GDP Growth and Health Care Expenditures Worldwide

Background: Impact of large recessions on GDP growth is well documented and their effect on Gross Domestic Product (GDP) growth is definitive. Health care expenditure is growing everywhere in the world. The most important factors such as GDP, income per capita, health system factors, urbanization, aging, and socio-demographic factors are well determined and described. Objective: The main aim of this literature review is the summation of all factors affecting the GDP and healthcare expenditure. The second aim is presenting the bigger picture of the multifactorial connection between all impacts on healthcare expenditure. The last aim is proposing possible strategies for the development of sustainable health systems. Conclusion: Tracking the economic trend changes is necessary. Government investments in health must be as large as countries can afford due to the population aging, non-communicable disease and treatment, and pharmacological innovations. The cost-effectiveness estimates and Hierarchical task analyses are among some plausible solutions for making informed resource allocation decisions.

GDP Growth and Health Care Expenditures Worldwide

Background: Impact of large recessions on GDP growth is well documented and their effect on Gross Domestic Product (GDP) growth is definitive. Health care expenditure is growing everywhere in the world. The most important factors such as GDP, income per capita, health system factors, urbanization, aging, and socio-demographic factors are well determined and described. Objective: The main aim of this literature review is the summation of all factors affecting the GDP and healthcare expenditure. The second aim is presenting the bigger picture of the multifactorial connection between all impacts on healthcare expenditure. The last aim is proposing possible strategies for the development of sustainable health systems. Conclusion: Tracking the economic trend changes is necessary. Government investments in health must be as large as countries can afford due to the population aging, non-communicable disease and treatment, and pharmacological innovations. The cost-effectiveness estimates and Hierarchical task analyses are among some plausible solutions for making informed resource allocation decisions.

The Vest™ High-Frequency Chest Wall Oscillation System Compared with Manual Chest Wall Physiotherapy for Managing Airway Clearance in Patients with Complex Neurological Disorders: A UK-based Cost-Effectiveness Analysis

Background: Weakness in the muscles used to breathe and swallow can lead to difficulties with airway clearance for people with neurological disorders including neuromuscular disease and cerebral palsy. This can lead to aspiration and other respiratory problems which are the leading causes of death in patients with complex neurological disorders. The Vest™ system supports airway clearance through the use of High-Frequency Chest Wall Oscillation (HFCWO) to loosen secretions in the chest by reducing their viscosity. Objective: To assess the cost-effectiveness of the Vest™ system versus Manual Chest Wall Physiotherapy (MCWP) for airway clearance in patients with neurological disorders including neuromuscular disease and cerebral palsy. Methods: A decision-analytic Markov model was developed to estimate the cost-effectiveness of HFCWO and MCWP over 5- and 10-year time horizons. Costs were estimated from the perspective of the UK National Health Service and personal social services. The main input parameters in the model were: rates of respiratory infection, respiratory-related hospitalisation, antibiotic use for respiratory infection and cost of the Vest™ system. The input parameters were informed by existing clinical guidelines and literature. Sensitivity analyses were conducted to explore uncertainties around the input parameters. Results: Over 5- and 10-year time horizons, the Vest™ system results in more quality-adjusted life-years and lower costs per patient. The Vest™ system has a high probability of being cost-effective (>98%) at willingness-to-pay thresholds of £20,000 and £30,000. The estimated average cost saving per patient over a 5-year time horizon is £5,660 (SD = £2362). Our results show that the Vest™ system may result in approximately £6 million cost savings per 1,000 patients with complex neurological disorders in 5 years. Per 1,000 patients, 2,442 hospital admissions and 49,868 bed days could be averted with the use of the Vest™ system. Our results were generally robust to the sensitivity analyses performed. Conclusion: The Vest™ system results in fewer respiratory infection episodes and hospitalisations, and thus less National Health Service (NHS) resource use, than current practice. Therefore, it is highly likely to be a cost-saving strategy.

