Effect of healthcare on mortality: trends in avoidable mortality in Australia and comparisons with Western Europe

OBJECTIVES: Using the concept of avoidable mortality, international studies suggest that healthcare has been effective in reducing mortality. This paper provides an analysis of avoidable mortality in Australia and compares trends with those of Western Europe. METHODS: Using unit-record mortality data, we calculated avoidable mortality rates in Australia for 1968-2001. We partitioned avoidable causes into three categories: those amenable to medical care; those mainly responsive to health policy; and ischaemic heart disease. We used Poisson regression to model the trends. We compared trends with those of nine European countries using published data. RESULTS: Total avoidable death rates fell by 68% in females and 72% in males. The corresponding non-avoidable death rates fell by 35 and 33%. The annual declines in avoidable mortality rates were: 3.47% [95% confidence intervals (CI) 3.44-3.50%] in males and 3.89% (95% CI 3.86-3.91%) in females. For non-avoidable mortality rates, the annual declines were 1.09% (95% CI 1.05-1.13%) and 0.95% (95% CI 0.92-0.98%), respectively. In females, declines in death rates from causes amenable to medical care contributed 54% to the decline in avoidable mortality rates, ischaemic heart disease contributed 45%, and causes responsive to health policy intervention contributed 1%. In males, the corresponding contributions were 32, 57 and 11%. These rates, and the declines between 1980 and 1998, were comparable with selected European countries, with Australia's ranking improving over the period. CONCLUSION: Trends in avoidable mortality in Australia suggest that the Australian healthcare system has been effective in improving population health. Australia's experience compares favourably with that of Europe.     

医院成本管理现状及对策研究

分析了国外医院成本管理的发展和研究现状，指出目前我国在医院成本管理中存在的问题，提出借鉴国外医院工业工程和成本管理的先进理念和方法，建立我国系统化的全面成本控制体系，拓展成本管理的新领域并引入战略成本管理，以提高我国成本管理的科学化水平。     

The impact of physician supply on avoidable cancer deaths in Germany. A spatial analysis

Background

Measures of avoidable deaths incorporate the notion that deaths from certain causes should not occur within specified age groups given effective prevention or timely and appropriate access to health care. The present study investigated the impact on specific types of avoidable cancer deaths (ACD) of regional variations in the supply of health services over five years using German districts (Kreise und kreisfreie Städte) as units of analysis.

Methods

Age-standardized, average ACD rates were calculated for 2000-2004 for each of the 439 districts in Germany using unit-record mortality data. The distribution of ACD was subsequently analyzed using country maps and negative binomial regression with random intercepts. Potential endogeneity of physician supply to ACD was controlled for using an instrumental variable approach.The panel data for the years 2000-2004 were merged from a range of official statistics including mortality and hospital records (DESTATIS) and statistics provided by the Federal Office for Building and Regional Planning (INKAR).

Results

In women, 27.81 per 100,000 died from preventable or treatable cancer types in an average year between 2000 and 2004. The rates for men were generally higher, with 40.07 standardized ACD per 100,000.The regression results showed that an increase in physician supply per 100,000 was significantly associated with lower ACD rates in cancer of the female breast, and cancer of the colon, rectosigmoid junction, rectum and anus in both sexes. The contribution ranged from a decrease by a factor of 0.9994 (female breast cancer) to a factor of 0.9986 (cancer of the colon, rectosigmoid junction, rectum and anus in men) in ACD rate as the physician-population ratio increased by one unit.

Conclusion

An increase in physician density tended to be associated with a small reduction in some ACD rates. We suggest that better accessibility or quality of care might have linked increased physician density with improved health outcomes.     

