This study was a brief review of issues related to health planning in the metropolitan area of Syracuse, New York. It suggested that population demographics and health care utilization can have an impact on the use of...This study was a brief review of issues related to health planning in the metropolitan area of Syracuse, New York. It suggested that population demographics and health care utilization can have an impact on the use of services at the community level. The study suggested that the utilization of services can be associated with patient demographics. In this study, younger populations were associated with lower use of hospital inpatient care. The data have also suggested that larger numbers of younger populations are not necessarily related to opportunities for expanding local health care providers. Younger populations can be associated with lower per capita use of services. The data demonstrated that there were substantial reductions in hospital discharges for adult medicine. Total discharges declined by 3999 patients between the seven months in 2019 and 2023. The data also demonstrated that there were notable reductions in hospital discharges for adult surgery.展开更多
This study evaluated changes in inpatient adult medicine and adult surgery services in the metropolitan area of Syracuse New York. These are the two largest inpatient hospital services. The study involved the use of t...This study evaluated changes in inpatient adult medicine and adult surgery services in the metropolitan area of Syracuse New York. These are the two largest inpatient hospital services. The study involved the use of these services as a basis for health care planning over time. The first component of the study focused on changes in hospital discharges for adult medicine and adult surgery. It demonstrated that, between the first three quarters of 2019 and 2022, before and after the coronavirus epidemic, numbers of adult medicine and adult surgery discharges declined by 16 - 21 percent. The second component of the study focused on changes in hospital lengths of stay for adult medicine and adult surgery. It demonstrated that, between the first three quarters of 2019 and 2022, hospital inpatient lengths of stay increased by approximately 19 - 21 percent at the aggregate and hospital specific levels. Effective planning involving utilization indicators such as hospital discharges and efficiency will be necessary if the potential for effective management of this sector is to be preserved. This planning should involve comparisons of data such as hospital discharges and stays, and identification of the sources of these developments at the community level.展开更多
Objective:To make evidence-based decisions based on broad mortality trends for Razavi Khorasan province,Iran.Methods:In order to determine the baseline number of deaths,we used univariate time series analyses for mont...Objective:To make evidence-based decisions based on broad mortality trends for Razavi Khorasan province,Iran.Methods:In order to determine the baseline number of deaths,we used univariate time series analyses for monthly data from the monthly vital statistics reports(From April 2015 to March 2022).For excess mortalities,these baselines were subtracted from reported deaths with a 95%prediction interval.To compare time and causes,a P-score was calculated.Results:From March 2020 to March 2022,there were 61949 registered deaths,and the estimated deaths with a 95%confidence interval(CI)were 43246.16(35718.28,50774.05).So,in 2020-2021 and 2021-2022,the death counts were 35.15%and 51.33%higher than projected.A total of 18666 cardiovascular diseases were reported and a total of 15704.46(12006.95,19401.96)was estimated.The P-score for this duration was 14.49%and 23.23%higher than expected.Infectious and parasitic diseases plus COVID-19 were 16633 and estimated to be 1044.87(456.77,1632.96).A total of 4420 diseases of the respiratory system were reported,and 4564.94 deaths were predicted(2277.43,6852.43).In the first year of the pandemic,the P-score dropped to-35.28%and in the second year,it jumped sharply to 22.38%.Conclusions:Excess mortality,along with cause-specific mortality,can be helpful for monitoring trends and developing public health policies at the local,national,and international levels.展开更多
Objectives: This paper aims to estimate the associations between common mental disorders (CMD) as well as cases of alcohol abuse/dependence (ADD) with sociodemographic variables in population assisted by Family Health...Objectives: This paper aims to estimate the associations between common mental disorders (CMD) as well as cases of alcohol abuse/dependence (ADD) with sociodemographic variables in population assisted by Family Health Program (FHP) in Santa Cruz do Sul, Southern Brazil. Methods: All residents over 14 years of age from 3 areas assisted by the FHP were invited to participate between 10 February 2006 to 10 February 2007. Results: Of 2921 participants, the prevalence estimates of suspected cases of CMD and ADD were 29.93% and 12.07%, respectively. Female, unfavorable employment situation, low schooling and low income showed a positive and independent association with CMD. Male, unfavorable employment situation and CMD showed an independent association with ADD. Conclusions: Groups with unfavorable socioeconomic conditions present the highest risk and should be taken into account when planning public mental health policies.展开更多
