Are people in the SADC region willing to pay more tax to fund public healthcare?

ABSTRACT

For Africa to develop and achieve sustainable development, African governments have to prioritise spending on public health. However, the current spending data shows that health spending is a continuing struggle for African countries. Many researchers have the view that African governments have to collect more tax to spend enough on public healthcare. The question here is what extent people are willing to pay more tax to increase spending on public healthcare? Employing a multilevel regression model on Afrobarometer survey data, this paper examined to what extent individual and country level factors influence people’s willingness to pay more tax to increase spending on public healthcare in 12 Southern African Development Community (SADC) member states. This study found that peoples’ trust in their government is an important determinant of willingness to pay more tax, while factors such as the country’s quality of democracy, economic condition, and current per capita health expenditure have no influence.     

Muddling through cybersecurity: Insights from the U.S. healthcare industry

The U.S. healthcare sector is inadequately prepared to deal with the reality of cyber threats. The increasing use of smart medical equipment and mobile devices is making healthcare organizations more susceptible to ransomware and other types of malware. The size and complexity of operations, coupled with the presence of numerous legacy and incompatible systems, make it difficult to implement effective cybersecurity measures. The daunting nature of the problem often results in an if-it-ain’t-broke-don’t-fix-it stance among senior healthcare leaders. The preponderance of healthcare-related laws, compliance regulations, and security guidance frameworks serve to complicate the cybersecurity challenge further and too often results in senior leadership assuming a state of blissful ignorance. This study sheds light on the key factors contributing to the chaotic state of affairs and presents a roadmap to a more deliberate and proactive approach to cybersecurity risk management.     

Improving an outpatient clinic utilization using decision analysis-based patient scheduling

This study presents a predictive model to be used in scheduling patients in an urban outpatient clinic. The model is based upon actual patient characteristics from a physical therapy clinic within an urban health and wellness center situated in a public university. A number of reported patients' characteristics such as age, education level, distance from the clinic, historical attendance records, etc. were examined to determine if they significantly impacted the patients' missing scheduled appointments (no-shows.) Decision tree analysis was used to develop a model that assessed the likelihood of a patient's no-show, using key patient characteristics and attendance records. Such a model can be used to assist with scheduling patients in an outpatient clinic, while attempting to increase the clinic's overall utilization. Four tree growing criteria were examined to develop the model with the strongest predictive power. Predictive power of each method was assessed by using the entire dataset as well as using split sampling. The results were then compared with those of a Bayesian networks model and a neural networks model. In addition, the trade-off between the selected decision tree model's predictive power versus simplicity of the associated classification rules was examined. We also assessed the impact of various levels of overbooking on the clinic's utilization when using patients' schedules based on the predictive model.     

Comparing post-operative resource consumption following transcatheter aortic valve implantation (TAVI) and conventional aortic valve replacement in the UK

Objective:

To define the in-hospital and 6-month post-discharge resource use, following Transcatheter Aortic Valve Implantation (TAVI) and conventional Aortic Valve Replacement (AVR) surgery within a single UK hospital.

Methods:

A local service evaluation of patients undergoing TAVI or AVR between January 2011 and May 2012 captured data until 6-months post-procedure, collected from hospital records and via a General Practitioner questionnaire. The main end-points were mortality, time in ITU/HDU, hospital length of stay (LoS), discharge destination, re-admission, and post-discharge primary/secondary care resource use. Sub-group analyses were performed for AVR patients aged ≥80 (AVR?≥?80) and with EuroSCORE of ≥10 (AVR ES?≥?10) to allow more direct comparison with ‘TAVI type’ patients.

Results:

Results are given as means (standard deviation) for TAVI (n?=?51), AVR (n?=?188), AVR?≥?80 (n?=?48), and AVR ES?≥?10 (n?=?47), respectively, unless otherwise stated. Age in years was 83.0 (8.1), 71.2 (13.1), 84.1 (2.7), 79.4 (7.1); EuroSCORE was 24.7 (11.9), 8.1 (6.4), 12.0 (6.0), and 16.5 (6.6); post-operative LoS (days) was 11.5 (11.2), 10.9 (10.8), 14.3 (16.7), and 15.2 (17.7). For discharged patients, 0%, 7%, 13%, and 9% had unplanned cardiac-related re-admissions within 30-days of discharge. Time to first readmission was 74.6 (34.0), 35.0 (34.2), 20.8 (9.7), and 22.6 (14.3) days.

Limitations:

This was a single-center retrospective evaluation, not prospectively powered to confirm differences in outcomes.

Conclusions:

Despite TAVI being performed in an older, higher risk population, LoS was similar to AVR. Most strikingly there were no cardiac-related re-admissions within 30-days for TAVI and time to first re-admission was significantly longer. This evaluation suggests that TAVI is clinically appropriate and provides economic advantages in both the hospital and post-discharge setting in this high risk group. Many patients undergoing TAVI are considered unfit for surgery and, hence, TAVI offers a treatment that delivers similar results to traditional AVR without the high risk associated with surgery.     

Chinese medical tourists – Their perceptions of Taiwan

This study explores the motivations and perceptions of Chinese medical tourists visiting Taiwan regarding the quality of tourism packages and the medical services consumed. Knowing the factors that motivate medical tourists and their quality demands for tourism operators and medical institutions is important for medical tourism planners to develop and organize services that serve their customers. Particularly, findings can help tourism operators plan customized itineraries and healthcare services, including software and hardware facilities, for Chinese tourists.     