Mortality among male and female smokers in Sweden: a 33 year follow up

STUDY OBJECTIVE: It is still unclear if men and women are equally susceptible to the hazards of tobacco smoking. The objective of this study was to examine smoking related mortality among men and women. DESIGN: In 1963 a questionnaire concerning tobacco smoking habits was sent out to a random sample from the 1960 Swedish census population. Date and cause of death have been collected for the deceased in the cohort through 1996. SETTING: Sweden. PARTICIPANTS: The survey included a total of 27 841 men and 28 089 women, aged 18-69 years. The response rate was 93.1% among the men and 95.4% among the women. MAIN RESULTS: After adjustment for age and place of residence positive associations were found between cigarette smoking and mortality from ischaemic heart disease, aortic aneurysm, bronchitis and emphysema, cancer of the lung, upper aerodigestive sites, bladder, pancreas in both men and women, but not from cerebrovascular disease. When the effect of amount of the cigarette consumption was considered, female smokers displayed, for example, slightly higher relative death rates from ischaemic heart disease. However, no statistically significant gender differential in relative mortality rates was observed for any of the studied diseases. CONCLUSIONS: Women and men in this Swedish cohort seem equally susceptible to the hazards of smoking, when the gender differential in smoking characteristics is accounted for. Although the cohort under study is large, there were few female smokers in the high consuming categories and the relative risk estimates are therefore accompanied by wide confidence intervals in these categories.     

An extension in eligibility for free primary care and avoidable hospitalisations: a natural experiment

In the Republic of Ireland, approximately 30 per cent of the population ('medical card patients') are entitled to free GP services. Eligibility is determined primarily on the basis of an income means test. The remaining 70 per cent of the population ('private patients') must pay the full cost of GP consultations. In July 2001, eligibility for a medical card was extended to all those over 70 years of age, regardless of income. This extension in eligibility provides a natural experiment whereby we can examine the influence of access to free GP services on avoidable hospitalisations. Avoidable hospitalisations are those that are potentially avoidable with timely and effective access to primary care services or that can be treated more appropriately in a primary care setting. Using hospital discharge data for the period 1999-2004, the purpose of this paper is to test the proposition that enhanced access to GP services for the over 70s after July 2001 led to a decline in avoidable hospitalisations among this group. The results indicate that while avoidable hospitalisations for the over 70s did decline after 2001, they also fell for the under 70s, meaning that a significant difference-in-difference effect could not be identified.     

Health care costs among smokers,former smokers,and never smokers in an HMO

OBJECTIVE: We estimate long-term health care costs of former smokers compared with continuing and never smokers using a retrospective cohort study of HMO enrollees. Previous research on health care costs associated with former smokers has suggested that quitters may incur greater health care costs than continuing smokers, therefore, getting people to quit creates more expensive health care consumers. We studied the trend in cost for former smokers over seven years after they quit to assess how the cessation experience impacts total health care cost. DATA SOURCES/STUDY SETTING: Group Health Cooperative (GHC), a nonprofit mixed model health maintenance organization in western Washington state. STUDY DESIGN: Retrospective cohort study using automated and primary data collected through telephone interviews. PRINCIPAL FINDINGS: We find that former smokers' costs are significantly greater (p<.05) in the year immediately following cessation relative to continuing smokers, but former smokers' costs fall in year two. This decrease maintains throughout the six-year follow-up period. Although former smokers cost more than continuing smokers in the year after cessation, this increase appears to be transient. Long-term costs for former smokers are not statistically different from those of continuing smokers and cumulative health care expenses are lower by the seventh year postquit. Our evidence suggests that smoking cessation does not increase long-term heath care costs. CONCLUSIONS: Health care costs among former smokers increase relative to continuing smokers in the year after cessation but fall to a level that is statistically indistinguishable in the second year postquit. Any net increase in costs among former smokers relative to continuing smokers appears compensated for within two years post-quit and is maintained for at least six years after cessation.     

Current and future costs of obesity in Sweden

BackgroundObesity is a growing health issue. This study estimated the costs of obesity among people aged 25–84 years in Sweden using disease and non-disease specific attributable fractions from published data. A prognosis of costs of obesity in 2030 is presented.Methods and materialsDiseases related to obesity and their respective risks and population attributable fraction were retrieved by literature review. Longitudinal data on age and sex related prevalence of obesity was used to construct three scenarios for costs of obesity in 2030.ResultsNearly 4% of all deaths among people 25–84 years in 2016 (n = 3,400) were attributed to obesity. Obesity cost EUR 2.7 billion in 2016, or EUR 377 per inhabitant aged ≥25 years. Non-health care costs were dominant and represented 80% of total societal costs. Main drivers were premature mortality (28%) and permanent sick leave (37%). If the proportion of obese remain at 2016 level, costs will increase 9% by 2030, but with continued linear growth, costs will increase by 66%.ConclusionsThe responsibility, costs and treatment fall on several actors with a considerable burden falling on the individual and the society at large. New health promoting interventions and policy programs are needed and must be evaluated in terms of resource use and expected return.     

