery to the Foothills Hospital were identified by the surgeons’ office. Two time periods were quantified from their charts: (1) time from referral to surgical consultation; and (2) time from surgical consultation to operative intervention. From July 1 until December 31, 2006 patients were similarly identified through Neurosurgical offices at the Prince of Wales Public and Private Hospitals in Sydney, Australia.Results:Four hundred ninety-one surgical patients were captured during the six month period in Calgary and 155 patients during the subsequent six months in Sydney. The majority of patients in Sydney were treated in the Private Health Care system. Public patients in Sydney have access to a surgical consultant twice as fast as public patients in Calgary while private patients have access ten times faster. Access to operating room time within the public system is a rate limiting step in both countries. However, Sydney private patients receive their surgery four times faster than Calgary patients.Conclusions:Compared to Calgary, access to specialized spine care in Sydney appears more efficient not only in the Private but also the Public Health Care System. Part of this efficiency may arise from offloading from the public into the private system. Solutions proposed to reduce wait list times should consider benefits of a Private Health Care System.

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A113 COST SAVINGS OF SEROLOGIC VERSUS BIOPSY PROVEN DIAGNOSIS OF PEDIATRIC CELIAC DISEASE

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.112 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 131-132

Author(s):

M Wiepjes ◽

H Q Huynh ◽

J Wu ◽

M Chen ◽

L Shirton ◽

...

Keyword(s):

Health Care ◽

Celiac Disease ◽

North America ◽

Cost Saving ◽

Health Care System ◽

Cost Savings ◽

Serologic Diagnosis ◽

Children's Hospital ◽

Children’S Hospital ◽

Care System

Abstract Background Celiac disease (CD) affects approximately one percent of the population in Canada and the United States. At present, endoscopic diagnosis (ED) of CD remains the gold standard in North America, despite mounting evidence and validated European guidelines for serologic diagnosis (SD). Within publicly funded healthcare systems there is pressure to ensure optimal resource utilization and cost efficiency, including for endoscopic services. At Stollery Children’s Hospital, Edmonton, Canada, we have adopted serologic diagnosis as routine practice since 2016. Aims The aim of this study is to estimate cost savings, i.e. hard dollar savings and capacity improvements, to the health care system as well as impacts on families in regard to reduced work days lost and missing child school days for SD versus ED. Initial cost saving data is presented. Methods Micro-costing methods were used to determine health care resource use in patients undergoing ED or SD from 2017–2018. SD testing included anti-tissue glutaminase antibody (aTTG) ≥200IU/mL (on two occasions), human leukocyte antigen (HLA) DQA5/DQ2, blood sampling, transport and laboratory costs. ED diagnosis included gastroenterologist, anesthetist, OR equipment, staff, overhead and histopathology. Cost of each unit of resource was obtained from the schedule of medical benefits (Alberta) and reported average ambulatory cost for day hospital endoscopy for Stollery Children’s Hospital determined in 2016; reported in CAN$. Results Between March 2017-December 2018, 473 patients were referred for diagnosis of CD; 233 had ED and 127 SD. Estimated cost for ED was $1240 per patient; for SD was $85 per patient (6.8% of ED cost). Based on 127 patients not requiring endoscopy and a cost saving of $1155 per patient there was a total cost savings of $146,685 over 22 months. Conclusions A SD approach presents a significant cost savings to the public health care system. It also frees up valuable endoscopic resources, and limits exposure of children to the immediate and long-term risks associated with anesthesia and biopsy. SD also decreases time to diagnosis and the cost of the process to families (lost days of school/work, travel costs etc.). Our costing data can be used in combination with mounting evidence on the test performance of SD versus ED to determine cost-effectiveness of serological diagnosis for pediatric CD. Given the potential for cost saving and more efficient operating room utilization, SD for pediatric CD warrants further investigation in North America. Funding Agencies None

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An Economic Evaluation of Disallowing Body Checking in 11- to 12-Year-Old Ice Hockey Leagues

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211021551 ◽

2021 ◽

pp. 194173812110215

Author(s):

Gillian R. Currie ◽

Raymond Lee ◽

Amanda M. Black ◽

Luz Palacios-Derflingher ◽

Brent E. Hagel ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Health Care System ◽

Policy Change ◽

National Policy ◽

Ice Hockey ◽

Public Health Care ◽

Public Health Care System ◽

Body Checking ◽

Care System

Background: After a national policy change in 2013 disallowing body checking in Pee Wee ice hockey games, the rate of injury was reduced by 50% in Alberta. However, the effect on associated health care costs has not been examined previously. Hypothesis: A national policy removing body checking in Pee Wee (ages 11-12 years) ice hockey games will reduce injury rates, as well as costs. Study Design: Cost-effectiveness analysis alongside cohort study. Level of Evidence: Level 3. Methods: A cost-effectiveness analysis was conducted alongside a cohort study comparing rates of game injuries in Pee Wee hockey games in Alberta in a season when body checking was allowed (2011-2012) with a season when it was disallowed after a national policy change (2013-2014). The effectiveness measure was the rate of game injuries per 1000 player-hours. Costs were estimated based on associated health care use from both the publicly funded health care system and privately paid health care cost perspectives. Probabilistic sensitivity analysis was conducted using bootstrapping. Results: Disallowing body checking significantly reduced the rate of game injuries (−2.21; 95% CI [−3.12, −1.31] injuries per 1000 player-hours). We found no statistically significant difference in public health care system (−$83; 95% CI [−$386, $220]) or private health care costs (−$70; 95% CI [−$198, $57]) per 1000 player-hours. The probability that the policy of disallowing body checking was dominant (with both fewer injuries and lower costs) from the perspective of the public health care system and privately paid health care was 78% and 92%, respectively. Conclusion: Given the significant reduction in injuries, combined with lower public health care system and private costs in the large majority of iterations in the probabilistic sensitivity analysis, our findings support the policy change disallowing body checking in ice hockey in 11- and 12-year-old ice hockey leagues.

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