scholarly journals Assessing The Cost of Medical Care For Patients Hospitalized After A Stroke Event in Gabon

2021 ◽  
Author(s):  
Gaetan MOUKOUMBI LIPENGUET ◽  
Prudence GNAMIEN AMANI ◽  
Euloge IBINGA ◽  
Jean Engohang-Ndong ◽  
Edgard Brice NGOUNGO NGOUNGOU ◽  
...  
Keyword(s):  
Health Insurance ◽  
Hospital Cost ◽  
Financial Burden ◽  
University Hospital ◽  
Stroke Management ◽  
Stroke Patients ◽  
Stroke Event ◽  
The Cost ◽  
The University ◽  
Very High

Abstract Background: The increasing incidence of recorded stroke cases is straining the economies of many developing countries. Very few studies have assessed the financial burden of stroke management in Gabon. The aim of this study was to assess the direct costs of stroke management in the neurology and cardiology departments at the University Hospital of Libreville.Methods: This retrospective study was based on a detailed review of financial records directly associated with the management of stroke cases admitted and treated in the CHUL between January 2018 and December 2019. The records reviewed were those of all stroke patients admitted and treated in the aforementioned timeframe, regardless of treatment outcome. The analysis of data focused on direct hospital cost.Results: Three hundred and thirteen stroke patients were admitted over the aforementioned period, 72.52% in neurology and 27.48% in cardiology. The average age of the patients was 58.44 (± 13.73) years. 56.23% of patients had health insurance. Ischemic stroke was more common than hemorrhagic stroke, 79.55% and 20.45% respectively. The expenditure per patient was estimated at 570,023 CFA francs.Of this global direct cost, government assistance in the form of health insurance was estimated at 422,883 CFA francs while the balance of approximately 147,140 CFA francs was paid by the patient.Conclusion: The hospital cost of stroke is very high for both patients and administrations. This observation pleads for the implementation of prevention programs for this pathology. The results of this study may be useful for work on the efficiency of these programs.

scholarly journals Cost Savings as a Result of Bortezomib Vial Sharing in Albania

2018 ◽  
Vol 14 (21) ◽  
pp. 278
Author(s):  
Florjana Rustemi ◽  
Ledjan Malaj ◽  
Ela Hoti ◽  
Enida Balla
Keyword(s):  
Treatment Cycle ◽  
Financial Burden ◽  
Cost Savings ◽  
University Hospital ◽  
Mother Teresa ◽  
Emerging Therapies ◽  
Cost Efficacy ◽  
The Cost ◽  
The University ◽  
Hospital Center

The costs associated with current and emerging therapies, as well as supportive care, are significant and pose a tremendous financial burden to both patients and healthcare system. The objective of this study was to calculate the cost savings as a result of bortezomib vial sharing in the University Hospital Center “Mother Teresa” Tirana. This study was a retrospective analysis of the use of bortezomib in patients with multiple myeloma, using vial sharing technique to minimize wastage. The study has been conducted during the period January 1, 2015 to June 30, 2015 before vial sharing and January 1, 2016 to June 30, 2016 after vial sharing, thereby enabling us to share vial contents between patients. We compared the cost in euro for the treatment with bortezomib in order to determine the cost savings of vial sharing and cost-efficacy of individualised preparation. As a result, the cost savings for one cycle/patient using vial sharing was calculated 226.81 euro, a reduction of 25.96% compared to the period when we did not use vial sharing. During January 1, 2015 to June 30, 2015 the average treatment cost was calculated 873.36 euro/cycle/patient, compared with January 1, 2016 to June 30, 2016 when it was calculated 646.55 euro/cycle/patient. Due to cost savings of each treatment cycle we administered 62 individualised preparations of bortezomib more during January 1, 2016 to June 30, 2016 for the same budget allocated. The same approach should be adopted for other suitable drugs prepared in the University Hospital Center “Mother Teresa” Tirana.

scholarly journals Can a University Reproductive Medicine Centre Be Financed Under the Pre-Existing General Conditions in Germany?

