WorldWideScience

Sample records for public health costs

  1. Estimating the Cost of Providing Foundational Public Health Services.

    Science.gov (United States)

    Mamaril, Cezar Brian C; Mays, Glen P; Branham, Douglas Keith; Bekemeier, Betty; Marlowe, Justin; Timsina, Lava

    2017-12-28

    To estimate the cost of resources required to implement a set of Foundational Public Health Services (FPHS) as recommended by the Institute of Medicine. A stochastic simulation model was used to generate probability distributions of input and output costs across 11 FPHS domains. We used an implementation attainment scale to estimate costs of fully implementing FPHS. We use data collected from a diverse cohort of 19 public health agencies located in three states that implemented the FPHS cost estimation methodology in their agencies during 2014-2015. The average agency incurred costs of $48 per capita implementing FPHS at their current attainment levels with a coefficient of variation (CV) of 16 percent. Achieving full FPHS implementation would require $82 per capita (CV=19 percent), indicating an estimated resource gap of $34 per capita. Substantial variation in costs exists across communities in resources currently devoted to implementing FPHS, with even larger variation in resources needed for full attainment. Reducing geographic inequities in FPHS may require novel financing mechanisms and delivery models that allow health agencies to have robust roles within the health system and realize a minimum package of public health services for the nation. © Health Research and Educational Trust.

  2. Cost analysis of public health influenza vaccine clinics in Ontario.

    Science.gov (United States)

    Mercer, Nicola J

    2009-01-01

    Public health in Ontario delivers, promotes and provides each fall the universal influenza immunization program. This paper addresses the question of whether Ontario public health agencies are able to provide the influenza immunization program within the Ministry of Health fiscal funding envelope of $5 per dose. Actual program delivery data from the 2006 influenza season of Wellington-Dufferin-Guelph Public Health (WDGPH) were used to create a model template for influenza clinics capturing all variable costs. Promotional and administrative costs were separated from clinic costs. Maximum staff workloads were estimated. Vaccine clinics were delivered by public health staff in accordance with standard vaccine administration practices. The most significant economic variables for influenza clinics are labour costs and number of vaccines given per nurse per hour. The cost of facility rental was the only other significant cost driver. The ability of influenza clinics to break even depended on the ability to manage these cost drivers. At WDGPH, weekday flu clinics required the number of vaccines per nurse per hour to exceed 15, and for weekend flu clinics this number was greater than 21. We estimate that 20 vaccines per hour is at the limit of a safe workload over several hours. Managing cost then depends on minimizing hourly labour costs. The results of this analysis suggest that by managing the labour costs along with planning the volume of patients and avoiding expensive facilities, flu clinics can just break even. However, any increased costs, including negotiated wage increases or the move to safety needles, with a fixed revenue of $5.00 per dose will negate this conclusion.

  3. Who pays for public employee health costs?

    Science.gov (United States)

    Clemens, Jeffrey; Cutler, David M

    2014-12-01

    We analyze the incidence of public-employee health benefits. Because these benefits are negotiated through the political process, relevant labor market institutions deviate significantly from the competitive, private-sector benchmark. Empirically, we find that roughly 15 percent of the cost of recent benefit growth was passed onto school district employees through reductions in wages and salaries. Strong teachers' unions were associated with relatively strong linkages between benefit growth and growth in total compensation. Our analysis is consistent with the view that the costs of public workers' benefits are difficult to monitor, contributing to benefit oriented, and often under-funded, compensation schemes. Copyright © 2014 Elsevier B.V. All rights reserved.

  4. Cost of Delivering Health Care Services in Public Sector Primary and Community Health Centres in North India.

    Science.gov (United States)

    Prinja, Shankar; Gupta, Aditi; Verma, Ramesh; Bahuguna, Pankaj; Kumar, Dinesh; Kaur, Manmeet; Kumar, Rajesh

    2016-01-01

    With the commitment of the national government to provide universal healthcare at cheap and affordable prices in India, public healthcare services are being strengthened in India. However, there is dearth of cost data for provision of health services through public system like primary & community health centres. In this study, we aim to bridge this gap in evidence by assessing the total annual and per capita cost of delivering the package of health services at PHC and CHC level. Secondly, we determined the per capita cost of delivering specific health services like cost per antenatal care visit, per institutional delivery, per outpatient consultation, per bed-day hospitalization etc. We undertook economic costing of fourteen public health facilities (seven PHCs and CHCs each) in three North-Indian states viz., Haryana, Himachal Pradesh and Punjab. Bottom-up costing method was adopted for collection of data on all resources spent on delivery of health services in selected health facilities. Analysis was undertaken using a health system perspective. The joint costs like human resource, capital, and equipment were apportioned as per the time value spent on a particular service. Capital costs were discounted and annualized over the estimated life of the item. Mean annual costs and unit costs were estimated along with their 95% confidence intervals using bootstrap methodology. The overall annual cost of delivering services through public sector primary and community health facilities in three states of north India were INR 8.8 million (95% CI: 7,365,630-10,294,065) and INR 26.9 million (95% CI: 22,225,159.3-32,290,099.6), respectively. Human resources accounted for more than 50% of the overall costs at both the level of PHCs and CHCs. Per capita per year costs for provision of complete package of preventive, curative and promotive services at PHC and CHC were INR 170.8 (95% CI: 131.6-208.3) and INR162.1 (95% CI: 112-219.1), respectively. The study estimates can be used

  5. The economic cost of Alzheimer's disease: Family or public-health burden?

    Directory of Open Access Journals (Sweden)

    Diego M. Castro

    Full Text Available Abstract Alzheimer's disease (AD patients suffer progressive cognitive, behavioral and functional impairment which result in a heavy burden to patients, families, and the public-health system. AD entails both direct and indirect costs. Indirect costs (such as loss or reduction of income by the patient or family members are the most important costs in early and community-dwelling AD patients. Direct costs (such as medical treatment or social services increase when the disorder progresses, and the patient is institutionalized or a formal caregiver is required. Drug therapies represent an increase in direct cost but can reduce some other direct or indirect costs involved. Several studies have projected overall savings to society when using drug therapies and all relevant cost are considered, where results depend on specific patient and care setting characteristics. Dementia should be the focus of analysis when public health policies are being devised. South American countries should strengthen their policy and planning capabilities by gathering more local evidence about the burden of AD and how it can be shaped by treatment options.

  6. The Potential to Forgo Social Welfare Gains through Over reliance on Cost Effectiveness/Cost Utility Analyses in the Evidence Base for Public Health

    International Nuclear Information System (INIS)

    Cohen, D.R.; Patel, N.

    2010-01-01

    Economic evaluations of clinical treatments most commonly take the form of cost effectiveness or cost utility analyses. This is appropriate since the main sometimes the only benefit of such interventions is increased health. The majority of economic evaluations in public health, however, have also been assessed using these techniques when arguably cost benefit analyses would in many cases have been more appropriate, given its ability to take account of non health benefits as well. An examination of the non health benefits from a sample of studies featured in a recent review of economic evaluations in public health illustrates how over focusing on cost effectiveness/cost utility analyses may lead to forgoing potential social welfare gains from programmes in public health. Prior to evaluation, programmes should be considered in terms of the potential importance of non health benefits and where these are considerable would be better evaluated by more inclusive economic evaluation techniques.

  7. Costs of medically assisted reproduction treatment at specialized fertility clinics in the Danish public health care system

    DEFF Research Database (Denmark)

    Christiansen, Terkel; Erb, Karin; Rizvanovic, Amra

    2014-01-01

    To examine the costs to the public health care system of couples in medically assisted reproduction.......To examine the costs to the public health care system of couples in medically assisted reproduction....

  8. Environmental Public Health Tracking: a cost-effective system for characterizing the sources, distribution and public health impacts of environmental hazards.

