Search Results (118)

Background/Objectives: Moral hazard represents a significant challenge in healthcare systems globally, reflecting the tendency of insured individuals to over-utilize medical services when shielded from the full costs of care. Methods: This paper investigates the dynamics and implications of moral hazard within the Romanian public hospital sector, offering practical recommendations for healthcare policymakers to mitigate the financial risks associated with excessive healthcare utilization and ensure long-term sustainability. To achieve the objectives of this study, a quantitative research approach utilizing vignettes was employed. Vignettes allow for the simulation of real-world decision-making under conditions of insurance coverage, capturing nuanced behaviors that traditional surveys may overlook. Results: The study examined patient behaviors in the context of moral hazard in public hospitals in Romania, employing a quantitative approach based on vignettes. A total of 303 valid responses were collected. The findings indicate a significant tendency among insured patients, both publicly and privately insured, to opt for more expensive treatments compared to uninsured patients, who preferred more affordable options such as medication or physiotherapy. In the case of treatments for severe conditions, insured patients frequently chose combinations of higher-cost therapies, while uninsured individuals either delayed treatment or opted for less expensive alternatives. These results highlight the impact of moral hazard, driven by a reduced sensitivity to costs in the presence of insurance, and underscore the need for cost-sharing policies to mitigate the overutilization of medical resources. Conclusions: This paper uniquely contributes to the understanding of moral hazard by integrating insights from both Romanian public hospitals and international case studies, offering practical policy recommendations for mitigating the financial risks associated with excessive healthcare utilization. Full article

Background/Objectives: The World Federation of the Deafblind Global Report 2023 reports that many countries do not have a comprehensive identification, assessment, and referral system for persons with deafblindness, a combination of hearing and vision loss, across all age groups and geographic regions. The scan seeks to inform researchers, policymakers, and community-based organizations about the status of and gaps in sensory healthcare initiatives in Canada, with the intent to raise awareness to enhance the integration and coordination of eye and ear care services. Methods: We conducted an environmental scan of Canada’s healthcare system and current public health policies addressing vision and hearing care in Canada at the federal and provincial levels. The scan was conducted using published literature searches from five scientific databases—Embase, Medline, PsycINFO, PubMed, and CINAHL—in combination with the gray literature review of federal, provincial, and territorial governments and non-profit organizations’ websites from April 2011–October 2022. Out of 1257 articles screened, 86 studies were included that met the inclusion/exclusion criteria. In total, 13 reports were included in the gray literature search, with 99 total articles used in the analysis. Results: The thematic findings indicate stigma and discrimination toward individuals with disabilities and marginalized communities (Indigenous people, rural communities, recent immigrants, people of older age, and people with disabilities), including hearing, vision, or dual sensory loss, persist. Barriers to vision and hearing healthcare access include inadequate policies, underinvestment in vision and/or hearing services, limited collaboration and coordinated services between hearing and vision services, discrepancies in insurance coverages, and lack of health system support. Conclusions: This scan demonstrates the persisting barriers to vision and/or hearing services present in Canada, stemming from inadequate policy and limited service coordination. Future work to address gaps, evaluate public education, and develop integrated sensory healthcare initiatives to enhance coordinated eye and ear care services, as recommended in the WHO Report on Hearing and Vision, is imperative. Full article

Background: Adverse maternal health outcomes lead to health loss and unnecessary medical costs. However, few have explored how severe maternal morbidity (SMM) affects medical costs separately from blood transfusion. Therefore, the aim of this study was to evaluate the delivery-related costs of healthcare services in patients with and without SMM as well as blood transfusion. Methods: This retrospective cohort study used the National Health Insurance Service (NHIS) Delivery Cohort database in South Korea. We included all delivering mothers in South Korea from 2016 to 2021, except those with incomplete data, totaling 1,517,773 participants. The measured outcomes included delivery-related medical costs associated with SMM. A generalized estimating equation model with a log link, gamma distribution, and robust standard errors was used to estimate the mean delivery-related medical costs of SMM. Results: SMM occurred in 2.2% of the cohort. The adjusted mean delivery-related medical costs were approximately 2.1- and 1.4-fold higher in cases with SMM without blood transfusion and only blood transfusion than in those without SMM, respectively ($2005, 95% CI: $1934–2078 and $1339, 95% CI: 1325–1354, respectively). The adjusted mean delivery-related medical costs were 1.5-fold higher in cases with SMM with blood transfusion than in those without SMM (SMM $1539, 95% CI: $1513–$1565). Conclusions: Medical costs associated with delivery-related SMM with or without blood transfusion were significantly higher than those of normal deliveries, with excess costs varying according to existing healthcare policies. Policymakers should consider supporting programs to prevent high medical costs by improving maternal health. Full article