2019 ◽  
Vol 79 (01) ◽  
pp. 63-71
Author(s):  
Thomas Hildebrandt ◽  
Nicola Oversohl ◽  
Ralf Dittrich ◽  
Laura Lotz ◽  
Matthias Beckmann ◽  
...  
Keyword(s):  
Health System ◽  
Reproductive Medicine ◽  
Treatment Cycle ◽  
Financial Burden ◽  
University Hospital ◽  
Demographic Development ◽  
Icsi Cycle ◽  
German Health ◽  
The Cost ◽  
The University

Abstract Background Reduced resources for financing healthcare services are available to the German health system. For this reason, demographic development represents one of the greatest challenges for the German health system. Reproductive medicine can offer potential solutions and counteract the ageing of the population through an increase in the birth rate. Most reproductive medical treatments take place in private centres. For the development of new, innovative therapeutic approaches, continuing education and scientific advancement, university centres are essential. Materials and Methods Using multistage contribution margin accounting, IVF and ICSI treatments at the University Fertility Centre Franken (UFF) were investigated in 2012. The cost situation from the perspective of the patient couple and the statutory payer were contrasted with the cost and revenue situation of the service provider as a university reproductive medicine centre. Results The costs for the patient couple for an IVF treatment cycle were 538.71 € and for an ICSI cycle, 700.07 €. For the payer, the costs, including the university flat rate (194.80 €) to be paid, amount to 733.51 € for an IVF cycle and 894.87 € for an ICSI cycle. The payments of the patient couple and the payer were added and this yielded total costs of 1272.22 € and 1594.94 €. The University Fertility Centre Franken, as a part of the Department of Gynaecology of the Erlangen University Hospital, incurred costs of 1364.47 € for an IVF treatment cycle and 1423.48 € for an ICSI treatment cycle. In addition, the OB/GYN clinic had to pay the university hospital a flat general expense rate of 14.9% of the income. There was thus a loss for the department of gynaecology of 281.81 € for an IVF cycle and 66.19 € for an ICSI cycle. Discussion From the perspective of a university reproductive medicine centre, IVF and ICSI treatments currently cannot be performed in a cost-covering manner. At the same time, a reproductive medicine treatment cycle represents a significant financial burden on the patient couple due to only partial cost coverage by most statutory health insurance funds. This therefore demonstrates a need for action in health policy to revise and, in the interest of the patient couples, reproductive medicine centres and, not least of all, in the interest of society, to improve existing cost absorption policies and thus also benefit from this as a society over the long term.

Ultra-resistant schizophrenia and potentiation strategies

2017 ◽  
Vol 41 (S1) ◽  
pp. s834-s834 ◽  
Author(s):  
S. Khouadja ◽  
R. Ben Soussia ◽  
S. Younes ◽  
A. Bouallagui ◽  
I. Marrag ◽  
...  
Keyword(s):  
Treatment Resistance ◽  
Cost Benefit ◽  
Clinical Excellence ◽  
University Hospital ◽  
Dsm Iv ◽  
Competing Interest ◽  
A Prospective Study ◽  
Psychiatric Department ◽  
The Cost ◽  
The University

IntroductionTreatment resistance to clozapine is estimated at 40–70% of the treated population. Several clozapine potentiation strategies have come into clinical practice although often without evidence-based support.ObjectiveThe aim of our work was to identify the potentiation strategies in ultra-resistant schizophrenia depending on the subtype of schizophrenia.MethodologyThis is a prospective study conducted on patients with the diagnosis of schizophrenia, based on DSM-IV-TR criteria, and hospitalized in the psychiatric department of the university hospital in Mahdia, Tunisia. The study sample consisted of patients meeting the resistant schizophrenia criteria as defined by national institute for clinical excellence (NICE), and the prescription of clozapine for 6 to 8 weeks was shown without significant improvement.Resultswe have collected 10 patients. The mean serum level of clozapine was 462.25 mg/L. The potentiation strategies were different depending on the subtype of schizophrenia. For the undifferentiated schizophrenia, we have chosen ECT sessions. For the disorganized schizophrenia, we opted for amisulpiride and aripiprazole. For the paranoid forms, we have chosen the association of risperidone and ECT. A psychometric improvement was noted in BPRS ranging from 34 to 40%.ConclusionEvery potentiation strategy entails a cost, whether it is an additional monetary cost, adverse effects or greater stress to caregivers. The cost/benefit equation should be thoroughly evaluated and discussed before commencing a strategy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Locked intramedullary nailing technique of the femur without brilliance amplifier at the trauma and orthopedics department of the university hospital of peace series on 35 cases during 1 year

