Economic Burden of Pneumococcal Disease in Individuals Aged 15 Years and Older in the Liguria Region of Italy

Despite the availability of vaccines against Streptococcus pneumoniae, the global incidence and economic cost of pneumococcal disease (PD) among adults is still high. This retrospective cohort analysis estimated the cost of emergency department (ED) visits/hospitalizations associated with non-invasive pneumonia and invasive pneumococcal disease among individuals ≥15 years of age in the Liguria region of Italy during 2012–2018. Data from the Liguria Region Administrative Health Databases and the Ligurian Chronic Condition Data Warehouse were used, including hospital admission date, length of stay, discharge date, outpatient visits, and laboratory/imaging procedures. A ≥30-day gap between two events defined a new episode, and patients with ≥1 ED or inpatient claim for PD were identified. The total mean annual number of hospitalizations for PD was 13,450, costing ~€49 million per year. Pneumonia accounted for the majority of hospitalization costs. The median annual cost of hospitalization for all-cause pneumonia was €38,416,440 (per-capita cost: €26.78) and was €30,353,928 (per-capita cost: €20.88) for pneumococcal and unspecified pneumonia. The total number and associated costs of ED visits/hospitalizations generally increased over the study period. PD still incurs high economic costs in adults in the Liguria region of Italy.

Intervening factors in the costs of fluoridation in water supply systems: a case study in seven population sizes

ABSTRACT The aim of this study was to analyze the costs of fluoridation in water supply systems of different population sizes. A case study was carried out comprising cities in the state of Espírito Santo, Brazil. The costs of initial installation, the chemical product, the operation of the system, and the control of fluoride levels between the years 2012 and 2017 were considered. The annual per capita cost of the treatment was calculated to estimate the fluoridation weight concerning the total expenses. The fluoridation annual per capita cost ranged from R$ 20.14 (US$ 7.23) in towns with less than two thousand inhabitants to R$ 0.39 (US$ 0.14) in cities with a population of approximately 520 thousand inhabitants. In systems that supply up to 30 thousand inhabitants, the running cost was responsible for most of the expenses, ranging from 98.2 to 84%. For cities with 520 thousand inhabitants, the costs with the chemical product corresponded to 74.7% of the expenses. Compared with the total treatment cost, the water fluoridation cost ranged from 0.2 to 0.6% for population sizes of 30 thousand inhabitants or more and varied from 1.3 to 7.3% for towns with less than 10 thousand inhabitants. Considering that the decision-making process is complex in the field of public policies, and decision-makers suffer multiple influences as for different policy alternatives, knowing the implications of population size for costs is essential for informed decision-making.

Prevalence and socioeconomic burden of diabetes mellitus in South Korean adults: a population-based study using administrative data

Background Diabetes leads to severe complications and imposes health and financial burdens on the society. However, currently existing domestic public health studies of diabetes in South Korea mainly focus on prevalence, and data on the nationwide burden of diabetes in South Korea are lacking. The study aimed to estimate the prevalence and economic burden of diabetes imposed on the South Korean society. Methods A prevalence-based cost-of-illness study was conducted using the Korean national claims database. Adult diabetic patients were defined as those aged ≥20 years with claim records containing diagnostic codes for diabetes (E10-E14) during at least two outpatient visits or one hospitalization. Direct costs included medical costs for the diagnosis and treatment of diabetes and transportation costs. Indirect costs included productivity loss costs due to morbidity and premature death and caregivers’ costs. Subgroup analyses were conducted according to the type of diabetes, age (< 65 vs. ≥65), diabetes medication, experience of hospitalization, and presence of diabetic complications or related comorbidities. Results A total of 4,472,133 patients were diagnosed with diabetes in Korea in 2017. The average annual prevalence of diabetes was estimated at 10.7%. The diabetes-related economic burden was USD 18,293 million, with an average per capita cost of USD 4090 in 2019. Medical costs accounted for the biggest portion of the total cost (69.5%), followed by productivity loss costs (17.9%), caregivers’ costs (10.2%), and transportation costs (2.4%). According to subgroup analyses, type 2 diabetes, presence of diabetic complications or related comorbidities, diabetes medication, and hospitalization represented the biggest portion of the economic burden for diabetes. As the number of complications increased from one to three or more, the per capita cost increased from USD 3991 to USD 11,965. In inpatient settings, the per capita cost was ~ 10.8 times higher than that of outpatient settings. Conclusions South Korea has a slightly high prevalence and economic burden of diabetes. These findings highlight the need for effective strategies to manage diabetic patients and suggest that policy makers allocate more health care resources to diabetes. This is the first study on this topic, conducted using a nationally representative claims database in South Korea.