    Science.gov (United States)

    Saunders, P J; Middleton, J D; Rudge, G

    2017-09-01

    The contemporary environment is a complex of interactions between physical, biological, socio-economic systems with major impacts on public health. However, gaps in our understanding of the causes, extent and distribution of these effects remain. The public health community in Sandwell West Midlands has collaborated to successfully develop, pilot and establish the first Environmental Public Health Tracking (EPHT) programme in Europe to address this 'environmental health gap' through systematically linking data on environmental hazards, exposures and diseases. Existing networks of environmental, health and regulatory agencies developed a suite of innovative methods to routinely share, integrate and analyse data on hazards, exposures and health outcomes to inform interventions. Effective data sharing and horizon scanning systems have been established, novel statistical methods piloted, plausible associations framed and tested, and targeted interventions informed by local concerns applied. These have influenced changes in public health practice. EPHT is a powerful tool for identifying and addressing the key environmental public health impacts at a local level. Sandwell's experience demonstrates that it can be established and operated at virtually no cost. The transfer of National Health Service epidemiological skills to local authorities in 2013 provides an opportunity to expand the programme to fully exploit its potential. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  9. The impact of antipsychotic polytherapy costs in the public health care in Sao Paulo, Brazil.

    Science.gov (United States)

    Razzouk, Denise; Kayo, Monica; Sousa, Aglaé; Gregorio, Guilherme; Cogo-Moreira, Hugo; Cardoso, Andrea Alves; Mari, Jair de Jesus

    2015-01-01

    Guidelines for the treatment of psychoses recommend antipsychotic monotherapy. However, the rate of antipsychotic polytherapy has increased over the last decade, reaching up to 60% in some settings. Studies evaluating the costs and impact of antipsychotic polytherapy in the health system are scarce. To estimate the costs of antipsychotic polytherapy and its impact on public health costs in a sample of subjects with psychotic disorders living in residential facilities in the city of Sao Paulo, Brazil. A cross-sectional study that used a bottom-up approach for collecting costs data in a public health provider's perspective. Subjects with psychosis living in 20 fully-staffed residential facilities in the city of Sao Paulo were assessed for clinical and psychosocial profile, severity of symptoms, quality of life, use of health services and pharmacological treatment. The impact of polytherapy on total direct costs was evaluated. 147 subjects were included, 134 used antipsychotics regularly and 38% were in use of antipsychotic polytherapy. There were no significant differences in clinical and psychosocial characteristics between polytherapy and monotherapy groups. Four variables explained 30% of direct costs: the number of antipsychotics, location of the residential facility, time living in the facility and use of olanzapine. The costs of antipsychotics corresponded to 94.4% of the total psychotropic costs and to 49.5% of all health services use when excluding accommodation costs. Olanzapine costs corresponded to 51% of all psychotropic costs. Antipsychotic polytherapy is a huge economic burden to public health service, despite the lack of evidence supporting this practice. Great variations on antipsychotic costs explicit the need of establishing protocols for rational antipsychotic prescriptions and consequently optimising resource allocation. Cost-effectiveness studies are necessary to estimate the best value for money among antipsychotics, especially in low and middle

  10. Cost-Utility Analysis of Extending Public Health Insurance Coverage to Include Diabetic Retinopathy Screening by Optometrists.

    Science.gov (United States)

    van Katwyk, Sasha; Jin, Ya-Ping; Trope, Graham E; Buys, Yvonne; Masucci, Lisa; Wedge, Richard; Flanagan, John; Brent, Michael H; El-Defrawy, Sherif; Tu, Hong Anh; Thavorn, Kednapa

    2017-09-01

    Diabetic retinopathy (DR) is one of the leading causes of vision loss and blindness in Canada. Eye examinations play an important role in early detection. However, DR screening by optometrists is not always universally covered by public or private health insurance plans. This study assessed whether expanding public health coverage to include diabetic eye examinations for retinopathy by optometrists is cost-effective from the perspective of the health care system. We conducted a cost-utility analysis of extended coverage for diabetic eye examinations in Prince Edward Island to include examinations by optometrists, not currently publicly covered. We used a Markov chain to simulate disease burden based on eye examination rates and DR progression over a 30-year time horizon. Results were presented as an incremental cost per quality-adjusted life year (QALY) gained. A series of one-way and probabilistic sensitivity analyses were performed. Extending public health coverage to eye examinations by optometrists was associated with higher costs ($9,908,543.32) and improved QALYs (156,862.44), over 30 years, resulting in an incremental cost-effectiveness ratio of $1668.43/QALY gained. Sensitivity analysis showed that the most influential determinants of the results were the cost of optometric screening and selected utility scores. At the commonly used threshold of $50,000/QALY, the probability that the new policy was cost-effective was 99.99%. Extending public health coverage to eye examinations by optometrists is cost-effective based on a commonly used threshold of $50,000/QALY. Findings from this study can inform the decision to expand public-insured optometric services for patients with diabetes. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  11. Costs of Dengue Control Activities and Hospitalizations in the Public Health Sector during an Epidemic Year in Urban Sri Lanka.

    Science.gov (United States)

    Thalagala, Neil; Tissera, Hasitha; Palihawadana, Paba; Amarasinghe, Ananda; Ambagahawita, Anuradha; Wilder-Smith, Annelies; Shepard, Donald S; Tozan, Yeşim

    2016-02-01

    Reported as a public health problem since the 1960s in Sri Lanka, dengue has become a high priority disease for public health authorities. The Ministry of Health is responsible for controlling dengue and other disease outbreaks and associated health care. The involvement of large numbers of public health staff in dengue control activities year-round and the provision of free medical care to dengue patients at secondary care hospitals place a formidable financial burden on the public health sector. We estimated the public sector costs of dengue control activities and the direct costs of hospitalizations in Colombo, the most heavily urbanized district in Sri Lanka, during the epidemic year of 2012 from the Ministry of Health's perspective. The financial costs borne by public health agencies and hospitals are collected using cost extraction tools designed specifically for the study and analysed retrospectively using a combination of activity-based and gross costing approaches. The total cost of dengue control and reported hospitalizations was estimated at US$3.45 million (US$1.50 per capita) in Colombo district in 2012. Personnel costs accounted for the largest shares of the total costs of dengue control activities (79%) and hospitalizations (46%). The results indicated a per capita cost of US$0.42 for dengue control activities. The average costs per hospitalization ranged between US$216-609 for pediatric cases and between US$196-866 for adult cases according to disease severity and treatment setting. This analysis is a first attempt to assess the economic burden of dengue response in the public health sector in Sri Lanka. Country-specific evidence is needed for setting public health priorities and deciding about the deployment of existing or new technologies. Our results suggest that dengue poses a major economic burden on the public health sector in Sri Lanka.

  12. Costs of Dengue Control Activities and Hospitalizations in the Public Health Sector during an Epidemic Year in Urban Sri Lanka

    Science.gov (United States)

    Thalagala, Neil; Tissera, Hasitha; Palihawadana, Paba; Amarasinghe, Ananda; Ambagahawita, Anuradha; Wilder-Smith, Annelies; Shepard, Donald S.; Tozan, Yeşim

    2016-01-01

    Background Reported as a public health problem since the 1960s in Sri Lanka, dengue has become a high priority disease for public health authorities. The Ministry of Health is responsible for controlling dengue and other disease outbreaks and associated health care. The involvement of large numbers of public health staff in dengue control activities year-round and the provision of free medical care to dengue patients at secondary care hospitals place a formidable financial burden on the public health sector. Methods We estimated the public sector costs of dengue control activities and the direct costs of hospitalizations in Colombo, the most heavily urbanized district in Sri Lanka, during the epidemic year of 2012 from the Ministry of Health’s perspective. The financial costs borne by public health agencies and hospitals are collected using cost extraction tools designed specifically for the study and analysed retrospectively using a combination of activity-based and gross costing approaches. Results The total cost of dengue control and reported hospitalizations was estimated at US$3.45 million (US$1.50 per capita) in Colombo district in 2012. Personnel costs accounted for the largest shares of the total costs of dengue control activities (79%) and hospitalizations (46%). The results indicated a per capita cost of US$0.42 for dengue control activities. The average costs per hospitalization ranged between US$216–609 for pediatric cases and between US$196–866 for adult cases according to disease severity and treatment setting. Conclusions This analysis is a first attempt to assess the economic burden of dengue response in the public health sector in Sri Lanka. Country-specific evidence is needed for setting public health priorities and deciding about the deployment of existing or new technologies. Our results suggest that dengue poses a major economic burden on the public health sector in Sri Lanka. PMID:26910907

  13. Cost and economic impact of obstructive sleep apnea-hypopnea syndrome (OSAHS on public health

    Directory of Open Access Journals (Sweden)

    David Ingram

    2017-08-01

    Full Text Available Untreated obstructive sleep apnea-hypopnea syndrome (OSAHS is associated with significant direct and indirect medical costs. This disorder also has a significant negative impact on work performance and safety, and is implicated in a substantial proportion of motor vehicular crashes. Timely diagnosis and optimal therapy have shown a lower utilization rate related to health care systems and reduced costs, while adverse risks are mitigated at the same time. Prompt diagnosis and optimal therapy have shown to decrease heath care utilizaton and costs, as well as mitigating these adverse risks. Similarly, untreated OSAHS is associated with higher unemployment rates. For health care professionals, having a patient with OSAHS involved in a MVC is of paramount importance for a several reasons, including personal and public damage, as well as the potential physical disability that may be caused by the accident. In Latin America, measuring direct and indirect costs is necessary considering the public health problem associated with OSAHS and the implications mentioned above.