2021 ◽  
Vol 13 (5) ◽  
pp. 95-97
Author(s):  
Augustin Delange Hendrick ◽  
Almenord Pharol ◽  
Khawly Clifford PG ◽  
Augustin Delange ◽  
Pierre Marie Woolley
Keyword(s):  
Hospital Stay ◽  
Intramedullary Nailing ◽  
Femoral Fractures ◽  
Length Of Hospital Stay ◽  
University Hospital ◽  
Patient Morbidity ◽  
Duration Of Hospitalization ◽  
The Cost ◽  
The University

Femoral fractures increase the length of hospital stay for our patients for several reasons such as lack of blood, economic resources, and lack of infrastructure. The use of a C-arm has been shown to reduce patient morbidity due to early functional recovery and reduced hospital stay. Objective: To develop an intramedullary nailing technique without c-arm with a closed focus to reduce the duration of hospitalization of its patients as well as the cost related to the equipment used for follow-up. Methodology: prospective study on 35 patients for 1 year August 2020 to August 2021 Results: We followed 35 patients in which the mean age was 37.83 years with extremes of 18 and 78 years. The male sex predominates 21 against 14 women or 60% against 40% respectively. The sex ratio is 1.5. A total of 19 diaphyseal fractures (54.3%) were nailed, 9 supracondylar (25.7%) and 7 subtrochanteric (20%). Twenty-seven were closed fractures (71.1%), and 8 were open fractures (22.9%). The length of hospitalization was less than 3 days for 30 patients (85.7%), and more than 3 days for 5 patients (14.3%). Conclusion: We recommend that we promote this closed-hearth technique because it improves the postoperative follow-up of patients. Additionally, it would reduce exposure to radiation from c-arm in hospitals that have this equipment.

scholarly journals Problems of Cardioembolic Stroke Primary and Secondary Prevention in the Latvian Population / Kardioemboliska Cerebrāla Infarkta Primārās un Sekundārās Profilakses Problēmas Latvijā

2015 ◽  
Vol 69 (5) ◽  
pp. 199-204
Author(s):  
Kristaps Jurjāns ◽  
Santa Sabeļnikova ◽  
Evija Miglāne ◽  
Baiba Luriņa ◽  
Oskars Kalējs ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Secondary Prevention ◽  
Patient Group ◽  
Oral Anticoagulants ◽  
Antiplatelet Agents ◽  
Cardioembolic Stroke ◽  
University Hospital ◽  
Primary And Secondary Prevention ◽  
Stroke Patients ◽  
Very High

Abstract Atrial fibrillation is one of major risk factors of cerebral infarction. The use of oral anticoagulants is the only evidence-based method of reducing the risk of cardioembolic accidents. The guidelines of oral anticoagulant admission and usage have been available since 2012. The results of this study show that of 550 stroke patients that were admitted to Pauls Stradiņš Clinical University Hospital, Rīga, Latvia, from 1 January 2014 until 1 July 2014, atrial fibrillation was diagnosed in 247 (45%) cases, and of these patients, only 8.5% used oral anticoagulants before the onset of stroke. Six months after discharge of 111 (44.9%) stroke survivors, five (4.5%) used no secondary prevention medication, 27 (24.3%) used antiplatelet agents, 54 (48.6%) warfarin, and 25 (22.5%) used target specific oral anticoagulants (TSOACs). The mortality rate was significantly higher in the patient group that used no secondary prevention medication or antiplatelet agents compared to the patient group that used oral anticoagulants. The use of oral anticoagulants for primary stroke prevention in Latvia is insufficient. The mortality of cardioembolic stroke in 180 days is very high - 40.4%. Secondary prevention is essential to prevent recurrent cardioembolic accidents.