A Comparative Analysis of the Costs and Benefits of Outsourcing Vs. Insourcing Cleaning Services in a Rural Hospital in Uganda

Background:This study estimates the net cost benefit of outsourcing cleaning services in a hospital in Uganda. The aim is to demonstrate an approach that can be applied by hospital managers using readily available data to conduct a cost benefit analysis as part of pre-sourcing evaluation.Methods:A before and after design was used to analyze, from the hospital manager’s perspective, the impact of outsourcing cleaning services on the hospital’s costs. Cost and service quality data was collected for the pre- and post- outsourcing period. Net costs of outsourcing were determined using a total cost pre- and post-out-sourcing approach. Benefits were monetized by comparing the costs of outsourcing with the theoretical in-sourcing costs that would be required to achieve the same quality as outsourced cleaning services. The theoretical in-sourcing costs were estimated by weighting the actual insourcing costs by a quality factor based on the hospital manager’s rating of service quality pre- and post-outsourcing. The outcome measures were the net total cost and cost per square meter cleaned for a one-year period.Results:Before adjusting for quality, outsourcing cleaning services were more costly than insourcing, with an annual cost of UGX 644.35 ($ 0.25) and UGX 568.07 ($ 0.22) per square meter cleaned, respectively. After adjusting for quality, outsourcing is cost-beneficial, providing a cost saving of UGX 372.20 ($ 0.14) per square meter cleaned. Sensitivity analysis indicates that cost of the outsourcing contract and manager’s quality rating of outsourced services have the greatest impact on value for money from outsourcing. An annual contract cost above UGX 1000 ($ 0.38) per square meter cleaned makes outsourcing less beneficial, keeping all other factors constant. An average quality rating below 5 for the outsourced service makes outsourcing less beneficial cost wise.Conclusion:Outsourcing resulted in additional hospital expenditure compared to in-sourcing, but also resulted in better quality service. Adjusting for quality makes outsourcing more cost beneficial. The magnitude of the cost benefit is sensitive to the contract value and the managers’ quality rating of the outsourced services.

Sociodemographic Characteristics Of The Over-The-Counter Drug Users In Serbia

Background:The analysis of socio-demographic factors on the use of over-the-counter drugs for self-medication and over the counter drugs such as vitamins and minerals for boosting the immune system.Objective:The objective is to look into socio-demographic factors of the interviewees who use Over-the-Counter drugs.Methods:Data obtained through the results of the National health survey of the Republic of Serbia 2013. Dependent variable was transformed such a way that vitamins and herbal medicaments for strengthening the body were merged into one group preparations for boosting the immune system and drugs for self-treatment into the group preparations for self-medication.Results:The interviewees more often use OTC for boosting the immune system rather that OTC for self-medication. Women and highly educated people use OTC preparations more often. Unemployed people coming from rural areas use OTC preparations less often. People who have primary education buy OTC products for boosting the immune system significantly more often in comparison to highly educated people (OR = 3.95), but they use OTC drugs for self-medication less frequently (OR = 0.25). The poorest interviewees buy OTC drugs for self-medication twice times less often than the rich, respectively, but they buy OTC vitamins and other immunoregulators 1.4 times more often than the rich, respectively.Conclusion:Highly educated, rich and people coming from developed regions very often buy OTC drugs for self-medication, while poor, less educated people coming from undeveloped regions more often buy OTC preparations for boosting the immune system.

Self-Reported Productivity Losses of People with Rheumatoid Arthritis in Alberta, Canada

Objectives: To estimate the annual cost of productivity losses per person with RA by 0.5 increment in HAQscore, and the annual cost of productivity losses for Alberta province. Methods: Using data from the Alberta Biologics Registry - a prospective observational cohort of consecutive patients receiving DMARD or anti-TNF therapies created in 2004, we compared the mean and median costs of productivity losses per patient per year between HAQ-score categories using multiple linear and quantile regressions, respectively. We used a prevalence-based approach to estimate the cost (in 2010 CA$) of productivity losses of RA for Alberta. Results: In total there were 1222 patients with RA interviewed at the baseline. Of this, 358 were the “current employees” and 204 were the “previous employees” totalling 563 patients for analyses. For all HAQ-score categories, the mean (median) of the cost per patient per year was estimated at $18,242 ($3,840). The cost was increasing along with the HAQscore increase. The lowest cost ($6,295) was found in category HAQ<=0.5 and the highest ($31,095) in category HAQ>2.0. The significant differences were found between the worse categories (HAQ>1.5) and the better categories (HAQ<=1.5). The mean costs of productivity losses of RA for the province of Alberta were estimated at $270 million. Conservatively, if median was used for mean, the costs for province would be $57 million. Conclusion: The results suggest that an improvement in the controlling of RA could have a significant economic impact in Alberta and that preventing HAQ-score from the worse categories may be associated with substantial savings in terms of productivity losses.