The economic burden of rotavirus hospitalization among children < 5 years of age in selected hospitals in Bangladesh

BackgroundRotavirus is a common cause of severe acute gastroenteritis among young children. Estimation of the economic burden would provide informed decision about investment on prevention strategies (e.g., vaccine and/or behavior change), which has been a potential policy discussion in Bangladesh for several years.MethodsWe estimated the societal costs of children <5 years for hospitalization from rotavirus gastroenteritis (RVGE) and incidences of catastrophic health expenditure. A total of 360 children with stool specimens positive for rotavirus were included in this study from 6 tertiary hospitals (3 public and 3 private). We interviewed the caregiver of the patient and hospital staff to collect cost from patient and health facility perspectives. We estimated the economic cost considering 2015 as the reference year.ResultsThe total societal per-patient costs to treat RVGE in the public hospital were 126 USD (95% CI: 116–136) and total household costs were 161 USD (95% CI: 145–177) in private facilities. Direct costs constituted 38.1% of total household costs. The out-of-pocket payments for RVGE hospitalization was 23% of monthly income and 76% of households faced catastrophic healthcare expenditures due to this expense. The estimated total annual household treatment cost for the country was 10 million USD.ConclusionsA substantial economic burden of RVGE in Bangladesh was observed in this study. Any prevention of RVGE through cost-effective vaccination or/and behavioural change would contribute to substantial economic benefits to Bangladesh.     

Construction of a modest-but-adequate food budget for households with two adults and one pre-school child: a preliminary investigation

• 1 A food budget which is modest-but-adequate rather than subsistence in concept has been constructed for households with 1 man, 1 woman and 1 child aged 1–4 years old. National Food Survey and Family Expenditure Survey data provided the initial points of reference with regard to food consumption patterns and expenditure.
• 2 The budget reflects current food consumption patterns in the median income group and incorporates guidelines for healthy eating. It is based on low but not minimum prices, and so allows for individual variations in food preferences and availability.
• 3 The estimated cost of home food consumption at July 1988 prices was £9.64 per person per week. Additional expenditure was required for sweets and soft drinks (73 p) and foods purchased and eaten away from home (£1.49), giving a total weekly expenditure of £11.86 per person per week, or £35.58 for the household.
• 4 The estimated increase in food costs between 1983 and 1988 was 20% using the Retail Price Index but 36% using 1988 supermarket prices. Any up-dating of budgets should therefore be based on current prices rather than on changes in the RPI.
• 5 £35.58 represents 52% of the income of a 2 adult, 1 child family on Income Support (£68.35). This is substantially in excess of the poverty line suggested by Orshansky (1965) (no more than 30% of net income spent on food). The purchase of a modest-but-adequate and healthy diet is likely to be out of the financial reach of the majority of families living on low incomes in the UK.

     

新型农村合作医疗参合农民住院费用的地区差异分析-以陕西省为例

目的：分析陕西省2011-2014年新型农村合作医疗参合农民的住院费用、自付住院费用地区差异的月度变化情况,为进一步完善新农合政策提供实证支持。方法：抽取陕西省榆林市和商洛市新农合系统内2011-2014年的住院补偿人次、住院总费用、住院补偿费用,采用时间序列分析方法进行建模分析。结果： 2011年以来,不发达地区与发达地区的次均住院费用、次均自付费用比都呈现显著上升趋势,且次均自付费用的地区差异更大。结论：新医改以来,新农合政策的不断调整和变化在改善不同地区居民医疗费用公平性方面的效果欠佳。建议新农合医保补偿政策向欠发达地区倾斜,加强对欠发达地区医疗机构的监督以及医疗机构的合理用药知识培训,严格控制欠发达地区的医疗费用。     

State-level medical and absenteeism cost of asthma in the United States

Objective: For medically treated asthma, we estimated prevalence, medical and absenteeism costs, and projected medical costs from 2015 to 2020 for the entire population and separately for children in the 50 US states and District of Columbia (DC) using the most recently available data. Methods: We used multiple data sources, including the Medical Expenditure Panel Survey, U.S. Census Bureau, Kaiser Family Foundation, Medical Statistical Information System, and Current Population Survey. We used a two-part regression model to estimate annual medical costs of asthma and a negative binomial model to estimate annual school and work days missed due to asthma. Results: Per capita medical costs of asthma ranged from $1,860 (Mississippi) to $2,514 (Michigan). Total medical costs of asthma ranged from $60.7 million (Wyoming) to $3.4 billion (California). Medicaid costs ranged from $4.1 million (Wyoming) to $566.8 million (California), Medicare from $5.9 million (DC) to $446.6 million (California), and costs paid by private insurers ranged from $27.2 million (DC) to $1.4 billion (California). Total annual school and work days lost due to asthma ranged from 22.4 thousand (Wyoming) to 1.5 million days (California) and absenteeism costs ranged from $4.4 million (Wyoming) to $345 million (California). Projected increase in medical costs from 2015 to 2020 ranged from 9% (DC) to 34% (Arizona). Conclusion: Medical and absenteeism costs of asthma represent a significant economic burden for states and these costs are expected to rise. Our study results emphasize the urgency for strategies to strengthen state level efforts to prevent and control asthma attacks.     