2005-2012年北京地区腹主动脉瘤患者费用分析

目的 了解北京地区腹主动脉瘤患者的诊疗及相关费用情况,并对腹主动脉瘤住院和门诊患者的费用构成及年均疾病花费情况进行分析。 方法 利用北京市城镇职工基本医疗保险信息系统数据库,采用数据挖掘的方法,从数据库中提取2005-2012年诊断为腹主动脉瘤的所有患者的相关信息进行系统整理分析。 结果 ①共纳入腹主动脉瘤患者763人（1 197人次）,其中住院患者434人（479人次）,门诊患者329人（718人次）。②住院患者次均花费98 502元,其中材料费所占比例达59.02%,其次为检查治疗费和药费,床位费用所占比例最低。③门诊患者次均就诊费用614元,其中药费所占比例达59.59%,其次是检查治疗费、材料费。合并其他疾病的患者药费显著高于无合并症患者（P＜0.000 1）。④住院患者年均花费104 617元,手术治疗的住院患者年均花费154 144元,非手术治疗的住院患者年均花费24 774元。门诊患者年均就诊次数为1.61次,年均花费1 257元,无合并症门诊患者年均花费1 198元,有合并症多次就诊的门诊患者年均花费2 741元。结论 腹主动脉瘤住院患者的费用构成中材料费所占比例较大。应进一步采取综合措施,降低腹主动脉瘤患者的诊疗费用,使患者能够获得更好的效价比。     

农民施用农药健康成本影响因素研究

目的 定量研究水稻主产区农民施用农药的健康成本及其影响因素,为制定农药中毒的防治对策提供科学依据.方法 采用分层抽样的方法抽取380户水稻种植户,调查内容包括农民农药施用情况、施用农药过程中急性中毒发生情况及其成本、农民的个人防护、体质状况、是否是农药标签文盲及到医院或诊所的距离等.利用疾病成本法定量测度健康成本,应用双对数模型定量分析影响因素.结果 被调查地区农民2009年度农药施用健康成本为每人54.44元/年,明显影响健康成本的因素包括喷洒轮次和每轮用工时间、喷洒农药时采取的防护措施数量、是否是农药标签文盲、到诊所或医院的距离以及农药施用者的年龄、性别、受教育程度和营养状况.结论 为降低农民施用农药过程中的健康成本,必须加强对农民施用农药防护知识培训,提高农民的职业安全知识和自我保护意识,规范农药标签说明.     

医疗设备成本测算的标准化

该研究采用标准成本核算的方法,对部分医疗设备的成本进行标准化测算,力求使成本测算更具有代表性和可比性。该次研究在全国10个城市31所医院的7种医疗设备实际成本研究的基础上,采用Delphi法、专项调查、专题访问等方法,对成本测算中的一些参数进行标化处理,从而测算出这7种设备的标准成本,并发现大多数医院设备有效利用不足,目标设备配置的人力物力尚需合理化,医务人员劳务价值有待提高。     

Cost of breast cancer in Sweden in 2002

Breast cancer is the most common cancer among Swedish women and an important cause of illness and death. The aim of this study was to estimate the total cost of breast cancer in Sweden in 2002, using a top-down prevalence-based cost-of-illness approach. The total cost of breast cancer in Sweden in 2002 was estimated at 3.0 billion SEK (1 € = 9.4 SEK). The direct costs were estimated at 895 million SEK and constituted 30% of the total cost. Indirect costs were estimated at 2.1 billion SEK and constituted 70% of the total cost. The main cost driver was production losses caused by premature mortality, amounting to 52% of the indirect costs. The reason that indirect costs were the dominant cost is because most newly detected breast cancers occur in patients aged below 65, thus causing significant production losses due to sick leave, early retirement, and premature mortality.

The gold industry standard for risk and cost of drug and vaccine development revisited

Gold dimensions of pharmaceutical drug development indicate that it takes on average 11.9 years, with an investment around US$ 0.8 Billion, to launch one product on the market. Furthermore, approximately 22% of the drug candidates successfully complete clinical testing. These universally acknowledged proportions largely originate from one single, much cited publication; Dimasi et al. [5]. However an additional six articles describing new chemical entities (NCE) development were identified, which contain little, if any, information on vaccines. Published cumulative success rates range from 7% to 78% and investments calculations span US$ 0.8 to 1.7 Billion. Obviously this disserves further clarification?     

