Societal Cost of Ischemic Stroke in Romania: Results from a Retrospective County-Level Study

Background: Health policies in transitioning health systems are rarely informed by the economic burden of disease due to scanty access to data. This study aimed to estimate direct and indirect costs for first-ever acute ischemic stroke (AIS) during the first year for patients residing in Cluj, Romania, and hospitalized in 2019 at the County Emergency Hospital (CEH). Methods: The study was conducted using a mixed, retrospective costing methodology from a societal perspective to measure the cost of first-ever AIS in the first year after onset. Patient pathways for AIS were reconstructed to aid in mapping inpatient and outpatient cost items. We used anonymized administrative and clinical data at the hospital level and publicly available databases. Results: The average cost per patient in the first year after stroke onset was RON 25,297.83 (EUR 5226.82), out of which 80.87% were direct costs. The total cost in Cluj, Romania in 2019 was RON 17,455,502.7 (EUR 3,606,505.8). Conclusions: Our costing exercise uncovered shortcomings of stroke management in Romania, particularly related to acute care and neurorehabilitation service provision. Romania spends significantly less on healthcare than other countries (5.5% of GDP vs. 9.8% European Union average), exposing stroke survivors to a disproportionately high risk for preventable and treatable post-stroke disability.

Cost-Sharing in Medical Care Can Increase Adult Mortality Risk in Lower-Income Countries

Patient cost-sharing in medical care constrains total health spending, presumably with little harm to underlying patient health. This paper re-evaluates the link between cost-sharing and health, studying Colombia’s entire formal sector workforce with individual-level health care utilization records linked to payroll data and vital statistics. Given discrete breaks in outpatient cost-sharing imposed at multiple income thresholds by Colombia’s national health system, we use a regression discontinuity design and find that outpatient cost-sharing reduces use of outpatient care, resulting in fewer diagnoses of common chronic diseases and increasing subsequent emergency room visits and hospitalizations. Ultimately, these effects measurably increase mortality, and disproportionately so among the poor – raising the absolute difference in 7-year mortality risk by 0.80 and 0.23 deaths per 1,000 individuals at lower- and higher-income thresholds, respectively. To the best of our knowledge, this study is the first to show a relationship between cost-sharing and adult mortality risk in lower-income countries, a relationship important to incorporate into social welfare analyses of cost-sharing policies.One Sentence SummaryOutpatient cost-sharing in medical care discourages use – but over time, also increases costly hospital service use and raises mortality risk.

A centralised complex venous service model in an NHS hospital

Background/aims Recent evidence supporting the efficacy and safety of deep venous interventions is likely to increase the demand for complex venous services on the NHS. This study aimed to analyse the clinical activity of a tertiary-referral complex venous service model and the estimated costs in an NHS hospital over a period of 1 year. Methods The clinical activity, admission type and treatment cost of all the patients managed by an NHS complex venous service between 1 February 2015 and 31 May 2016 were reviewed. Findings The mean monthly demand for outpatient services for new referrals and follow-ups was 22 and 82.9 respectively. The total number of admissions was 328 (mean of 27.3 admissions per month), with the outpatient cost totaling at £141 888 in 1 year. Conclusions The analysis suggests that the current complex venous service model is feasible and potentially sustainable in an NHS hospital.

Estimating Health Care Costs of Non-Melanoma Skin Cancer in Saskatchewan using Physician Billing Data

Introduction Given the high occurrence and morbidity of non-melanoma skin cancer (nmsc), its economic burden on the Canadian health care system is a cause for concern. Despite that relevance, few studies have used patient-level data to calculate the cost of nmsc. The objective of the present study was to use physician billing data to describe the health care costs and service utilization associated with nmsc in Saskatchewan.Methods The Saskatchewan Cancer Agency’s cancer registry was used to identify patients diagnosed with nmsc between 2004 and 2008. Treatment services and costs were based on physician billing claims, which detail physician services performed in an outpatient setting. Total and annual outpatient costs for nmsc and mean outpatient cost per person were calculated by skin cell type, lesion site, and geographic location. Service utilization and costs by physician specialty were also explored.Results Total outpatient costs grew 12.08% annually, to $845,954.98 in 2008 from $527,458.76 in 2004. The mean outpatient cost per person was estimated at $397.86. Differences in the cost-per-person estimates were observed when results were stratified by skin cell type ($403.41 for basal cell carcinoma vs. $377.85 for squamous cell carcinoma), lesion site ($425.27 for the face vs. $317.80 for an upper limb), and geographic location ($415.07 urban vs. $363.48 rural). Investigation of service utilization found that 92.14% of treatment was delivered by general practice and plastic surgery/otolaryngology physicians; dermatology delivered only 6.33% of services.Conclusions Our results underestimate the direct costs of nmsc because inpatient services and non-physician costs were not included in the calculations. The present research represents a first step in understanding the cost burden of nmsc in Saskatchewan.

The Research on the Outpatient Cost Adjustment Framework of the Urban Workers in a Southern China City During 2013 to 2015

Based on a large amount of data, the study aimed to analyze all expenses of outpatients in a southern China city from 2013 to 2015. It draws a conclusion that the total cost of outpatient has increased in the past 3 years, and various cost indexes either increased or decreased in different ways. Drug costs and treatment fees are the main influencing factors for the change in total outpatient cost. The structural change from 2013 to 2015 was 70.15%. Drug costs, laboratory fees, and inspection fees are the main indexes that account for the increasing total outpatient costs. This study puts emphasis on the cost of human resources, which eliminates the phenomenon of “Yi Yao Yang Yi” (support medical cost with medicine) and “Yi Xie Yang Yi” (support medical cost with medical device). This study also focuses on the balance of outpatient cost, as well as the compensation function of medical insurance, which encourages multiple participation and coordinated adjustment.