Search Results (177)

Although technological innovations are often intended to improve quality and efficiency, they can exacerbate systemic challenges when not aligned with the principles of value-based care. As a result, healthcare systems in many countries face persistent inefficiencies stemming from the overuse, underuse, misuse, and waste associated with the adoption of health technology. This narrative review examines the dual impact of healthcare technology and evaluates how contract mechanisms can serve as strategic tools for promoting cost-effective, outcome-oriented integration. Drawing from healthcare management, and supply chain literature, this paper analyzes various payment and contract models, including performance-based, bundled, cost-sharing, and revenue-sharing agreements, through the lens of stakeholder alignment. It explores how these mechanisms influence provider behavior, patient access, and system sustainability. The study contends that well-designed contract mechanisms can align stakeholder incentives, reduce inefficiencies, and support the delivery of high-value care across diverse healthcare settings. We provide concrete examples to illustrate how various contract mechanisms impact the integration of health technologies in practice. Full article

A growing number of research studies show that children spend less time in natural environments, which may have detrimental effects on children’s mental and physical health. This study explores changes in children’s (6–12 years) use of nearby nature and constraints on playing in nature between 2013 and 2023. We apply an ecological approach, including individual, social, and structural constraints on outdoor play. The study is based on national surveys of parents reporting child play behavior for eight activity categories and nineteen categories of constraints/motivation. Findings reveal a decreasing tendency for time spent on all activity categories and increasing constraints for 17 of 19 categories during the study period. Our ecological approach reveals that there is less time for children’s nature use in contemporary society, and activities are more common in built areas than in nature. The survey identifies some important socio-cultural differences regarding gender, age, and residential setting. In future research, the focus should be on how reduced connection to nature affects children’s mental and physical health, and beyond this, how it affects the understanding of and care for nature among future generations. Full article

Background/Objectives: Community benefit (CB) obligations by not-for-profit (NFP) hospitals have attracted renewed scrutiny at federal and state levels due to wide variation in CB spending. In 2020, Oregon implemented a CB policy for all NFP hospitals that included requirements to expand patient financial assistance and a hospital-specific minimum CB spending floor. We examined trends in CB spending after the implementation of Oregon’s CB policy. Methods: Interrupted time-series analyses to compare hospital CB spending before and after policy implementation. Results: Overall, Oregon’s CB policy was not associated with changes in CB spending, except for a 0.2% decrease in the Social Determinants of Health spending (−0.0018; p < 0.05). Among hospitals in the first tercile of pre-policy CB spending, Oregon’s policy was associated with a 0.4% decrease in charity care (−0.0041; p < 0.05) and a 0.6% increase in subsidized health services spending (0.0063; p < 0.05). Hospitals in the second tercile of pre-policy CB spending experienced a 0.7% decrease in subsidized health services (−0.0074; p < 0.05). Among frontier hospitals, total CB spending and Medicaid shortfalls increased by 2.9% (0.0292; p < 0.10) and 2.2% (0.0220; p < 0.10) respectively, while non-frontier hospitals experienced a 0.7% decrease in Medicaid shortfall (−0.0068; p < 0.05). Critical access hospitals experienced a 1.3% increase in subsidized health services spending (0.0131; p < 0.05). Conclusions: Although total CB spending did not change in the two years following Oregon’s CB policy implementation, findings suggest that hospitals may be shifting the composition of their CB spending. Oregon’s CB policy encourages proactive CB spending tailored to community needs, but opportunities exist to fine-tune the policy to boost hospital CB spending. Specifically, planned spending in categories such as charity care may alleviate the increasing burden of medical debt and its financial implications for patients. Full article

Heart failure (HF) is a highly prevalent cardiovascular clinical syndrome. Health care spending on HF treatment is high. Therefore, its treatment has generated a great deal of interest in pharmacological research in recent years. Recent guidelines have introduced several molecules for the treatment of HF that have demonstrated safety, and above all, efficacy. One of the worst aspects of HF is ventricular dyssynchrony (VD) with a wide QRS interval. Currently, the cornerstone of VD therapy is cardiac resynchronization therapy (CRT). Our comprehensive review aims to analyze the effects of new molecules on QRS width and understand whether these molecules can provide benefits. Full article

