Search Results (117)

This article investigates the macroeconomic and labor market conditions that shape the adoption of artificial intelligence (AI) technologies among large firms in Europe. Based on panel data econometrics and supervised machine learning techniques, we estimate how public health spending, access to credit, export activity, gross capital formation, inflation, openness to trade, and labor market structure influence the share of firms that adopt at least one AI technology. The research covers all 28 EU members between 2018 and 2023. We employ a set of robustness checks using a combination of fixed-effects, random-effects, and dynamic panel data specifications supported by Clustering and supervised learning techniques. We find that AI adoption is linked to higher GDP per capita, healthcare spending, inflation, and openness to trade but lower levels of credit, exports, and capital formation. Labor markets with higher proportions of salaried work, service occupations, and self-employment are linked to AI diffusion, while unemployment and vulnerable work are detractors. Cluster analysis identifies groups of EU members with similar adoption patterns that are usually underpinned by stronger economic and institutional fundamentals. The results collectively suggest that AI diffusion is shaped not only by technological preparedness and capabilities to invest but by inclusive macroeconomic conditions and equitable labor institutions. Targeted policy measures can accelerate the equitable adoption of AI technologies within the European industrial economy. Full article

Healthcare cost acceleration and resource allocation issues have worsened across European health systems, where a small group of patients drives excessive healthcare spending. The prediction of high-cost utilization patterns is important for the sustainable management of healthcare and focused intervention measures. The aim of our study was to derive and validate machine learning algorithms for high-cost healthcare utilization prediction based on detailed administrative data and by comparing three algorithmic methods for the best risk stratification performance. The research analyzed extensive insurance beneficiary records which compile data from health group collective funds operated by non-life insurers across EU countries, across multiple service classes. The definition of high utilization was equivalent to the upper quintile of overall health expenditure using a moderate cost threshold. The research applied three machine learning algorithms, namely logistic regression using elastic net regularization, the random forest, and support vector machines. The models used a comprehensive set of predictor variables including demographics, policy profiles, and patterns of service utilization across multiple domains of healthcare. The performance of the models was evaluated using the standard train–test methodology and rigorous cross-validation procedures. All three models demonstrated outstanding discriminative ability by achieving area under the curve values at near-perfect levels. The random forest achieved the best test performance with exceptional metrics, closely followed by logistic regression with comparable exceptional performance. Service diversity proved to be the strongest predictor across all models, while dentistry services produced an extraordinarily high odds ratio with robust confidence intervals. The group of high utilizers comprised approximately one-fifth of the sample but demonstrated significantly higher utilization across all service classes. Machine learning algorithms are capable of classifying patients eligible for the high utilization of healthcare services with nearly perfect discriminative ability. The findings justify the application of predictive analytics for proactive case management, resource planning, and focused intervention measures across private group health insurance providers in EU countries. Full article

There is increasing evidence of the benefits of natural environments for human health. Interest is growing in nature-based therapy (NBT), organised initiatives that promote human–nature interactions with the aim of achieving positive health outcomes. Although the benefits of spending time in nature are now widely recognised, the public’s perspective of NBTs is still not well understood nor quantified. At the same time, chronic non-communicable diseases such as cardiovascular disease are on the rise, increasing costs and pressure for public health services. Using a sample of 96 respondents in Italy, this exploratory study investigates the economic value and perceptions of an NBT for cardiovascular disease. We employed the contingent valuation method to estimate marginal willingness to pay (WTP) for a nature-based rehabilitation programme compared to a standard indoor clinic-based programme. Logistic regression was used to estimate median WTP and influencing factors. We investigated the preferences of patients for the features and potential benefits of nature-based rehabilitation. We show that patients with cardiovascular disease in Italy have a positive WTP between EUR 14.01 to EUR 42.69 per day (median value EUR 27.26). Our findings indicate that NBTs could offer a promising alternative to standard indoor programmes. We provide recommendations for designing NBTs based on the preferences of our sample, aiming to contribute to sustainable health and land management policies. 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