“Top-down bottom-up” estimation of per capita cost of new-born care interventions in four regions of Ghana: beyond implementation to scalability and sustainability

Background Limited financial, human and material health resources coupled with increasing demand for new-born care services require efficiency in health systems to maximize the available sources for improved health outcomes. Making Every Baby Count Initiative (MEBCI) implemented by local and international partners in 2013 in Ghana aimed at attaining neonatal mortality of 21 per 1000 livebirths by 2018 in four administrative regions in Ghana. MEBCI interventions benefited 4027 health providers, out of which 3453 (86%) were clinical healthcare staff. Objective Determine the per capita cost of the MEBCI interventions towards enhancing new-born care best practices through capacity trainings for frontline clinical and non-clinical staff. Methods Parameters for determining per capita cost of the new-born care interventions were estimated using expenditure on trainings, supervisions, monitoring and evaluation, advocacy, administrative/services and medical logistics. Data collection started in October 2017 and ended in September 2018. Data sources for the per capita cost estimations were invoices, expense reports and ledger books at the national, regional and district levels of the health system. Results Total of 4027 healthcare providers benefited from the MEBCI training activities comprising of 3453 clinical staff and 574 non-clinical personnel. Cumulative cost of implementing the MEBCI interventions did not necessarily match the cost per capita in staff capacity building; average cost per capita for all staff (clinical and non-clinical staff) was approximately US$ 982 compared to a per capita cost of US$ 799 for training only core clinical staff. Average cost per capita for all regions was approximately US$ 965 for all staff compared to US$ 777 per capita cost for only clinical staff. Per capita cost of training was relatively lower in regions with more staff than regions with lower numbers, perhaps due to economies of scale. Conclusion The MEBCI intervention had a wide coverage in terms of training for frontline healthcare providers albeit the associated cost may be potentially unsustainable for Ghana’s health system. Emerging digital training platforms could be leveraged to reduce per capita cost of training. Large-scale on-site batch-training approach could also be replaced with facility-based workshops using training of trainers (TOTs) approach to promote efficiency.

Sources and Sociology Concerns of Financing the Innovation Activities in Russia

The innovation abilities of an enterprise and the feasibility of an innovative project always depend on financing. We can say that the main issue is the assessment of funds required for the implementation of an innovation and the analysis of their possible sources. In this paper, different mechanisms of financing and allocation of financial resources and their impact on innovative performance were examined. In general, financing sources of the institutes in different countries have adopted different mechanisms to provide and allocate resources from the range of public funding to private financing. But the amount varies from country to country so that in European institutions most government funding and the United States, private financing is the predominant form of financing. Some governments subsidize the supply side (higher education institutions), some on the demand side (customers), and some on both sides of the higher education services market. In general, negotiation-based and formula-based allocation, personnel-based allocation, student-based allocation, per capita cost, priority-based, and performance-based allocation are among the mechanisms used in this regard. The results of this article showed that the mechanisms of allocating and allocating resources in higher education play the role of policy-making and guiding the behavior of actors and can affect the performance of universities and institutions of higher education at the macro and micro level (individual). In the area of funding, graduates should contribute to the financing of universities, and in the area of allocation, performance-based allocation mechanisms should be used to achieve greater efficiency, accessibility, and equity.

Prevalence and Socioeconomic Burden of Diabetes Mellitus in South Korean Adults: A Population-Based Study using Administrative Data

Background: Diabetes leads to severe complications and imposes health and financial burdens on the society. However, currently existing domestic public health studies of diabetes in South Korea mainly focus on prevalence, and data on the nationwide burden of diabetes in South Korea are lacking. The study aimed to estimate the prevalence and economic burden of diabetes imposed on the South Korean society.Methods: A prevalence-based cost-of-illness study was conducted using the Korean national claims database. Adult diabetic patients were defined as those aged ≥20 years with claim records containing diagnostic codes for diabetes (E10-E14) during at least two outpatient visits or one hospitalization. Direct costs included medical costs for the diagnosis and treatment of diabetes and transportation costs. Indirect costs include productivity loss costs due to morbidity and premature death and caregivers’ costs. Subgroup analyses were conducted according to the type of diabetes, age (<65 vs. ≥65), diabetes medication, experience of hospitalization, and presence of diabetic complications or related comorbidities.Results: A total of 4,472,133 patients were diagnosed with diabetes in Korea in 2017. The average annual prevalence of diabetes was estimated at 10.7%. The diabetes-related economic burden was USD 18,293 million, with an average per capita cost of USD 4,090 in 2019. Medical costs accounted for the biggest portion of the total cost (69.5%), followed by productivity loss costs (17.9%), caregivers’ costs (10.2%), and transportation costs (2.4%). According to subgroup analyses, type 2 diabetes, presence of diabetic complications or related comorbidities, diabetes medication, and hospitalization represented the biggest portion of the economic burden for diabetes. As the number of complications increased from one to three or more, the per capita cost increased from USD 3,991 to USD 11,965. In inpatient settings, the per capita cost was ~10.8 times that of outpatient settings.Conclusions: South Korea exist a slightly higher prevalence and economic burden of diabetes. These findings highlight the need for effective strategies to manage diabetic patients and suggest that policy makers allocate more health care resources to diabetes. This is the first study on this topic, conducted using a nationally representative claims database in South Korea.

