No abstract

Various types of financial agreements have been implemented in Europe to reduce health care expenditure by stimulating integrated chronic care. This study used difference-in-differences (DID) models to estimate differences in health care expenditure trends before and after the introduction of a financial agreement between 9 intervention countries and 16 control countries. Intervention countries included countries with pay-for-coordination (PFC), pay-for-performance (PFP), and/or all inclusive agreements (bundled and global payment) for integrated chronic care. OECD and WHO data from 1996 to 2013 was used. The results from the main DID models showed that the annual growth of outpatient expenditure was decreased in countries with PFC (by 21.28 US$ per capita) and in countries with all-inclusive agreements (by 216.60 US$ per capita). The growth of hospital and administrative expenditure was decreased in countries with PFP by 64.50 US$ per capita and 5.74 US$ per capita, respectively. When modelling impact as a non-linear function of time during the total 4-year period after implementation, PFP decreased the growth of hospital and administrative expenditure and all-inclusive agreements reduced the growth of outpatient expenditure. Financial agreements are potentially powerful tools to stimulate integrated care and influence health care expenditure growth. A blended payment scheme that combines elements of PFC, PFP, and all-inclusive payments is likely to provide the strongest financial incentives to control health care expenditure growth.

The endogenous cannabinoid system has been identified as playing a central role in the regulation of energy homeostasis, and its overactivity has been associated with obesity. Rimonabant is a selective endocannabinoid CB(1) receptor antagonist that has been shown to be an effective treatment for obesity and cardiometabolic risk factors. Studies comparing 20 mg/d of rimonabant with placebo show a placebo-subtracted weight loss between 6.3 and 6.9 kg at 1 year. In addition to the health benefits already associated with weight loss, rimonabant has shown additional improvements in lipid and glycemic cardiometabolic biomarkers such as low-density lipoprotein cholesterol, triglycerides, C-reactive protein, glucose, and adiponectin. The use of endocannabinoid antagonists such as rimonabant provides a promising therapeutic approach to the treatment of obesity and its associated cardiometabolic risks.

health care use resulting from ADRs and STEs. The prevalence-based cost-of-illness analysis included direct costs for drugs, from the Swedish Prescribed Drug Register, and health care use, based on national statistics, during a 30 day study-period. RESULTS: Of the 7099 respondents, 1,377 reported at least one ADE and 943 reported an ADR or STE. During the study-period, respondents with/without self-reported ADEs respectively reported 124/164 general practitioner visits, 182/310 nurse visits, 191/310 specialist physician or emergency department visits, 39/48 home-health care visits, 159/283 other somatic visits, 4/4 psychiatrist visits, 120/72 other psychiatric visits, 20/17 hospitalizations, 267/228 health care contacts by phone or mail, and the use of 3,908/8,663 prescription medicines. The average direct cost per respondent was higher among respondents reporting ADEs compared to those not reporting an ADE (mean Ϯ SD): EUR 202.0 Ϯ 901.2 vs. EUR 61.2 Ϯ 356.9 (pϽ0.001). The average direct costs of respondents reporting at least one ADR or STE were EUR 239.6 Ϯ 950.7, and costs resulting from ADRs or STEs were EUR 16.8 Ϯ 150.5 and EUR 33.4 Ϯ 266.9, respectively. CONCLUSIONS: According to our results, the resource use and costs associated with ADEs are extensive, and occurs both in hospitals and primary care. There is a need to further examine the relationships between self-reported ADEs and the high overall COI, and study the indirect costs of self-reported ADEs.

Objectives: Different payment schemes have been implemented in Europe to stimulate integrated chronic care and to reduce health care expenditure. We aimed to investigate the impact of different payment schemes on national total health care expenditures.