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1.
Aims: Depression is the most frequent comorbidity reported among patients with rheumatoid arthritis (RA). Comorbid depression negatively impacts RA patients’ health-related quality-of-life, physical function, mental function, mortality, and experience of pain and symptom severity. The objective of this study was to assess healthcare utilization, expenditures, and work productivity among patients with RA with or without depression.Materials and methods: Data from adult patients who had at least two visits each related to RA and depression over a 1-year period were extracted from the Truven Health MarketScan research databases. Outcomes comprised healthcare resource utilization, work productivity loss, and direct healthcare costs comparing patients with RA with depression (n?=?3,478) vs patients with RA without depression (n?=?43,222).Results: Patients with RA and depression had a significantly greater relative risk of hospitalization and number of all-cause and RA-related hospitalizations, utilization of emergency services, days spent in the hospital, physician visits, and RA-related surgeries compared with RA patients without depression. Patients with RA and depression had a higher risk of and experienced more events and days of short-term disability compared with patients without depression. The incremental adjusted annual all-cause and RA-related direct costs were $8,488 (95% CI = $6,793–$10,223) and $578 (95% CI = –$98–$1,243), respectively, when comparing patients with RA and depression vs RA only.Limitations: The current analysis is subject to the known limitations of retrospective studies based on administrative claims data.Conclusions: This study suggested increased healthcare utilization, work productivity loss, and economic burden among RA patients due to comorbid depression. These findings emphasize the importance of managing depression and including depression as a factor when devising treatment algorithms for patients with RA. 相似文献
2.
新兴互联网医疗企业如何摆脱"盈利困局"?本研究以广东医特为案例研究对象,基于服务主导逻辑视角,揭示并构建了互联网医疗服务产品化实现机制模型。实现机制模型包括服务能力可视化、服务流程标准化、服务反馈客观化三个阶段,明确了各个阶段的背景诱因、形成过程和最终效果。研究结论有助于现有服务产品化理论和服务主导逻辑的演化研究,对互联网医疗企业有一定的现实启示作用。 相似文献
3.
Athanasia Daskalopoulou Mark Palmer Kathy Keeling Rowan Pritchard Jones 《New Technology, Work and Employment》2019,34(1):73-89
We explore individuals who take some of their technology use ‘underground’, described as ‘bootlegging’, to enhance healthcare work. We find that healthcare professionals’ informal use of mobile applications in healthcare work sometimes ‘sticks out’ and this produces professional identity tensions: (1) conflict with perceptions of professional behaviour, and (2) defilement of expert judgment. Our analysis, moreover, reveals that identity work (i.e. ‘accepting’ and ‘sensemaking’) provides a coping mechanism to deal with these unresolved professional identity tensions. This paper contributes to a better understanding of the constitutive entanglements and two‐way interactions of discretionary technology bootlegging, professional identity and autonomy in institutional healthcare work. 相似文献
4.
English National Health Service Foundation Trusts are subject to a regulatory regime in which the level of monitoring and intervention is determined by performance against two key performance metrics: a ‘financial risk rating’, based on a number of performance metrics, such as the reported surplus margin and return on assets, and a ‘prudential borrowing limit’. In this paper, we investigate the variation in financial reporting quality, proxied by discretionary accruals, with the incentives introduced by this regime. We find: first, that discretionary accruals are managed to report small surpluses; second, that, consistent with the avoidance of regulatory intervention in both the short and medium term, discretionary accruals are more positive when pre-managed performance is below intervention triggering thresholds and more negative when well above threshold; third, that, despite a move away from financial breakeven as the primary performance objective, there remains an aversion to small loss reporting. We further find that the level of discretionary accruals is driven by two metrics of strategic significance: the surplus margin (a measure of retained earnings) and the prudential borrowing limit (a measure of borrowing capacity). 相似文献
5.