Promoting Healthy Aging Through Policy Change on the Federal Level: Strategies for Scholars and Clinicians

Influencing health policy change is a significant focus for scholars and clinicians in the aging field. Nevertheless, they seldom receive formal training on how to influence the policymaking process effectively or how to translate their clinical and research experiences to inform policymakers best. Exposing scholars and clinicians to the policymaking process can advance their effectiveness as they seek to realize meaningful change to promote healthy aging of our population. This poster presentation focuses on providing scholars and clinicians with strategies to understand and influence the federal policymaking process. The presentation addresses the current policy environment in which federal health and aging policy is made and describes challenges to this process. Four strategies are identified to help scholars and clinicians influence the policymaking process: 1) identify a problem and any relevant policy that corresponds to the issue, 2) identify evidence-based solutions that relate to quality improvement, population health, or reducing per capita cost of healthcare, 3) grow relevant networks, meet experts, build relationships and connect with key stakeholders, 4) identify potential unintended consequences or barriers to the implementation of policy. By providing examples, this how-to aging and health policy road map provides context and guidance to stakeholder engagement, frameworks, and methods that can be used to engage in the policymaking process. The final part of this presentation explores ways to integrate health policy training and experience into scholars’ and clinicians’ professional development.

How different Cape Town residential suburbs helped avert Day Zero

Between 2015 and 2018, the Western Cape region of South Africa experienced three consecutive years of below average rainfall. The local authority of Cape Town imposed water restrictions to avert ‘Day Zero’, an event that was expected to occur if the storage capacity of the main dams supplying the city fell to below 13.5%. This study analyses how different residential areas in Cape Town responded to water restrictions and tariffs that were imposed from January 2016 to October 2018 during the midst of the water crisis. It further explores the potential implications for tariff adjustments that were designed to sustain water conservation measures beyond the drought, while also being sensitive to the ability of poorer households to access sufficient water at an appropriate per capita cost. Different socio-economic groups displayed a different response to the restrictions. A delay or lag-time was observed in lower-income suburbs during the initial phases of water restrictions, while middle- and higher-income suburbs responded immediately. Once the water crisis eased by mid-2018 and restrictions were reduced, more affluent suburbs began relaxing their water conservation efforts. Nevertheless, lower-, middle-, and higher-income suburbs significantly reduced their water demand by 32, 59, and 58%, respectively, over the study period. It can therefore be concluded that water restrictions and accompanying tariffs altered water use of all users regardless of socio-economic status.

Estimating the costs of the national basic public health services in Zhuhai, China, through activity-based costing: a cross-sectional study

ObjectiveOur research aims to estimate the per capita cost of 13 items in the basic public health service (BPHS) project in Zhuhai, China, and provide an economical basis for the improvement of the cost compensation mechanism used by the government.DesignThis research is a cross-sectional study.SettingA total of 19 primary healthcare facilities (PHFs) in Zhuhai, China, are involved in this research.ParticipantsA total of 152 participants (114 personnel engaged in BPHS, 19 financial personnel and 19 PHF heads) were included in this study, which was conducted from May 2017 to July 2017.Primary and secondary outcome measuresWe used the activity-based costing model to calculate the cost of providing BPHS in Zhuhai. An analytical hierarchy process was used to determine the difficulty dimension and workload coefficient.ResultsThe weights of the difficulty dimensions in the provision of BPHS in Zhuhai were 35.04% (coordination of residents), 24.03% (staff workload), 21.36% (complexity of work-related skills) and 19.59% (basic qualities of staff). The average difficulty coefficient of each subproject was 5.28. The actual per capita cost of BPHS provision in 2016 was 97.48 RMB (12.76 EUR), which was higher than the actual standard compensation of 55 RMB (7.2 EUR) in Zhuhai. Immunisation was the most costly among the 13 service items (17.82 RMB or 2.33 EUR per person), whereas the management of tuberculosis was the least costly item (0.57 RMB or 0.07 EUR per person).ConclusionsGovernment funds for basic public health services cannot compensate for the actual costs. Accordingly, subsidies should be increased based on the actual per capita cost for sustainable BPHS development. The government should improve the methods used in cost estimation and measures used as the basis for awarding performance incentives.

Building an Integrative Health Program

Aligning an integrative health initiative or program with the organization’s mission, vision, and values is critical. Implementation of integrative therapies is an effective strategy to achieve organizational goals. Understanding the needs of stakeholders and end users is a critical first step. This chapter discusses building an integrative health program in the context of organizational and system change. The emphasis is on the Triple Aim initiative, which focuses on the simultaneous pursuit of three aims: improving the health of the population, enhancing the patient experience of care (including quality, access, and reliability), and reducing the per capita cost of care. Design, implementation, and evaluation are covered.