Efficiency in the hospital sector: A study of elective surgery in Spain.

This thesis provides a comprehensive assessment of the reasons for the differences in hospital utilisation. The research starts with a quantitative analysis of the reasons for the differences in the length of stay and inpatient costs for elective surgery. Both these topics are central to efficiency and value for money in the hospital sector. Subsequently, a qualitative component is introduced involving a questionnaire answered by surgeons. A comprehensive statistical model is developed by using 1991 data from a number of hospitals in Spain. The model includes a large set of control variables: health status indicators, hospitalization-related variables, hospital and doctors characteristics and regional supply. Using a large data set, the analysis confirms many hypotheses concerning the reasons for the variations in the length of stay and inpatient costs. Longer stays were estimated for a) patients with more severe Diagnoses Related Groups; b) comorbidity or multiple diagnoses; c) complications after the operation; d) patients over 65 year old; e) admitted through the emergency room or referred by the Internal Medicine Department; f) admitted to hospital on a Friday or a Saturday and discharged on a Monday; g) living in an area with a relative large supply of surgeons, beds per specialty and resident surgeons. In contrast, patients who were admitted to a hospital with a high turnover rate, a high percentage of operations and a high number of total hospital beds experience shorter lengths of stay. Higher costs were estimated for patients with a) longer lengths of stay; b) longer operating theatre minutes; c) admitted through the emergency room; d) and in areas with a high number of surgeons. In contrast, hospitals with a high number of beds per specialty and a high number of total hospital beds experience lower hospital costs

Health related quality of life of Canary Island citizens

<p>Abstract</p> <p>Background</p> <p>The aim of the study was to describe the health-related quality of life of Canarian population using information from the Canary Island Health Survey and three observational studies developed in the Canary Islands.</p> <p>Methods</p> <p>A descriptive analysis was carried out on a sample of 5.549 Canarian citizens using information from 2004 Canary Island Health Survey and three observational studies on Alzheimer's disease, Stroke and HIV. EQ-5 D was the generic tool used for revealing quality of life of people surveyed. Besides the rate of people reporting moderate or severe decrease in quality of life, TTO-index scores and visual analogue scale were used for assessing health related quality of life of people that suffer a specific diseases and general population.</p> <p>Results</p> <p>Self-perceived health status of citizens that suffer chronic diseases of high prevalence, identifies by the Canary Island Health Survey and other diseases such Alzheimer's disease, Stroke and HIV, independently examined in observational studies, are worse than self-perceived health of general population. Depression/anxiety and pain/discomfort were identified as the dimensions of the EQ-5 D with highest prevalence of problems. Alzheimer's disease and stroke were the illnesses with greater loss of quality of life.</p> <p>Conclusions</p> <p>Health related quality of life should be integrated into a set of information along with expectancy of life, incidence and prevalence of chronic diseases for developing health policy and planning health care activities The combination of information on health related quality of life from population health surveys with data from observational studies enlarges the sources of relevant information for setting health priorities and assessing the impact of health policies.</p

Indirect costs of cervical and breast cancers in Spain

This study estimated the indirect costs (productivity loss) caused by mortality and morbidity of cervical and breast cancers in Spain. We used two alternative methods: (a) the traditional human capital (HC) approach and (b) the friction cost (FC) method. The annual costs were €43.4 and 288.7 for cervical and breast cancer, respectively, by the HC approach and €1.1 and 11.6 mil lion by the FC approach. Cost-of-ill ness studies help to illustrate the real dimension of health problems and should be a major concern for health policies. Indirect costs are relevant information about diseases. However, the estimated indirect costs depend heavily on the approach adopted.© Springer Medizin Verlag 2005Publicad

Social economic costs of type 1 diabetes mellitus in pediatric patients in Spain: CHRYSTAL observational study