现代医院建立医疗质量成本报告体系的思考

通过对医疗质量成本报告体系的研究分析，阐述了医疗质量管理是永恒的主题，充分认识和高度重视与质量管理相关的成本，并对其实施有效的管理，是在质量竞争中取得优势的重要保证。     

The societal cost of alcohol consumption: an estimation of the economic and human cost including health effects in Sweden, 2002

This article estimates the societal cost of alcohol consumption in Sweden in 2002, as well as the effects on health and quality of life. The estimation includes direct costs, indirect costs and intangible costs. Relevant cost-of-illness methods are applied using the human capital method and prevalence-based estimates, as suggested in existing international guidelines, allowing cautious comparison with prior studies. The results show that the net cost (i.e. including protective effects of alcohol consumption) is 20.3 billion Swedish kronor (SEK) and the gross cost (counting only detrimental effects) is 29.4 billon (0.9 and 1.3% of GDP). Alcohol consumption is estimated to cause a net loss of 121,800 QALYs. The results are within the range found in prior studies, although at the low end. A large number of sensitivity analyses are performed, indicating a sensitivity range of 50%.

Methods for cost analysis,cost recovery,and cost control for a public hospital in a developing country: Victoria Hospital,St. Lucia

International attention has focused in recent years on methods for analysing costs of public hospitals in developing countries, with the goal of reducing the financial burden on governments by enabling improved resource allocation, by identifying areas for cost recovery and cost control, and by developing management systems to facilitate these efforts. A range of methods for cost analysis, cost recovery, and cost control are reviewed in this article, with illustrations of applications of the methods at Victoria Hospital, the national hospital in St. Lucia. Comparisons are made to similar studies in Belize, Lesotho, and the Dominican Republic. Cost-analysis methods focus on a detailed cost accounting effort which identifies the full financial costs of hospital operations and the unit costs of individual hospital services. Cost-recovery methods include an analysis of cost-related and other issues involved in setting fee levels for hospital services, determination of exemptions for certain population groups, and management of fee collection systems. Cost-control methods include analysing the degree of managerial authority exercised by hospital managers in relation to the central Ministry of Health and other government departments, identifying opportunities and incentives for cost control by individual departments within the hospital, and evaluating methods for involving physicians and other clinical decision-makers in cost control efforts. A diagnosis-independent method for utilization review of clinical decisions, the Appropriateness Evaluation Protocol, is pilot-tested and alternatives, including Diagnosis Related Groups, are discussed. Implementation issues related to long-term systems development efforts are reviewed.     

Estimation of the cost of large-scale school deworming programmes with benzimidazoles

This study estimates the cost of distributing benzimidazole tablets in the context of school deworming programmes: we analysed studies reporting the cost of school deworming from seven countries in four WHO regions.The estimated cost for drug procurement to cover one million children (including customs clearance and international transport) is approximately US$20 000.The estimated financial costs (including the cost of training of personnel, drug transport, social mobilization and monitoring) is, on average, equivalent to US$33 000 per million school-age children with minimal variation in different countries and continents.The estimated economic costs of distribution (including the time spent by teachers, and health personnel at central, provincial and district level) to cover one million children approximately corresponds to US$19 000. This study shows the minimal cost of school deworming activities, but also shows the significant contribution (corresponding to a quarter of the entire cost of the programme) provided by health and education systems in endemic countries even in the case of drug donations and donor support of distribution costs.     

北京市传统模式下避孕药具发放成本测算研究

目的:利用卫生经济学方法,对北京市传统发放模式下药具发放成本及构成进行测算。方法:对北京市药具发放4级机构抽样进行成本核算专题调研,进而推演北京市2010年度药具发放总成本。结果:育龄妇女年人均药具发放成本约为每年16.93元/人,推算药具发放总成本约为10 392万元;其中,药具成本占14.5%,固定成本占15.1%,人力成本占51.6%,日常运营成本占18.8%。结论:传统模式下药具发放成本中人力成本比重较大,亟需进行模式创新激发药具发放工作的内在活力。     