Since the introduction of the Health Insurance Act in the Netherlands in 2006, insurers are incen-tivized to compete on price for basic health insurance, and on price and quality for supplementary insurance. It is pos...Since the introduction of the Health Insurance Act in the Netherlands in 2006, insurers are incen-tivized to compete on price for basic health insurance, and on price and quality for supplementary insurance. It is possible for health insurers to implement a differentiated deductible since the first of January 2009. This paper describes an experiment. It is designed to study this differentiated deductible as a financial policy instrument. It focuses on the effect of selective contracting with positive incentives on the choice-behaviour of the insured. The goal of this study is to gain insight in the working mechanism of this financial policy instrument that is meant to reduce healthcare costs. The study is designed as a vignette study. The vignettes are presented in pairs of two to the respondents. The vignettes contain various elements including premium costs, deductible, degree of selective contracting and availability of quality-information (CQI). As the respondents in the design of this choice experiment have to choose between confronting health plans, it is understandable that they value these policies on their characteristics (so-called attributes). Subsequently, a statement can be formulated on the relative value assigned to these attributes by the respondents, clearly preferring one health plan over the other. Finally 99 respondents were included in our study. Logistic regression analysis was performed. This study shows that the deducti-ble as choice-influencing instrument has less influence as age increases. The proclaimed cost savings of this deductible might be lower than expected. Generally, it can be concluded that healthier people are less likely to choose the extensive health plan. However, this effect reverses when the most extensive and less extensive are presented to the participants. The results thus show a clear demarcation in the preferences of consumers. A similar demarcation also has been found in the data concerning travel distance. When contracted care is within 30 minutes, this health plan is preferred over the more extensive and expensive one. However, this study also shows that this effect reverses when the travel distance increases to 45 minutes. Consumers in this situation are reluctant to choose selective care and choose for the extensive and expensive option. Premium costs have a negative effect. A health plan becomes less attractive when the price increases. In addition, an increase in the availability of CQI makes a health plan more attractive. It can be concluded from this study that the deductible as choice-influencing instrument seems to work for young and healthy people, provided that they do not have to travel more that 30 minutes.展开更多
The objective of this work is to analyze the reasons why community health interventions in Africa do not consider multisectoral approaches. To achieve it, we perform a mini-review of health development policies and pl...The objective of this work is to analyze the reasons why community health interventions in Africa do not consider multisectoral approaches. To achieve it, we perform a mini-review of health development policies and plans available online in seven countries from four regions of Sub-Saharan Africa. Thus, two main reasons have been highlighted. First, national strategic plans and policies for health development, in their formulation, neither sufficiently emphasize multisectoral approaches, nor sufficiently make these approaches operational in strategies and activities. Second, the mindset of health professionals due to their initial training orientation based on the biomedical approach, stands that disease is only a result of a physiological imbalance in the body;therefore, to restore health, such an imbalance only needs sophisticated procedures and interventions to be overcome. Such an orientation completely ignores the social, cultural and economic context in which the individual lives, which has an irretrievable influence on the health imbalance. However, health, influenced by the conditions in which people are conceived, born, grow, live, work and aged, cannot be effectively improved in a sustainable way without taking into account all these conditions. Whence the importance of approaches based on every sector of human activity that influences the living conditions.展开更多
A county in eastern Jiangsu Province leads the way in low-cost medical treatment THE extremely cold weather that has ravaged large parts of the northern hemisphere this winter also took its toll on the small village o...A county in eastern Jiangsu Province leads the way in low-cost medical treatment THE extremely cold weather that has ravaged large parts of the northern hemisphere this winter also took its toll on the small village of Dazhuyin in Ganyu County,east China＇s Jiangsu Province. The dry,freezing days laid low scores展开更多