AIMS: To estimate the social-economic costs of Type 1 Diabetes Mellitus (T1DM) in patients aged 0-17 years in Spain from a social perspective. METHODS: We conducted a cross-sectional observational study in 2014 of 275 T1DM pediatric outpatients distributed across 12 public health centers in Spain. Data on demographic and clinical characteristics, healthcare utilization and informal care were collected from medical records and questionnaires completed by clinicians and patients' caregivers. RESULTS: A valid sample of 249 individuals was analyzed. The average annual cost for a T1DM patient was €27,274. Direct healthcare costs were €4070 and direct non-healthcare cost were €23,204. Informal (familial) care represented 83% of total cost, followed by medical material (8%), outpatient and primary care visits (3.1%) and insulin (2.1%). Direct healthcare cost per patient statistically differed by glycated haemoglobin (HbA1c) level [mean cost €4704 in HbA1c ?7.5% (?58mmol/mol) group vs. €3616 in HbA1c<7.5% (<58mmol/mol) group)]; and by the presence or absence of complications and comorbidities (mean cost €5713 in group with complications or comorbidities vs. €3636 in group without complications or comorbidities). CONCLUSIONS: T1DM amongst pediatric patients incurs in considerable societal costs. Informal care represents the largest cost category

Economic burden and health‑related quality of life in tenosynovial giant‑cell tumour patients in Europe: an observational disease registry

Background: Tenosynovial Giant-Cell Tumour (TGCT) is a benign clonal neoplastic proliferation arising from the syn‑ ovium, causing a variety of symptoms and often requiring repetitive surgery. This study aims to defne the economic burden—from a societal perspective—associated with TGCT patients and their health-related quality of life (HRQOL) in six European countries. Methods: This article analyses data from a multinational, multicentre, prospective observational registry, the TGCT Observational Platform Project (TOPP), involving hospitals and tertiary sarcoma centres from six European countries (Austria, France, Germany, Italy, the Netherlands, and Spain). It includes information on TGCT patients’ health-related quality of life and healthcare and non-healthcare resources used at baseline (the 12-month period prior to the patients entering the registry) and after 12 months of follow-up. Results: 146 TGCT patients enrolled for the study, of which 137 fulflled the inclusion criteria. Their mean age was 44.5 years, and 62% were female. The annual average total costs associated with TGCT were €4866 at baseline and €5160 at the 12-month follow-up visit. The annual average healthcare costs associated with TGCT were €4620 at baseline, of which 67% and 18% corresponded to surgery and medical visits, respectively. At the 12-month follow up, the mean healthcare costs amounted to €5094, with surgery representing 70% of total costs. Loss of productivity represented, on average, 5% of the total cost at baseline and 1.3% at follow-up. The most-afected HRQOL dimensions, measured with the EQ-5D-5L instrument, were pain or discomfort, mobility, and the performance of usual activities, both at baseline and at the follow-up visit. Regarding HRQOL, patients declared a mean index score of 0.75 at baseline and 0.76 at the 12-month follow-up. Conclusion: The results suggest that TGCT places a heavy burden on its suferers, which increases after one year of follow-up, mainly due to the healthcare resources required—in particular, surgical procedures. As a result, this condi‑ tion has a high economic impact on healthcare budgets, while the HRQOL of TGCT patients substantially deteriorates over time

Pharmaceutical regulation in 15 European countries: review

In the context of pharmaceutical care, policy-makers repeatedly face the challenge of balancing patient access to effective medicines with affordability and rising costs. With the aim of guiding the health policy discourse towards questions that are important to actual and potential patients, this study investigates a broad range of regulatory measures, spanning marketing authorization to generic substitution and resulting price levels in a sample of 16 European health systems (Austria, Belgium, Denmark, England, Finland, France, Germany, Greece, Ireland, Italy, the Netherlands, Poland, Portugal, Scotland, Spain and Sweden). All countries employ a mix of regulatory mechanisms to contain pharmaceutical expenditure and ensure quality and efficiency in pharmaceutical care, albeit with varying configurations and rigour. This variation also influences the extent of publicly financed pharmaceutical costs. Overall, observed differences in pharmaceutical expenditure should be interpreted in conjunction with the differing volume and composition of consumption and price levels, as well as dispensation practices and their impact on measurement of pharmaceutical costs. No definitive evidence has yet been produced on the effects of different cost-containment measures on patient outcomes. Depending on the foremost policy concerns in each country, different levers will have to be used to enable the delivery of appropriate care at affordable prices