88 research outputs found
The Measurement of Health Care System Efficiency: Cross-country Comparison by Geographical Region
Performance of health care delivery at the cross-country level has not
often been directly evaluated by given inputs and outputs. This study estimates
the efficiency of the health care systems of 170 countries by extending recent
research using Simar and Wilsons bootstrap data envelopment analysis with a
sensitivity test. The 170 countries are divided into four groups to compute efficiency
estimators necessary to attaining a homogeneity requirement. The major finding
is that most countries were inefficient to maximize the use of their inputs at the
given output level. Countries in the high-income group have a relatively high
average efficiency, but only 16.7% of the countries performed efficiently in the
management of their health care systems. Notably, Asian countries performed
more efficiently among other regions in each group. This study suggests that
inefficient countries should pay attention to benchmark health care best practices
within their regional peer groups.This work was supported by the National Research Foundation of Korea Grant funded by
the Korean government (NRF-2012S1A3A2033416)
A four-country survey of public attitudes towards restricting healthcare costs by limiting the use of high-cost medical interventions
Objective: To discern how the public in four countries, each with unique health systems and cultures, feels about efforts to restrain healthcare costs by limiting the use of high-cost prescription drugs and medical/surgical treatments. Design: Cross-sectional survey. Setting: Adult populations in Germany, Italy, the UK and the USA. Participants: 2517 adults in the four countries. A questionnaire survey conducted by telephone (landline and cell) with randomly selected adults in each of the four countries. Main outcome measures: Support for different rationales for not providing/paying for high-cost prescription drugs/medical or surgical treatments, measured in the aggregate and using four case examples derived from actual decisions. Measures of public attitudes about specific policies involving comparative effectiveness and cost-benefit decision making. Results: The survey finds support among publics in four countries for decisions that limit the use of high-cost prescription drugs/treatments when some other drug/treatment is available that works equally well but costs less. The survey finds little public support, either in individual case examples or when asked in the aggregate, for decisions in which prescription drugs/treatments are denied on the basis of cost or various definitions of benefits. The main results are based on majorities of the public in each country supporting or opposing each measure. Conclusions: The survey findings indicate that the public distinguishes in practice between the concepts of comparative effectiveness and cost-effectiveness analysis. This suggests that public authorities engaged in decision-making activities will find much more public support if they are dealing with the first type of decision than with the second
Effect of regional medical disparities on complications in patients with hypertension: Cox’s proportional hazard models
ObjectiveComplications associated with hypertension can be alleviated by providing necessary medical services. However, there may be disparities in their provision depending on regional differences. Thus, this study aimed to examine the effects of regional healthcare disparities on complications in patients with hypertension in South Korea.MethodsData from the National Health Insurance Service National Sample Cohort (2004–2019) were analyzed. The position value for the relative composite index was used to identify medically vulnerable regions. The diagnosis of hypertension within the region was also considered. The risk of complications associated with hypertension included cardiovascular, cerebrovascular, and kidney diseases. Cox proportional hazards models were used for statistical analysis.ResultsA total of 246,490 patients were included in this study. Patients who lived in medically vulnerable regions and were diagnosed outside their residential area had a higher risk of complications than those living in non-vulnerable regions and were diagnosed outside the residential area (hazard ratio: 1.156, 95% confidence interval: 1.119–1.195).ConclusionPatients living in medically vulnerable regions who were diagnosed outside their residential areas were more likely to have hypertension complications regardless of the type of complication. Necessary policies should be implemented to reduce regional healthcare disparities
Unique health identifiers for universal health coverage
Identifying everyone residing in a country, especially the poor, is an
indispensable part of pursuing universal health coverage (UHC). Having
information on an individuals\u2019 financial protection is also
imperative for measuring the progress of UHC. This paper examines
different ways of instituting a system of unique health identifiers
that can lead toward achieving UHC, particularly in relation to
utilizing universal civil registration and national unique
identification number systems. Civil registration is a fundamental
function of the government that establishes a legal identity for
individuals and enables them to access essential public services.
