Downsizing Health Care in the Community

This study reviewed recent changes in health care utilization in the health care providers of Syracuse, New York. The data indicated the largest decline in the numbers of inpatient volumes involved adult surgery and orthopedics. Numbers of inpatient discharges for this service declined by more than 2900 discharges for the combined Syracuse hospitals. The data also indicated that adult medicine discharges declined by more than 2600 during this time. For Diagnosis Related Groups with discharge differences of 30 or more, adult medicine discharges declined by 451 in neurology, 943 in respiratory medicine, and 625 in circulatory medicine. It was estimated that the value of the inpatient discharges amounted to approximately $1,740,000 in adult surgery and more than $1,560,000 for adult medicine. The savings that were achieved in this process related to staffing, pharmaceuticals, and testing.

Estimating the Future of Health Care at the Community Level

Developments in health care in the United States are changing the delivery of services for providers and payors. This study focused on inpatient hospital discharges in the Syracuse hospitals and other services. It demonstrated that, during the past five years, numbers of inpatient adult medicine discharges had increased while adult surgery discharges had declined. This information suggested that adult medicine discharges could be expected to increase and approach levels of five years ago. It also suggested adult surgery discharges could be expected to remain at previous levels or decline. This information indicated that the combined emergency department visits declined from 238,000 to 202,000 between 2019 and 2020, then increased from 218,000 to 228,000 visits between 2021 and 2023. These developments will probably result in greater efficiency at the community level. With a decline in numbers of inpatient beds, providers will be able to focus on the more efficient management by reducing numbers of staff as well as fewer pharmaceuticals and testing.

Cost-effectiveness of Crohn's disease post-operative care

AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection.METHODS: In the “POCER” study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care (6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin (FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo.RESULTS: Sixty patients (active care n = 43, standard care n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those in remission [$26347 (IQR 25045-27485) vs $2729 (IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented.CONCLUSION: Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated.

Does higher tax rate affect tobacco usage?Unravelling the nexus between tobacco regulatory control and public health concern

Objectives:Bangladesh stands as a prominent global consumer of tobacco,with alarming consequences on public health.The Global Adult Tobacco Survey reported that tobacco consumption claimed over 126000 lives in 2018,contributing to 13.5%of all deaths in the country.This study aims to explore the effectiveness of higher tax rates and tobacco use regulation as control mechanisms in mitigating tobacco consumption and health care cost burden,with a particular emphasis on its implications for public health.Methods:This study is based on the annual time series data over the period 2000-2020.The study employs the ordinary least square method to analyze the quantitative confirming the stationarity of data at level.This research uses different models to investigate individual effects and combined effects on both tobacco consumption and tobacco health care cost burden.Results:The study finds a negative relationship between tobacco tax rate and tobacco consumption.More specifically,the higher tax rate of tobacco(low(β=-0.3495),medium(β=-0.2319),high(β=-0.9033),premium(β=-0.7322),filtered(β=-0.2114),and non-filtered(β=-0.3452)categories)is significant to reduce tobacco use at 1%level of significance.The study finds similar results when it applied tobacco retail price instead of tobacco tax rate as the independent variable.Finally,the study investigates the impact on health care cost through tobacco consumption,tobacco control law,growth rate,export-import,and tobacco production.The results indicate that tobacco consumption,export-import,and tobacco production increases health care cost burden while tobacco use regulatory decreases it.By reducing tobacco consumption,higher taxes and tobacco use regulation contribute to alleviating the burden on the healthcare system,promoting healthier lifestyles,and aligning with global health objectives.Conclusions:Higher tax rate on tobacco products is necessary to increase the retail price so that tobacco users cannot consume tobacco.Specific tax and uniform tax base are needed so that tobacco users cannot switch to lower priced brands.Tobacco control laws need to revised and proper implementation should be ensured as well,to achieve the goal of tobacco free Bangladesh by 2040.Tobacco-related diseases,responsible for a significant proportion of deaths in the country,could witness a considerable decline with the successful implementation of higher tax rates and tobacco use regulation.This study provides insights that not only contribute to the economic discourse but also accentuate the broader public health benefits arising from effective tobacco taxation policies.

