Search

Since 1958, the Japanese public health insurance system has covered psychoanalytic psychotherapy. Although it is called ‘standard-type psychoanalytic therapy’, it is essentially psychoanalytic psyc...

France has a single-payer health insurance system that has the authority to impose pharmaceutical price reductions but relies on decentralized market negotiations between hospitals and manufacturers to establish prices for injected and infused biologics. Hospitals rely on biosimilars-less expensive but therapeutically equivalent variants of biologic medications-to stimulate competition. Price reductions negotiated by hospitals subsequently are adopted by the health insurance system, driving hospitals to negotiate a new round of discounts. This article measures 2004-20 trends in prices, price reductions, utilization, and market shares for three prominent biologics-Remicade, Enbrel, and Humira-and their eleven competing biosimilars. Biosimilar launches are associated with a sequence of price reductions for the reference biologic, for other biologics that treat similar conditions, and for all related biosimilars. The French experience provides lessons for the US in its efforts to use competition from biosimilars to drive price reductions and savings from biologics.

Objectives: To compare the total medical cost and post-operative quality of life between laparoscopic radical prostatectomy (LRP) and robotic-assisted laparoscopic radical prostatectomy (RALP) and to discuss the cost differences of each approach. Materials and Methods: Data were retrospectively reviewed from patients diagnosed with prostate cancer and who underwent LRP (n=68) or RALP (n=104) during a 36-month period. The prostate cancers of all patients were classified as low, intermediate, or high risk. Patient variables, inpatient hospital charges, outpatient total medical costs within 24 months and post-operative quality of life were compared. Results: The baseline patient characteristics were similar between each group. Rates of positive margins and the need for further cancer treatment were correlated with the burden of disease (highest in the high risk group). The RALP inpatient hospital charges were higher in all risk groups. However, the mean total outpatient hospital charges were comparable. The RALP group demonstrated a trend towards better sexual-related quality of life in all risk groups. However, urinary incontinence, urinary-related, bowel-related, vitality-related quality of life were not significantly different between LRP and RALP. Conclusion: From the payer’s perspective, RALP costs are higher than LRP costs. The clinical and quality of life benefits associated with RALP may not convert into a net savings of total medical costs within 24 months after surgery.

The purpose of the present analysis was to explore the cost-effectiveness of tisagenlecleucel in relapsed or refractory (r/r) paediatric acute lymphoblastic leukaemia (pALL) and r/r adult diffuse large B-cell lymphoma (DLBCL) in Switzerland against a range of historical standard-of-care treatments. Two cost-utility models were constructed for the two licensed indications using similar methodologies but indication-specific data. Clinical efficacy data were based on pooled analyses of clinical trials for tisagenlecleucel (pALL: ELIANA, ENSIGN, B2101J; DLBCL: JULIET, NCT02030834) and published data for comparator treatments. Treatment effects were compared based on matching-adjusted indirect comparison (MAIC) analyses. Four clinical lymphoma and leukaemia experts provided Switzerland-specific input regarding comparators, diagnostic and therapeutic procedures, clinical evidence and costs, which were used to inform the models. The base case analysis reflected the perspective of the Swiss mandatory health insurance system. Deterministic, probabilistic and scenario analyses were carried out to explore the robustness of results. The base case analysis resulted in incremental costs of CHF 31,961–CHF 36,419 per quality-adjusted life year (QALY) gained for pALL across the different comparators and CHF 113,179 for DLBCL (1 CHF = 1.09 USD). Incremental costs per life-year gained ranged between CHF 33,906–CHF 97,399 across the two indications. Including productivity gains, tisagenlecleucel was shown to be dominant (more effective and less costly) over all the comparators for pALL and to result in incremental costs per life-year gained of CHF 57,324 for DLBCL. Using hypothetical willingness-to-pay thresholds of CHF 100,000–150,000 per QALY gained, the present analysis has shown tisagenlecleucel to be a cost-effective treatment option in pALL and DLBCL.