Background: Immunization coverage in Nigeria is low, with many children missing out on important lifesaving vaccines. To enable a better understanding of contextual factors towards increasing uptake, we piloted a Decentralized Immunization Monitoring (DIM) approach in the Kumbotso local government area (LGA) of Kano state, Nigeria, to identify wards with low vaccination rates and understand why this is happening. The findings were used to improve routine immunization (RI) programs and reduce the number of unvaccinated children and children yet to receive their first dose of diphtheria–pertussis–tetanus (DPT) vaccine, referred to as Zero-Dose children (ZD). Methods: This study adopted a cross-sectional design approach using the Behavioural and Social Drivers of Vaccination (BeSD) framework and the Lot Quality Assurance Sampling (LQAS). The study population comprised caregivers of children aged 0–11 months and 12–23 months across the 11 wards in Kumbotso District, Kano State, Nigeria, using a segmentation sampling approach. The study covered 209 settlements selected using probability proportionate to size (PPS) sampling from the wards. Univariate and bivariate analyses were performed to show patterns and relations across variables. Results: Out of 418 caregivers surveyed, 98.1% were female. Delayed vaccination was experienced by 21.9% of children aged 4.5–11 months, while the prevalence of ZD was estimated at 26.8% amongst the older cohort (12–23 months). A total of 71.4% of the delayed group and 89.1% of the ZD group remained unvaccinated. Caregiver education, rural residence, and home births correlated with delayed/ZD status (p < 0.05). Logistic regression associated higher caregiver education with reduced delayed vaccination odds (OR:0.34, p < 0.001) and urban residence with lower ZD odds (OR:1.89, p = 0.036). The antigen coverages of BCG (81.5%), DPT3 (63.6%), and measles 1 (59.7%) all surpassed the national dropout thresholds. Kumbotso, Unguwar Rimi, and Kureken Sani wards were all identified as underperforming and therefore targeted for intervention. Negative vaccine perceptions (50% delayed, 53.6% ZD) and distrust in health workers (46.4% delayed, 48.2% ZD) were significant barriers, though the caregiver intent to vaccinate was protective (OR: 0.27, p < 0.001). The cost of accessing immunization services appeared to have a minor effect on coverage, as the majority of caregivers of delayed and ZD children reported spending less than 200 Naira (equivalent to USD 0.15) on transport. Conclusions: This pilot study highlighted the utility of LQAS and BeSD in identifying low-performing wards, barriers, and routine immunization gaps. Barriers included low caregiver education, rural residence, and negative vaccine perceptions/safety. Caregiver education and urban residence were protective factors against delayed and ZD vaccination, suggesting social and systemic barriers, particularly in rural and less educated populations. Antigen-specific coverage showed disparities, with dropouts for multi-dose vaccines exceeding the national thresholds of 10%. Targeted measures addressing education, trust, and systemic issues are needed. Findings emphasize decentralized monitoring, community engagement, and context-specific strategies to reduce ZD children and ensure equitable vaccination in Nigeria. 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

The empirical findings of this study suggest a significant long-term relationship between the probability of mortality due to non-communicable diseases (NCDs) among individuals aged 30–70 in Azerbaijan and key economic and social indicators, including Gross Domestic Product per Capita, Waged Employment, Human Development Index, and out-of-pocket health expenditures. The Error Correction Model coefficient (−0.724701) implies that the system adjusts back to equilibrium at a rate of 72.47% per period, highlighting a strong corrective mechanism. Additionally, in the short run, GDP, HDI, wage employment, and out-of-pocket health expenditures significantly influence mortality rates. The model’s statistical diagnostics confirm its robustness, and the results align with economic theory, reinforcing their validity and policy relevance. According to the conclusion of this research, we suggest the enhancement of the HDI and Employment, control out-of-pocket expenditures, and increase Government Healthcare Spending to significantly reduce mortality rates. This study emphasizes that enhancing social determinants like the HDI, Waged Employment, and accessible healthcare services is crucial for reducing mortality rates of NCDs. While Azerbaijan’s economic growth has improved living standards, further efforts are necessary to improve healthcare investments and reduce inequalities in health outcomes. Full article

Background: Saudi Arabia is undertaking a comprehensive reform of its healthcare system to improve the efficiency and accessibility of public healthcare services. A key aspect of this initiative is outsourcing outpatient pharmacy services within the public health sector to retail pharmacies through an electronic prescribing platform known as Wasfaty. The National Unified Procurement Company (NUPCO) manages this platform to ensure spending efficiency and patient accessibility to essential medications. However, there has been a lack of research evaluating the adherence of the Wasfaty e-prescribing platform to established best practices for Computerized Provider Order Entry (CPOE), which are commonly used to assess the performance of various ambulatory e-prescribing systems globally. Objective: This study aimed to assess the level of adherence of Wasfaty to best practices for CPOE. Methods: This descriptive cross-sectional single-center study reviewed filled prescriptions through Wasfaty from May 2022 to December 2023. A list of 60 functional features, including but not limited to patient identification and data access, medication selection, alerts, patient education, data transmission and storage, monitoring and renewals, transparency and accountability, and feedback, was utilized to evaluate adherence. The adherence level was categorized into four groups: fully implemented, partially implemented, not implemented, and not applicable. Two pharmacy interns, a clinical pharmacist, and a researcher, reviewed the prescriptions to determine the platform’s adherence to these 60 CPOE features. Results: From May 2022 to December 2023, a total of 1965 prescriptions were filled in retail pharmacies for out-of-stock medications for 1367 patients. These prescriptions included medications for various areas, with the following distribution: gastroenterology (44.10%), cardiology (18.14%), anti-infectives (2.42%), urology (8.85%), dermatology (3.6%), hematology (0.29%), muscle relaxants (0.8%), neurology (19.17%), pulmonology (1.46%), and other categories (1.23%). Of the 60 functional characteristics a CPOE platform should include, only 19 (31.66%) were fully implemented, while 10 (16.66%) were partially implemented. Conclusions: The Wasfaty platform is deficient in several key functional features necessary for e-prescribing, which are essential for ensuring patient safety and enhancing the satisfaction of both prescribers and patients. This study underscores the importance of improving the Wasfaty platform to reduce the risk of adverse drug events. Full article

