Rare Disease Curative Care Expenditure- Financing Scheme-Health Provider- Beneficiary Group Analysis — An Empirical Study in Sichuan Province, China

Background: Rare diseases impose heavy economic burdens on patients’ families and society worldwide. This study has used the samples from Sichuan Province of China to estimate the curative care expenditure(CCE) of ten rare diseases to provide reference and support for the prioritization of rare disease health policies. Methods: The multi-stage cluster sampling method was adopted to conduct a survey of 9714 rare disease patients from 1,556 medical institutions in Sichuan Province in 2018. Based on System of Health Accounts 2011, the study estimated the total curative care expenditure on rare diseases and identified financing sources and their allocation among different health institutions and the patient population. Results: In 2018, the total CCE of the ten rare diseases in Sichuan Province was 19.001 million US dollars; the top three rare diseases in terms of CCE were Hemophilia ($4.3786 million), Young-onset Parkinson Disease ($2.9627 million) , and Systemic Sclerosis ($2.4457 million); household out-of-pocket expenditure (86.00% for outpatients, 41.60% for inpatients) and social health insurance (7.85% for outpatients; 39.58% for inpatients) were the main sources of financing. The out-of-pocket expenditures for patients with Young-onset Parkinson Disease, Congenital Scoliosis, Autoimmune accounted for more than 60% of the total CCE. More than 80% of the rare disease CCE was incurred in general hospitals. The 40-59 age group consumed the highest percentage of CCE (38.70%) while men spent slightly more (55.37%) than women (44.64%). Conclusions: Since rare disease treatment is costly and household out-of-pocket expenditure is high, we suggest taking steps to include rare disease drugs in the National Reimbursement Drug List, scientifically design insurance coverage range. It is also necessary to explore a multi-tiered Healthcare Security System to pay for the CCE of rare diseases and to reduce the economic burdens of patients.

Intolerable Burden of Malaria among Primitive Tribal Community in Odisha: Examining the Fundamental Cause

This study seeks to examine the living conditions, working conditions, and health seeking behaviour for malaria among Kondho community after one is infected with malaria. The residential surroundings of those diagnosed with malaria positive cases were extremely conducive for mosquito breeding. For instance, the majority of households threw garbage near their house, went for open defecation, the cowshed was beside their houses, and above all the houses were mostly situated in the jungle or near thick forest. Sub-centre followed by the community health centres was the first point of contact in most cases but medical care was sought only after routine life was affected. While malaria treatment plans are changing towards administering more powerful drugs as a result of chloroquine resistance but not as much has been done in the ground to prevent malaria at the first place. Therefore, together with continuing curative care for malaria—more emphasis is needed on its prevention. Community, civil society and the government need to work in tandem to improve the living and working conditions of backward communities particularly those living in malaria endemic zone so as to be able to take effective preventive measures for malaria.

Impact of Beijing healthcare reform on the curative care expenditure of outpatients with noncommunicable diseases based on SHA2011 and interrupted time series analysis

Background To analyse the changes in curative care expenditure (CCE) associated with noncommunicable diseases (NCDs) before and after the Beijing healthcare reform, thus providing a reference for the healthcare system. Methods A total of 60 medical institutions were selected using multistage stratified cluster random sampling in Beijing, China. The records of approximately 100 million outpatients with NCDs in 2016–2018 were extracted. System of Health Accounts 2011 (SHA2011) was used to estimate the CCE. The segmented regression model was established to observe both the instant change and the slope change of intervention in interrupted time series analysis (ITSA). The study was conducted from December 2019 to May 2020 in Beijing, China. Results From SHA2011, we found that the CCE for outpatients with NCDs in Beijing were 58.59, 61.46 and 71.96 billion RMB in 2016, 2017 and 2018, respectively. The CCE continued to rise at all hospital levels, namely, tertiary, secondary, and community-level hospitals. However, the proportion of CCE in tertiary hospitals decreased. From ITSA, we can also conclude that the CCE showed a significant increasing trend change at the three hospital levels after the intervention. The drug proportion showed a significant decreasing trend change in secondary and tertiary hospitals. Conclusions Beijing healthcare reform does have an impact on the CCE of NCDs.

Connected care for endocarditis and heart failure patients: a hospital-at-home programme

