The Financial Implications of Using Decision Tree Analysis for Publicly Funded Health Care Screening in Canada

This article demonstrates that decision trees have several applications in screening for incidences of various cancers in the publicly funded health care system of Canada. This article reviews previous research on the design of various types of decision trees to identify the relevant decision-making parameters that should be incorporated into enhanced usage of decision trees. This article proposes a methodology for screening breast and prostate cancers. While an accounting is made for various financial costs and benefits, comments are made on the limitations of the modeling exercise through identification of problems in assigning probabilities, the use of samples in ascertaining population parameters, ethical concerns, and measuring a cost per life year. This article concludes with prospects for future research including private sector versus public sector financing and the incorporation of opportunity costs into the decision-making process.

Community-Based Health Insurance： An Evolutionary Approach to Achieving Universal Coverage in Low-Income Countries

The WHO World Health Assembly, and the most recent WHO World Health Report, have called for all health systems to move toward universal coverage. However, low-income countries have made little progress in this respect. We use existing evidence to describe the evolution of community-based health insurance in low-income countries through the three stages of basic model, enhanced model, and nationwide model. We have concluded that community-based health insurance development is a potential strategy to meet the urgent need for health financing in low-income countries. With careful planning and implementation, it is possible to adopt such evolutionary approach to achieve universal coverage by extending tax-based financing/social insurance characteristics to community-based health insurance schemes.

The Efficiency of Public Health Expenditure in Turkey Between 2003 and 2013

Turkey launched a project in 2003 known as ＂Health Transformation Programme＂ （HTP）, which enabled Turkey to make considerable progress and radical changes to the health care system. The programme in 2003 included the effectiveness and the efficiency factors within the process by setting them as the primary objectives to increase the health status of the population （effectiveness） and to use resources in the best possible manner and at the lowest possible cost （efficiency）. Accessing services according to the need of patients and state benefits according to their ability to pay would be viable under these objectives. In this study, initially, Turkish National Health System will be articulated on a literature-study basis approach to measure the efficiency of public expenditure on health. Then, the measured level of the efficiency will be analysed in Turkey, The paper serves a purpose to analyse the efficiency based on the outcomes of heath service such as satisfaction with public health services over the period of 2003-2013. A simple linear regression was employed to test the degree of statistical relation between public health expenditure and satisfaction with public health care services.

Behavioral Aspects in Obligatory Reports of Public Hospitals in Poland

The health care sector is the most difficult one to manage and control. Special units in this field are public hospitals which are required to prepare a lot of reports to various institutions, including the ownership body. The paper focuses on two issues. The first is the presence of behavioral factors in the reporting of public hospitals in Poland to the ownership bodies. This article aims to indicate the thematic areas of specific reports, most affected by behavioral factors and explain the causes and consequences of their occurrence. The second issue is the analysis of the legal status of obligatory reporting of public hospitals. Participants of the conducted research, due to their specific ownership and political and social position, were public hospitals in Poland. The paper uses the research methods of the meta-analysis of the literature, legal acts in Poland and empirical materials, and also the methods of synthesis, observation, and deduction. Data analysis focused on specific sample of reports issued by Polish public hospitals for their ownership body. The research shows that hospitals draw up a tremendous number of often thematically overlapping and redundant reports addressed to different institutions in different time periods. It is a consequence of legal regulations failing to streamline the reporting of the health care sector institutions, in particular public hospitals. The paper points to the large number of legal instruments that contain imprecise requirements resulting from the complex and obscure forms of control of public funds allocation in this sector. There are many behavioral factors that shape some fields of public hospitals＇ reports, for example, interpersonal relationships, egoism, private financial interests, strengthening of the employment status and professional position, and professional competences. There is considerable freedom in the reporting process fulfilled by public hospitals in Poland for their ownership body. It causes strong consequences, like poor-quality data, duplication of information, and its chaos, as well as high costs of obtaining information. Reporting system of financial and non-financial data of public hospitals in Poland is dysfunctional.

Factors that associated with TB patient admission rate and TB inpatient service cost: a cross-sectional study in China

Background:China has recently adopted the“TB designated hospital model”to improve the quality of tuberculosis(TB)treatment and patient management.Considering that inpatient service often results in high patient financial burden,and therefore influences patient adherence to treatment,it is critical to better understand the TB patient admission rate and TB inpatient service cost,as well as their influential factors in this new model.Methods:Quantitative and qualitative studies were conducted in two cities,Hanzhong in Shaanxi Province and Zhenjiang in Jiangsu Province,in China.Quantitative data were obtained from a sample survey of 533 TB patients and TB inpatient records from 2010–2012 in six county designated hospitals.Qualitative information was obtained through interviews with key stakeholders(40 key informant interviews,14 focus group discussions)and reviews of health policy documents in study areas.Both univariate and multivariate statistical analyses were applied for the quantitative analysis,and the thematic framework approach was applied for the qualitative analysis.Results:The TB patient admission rates in Zhenjiang and Hanzhong were 54.8 and 55.9%,respectively.Qualitative analyses revealed that financial incentives,misunderstanding of infectious disease control and failure of health insurance regulations were the key factors associated with the admission rates and medical costs.Quantitative analyses found differences in hospitalization rate existed among patients with different health insurance and patients from different counties.Average medical costs for TB inpatients in Jurong and Zhenba were 7,215 CNY and 4,644 CNY,which was higher than the 5,500 CNY and 3,800 CNY limits set by the New Rural Cooperative Medical System.No differences in medical cost or length of stay were found between patients with and without comorbidities in county-level hospitals.Conclusions:TB patient admission rates and inpatient service costs were relatively high.Studies of related factors indicated that a package of interventions,including health education programs,reform of health insurance regulations and improvement of TB treatment guidelines,are urgently required to ensure that TB patients receive appropriate care.