  14. Does public insurance provide better financial protection against rising health care costs for families of children with special health care needs?

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    Yu, Hao; Dick, Andrew W; Szilagyi, Peter G

    2008-10-01

    Health care costs grew rapidly since 2001, generating substantial economic pressures on families, especially those with children with special health care needs (CSHCN). To examine how the growth of health care costs affected financial burden for families of CSHCN between 2001 and 2004 and to determine the extent to which health insurance coverage protected families of CSHCN against financial burden. In 2001-2004, 5196 families of CSHCN were surveyed by the national Medical Expenditure Panel Survey (MEPS). The main outcome was financial burden, defined as the proportion of family income spent on out-of-pocket (OOP) health care expenditures for all family members, including OOP costs and premiums. Family insurance coverage was classified as: (1) all members publicly insured, (2) all members privately insured, (3) all members uninsured, (4) partial coverage, and (5) a mix of public and private with no uninsured periods. An upward trend in financial burden for families of CSHCN occurred and was associated with growth of economy-wide health care costs. A multivariate analysis indicated that, given the economy-wide increase in medical costs between 2001 and 2004, a family with CSHCN was at increased risk in 2004 for having financial burden exceeding 10% of family income [odds ratio (OR) = 1.39; P financial burden exceeding 20% of family income. Over 15% of families with public insurance had financial burden exceeding 10% of family income compared with 20% of families with private insurance (P financial burden of >10% or 20% of family income than privately-insured families. Rising health care costs increased financial burden on families of CSHCN in 2001-2004. Public insurance coverage provided better financial protection than private insurance against the rapidly rising health care costs for families of CSHCN.

  15. [Quality management (TQM) in public health-care (PHC): principles for cost-performance calculations and cost reductions with better quality].

    Science.gov (United States)

    Bergholz, W

    2008-11-01

    In many high-tech industries, quality management (QM) has enabled improvements of quality by a factor of 100 or more, in combination with significant cost reductions. Compared to this, the application of QM methods in health care is in its initial stages. It is anticipated that stringent process management, embedded in an effective QM system will lead to significant improvements in health care in general and in the German public health service in particular. Process management is an ideal platform for controlling in the health care sector, and it will significantly improve the leverage of controlling to bring down costs. Best practice sharing in industry has led to quantum leap improvements. Process management will enable best practice sharing also in the public health service, in spite of the highly diverse portfolio of services that the public health service offers in different German regions. Finally, it is emphasised that "technical" QM, e.g., on the basis of the ISO 9001 standard is not sufficient to reach excellence. It is necessary to integrate soft factors, such as patient or employee satisfaction, and leadership quality into the system. The EFQM model for excellence can serve as proven tool to reach this goal.

  16. Low-Cost National Media-Based Surveillance System for Public Health Events, Bangladesh

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    Ao, Trong T.; Rahman, Mahmudur; Haque, Farhana; Chakraborty, Apurba; Hossain, M. Jahangir; Haider, Sabbir; Alamgir, A.S.M.; Sobel, Jeremy; Luby, Stephen P.

    2016-01-01

    We assessed a media-based public health surveillance system in Bangladesh during 2010–2011. The system is a highly effective, low-cost, locally appropriate, and sustainable outbreak detection tool that could be used in other low-income, resource-poor settings to meet the capacity for surveillance outlined in the International Health Regulations 2005. PMID:26981877

  17. Direct healthcare cost of obesity in brazil: an application of the cost-of-illness method from the perspective of the public health system in 2011.

    Science.gov (United States)

    de Oliveira, Michele Lessa; Santos, Leonor Maria Pacheco; da Silva, Everton Nunes

    2015-01-01

    Obesity is a global public health problem and a risk factor for several diseases that financially impact healthcare systems. To estimate the direct costs attributable to obesity (body mass index {BMI} ≥ 30 kg/m2) and morbid obesity (BMI ≥ 40 kg/m2) in adults aged ≥ 20 incurred by the Brazilian public health system in 2011. Public hospitals and outpatient care. A cost-of-illness method was adopted using a top-down approach based on prevalence. The proportion of the cost of each obesity-associated comorbidity was calculated and obesity prevalence was used to calculate attributable risk. Direct healthcare cost data (inpatient care, bariatric surgery, outpatient care, medications and diagnostic procedures) were extracted from the Ministry of Health information systems, available on the web. Direct costs attributable to obesity totaled US$ 269.6 million (1.86% of all expenditures on medium- and high-complexity health care). The cost of morbid obesity accounted for 23.8% (US$ 64.2 million) of all obesity-related costs despite being 18 times less prevalent than obesity. Bariatric surgery costs in Brazil totaled US$ 17.4 million in 2011. The cost of morbid obesity in women was five times higher than it was in men. The cost of morbid obesity was found to be proportionally higher than the cost of obesity. If the current epidemic were not reversed, the prevalence of obesity in Brazil will increase gradually in the coming years, as well as its costs, having serious implications for the financial sustainability of the Brazilian public health system.

  18. Controlling Health Care Costs

    Science.gov (United States)

    Dessoff, Alan

    2009-01-01

    This article examines issues on health care costs and describes measures taken by public districts to reduce spending. As in most companies in America, health plan designs in public districts are being changed to reflect higher out-of-pocket costs, such as higher deductibles on visits to providers, hospital stays, and prescription drugs. District…

  19. Cost of delivering secondary-level health care services through public sector district hospitals in India

    Science.gov (United States)

    Prinja, Shankar; Balasubramanian, Deepak; Jeet, Gursimer; Verma, Ramesh; Kumar, Dinesh; Bahuguna, Pankaj; Kaur, Manmeet; Kumar, Rajesh

    2017-01-01

    Background & objectives: Despite an impetus for strengthening public sector district hospitals for provision of secondary health care in India, there is lack of robust evidence on cost of services provided through these district hospitals. In this study, an attempt was made to determine the unit cost of an outpatient visit consultation, inpatient bed-day of hospitalization, surgical procedure and overall per-capita cost of providing secondary care through district hospitals. Methods: Economic costing of five randomly selected district hospitals in two north Indian States - Haryana and Punjab, was undertaken. Cost analysis was done using a health system perspective and employing bottom-up costing methodology. Quantity of all resources - capital or recurrent, used for delivering services was measured and valued. Median unit costs were estimated along with their 95 per cent confidence intervals. Sensitivity analysis was undertaken to assess the effect of uncertainties in prices and other assumptions; and to generalize the findings for Indian set-up. Results: The overall annual cost of delivering secondary-level health care services through a public sector district hospital in north India was 11,44,13,282 [US Dollars (USD) 2,103,185]. Human resources accounted for 53 per cent of the overall cost. The unit cost of an inpatient bed-day, surgical procedure and outpatient consultation was 844 (USD 15.5), i; 3481 (USD 64) and 170 (USD 3.1), respectively. With the current set of resource allocation, per-capita cost of providing health care through district hospitals in north India was 139 (USD 2.5). Interpretation & conclusions: The estimates obtained in our study can be used for Fiscal planning of scaling up secondary-level health services. Further, these may be particularly useful for future research such as benefit-incidence analysis, cost-effectiveness analysis and national health accounts including disease-specific accounts in India. PMID:29355142

  20. Cost of delivering secondary-level health care services through public sector district hospitals in India.

    Science.gov (United States)