四个县级疾病预防控制机构公共卫生服务项目成本分析

目的 分析县级公共卫生服务项目实际成本中的不合理成分和影响因素。方法2005年对4个县级疾病预防控制机构进行典型案例调查,发放问卷18份,有效回收率100％。采用全成本核算和阶梯分摊法对机构的公共卫生项目分别测算了包括所有项目的实际成本、国家要求的项目成本和国家要求的全国性项目成本。结果发现县级疾病预防控制机构有28．4％～54．9％的国家要求的全国性公共卫生项目没有提供。同时,实际提供的项目中又包含了2．8％～10．2％的非国家要求的项目。部分已提供项目的监督频次未完全符合国家要求,最高达户均8次,最低仅户均2次。没有必备车辆、缺乏33．3％～43．6％的实验室设备、18．1％～45．8％的高比例后勤人员、专业技术人员年平均仅2／3时间处于满负荷状态,导致服务效率不高。因此,测算的实际成本可能存在着相当多的不合理成分,从而偏离了政府要求的合理成本。结论 建议建立一种在一定效率水平基础上、提供项目的类型和质量符合国家要求的县级公共卫生服务项目的标准成本,以保证政府补偿水平的合理性和准确性。     

The total lifetime health cost savings of smoking cessation to society

BACKGROUND: Smoking cessation has major immediate and long-term health benefits. However, ex-smokers' total lifetime health costs and continuing smokers' costs remain uncompared, and hence the economic savings of smoking cessation to society have not been determined. METHODS: The economic effects of smoking cessation in a lifetime perspective have been examined by comparing the health costs of continuing smokers and ex-smokers by quantity of daily tobacco consumption, age, gender and disease group, while taking differences in life expectancy and the reductions in relative risks after cessation into account. RESULTS: The total lifetime health cost savings of smoking cessation are highest at the younger ages. Although the economic savings vary with age at quitting, gender and quantity of daily tobacco consumption, all ex-smoking men and women who quit smoking at the age of 35 to 55 years generate sizeable total lifetime cost savings. At older ages, the total lifetime health cost savings of smoking cessation are of little economic consequence to the society. The total, direct and productivity lifetime cost savings of smoking cessation in moderate smokers who quit smoking at the age of 35 years are 24,800 euros, 7600 euros, and 17,200 euros in men, and 34,100 euros, 12,200 euros, and 21,800 euros in women, respectively. CONCLUSIONS: Lifetime health cost savings of smoking cessation to society are substantial at younger ages, in terms of both direct and productivity costs.     

Cost of introducing and delivering RTS,S/AS01 malaria vaccine within the malaria vaccine implementation program

BackgroundThe World Health Organization (WHO) recommended widespread use of the RTS,S/AS01 (RTS,S) malaria vaccine among children residing in regions of moderate to high malaria transmission. This recommendation is informed by RTS,S evidence, including findings from the pilot rollout of the vaccine in Ghana, Kenya, and Malawi. This study estimates the incremental costs of introducing and delivering the malaria vaccine within routine immunization programs in the context of malaria vaccine pilot introduction, to help inform decision-making.MethodsAn activity-based, retrospective costing was conducted from the governments’ perspective. Vaccine introduction and delivery costs supported by the donors during the pilot introduction were attributed as costs to the governments under routine implementation. Detailed resource use data were extracted from the pilot program expenditure and activity reports for 2019–2021. Primary data from representative health facilities were collected to inform recurrent operational and service delivery costs. Costs were categorized as introduction or recurrent costs. Both financial and economic costs were estimated and reported in 2020 USD. The cost of donated vaccine doses was evaluated at $2, $5 and $10 per dose and included in the economic cost estimates. Financial costs include the procurement add on costs for the donated vaccines and immunization supplies, along with other direct expenses.FindingsAt a vaccine price of $5 per dose, the incremental cost per dose administered across countries ranges from $2.30 to $3.01 (financial), and $8.28 to $10.29 (economic). The non-vaccine cost of delivery ranges between $1.04 and $2.46 (financial) and $1.52 and $4.62 (economic), by country. Considering only recurrent costs, the non-vaccine cost of delivery per dose ranges between $0.29 and $0.89 (financial) and $0.59 and $2.29 (economic), by country. Introduction costs constitute between 33% and 71% of total financial costs. Commodity and procurement add-on costs are the main cost drivers of total cost across countries. Incremental resource needs for implementation are dependent on country’s baseline immunization program capacity constraints.InterpretationThe financial costs of introducing RTS,S are comparable with costs of introducing other new vaccines. Country resource requirements for malaria vaccine introduction are most influenced by vaccine price and potential donor funding for vaccine purchases and introduction support.