Abstract 18272: The Increasing Proportion of Acute Myocardial Infarction Represented by the Uninsured: a Growing Financial Burden in the United States

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Bethany Doran ◽  
Yu Guo ◽  
Jinfeng Xu ◽  
Sripal Bangalore
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Health Insurance ◽  
Financial Burden ◽  
Insurance Coverage ◽  
The United States ◽  
The Us ◽  
Hospital Stays ◽  
Nationally Representative ◽  
The Cost

Introduction: Under the provisions of the Affordable Care Act, insurance coverage will markedly increase with the Congressional Budgetary Office estimating the number of insured to increase by approximately 13 million in 2014 and 25 million in 2016. However, approximately 31 million non-elderly US citizens are expected to remain without health insurance in 2016. Acute myocardial infarction (AMI) remains a source of significant morbidity and mortality, as well as cost to society. No prior studies have examined temporal rates of uninsured among patients presenting with an AMI using a nationally representative database. Hypothesis: We tested the hypothesis that the proportion of uninsured individuals with AMI and cost of uninsured to society will vary by year. Methods: We used the Nationwide Inpatient Sample (NIS), which contains estimates from approximately 8 million hospital visits and information related to number of discharges, aggregate charges, and principal diagnoses of all patients discharged in the US. We calculated the percentage of acute myocardial infarction by insurance status, and the sum of all charges of hospital stays in the US adjusted for inflation. Results: The cost to society due to acute myocardial infarction in the uninsured increased substantially from 1997 to 2012, with total cost in 1997 of $852,596,272 and $3,446,893,954 in 2012 after adjustment for inflation. In addition, although rates of AMI decreased in the general population (from 268.6/100,000 individuals in 1997 to 193.8/100,000 individuals in 2012), the proportion of individuals with AMI who were uninsured increased (from 3.83% in 1997 to 7.37% in 2012). Conclusions: The proportion of those experiencing AMI who are uninsured is rising, as is cost to society. It remains to be seen what the effects of expanding health insurance will have on the rate of AMI as well as proportion of AMI represented by the uninsured.

scholarly journals Costs of bariatric surgery in a teaching hospital and the financing provided by the Public Unified Health System

2010 ◽  
Vol 25 (2) ◽  
pp. 201-205 ◽  
Author(s):  
Wilson Salgado Júnior ◽  
Karoline Calfa Pitanga ◽  
José Sebastião dos Santos ◽  
Ajith Kumar Sankarankutty ◽  
Orlando de Castro e Silva Jr ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Health System ◽  
Perioperative Period ◽  
University Hospital ◽  
Retrospective Evaluation ◽  
The Public ◽  
Unified Health System ◽  
The Government ◽  
The Cost ◽  
The University

PURPOSE: Analyze the effect of some measures on the costs of bariatric surgery, adopting as reference the remuneration of the procedure provided by the Unified Health System (SUS). METHODS: A retrospective evaluation conducted in the Costs Section of the University Hospital of Ribeirão Preto, of the costs involved in the perioperative period for patients submitted to bariatric surgery from 2004 to 2007. Changes in the routines and protocols of the service aiming at the reduction of these costs during the study period were also analyzed. RESULTS: Nine patients in 2004 and seven in 2007 submitted to conventional vertical banded "Roux-en-Y" gastric bypass were studied. All patients presented good postoperative evolution. The average cost with these patients was R$ 6,845.17 in 2004. Even though an effort was made to contain expenditures, the cost in 2007 was of R$ 7,525.64 because of the increase in the price of materials and medicines. The Government remuneration of the procedure in the two years was R$ 3,259.72. CONCLUSION: Despite the adoption of diverse measures to reduce the expenditures of bariatric surgery, in fact there was an increase in the costs, a fact supporting the necessity of permanent evaluation of the financing of public health.

scholarly journals Administrative Growth At The University: A Case Study

2005 ◽  
Vol 2 (1) ◽  
Author(s):  
Leon B. Hoshower ◽  
David Kirch
Keyword(s):  
Student Loans ◽  
Financial Burden ◽  
College Education ◽  
Cumulative Effect ◽  
Government Support ◽  
Administrative Costs ◽  
Current Topic ◽  
Study Programs ◽  
The Cost ◽  
The University