    Prinja, Shankar; Balasubramanian, Deepak; Jeet, Gursimer; Verma, Ramesh; Kumar, Dinesh; Bahuguna, Pankaj; Kaur, Manmeet; Kumar, Rajesh

    2017-09-01

    Despite an impetus for strengthening public sector district hospitals for provision of secondary health care in India, there is lack of robust evidence on cost of services provided through these district hospitals. In this study, an attempt was made to determine the unit cost of an outpatient visit consultation, inpatient bed-day of hospitalization, surgical procedure and overall per-capita cost of providing secondary care through district hospitals. Economic costing of five randomly selected district hospitals in two north Indian States - Haryana and Punjab, was undertaken. Cost analysis was done using a health system perspective and employing bottom-up costing methodology. Quantity of all resources - capital or recurrent, used for delivering services was measured and valued. Median unit costs were estimated along with their 95 per cent confidence intervals. Sensitivity analysis was undertaken to assess the effect of uncertainties in prices and other assumptions; and to generalize the findings for Indian set-up. The overall annual cost of delivering secondary-level health care services through a public sector district hospital in north India was ' 11,44,13,282 [US Dollars (USD) 2,103,185]. Human resources accounted for 53 per cent of the overall cost. The unit cost of an inpatient bed-day, surgical procedure and outpatient consultation was ' 844 (USD 15.5), ' 3481 (USD 64) and ' 170 (USD 3.1), respectively. With the current set of resource allocation, per-capita cost of providing health care through district hospitals in north India was ' 139 (USD 2.5). The estimates obtained in our study can be used for Fiscal planning of scaling up secondary-level health services. Further, these may be particularly useful for future research such as benefit-incidence analysis, cost-effectiveness analysis and national health accounts including disease-specific accounts in India.

  1. Collecting and analysing cost data for complex public health trials: reflections on practice

    Directory of Open Access Journals (Sweden)

    Neha Batura

    2014-02-01

    Full Text Available Background: Current guidelines for the conduct of cost-effectiveness analysis (CEA are mainly applicable to facility-based interventions in high-income settings. Differences in the unit of analysis and the high cost of data collection can make these guidelines challenging to follow within public health trials in low- and middle- income settings. Objective: This paper reflects on the challenges experienced within our own work and proposes solutions that may be useful to others attempting to collect, analyse, and compare cost data between public health research sites in low- and middle-income countries. Design: We describe the generally accepted methods (norms for collecting and analysing cost data in a single-site trial from the provider perspective. We then describe our own experience applying these methods within eight comparable cluster randomised, controlled, trials. We describe the strategies used to maximise adherence to the norm, highlight ways in which we deviated from the norm, and reflect on the learning and limitations that resulted. Results: When the expenses incurred by a number of small research sites are used to estimate the cost-effectiveness of delivering an intervention on a national scale, then deciding which expenses constitute ‘start-up’ costs will be a nontrivial decision that may differ among sites. Similarly, the decision to include or exclude research or monitoring and evaluation costs can have a significant impact on the findings. We separated out research costs and argued that monitoring and evaluation costs should be reported as part of the total trial cost. The human resource constraints that we experienced are also likely to be common to other trials. As we did not have an economist in each site, we collaborated with key personnel at each site who were trained to use a standardised cost collection tool. This approach both accommodated our resource constraints and served as a knowledge sharing and capacity

  2. Collecting and analysing cost data for complex public health trials: reflections on practice

    Science.gov (United States)

    Batura, Neha; Pulkki-Brännström, Anni-Maria; Agrawal, Priya; Bagra, Archana; Haghparast-Bidgoli, Hassan; Bozzani, Fiammetta; Colbourn, Tim; Greco, Giulia; Hossain, Tanvir; Sinha, Rajesh; Thapa, Bidur; Skordis-Worrall, Jolene

    2014-01-01

    Background Current guidelines for the conduct of cost-effectiveness analysis (CEA) are mainly applicable to facility-based interventions in high-income settings. Differences in the unit of analysis and the high cost of data collection can make these guidelines challenging to follow within public health trials in low- and middle- income settings. Objective This paper reflects on the challenges experienced within our own work and proposes solutions that may be useful to others attempting to collect, analyse, and compare cost data between public health research sites in low- and middle-income countries. Design We describe the generally accepted methods (norms) for collecting and analysing cost data in a single-site trial from the provider perspective. We then describe our own experience applying these methods within eight comparable cluster randomised, controlled, trials. We describe the strategies used to maximise adherence to the norm, highlight ways in which we deviated from the norm, and reflect on the learning and limitations that resulted. Results When the expenses incurred by a number of small research sites are used to estimate the cost-effectiveness of delivering an intervention on a national scale, then deciding which expenses constitute ‘start-up’ costs will be a nontrivial decision that may differ among sites. Similarly, the decision to include or exclude research or monitoring and evaluation costs can have a significant impact on the findings. We separated out research costs and argued that monitoring and evaluation costs should be reported as part of the total trial cost. The human resource constraints that we experienced are also likely to be common to other trials. As we did not have an economist in each site, we collaborated with key personnel at each site who were trained to use a standardised cost collection tool. This approach both accommodated our resource constraints and served as a knowledge sharing and capacity building process within the

  3. Adherence and health care costs

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    Iuga AO

    2014-02-01

    Full Text Available Aurel O Iuga,1,2 Maura J McGuire3,4 1Johns Hopkins Bloomberg School of Public Health, 2Johns Hopkins University, 3Johns Hopkins Community Physicians, 4Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e-prescribing. Keywords: patient, medication, adherence, compliance, nonadherence, noncompliance, cost

  4. The burden of unintended pregnancies in Brazil: a social and public health system cost analysis

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    Le HH

    2014-07-01

    Full Text Available Hoa H Le,1 Mark P Connolly,1,2 Luis Bahamondes,3 Jose G Cecatti,3 Jingbo Yu,4 Henry X Hu4 1Department of Pharmacoeconomics and Pharmacoepidemiology, University of Groningen, Groningen, the Netherlands; 2Global Market Access Solutions, Saint-Prex, Switzerland; 3Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil; 4Merck & Co, Whitehouse Station, NJ, USA Background: Unintended pregnancy (UP is an unmet medical need with consequences worldwide. We evaluate the costs of UP based on pregnancies in Brazil from for the year 2010. Methods: The consequences of UP were evaluated using decision analysis based on pregnancy rates and outcomes as miscarriage, induced abortion, and live birth, which were factored into the analysis. The model discriminated between maternal and child outcomes and accounted for costs (in Brazilian currency [Real$, R$] within the Brazilian public health service attributed to preterm birth, neonatal admission, cerebral palsy, and neonatal and maternal mortality. Event probabilities were obtained from local resources. Results: We estimate that 1.8 million UPs resulted in 159,151 miscarriages, 48,769 induced abortions, 1.58 million live births, and 312 maternal deaths, including ten (3% attributed to unsafe abortions. The total estimated costs attributed to UP are R$4.1 billion annually, including R$32 million (0.8% and R$4.07 billion (99.2% attributed to miscarriages and births and complications, respectively. Direct birth costs accounted for approximately R$1.22 billion (30.0%, with labor and delivery responsible for most costs (R$988 million; 24.3% for the year 2010. The remainder of costs were for infant complications (R$2.84 billion; 72.3% with hospital readmission during the first year accounting for approximately R$2.15 billion (52.9%. Based on the national cost, we estimate the cost per UP to be R$2,293. Conclusion: Despite weaknesses in precise estimates in annual

  5. Cost-effectiveness analysis of medical treatment of benign prostatic hyperplasia in the Brazilian public health system

    Directory of Open Access Journals (Sweden)