Background/Objectives: The Brazilian health system provides healthcare financed by the public and private sector, being the first designed to encompass universal healthcare coverage delivered to the population without charge to patients (Sistema Único de Saúde, SUS), whilst the second refers to healthcare coverage delivered for individuals with the capacity to pay for assistance through health insurance or out-of-pocket disbursements. Health insurance companies with beneficiaries receiving publicly financed healthcare from the SUS are required to provide the reimbursement of healthcare expenditures to the government, considering that the health insurance beneficiaries obtain deductions of income taxes designed to fund the SUS. Therefore, the study investigated patterns of healthcare utilization and public expenditure due to the use of public healthcare by beneficiaries of health insurance between 2003 and 2019. Methods: Datasets including annual information on healthcare utilization by beneficiaries of health insurance from the National Agency of Supplementary Health (Agência Nacional de Saúde Suplementar, ANS) were organized into a single database to allow for the identification of patterns of interest to inform public policies of health. The empirical strategy adopted included the estimation of regression models and agglomerative hierarchical cluster analysis to identify factors associated with public sector expenditure. Results: The regression results indicated lower expenditure with female patients, particularly children and adolescents under 20 years old, receiving treatment in public sector facilities linked to the federal government. The cluster analysis showed five types of health insurance beneficiaries with a higher level of healthcare utilization, being three clusters referring to medium complexity procedures with lower public expenditures, and two clusters with higher public expenditures, one cluster that refers to high complexity procedures, and one cluster referring to health insurance schemes without hospitalization. Conclusions: The findings of the study highlight the existence of patterns of healthcare utilization by health insurance beneficiaries that may compromise the sustainability of public funding within the Brazilian health system. Full article

With the increase in insured patients and an aging population, managing the length of stay (LOS) for inpatients has become crucial for controlling medical costs. Analyzing the factors influencing LOS is necessary for effective management. Previous studies often used multiple or logistic regression analyses, which have limitations such as unmet assumptions and the inability to handle time-dependent variables. To address these issues, this study applied survival analysis to examine the factors affecting LOS using the National Health Insurance Service (NHIS) sample cohort data from 2016 to 2019, covering over 4 million records. We used Kaplan–Meier survival estimation to assess LOS probabilities based on sociodemographic, patient, health checkup, and institutional characteristics. Additionally, the Cox proportional hazards model controlled for confounding factors, providing more robust validation. Key findings include the influence of age, gender, type of insurance, and hospital type on LOS. For instance, older patients and medical aid recipients had longer LOS, while general hospitals showed shorter stays. This study is the first in Korea to use survival analysis with a large cohort database to identify LOS determinants. The results provide valuable insights for shaping healthcare policies aimed at optimizing inpatient care and managing hospital resources more efficiently. Full article

Background: Viral hepatitis B and C (HBV and HCV) pose significant public health concern in Nigeria, where access to healthcare and treatment affordability are limited. This study investigated sociodemographic and clinical predictors of health insurance coverage and access to care among patients with HBV and HCV in Nasarawa State, Nigeria. Methods: A cross-sectional facility-based study was conducted at two secondary hospitals in Nasarawa State, Nigeria. Participants included patients diagnosed with HBV, HCV, or both who were ≥18 years old. Data were collected using a structured questionnaire covering sociodemographic and clinical information, health insurance details, and economic impact. Binary logistic regression was used to analyze the relationship between sociodemographic/clinical factors and health insurance status. Results: Out of 303 participants, 68% had health insurance, which mostly covered hepatitis screening and vaccination. Significant predictors of health insurance coverage included being aged 36–40 years (adjusted odds ratio [aOR]: 11.01, 95% confidence interval [CI]: 2.38–50.89, p = 0.002), having post-secondary education (aOR: 25.2, 95% CI: 9.67–65.68, p < 0.001), being employed (aOR: 27.83, 95% CI: 8.85–87.58, p < 0.001), and being HIV-positive (aOR: 4.06, 95% CI: 1.55–10.61, p = 0.004). Nearly all those insured (99%) faced restrictions in insurance coverage for viral hepatitis services. Conclusions: This study reveals that while health insurance coverage is relatively high among viral hepatitis patients in Nasarawa State, significant restrictions hinder access to comprehensive services, especially for vulnerable groups like younger adults, the unemployed, and PLHIV. Key factors influencing coverage include age, education, employment, and HIV status. Expanding benefit packages to include viral hepatitis diagnosis and treatment, raising awareness about viral hepatitis as part of insurance strategy, improving access for underserved populations, and integrating hepatitis services into existing HIV programs with strong policy implementation monitoring frameworks are crucial to advancing universal health coverage and meeting the WHO’s 2030 elimination goals. Full article

