-
The American Journal of Medicine Mar 2024Even though a well-functioning primary care system is widely acknowledged as critical to population health, the number of primary care physicians (PCPs) practicing in... (Review)
Review
Even though a well-functioning primary care system is widely acknowledged as critical to population health, the number of primary care physicians (PCPs) practicing in the United States has steadily declined, and PCPs are in short supply. The reasons are multiple and include inadequate income relative to other specialties, excessive administrative demands on PCPs and the lack of respect given to primary care specialties during medical school and residency. Advanced practice nurses can augment the services of primary care physicians but cannot substitute for them. To change this situation, we need action on several fronts. Medical schools should give preference to students who are more likely to enter the primary care specialties. The income gap between primary care and other specialties should be narrowed. The administrative load placed on PCPs, including cumbersome electronic medical records, must be lessened. Insurers, including Medicare and Medicaid, must provide the resources to allow primary care physicians to act as leaders of multidisciplinary teams.
PubMed: 38499134
DOI: 10.1016/j.amjmed.2024.03.012 -
Value in Health : the Journal of the... Jan 2024The aim of this review is to appraise and assimilate evidence from studies that have reported on the cost-effectiveness of screening programs for chronic kidney disease... (Review)
Review
OBJECTIVES
The aim of this review is to appraise and assimilate evidence from studies that have reported on the cost-effectiveness of screening programs for chronic kidney disease (CKD).
METHODS
The study protocol was registered on International Prospective Register of Systematic Reviews (PROSPERO). The final search was conducted on 18 January 2023 using 7 databases. Screening of articles, data extraction, and quality assessment was performed by 2 independent reviewers. The ISPOR-AMCP-NPC checklist was used to assess the credibility of the included studies.
RESULTS
From 4948 retrieved studies, a final total of 20 studies were included in the qualitative synthesis. Studies found that screening in diabetic populations was cost-effective (n = 8, 57%) or even cost-saving (n = 6, 43%). Four studies (67%) found that screening in hypertensive populations was also cost-effective. For the general population, findings were inconsistent across studies in which many found screening to be cost-effective (n = 11, 69%), some cost-saving (n = 2, 12%), and others not cost-effective (n = 3, 19%). The most influential parameters identified were prevalence of CKD and cost of screening.
CONCLUSIONS
Screening for CKD in patients with diabetes or hypertension is recommended from a cost-effectiveness point of view. For the general population, despite some inconsistent findings, the majority of studies demonstrated that screening in this population is cost-effective, depending mainly on the prevalence and the costs of screening. Healthcare decision makers need to consider the prevalence, stratification strategies, and advocate for lower screening costs to reduce the burden on healthcare budgets and to make screening even more favorable from the health-economic perspective.
Topics: Humans; Cost-Benefit Analysis; Diabetes Mellitus; Hypertension; Renal Insufficiency, Chronic; Mass Screening
PubMed: 37657659
DOI: 10.1016/j.jval.2023.08.003 -
Circulation Jun 2024Quantifying the economic burden of cardiovascular disease and stroke over the coming decades may inform policy, health system, and community-level interventions for... (Review)
Review
BACKGROUND
Quantifying the economic burden of cardiovascular disease and stroke over the coming decades may inform policy, health system, and community-level interventions for prevention and treatment.
METHODS
We used nationally representative health, economic, and demographic data to project health care costs attributable to key cardiovascular risk factors (hypertension, diabetes, hypercholesterolemia) and conditions (coronary heart disease, stroke, heart failure, atrial fibrillation) through 2050. The human capital approach was used to estimate productivity losses from morbidity and premature mortality due to cardiovascular conditions.
RESULTS
One in 3 US adults received care for a cardiovascular risk factor or condition in 2020. Annual inflation-adjusted (2022 US dollars) health care costs of cardiovascular risk factors are projected to triple between 2020 and 2050, from $400 billion to $1344 billion. For cardiovascular conditions, annual health care costs are projected to almost quadruple, from $393 billion to $1490 billion, and productivity losses are projected to increase by 54%, from $234 billion to $361 billion. Stroke is projected to account for the largest absolute increase in costs. Large relative increases among the Asian American population (497%) and Hispanic American population (489%) reflect the projected increases in the size of these populations.
CONCLUSIONS
The economic burden of cardiovascular risk factors and overt cardiovascular disease in the United States is projected to increase substantially in the coming decades. Development and deployment of cost-effective programs and policies to promote cardiovascular health are urgently needed to rein in costs and to equitably enhance population health.