National unique identification numbers assigned at birth registration
can further link their vital event information with data collected in
different sectors, including in finance and health. Some countries use
the national unique identification number as the unique health
identifier, such as is done in South Korea and Thailand. In other
countries, a unique health identifier is created in addition to the
national unique identification number, but the two numbers are linked;
Slovenia offers an example of this arrangement. The advantages and
disadvantages of the system types are discussed in the paper. In either
approach, linking the health system with the civil registration and
national identity management systems contributed to advancing effective
and efficient UHC programs in those countries
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Adoption of preventive behaviors in response to the 2009 H1N1 influenza pandemic: a multiethnic perspective
Background: As public health leaders prepare for possible future influenza pandemics, the rapid spread of 2009 H1N1 influenza highlights the need to focus on measures the public can adopt to help slow disease transmission. Such measures may relate to hygiene (e.g., hand washing), social distancing (e.g., avoiding places where many people gather), and pharmaceutical interventions (e.g., vaccination). Given the disproportionate impact of public health emergencies on minority communities in the United States, it is important to understand whether there are differences in acceptance across racial/ethnic groups that could lead to targeted and more effective policies and communications. Objectives: This study explores racial/ethnic differences in the adoption of preventive behaviors during the 2009 H1N1 influenza pandemic. Patients/Methods Data are from a national telephone poll conducted March 17 to April 11, 2010, among a representative sample of 1123 white, 330 African American, 317 Hispanic, 268 Asian, and 262 American Indian/Alaska Native adults in the USA. Results: People in at least one racial/ethnic minority group were more likely than whites to adopt several behaviors related to hygiene, social distancing, and healthcare access, including increased hand washing and talking with a healthcare provider (P-values <0·05). Exceptions included avoiding others with influenza-like illnesses and receiving 2009 H1N1 and seasonal influenza vaccinations. After we controlled the data for socioeconomic status, demographic factors, healthcare access, and illness- and vaccine-related attitudes, nearly all racial/ethnic differences in behaviors persisted. Conclusions: Minority groups appear to be receptive to several preventive behaviors, but barriers to vaccination are more pervasive
Brain ageing in schizophrenia: evidence from 26 international cohorts via the ENIGMA Schizophrenia consortium
Schizophrenia (SZ) is associated with an increased risk of life-long cognitive impairments, age-related chronic disease, and premature mortality. We investigated evidence for advanced brain ageing in adult SZ patients, and whether this was associated with clinical characteristics in a prospective meta-analytic study conducted by the ENIGMA Schizophrenia Working Group. The study included data from 26 cohorts worldwide, with a total of 2803 SZ patients (mean age 34.2 years; range 18-72 years; 67% male) and 2598 healthy controls (mean age 33.8 years, range 18-73 years, 55% male). Brain-predicted age was individually estimated using a model trained on independent data based on 68 measures of cortical thickness and surface area, 7 subcortical volumes, lateral ventricular volumes and total intracranial volume, all derived from T1-weighted brain magnetic resonance imaging (MRI) scans. Deviations from a healthy brain ageing trajectory were assessed by the difference between brain-predicted age and chronological age (brain-predicted age difference [brain-PAD]). On average, SZ patients showed a higher brain-PAD of +3.55 years (95% CI: 2.91, 4.19; I2 = 57.53%) compared to controls, after adjusting for age, sex and site (Cohen's d = 0.48). Among SZ patients, brain-PAD was not associated with specific clinical characteristics (age of onset, duration of illness, symptom severity, or antipsychotic use and dose). This large-scale collaborative study suggests advanced structural brain ageing in SZ. Longitudinal studies of SZ and a range of mental and somatic health outcomes will help to further evaluate the clinical implications of increased brain-PAD and its ability to be influenced by interventions
The thalamus and its subnuclei—a gateway to obsessive-compulsive disorder
Larger thalamic volume has been found in children with obsessive-compulsive disorder (OCD) and children with clinical-level symptoms within the general population. Particular thalamic subregions may drive these differences. The ENIGMA-OCD working group conducted mega- and meta-analyses to study thalamic subregional volume in OCD across the lifespan. Structural T-1-weighted brain magnetic resonance imaging (MRI) scans from 2649 OCD patients and 2774 healthy controls across 29 sites (50 datasets) were processed using the FreeSurfer built-in ThalamicNuclei pipeline to extract five thalamic subregions. Volume measures were harmonized for site effects using ComBat before running separate multiple linear regression models for children, adolescents, and adults to estimate volumetric group differences. All analyses were pre-registered (https://osf.io/73dvy) and adjusted for age, sex and intracranial volume. Unmedicated pediatric OCD patients (<12 years) had larger lateral (d = 0.46), pulvinar (d = 0.33), ventral (d = 0.35) and whole thalamus (d = 0.40) volumes at unadjusted p-values <0.05. Adolescent patients showed no volumetric differences. Adult OCD patients compared with controls had smaller volumes across all subregions (anterior, lateral, pulvinar, medial, and ventral) and smaller whole thalamic volume (d = -0.15 to -0.07) after multiple comparisons correction, mostly driven by medicated patients and associated with symptom severity. The anterior thalamus was also significantly smaller in patients after adjusting for thalamus size. Our results suggest that OCD-related thalamic volume differences are global and not driven by particular subregions and that the direction of effects are driven by both age and medication status
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