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Dec 2018 DOI 10.14302/issn.2576-9359.jot-18-2388
This review article provides ethical guidance for determining which kinds of financial benefits provided to living organ donors are ethically appropriate. It does so by way of ethical analysis of a policy case study: the National Kidney Registry (NKR) has implemented a donor insurance program to all its living donors. Is such a policy ethically supportable, or is it an unethical practice? The article proceeds as follows. First, a framework for grounding the ethical commitments of transplant programs is defended. It is argued that this framework can be accepted by all who work in transplant medicine, regardless of differences in ethical theory preference or background. Second, from this framework two ethical principles are formulated. (1) Living donors should, as far as possible, not be worse off for donating. (2) Disincentives towards donation should be removed as much as possible. Third, issues with unethical incentives are explored: undue inducement, commodification of the body, potential decreased organ donation rates, and potential exploitation of vulnerable populations. Lastly, these ethical considerations are applied to the policy change at the NKR, showing that the NKR policy change appears to be ethically supportable. Financial benefits provided to donors are ethically sound if they are in keeping with principles (1) and (2), and do not cause undue inducement, commodification, decreased organ donation, or exploitation. It is ethically appropriate for transplant programs to institute as well as study such programs with the goal of serving the welfare and interests of patients, donors, and the general public.
Sep 2017 DOI 10.14302/issn.2474-7785.jarh-17-1727
Background: Healthcare services provided to patients should vary depending on disease severity. However, disease severity bias, a type of selection bias, is a commonly encountered problem in administrative database studies. Herein, we selected chronic obstructive pulmonary disease (COPD), which commonly affects elderly Japanese citizens, for the development and validation of a severity classification system based on a health insurance claims database. Methods: Patients who received COPD-related diagnostic codes in 2011 were selected from a commercially based health insurance claims database. COPD patients were randomly divided into two groups to develop and validate severity scores. A principal component analysis was used to estimate factor loadings used to weight calculations of COPD severity scores. Score validity was evaluated using a linear trend test to predict COPD treatment costs and acute exacerbation events. Results: Using records from 880 patients, ten variables were created: acute exacerbation events, emphysema diagnoses, laboratory test and oxygen therapy procedures, prescribed anticholinergic, inhaled corticosteroid (ICS), short acting beta-agonist, and long acting bronchodilator (LABA) agents, asthma diagnosis and patient birth years. Factor loadings from LABA and ICS prescriptions had the strongest impacts on estimated severity scores (0.50 and 0.49, respectively). Among 300 validation group patients, scores were found to associate with increasing trends of median costs and exacerbation risks (p for trend < 0.05). Conclusions: Estimatedseverity scores would help to predict COPD-related medical costs and exacerbation events. For further clinical implementation, this classification system should be re-evaluated using clinical lung functions information indicative COPD severity and treatment choices.
Jun 2017 DOI 10.14302/issn.2474-7785.jarh-17-1489
We aimed to find the population coverage, health service utilization and out-of-pocket spending among the elderly who are insured under Comprehensive Health Insurance Scheme (CHIS), Kerala through a longitudinal study of 600 non-rich households for nine months. The study found that only 57.7% the elderly were insured under CHIS which is lower than the population average of 80%. Single elderly from a socially backward caste, living alone in kutcha or semi-pucca houses were excluded from CHIS. Even though insured elderly had more episodes of hospitalization, only 38.4% of the elderly could make use of CHIS smart card for payment during hospitalization and 43.6% of the episodes were covered by CHIS. The mean indirect out-of-pocket expenses among insured elderly who had used smart cards for hospitalization (INR 7679.25) was higher than that for the un-insured (INR 4455.26), p = 0.027. The mean monthly drug expenditure (INR 1105.09) was also significantly higher among the insured as compared to the un-insured elderly (INR 650.03), p=.004. More than 80% of the hospitalized households had to use distress finance mechanisms to meet health- related expenses. We found that population coverage among elderly did not translate into service coverage and thus financial risk protection was not achieved even in a state like Kerala which is considered to be well-performing in terms of health insurance coverage. This study points out that elderly being a vulnerable group with special needs require a more comprehensive service package including chronic disease care, and a higher level of financial coverage.
Apr 2024 DOI 10.14302/issn.2574-4526.jddd-24-4996
The General Accounting Office released a study in August 1992 of twenty-nine sampled prescription drugs that reported an average increase in the price of approximately 138 percent between 1985 and 1991 (GAO 1992, 4, Table 1) Those and other published price indexes are increasingly being used in the public policy arena to focus the debate on the potential regulation of pharmaceutical prices and the coverage of health insurance. In an industry where products are multidimensional and the rate of technological progress is brisk, misinterpretation of unadjusted indices of drug prices can easily arise. This can lead to erroneous conclusions regarding appropriate policies for the pharmaceutical industry. Researchers have addressed numerous general theoretical issues concerning the construction and interpretation of price indices 1. Two issues of particular interest for pharmaceutical markets are the new goods problem, which deals with the introduction of generic drugs into a drug price index, and the quality problem, which recognizes that newer versions of drugs with the same basic Chemical action may be superior in certain dimensions to drugs already on the market. Specific to pharmaceutical markets, 2 have also argued that the sampling procedure used by the Bureau of Labor Statistics to calculate pharmaceutical price indices is flawed. Each of those problems deserves careful analysis. This study focuses on the issue of product quality measurement and quality change.