Out-of-pocket expenditure (OOPE) directly reflects households’ financial burden for healthcare. Despite efforts to enhance accessibility and affordability through government initiatives and insurance schemes, OOPE remains problematic, especially in rural areas with inadequate public healthcare infrastructure. This study examines factors influencing OOPE in Karnataka’s Dakshina Kannada, Udupi, and Shimoga districts, investigating socioeconomic characteristics, healthcare infrastructure, and accessibility to inform policies for equitable healthcare access and reduced household financial strain. Using purposive sampling, 61 semi-structured interviews were conducted in rural and urban South Karnataka, recorded in Kannada after obtaining consent, and thematically analyzed. Results revealed mixed perceptions of healthcare quality, cost, and accessibility between government and private hospitals. Government facilities were lauded for improved infrastructure and affordability, while private hospitals were preferred for quality and personalized care despite higher costs. Health insurance significantly impacted OOPE reduction. Participants emphasized the need for increased awareness of government insurance programs and improved quality in public hospitals. The study concludes that private hospitals are favored for superior care despite expenses, while government hospitals are valued for affordability. Expanding insurance coverage and improving public awareness are crucial for enhancing healthcare accessibility and affordability. Full article

Background: Mental and behavioral disorders significantly impair psychophysical functioning, leading to challenges in daily activities. The increasing recognition of the importance of mental health in global development goals has resulted in its inclusion in the United Nations’ Sustainable Development Goals. The burden of mental disorders has grown worldwide due to demographic changes, with substantial economic and social impacts. Objective: This study aimed to examine the indirect costs of mental disorders in Poland by analyzing the expenditures by the Social Insurance Institution (ZUS) on work incapacity benefits and disability pensions from 2012 to 2023. The goal was to identify trends, dependencies, and the economic impact of policy changes. Material and Methods: Data were collected from ZUS reports on annual expenditures for work incapacity benefits and disability pensions. Advanced statistical methods, including linear regression and Pearson correlation, were employed to analyze trends and relationships. Student’s t-tests assessed the statistical significance of the observed trends. Results: The expenditures on benefits for work incapacity due to mental disorders increased significantly over the past decade, particularly from 2020 to 2023, partly due to the COVID-19 pandemic. Short-term absenteeism due to mental disorders accounted for 10.5% of the total sick leave days. A strong positive correlation was found between years and benefit expenditures. Conversely, the disability pension expenditures exhibited a downward trend, potentially reflecting improvements in public health or policy changes. Conclusions: The significant increase in expenditures on benefits related to mental disorders may reflect greater awareness, improved diagnostics, and the impact of the COVID-19 pandemic. In contrast, the decline in disability pension expenditures could suggest improved mental health or effective policy measures. However, it is important to emphasize that the presented data are not the only factor influencing this situation. Multiple variables, including societal, economic, and healthcare system changes, contribute to these trends. Therefore, further research is necessary to fully understand the underlying causes and to guide effective policy development. Regular monitoring and continued investment in mental health are essential to managing indirect costs such as absenteeism and presenteeism efficiently. Full article

We explored the outcomes and challenges encountered during a 12-year collaborative development endeavor in Tanzania, focused on enhancing the healthcare system. The Health Promotion and System Strengthening (HPSS) project, supported by the Swiss Government and implemented by the Swiss Tropical and Public Health Institute (Swiss TPH) from 2011 to 2023, aimed to strengthen various aspects of Tanzania’s healthcare landscape. This included reforms in health insurance through the improved Community Health Fund (iCHF), the establishment of a public–private partnership to optimize the health commodity supply chain via a Prime Vendor System (Jazia PVS), the implementation of health technology management innovations, and the facilitation of participatory community and school health promotion initiatives. Operating in a multisectoral, interdisciplinary, and systemic manner, the HPSS project employed a variety of interconnected strategies, focusing on key entry points within the Tanzanian health system, starting from district level to national policies. These efforts followed a three-stages approach to reach a sustainable adoption of the innovations, going through the process of service and product innovation, integration into service delivery systems, and finally their adoption in the respective institutional policies. Each stage presented distinct frameworks and challenges, detailed in this article. The development of innovative concepts was complemented by capacity building through on-the-job training, establishment of new accredited training programs for pre-service trainings, and the development of new IT systems integrated into the governmental IT environment, as well as efforts to improve transparency, accountability, and governance. Activities in these fields were guided by operational research, following the translational approach of Swiss TPH to go from innovation and validation to application. The example of the HPSS project highlights the cycle of developing and testing innovations at the community and district level, followed by endeavoring national-level integration and policy adjustments, consequently resulting in improved service delivery at the district and community level. Full article