Tim Benson 《Journal of medical economics》2017,20(2):107-113
Background: QALYs are widely used in health economic evaluation, but remain controversial, largely because they do not reflect how many people behave in practice. This paper presents a new conceptual model (Load Model) and illustrates it in comparison with the QALY model.Methods: Load is the average annual weight attributed to morbidity and mortality over a defined period, using weightings based on preference judgements. Morbidity Load is attributed to states of illness, according to their perceived severity. When people are in full health, Load is zero (no morbidity). Death is treated as an event with negative consequences, incurred in the year following death. Deaths may be weighted equally, with a fixed negative weight such as ?100, or differ according to the context of death. After death, Load is zero. In a worked example, we use the standard gamble method to obtain a weighting for an illness state, for both Load and QALY models. A judge is indifferent between certainty of 1.5 years’ illness followed by death, or a 50/50 chance of 1.5 years’ full health or 1-year illness, each followed by death. The weightings calculated are applied to a hypothetical life, 72 years in full health followed by 3 years with illness then death, using both models. Three other hypothetical outcomes are also compared.Results: For an example life, the relative size of the morbidity component compared with the mortality component is much higher in the Load model than in the QALY model. When comparing alternative outcomes, there are also substantial differences between the two models.Conclusions: In the Load model the weight of morbidity, relative to mortality, is very different from that in the QALY model. Given the role of the QALYs in economic evaluation, the implications of an alternative, which generates very different results, warrant further exploration. 相似文献
6.
Heather M. Rozjabek Craig I. Coleman Veronica Ashton François Laliberté Paul Oyefesobi Dominique Lejeune 《Journal of medical economics》2019,22(8):751-759
Objective: To assess long-term healthcare costs related to ischemic stroke and systemic embolism (stroke/SE) and major bleeding (MB) events in patients with non-valvular atrial fibrillation (NVAF) treated with non-vitamin K antagonist oral anticoagulants (NOACs).Materials and methods: Optum’s Clinformatics Data Mart database from 1/2009–12/2016 was analyzed. Adult patients with ≥1 stroke/SE hospitalization (index date) were matched 1:1 to patients without stroke/SE (random index date), based on propensity scores. Patients with an MB event were matched to patients without MB. All patients had an NOAC dispensing overlapping index date, ≥12?months of eligibility pre-index date, and ≥1 NVAF diagnosis. The observation period spanned from the index date until the earliest date of death, switch to warfarin, end of insurance coverage, or end of data availability. Mean costs were evaluated: (1) per-patient-per-year (PPPY) and (2) at 1, 2, 3, and 4?years using Lin's method.Results: The cost differences were, respectively, $48,807 and $28,298 PPPY for NOAC users with stroke/SE (n?=?1,340) and those with MB (n?=?3,774) events compared to controls. Cost differences of patients with vs without stroke/SE were $49,876, $51,627, $57,822, and $60,691 at 1, 2, 3, and 4?years post-index, respectively (p?0.001). These cost differences were $31,292, $35,658, $44,069, and $47,022 for patients with vs without MB after 1, 2, 3, and 4?years post-index, respectively (p?0.001).Limitations: Limitations include unobserved confounders, coding and/or billing inaccuracies, limited sample sizes over longer follow-up, and the under-reporting of mortality for deaths occurring after 2011.Conclusions: The incremental healthcare costs incurred by patients with vs without stroke/SE was nearly twice as high as those of patients with vs without MB. Moreover, each additional year up to 4?years after the first event was associated with an incremental cost for patients with a stroke/SE or MB event compared to those without an event. 相似文献
7.
Antoon Spithoven 《Journal of economic issues》2016,50(2):630-638
Collective lobbying organizations and some big companies acted as cautious partners in the design of the Affordable Care Act of the Obama Administration. In addition to being consulted by government executives, these entities intensively lobbied legislators. The qualitative and statistical analysis I conduct here shows a positive impact of healthcare lobbying. Collective lobbying organizations have a significant impact on lawmaking and complementary lobbying enhances their impact. However, not all (disjointed) lobbying is successful. Perspective-based distortion might explain why organizations lobby on issues against all odds of ever being effective. 相似文献
8.
