Economic perspectives on diagnosis and treatment planning in periodontology

Abstract Economic factors in diagnosis and treatment planning in periodontology may be considered from several points of view. A first perspective is that of government responsibility. Because of the explosion in health care expenditure in the last decade, public funding of dental care programmes may become static or even reduced. Most governments try to curb the ever growing public health expenditure. Consequently, terms like effectiveness, efficiency and accountability are now becoming common words also in relation to periodontal health care. Moreover, private insurance companies, which have entered this area, may be individual patient who, explicitly or implicitly, would like to consider the services individual patient, who explicitly or implicitly, would like to consider the sendees rendered in periodontal therapy and prevention as cost-effective. Features of supply of and demand for care on an individual basis should also be considered. Finally, the periodontist or general practitioner has to consider economic factors. In professional life, there should be a balance between good working conditions providing satisfactory care, and the demands and priorities of individual patients and the community at large.     

降压治疗的临床探讨

目的通过对齐齐哈尔地区高血压病人治疗情况及血压、心、脑、肾、大血管损害情况的2年的跟踪调查,观察不同的降压药物对患者降压达标率,靶器官损害程度的影响。方法对齐齐哈尔地区确诊为高血压病者523人根据服药情况分为三组：A组、B组和C组。对这三组病人血压情况、靶器官损害情况通过心电图、心脏彩超、血脂、肾功等进行评价,同时还进行了组别之间的经济学评价。结果A组在血压控制达标率,保护靶器官方面均优于B、C组,A、B、C三组在长期服用的药物价格上依次减少,但住院率、恶性事件顺次增加。结论高血压病的药物治疗更强调合理和规范。本研究中A组使用了良好的规范的降压药物从而大大减低了心脑血管恶性事件的发生率,获得了良好的价效比。     

Sustainability: Concept,implementation, economic implications

This paper defines environmental sustainability and draws attention to the aggregate unsustainability of current human lifestyles and economic activities. It lists a set of sustainability conditions which imply a fundamental transformation in patterns of production and consumption, and the ways in which government policies could help to bring this transformation about. The effects of such policies on macroeconomic quantities such as output, inflation, unemployment and the balance of payments are uncertain and depend to a large extent on whether new technologies or institutional arrangements will allow the transformation to be achieved at little or no net cost — a point of controversy between technological optimists and pessimists. Whether or not moves towards environmental sustainability will permit continuing economic growth, there is no likelihood of living standards collapsing under the challenge, but new approaches to unemployment will have to be developed. Finally, although economic growth may come about as a result of environmental sustainability becoming the dominant policy objective, the converse is unlikely to be true. Putting sustainability first is both the prudent and responsible policy orientation.     

Clinical and Economic Burden of Depression/Anxiety in Chronic Obstructive Pulmonary Disease Patients within a Managed Care Population

Background: Anxiety and depression are common co-morbidities that can complicate the course of chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate their impact on healthcare utilization and costs in a managed care COPD population. Methods: Administrative claims data were used to conduct a retrospective cohort study of COPD patients ≥40 years of age, including those with co-morbid COPD-Depression (including anxiety). COPD-Depression patients were matched to COPD patients without depression (COPD-Only cohort) using propensity scores. Conditional logistic regression models assessed the 1-year risk of COPD exacerbations (i.e., emergency room [ER] visit/inpatient hospitalization) between cohorts. Differences in annual all-cause and COPD-related utilization/costs, along with 2-year costs, were also compared between the cohorts. Results: There were 3,761 patients per cohort. Patients in the COPD-Depression cohort were 77% more likely to have a COPD-related hospitalization (odds ratio [OR] = 1.77, P < 0.001), 48% more likely to have an ER visit (OR = 1.48, P < 0.001), and 60% more likely to have hospitalization/ER visit (OR = 1.60, P < 0.001) compared to the COPD-Only cohort. Average annual all-cause medical cost per patient was $23,759 for COPD-Depression vs $17,765 for COPD-Only (P < 0.001) and total (medical plus pharmacy) cost was $28,961 vs $22,512 (P < 0.001), respectively; corresponding average annual COPD-related medical cost was $2,040 vs $1,392 (P < 0.001) and total cost was $3,185 vs $2,680 (P < 0.001). Similar trends were observed over the 2-year period. Conclusions: In the COPD population, patients with depression/anxiety have significantly higher risk of COPD exacerbations and annual all-cause and COPD-related costs than patients without these co-morbidities. These findings may have therapeutic implications and seem worthy of further exploration.     

医患关系的卫生经济学思考

随着我国社会主义市场经济体制的建立,医患关系的经济色彩和法律属性逐步显露出来。我国卫生经济福利性、公益性的基本属性,决定了医患关系的非经济性和不平等性。目前：由于尚无专门调整医患关系的法律,造成了调整医患关系法的适用上的无序局面。作者认为,改善医患关系的当务之急是首肯“医疗服务是一种有别于其他服务的特殊服务”,有其自身属性和规律,因此在维护患者合法利益时,惩戒医方的力度应适当,以最终保护患者利益。