An important component of health care planning at the community level is the identification of inpatient hospital bed capacity. In the United States, hospitals are major providers of patient care and the largest sourc...An important component of health care planning at the community level is the identification of inpatient hospital bed capacity. In the United States, hospitals are major providers of patient care and the largest sources of health care expenses. This study evaluated inpatient hospital capacity for major services including adult medicine, adult surgery, and obstetrics. It was based on local and regional demographics, admissions per capita, inmigration, and inpatient lengths of stay. The study also involved the use of the methodology to estimate bed need based on a reduction in hospital admissions and discharges of 15 percent. This level has been the experience of area hospitals between 2019 and 2022. The study also included the use of the bed need methodology to estimate the hospital utilization based on a decline in inpatient lengths of stay. It resulted in a decline in hospital occupancy in the hospital service area from 1213.1 to 1012.6 patients based on 80 percent occupancy and the best practice hospital stays in the region.展开更多
The new challenges that the phenomenon of demographic aging imposes on society in general, and health services in particular, can impact active and healthy aging. The project was implemented for two years （2012/2013...The new challenges that the phenomenon of demographic aging imposes on society in general, and health services in particular, can impact active and healthy aging. The project was implemented for two years （2012/2013） and aimed to combat loneliness in the elderly, which constitutes an obstacle to healthy and active aging. Decrease the sense of loneliness of individuals from 65 to 84 years of age, the project was made by using the health planning methodology, starting with a descriptive study （health diagnosis of the independent elderly population） followed by the development, implementation and evaluation of a community intervention project, which included home visits to the elderly, assessment of the level of loneliness in two different times （UCLA scale） and various intergenerational activities of social life （dancing, walking, online courses, games...） using a cross-section of partnerships and community involvement. There was a decrease from 62.8% to 41.9% in the reported overall feeling of loneliness of independent individuals between the ages of 65 and 84 years of age. There was an increase from 50.0% to 86.4% of seniors who now have dreams/life projects. The reduction of social and emotional isolation resulted in the promotion of social networks, which not only encouraged social interaction but also considered the elderly who live alone. The health gains arising from it are evidenced in contributing more proactively and the improvement of the quality of life in the elderly community.展开更多
Objective: to assess the evolution of serum creatinine in patients undergoing radical nephrectomy (malignant) or total (benign), to identify risk factors connected with an unfavorable renal function outcome. Material ...Objective: to assess the evolution of serum creatinine in patients undergoing radical nephrectomy (malignant) or total (benign), to identify risk factors connected with an unfavorable renal function outcome. Material and Methods: observational, transversal and retrospective study, through analysis of records and lab exams of 146 patients undergoing nephrectomy from January 2015 to December 2018. Results: Statistically significant difference was found between etiology and patients’ age (p-value Conclusion: This study shows that a large number of young patients undergo nephrectomy, many times avoidable;within a benign disease context with an increased risk of developing renal failure. Greater attention from the public service is required to tackle such chronic condition and its complications.展开更多
The aim was to explore the implementation of individual care plans in municipal elderly care in relation to characteristics of staff. Data regarding characteristics of staff were derived through a questionnaire distri...The aim was to explore the implementation of individual care plans in municipal elderly care in relation to characteristics of staff. Data regarding characteristics of staff were derived through a questionnaire distributed to all staff working in the care for older people, (N = 908, n = 245) in four municipalities in Sweden. The number of care plans established during a one-year period was collected through a contact person in each municipality. In total 47 individual care plans were established during the study year. Significantly more staff in the municipality that had the most number of established individual care plans agreed that there had been sufficient education (p = 0.017), sufficient time (p = 0.002) and routines established regarding individual care plans (p = 0.014) and had a significantly better job satisfaction (p = 0.001), compared to staff in the other municipalities. Implementation leaders may need to take the working conditions and the perception of available resources among staff into consideration in the on-going process of implementing individual care plans.展开更多