Prevalence of-and risk factors for work disability in Dutch patients with inflammatory bowel disease

AIM To determine the prevalence of work disability in inflammatory bowel disease(IBD), and to assess risk factors associated with work disability.METHODS For this retrospective cohort study, we retrieved clinical data from the Dutch IBD Biobank on July 2014, containing electronic patient records of 3388 IBD patients treated in the eight University Medical Centers in the Netherlands. Prevalence of work disability was assessed in 2794 IBD patients and compared with the general Dutch population. Multivariate analyses were performed for work disability(sick leave, partial and full disability) and long-term full work disability(> 80% work disability for > 2 years).RESULTS Prevalence of work disability was higher in Crohn's disease(CD)(29%) and ulcerative colitis(UC)(19%) patients compared to the general Dutch population(7%). In all IBD patients, female sex, a lower education level, and extra-intestinal manifestations, were associated with work disability. In CD patients, an age > 40 years at diagnosis, disease duration > 15 years,smoking, surgical interventions, and anti-TNFα use were associated with work disability. In UC patients, an age > 55 years, and immunomodulator use were associated with work disability. In CD patients, a lower education level(OR = 1.62, 95%CI: 1.02-2.58), and in UC patients, disease complications(OR = 3.39, 95%CI: 1.09-10.58) were associated with long-term full work disability.CONCLUSION The prevalence of work disability in IBD patients is higher than in the general Dutch population. Early assessment of risk factors for work disability is necessary, as work disability is substantial among IBD patients.

Economic evaluations in gastroenterology in Brazil: A systematic review

AIM: To systematically review economic evaluations in gastroenterology, relating to Brazil, published between 1980 and 2013. METHODS: We selected full and partial economic evaluations from among those retrieved by searching the following databases: MEDLINE(PubM ed); Excerpta Medica; the Latin American and Caribbean Health Sciences Literature database; the Scientific Electronic Library Online; the database of the Centre for Reviews and Dissemination; the National Health Service(NHS) Economic Evaluation Database; the NHS Health Technology Assessment database; the Health Economics database of the Brazilian Virtual Library of Health; Scopus; Web of Science; and the Brazilian Network for the Evaluation of Health Technologies. Two researchers, working independently, selected the studies and extracted the data. RESULTS: We ide nt if ie d 535 he alt h e c onomic evaluations relating to Brazil and published in the 1980-2013 period. Of those 535 articles, only 40 dealt with gastroenterology. Full and partial economic evaluations respectively accounted for 23(57.5%) and 17(42.5%) of the 40 studies included. Among the 23 full economic evaluations, there were 11 cost-utility analyses, seven cost-effectiveness analyses, four costconsequence analyses, and one cost-minimization analysis. Of the 40 studies, 25(62.5%) evaluated medications; 7(17.5%) evaluated procedures; and 3(7.5%) evaluated equipment. Most(55%) of the studies were related to viral hepatitis, and most(63.4%) were published after 2010. Other topics included gastrointestinal cancer, liver transplantation, digestive diseases and hernias. Over the 33-year period examined, the number of such economic evaluations relating to Brazil, especially of those evaluating medications for the treatment of hepatitis, increased considerably. CONCLUSION: Further studies are needed in order to ensure that expenditures on health care in Brazil are made as fairly and efficiently as possible.

