Removal of user fees for caesareans and under‐fives in northern Sudan: a review of policy implementation and effectiveness

In 2008, the Government of Sudan launched a policy of free curative care for under‐fives and caesareans. This paper presents the findings of a review of this policy, on the basis of research conducted in five focal states of northern Sudan in 2010. Policy implementation was assessed using four research tools: key informant interviews, exit interviews, a facility survey, and analysis of facility finances and the cost of the package of care. The findings point to important weaknesses in implementation, such as unclear specification of the exact target group and package of care and inadequate funding. Despite this, service utilisation appears to have responded, at least in the short term. The findings also highlight the urgent need for improved access to basic health care and financial protection against health care costs in northern Sudan (for those with and without national health insurance membership). This review contributes to the growing literature on the selective removal of user fees for priority services. It indicates the range of challenges to effective implementation (strategic, financial and organisational). Some of these are particular to Sudan, but many are shared, and indicate important lessons for improving access to and quality of care for women and children in Africa. Copyright © 2012 John Wiley & Sons, Ltd.     

Subsidising patient dispensing fees: The cost of injecting equity into the opioid pharmacotherapy maintenance system

Introduction and Aims. Australian pharmacotherapy maintenance programs incur costs to patients. These dispensing fees represent a financial burden to patients and are inconsistent with Australian health‐care principles. No previous work has examined the current costs nor the future predicted costs if government subsidised dispensing fees. Design and Methods. A system dynamics model, which simulated the flow of patients into and out of methadone maintenance treatment, was developed. Costs were imputed from existing research data. The approach enabled simulation of possible behavioural responses to a fee subsidy (such as higher retention) and new estimates of costs were derived under such scenarios. Results. Current modelled costs (AUS$11.73m per month) were largely borne by state/territory government (43%), with patients bearing one‐third (33%) of the total costs and the Commonwealth one‐quarter (24%). Assuming no behavioural changes associated with fee subsidies, the cost of subsidising the dispensing fees of Australian methadone patients would be $3.9m per month. If retention were improved as a result of fee subsidy, treatment numbers would increase and the model estimates an additional cost of $0.8m per month. If this was coupled with greater numbers entering treatment, the costs would increase by a further $0.4m per month. In total, full fee subsidy with modelled behavioural changes would increase per annum government expenditure by $81.8m to $175.8m. Discussion and Conclusions. If government provided dispensing fee relief for methadone maintenance patients, it would be a costly exercise. However, these additional costs are offset by the social and health gains achieved from the methadone maintenance program.[Chalmers J, Ritter A. Subsidising patient dispensing fees: The cost of injecting equity into the opioid pharmacotherapy maintenance system. Drug Alcohol Rev 2012;31:911–917]     

不稳定性心绞痛的病种费用分析

目的 探讨近两年本院收治的不稳定性心绞痛(ICD10 编码为I20.0) 在平均住院日、住院费用等方面的变化规律,为病种费用控制提供参考.方法 通过医院信息系统(HIS) 抽取满足条件的住院患者费用、用药、材料等信息,计算平均住院日、费用消耗、费用构成等指标,分析该病种的常规用药与治疗措施.结果 该病种2 年平均住院日8.85d,次均住院费4万元左右.材料费占总住院费56.06%.费用前10 位的药品占总药费50.45%,且有7 个品种是辅助用药.结论 不稳定性心绞痛住院人次逐年升高,治疗费用高昂,高值耗材是费用控制的关键;辅助用药比例偏高,存在不合理用药问题.     

Learning from health system reforms: lessons from Burkina Faso

OBJECTIVES: Burkina Faso has implemented a macroeconomic adjustment programme (MAP) along with an ambitious reform of the health care system. Our aim was (1) to verify whether MAPs led to a reduction in health resources, and (2) to analyze the consequences of health policies implemented. METHOD: Cross-sectional and retrospective study, spanning the years 1983-2003. The macro aspect is based upon documents from national and international sources, a database of secondary socioeconomic data, and interviews of key informants working in upper management. Household and health facility surveys were conducted in three regions covering 53 communities. RESULTS: Within the reforms, the health sector benefited from an important flow of resources. There were significant increases in public expenditures, health care staff, the number of primary care facilities and the availability of generic drugs. However, health facilities in the public sector remain underused and major inequities subsist. Access to health care is constrained by the population's ability to pay. Health expenditures impoverish households, creating new poor and impoverishing the already poor. CONCLUSIONS: The success of reforms depends largely on the extent to which they remove financial barriers to access to services. The experience of Burkina Faso also reveals the need for fundamental changes that will motivate staff, improve productivity, and ensure good quality services. Integrating health development policies with strategic plans for poverty reduction can provide new opportunities for African countries to redesign their health systems within this type of perspective.     