During the past two decades, the cost of higher education has increased at a higher rate than inflation.  Although this increase is small each year, the cumulative effect is great.  These increased costs are funded mainly through increased tuition and increased government support, either through subsidies to state funded universities or through government supported student loans, grants, work-study programs, and tax credits.  These subsidies are straining governmental budgets.  Many students are graduating with large debt burdens.  There is a rising fear among the working class that providing a college education for their children will be beyond their financial means. Thus, it is generally understood that the cost of a college education is rising faster than inflation and that these rising costs are creating a financial burden for both governments and individuals.  What is not generally understood is the source of these rising costs.  This study examined the financial records of a state supported, mid-western university with enrollment between 15,000 and 20,000 students, hereafter referred to as the University, over an eighteen-year period.  The study found that the rising cost of the University’s administration was the major source of the university’s cost increases.  This paper documents this finding and offers five possible explanations for these rising administrative costs.  The paper neither condemns nor justifies the rises in costs and it offers no suggestions for effectively decreasing administrative costs.  Diagnosis of the problem is the current topic of discussion, while possible solutions remain to be devised at a later date

Employment Rank and the Choice of Health Insurance Benefit Scheme among Bangladeshi Civil Servants

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Syed Abdul Hamid ◽  
Afroza Begum ◽  
Syed M Ahsan ◽  
Sushil Ranjan Howlader ◽  
Azhar Uddin ◽  
...  
Keyword(s):  
Health Insurance ◽  
Financial Burden ◽  
Civil Servants ◽  
Fiscal Capacity ◽  
Insurance Benefit ◽  
Sharing Rules ◽  
The Government ◽  
Basic Salary ◽  
Very High ◽  
High Willingness

Abstract This study surveys 622 Bangladeshi civil servants of all administrative jurisdictions and elicits their preference for health insurance schemes. The latter vary in the amount of sum assured as well as in terms of premium sharing rules with the government. The paper also explores the financial burden that the premium subsidy may impose on the exchequer and the state’s fiscal capacity to shoulder it. We discover a very high willingness to join the scheme. Though all three premium-sharing options posit flat rates common for all employment ranks, respondents appear to prefer premiums proportional to their basic salary.

Abstract P265: Identifying Factors Associated With Early Transfer Death of Stroke Patients Can Improve Transfer Criteria

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Randi R Toumbs ◽  
Thanh Dao ◽  
Liang Zhu ◽  
Sean I Savitz
Keyword(s):  
Hospital Mortality ◽  
High Mortality ◽  
Financial Burden ◽  
Early Death ◽  
University Hospital ◽  
Stroke Patients ◽  
Chi Square ◽  
Exact Test ◽  
Chi Square Test ◽  
Ich Score

Introduction: Mortality is an important performance metric monitored by CMS, US News and World Report, and Vizient UHC. Large academic medical centers have high mortality given higher severity of disease and volume. We analyzed mortality of stroke patients transferred to our university hospital from community EDs. Transferring patients who die within 48 hours raises questions about resources, financial burden, and unrealistic expectations from families. We analyzed our transfer early death (TED) population to improve identification of patients who likely do not benefit from transfer out of a community hospital. Methods: Patients with DRG codes for ischemic and hemorrhagic strokes admitted from July 2018-June 2020 were identified. Transfer patients were isolated and grouped as outside hospital (OSH) or intra-system transfers. Data were analyzed for overall hospital mortality and TED mortalities and characteristics. Demographic and clinic variables were compared between intra-system and outside transfers by chi-square test, Fisher’s exact test, t test or Wilcoxon rank sum test. Results: The total stroke mortality rate was 13% with 276 deaths out of 2,145 patients. There were 171 early deaths out of 276 deaths (62%). There were a total of 923 transfer patients in the 2-year period; 76 were TED (8%) and TED accounted for 27% of all in-hospital mortality at our center. Median age of TED was 67, median NIHSS was 27, 39% were >70, and 80% were ICH with a median ICH score 4. The mean volume of ICH was 68mL (SD=55.2). There were no significant associations between age, sex and ethnicity with TED compared with patients who survived beyond 48 hrs. Among TED, 31 (41%) were from within our health system and 45 (59%) were OHS transfers. There were no significant differences among stroke type, severity (GCS, NIHSS, ICH score, MRS), or demographics between intra-system and OSH transfers. Conclusions: TED patients are more likely to have severe ICH where medical care may be futile. Strategies are needed to work with community hospitals to establish goals of care and implement approaches to provide end-of-life services at these facilities. Identification and implementation of such strategies may also reduce intra-system transfers of patients with high mortality.

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