Fraudster’s and victims’ profiles and loss predictors’ hierarchy in the mental healthcare industry in the US

Abstract

Background

Fraud- or theft-related crimes account for the highest number of crimes in the mental health industry in the US.     

Farming systems and Conservation Agriculture: Technology,structures and agency in Malawi

Conservation Agriculture (CA) is advocated as an agricultural innovation that will improve smallholder famer resilience to future climate change. Under the conditions presented by the El Niño event of 2015/16, the implementation of CA was examined in southern Malawi at household, district and national institutional levels. Agricultural system constraints experienced by farming households are identified, and in response the technologies, structures and agency associated with CA are evaluated. The most significant constraints were linked to household health, with associated labour and monetary impacts, in addition to the availability of external inputs of fertiliser and improved seed varieties. Our findings show that such constraints are not adequately addressed through current agricultural system support structures, with the institutions surrounding CA (in both Government extension services and NGO agricultural projects) focusing attention predominantly at field level practice, rather than on broader system constraints such as education and health support systems. Limited capacity within local institutions undermines long term efforts to implement new technologies such as CA. It is vitally important that the flexibility of farmers to adapt new technologies in a locally-appropriate manner is not closed down through national and institutional aims to build consensus around narrow technical definitions of a climate-smart technology such as CA. To enable farmers to fully utilise CA programmes, interventions must take a more holistic, cross-sectoral approach, understanding and adapting to address locally experienced constraints. Building capacity within households to adopt new agricultural practices is critical, and integrating healthcare support into agricultural policy is a vital step towards increasing smallholder resilience to future climate change.     

The economic burden of tuberous sclerosis complex in UK patients with renal manifestations: a retrospective cohort study in the clinical practice research datalink (CPRD)

Background: Tuberous sclerosis complex (TSC) is a multi-system genetic disorder in which renal manifestations occur in ～50% of children and 80% of adults. Since these often present alongside other manifestations, renal TSC is likely to incur significant costs. This study aims to quantify healthcare resource use (HCRU) and costs for renal TSC patients in the UK.

Methods: TSC patients in the Clinical Practice Research Datalink (CPRD) linked to Hospital Episodes Statistics were identified from January 1987–June 2013. Clinical data were extracted over the entire history and costs were reported over the most recent 3-year period. HCRU was compared with a matched comparator cohort. Incremental costs were reported and the key cost drivers by primary manifestation category were identified by regression modeling.

Results: A total of 79 renal TSC patients were identified with manifestations including chronic kidney disease stage 3–5 (with prevalence increasing with age) and renal angiomyolipoma. Renal TSC patients consistently reported greater HCRU than the comparator. Inpatient hospitalizations were more frequent for renal TSC patients (3.2 vs 1.6), but length of stay was comparable; however, 70.9% of renal TSC patients recorded no kidney-related procedures ever and averaged <1 test per year in the 3-year period. Average costs for renal TSC patients were nearly 3-fold greater than the comparator (£15,162 vs £5672). Costs increased with additional manifestation categories (£3600: only renal; £27,531: renal with ≥4 additional manifestation categories [25% of patients]). Additional nervous system and dermatology/psychiatric manifestations significantly (p?Conclusions: Renal TSC patients have greater HCRU than the general CPRD population, likely to result from progression of renal disease and additional manifestations; however, surveillance for disease progression appears to be deficient. Inadequate monitoring may contribute to a lack of co-ordinated care and increased healthcare-associated costs. Efforts should be made to follow the TSC guidelines to effectively monitor and treat patients.     

Cost of skeletal-related events in European patients with solid tumours and bone metastases: data from a prospective multinational observational study

Abstract

Objectives:

Patients with bone metastases often experience skeletal-related events (SREs: radiation or surgery to bone, pathologic fracture, and spinal cord compression). This study examined health resource utilization and costs associated with SREs.

Methods:

Data presented are from the European cohort (Germany, Italy, Spain, and the UK) of patients with solid tumours enrolled in a multi-national, prospective, observational study in patients with solid tumours or multiple myeloma. Patients with Eastern Cooperative Oncology Group score 0–2 and life expectancy ≥6 months, who experienced an SRE up to 97 days before enrolment, were eligible. Health resource utilization associated with SREs (including number/length of inpatient stays, numbers of procedures and outpatient visits) were collected through chart review for up to 97 days before enrolment and prospectively during follow-up. Country-specific cost calculations were performed.

Results:

In total, 478 eligible patients contributed 893 SREs to this analysis. Radiation to bone occurred most frequently (66% of total). Spinal cord compression (7%) and surgery to bone (10%) were the least common events, but most likely to require inpatient stays. The most costly SREs were also spinal cord compression (mean per SRE across countries, €4884–€12,082) and surgery to bone (€3348–€9407). Inpatient stays were the main cost drivers.

Limitations:

Health resource utilization used to calculate the costs associated with SREs may have been under-estimated as a result of exclusion of patients with low performance status or life expectancy; unavailable information and exclusion of resource consumption associated with pain. Thus, the estimate of associated costs is likely to be conservative.

Conclusions:

SREs result in considerable health resource utilization, imposing a substantial financial burden driven by inpatient stays. Treatments that prevent/delay SREs may help ease this burden, thereby providing cost savings across European healthcare systems.