Background: Children, including the estimated 7% with food allergy, spend most of their waking hours in school. Variations in school-based food allergy (FA) practices exist. We aimed to examine differences in FA management practices across schools in Canada and the United States (US). Methods: Parents of children with Immunoglobulin E (IgE)-mediated FA were recruited through social media to complete a survey evaluating the schools’ stock epinephrine, epinephrine storage locations, school type, and location. Data were described, analyzed using logistic and linear regressions, and then reported as odds ratios (ORs) and standardized coefficients (b), respectively, with corresponding 95% confidence intervals (95%CIs) and p < 0.05. This study was approved by the University of Manitoba Health Research Ethics Board. Results: Overall, 177 participants (14% [26/177] Canada, 86% [151/177] US) were included. Children were, on average, 4.92 ± 3.12 years and were commonly but not mutually exclusively allergic to tree nuts (50% Canada; 40% US) and peanuts (33% Canada; 29% US). Compared to US parents, Canadian parents were more likely to report epinephrine self-carriage by their children (OR = 4.58; 95%CI = 1.67–12.59). Parents with children age > 5 years were more likely to report epinephrine self-carriage by their children (OR = 3.70; 95%CI = 1.38–9.93) but less likely to report that their children’s school had an allergen-friendly zone (OR = 0.25; 95%CI = 0.06–0.99). Compared to US parents, Canadian parents were more likely to report their child’s school had anaphylaxis management policies (OR = 8.98; 95%CI = 1.11–72.42). Conclusions: Significant in-school FA management differences exist between countries. These findings stress the need for consistent policies and practices to ensure effective care. Full article

In this paper, we utilize the 2019/20 Uganda National Household Survey data to answer three related questions: (i) To what extent did out-of-pocket payments (OOPs) for health care services exceed the threshold for household financial catastrophe amidst COVID-19? (ii) What is the impoverishing effect of OOPs for health care services on household welfare? (iii) What are the socioeconomic and demographic determinants of OOPs for health care services in Uganda? Leveraging three health expenditure thresholds (10%, 25%, and 40%), we run a Tobit model for “left-censored” health expenditures and quantile regressions, and we find that among households which incur any form of health care expense, 37.7%, 33.6%, and 28.7% spend more than 10%, 25%, and 40% of their non-food expenditures on health care, respectively. Their average OOP budget share exceeds the respective thresholds by 82.9, 78.0, and 75.8 percentage points. While, on average, household expenditures on medicine increased amidst the COVID-19 pandemic, expenditures on consultations, transport, traditional doctors’ medicines, and other unbroken hospital charges were reduced during the same period. We find that the comparatively low incidence and intensity of catastrophic health expenditures (CHEs) in the pandemic period was not necessarily due to low household health spending, but due to foregone and substituted care. Precisely, considering the entire weighted sample, about 22% of Ugandans did not seek medical care during the pandemic due to a lack of funds, compared to 18.6% in the pre-pandemic period. More Ugandans substituted medical care from health facilities with herbs and home remedies. We further find that a 10% increase in OOPs reduces household food consumption expenditures by 2.6%. This modality of health care financing, where households incur CHEs, keeps people in chronic poverty. Full article

In this study, we provide the first estimates of the effect of COVID-19 (COVID-19 legal restrictions) on catastrophic medical expenditure and forgone medical care in Africa. Data for this study were drawn from the 2018/19 Nigeria General Household Survey (NGHS) panel and the 2020/21 Nigeria COVID-19 National Longitudinal Phone Survey panel (COVID-19 NLPS). The 2020/21 COVID-19 panel survey sample was drawn from the 2018/19 NGHS panel sample monitoring the same households. Hence, we leveraged a rich set of pre-COVID-19 and COVID-19 panel household surveys that can be merged to track the effect of the pandemic on welfare outcomes. We found that the COVID-19 legal restrictions decreased catastrophic medical expenditure (measured by out-of-pocket (OOP) expenditures exceeding 10% of total household expenditure). However, the COVID-19 legal restrictions increased the incidences of forgone medical care. The results showed a consistent positive effect on forgone medical care across waves one and two, corresponding to full and partial implementation of COVID-19 legal restrictions, respectively. However, the negative effect on catastrophic medical spending was only observed when the COVID-19 legal restrictions were fully in force, but the sign reversed when the restriction enforcement became partial. Moreover, our panel regression analyses revealed that having health insurance is associated with a reduced probability of incurring CHE and forgoing medical care relative to having no health insurance. We suggest that better policy design in terms of expanding the depth and coverage of health insurance will broaden access to quality healthcare services during and beyond the pandemic periods. Full article