研究生助研经费的发放有利于提高医院学科建设水平

针对西安交通大学医学院第一附属医院研究生助研经费发放过程中存在的一些问题，笔者提出了相应的解决办法，并进一步分析了通过发放助研经费不仅有利于促进各学科师资队伍、人才培养水平的提高，学科方向的凝练与稳定，科研支撑条件的改善，从而还有利于促进整个医院学科建设水平的提高。     

医院微机化管理后乱收费的表现及治理对策

随着微机在医院收费管理中的广泛应用,出现了各种新形式及名目的乱收费现象。文章对医院微机化管理后乱收费的主要表现进行了分析,提出了遏止医院乱收费的对策及建议。     

The Impact of Medicaid Reform on Children’s Dental Care Utilization in Connecticut,Maryland, and Texas

ObjectiveTo measure the impact of Medicaid reforms, in particular increases in Medicaid dental fees in Connecticut, Maryland, and Texas, on access to dental care among Medicaid-eligible children.Data2007 and 2011–2012 National Survey of Children’s Health.ConclusionsIncreasing Medicaid dental fees closer to private insurance fee levels has a significant impact on dental care utilization and unmet dental need among Medicaid-eligible children.     

The effect of differential eligibility for free GP services on GP utilisation in Ireland

Internationally, there is extensive empirical evidence that a strong primary care-led health system is associated with improved health outcomes, increased quality of care, decreased health inequalities and lower overall health-care costs. Within primary care, factors influencing access to, and utilisation of, general practitioner (GP) services have been widely examined and this paper focuses on the role of user financial incentives. In particular, user charges for health care have been observed to deter health-care utilisation. Relative to other countries, the Irish health-care system is unusual in that the majority of the population are required to pay out-of-pocket for GP care. However, in 2005 the Irish government extended eligibility for free GP care to a further small subset of the population. Using micro-data from a nationally representative survey of the population in 2007, this paper analyses the impact of differential coverage of free GP services on GP utilisation in Ireland. Results from multivariate regression analysis indicate that GP utilisation is significantly more likely in the context of free GP care, controlling for a range of demographic, socio-economic and health factors. Interpretation of the results for the new category of coverage is complicated by possible pent-up demand and selection effects.     

Healthcare Spending and Performance of Specialty Hospitals: Nationwide Evidence from Colorectal-Anal Specialty Hospitals in South Korea

Purpose

Aim of this study is to investigate the characteristics and performance of colorectal-anal specialty vs. general hospitals for South Korean inpatients with colorectal-anal diseases, and assesses the short-term designation effect of the government''s specialty hospital.

Materials and Methods

Nationwide all colorectal-anal disease inpatient claims (n=292158) for 2010-2012 were used to investigate length of stay and inpatient charges for surgical and medical procedures in specialty vs. general hospitals. The patients'' claim data were matched to hospital data, and multi-level linear mixed models to account for clustering of patients within hospitals were performed.

Results

Inpatient charges at colorectal-anal specialty hospitals were 27% greater per case and 92% greater per day than those at small general hospitals, but the average length of stay was 49% shorter. Colorectal-anal specialty hospitals had shorter length of stay and a higher inpatient charges per day for both surgical and medical procedures, but per case charges were not significantly different. A "specialty" designation effect also found that the colorectal-anal specialty hospitals may have consciously attempted to reduce their length of stay and inpatient charges. Both hospital and patient level factors had significant roles in determining length of stay and inpatient charges.

Conclusion

Colorectal-anal specialty hospitals have shorter length of stay and higher inpatient charges per day than small general hospitals. A "specialty" designation by government influence performance and healthcare spending of hospitals as well. In order to maintain prosperous specialty hospital system, investigation into additional factors that affect performance, such as quality of care and patient satisfaction should be carried out.