Growth In US Health Spending Remained Slow In 2010; Health Share Of Gross Domestic Product Was Unchanged From 2009

Martin, Anne; Lassman, David; Washington, Benjamin; Catlin, Aaron

doi:10.1377/hlthaff.2011.1135

Cited by 152 publications

(93 citation statements)

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“…26,27 Resources must be considered in relation to outcome achieved. The balance between outcomes and resources will look different depending on the perspective (Fig 2).…”

Section: Should Cost and Resource Use Influence Willingness To Providmentioning

confidence: 99%

Tracheostomies and Assisted Ventilation in Children With Profound Disabilities: Navigating Family and Professional Values

Wilfond

2014

Pediatrics

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Parental requests for gastrostomies, tracheostomies, or assisted ventilation in children with profound disabilities raise ethical concerns about children’s interests, parental decision-making, and health care costs. The underlying concern for many relates to the perceived value of these children. Clinicians should make efforts to appreciate the family’s perspective regarding children with profound disabilities who require respiratory and nutritional medical support. Finding opportunities to learn about the family members’ lives outside of the health care setting may facilitate a deeper understanding of what it means to live with a child who has profound disabilities. In conversations with families, referring to interventions as futile and conditions as lethal will obscure the value-based nature of these decisions. Respiratory and nutritional interventions are not clearly against the interests of most children. Even for children with a limited life span, life-sustaining interventions may be important for the child and family. Health care costs are a serious societal issue; however, the costs associated with profound disabilities are not the most significant contributor. Societal decisions not to provide life-sustaining health care to children with profound disabilities would require a public process. Clinicians may have personal views regarding decisions for their own family or for their vision for society. However, clinicians have professional obligations to families who have different values. It is important to present balanced information and support parental decision-making so parents may decide to forgo or use life-sustaining interventions according to their values and goals.

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“…26,27 Resources must be considered in relation to outcome achieved. The balance between outcomes and resources will look different depending on the perspective (Fig 2).…”

Section: Should Cost and Resource Use Influence Willingness To Providmentioning

confidence: 99%

Tracheostomies and Assisted Ventilation in Children With Profound Disabilities: Navigating Family and Professional Values

Wilfond

2014

Pediatrics

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“…A similar trend was seen in the United States (US) health economy [2]. Health care spending grew by 3.9 percent to an annual expenditure of $2.6 trillion or $8402 for each individual in 2010, equal to 17.9 percent of GDP [3]. The total expenditure for individual health care is approximately double the amount of other industrialized nations and has wiped out any real income gains over a decade for an average US family [4].…”

Section: Introductionmentioning

confidence: 54%

An autonomous model of health care: Are third parties really needed?

Frangenberg¹

2013

Health

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This proposal offers a novel approach to the organization and financing of health care and is explored for its impact on the current United States system as the most prominent outlier regarding excessive cost in relation to value. The unique nature of health as a private and common good as well as a foundation for equal opportunity has eluded satisfactory management through either market forces or government intervention. The remedy is an independent, citizen-carried cooperative administrative structure, whose members own and apply their aggregate assets for their own benefit according to democratic principles. Citizens are assessed at a collectively approved rate of equitable tax deductions proportionate to their means for a designated health care fund. The resulting single payer guarantees standardization of services and reimbursements with an expanding emphasis on outcome towards optimum population health. Transparency ensures parity and flexibility for diversity and a goal of personalized medicine. All persons are enrolled on the basis of their civil status as beneficiaries. A close partnership between integrated providers and patients is practiced towards an affordable balance between investment in and value of services. Thus financing is a closed loop and therefore the most effective cost control mechanism at the individual and collective levels. Other than a regulatory and oversight function of government, the traditional third parties, namely employers, insurers and public subsidizing entities, are no longer required for catering to individual health care needs. Useful functions of existing institutions are transitioned into direct collective consumer control. Far reaching positive social, economic and political consequences are explored. The principles of this new approach have general societal appeal.

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“…La edad de los pacientes se agrupó en 4 categorías (paciente pediátrico (0-12 años), paciente adulto joven (13-44 años), paciente adulto maduro (45-64 años) y paciente anciano (≥ 65 años); de acuerdo a lo establecido por el Grupo Nacional de Estadísticas en Salud de Medicare y Medicaid (13). El diagnóstico médico se agrupó en 5 categorías de acuerdo a los objetivos del estudio (patología gastrointestinal, que incluyó gastritis, duodenitis, esofagitis, úlceras gástrica, duodenal, péptica y gastroyeyunal, enfermedad por reflujo gastroesofágico (ERGE), varices esofágicas, gástricas y duodenales y cánceres del tracto gastrointestinal superior; patologías graves que incluyó septicemias, otros cánceres, hepatitis y otras hepatopatías, insuficiencia renal crónica y otras disfunciones renales, traumatismos graves y quemaduras graves; hipertensión arterial, diabetes mellitus y otros, para ello se utilizó la Clasificación Internacional de Enfermedades de la Organización Mundial de la Salud (OMS) en su décima versión (CIE-10).…”

Section: Materials Y Métodounclassified

Descripción del uso de medicamentos gastroprotectores en pacientes con polifarmacia en una población colombiana, a partir de bases de datos transaccionales

Vallejos¹,

Maldonado²,

Calvache³

et al. 2017

Rev. Colomb. Gastroenterol.

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Objetivo: el objetivo de este estudio fue describir y analizar los patrones de prescripción de fármacos antiulcerosos, los factores asociados a su prescripción y su costo en pacientes ambulatorios polimedicados en un período de 6 meses, en una Entidad Promotora de Salud (EPS) colombiana a nivel nacional. Metodología: estudio descriptivo retrospectivo de corte transversal, basado en registros electrónicos de prescripción de medicamentos ambulatorios de 2 458 447 afiliados. Se incluyeron pacientes con prescripción de 5 o más fármacos por mes y se excluyeron aquellos cuyos registros transaccionales no tenían información completa para su análisis. Se evaluó la asociación entre prescripción de fármacos antiulcerosos y factores que justifican su prescripción mediante los odds ratio (OR) calculados a partir de un modelo de regresión logística. Resultados: de 2 458 447 afiliados, 60 671 pacientes estuvieron polimedicados mensualmente; 40% tuvieron fármacos antiulcerosos y 70% fármacos gastrolesivos. De los gastroprotegidos, 47% fueron adultos mayores y 12% tuvieron asociado diagnóstico de riesgo gastrointestinal superior. Gastroprotección no justificada en 35% de los pacientes polimedicados, representando $75 millones de pesos colombianos (COP) mensuales. No hubo asociación estadística entre la prescripción de antiulcerosos y factores que justifiquen su prescripción (OR: 1,13; IC 95%: 1,00-1,27). Conclusión: ante la falta de asociación entre la prescripción de fármacos antiulcerosos y los factores que la justifican, es probable que su prescripción se haya realizado por la polifarmacia per se. Se recomienda optimizar la gastroprotección y reservarla a pacientes con más de un gastrolesivo y riesgo gastrointestinal superior, estén estos polimedicados o no.

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Growth In US Health Spending Remained Slow In 2010; Health Share Of Gross Domestic Product Was Unchanged From 2009

Cited by 152 publications

References 1 publication

Tracheostomies and Assisted Ventilation in Children With Profound Disabilities: Navigating Family and Professional Values

Tracheostomies and Assisted Ventilation in Children With Profound Disabilities: Navigating Family and Professional Values

An autonomous model of health care: Are third parties really needed?

Descripción del uso de medicamentos gastroprotectores en pacientes con polifarmacia en una población colombiana, a partir de bases de datos transaccionales

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