Policies towards implementation of positive changes and the introduction of integrated health care for health systems

1 Introduction Quality of life is influenced by health, education, environment, fairness and respect of public benefits by main stake holders of each country. A pre-summit policy roundtable report of the European Congress for Integrative Medicine （ECIM） 2015 Global Summit on Integrative Medicine and Healthcare held on September 26-27, 2015 in Greater Copenhagen, declared a call for strategic policies in support of integrated health care that would include a vision for setting up ＂an integrative medicine （IM） department in at least one hospital in every European country.＂

Patents and intellectual property in orthopaedics and arthroplasty

The provision of musculoskeletal services comes at a cost.This is,in part,due to the expense of patent-protected orthopaedic implants.However,patents have a finite lifespan.Patents of the most successful implants are now beginning to expire.They will be exposed to competition from generic but equivalent implants.The net effect is potentially a dramatic diminution in cost.One company,Orthimo,has taken advantage of this and begun manufacturing generic implants with identical design specifications to the most bio-durable hip prostheses.This will ultimately have a radical impact upon musculoskeletal healthcare provision with regard to cost and accessibility.The expiration of drug patents,with the subsequent use of generic drugs saves£7.1 billion annually in the United Kingdom and$254 billion in the USA.Estimates suggest the introduction of equivalent implants could result in an annual cost saving to the United Kingdom National Health Service of£120 million.Intellectual property remains an enigmatic area of law.It encompasses anodyne principles that seek to protect innovation but are open to manipulation and exploitation.The last decade has seen the emergence of undesirable practices in the medical industry such as"patent trolling".Here we explore patents and their repercussions for musculoskeletal care.

Improving System Wide Hospital Efficiency at the Community Level

This study reviewed programs to improve the efficiency of hospital utilization in the metropolitan area of Syracuse, New York between 1998 and 2015. It involved indicators that were largely under the control of hospitals and their nursing and administrative staffs, such as inpatient stays and post admission complications, as well as programs where there was less provider control such as inpatient admissions and readmissions. Large reductions in inpatient lengths of stay were generated by the Syracuse hospitals, contributing to a decline in the average daily adult medicine and adult surgery census of 140 patients. Reductions in post admission complications contributed to these developments. The study suggested that efforts to reduce inpatient admissions in the Syracuse hospitals had limited results. The areas hospital admission rate was conservative, but approximately 2000 resident discharges per year above that of a neighboring community. The need for reduction of hospital admissions resulted from the absence of provider or payor efforts to develop alternative resources in the community. If the experience of the Syracuse hospitals is typical, improvement of the efficiency of community health systems will require creativity and resources from providers. Perhaps more importantly, health care payors will need to assume an active role in these efforts.

Reducing Hospital Lengths of Stay: A Five-Year Study

Hospital length of stay reduction is an important mechanism for improving the outcomes and efficiency of care. This study evaluated the impact of length of stay reduction in the hospitals of Syracuse, New York. Between 2015 and 2020, length of stay reduction saved 7106 inpatient days for adult medicine, and 10,605 patient days for adult surgery in the hospitals. At a conservative late stay rate of $600 per day, $4,263,600 was eliminated for adult medicine and $6,363,000 was eliminated for adult surgery between 2015 and 2020. The study data suggested that the numbers of days saved were the greatest for patients with Major and Extreme severity of illness. At the community level, length of stay reduction can support the efforts of health care providers to free inpatient capacity for patients with Coronavirus and other conditions. It can also generate the efficiency needed to reimburse the costs of care.

Research on diagnosis-related group grouping of inpatient medical expenditure in colorectal cancer patients based on a decision tree model