Background: Breast reconstruction (BR) following mastectomy is a well-established beneficial medical intervention for patient physical and psychological well-being. Previous studies have emphasized BR as the gold standard of care for breast cancer patients requiring surgery. Multiple policies have improved BR access, but there remain social, economic, and geographical barriers to receiving reconstruction. Threats to equitable healthcare for all breast cancer patients in America persist despite growing awareness and efforts to negate these disparities. While race/ethnicity has been correlated with differences in BR rates and outcomes, ongoing research outlines a multitude of issues underlying this variance. Understanding the current and continuous barriers will help to address and overcome gaps in access. Methods: A systematic review assessing three reference databases (PubMed, Web of Science, and Ovid Medline) was carried out in accordance with PRISMA 2020 guidelines. A keyword search was conducted on 3 February 2024, specifying results between 2004 and 2024. Studies were included based on content, peer-reviewed status, and publication type. Two independent reviewers screened results based on title/abstract appropriateness and relevance. Data were extracted, cached in an online reference collection, and input into a cloud-based database for analysis. Results: In total, 1756 references were populated from all databases (PubMed = 829, Ovid Medline = 594, and Web of Science = 333), and 461 duplicate records were removed, along with 1147 results deemed ineligible by study criteria. Then, 45 international or non-English results were excluded. The screening sample consisted of 103 publications. After screening, the systematic review produced 70 studies with satisfactory relevance to our study focus. Conclusions: Federal mandates have improved access to women undergoing postmastectomy BR, particularly for younger, White, privately insured, urban-located patients. Recently published studies had a stronger focus on disparities, particularly among races, and show continued disadvantages for minorities, lower-income, rural-community, and public insurance payers. The research remains limited beyond commonly reported metrics of disparity and lacks examination of additional contributing factors. Future investigations should elucidate the effect of these factors and propose measures to eliminate barriers to access to BR for all patients. Full article

β-thalassemia, a life-threatening inheritable hemoglobin disorder caused by mutations in the HBB gene, poses a significant public health challenge in the world. Although no comprehensive work has been carried out in Bangladesh, the world prevalence and small-scale works indicated the possibility of a high prevalence of this disease in the country. Therefore, this review aims to explore the present situation of β-thalassemia in Bangladesh and propose approaches to mitigate its impact in the future. Limited awareness, a high incidence of consanguineous marriage, and inadequate access to healthcare are possible factors responsible for the high prevalence of thalassemia in Bangladesh, while the absence of public health policy and a national health insurance system further exacerbate the situation. The understanding of the genetic landscape and modern treatment strategies for β-thalassemia is hindered by the lack of comprehensive data on the mutation spectrum. In addition to conventional therapy such as blood transfusion, advanced practices such as splenectomy, hematopoietic stem cell transplantation, and emerging therapies such as gene therapy show promise for future cures but have yet to be widely implemented in this country. To effectively address the challenges of β-thalassemia, it is crucial to adopt comprehensive strategies, including a public awareness campaign, public health intervention, mandatory premarital screening, genetic counselling, and a national thalassemia prevention program. Additionally, understanding the spectrum of mutations and new therapeutic interventions is crucial for advanced healthcare strategies. Full article