A critical problem plaguing regulators in promoting pharmaceutical innovation is to design and select efficient incentive policies. In this study, we develop a stylized model comprising a regulator and two representat...A critical problem plaguing regulators in promoting pharmaceutical innovation is to design and select efficient incentive policies. In this study, we develop a stylized model comprising a regulator and two representative drug producers to evaluate the effects of three incentive policies: Innovation subsides, inclusion new drugs in the health insurance plan, and the combination of the above two policies(also called hybrid policy). Our analysis shows that innovation subsidies and inclusion of new drugs in the health insurance plan can both promote pharmaceutical innovation, but their incentive effects vary in different policy objectives. Specifically, if the regulator aims to improve patient welfare, he should incorporate new drugs into the health insurance plan to expand the accessibility of new drug when the copayment level is low. However, if the regulator aims to improve social welfare, he should choose innovation subsidies when the copayment level is high, and the hybrid policy when the copayment level is low. In particular, with a sufficiently low copayment level, the hybrid policy allows the new drug producer, patients and the regulator to achieve Pareto improvement due to a lower regulator’s innovation subsidy expenditure, higher profits of the new drug producer and consumer surplus.展开更多
文摘This study was a brief review of issues related to health planning in the metropolitan area of Syracuse, New York. It suggested that population demographics and health care utilization can have an impact on the use of services at the community level. The study suggested that the utilization of services can be associated with patient demographics. In this study, younger populations were associated with lower use of hospital inpatient care. The data have also suggested that larger numbers of younger populations are not necessarily related to opportunities for expanding local health care providers. Younger populations can be associated with lower per capita use of services. The data demonstrated that there were substantial reductions in hospital discharges for adult medicine. Total discharges declined by 3999 patients between the seven months in 2019 and 2023. The data also demonstrated that there were notable reductions in hospital discharges for adult surgery.
文摘This study evaluated changes in inpatient adult medicine and adult surgery services in the metropolitan area of Syracuse New York. These are the two largest inpatient hospital services. The study involved the use of these services as a basis for health care planning over time. The first component of the study focused on changes in hospital discharges for adult medicine and adult surgery. It demonstrated that, between the first three quarters of 2019 and 2022, before and after the coronavirus epidemic, numbers of adult medicine and adult surgery discharges declined by 16 - 21 percent. The second component of the study focused on changes in hospital lengths of stay for adult medicine and adult surgery. It demonstrated that, between the first three quarters of 2019 and 2022, hospital inpatient lengths of stay increased by approximately 19 - 21 percent at the aggregate and hospital specific levels. Effective planning involving utilization indicators such as hospital discharges and efficiency will be necessary if the potential for effective management of this sector is to be preserved. This planning should involve comparisons of data such as hospital discharges and stays, and identification of the sources of these developments at the community level.
基金supported by Mashhad University of Medical Sciencesapproved by the Ethics Committee of Mashhad University of Medical Sciences(Ethics ID:IR.MUMS.REC.1400.144).
文摘Objective:To make evidence-based decisions based on broad mortality trends for Razavi Khorasan province,Iran.Methods:In order to determine the baseline number of deaths,we used univariate time series analyses for monthly data from the monthly vital statistics reports(From April 2015 to March 2022).For excess mortalities,these baselines were subtracted from reported deaths with a 95%prediction interval.To compare time and causes,a P-score was calculated.Results:From March 2020 to March 2022,there were 61949 registered deaths,and the estimated deaths with a 95%confidence interval(CI)were 43246.16(35718.28,50774.05).So,in 2020-2021 and 2021-2022,the death counts were 35.15%and 51.33%higher than projected.A total of 18666 cardiovascular diseases were reported and a total of 15704.46(12006.95,19401.96)was estimated.The P-score for this duration was 14.49%and 23.23%higher than expected.Infectious and parasitic diseases plus COVID-19 were 16633 and estimated to be 1044.87(456.77,1632.96).A total of 4420 diseases of the respiratory system were reported,and 4564.94 deaths were predicted(2277.43,6852.43).In the first year of the pandemic,the P-score dropped to-35.28%and in the second year,it jumped sharply to 22.38%.Conclusions:Excess mortality,along with cause-specific mortality,can be helpful for monitoring trends and developing public health policies at the local,national,and international levels.
