Analisis Perbandingan Biaya Perawatan (Cost of illness Stroke Iskemik dan Stroke Hemoragik Pasien Rawat Inap di SUD Pannembahan Senopati

Stroke termasuk dalam penyakit katarostropik yang dapat mengancam jiwa, dan memiliki resiko tinggi serta membutuhan pertolongan segera. Stroke dapat menyebabkan penderitanya memiliki faktor resiko morbiditas seusia hidupnya yang dapat menimbulkan Burden disease sehingga menyebabkan kematian, cedera, hilangnya produktifitas dan membutuhkan biaya penanganan yang cukup tinggi. Tujuan utama dari penelitian ini adalah untuk mengetahui total biaya perawatan dan selisish biaya perawatan stroke iskemik dan stroke hemoragik pasien rawat inap di RSUD Panembahan Senopati Bantul. Penelitian ini menggunakan rancangan penelitian deskriptif analitik non-eksperimental dengan pendekatan cross sectional study menurut perspektif penyedia layanan kesehatan (provider). Biaya yang diperhitungkan adalah biaya langsung (direct cost) menggunakan pendekatan bottom up. Subyek penelitian adalah semua pasien stroke rawat inap yang terdaftar sebagai pasien umum di rumah sakit yang memenuhi kriteria inklusi. Data dianalisis menggunakan software Excel dan SPSS. Hasil penelitian melibatkan 50 sampel yang terdiri dari 32 pasien stroke iskemik dan 18 pasien stroke hemoragik menunjukan dengan analisis regresi linear variabel bebas berpengaruh terhadap biaya stroke sebesar 49,1%. Lama rawat inap menjadi faktor yang paling berpengaruh terhadap tingginya biaya dengan nilai p 0,00 (<0,05). Total direct health cost perawatan stroke adalah sebesar Rp151.633.600,00 Sedangkan material cost sebesar Rp113.954.918,00. Total rata-rata biaya stroke iskemik Rp4.625.511.006, stroke hemoragik Rp6.531.786.277 dengan selisih Rp1.906.275.271.

Association between service scope of primary care facilities and patient outcomes: a retrospective study in rural Guizhou, China

Background Extending service scope of primary care facilities (PCFs) has been widely concerned in China. However, no current data about association between service scope of PCFs with patient outcomes are available. This study aims to investigate association between service scope of PCFs and patient outcomes. Methods A multistage, stratified clustered sampling method was used to collect information about service scope of PCFs from rural Guizhou, China. Claim data of 299,633 inpatient cases covered by 64 PCFs were derived from local information system of New Rural Cooperation Medical Scheme. Service scope of PCFs was collected with self-administrated questionnaires. Primary outcomes were (1) level of inpatient institutions, (2) length of stay, (3) per capita total health cost, (4) per capita out-of-pocket cost, (5) reimbursement ratio, (6) 30-day readmission. A total of 64 PCFs were categorized into five groups per facility-level service scope scores. Generalized linear regression models, logistic regression model, and ordinal regression model were conducted to identify association between service scope of PCFs and patient outcomes. Results On average, the median service scope score of PCFs was 20, with wide variation across PCFs. After controlling for demographic and clinical characteristics, patients living in communities with PCFs of greatest service scope (Quintile V vs. I) tended to have smaller rates of admission by county-level hospitals (-6.2 % [-6.5 %, -5.9 %], city-level hospitals (-1.9 % [-2.0 %, -1.8 %]), and provincial hospitals (-2.1 % [-2.2 %, -2.0 %]), smaller rate of 30-day readmission (-0.5 % [-0.7 %, -0.2 %]), less total health cost (-201.8 [-257.9, -145.8]) and out-of-pocket cost (-210.2 [-237.2, -183.2]), and greater reimbursement ratio (2.3 % [1.9 %, 2.8 %]) than their counterparts from communities with PCFs of least service scope. Conclusions Service scope of PCFs varied a lot in rural Guizhou, China. Greater service scope was associated with a reduction in secondary and tertiary hospital admission, reduced total cost and out-of-pocket cost, and 30-day readmission and increased reimbursement ratio. These results raised concerns about access to care for patients discharged from hospitals, which suggests potential opportunities for cost savings and improvement of quality of care. However, further evidence is warranted to investigate whether extending service scope of PCFs is cost-effective and sustainable.