Background Healthcare expenditure in the Netherlands is increasing at such a rate that currently 1 in 7 employees are working in healthcare/curative care. Future increases in healthcare spending will be restricted, given that 10% of the country’s gross domestic product is spent on healthcare and the fact that there is a workforce shortage. Dutch healthcare consists of a curative sector (mostly hospitals) and nursing care at home. The two entities have separate national budgets (€25 bn + €20 bn respectively) Aim In a proof of concept, we explored a new hospital-at-home model combining hospital cure and nursing home care budgets. This study tests the feasibility of (1) providing hospital care at home, (2) combining financial budgets, (3) increasing workforces by combining teams and (4) improving perspectives and increasing patient and staff satisfaction. Results We tested the feasibility of combining the budgets of a teaching hospital and home care group for cardiology. The budgets were sufficient to hire three nurse practitioners who were trained to work together with 12 home care cardiovascular nurses to provide care in a hospital-at-home setting, including intravenous treatment. Subsequently, the hospital-at-home programme for endocarditis and heart failure treatment was developed and a virtual ward was built within the e‑patient record. Conclusion The current model demonstrates a proof of concept for a hospital-at-home programme providing hospital-level curative care at home by merging hospital and home care nursing staff and budgets. From the clinical perspective, ambulatory intravenous antibiotic and diuretic treatment at home was effective in safely achieving a reduced length of stay of 847 days in endocarditis patients and 201 days in heart-failure-at-home patients. We call for further studies to facilitate combined home care and hospital cure budgets in cardiology to confirm this concept.

Self-care: Concept, Rationale, and Framework

The role and importance of self-care in the continuum of health care are becoming important subjects of debate among social scientists and health professionals. Interest in the self-care component of health services is stimulated by the convergence of diverse pressures common to health services systems. Depersonalized medical care, rising costs of high technology, focus on curative care, growth of lay knowledge, recognition of the limits of medical care, and documentation of the impact of the individual’s health behavior on patterns of morbidity are all factors stimulating new thinking regarding the importance of individuals and families to the effective and efficient functioning of health service systems.

Evolution of plasma vitamin B12 in patients with solid cancers during curative versus supportive care

IntroductionThe direction of the causal link between solid cancers and elevated plasma vitamin B₁₂ (B₁₂) remains uncertain.Material and methodsWe retrospectively included patients having two B₁₂ measurements with a B₁₂ initially ≥ 1000 ng/l and a solid cancer diagnosed between the measurements. Patients were included in the Curative or Supportive group according to their treatments.ResultsB₁₂ changes over time differed among groups (<i>p</i> = 0.001): +157.4 ng/L/month in the Supportive care group versus -171.6 ng/L/month in the Curative care group.ConclusionsThe decrease of plasma B₁₂ in cases of curative care could suggest that this B₁₂ elevation is secondary to solid cancers.

Costs and Affordability of COVID-19 Testing and Treatment in India

BackgroundThe COVID-19 pandemic has triggered several underlying vulnerabilities with potentially far reaching consequences in low- and middle-income countries (LMICs) like India. Evidence of physical and socio-economic vulnerabilities caused by the pandemic are emerging rapidly, but one area that has received limited attention so far, is the financial vulnerability COVID-19 causes for households and the government. This paper aims to assess the financial burden imposed on governments and households and the ability of households to afford the required medical costs. Methods and FindingsUsing publicly available data, we computed per-episode mean costs for COVID-19 diagnosis and curative care by government and households. The curative costs included per-episode expenditure for (i) home isolation, (ii) hospital isolation and (i) ICU support. Expenditure was estimated based on mean costs derived from government capped package rates set for private facilities. Households’ affordability was assessed by comparing costs per episode to the estimated household income. The number of days required to pay for the cost of testing and treatment served as a proxy for households’ ability-to-pay. Work-days and wages/salaries for different types of workers were estimated based on Periodic Labor Force Surveys (PLFS, 2017-18) – a national level survey, with a sample size of 102,113 households and 433,339 persons, sampled through a stratified multi-stage random sampling approach. The mean cost for COVID-19 testing was Rs. 2,229 per test (Min-Max: Rs. 2200 – 2500) in a private facility and free in public facilities. The average cost of home isolation was Rs. 829 (Min-Max: Rs. 164 – 2743), while a 10-day episode of hospital isolation in a private facility was Rs. 67,470 (Min-Max: Rs. 2700 – 12600), and admission to the intensive care unit (ICU) cost Rs. 128,110 (Min-Max: Rs. 82500 – 200,000). To afford hospital isolation, regular employees would need to spend the equivalent of 124 days of wages while self-employed and casual workers would spend 170 days, and 257 days respectively. For ICU hospitalization, casual workers, regular employees, and self-employed workers would require 481 days, 318 days and 232 days of work respectively. Thus, affordability of COVID-19 services is far worse among casual workers, wherein annual wage falls short of ICU hospitalization cost for 90% of workers and hospital isolation costs for 48% of workers. Among self-employed workers, the proportions whose annual wages could not afford ICU hospitalization and home isolation were 66% and 27% respectively. For regular employees, we found that for 51% and 15% of them, their annual salaries could not afford to pay for ICU admission or hospital isolation respectively. ConclusionsBesides the financial burden associated with economic costs of COVID-19 lockdowns and other containment measures, the direct medical cost of seeking treatment by households is enormous and unsustainable. Our study has shown that households are subject to considerable financial burden rendering a sizeable segment unable to afford COVID-19 services. Future research must pay attention to measurements that can capture catastrophe and impoverishment inflicted by COVID-19 conditions. A deep dive to measure unaffordability must focus on what other basic needs are sacrificed while paying for COVID-19 conditions and treatments foregone.