文摘Objectives: This paper aims to estimate the associations between common mental disorders (CMD) as well as cases of alcohol abuse/dependence (ADD) with sociodemographic variables in population assisted by Family Health Program (FHP) in Santa Cruz do Sul, Southern Brazil. Methods: All residents over 14 years of age from 3 areas assisted by the FHP were invited to participate between 10 February 2006 to 10 February 2007. Results: Of 2921 participants, the prevalence estimates of suspected cases of CMD and ADD were 29.93% and 12.07%, respectively. Female, unfavorable employment situation, low schooling and low income showed a positive and independent association with CMD. Male, unfavorable employment situation and CMD showed an independent association with ADD. Conclusions: Groups with unfavorable socioeconomic conditions present the highest risk and should be taken into account when planning public mental health policies.
文摘Since the introduction of the Health Insurance Act in the Netherlands in 2006, insurers are incen-tivized to compete on price for basic health insurance, and on price and quality for supplementary insurance. It is possible for health insurers to implement a differentiated deductible since the first of January 2009. This paper describes an experiment. It is designed to study this differentiated deductible as a financial policy instrument. It focuses on the effect of selective contracting with positive incentives on the choice-behaviour of the insured. The goal of this study is to gain insight in the working mechanism of this financial policy instrument that is meant to reduce healthcare costs. The study is designed as a vignette study. The vignettes are presented in pairs of two to the respondents. The vignettes contain various elements including premium costs, deductible, degree of selective contracting and availability of quality-information (CQI). As the respondents in the design of this choice experiment have to choose between confronting health plans, it is understandable that they value these policies on their characteristics (so-called attributes). Subsequently, a statement can be formulated on the relative value assigned to these attributes by the respondents, clearly preferring one health plan over the other. Finally 99 respondents were included in our study. Logistic regression analysis was performed. This study shows that the deducti-ble as choice-influencing instrument has less influence as age increases. The proclaimed cost savings of this deductible might be lower than expected. Generally, it can be concluded that healthier people are less likely to choose the extensive health plan. However, this effect reverses when the most extensive and less extensive are presented to the participants. The results thus show a clear demarcation in the preferences of consumers. A similar demarcation also has been found in the data concerning travel distance. When contracted care is within 30 minutes, this health plan is preferred over the more extensive and expensive one. However, this study also shows that this effect reverses when the travel distance increases to 45 minutes. Consumers in this situation are reluctant to choose selective care and choose for the extensive and expensive option. Premium costs have a negative effect. A health plan becomes less attractive when the price increases. In addition, an increase in the availability of CQI makes a health plan more attractive. It can be concluded from this study that the deductible as choice-influencing instrument seems to work for young and healthy people, provided that they do not have to travel more that 30 minutes.
文摘The objective of this work is to analyze the reasons why community health interventions in Africa do not consider multisectoral approaches. To achieve it, we perform a mini-review of health development policies and plans available online in seven countries from four regions of Sub-Saharan Africa. Thus, two main reasons have been highlighted. First, national strategic plans and policies for health development, in their formulation, neither sufficiently emphasize multisectoral approaches, nor sufficiently make these approaches operational in strategies and activities. Second, the mindset of health professionals due to their initial training orientation based on the biomedical approach, stands that disease is only a result of a physiological imbalance in the body;therefore, to restore health, such an imbalance only needs sophisticated procedures and interventions to be overcome. Such an orientation completely ignores the social, cultural and economic context in which the individual lives, which has an irretrievable influence on the health imbalance. However, health, influenced by the conditions in which people are conceived, born, grow, live, work and aged, cannot be effectively improved in a sustainable way without taking into account all these conditions. Whence the importance of approaches based on every sector of human activity that influences the living conditions.