BACKGROUND In 2018,the diagnosis-related groups prospective payment system(DRGs-PPS)was introduced in a trial operation in Beijing according to the requirements of medical and health reform.The implementation of the system requires that more than 300 disease types pay through the DRGs-PPS for medical insurance.Colorectal cancer(CRC),as a common malignant tumor with high prevalence in recent years,was among the 300 disease types.AIM To investigate the composition and factors related to inpatient medical expenditure in CRC patients based on disease DRGs,and to provide a basis for the rational economic control of hospitalization expenses for the diagnosis and treatment of CRC.METHODS The basic material and cost data for 1026 CRC inpatients in a Grade-A tertiary hospital in Beijing during 2014-2018 were collected using the medical record system.A variance analysis of the composition of medical expenditure was carried out,and a multivariate linear regression model was used to select influencing factors with the greatest statistical significance.A decision tree model based on the exhaustiveχ^2 automatic interaction detector(E-CHAID)algorithm for DRG grouping was built by setting chosen factors as separation nodes,and the payment standard of each diagnostic group and upper limit cost were calculated.The correctness and rationality of the data were re-evaluated and verified by clinical practice.RESULTS The average hospital stay of the 1026 CRC patients investigated was 18.5 d,and the average hospitalization cost was 57872.4 RMB yuan.Factors including age,gender,length of hospital stay,diagnosis and treatment,as well as clinical operations had significant influence on inpatient expenditure(P<0.05).By adopting age,diagnosis,treatment,and surgery as the grouping nodes,a decision tree model based on the E-CHAID algorithm was established,and the CRC patients were divided into 12 DRG cost groups.Among these 12 groups,the number of patients aged≤67 years,and underwent surgery and chemotherapy or radiotherapy was largest;while patients aged>67 years,and underwent surgery and chemotherapy or radiotherapy had the highest medical cost.In addition,the standard cost and upper limit cost in the 12 groups were calculated and re-evaluated.CONCLUSION It is important to strengthen the control over the use of drugs and management of the hospitalization process,surgery,diagnosis and treatment to reduce the economic burden on patients.Tailored adjustments to medical payment standards should be made according to the characteristics and treatment of disease types to improve the comprehensiveness and practicability of the DRGs-PPS.

Research of Medical Expenditure among Inpatients with Unstable Angina Pectoris in a Single Center

Background： With the rising incidence as well as the medical expenditure among patients with unstable angina pectoris, the research aimed to investigate the inpatient medical expenditure through the combination of diagnosis-related groups （DRGs） among patients with nnstable angina pectoris in a Grade A tertiary hospital to conduct the referential standards of medical costs for the diagnosis. Methods： Single-factor analysis and multiple linear stepwise regression method were used to investigate 3933 cases between 2014 and 2016 in Beijing Hospital （China） whose main diagnosis was defined as unstable angina pectoris to determine the main factors influencing the inpatient medical expenditure,and decision tree method was adopted to establish the model of DRGs grouping combinations. Results： The major influential factors of inpatient medical expenditure included age, operative method, therapeutic effects as well as comorbidity and complications （CCs） of the disease, and the 3933 cases were divided into ten DRGs by four factors： age, CCs, therapeutic effects, and the type of surgery with corresponding inpatient medical expenditure standards setup. Data of nonparametric test on medical costs among different groups were all significant （P 〈 0.001, by Kruskal-Wallis test）, with R2 = 0.53 and coefficient of variation （CV） 0.524. Conclusions： The classification of DRGs by adopting the type of surgery as the main branch node to develop cost control standards in inpatient treatment of unstable angina pectoris is conducive in standardizing the diagnosis and treatment behaviors of the hospital and reducing economic burdens among patients.

Hepatitis C Virus: A Review of Treatment Guidelines,Cost-effectiveness, and Access to Therapy

Hepatitis C virus (HCV) infection remains a significant medical concern in the United States and around the world.It is still one of the leading causes of chronic liver disease,and,for more than 20 years,there has been little progress in the treatment of HCV infection.The advent of direct-acting antivirals (DAAs) initiated the era of high efficacy and well-tolerated medications with high cure rates.The efficacy of these medications has prompted many professional societies around the world to update their treatment guidelines to include DAAs as first-line treatment.Guidelines by the American Association for the Study of Liver Disease/Infectious Disease Society of America,World Health Organization,Asian-Pacific Association for the Study of Liver and the European Association for the Study of Liver have all incorporated DAAs into their treatment guidelines.Despite the promising data supporting these medications,however,their cost represents a limiting factor to their use,even though studies have shown DAAs to be cost-effective.In addition to the expense of these medications and limited resources,there are many barriers preventing patients from receiving this potentially life-saving treatment.In order to overcome these barriers,these issues need to be recognized and addressed.