4 research outputs found
Crowdfunding our health: economic risks and benefits
Get PDFCrowdfunding is an expanding form of alternative financing that is gaining traction in the health sector. This article presents a typology for crowdfunded health projects and a review of the main economic benefits and risks of crowdfunding in the health market. We use evidence from a literature review, complimented by expert interviews, to extend the fundamental principles and established theories of crowdfunding to a health market context. Crowdfunded health projects can be classified into four types according to the venture's purpose and funding method. These are projects covering health expenses, fundraising health initiatives, supporting health research, or financing commercial health innovation. Crowdfunding could economically benefit the health sector by expanding market participation, drawing money and awareness to neglected health issues, improving access to funding, and fostering project accountability and social engagement. However, the economic risks of health-related crowdfunding include inefficient priority setting, heightened financial risk, inconsistent regulatory policies, intellectual property rights concerns, and fraud. Theorized crowdfunding behaviours such as signalling and herding can be observed in the market for health-related crowdfunding. Broader threats of market failure stemming from adverse selection and moral hazard also apply. Many of the discussed economic benefits and risks of crowdfunding health campaigns are shared more broadly with those of crowdfunding projects in other sectors. Where crowdfunding health care appears to diverge from theory is the negative externality inefficient priority setting may have towards achieving broader public health goals. Therefore, the market for crowdfunding health care must be economically stable, as well as designed to optimally and equitably improve public health
Patient outcomes following discharge from secure hospitals
No full textBackground: Despite limited evidence for service benefit, the demand for forensic psychiatric beds is growing. Some studies have reported rates of serious adverse outcomes post-discharge, however, the role of psychiatric diagnosis as a determinant of these outcomes needs to be clarified to ensure patients are managed in the most appropriate way. Aims: The first aim of this thesis is to summarize evidence on key adverse outcomes, and to provide comparative information for public health and policy. The second aim of this thesis is to elucidate the role of diagnosis and comorbidity in the risk of some adverse outcomes. Methods: The first study is a systematic review and a meta-analysis of investigations that followed patients discharged from secure hospitals, and reported data on key adverse outcomes after discharge. The second is a historical cohort study of forensic patients discharged from Swedish secure hospitals between 1972 and 2009, which examines the role of psychiatric diagnosis in risk of some adverse outcomes. Results: Thirty-six studies from 10 countries were included. Mortality rates were lower in studies from England and Wales (crude rate=1,239, 95&percnt; CI 932-1,547) compared to other countries (2,331; 1,738-2,925). Readmission rates were higher in samples with a bigger proportion of patients with a diagnosis of mental illness (β=105.57, [se(β)]=54.90, p=0.070) as opposed to personality disorder (β=-181.45, [se(β)]=90.59, p=0.070). Reoffending rates were lower in more recent studies (β=-101.15, [se(β)]=43.34, p=0.026). Compared with different cohorts of discharged prisoners matched on gender, age, and type of offence, reoffending rates were lower for the forensic psychiatric samples (UK prevalence ratios 1.4-7.7 in UK studies) In the Swedish study, substance use was associated with increased risk of death (HR=1.783, 95&percnt; CI=1.556-2.044, p&LT;.000) and violent offending (HR=1.980, 95&percnt; CI=1.740-2.254, p&LT;.000). Schizophrenia increased the risk of readmission. Bipolar disorder (HR=1.461, 95&percnt; CI=1.196-1.785, p&LT;.000 and personality disorder (HR=1.496, 95&percnt; CI=1.345-1.663, p&LT;.000) were associated with increased risk of violent offending. Conclusions: Treatment and post-discharge support strategies should take into account primary and comorbid diagnosis. Services should provide better overall care to improve patients' general health aiming to reduce premature mortality. Better health could also improve social functioning of these patients reducing readmissions and post-discharge offending in the long-term.</p
Patient outcomes following discharge from secure hospitals
No full textBackground: Despite limited evidence for service benefit, the demand for forensic psychiatric beds is growing. Some studies have reported rates of serious adverse outcomes post-discharge, however, the role of psychiatric diagnosis as a determinant of these outcomes needs to be clarified to ensure patients are managed in the most appropriate way.
Aims: The first aim of this thesis is to summarize evidence on key adverse outcomes, and to provide comparative information for public health and policy. The second aim of this thesis is to elucidate the role of diagnosis and comorbidity in the risk of some adverse outcomes.
Methods: The first study is a systematic review and a meta-analysis of investigations that followed patients discharged from secure hospitals, and reported data on key adverse outcomes after discharge. The second is a historical cohort study of forensic patients discharged from Swedish secure hospitals between 1972 and 2009, which examines the role of psychiatric diagnosis in risk of some adverse outcomes.
Results: Thirty-six studies from 10 countries were included. Mortality rates were lower in studies from England and Wales (crude rate=1,239, 95% CI 932-1,547) compared to other countries (2,331; 1,738-2,925). Readmission rates were higher in samples with a bigger proportion of patients with a diagnosis of mental illness (β=105.57, [se(β)]=54.90, p=0.070) as opposed to personality disorder (β=-181.45, [se(β)]=90.59, p=0.070). Reoffending rates were lower in more recent studies (β=-101.15, [se(β)]=43.34, p=0.026). Compared with different cohorts of discharged prisoners matched on gender, age, and type of offence, reoffending rates were lower for the forensic psychiatric samples (UK prevalence ratios 1.4-7.7 in UK studies)
In the Swedish study, substance use was associated with increased risk of death (HR=1.783, 95% CI=1.556-2.044, p<.000) and violent offending (HR=1.980, 95% CI=1.740-2.254, p<.000). Schizophrenia increased the risk of readmission. Bipolar disorder (HR=1.461, 95% CI=1.196-1.785, p<.000 and personality disorder (HR=1.496, 95% CI=1.345-1.663, p<.000) were associated with increased risk of violent offending.
Conclusions: Treatment and post-discharge support strategies should take into account primary and comorbid diagnosis. Services should provide better overall care to improve patients' general health aiming to reduce premature mortality. Better health could also improve social functioning of these patients reducing readmissions and post-discharge offending in the long-term.</p