文摘A county in eastern Jiangsu Province leads the way in low-cost medical treatment THE extremely cold weather that has ravaged large parts of the northern hemisphere this winter also took its toll on the small village of Dazhuyin in Ganyu County,east China＇s Jiangsu Province. The dry,freezing days laid low scores
文摘An important component of health care planning at the community level is the identification of inpatient hospital bed capacity. In the United States, hospitals are major providers of patient care and the largest sources of health care expenses. This study evaluated inpatient hospital capacity for major services including adult medicine, adult surgery, and obstetrics. It was based on local and regional demographics, admissions per capita, inmigration, and inpatient lengths of stay. The study also involved the use of the methodology to estimate bed need based on a reduction in hospital admissions and discharges of 15 percent. This level has been the experience of area hospitals between 2019 and 2022. The study also included the use of the bed need methodology to estimate the hospital utilization based on a decline in inpatient lengths of stay. It resulted in a decline in hospital occupancy in the hospital service area from 1213.1 to 1012.6 patients based on 80 percent occupancy and the best practice hospital stays in the region.
文摘The new challenges that the phenomenon of demographic aging imposes on society in general, and health services in particular, can impact active and healthy aging. The project was implemented for two years （2012/2013） and aimed to combat loneliness in the elderly, which constitutes an obstacle to healthy and active aging. Decrease the sense of loneliness of individuals from 65 to 84 years of age, the project was made by using the health planning methodology, starting with a descriptive study （health diagnosis of the independent elderly population） followed by the development, implementation and evaluation of a community intervention project, which included home visits to the elderly, assessment of the level of loneliness in two different times （UCLA scale） and various intergenerational activities of social life （dancing, walking, online courses, games...） using a cross-section of partnerships and community involvement. There was a decrease from 62.8% to 41.9% in the reported overall feeling of loneliness of independent individuals between the ages of 65 and 84 years of age. There was an increase from 50.0% to 86.4% of seniors who now have dreams/life projects. The reduction of social and emotional isolation resulted in the promotion of social networks, which not only encouraged social interaction but also considered the elderly who live alone. The health gains arising from it are evidenced in contributing more proactively and the improvement of the quality of life in the elderly community.
文摘Objective: to assess the evolution of serum creatinine in patients undergoing radical nephrectomy (malignant) or total (benign), to identify risk factors connected with an unfavorable renal function outcome. Material and Methods: observational, transversal and retrospective study, through analysis of records and lab exams of 146 patients undergoing nephrectomy from January 2015 to December 2018. Results: Statistically significant difference was found between etiology and patients’ age (p-value Conclusion: This study shows that a large number of young patients undergo nephrectomy, many times avoidable;within a benign disease context with an increased risk of developing renal failure. Greater attention from the public service is required to tackle such chronic condition and its complications.
文摘The aim was to explore the implementation of individual care plans in municipal elderly care in relation to characteristics of staff. Data regarding characteristics of staff were derived through a questionnaire distributed to all staff working in the care for older people, (N = 908, n = 245) in four municipalities in Sweden. The number of care plans established during a one-year period was collected through a contact person in each municipality. In total 47 individual care plans were established during the study year. Significantly more staff in the municipality that had the most number of established individual care plans agreed that there had been sufficient education (p = 0.017), sufficient time (p = 0.002) and routines established regarding individual care plans (p = 0.014) and had a significantly better job satisfaction (p = 0.001), compared to staff in the other municipalities. Implementation leaders may need to take the working conditions and the perception of available resources among staff into consideration in the on-going process of implementing individual care plans.
基金Supported by the National Social Science Fund of China(18BGL045)。
文摘A critical problem plaguing regulators in promoting pharmaceutical innovation is to design and select efficient incentive policies. In this study, we develop a stylized model comprising a regulator and two representative drug producers to evaluate the effects of three incentive policies: Innovation subsides, inclusion new drugs in the health insurance plan, and the combination of the above two policies(also called hybrid policy). Our analysis shows that innovation subsidies and inclusion of new drugs in the health insurance plan can both promote pharmaceutical innovation, but their incentive effects vary in different policy objectives. Specifically, if the regulator aims to improve patient welfare, he should incorporate new drugs into the health insurance plan to expand the accessibility of new drug when the copayment level is low. However, if the regulator aims to improve social welfare, he should choose innovation subsidies when the copayment level is high, and the hybrid policy when the copayment level is low. In particular, with a sufficiently low copayment level, the hybrid policy allows the new drug producer, patients and the regulator to achieve Pareto improvement due to a lower regulator’s innovation subsidy expenditure, higher profits of the new drug producer and consumer surplus.