Government efforts and reforms in health financing systems in various countries are aimed at achieving universal health coverage. Household spending on healthcare plays a very important role in achieving this goal. The aim of this systematic review was to assess out-of-pocket health expenditure inequalities measured by the FIA across different territories, in the context of achieving UHC by 2030. A comprehensive systematic search was conducted in the PubMed, Scopus, and Web of Science databases to identify original quantitative and mixed-method studies published in the English language between 2016 and 2022. A total of 336 articles were initially identified, and after the screening process, 15 articles were included in the systematic review, following the removal of duplicates and articles not meeting the inclusion criteria. Despite the overall regressivity, insurance systems have generally improved population coverage and reduced inequality in out-of-pocket health expenditures among the employed population, but regional studies highlight the importance of examining the situation at a micro level. The results of the study provide further evidence supporting the notion that healthcare financing systems relying less on public funding and direct tax financing and more on private payments are associated with a higher prevalence of catastrophic health expenditures and demonstrate a more regressive pattern in terms of healthcare financing, highlighting the need for policy interventions to address these inequities. Governments face significant challenges in achieving universal health coverage due to inequalities experienced by financially vulnerable populations, including high out-of-pocket payments for pharmaceutical goods, informal charges, and regional disparities in healthcare financing administration. Full article

Background: Additive manufacturing (AM) for patient-specific medical care products offers great opportunities. However, evidence about the supply chain (SC) performance impact based on empirical data is limited. Methods: In this case study, we gathered real-life data about a traditional manufacturing orthopedic shoe SC and developed future scenarios in which AM is introduced at various points and with different degrees of penetration in the SC. Results: Presently, AM can only replace traditional manufacturing of tools and shoe components at a higher total cost. However, with maturing technology, the complete AM production of orthopedic shoes is expected to become feasible. Theoretically, that could disrupt existing SCs, eliminating 70% of the SC steps, improving SC lead time by 90%, and altering SC relations. However, certain thresholds currently prevent disruption. Specifically, the AM of complete orthopedic shoes has to become possible, manufacturing prices have to drop, and traditional craftsmanship has to be integrated into the digital product design. Conclusions: A framework for transition pathways, including directions for future research, is formed. Findings provide valuable insights for scholars and decision makers in the patient-specific products industry, health insurance providers, and healthcare policy makers to be better prepared by adjusting SC designs, relationships, and remuneration programs while AM technology develops towards maturity. Full article

Pediatric multiple sclerosis (MS) and neuromyelitis optica (NMO) are rare acquired demyelinating syndrome with limited epidemiological data available, particularly in non-Western setting. This study aimed to demonstrate the epidemiology of pediatric MS and NMO in South Korea and to analyze of healthcare utilization and economic burden associated with these conditions. Using a nationwide population-based database from the Korean Health Insurance Review and Assessment Service database, we identified pediatric cases (age < 20 years) of MS and NMO from 2016 to 2020. We analyzed incidence, prevalence, healthcare utilization and medical costs. The study found low age-standardized incidence and prevalence rates for pediatric MS and NMO in South Korea. There was a marked disparity in healthcare utilization between urban and rural areas. Most healthcare interactions occurred in tertiary hospitals in urban settings, particularly in Seoul. The study also highlighted the substantial economic burden associated with the management of rare diseases, with annual variability in medical costs. Pediatric MS and NMO are extremely rare in South Korea, with significant regional disparity in healthcare utilization. The findings emphasize the need for targeted healthcare policies to improve access and reduce disparities, particularly for chronic and rare diseases requiring specialized care. Full article

The introduction of high-cost medications often poses challenges in achieving cost-effectiveness for drug insurance coverage. Incorporating future price reductions for these medications may enhance their cost-effectiveness. We examined the influence of future cost reductions mandated by the national insurer’s equal pricing for equivalent drugs (EPED) policy on the cost-effectiveness of dupilumab, a biologic drug for moderate to severe atopic dermatitis in the Korean healthcare system. We conducted a policy simulation study using semi-Markovian cost utility analysis of dupilumab in combination with supportive care (SC) versus SC alone, with and without the EPED policy adjustment. The EPED would lower dupilumab’s price to 70% following the entry of a biosimilar drug in 10.3 years. Scenario analyses quantified the impact of changing time to the EPED, chemical versus biological designation, response criteria, discount rates, and time horizons on the Incremental Cost-Effectiveness Ratio (ICER) and acceptability with and without EPED adjustment. The EPED adjustment of dupilumab’s future price significantly improved its cost-effectiveness, with a 9.7% decrease in ICER and a substantial 14.6% increase in acceptability. Assuming EPED in 5 years, the ICER fell below the predefined willingness-to-pay threshold. If dupilumab were a chemical drug, EPED adjustment demonstrated a 19.1% increase in acceptability. Incorporating future cost reductions via the EPED system in economic evaluations is crucial, especially for drugs facing imminent generic entry. This study underscores the importance of EPED adjustment in the cost-effectiveness analysis of innovative medications, especially for those nearing willingness-to-pay thresholds. Full article