    Luciana Ribeiro Bahia

    2012-10-01

    Full Text Available OBJECTIVE: To perform a cost-effectiveness analysis of medical treatment of benign prostatic hyperplasia (BPH under Brazilian public health system perspective (Unified Health System - "Sistema Único de Saúde (SUS". MATERIAL AND METHODS: A revision of the literature of the medical treatment of BPH using alpha-blockers, 5-alpha-reductase inhibitors and combinations was carried out. A panel of specialists defined the use of public health resources during episodes of acute urinary retention (AUR, the treatment and the evolution of these patients in public hospitals. A model of economic analysis(Markov predicted the number of episodes of AUR and surgeries (open prostatectomy and transurethral resection of the prostate related to BPH according to stages of evolution of the disease. Brazilian currency was converted to American dollars according to the theory of Purchasing Power Parity (PPP 2010: US$ 1 = R$ 1.70. RESULTS: The use of finasteride reduced 59.6% of AUR episodes and 57.9% the need of surgery compared to placebo, in a period of six years and taking into account a treatment discontinuity rate of 34%. The mean cost of treatment was R$ 764.11 (US$449.78 and R$ 579.57 (US$ 340.92 per patient in the finasteride and placebo groups, respectively. The incremental cost-effectiveness ratio (ICERs was R$ 4.130 (US$ 2.429 per episode of AUR avoided and R$ 2.735 (US$ 1.609 per episode of surgery avoided. The comparison of finasteride + doxazosine to placebo showed a reduction of 75.7% of AUR episodes and 66.8% of surgeries in a 4 year time horizon, with a ICERs of R$ 21.191 (US$ 12.918 per AUR episodes avoided and R$ 11.980 (US$ 7.047 per surgery avoided. In the sensitivity analysis the adhesion rate to treatment and the cost of finasteride were the main variables that influenced the results. CONCLUSIONS: These findings suggest that the treatment of BPH with finasteride is cost-effective compared to placebo in the Brazilian public health system

  6. Robotic and open radical prostatectomy in the public health sector: cost comparison.

    Science.gov (United States)

    Hall, Rohan Matthew; Linklater, Nicholas; Coughlin, Geoff

    2014-06-01

    During 2008, the Royal Brisbane and Women's Hospital became the first public hospital in Australia to have a da Vinci Surgical Robot purchased by government funding. The cost of performing robotic surgery in the public sector is a contentious issue. This study is a single centre, cost analysis comparing open radical prostatectomy (RRP) and robotic-assisted radical prostatectomy (RALP) based on the newly introduced pure case-mix funding model. A retrospective chart review was performed for the first 100 RALPs and the previous 100 RRPs. Estimates of tangible costing and funding were generated for each admission and readmission, using the Royal Brisbane Hospital Transition II database, based on pure case-mix funding. The average cost for admission for RRP was A$13 605, compared to A$17 582 for the RALP. The average funding received for a RRP was A$11 781 compared to A$5496 for a RALP based on the newly introduced case-mix model. The average length of stay for RRP was 4.4 days (2-14) and for RALP, 1.2 days (1-4). The total cost of readmissions for RRP patients was A$70 487, compared to that of the RALP patients, A$7160. These were funded at A$55 639 and A$7624, respectively. RALP has shown a significant advantage with respect to length of stay and readmission rate. Based on the case-mix funding model RALP is poorly funded compared to its open equivalent. Queensland Health needs to plan on how robotic surgery is implemented and assess whether this technology is truly affordable in the public sector. © 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons.

  7. Direct costs of dengue hospitalization in Brazil: public and private health care systems and use of WHO guidelines.

    Science.gov (United States)

    Vieira Machado, Alessandra A; Estevan, Anderson Oliveira; Sales, Antonio; Brabes, Kelly Cristina da Silva; Croda, Júlio; Negrão, Fábio Juliano

    2014-09-01

    Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed. To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO) guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002) in the group that received blood products (US $1,622.40) compared with the group that did not receive blood products (US $550.20). The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care.

  8. Cost-effectiveness of insulin analogs from the perspective of the Brazilian public health system

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    Maurílio de Souza Cazarim

    2017-11-01

    Full Text Available ABSTRACT Human insulin is provided by the Brazilian Public Health System (BPHS for the treatment of diabetes, however, legal proceedings to acquire insulin analogs have burdened the BPHS health system. The aim of this study was to perform a cost-effectiveness analysis to compare insulin analogs and human insulins. This is a pharmacoeconomic study of cost-effectiveness. The direct medical cost related to insulin extracted from the Ministry of Health drug price list was considered. The clinical results, i.e. reduction in glycated hemoglobin (HbA1c, were extracted by meta-analysis. Different scenarios were structured to measure the uncertainties regarding the costs and reduction in HbA1c. Decision tree was developed for sensitivity of Incremental Cost Effectiveness Ratio (ICER. A total of fifteen scenarios were structured. Given the best-case scenario for the insulin analogs, the insulins aspart, lispro, glargine and detemir showed an ICER of R$ 1,768.59; R$ 3,308.54; R$ 11,718.75 and R$ 2,685.22, respectively. In all scenarios in which the minimum effectiveness was proposed, lispro, glargine and detemir were dominant strategies. Sensitivity analysis showed that the aspart had R$ 3,066.98 [95 % CI: 2339.22; 4418.53] and detemir had R$ 6,163.97 [95% CI: 3919.29; 11401.57] for incremental costs. We concluded there was evidence that the insulin aspart is the most cost-effective.

  9. The costs of breast cancer in a Mexican public health institution

    Directory of Open Access Journals (Sweden)

    Jacobo Alejandro Gómez-Rico

    2008-11-01

    Full Text Available Jacobo Alejandro Gómez-Rico1, Marina Altagracia-Martínez1, Jaime Kravzov-Jinich1, Rosario Cárdenas-Elizalde1, Consuelo Rubio-Poo21Universidad Autónoma Metropolitano–Xochimilco (UAM-X, Departments: Biological Systems and Healthcare, Biological and Health Sciences Division (DCBS; 2Universidad Nacional Autónoma de México (UNAM, Faculty of Professional Studies-Zaragoza (FES-ZaragozaAbstract: Breast cancer (BC is the second leading cause of death as a result of neoplasia in Mexico. This study aimed to identify the direct and indirect costs of treating female outpatients diagnosed with BC at a Mexican public hospital. A cross-sectional, observational, analytical study was conducted. A total of 506 medical records were analyzed and 102 were included in the cost analysis. The micro-costing process was used to estimate treatment costs. A 17-item questionnaire was used to obtain information on direct and indirect costs. Of the 102 women with BC included in the study, 92.2% (94 were at Stage II, and only 7.8% at Stage I. Total direct costs over six months for the 82 women who had modified radical mastectomy (MRM surgury were US$733,821.15. Total direct costs for the 15 patients with conservative surgery (CS were US$138,190.39. We found that the total economic burden in the study population was much higher for patients with MRM than for patients with CS.Keywords: breast cancer, Mexican women, direct and indirect costs

  10. Collaboration across private and public sector primary health care services: benefits, costs and policy implications.

    Science.gov (United States)

    McDonald, Julie; Powell Davies, Gawaine; Jayasuriya, Rohan; Fort Harris, Mark

    2011-07-01

    Ongoing care for chronic conditions is best provided by interprofessional teams. There are challenges in achieving this where teams cross organisational boundaries. This article explores the influence of organisational factors on collaboration between private and public sector primary and community health services involved in diabetes care. It involved a case study using qualitative methods. Forty-five participants from 20 organisations were purposively recruited. Data were collected through semi-structured interviews and from content analysis of documents. Thematic analysis was used employing a two-level coding system and cross case comparisons. The patterns of collaborative patient care were influenced by a combination of factors relating to the benefits and costs of collaboration and the influence of support mechanisms. Benefits lay in achieving common or complementary health or organisational goals. Costs were incurred in bridging differences in organisational size, structure, complexity and culture. Collaboration was easier between private sector organisations than between private and public sectors. Financial incentives were not sufficient to overcome organisational barriers. To achieve more coordinated primary and community health care structural changes are also needed to better align funding mechanisms, priorities and accountabilities of the different organisations.

  11. Investment Success in Public Health: An Analysis of the Cost-Effectiveness and Cost-Benefit of the Global Programme to Eliminate Lymphatic Filariasis

    Science.gov (United States)

    Bettis, Alison A.; Chu, Brian K.; McFarland, Deborah A.; Hooper, Pamela J.; Mante, Sunny D.; Fitzpatrick, Christopher; Bradley, Mark H.