The last decade has brought a sharp rise in healthcare costs in the US. This was not accompanied by an improvement in the indicators of the quality of healthcare. The health care system in the US, based in the same amount on private insurance as public funding, proved to be ineffective. This fact is mainly attributed to the growing costs of administering the complex system and high prices of medicines. And although the share of labor costs, including the remuneration of doctors in general health care expenditures, is relatively small (20%), there is an urgent need to look for pro-efficiency solutions also in this area. However, they must be accompanied by fuses that ensure adequate quality of health services and their availability. The article presents the mechanisms of employing doctors and their remuneration as an important element of systemic solutions in health care in the USA. It also features some characteristics of the pay relation. The article uses mainly secondary sources, including OECD statistical data. The results of reports published in American literature by various bodies and institutions, including Medscape and Doximity – the most popular American portals associating doctors, were also used. The information collected during unstructured interviews with participants of the health care system (doctors, hospital directors) during their stay in the USA was used as auxiliary.

Background: Cardiovascular diseases have been noted to be expensive to manage and tend to cause significant morbidity and financial burden to affected individuals and households. Objective: This study aimed to determine the various sources of health financing among patients admitted to UNTH Ituku/Ozalla for open-heart surgery. Methodology: Twenty-five patients admitted for cardiac surgery over a 6-month period were selected for the study. A structured questionnaire was administered to the patients or their caregivers. Data were analyzed using SPSS version 20. Results: There were 25 respondents who were admitted during the study period, this comprised 17 children and 8 adults. Among the respondents 24 (96%) paid out of pocket, 1 (4%) was by government tax. The major sources of funds were from personal savings 56% and goodwill from friend's relations, faith-based organizations (4%), while 36% of the respondents borrowed money for the surgery. Three of the respondents had a form of health insurance, while 22 (88%) had no form of health insurance. The mean monthly income of the households was 86,320 (81,384.7) Naira and the mean monthly food expenditure was 33,200 (15934.76) Naira. About 72% (18) of the subjects knew about the National Health Insurance Scheme (NHIS), 4 (16%) knew about the Voluntary Health Insurance Scheme (VHIS), while 84% did not know about the VHIS. However, about 56% of the subjects were willing to enroll under the NHIS voluntary scheme. The cardiac surgery was catastrophic for 96% of the respondents. Conclusion: Cardiac surgery causes a significant financial burden to individuals and households. Individuals and households should be properly counselled on the benefits of health insurance. The government should increase funding for cardiovascular health and strengthen the health insurance system.

The review reflects the priorities and main directions of development of compulsory medical insurance and legal regulation in the field of health care, as well as tasks aimed at preserving and strengthening the health of citizens of the Russian Federation based on increasing the availability and quality of medical care, respecting the rights of citizens in the field of health protection and ensuring state guarantees related to these rights, the priority of prevention in the field of health protection in the Russian Federation.

To achieve universal health insurance coverage, many developing countries have established a segmented health insurance system, which contains separate programs for workers with formal employment and residents without formal employment. A potential concern with such a segmented system is that the establishment of a non-employment-based insurance program may generate a disincentive for firms to provide health insurance benefits to workers. In this study, we empirically examine this crowd-out effect of a non-employment-based insurance program, the Urban Residents Basic Medical Insurance (URBMI), in China. Exploiting city-by-year variations in the roll-out process of the program and utilizing a unique administrative dataset on Chinese firms, we find that the enactment of URBMI reduced a firm's offering of an employment-based health insurance program by a statistically significant 0.94-1.29 percentage point. This crowd-out effect was stronger among domestic private firms, new firms, and firms that are individual-owned.

RESUMEN Objetivos Evaluar el impacto nutricional de un minimercado mensual de alto valor nutricional entregado, mediante charlas educativas, a familias de recién nacidos prematuros y/o de bajo peso al nacer (BPN), en el marco de los Programas Madre Canguro (PMC), en Bogotá y Cundinamarca; asimismo, identificar los factores de riesgo que predisponen la aparición de la desnutrición (

The health insurance system in Korea is well-established and provides benefits for the entire national population. In Korea, when patients are treated at a hospital, the hospital receives a partial payment for the treatment from the patient, and the remaining amount is provided by the health insurance service. The Health Insurance Review and Assessment Service (HIRA) assesses whether the treatment was appropriate. If HIRA deems the treatment appropriate, the doctor can receive payment from the health insurance service. However, this system has several drawbacks. In this study, we aimed to provide examples of the problems that can occur in relation to HIRA assessments in Korea through actual clinical cases.