PubMed: 38832515
DOI: 10.1161/CIR.0000000000001258 -
JAMA Jan 2024
Topics: Hospitals; Economics, Hospital; Reimbursement Mechanisms; United States; Hospital Charges
PubMed: 38109155
DOI: 10.1001/jama.2023.25318 -
JAMA Sep 2023
Topics: Aged; Humans; Conflict of Interest; Equipment and Supplies; Medicare; United States; Insurance Coverage
PubMed: 37589985
DOI: 10.1001/jama.2023.14414 -
The Veterinary Clinics of North... Mar 2024Recent economic cycles and unique factors like the COVID-19 pandemic have all affected small animal veterinary practice, changing both demand and supply-side factors....
Recent economic cycles and unique factors like the COVID-19 pandemic have all affected small animal veterinary practice, changing both demand and supply-side factors. One-time events exacerbated cyclical macroeconomic factors, increasing the highs and worsening the lows. Behind the perceived labor shortage, the mental health concerns, and the challenges of staff turnover in the profession's daily work to meet client expectations and provide the best possible medical care lurks a productivity problem. The good news is that veterinary practices can take steps to improve productivity and resilience in the face of these challenging trends.
Topics: Veterinary Medicine
PubMed: 37951763
DOI: 10.1016/j.cvsm.2023.10.001 -
Gynecologic Oncology Jul 2024Patients may use crowdfunding to solicit donations, typically from multiple small donors using internet-based means, to offset the financial toxicity of cancer care.
BACKGROUND
Patients may use crowdfunding to solicit donations, typically from multiple small donors using internet-based means, to offset the financial toxicity of cancer care.
OBJECTIVE
To describe crowdfunding campaigns by gynecologic cancer patients and to compare campaign characteristics and needs expressed between patients with cervical, uterine, and ovarian cancer.
STUDY DESIGN
We queried the public crowdfunding forum GoFundMe.com for "cervical cancer," "uterine cancer," and "ovarian cancer." The first 200 consecutive posts for each cancer type fundraising within the United States were analyzed. Data on campaign goals and needs expressed were manually extracted. Descriptive statistics and bivariate analyses were performed.
RESULTS
Among the 600 fundraising pages, the median campaign goal was $10,000 [IQR $5000-$23,000]. Campaigns raised a median of 28.6% of their goal with only 8.7% of campaigns reaching their goal after a median of 54 days online. On average, ovarian cancer campaigns had higher monetary goals, more donors, and larger donation amounts than cervical cancer campaigns and raised more money than both cervical and uterine cancer campaigns. Campaigns were fundraising to support medical costs (80-85%) followed by lost wages (36-56%) or living expenses (27-41%). Cervical cancer campaigns reported need for non-medical costs more frequently than uterine or ovarian cancer campaigns. States without Medicaid expansions (31% of the national population) were over-represented among cervical cancer and uterine cancer, but not ovarian cancer campaigns.
CONCLUSIONS
Crowdfunding pages reveal patients fundraising for out-of-pocket costs in the thousands of dollars and a wide range of unmet financial needs based on cancer type.
Topics: Humans; Female; Fund Raising; Genital Neoplasms, Female; United States; Crowdsourcing; Uterine Cervical Neoplasms; Ovarian Neoplasms
PubMed: 38833852
DOI: 10.1016/j.ygyno.2024.05.017 -
Health Economics Jul 2024We study the welfare impacts of illness shocks on rural agricultural households in the semi-arid tropical and humid eastern regions of India. These regions are...
We study the welfare impacts of illness shocks on rural agricultural households in the semi-arid tropical and humid eastern regions of India. These regions are characterized by rainfed agriculture, missing markets for credit and insurance, and limited access to publicly funded healthcare infrastructure. We find that illness shocks increase households' medical expenditures and reduce wage income. However, aggregate non-medical, food, and non-food consumption expenditures are insensitive to illness shocks. Disaggregating illness by the age and the gender of the household members, we observe that illness in male children leads to the largest increase in medical expenditure, and illness in prime-aged adults leads to the largest decline in per-capita wage earnings. We also find illness shocks leading to changes in household dietary diversity, higher travel expenditures, and a compensating reduction in spending on education and entertainment. Analysis of risk-coping strategies reveals that households rely on transfers from kinship networks and loans from informal sources like local moneylenders to smooth consumption. While large landowners rely on gifts from kinship networks, landless and smallholders increase borrowings from informal sources.
Topics: Humans; Male; Female; India; Family Characteristics; Adult; Health Expenditures; Rural Population; Income; Child; Middle Aged; Adolescent; Agriculture; Child, Preschool; Sex Factors; Age Factors; Young Adult; Socioeconomic Factors
PubMed: 38499984
DOI: 10.1002/hec.4830 -
Population Health Management Jun 2024
Topics: Humans; Reimbursement, Incentive; Academic Medical Centers
PubMed: 38708955
DOI: 10.1089/pop.2024.0058 -
BMJ (Clinical Research Ed.) Apr 2024
Topics: Tobacco Industry; Humans; Education, Medical, Continuing; Conflict of Interest
PubMed: 38670579
DOI: 10.1136/bmj.q950