    2017-01-01

    Abstract Background. It has been estimated that $154 million per year will be required during 2015–2020 to continue the Global Programme to Eliminate Lymphatic Filariasis (GPELF). In light of this, it is important to understand the program’s current value. Here, we evaluate the cost-effectiveness and cost-benefit of the preventive chemotherapy that was provided under the GPELF between 2000 and 2014. In addition, we also investigate the potential cost-effectiveness of hydrocele surgery. Methods. Our economic evaluation of preventive chemotherapy was based on previously published health and economic impact estimates (between 2000 and 2014). The delivery costs of treatment were estimated using a model developed by the World Health Organization. We also developed a model to investigate the number of disability-adjusted life years (DALYs) averted by a hydrocelectomy and identified the cost threshold under which it would be considered cost-effective. Results. The projected cost-effectiveness and cost-benefit of preventive chemotherapy were very promising, and this was robust over a wide range of costs and assumptions. When the economic value of the donated drugs was not included, the GPELF would be classed as highly cost-effective. We projected that a typical hydrocelectomy would be classed as highly cost-effective if the surgery cost less than $66 and cost-effective if less than $398 (based on the World Bank’s cost-effectiveness thresholds for low income countries). Conclusions. Both the preventive chemotherapy and hydrocele surgeries provided under the GPELF are incredibly cost-effective and offer a very good investment in public health. PMID:27956460

  12. The cost-effectiveness of public postsecondary education subsidies.

    Science.gov (United States)

    Muennig, P; Fahs, M

    2001-02-01

    Although educational attainment is a well-recognized covariate of health status, it is rarely thought of as a tool to be used to improve health. Since fewer than 40% of U.S. citizens have a college degree, it may be possible for the government to improve the health status of the population by assuming a larger burden of the cost of postsecondary education. This paper examines the costs and health effects of a government subsidy for public postsecondary education institutions. All high school graduates in 1997 were included in a decision analysis model as a hypothetical cohort. Data from the U.S. Department of Education, the World Health Organization, and the National Center for Health Statistics were used as model inputs. Results. Relative to the present educational system, a federal subsidy for public and private colleges equal to the amount now paid by students for tuition and living expenses would save $6,176 and avert 0.0018 of a disability-adjusted life-year (DALY) per person annually if enrollment increased 5%. The overall savings among 1997 high school graduates would be $17.1 billion and 4,992 DALYs would be averted per year relative to the present educational system. If enrollment increased by just 3%, $3,743 would be saved and 0.0011 DALYs would be averted per person. An enrollment increase of 7% would lead to savings of $8,610 and 0.0025 DALYs would be averted per person relative to the present educational system. If the government were to offer a full subsidy for college tuition at public universities, both lives and money would be saved, so long as enrollment levels increased. Providing a free postsecondary education for students attending public schools may be more cost-effective than most health investments. Copyright 2001 American Health Foundation and Academic Press.

  13. Utilisation and costs of nursing agencies in the South African public health sector, 2005-2010.

    Science.gov (United States)

    Rispel, Laetitia C; Angelides, George

    2014-01-01

    Globally, insufficient information exists on the costs of nursing agencies, which are temporary employment service providers that supply nurses to health establishments and/or private individuals. The aim of the study was to determine the utilisation and direct costs of nursing agencies in the South African public health sector. A survey of all nine provincial health departments was conducted to determine utilisation and management of nursing agencies. The costs of nursing agencies were assumed to be equivalent to expenditure. Provincial health expenditure was obtained for five financial years (2005/6-2009/10) from the national Basic Accounting System database, and analysed using Microsoft Excel. Each of the 166,466 expenditure line items was coded. The total personnel and nursing agency expenditure was calculated for each financial year and for each province. Nursing agency expenditure as a percentage of the total personnel expenditure was then calculated. The nursing agency expenditure for South Africa is the total of all provincial expenditure. The 2009/10 annual government salary scales for different categories of nurses were used to calculate the number of permanent nurses who could have been employed in lieu of agency expenditure. All expenditure is expressed in South African rands (R; US$1 ∼ R7, 2010 prices). Only five provinces reported utilisation of nursing agencies, but all provinces showed agency expenditure. In the 2009/10 financial year, R1.49 billion (US$212.64 million) was spent on nursing agencies in the public health sector. In the same year, agency expenditure ranged from a low of R36.45 million (US$5.20 million) in Mpumalanga Province (mixed urban-rural) to a high of R356.43 million (US$50.92 million) in the Eastern Cape Province (mixed urban-rural). Agency expenditure as a percentage of personnel expenditure ranged from 0.96% in KwaZulu-Natal Province (mixed urban-rural) to 11.96% in the Northern Cape Province (rural). In that financial year

  14. Cost-effectiveness of cognitive-behavioural therapy for mental disorders: implications for public health care funding policy in Canada.

    Science.gov (United States)

    Myhr, Gail; Payne, Krista

    2006-09-01

    Publicly funded cognitive-behavioural therapy (CBT) for mental disorders is scarce in Canada, despite proven efficacy and guidelines recommending its use. This paper reviews published data on the economic impact of CBT to inform recommendations for current Canadian mental health care funding policy. We searched the literature for economic analyses of CBT in the treatment of mental disorders. We identified 22 health economic studies involving CBT for mood, anxiety, psychotic, and somatoform disorders. Across health care settings and patient populations, CBT alone or in combination with pharmacotherapy represented acceptable value for health dollars spent, with CBT costs offset by reduced health care use. International evidence suggests CBT is cost-effective. Greater access to CBT would likely improve outcomes and result in cost savings. Future research is warranted to evaluate the economic impact of CBT in Canada.

  15. Investment Success in Public Health: An Analysis of the Cost-Effectiveness and Cost-Benefit of the Global Programme to Eliminate Lymphatic Filariasis.

    Science.gov (United States)

    Turner, Hugo C; Bettis, Alison A; Chu, Brian K; McFarland, Deborah A; Hooper, Pamela J; Mante, Sunny D; Fitzpatrick, Christopher; Bradley, Mark H

    2017-03-15

    It has been estimated that $154 million per year will be required during 2015-2020 to continue the Global Programme to Eliminate Lymphatic Filariasis (GPELF). In light of this, it is important to understand the program's current value. Here, we evaluate the cost-effectiveness and cost-benefit of the preventive chemotherapy that was provided under the GPELF between 2000 and 2014. In addition, we also investigate the potential cost-effectiveness of hydrocele surgery. Our economic evaluation of preventive chemotherapy was based on previously published health and economic impact estimates (between 2000 and 2014). The delivery costs of treatment were estimated using a model developed by the World Health Organization. We also developed a model to investigate the number of disability-adjusted life years (DALYs) averted by a hydrocelectomy and identified the cost threshold under which it would be considered cost-effective. The projected cost-effectiveness and cost-benefit of preventive chemotherapy were very promising, and this was robust over a wide range of costs and assumptions. When the economic value of the donated drugs was not included, the GPELF would be classed as highly cost-effective. We projected that a typical hydrocelectomy would be classed as highly cost-effective if the surgery cost less than $66 and cost-effective if less than $398 (based on the World Bank's cost-effectiveness thresholds for low income countries). Both the preventive chemotherapy and hydrocele surgeries provided under the GPELF are incredibly cost-effective and offer a very good investment in public health. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.

  16. Costs and utilization of public sector family planning services in Pakistan.

    Science.gov (United States)

    Abbas, Khadija; Khan, Adnan Ahmad; Khan, Ayesha

    2013-04-01

    The public sector provides a third of family planning (FP) services in Pakistan. However, these services are viewed as being underutilized and expensive. We explored the utilization patterns and costs of FP services in the public sector. We used overall budgets and time allocation by health and population departments to estimate the total costs of FP by these departments, costs per woman served, and costs per couple-year of protection (CYP). The public sector is the predominant provider of FP to the poorest and is the main provider of female sterilization services. The overall costs of FP in the public sector are USD 55 per woman served, annually (USD 17 per CYP). Within the public sector, the population welfare departments provide services at USD 72 per woman served, annually (USD 17 per CYP) and the health departments at USD 39 per woman per year (USD 29 per CYP). While the public sector has a critical niche in serving the poor and providing female sterilization, its services are considerably more expensive compared to international and even some Pakistani non-government organization (NGO) costs. This reflects inefficiencies in services provided, client mistrust in the quality of services provided, and inadequate referrals, and will require specific actions for improving referrals and the quality of services.