As a core and long-established part of urban blue–green infrastructure (BGI), public parks play a significant role in the sustainable development of cities. In particular, they make a major contribution to maintaining healthy ecosystems and providing multiple benefits that support human health and quality of life as a kind of nature-based solution (NBS). Still, planning, design, and management of public parks mostly rely on official standards and technical guidelines, whereas societal perspectives and the use of the ecosystem services (ES) approach (and cultural ecosystem services (CES) in particular) remain inadequately integrated. By assessing CES offered by Gorky Park in Moscow (Russia), the paper aims to bridge this gap and investigate the flow of CES and its relation to park infrastructure and the visitors’ needs. For this purpose, non-participant observation, field notes, and photographs were used in different functional park zones. By investigating visitor activities and factors affecting them, a variety of CES provided by the park have been detected. As aligned with its original idea, the park was mostly used for recreation, leisure, sports, and socializing. Moreover, the CES related to aesthetic, educational, and cultural heritage values were also partially utilized. The park was mostly attractive to the younger generation (the highest number of visitors), whereas visitors over 60 years old were hardly represented. Notably, men were more interested in sports (especially, team sports), whereas women mostly preferred walking (alone, with family, and with friends), relaxation, playing and spending time with children, picnicking, etc., which indicated certain preferences for CES among the park visitors. An interdependent relationship between the CES supply and the park infrastructure was found: the more infrastructural components were identified, the greater variety of park activities and corresponding CES were detected at certain observation points, which could ultimately lead to overcrowding and overutilization of the ES capacity. Given that the Moscow government claims integrating ES into the planning and management of urban BGI as one of the priorities in the city’s environmental policies, the related recommendations are provided. They address the recent challenges of creating integrated BGI, increasing demand for multifunctionality, and the conflicting interests of different visitor groups to maximize the benefits and diversity of CES delivered by the park. Full article

Background/Objectives: As adults spend about 30% of each day asleep, having a sleep disorder can negatively affect their functioning. The study objective was to determine the factors that influence sleep quality among patients and healthcare providers in the primary healthcare setting. Methods: This study included respondents of both sexes aged 18–90 years, comprising outpatients and the healthcare providers working in the General Medicine Service at the “Liman” Department of the “Novi Sad” Health Center in Novi Sad, Republic of Serbia. Demographic data along with factors related to lifestyle and sleep habits were collected using a demographic questionnaire specifically designed for this research. The standardized Pittsburgh Sleep Quality Questionnaire, Serbian version (PSQI), was used to assess sleep quality. Results: The study sample comprised 92 respondents (42 healthcare providers and 50 patients), 73.9% of whom were female, with an average age of 50.0 years. Although 50% of healthcare providers reported sleeping only 3–6 h the previous night, according to the PSQI results, patients had lower overall sleep quality (54.0% vs. 33.3%; p = 0.046) and achieved lower scores in the DISTB (sleep disturbances, p = 0.001), SLPQUAL (subjective sleep quality, p = 0.013) and MEDS (use of sleeping medication, p = 0.003) PSQI domains. Conclusions: Sleep quality is impaired in more than half of patients and more than a third of healthcare providers. By detecting and acting on the factors in the home and work environment that affect quality of sleep, and by changing lifestyle habits, sleep quality in adults can be improved. 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

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

In health insurance, “moral hazard” describes the concept that coverage without an out-of-pocket cost to consumers could result in health care utilization beyond economically efficient levels. In response, payers in the United States (US) have designed pharmaceutical benefit plans with significant cost exposure (e.g., co-pays, co-insurance, or deductibles). While substantial evidence links patient cost exposure to reduced drug spending, it remains unclear to what degree this translates into greater efficiency or an indiscriminate drop in overall consumption also reducing needed utilization. We conducted a systematic literature review to understand whether commonly implemented utilization management (UM) strategies and insurance designs with a behavioral or value-based (BID/VBID) component have been explored as tools to mitigate moral hazard and to assess how cost-sharing policies and innovative insurance designs impact consumer spending. Eligible studies compared conventional cost-exposure policies to BID/VBID, including tiered cost-sharing and other UM strategies. We found that broad implementation of patient cost exposure is not well supported by empirical evidence assessing efficiency—defined as the use of clinically appropriate services with value at or above the marginal cost of health care utilization in the contemporary US setting. As a result, payers and policy makers alike ought to explore insurance alternatives that more closely align health care consumption incentives to value of care. Full article