Саламаттыкты сактоо үчүн ресурстардын потенциалдуу булактарын издөө каржылоону жакшыртууну талап кылат. Республикалык бюджеттин каражаттары чыгашаларынын негизги булагы болуп калууда. Мамлекеттик кепилдиктер менен медициналык жардамды алуунун реалдуу экономикалык шарттарынын ортосунда ажырым бар. “Милдеттүү медициналык камсыздандыруу системасы”, камсыздандыруунун чыныгы үлгүсү болуп эсептелбейт, анткени ал салык органдары жана Социалдык фонд кызматкерлери тарабынан топтолуучу камсыздандыруу төгүмдөрүн кайра бөлүштүрүү функциясын гана аткарат. Камсыздандырылган бейтап ММК системасынын субъектилеринин мамилелер системасынан тышкары болот. Акылуу медициналык кызмат көрсөтүүлөр саламаттык сактоо бюджетиндеги үлүшү 6%дан ашпайт, төлөмдүн олуттуу бөлүгү «формалдуу эмес төлөмдөрдүн» формасына ээ болот. Стационарларда дарылоо үчүн кошумча төлөө көлөмүн белгилөө принциби негиздүү эмес экенин белгилеп коюу керек.

Objective Kampo is a traditional Japanese medicine using formulae of natural agents. Although Kampo is widely practiced, information regarding the current prescriptions of Kampo formulations is lacking. The aim of the study was to describe the outpatient use of Kampo formulations in the current Japanese health insurance system. Methods From the JMDC Claims Database, we identified subscribers with outpatient prescriptions of Kampo extract formulations between April 2017 and March 2018. Prescription records were summarized at the individual level to describe the pattern of each formula's use, such as the frequency of prescription and the number of days within a year that were covered by the prescriptions. We also examined whether or not Kampo formulations were prescribed in combination with other drugs. Results Of the 4.5 million subscribers, 13.5% received prescriptions of Kampo extracts within 1 year, and 54% of Kampo users were women. The most commonly prescribed Kampo formulae included kakkonto, shoseiryuto, and maoto, which were used for the short term covering a median of 5 to 7 days. There were also several formulae that were prescribed for longer periods. The median numbers of days covered by kamishoyosan and keishibukuryogan were 60 and 56, respectively. Kampo formulations were used in combination with Western drugs in 85% of prescriptions. Conclusion Kampo formulations are commonly prescribed under the Japanese insurance system and are frequently used in combination with Western drugs. The pattern of prescriptions varied across different formulae.

The paper aims to identify key aspects of the essence of eHealth (digital hospitals, clinical information systems, computerized medical records, telemedicine) as a priority European policy and how it is reflected in the national legislation of Bulgaria. In this sense, the aim of the study is first to highlight the typical European trends in the development of eHealth through continuous and well-established processes of application of digital technology to healthcare and their incorporation into the Community policies as a legal framework, and second to analyze national processes and stages of digitalization of healthcare and the health insurance system in terms of the creation of functioning and adequate eHealth. Based on the analysis performed, the authors have drawn conclusions about trends in and legal effects of the regulatory framework related to the efficiency of healthcare and the effective management of the health insurance systems.

This article explores the development of health insurance system in China over the period from 1978 to 2001. The author reviews the implementation of market mechanisms in health insurance system; provides statistical data on the number of insured persons residing in the city or rural localities. Analysis is conducted on legislation that regulates insurance activity in the sphere of medicine. The conclusion is made that the implementation of such systems affected by migration from rural to urban areas led to imbalance in the quality and availability of medical services. It is noted that despite the efforts of Chinese authorities, health insurance system did not expand neither the number of insured rural or urban residents; dependence of the level of medical care on the level of salaries led to segregation of rich and poor citizens. The employees with insufficient salary level were trying to reduce the cost treatment, as it partially compensated from their personal savings, which also led to severe sanitary consequences. Therefore, the implementation of market mechanisms in health insurance led to inequality of the citizens with regards to availability of medical services. &nbsp

Using an interpretative comparison in search for cross-case similarities and differences, we examine the evolution of equity of access to healthcare during the economic crisis in two potentially vulnerable Eastern and Southern European countries – Lithuania and Spain. While the type of healthcare system may have shown higher resilience, i.e. equity of access to care during the crisis should have been affected more in Lithuania – a relatively immature health insurance system – than in Spain – a consolidated national health service, the intensity and length of the crisis and types of adjustment measures undertaken may have led, in turn, to different results in terms of equity of access. The analysis focuses on the respective institutional designs and healthcare reforms under austerity as well as subjective and objective indicators of access to care. We conclude that the Lithuanian healthcare system, despite potential comparative disadvantage, has shown greater performance than the Spanish one during the crisis.