Background: Children with medical complexity (CMC), a subset of children with special healthcare needs, have chronic conditions affecting multiple organ systems, require medical technology, and account for a significant share of pediatric healthcare spending despite comprising only 1% of the population. Their families experience unique stressors, including financial strain and high rates of workforce attrition, suggesting medical inequity is an independent risk factor for health inequity. The role of universal caregiver stress screening using a validated tool within the outpatient primary care medical home for CMC youth has not been explored in the literature. Methods: Caregivers of all patients in the Complex Care Program (CCP) within a large academic pediatric primary care Medical Home-certified practice at the Children’s National Hospital were screened for caregiver stress during routine primary care appointments using the University of Washington Caregiver Stress Scale 8-Item Short Form V. 2.0 (UW-CSS). Elevated scores prompted referrals to the CCP psychosocial team, and composite scores were recorded in the electronic medical record. Demographics, medical diagnoses, and technology support status were extracted from the medical chart. The childhood opportunity index (COI) was calculated as a proxy for socioeconomic position. Results: Screening for caregiver stress in our medical home for CMC was feasible and yielded unexpected results. We found no difference in levels of stress among caregivers based on the COI. This finding highlights the importance of universal rather than targeted screening. Future directions include measuring the impact of targeted interventions for families who initially screen positive via longitudinal follow-up. Conclusions: Screening for caregiver stress in a primary care medical home for CMC is feasible. As no single variable alone was a predictor of high caregiver stress, universal screening seems to be the most appropriate strategy to capture all families at the highest risk. Full article

Background: Primary healthcare workers (PHCWs) serve as critical contributors to public health, yet their physical activity (PA) patterns and lifestyle habits often reflect the very challenges they address in their patients. The aim of this study is to determine the PA patterns and lifestyle habits among PHCWs in the Lepelle-Nkumpi sub-district of Limpopo Province, South Africa. Methodology: A quantitative, cross-sectional design with stratified random sampling (n = 174) was used. A validated, closed-ended questionnaire assessed demographic data and occupational and leisure-time physical activity. Data were analysed using SPSS version 28, with descriptive statistics summarising characteristics. Chi-square tests identified significant associations (p < 0.05) between lifestyle scores (poor, good, excellent) and demographic factors. Results: The majority of the participants (53%) reported engaging in shorter walking durations during work, with only 7.5% of the participating engaging in moderate physical activity and 39.7% achieving 30 min or more of activity. Additionally, 59.8% do not use walking or cycling for transportation, while only 27% do so for at least 30 min daily. During leisure time, 33.9% of the participants engage in moderate-to-vigorous physical activities, with 37.9% spending 30 min or more on such activities daily. Nearly two-thirds of the participants (65.5%) had poor lifestyle scores (0–50%), while 23.6% achieved excellent scores (81–100%). Significant associations were found between gender and lifestyle scores (p = 0.022). Conclusion: This study reveals critical gaps in the physical activity levels of PHCWs, with low engagement in moderate activity during work and limited active commuting. This study underscores the need for workplace wellness interventions, such as walking meetings and fitness facilities, to boost physical activity among healthcare workers, enhancing their health, resilience, and the quality of care they provide. Full article

A high prevalence of chronic diseases exposes diverse healthcare pain points due to the limited effectiveness of pharmaceutical drugs and biologics, sedentary lifestyles, insufficient health literacy, chronic stress, unsatisfactory patient experience, environmental pollution and competition with commercial determinants of health. To improve patient care and long-term outcomes, the impact of the home environment is overlooked and underutilized by healthcare. This cross-disciplinary work describes perspectives on (1) the home environment as a therapeutic target for the prevention and treatment of chronic diseases and (2) transforming health-centric household goods e-commerce platforms into digital health interventions. We provide a rationale for creating therapeutic home environments grounded in biophilic design (multisensory, environmental enrichment) and supporting physical activities, quality sleep, nutrition, music, stress reduction, self-efficacy, social support and health education, hence providing clinical benefits through the modulation of the autonomic nervous system, neuroplasticity and behavior change. These pleiotropic “active non-pharmacological ingredients” can be personalized for people living with depression, anxiety, migraine, chronic pain, cancer, cardiovascular and other conditions. We discuss prospects for integrating e-commerce with digital health platforms to create “therapeutic home environment” interventions delivered through digital therapeutics and their combinations with prescription drugs. This multimodal approach can enhance patient engagement while bridging consumer spending with healthcare outcomes. Full article