  17. Health economic studies: an introduction to cost-benefit, cost-effectiveness, and cost-utility analyses.

    Science.gov (United States)

    Angevine, Peter D; Berven, Sigurd

    2014-10-15

    Narrative overview. To provide clinicians with a basic understanding of economic studies, including cost-benefit, cost-effectiveness, and cost-utility analyses. As decisions regarding public health policy, insurance reimbursement, and patient care incorporate factors other than traditional outcomes such as satisfaction or symptom resolution, health economic studies are increasingly prominent in the literature. This trend will likely continue, and it is therefore important for clinicians to have a fundamental understanding of the common types of economic studies and be able to read them critically. In this brief article, the basic concepts of economic studies and the differences between cost-benefit, cost-effectiveness, and cost-utility studies are discussed. An overview of the field of health economic analysis is presented. Cost-benefit, cost-effectiveness, and cost-utility studies all integrate cost and outcome data into a decision analysis model. These different types of studies are distinguished mainly by the way in which outcomes are valued. Obtaining accurate cost data is often difficult and can limit the generalizability of a study. With a basic understanding of health economic analysis, clinicians can be informed consumers of these important studies.

  18. Public health educational comprehensiveness: The strategic rationale in establishing networks among schools of public health.

    Science.gov (United States)

    Otok, Robert; Czabanowska, Katarzyna; Foldspang, Anders

    2017-11-01

    The establishment and continuing development of a sufficient and competent public health workforce is fundamental for the planning, implementation, evaluation, effect and ethical validity of public health strategies and policies and, thus, for the development of the population's health and the cost-effectiveness of health and public health systems and interventions. Professional public health strategy-making demands a background of a comprehensive multi-disciplinary curriculum including mutually, dynamically coherent competences - not least, competences in sociology and other behavioural sciences and their interaction with, for example, epidemiology, biostatistics, qualitative methods and health promotion and disease prevention. The size of schools and university departments of public health varies, and smaller entities may run into problems if seeking to meet the comprehensive curriculum challenge entirely by use of in-house resources. This commentary discusses the relevance and strength of establishing comprehensive curriculum development networks between schools and university departments of public health, as one means to meet the comprehensiveness challenge. This commentary attempts to consider a two-stage strategy to develop complete curricula at the bachelor and master's as well as PhD levels.

  19. A model to estimate the cost of the National Essential Public Health Services Package in Beijing, China.

    Science.gov (United States)

    Yin, Delu; Wong, Sabrina T; Chen, Wei; Xin, Qianqian; Wang, Lihong; Cui, Mingming; Yin, Tao; Li, Ruili; Zheng, Xiaoguo; Yang, Huiming; Yu, Juanjuan; Chen, Bowen; Yang, Weizhong

    2015-06-06

    In order to address several health challenges, the Chinese government issued the National Essential Public Health Services Package (NEPHSP) in 2009. In China's large cities, the lack of funding for community health centers and consequent lack of comprehensive services and high quality care has become a major challenge. However, no study has been carried out to estimate the cost of delivering the services in the package. This project was to develop a cost estimation approach appropriate to the context and use it to calculate the cost of the NEPHSP in Beijing in 2011. By adjusting models of cost analysis of primary health care and workload indicators of staffing need developed by the World Health Organization, a model was developed to estimate the cost of the services in the package through an intensive interactive process. A total of 17 community health centers from eight administrative districts in Beijing were selected. Their service volume and expenditure data in 2010 were used to evaluate the costs of providing the NEPHSP in Beijing based on the applied model. The total workload of all types of primary health care in 17 sample centers was equivalent to the workload requirement for 14,056,402 standard clinic visits. The total expenditure of the 17 sample centers was 26,329,357.62 USD in 2010. The cost of the workload requirement of one standard clinic visit was 1.87 USD. The workload of the NEPHSP was equivalent to 5,514,777 standard clinic visits (39.23 % of the total workload). The model suggests that the cost of the package in Beijing was 7.95 USD per capita in 2010. The cost of the NEPHSP in urban areas was lower than suburban areas: 7.31 and 8.65 USD respectively. The average investment of 3.97 USD per capita in NEPHSP was lower than the amount needed to meet its running costs. NEPHSP in Beijing is therefore underfunded. Additional investment is needed, and a dynamic cost estimate mechanism should be introduced to ensure services remain adequately funded.

  20. Visualizing value for money in public health interventions.

    Science.gov (United States)

    Leigh-Hunt, Nicholas; Cooper, Duncan; Furber, Andrew; Bevan, Gwyn; Gray, Muir

    2018-01-23

    The Socio-Technical Allocation of Resources (STAR) has been developed for value for money analysis of health services through stakeholder workshops. This article reports on its application for prioritization of interventions within public health programmes. The STAR tool was used by identifying costs and service activity for interventions within commissioned public health programmes, with benefits estimated from the literature on economic evaluations in terms of costs per Quality-Adjusted Life Years (QALYs); consensus on how these QALY values applied to local services was obtained with local commissioners. Local cost-effectiveness estimates could be made for some interventions. Methodological issues arose from gaps in the evidence base for other interventions, inability to closely match some performance monitoring data with interventions, and disparate time horizons of published QALY data. Practical adjustment for these issues included using population prevalences and utility states where intervention specific evidence was lacking, and subdivision of large contracts into specific intervention costs using staffing ratios. The STAR approach proved useful in informing commissioning decisions and understanding the relative value of local public health interventions. Further work is needed to improve robustness of the process and develop a visualization tool for use by public health departments. © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  1. Strategic Planning in Population Health and Public Health Practice: A Call to Action for Higher Education.

    Science.gov (United States)

    Phelps, Charles; Madhavan, Guruprasad; Rappuoli, Rino; Levin, Scott; Shortliffe, Edward; Colwell, Rita

    2016-03-01

    Scarce resources, especially in population health and public health practice, underlie the importance of strategic planning. Public health agencies' current planning and priority setting efforts are often narrow, at times opaque, and focused on single metrics such as cost-effectiveness. As demonstrated by SMART Vaccines, a decision support software system developed by the Institute of Medicine and the National Academy of Engineering, new approaches to strategic planning allow the formal incorporation of multiple stakeholder views and multicriteria decision making that surpass even those sophisticated cost-effectiveness analyses widely recommended and used for public health planning. Institutions of higher education can and should respond by building on modern strategic planning tools as they teach their students how to improve population health and public health practice. Strategic planning in population health and public health practice often uses single indicators of success or, when using multiple indicators, provides no mechanism for coherently combining the assessments. Cost-effectiveness analysis, the most complex strategic planning tool commonly applied in public health, uses only a single metric to evaluate programmatic choices, even though other factors often influence actual decisions. Our work employed a multicriteria systems analysis approach--specifically, multiattribute utility theory--to assist in strategic planning and priority setting in a particular area of health care (vaccines), thereby moving beyond the traditional cost-effectiveness analysis approach. (1) Multicriteria systems analysis provides more flexibility, transparency, and clarity in decision support for public health issues compared with cost-effectiveness analysis. (2) More sophisticated systems-level analyses will become increasingly important to public health as disease burdens increase and the resources to deal with them become scarcer. The teaching of strategic planning in public

  2. Public health system - current status and world experience

    Directory of Open Access Journals (Sweden)

    Andreyeva І.А.

    2016-09-01

    Full Text Available In the review, the evolution of Public Health and global development tendencies of Public Health system have been discussed. Stages of formation of the updated concept, principles of Public Health organization and the role of various organizations have been shown in the connection with development of the global concept of "Health for All". A well-functioning public health system is primarily the result of multisectoral cooperation. The aim of modern Public Health is to provide conditions of access to appropriate and cost-effective health care for all population groups, including health promotion and disease prevention.