The Nordic healtheare model is recognized to be one of the most innovative in the world. Here billions of USD are annually invested in developing new treatments, drugs, robots etc. to diagnose and cure diseases. Nevertheless, this study establishes that there is a fundamental shortcoming in the system that supports healthcare innovation: It is strongly biased towards micro-level innovation projects focusing on new products, alternative processes, and new financial solutions. The problem with this approach to support new projects is that the results are created as inventions within the system thus lacking holistic perspectives. This has consequently contributed with increasing costs that are out of proportion with existing budgets. Therefore this study seeks to analyze the current understanding of the Nordic healthcare system from a business model perspective. Here other aspects of the healthcare system are explored to determine if they could be redesigned to promote new types of innovation projects. The purpose of undertaking this task is to challenge the established patterns of the current healthcare innovation support practices. Here the vertical innovation process (VIP) framework, which is a systematic radical innovation model that seeks macro-level outcomes based on standalone inventions (see more below), is applied to analyze the current state-of-the-art in Nordic healthcare innovation projects. The results determine that very little attention is given to rethink and redesign the healthcare system at a macro-level, and it is discussed that stand-alone inventions ought to be rethought into the entire healthcare system to create a larger impact. Finally, it is argued that existing performance measures are inappropriate to foster projects that innovate the existing system: New measuring points should be developed to promote macro-level projects and to avoid the current rapid increase of costs in the Nordic healthcare system. 相似文献
9.
Jay Lin Jeffrey Trocio Kiran Gupta Jack Mardekian Melissa Lingohr-Smith Brandy Menges 《Journal of medical economics》2017,20(9):952-961
Aims: This study compared the risk for major bleeding (MB) and healthcare economic outcomes of patients with non-valvular atrial fibrillation (NVAF) after initiating treatment with apixaban vs rivaroxaban, dabigatran, or warfarin.Methods: NVAF patients who initiated apixaban, rivaroxaban, dabigatran, or warfarin were identified from the IMS Pharmetrics Plus database (January 1, 2013–September 30, 2015). Propensity score matching (PSM) was used to balance differences in patient characteristics between study cohorts: patients treated with apixaban vs rivaroxaban, apixaban vs dabigatran, and apixaban vs warfarin. Risk of hospitalization and healthcare costs (all-cause and MB-related) were compared between matched cohorts during the follow-up.Results: During the follow-up, risks for all-cause (hazard ratio [HR]?=?1.44, 95% confidence interval [CI]?=?1.2–1.7) and MB-related (HR?=?1.57, 95% CI?=?1.0–2.4) hospitalizations were significantly greater for patients treated with rivaroxaban vs apixaban. Adjusted total all-cause healthcare costs were significantly lower for patients treated with apixaban vs rivaroxaban ($3,950 vs $4,333 per patient per month [PPPM], p?=?.002) and MB-related medical costs were not statistically significantly different ($100 vs $233 PPPM, p?=?.096). Risk for all-cause hospitalization (HR?=?1.98, 95% CI?=?1.6–2.4) was significantly greater for patients treated with dabigatran vs apixaban, although total all-cause healthcare costs were not statistically different. Risks for all-cause (HR?=?2.22, 95% CI?=?1.9–2.5) and MB-related (HR?=?2.05, 95% CI?=?1.4–3.0) hospitalizations were significantly greater for patients treated with warfarin vs apixaban. Total all-cause healthcare costs ($3,919 vs $4,177 PPPM, p?=?.025) and MB-related medical costs ($96 vs $212 PPPM, p?=?.026) were significantly lower for patients treated with apixaban vs warfarin.Limitations: This retrospective database analysis does not establish causation.Conclusions: In the real-world setting, compared with rivaroxaban and warfarin, apixaban is associated with reduced risk of hospitalization and lower healthcare costs. Compared with dabigatran, apixaban is associated with lower risk of hospitalizations. 相似文献
10.
A Social Marketing Template for Solving the Musicians’ Dilemma Through Nonprofit Healthcare Networks
Corey S. Jackson 《非赢利和公共部门市场学杂志》2014,26(1):80-98
The Musicians’ Dilemma—the lack of affordable healthcare for the uninsured or underinsured musical entrepreneur—is actually a common problem plaguing not only 33% of musicians, but approximately 19% of the American population as a whole. The current research uses social marketing principles to conceptualize a template for designing a marketing program that meets the healthcare needs of the target market. Health Alliance for Austin Musicians (HAAM) is a nonprofit organization that links healthcare providers, local businesses, and community donors in a network providing basic preventive health services to this essential segment of the community. HAAM's business model is analyzed and cast on the social marketing framework so that it can be adapted for use by other music cities. Although the template could also be applied to serve other uninsured populations, it is critical that research be undertaken to understand the specific characteristics and needs of each target market and used to adapt the model to those populations. 相似文献