This review evaluates the financial burden of current treatments for triple-negative breast cancer (TNBC) and projects potential financial scenarios to assess the feasibility of introducing a peptide-based neoantigen cancer vaccine (NCV) targeting the disease, using the UK as a healthcare system model. TNBC, the most aggressive breast cancer subtype, is associated with poor prognosis, worsened by the lack of personalised treatment options. Neoantigen cancer vaccine therapies present a personalised alternative with the potential to enhance T-cell responses independently of genetic factors, unlike approved immunotherapies for TNBC. Through a systematic literature review, the underlying science and manufacturing processes of NCVs are explored, the direct medical costs of existing TNBC treatments are enumerated, and two contrasting pricing scenarios for NCV clinical adoption are evaluated. The findings indicate that limited immunogenicity is the main scientific barrier to NCV clinical advancement, alongside production inefficiencies. Financial analysis shows that the UK spends approximately GBP 230 million annually on TNBC treatments, ranging from GBP 2200 to GBP 54,000 per patient. A best-case pricing model involving government-sponsored NCV therapy appears financially viable, while a worst-case, privately funded model exceeds the National Institute for Health and Care Excellence (NICE) cost thresholds. This study concludes that while NCVs show potential clinical benefits for TNBC, uncertainties about their standalone efficacy make their widespread adoption in the UK unlikely without further clinical research. Full article

Caregiving plays a crucial role in aging societies by supporting individuals with chronic illnesses, disabilities, or aging-related needs. The unpaid labour provided by caregivers diverts healthcare resources from the formal healthcare system; however, this incurs costs to the caregivers themselves in terms of declines in personal wellbeing. This study explores the relationship between caregiving and healthcare spending for two groups of caregivers: eldercare only and sandwiched. We found that physician visits were the most common resource used by caregivers, at a mean of 3.69 (SD = 4.01) visits over a 6-month period, excluding non-users of this service. This was followed by mental health services (M = 5.86, SD = 7.02), emergency room visits (M = 1.77, SD = 1.38), and hospital admissions (M = 3.61, SD = 8.53). There were no significant differences in healthcare utilization between eldercare and sandwiched caregivers. There were mixed results regarding characteristics associated with greater resource use; however, the hours of weekly caregiving were most consistently associated with greater healthcare utilization, indicating that healthcare use may increase with care burden. Full article

Saudi Vision 2030 is a game-changer for all aspects of the economy, including healthcare. This article provides a comprehensive overview of healthcare financing in the Kingdom of Saudi Arabia (KSA). It identifies key healthcare financing challenges that must be addressed to achieve the initiative’s envisioned health system goals. The review also examines and demonstrates how healthcare funds in the KSA are allocated among different healthcare services, to offer a perspective on resource use efficiency at various healthcare levels. This research used a mixed-method design which includes a literature review and secondary data analysis. A literature review was conducted aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. The secondary data were gathered from the reports and websites of government agencies, international organizations, and non-governmental organizations. Despite implementing significant reforms in its healthcare system, the share of private healthcare expenditure in total healthcare spending has seen only marginal growth. The current healthcare financing system appears insufficient to adequately support the chronically ill and the poor. There is a significant imbalance in the allocation of government budgets between hospitals and primary care, with four-fifths of financial resources directed towards hospital services. The Ministry of Health’s budget allocation prioritizes personnel compensation, potentially reducing the available budget for medicines and other essential healthcare supplies. Ongoing reforms in the health sector, including privatization, public–private partnership initiatives, and the government’s commitment to developing a robust primary healthcare network, are expected to play a significant role in controlling rapidly increasing public healthcare expenditures in Saudi Arabia. Full article

US life expectancy now lags significantly behind the majority of high-income countries, having grown more slowly since 1980 for reasons that are not evident and have been debated. An exploratory system dynamics model is presented that reproduces the full pattern of US life expectancy from 1960 to the present. Multiple socioeconomic and behavioral factors help to explain the historical pattern, two of them apparently most responsible for the stagnation since 1980: the growth of obesity and the leveling off of growth in social spending. Some of the factors in the model are traced back to earlier causes, and obesity’s growth in particular is traced back to excess growth in private health care spending and its adverse effect on workers’ wages. The model’s base run does a good job of reproducing a variety of historical time series data going back to the 1960s, and counterfactual tests produce plausible results and clarify the model’s main themes. The model may thus be considered a reasonable starting point for more conclusive future modeling of US life expectancy. Full article

This article examines the impact of income level on family care organizations in Mexico to elucidate how families apportion care responsibilities according to their economic standing. The study design employed a quantitative approach, utilizing two distinct methodologies to construct two indices: one representing the time devoted to care and the other representing care transferred to the market. Factor analysis converts minutes and hours into a time index and transforms the number of domestic workers and health and hospital expenses into a market index. A regression model estimates the effect of income on these indices, aiming to analyze the relationship between income and spending on health and services and between income and time spent on home care. The results are based on data from the National Household Income and Expenditure Survey (ENIGH) 2010–2020, using a nationally representative sample of 81 thousand dwellings. The data analysis concluded that households with higher incomes spend a more significant proportion of their expenditure on domestic care-paid services and have greater access to professional care. In contrast, lower-income households face significant challenges due to their limited financial resources and the higher demands for unpaid care. Full article