Oct 2022 DOI 10.14302/issn.2641-4538.jphi-22-4325
The aim of this study is determine the prevalence and factors associated with caesarean section among women delivered at Kirehe District Hospital. A retrospective study was conducted among women delivered at Kirehe District Hospital from January 2018 to December 2019. The medical files of all women delivered at the hospital who meet the inclusion criteria were reviewed. Data were checked for completeness, cleaned, coded and entered into excel sheet, and then exported to SPSS version 22.0 for further analysis. Descriptive statistics was used to estimate the prevalence and description of study participants. Multivariable logistic regression models were used to estimate risk for CS with 95% confidence intervals (CIs). The study was conducted in accordance with the research protocol Mount Kenya University Rwanda research ethical committee. The majority 806 (69.9%) of women who delivered at Kirehe district hospital from January 2018 to December 2019 were aged 22-35 years old. The prevalence of C-section at Kirehe District Hospital was 23.1%. Demographic and economic factors associated with Caesaren section in bivariate and multivariate analysis was respondent’s type of health insurance where women who used private health insurance were 3 times more likely to deliver by C-section. The findings from multivariate analysis revealed that women who experienced eclampisa had 45% risk of C-Setion compared to those without Eclampsia. Women in rural area of Rwanda seem to have increased access to and use of CS. However, the significant increase in the rate of CS is of concern due to the potential of unnecessary CS.
May 2021 DOI 10.14302/issn.2641-4538.jphi-21-3632
Introduction Reporting of suspected or confirmed communicable diseases is paramount. Although physicians have primary responsibility for reporting, school nurses, laboratory directors, infection control practitioners, daycare center directors, health care facilities, state institutions and any other individuals providing health care services are also required to report communicable disease. Therefore, community health needs assessment in urban communities remains an essential instrument for the rapid and accurate dissemination of epidemiological information on cases and outbreaks of diseases under the national health regulations and other communicable diseases of public health importance, including emerging or re-emerging infections. Purpose of the Study Todescribe relevant medical needs of townspeople so that treatment plans can be developed accordingly. Methods The Study was a cross-sectional with qualitative approach. In-depth interviews and focus group interviews was used as research technique. Data was categorized to look for emerging themes then further distilled to identify any abstract themes that could be understood holistically. Results Urban decision-makers need to advocate the problem of human resources in public health facilities and the mutual health insurance to revise its insurance policy to allow their clients to be received even in private clinics. Dental services was wished to be available in public health centers. Study participants suggested that new useful information could be posted in private public premises rather than to be in public institutions only. Conclusion The patient waiting time, dental services in health centers, and the way of dissemination new health information, mutual health insurance and insufficient human resources are the major concerns of townspeople that they wish improvement.
Jan 2019 DOI 10.14302/issn.2574-4496.jtc-18-2473
This study aimed to investigate the trend of patients with thyroid cancer undergoing thyroidectomy and those undergoing fine needle aspiration (FNA) and its relationship with thyroid cancer, using a large-scale, real-world database established based on the employment-based health insurance claims data in Japan. In this retrospective descriptive study, annual incidence rates of patients with thyroid cancer undergoing thyroidectomy and FNA from 2005 to 2014 were calculated. Among the 3,130,757 enrollees, 926 patients were diagnosed with thyroid cancer and underwent thyroidectomies. The annual incidence of patients with thyroid cancer undergoing thyroidectomy increased from 5.4 (95% confidence interval 95% CI, 3.4–8.5) in 2005 to 11.7 (10.1–13.5) per 100,000 patient-years in 2013, with a gradual increase among patients in their 20s and 30s and with the most notable increase among those in their 40s and 50s. The annual FNA rate also increased during those years, whereas no noticeable change was observed in the thyroid cancer detection rate. The incidence rates of patients with thyroid cancer undergoing thyroidectomy and those undergoing FNA were strongly correlated, with Pearson’s correlation coefficients of 0.935 for men and 0.886 for women. In conclusion, an increasing trend in the incidence of patients with thyroid cancer undergoing thyroidectomy was observed from 2005 to 2013 among a large group of Japanese employees of working age and their dependents. These results provide useful information on the impact of patients with thyroid cancer undergoing thyroidectomy on the working population.
Jan 2016 DOI 10.14302/issn.2381-862X.jwrh-15-801
Objectives: To measure the horizontal inequity in the uptake of hospital delivery and quantify the contribution of various social determinants of health (SDH) to such inequity in China from 1993-2008 Methods: With four national representative surveys in China conducted in 1993, 1998, 2003 and 2008, we measured horizontal inequity in the uptake of hospital delivery using indirect standardized concentration indices (CIs). By decomposing Cis into components, we explored the contributions of income, health insurance, education, living conditions to such inequities. Oaxaca type decomposition was further used to explain the role for each SDH on the changes of inequities between 1993 and 2008. Results: We found that horizontal inequity in the coverage of hospital delivery approached equal line in the urban areas and shrank by 90% in rural China in 1993-2008. The data also showed that dramatic socio-economic achievement was made across the 16 years, including education, income, health insurance and living conditions, which contributed substantially to the reduction of the inequities in the uptake of hospital delivery. Income’s contribution was mainly made by its protection effect, while health insurance’s role was mainly played by its equal distributions in the rural areas. Conclusions: The horizontal inequity in the uptake of hospital births vanished in urban China and decreased in the rural. The leading contributors to such inequity were income, health insurance, living conditions and education. Decomposition analysis suggests that more investments are warranted for financial risk protection and targeted demand side subsidies may make a difference.