Can We Get Better for Less: Value for Money in Canadian Health Care

Over the past decade, Canadian health care expenditures have grown at a rate significantly higher than that of the growth in the economy and the growth in combined federal-provincial tax revenues. However, allocating an increasing amount of resources to health care does not necessarily lead to better health care, and despite significant investment, Canadians do not seem to receive sufficient value from the health care system. This paper aims to analyze the prospective rationale for emphasizing the concept of value-for-money in the largest segment of the Canadian health care system – hospitals. The results of the analysis show that a lack of activity-based or patient-based funding historically may have limited hospitals’ ability to assess their own effectiveness and efficiency. A focus on outcome measures alone may not be sufficient to assess and evaluate management for the stewardship of resources allocated to them. Outcome measures may not reflect how much value-for-money results from health care spending, while introducing incentives for improving quality of health care is not sufficient to improve efficiency of health care delivery.health care, hospitals, value-for-money measurement

Risk Factors Associated with Childhood Vaccination Coverage in Afghanistan

Globally, vaccination is among the most successful and cost-effective public health practices in the prevention of infectious diseases. The purpose of this study was to examine the child, parental, and geographical risk factors that influence childhood vaccination coverage in Afghanistan. The health belief model and socio-ecological model was used in this study as the theoretical framework to examine the effects of these risk factors on vaccination coverage among children in Afghanistan. Univariate, bivariate, and multivariate tests were conducted within the secondary data analysis of the 2015 Afghanistan national Demographic and Health Survey dataset. Of the 32,420 children aged 0 to 5 years, for all vaccines (BCG, DPT, measles, and polio), only 14.2% had complete vaccination, 65% had partial, and 20.8% had no vaccination. Vaccination coverage was significantly related to the region, age of child, and wealth index of parents (p \u3c 0.001). Similarly, birth order and ethnicity of child; and age, educational level, and occupation of parents were also significantly related to vaccination coverage (p \u3c 0.001). The child’s gender was not significantly related to vaccination coverage (p \u3c 0.597). Region, age of child, and wealth index of parents were significantly associated with complete vaccination coverage for all vaccines examined at 95% confidence interval in multivariate analysis. Positive social change implications of this study include the evidence found on the identification of the specific risk factors that could be barriers to complete vaccination coverage and other relevant information for stakeholders to achieve sustainable success in complete vaccination coverage in Afghanistan

Impact of Ramadan fasting on thyroid status and quality of life in patients with primary hypothyroidism: A prospective cohort study from Karachi, Pakistan

Objective: Ramadan is the ninth month in the lunar calendar, during which Muslims fast from predawn to sunset and major changes occur in their dietary, sleep, and physical activity patterns. Most patients with hypothyroidism are unable to comply with the proper timings of levothyroxine (LT4) administration. The objective of the study was to determine the change in thyroid-stimulating hormone (TSH) level and quality of life (QOL) before and after Ramadan in patients with primary hypothyroidism.Methods: This prospective cohort study included adult patients on stable doses of LT4 who fasted for at least 20 days during the month of Ramadan in the Islamic year 1437 Hijri (June/July 2016). Baseline characteristics and TSH levels were recorded on all consenting patients within 6 weeks prior to Ramadan. Post-Ramadan TSH was tested within 1 to 2 weeks after Eid-ul-Fitr.Results: During the study period, 64 patients with hypothyroidism were enrolled, of which 58 were female. The mean age of participants was 44.2 ± 13.2 years. Average daily dose of LT4 was 95.3 ± 35.4 μg. On average, patients fasted for 26.5 days and missed a dose of LT4 on 1.27 days. Mean TSH pre-Ramadan was 2.37 ± 1.35 mIU/L, and post-Ramadan, it was 4.69 ± 3.87 mIU/L. Mean difference between TSH pre- and post-Ramadan was 2.32 ± 3.80 mIU/L ( P\u3c.001). However, the difference in TSH was not significantly different between those who were compliant with meals and LT4 interval versus those who were not (compliant, 2.04 mIU/L; noncompliant, 3.15 mIU/L; P = .30). Overall, an increase in QOL scores in the domains of physical health, psychological health, and social relationships was observed after Ramadan.Conclusion: We observed statistically significant changes in TSH concentrations after the month of Ramadan in hypothyroid patients who fasted. The change in TSH was not affected by timing of LT4 intake and interval from meal