中国公共卫生支出效率的时空演变及影响因素分析

目的:从时空角度研究我国省级单元公共卫生支出效率的分布特征及影响因素,为进一步提升公共卫生支出效率提供实证依据。方法:采用DEA-Malmquist模型对我国31个省区2010~2019年公共卫生支出效率的时空演化特征进行实证分析,构建Tobit回归模型探究影响公卫生支出效率的因素。结果:综合效率(0.674)、纯技术效率(0.775)、规模效率(0.869)三者均值表明纯技术效率是致使综合效率偏低的主要因素;各时段,全要素生产率指数值普遍小于1,全要素生产率整体表现为下降;技术效率变化和技术进步变化年均降低率分别为1.37%和5.29%,技术进步是驱动全要素生产率降低的主要因素;公共卫生支出效率存在明显的空间分异,中部地区的综合效率普遍高于东西部地区,中部(0.9280)及西部(0.9535)地区全要素生产率指数值整体高于东部地区(0.9123);人均GDP、城镇化率、公共卫生支出占比和人口密度对公共卫生支出效率具有显著影响。结论:我国公共卫生支出效率有待提高且存在明显的空间分异特征,组织管理水平、技术进步不足是阻碍我国公共卫生支出效率提高的主要因素,应采取完善转移支付制度、合理调整公共卫生支出结构与规模等相关措施提高我国公共卫生支出效率。     

基于GM(1,1)模型的北京市卫生总费用及构成变化趋势预测分析

目的 对北京市2020—2026年未来7年卫生总费用及构成的变化情况进行科学预测。方法 基于北京市2011—2019年卫生总费用相关数据构建灰色GM(1，1)预测模型。结果 模型的精确度均达93%以上，模型的精度较高。2020—2026年，北京市卫生总费用将从3195.31亿元增加到6511.04亿元，年均增长率为12.60%，其中政府和个人卫生支出占比分别从21.44%、13.55%下降至17.75%、9.25%，社会卫生支出将从65.02 %上升至72.80%。结论 北京地区仍需科学合理地配置卫生资源，有效减轻人民的就医负担，，满足新时代人民的健康生活需要，让人民共享经济发展成果。     

Self-paced and fixed speed treadmill walking yield similar energetics and biomechanics across different speeds

BackgroundTreadmill assessments are often performed at a fixed speed. Feedback-controlled algorithms allow users to adjust the treadmill speed, hereby potentially better resembling natural self-paced locomotion. However, it is currently unknown whether the energetics and biomechanics of self-paced differ from fixed-paced treadmill walking. Such information is important for clinicians and researchers using self-paced locomotion for assessing gait.Research questionTo investigate whether energy cost and biomechanics are different between self-paced and matched-speed fixed-paced locomotion.Methods18 healthy participants (9 males/9 females, mean ± standard deviation age 24.8 ± 3.3 years, height 1.71 ± 0.81 m, weight 65.9 ± 8.1 kg) walked at four different self-paced speeds (comfortable, slow, very slow, fast) in randomized order on an instrumented treadmill while three-dimensional motion capture and gas exchange were measured continuously. The average walking speed during the last 2 min of the self-paced trials was used to match the speed in fixed-paced conditions. Linear mixed models were used to assess differences in mean values and within-subject variations between conditions (self-paced and fixed-paced) and speeds. Statistical Parametric Mapping was used to assess differences in kinematics of the lower limb between conditions.ResultsAlthough self-paced walking consistently resulted in a 4–6% higher net cost of walking, there were no significant differences in the net cost of walking between conditions. Further, there were also no differences of clinical relevance in spatiotemporal outcomes and sagittal-plane lower-limb kinematics between the self-paced and fixed-paced conditions. Within-trial variability was also not significantly different between conditions.SignificanceSelf-paced and fixed-paced treadmill walking yield similar energetics and kinematics in healthy young individuals when mean values or linear measures of variation are of interest.