The article discusses issues of antineoplastic radiation, particularly radionuclide, therapy payment through compulsory health insurance system. Healthcare organization faces several problems in this field when introducing new treatment methods. Regulatory and infrastructural aspects of the radionuclide therapy provision are brought up. The article discusses the problem raised by the average payment for the diagnostic-related groups (DRG) at the federal level, which makes it difficult to use selected medical services with the cost above the average DRG tariff. As an example, the article describes the experience of Kemerovo region on tariff correction using subgroup split-off method for DRG that includes systemic radionuclide therapy with radium-223. Splitting the federal DRG for sub-groups gave the possibility of providing therapy to patients with prostate cancer in the region. Besides, the authors discuss the relevance and practical aspects of interregional payments in the compulsory healthcare insurance system with respect to the radionuclide therapy in order to improve the quality of medical care for patients with cancer, regardless of infrastructural restrictions and the patients’ residence.

The purpose of the article was to reveal the analytical tools for evaluating the effectiveness of the allocated financing funds for the provision of the services provided in the public sector of the economy, the application of which does not have a uniform methodology today. The possibility to solve this issue is shown with regard to the compulsory health insurance system. To achieve the goal, the study reveals the definition of such categories as “effect” and “efficiency” of the medical institutions activities, “efficiency of spending” of the Territorial Fund for Compulsory Health Insurance. There is revealed the analytical significance of the existing methodological approaches to assessing the effectiveness of health care costs; their comparative analysis is carried out. Based on the results, the alternative is proposed, based on the system of the cost-effectiveness indices to achieve the health, social and economic effects of medical institutions; the analytical advantages of the alternative proposed are justified.

The Affordable Care Act (ACA) is one of the most important reforms of the US health insurance system since the introduction of Medicare. Since employment is a main source of health insurance for the working age population in the United States, this sweeping health insurance reform also has important implications for the labor market and the macro economy. In this paper, we survey the prototype models that are used in the macro and labor literature, extended to integrate health and health insurance, to study the short- and long-run consequences of the ACA. We also suggest open areas for future research. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Objectives To evaluate the cost-effectiveness of biologics and methotrexate (MTX) for rheumatoid arthritis (RA) using the number needed to treat (NNT) concept and total actual health care cost. Methods This study included 121 RA patients with newly prescribed biologics and/or MTX between 2012 and 2017. The NNT was calculated based on the 24 week remission rate of Disease Activity Score in 28 joints using erythrocyte sedimentation rate (DAS28-ESR) and Clinical Disease Activity Index (CDAI). Results Remission rates were 76.4% for DAS28-ESR and 45.4% for CDAI in the biologics group and 63.6% and 24.2%, respectively, in the MTX group. The NNT was calculated as 6.4 and 4.2 in the biologics group and 34.2 and 35.2 in the MTX group, respectively. Mean total actual health care costs were 1,044,066 JPY (9835 US$)/24 weeks per treated patient in the biologics group and 75,860 JPY (715 US$)/24 weeks in the MTX group. Although the effectiveness of biologics was superior to MTX from the standpoint of NNT, the mean total health care cost and mean cost per NNT were much higher in the biologics group. Conclusions Cost-effectiveness is clearly higher for MTX than biologics from the standpoint of mean total health care cost per adjusted NNT under the Japanese health insurance system.

This article analyzes the strengths and weaknesses of the existing global health care models and proposals for health care reform in the social protection system of Uzbekistan

The Belgian Law of 20 July 2007 has drastically changed the Belgian private health insurance sector by making individual contracts lifelong with the technical basis (i.e. actuarial assumptions) fixed at policy issue. The goal of the Law is to ensure the accessibility to supplementary health coverage in order to protect policyholders from discrimination and exclusion, essentially when these operate on the basis of age. Due to the unpredictable nature of medical inflation risk and the difficulty to model future increases of health claims, the legislator introduced medical indices together with a specific updating mechanism, which aim at establishing standardized and fair premium adjustments across the sector. This paper considers two major issues of the current Belgian system. The first one is related to the transferability of the reserves, whereas the second one is related to age-discrimination. We discuss these issues and their interplay, and we address the conflict between the goal of the Law and the practical problems arising in the light of the actuarial techniques., SCOPUS: re.j, info:eu-repo/semantics/published