Health Cost Estimation of Traffic-Related Air Pollution and Assessing the Pollution Reduction Potential of Zero-Emission Vehicles in Toronto, Canada

Fossil fuel vehicles, emitting air toxics into the atmosphere, impose a heavy burden on the economy through additional health care expenses and ecological degradation. Air pollution is responsible for millions of deaths and chronic and acute health problems every year, such as asthma and chronic obstructive pulmonary disease. The fossil-fuel-based transportation system releases tons of toxic gases into the atmosphere putting human health at risk, especially in urban areas. This analysis aims to determine the economic burden of environmental and health impacts caused by Highway 401 traffic. Due to the high volume of vehicles driving on the Toronto Highway 401 corridor, there is an annual release of 3771 tonnes of carbon dioxide equivalent (CO2e). These emissions are mainly emitted onsite through the combustion of gasoline and diesel fuel. The integration of electric and hydrogen vehicles shows maximum reductions of 405–476 g CO2e per vehicle-kilometer. Besides these carbon dioxide emissions, there is also a large amount of hazardous air pollutants. To examine the impact of air pollution on human health, the mass and concentrations of criteria pollutants of PM2.5 and NOx emitted by passenger vehicles and commercial trucks on Highway 401 were determined using the MOVES2014b software. Then, an air dispersion model (AERMOD) was used to find the concentration of different pollutants at the receptor’s location. The increased risk of health issues was calculated using hazard ratios from literature. Finally, the health cost of air pollution from Highway 401 traffic was estimated to be CAD 416 million per year using the value of statistical life, which is significantly higher than the climate change costs of CAD 55 million per year due to air pollution.

Tobacco Farming and Illness Induced Poverty in Pakistan

Tobacco has been projected for its economic prosperity in Pakistan and many other developing countries while the opportunity cost of domestic labor, health issues and associated health cost related with tobacco farming are often overlooked. Various health conditions associated with tobacco farming result in catastrophic health expenditures which not only increase the chances of poverty head counts but also deepens it further. Taking into account the opportunity cost of domestic labor and health cost associated with tobacco induced illnesses obscure the tobacco prosperity rhetoric. This study examined effect of incremental health cost associated with tobacco farming on poverty head counts and severity. Using survey data from the tobacco producing districts in Khyber Pakhtunkhwa, Pakistan, this study found that tobacco farmers experienced higher proportion of sever health hazards and illnesses like CVD and respiratory issues. The severe nature of ailments caused them higher share of out of pocket expenditures as compared to non-tobacco farmers and general population. Increase in health expenditures not only increased their poverty head counts by four and half percent but also severity of poverty worsened further by 8 percentage points using the Cost of Basic Needs (CBN) approach for measuring poverty. This study concludes that it is not only tobacco consumption associated with various health conditions but also tobacco farming. It is recommended that health cost associated with tobacco farming be considered both in setting up of minimum indicative prices for tobacco and consideration of health cost can be used as a tool against prosperity rhetoric which is used to block tobacco control policy.

The Warming Climate Aggravates Atmospheric Nitrogen Pollution in Australia

Australia is a warm country with well-developed agriculture and a highly urbanized population. How these specific features impact the nitrogen cycle, emissions, and consequently affect environmental and human health is not well understood. Here, we find that the ratio of reactive nitrogen (Nr) losses to air over losses to water in Australia is 1.6 as compared to values less than 1.1 in the USA, the European Union, and China. Australian Nr emissions to air increased by more than 70% between 1961 and 2013, from 1.2 Tg N yr-1 to 2.1 Tg N yr-1. Previous emissions were substantially underestimated mainly due to neglecting the warming climate. The estimated health cost from atmospheric Nr emissions in Australia is 4.6 billion US dollars per year. Emissions of Nr to the environment are closely correlated with economic growth, and reduction of Nr losses to air is a priority for sustainable development in Australia.