A moneymaking scan: Dual reimbursement systems and supplier‐induced demand for diagnostic imaging

In complex health systems with growing healthcare spending, combining reimbursement systems that incentivize cost-efficient healthcare provision within and across care sectors is key. This study investigates whether dual reimbursement systems lead hospitals to offset financial pressures in one care sector by inducing demand in another. We find that hospital imaging units induced demand for costly and unnecessary ambulatory imaging examinations reimbursed under fee-for-service, following a reform that introduced prospective payment and increased competition in the inpatient sector in Switzerland in 2012. Market structure, competitive pressures, and price regulations also influence demand inducement by varying the response to the reform. Reimbursement systems can influence supplier-induced demand in other care sectors within hospitals where revenue is tied to the intensity of care provision. In particular, the possibility to self-refer patients to high-margin diagnostic examinations bears negative consequences on healthcare expenditures and potentially patient health

Information-Analytical Systems for Assessing the Rehabilitation of the Patients with Endocrine Diseases

Assessing the body’s reserves (rehabilitation potential) to predict the risk of developing diseases or their outcomes (rehabilitation prognosis) is very important. This provides an opportunity for an individual approach to the patient. The proposed method for assessing the basic component of the rehabilitation potential - the morpho-functional index (MFI), developed using computer modeling methods, allows you to obtain accurate (quantitative) and objective information about the state of the human body at the starting point of the examination and to monitor the course of the process in dynamics. The effectiveness of the use of the MFI indicator is confirmed by examples of its use in clinical practice. © 2020, The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG

Mathematical Model for Assessing a Single Autonomic Nervous System Index in Express Diagnostics of Thyroid Function

The article presents a method of mathematical computer analysis of the state of the main regulatory system of the body - the autonomic nervous system in patients with thyroid diseases. A formula has been proposed that allows one to calculate the severity of impairments in the regulatory system and the degree of stress (depletion) of adaptive mechanisms - a single vegetative index (SVI). Using the method of computer modeling, the boundary values of this indicator were determined and the effectiveness of its use was tested on a group of patients (26 people) diagnosed with thyroid diseases. The results obtained confirmed the effectiveness of using the method, both for assessing the current state of the body, and for determining the safety of the functional reserves of the body and predicting the course of the disease. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG

The structure of hereditary diseases in children hospitalized in a specialized clinic

Purpose: to analyze the structure of hereditary pathology and the results of genetic studies in children in a specialized clinic.Results.1045 children from 79 regions of the Russian Federation were examined and treated in the pediatric department of congenital and hereditary diseases in 2018. There were 25% of patients from Moscow and Moscow region and 75% from other territories. After examination all patients were divided into 2 large cohorts: patients with hereditary diseases diagnosed by clinical and laboratory data (737 children; 70%) and patients with undifferentiated pathological conditions with unclear genesis at the time of discharge from the hospital (308 children; 30%). In the cohort of hereditary diseases there were the most numerous (about 100 children in each) groups of patients with Ehlers–Danlos syndrome, imperfect osteogenesis and rare heterogeneous genetic syndromes. The groups of rickets- like diseases, chromosomal syndromes and Rett syndrome included 50-70 patients. Other groups were smaller. Half of the hospitalized patients required genetic analysis. The highest percentage of molecular genetically / cytogenetically confirmed diagnoses was found in the groups of chromosomal diseases, rare genetic syndromes of lysosomal and mitochondrial diseases, Rett syndrome, and aminoacidopathy. It is worth mentioning that a primary diagnosis was not established during a genetic study in 57 children (18%) children from the general cohort of patients with hereditary diseases, so the researchers used other methods of analysis or bioinformatic revision of the results.Conclusion: The authors found a large variety of genetic diseases in children requiring examination and treatment in a specialized hospital. 1/5 of the examined children require additional genetic testing or repeated bioinformatic interpretation of the data

IXa glycogenosis – diagnosis, features of clinical manifestations and treatment

IXa glycogenosis is the most common of the currently known 15 types of glycogenosis. The disease has X-linked recessive inheritance, is caused by mutations in  the PHKA2 gene localized on the short arm of X chromosome in  the Хр22.13 region. The main manifestations of the disease: stunted growth, increased liver size, episodes of hypoglycemia, fasting ketosis, increased blood levels of cholesterol, low-density lipoproteins, triglycerides, liver transaminases. In many cases, the course of the disease can be relatively mild, which complicates early diagnosis and the timely administration of therapy. Clinical observations of two children from unrelated families with the same homozygous c.884G> A mutation (р.Arg295His, or R295H) in the PHKA2 gene are presented. The similarities and differences in clinical symptoms are emphasized, and the features of patient management are presented