  3. Return on investment of public health interventions: a systematic review.

    Science.gov (United States)

    Masters, Rebecca; Anwar, Elspeth; Collins, Brendan; Cookson, Richard; Capewell, Simon

    2017-08-01

    Public sector austerity measures in many high-income countries mean that public health budgets are reducing year on year. To help inform the potential impact of these proposed disinvestments in public health, we set out to determine the return on investment (ROI) from a range of existing public health interventions. We conducted systematic searches on all relevant databases (including MEDLINE; EMBASE; CINAHL; AMED; PubMed, Cochrane and Scopus) to identify studies that calculated a ROI or cost-benefit ratio (CBR) for public health interventions in high-income countries. We identified 2957 titles, and included 52 studies. The median ROI for public health interventions was 14.3 to 1, and median CBR was 8.3. The median ROI for all 29 local public health interventions was 4.1 to 1, and median CBR was 10.3. Even larger benefits were reported in 28 studies analysing nationwide public health interventions; the median ROI was 27.2, and median CBR was 17.5. This systematic review suggests that local and national public health interventions are highly cost-saving. Cuts to public health budgets in high income countries therefore represent a false economy, and are likely to generate billions of pounds of additional costs to health services and the wider economy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  4. Billing and insurance-related administrative costs in United States' health care: synthesis of micro-costing evidence.

    Science.gov (United States)

    Jiwani, Aliya; Himmelstein, David; Woolhandler, Steffie; Kahn, James G

    2014-11-13

    The United States' multiple-payer health care system requires substantial effort and costs for administration, with billing and insurance-related (BIR) activities comprising a large but incompletely characterized proportion. A number of studies have quantified BIR costs for specific health care sectors, using micro-costing techniques. However, variation in the types of payers, providers, and BIR activities across studies complicates estimation of system-wide costs. Using a consistent and comprehensive definition of BIR (including both public and private payers, all providers, and all types of BIR activities), we synthesized and updated available micro-costing evidence in order to estimate total and added BIR costs for the U.S. health care system in 2012. We reviewed BIR micro-costing studies across healthcare sectors. For physician practices, hospitals, and insurers, we estimated the % BIR using existing research and publicly reported data, re-calculated to a standard and comprehensive definition of BIR where necessary. We found no data on % BIR in other health services or supplies settings, so extrapolated from known sectors. We calculated total BIR costs in each sector as the product of 2012 U.S. national health expenditures and the percentage of revenue used for BIR. We estimated "added" BIR costs by comparing total BIR costs in each sector to those observed in existing, simplified financing systems (Canada's single payer system for providers, and U.S. Medicare for insurers). Due to uncertainty in inputs, we performed sensitivity analyses. BIR costs in the U.S. health care system totaled approximately $471 ($330 - $597) billion in 2012. This includes $70 ($54 - $76) billion in physician practices, $74 ($58 - $94) billion in hospitals, an estimated $94 ($47 - $141) billion in settings providing other health services and supplies, $198 ($154 - $233) billion in private insurers, and $35 ($17 - $52) billion in public insurers. Compared to simplified financing, $375

  5. Containing health costs in the Americas.

    Science.gov (United States)

    Márquez, P

    1990-01-01

    In recent years, a series of policy measures affecting both demand and supply components of health care have been adopted in different Latin American and Caribbean countries, as well as in Canada and the United States. In applying these measures various objectives have been pursued, among them: to mobilize additional resources to increase operating budgets; to reduce unnecessary utilization of health services and consumption of pharmaceuticals; to control increasing production costs; and to contain the escalation of health care expenditures. In terms of demand management, some countries have established cost-recovery programmes in an attempt to offset declining revenues. These measures have the potential to generate additional operating income in public facilities, particularly if charges are levied on hospital care. However, only scant information is available on the effects of user charges on demand, utilization, or unit costs. In terms of supply management, corrective measures have concentrated on limiting the quantity and the relative prices of different inputs and outputs. Hiring freezes, salary caps, limitations on new construction and equipment, use of drug lists, bulk procurement of medicines and vaccines, and budget ceilings are among the measures utilized to control production costs in the health sector. To moderate health care expenditures, various approaches have been followed to subject providers to 'financial discipline'. Among them, new reimbursement modalities such as prospective payment systems offer an array of incentives to modify medical practice. Cost-containment efforts have also spawned innovations in the organization and delivery of health services. Group plans have been established on the basis of prepaid premiums to provide directly much or all health care needs of affiliates and their families. The issue of intrasectorial co-ordination, particularly between ministries of health and social security institutions, has much relevance for cost

  6. Improving the quality of percutaneous revascularisation in patients with multivessel disease in Australia: cost-effectiveness, public health implications, and budget impact of FFR-guided PCI.

    Science.gov (United States)

    Siebert, Uwe; Arvandi, Marjan; Gothe, Raffaella M; Bornschein, Bernhard; Eccleston, David; Walters, Darren L; Rankin, James; De Bruyne, Bernard; Fearon, William F; Pijls, Nico H; Harper, Richard

    2014-06-01

    The international multicentre FAME Study (n=1,005) demonstrated significant health benefits for patients undergoing multivessel percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) measurement compared with angiography guidance alone (ANGIO). We determined the cost-effectiveness and the public health/budget impact for Australia. We performed a prospective economic evaluation comparing FFR vs. ANGIO in patients with multivessel disease based on original patient-level FAME data. We used Australian utilities (EQ-5D) and costs to calculate quality-adjusted life years (QALYs) and incremental cost-effectiveness adopting the societal perspective. The public health and budget impact from the payer's perspective was based on Australian PCI registries. Uncertainty was explored using deterministic sensitivity analyses and the bootstrap method (n=5,000 samples). The cost-effectiveness analysis showed that FFR was cost-saving and reduces costs by 1,776 AUD per patient during one year. Over a two-year time horizon, the public health impact ranged from 7.8 to 73.9 QALYs gained and the budget impact from 1.8 to 14.5 million AUD total cost savings. Sensitivity analyses demonstrated that FFR was cost-saving over a wide range of assumptions. FFR-guided PCI in patients with multivessel coronary disease substantially reduces cardiac events, improves QALYs and is cost-saving in the Australian health care system. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  7. The cost of universal health care in India: a model based estimate.

    Science.gov (United States)

    Prinja, Shankar; Bahuguna, Pankaj; Pinto, Andrew D; Sharma, Atul; Bharaj, Gursimer; Kumar, Vishal; Tripathy, Jaya Prasad; Kaur, Manmeet; Kumar, Rajesh

    2012-01-01

    As high out-of-pocket healthcare expenses pose heavy financial burden on the families, Government of India is considering a variety of financing and delivery options to universalize health care services. Hence, an estimate of the cost of delivering universal health care services is needed. We developed a model to estimate recurrent and annual costs for providing health services through a mix of public and private providers in Chandigarh located in northern India. Necessary health services required to deliver good quality care were defined by the Indian Public Health Standards. National Sample Survey data was utilized to estimate disease burden. In addition, morbidity and treatment data was collected from two secondary and two tertiary care hospitals. The unit cost of treatment was estimated from the published literature. For diseases where data on treatment cost was not available, we collected data on standard treatment protocols and cost of care from local health providers. We estimate that the cost of universal health care delivery through the existing mix of public and private health institutions would be INR 1713 (USD 38, 95%CI USD 18-73) per person per annum in India. This cost would be 24% higher, if branded drugs are used. Extrapolation of these costs to entire country indicates that Indian government needs to spend 3.8% (2.1%-6.8%) of the GDP for universalizing health care services. The cost of universal health care delivered through a combination of public and private providers is estimated to be INR 1713 per capita per year in India. Important issues such as delivery strategy for ensuring quality, reducing inequities in access, and managing the growth of health care demand need be explored.

  8. The cost of universal health care in India: a model based estimate.

    Directory of Open Access Journals (Sweden)

    Shankar Prinja

    Full Text Available INTRODUCTION: As high out-of-pocket healthcare expenses pose heavy financial burden on the families, Government of India is considering a variety of financing and delivery options to universalize health care services. Hence, an estimate of the cost of delivering universal health care services is needed. METHODS: We developed a model to estimate recurrent and annual costs for providing health services through a mix of public and private providers in Chandigarh located in northern India. Necessary health services required to deliver good quality care were defined by the Indian Public Health Standards. National Sample Survey data was utilized to estimate disease burden. In addition, morbidity and treatment data was collected from two secondary and two tertiary care hospitals. The unit cost of treatment was estimated from the published literature. For diseases where data on treatment cost was not available, we collected data on standard treatment protocols and cost of care from local health providers. RESULTS: We estimate that the cost of universal health care delivery through the existing mix of public and private health institutions would be INR 1713 (USD 38, 95%CI USD 18-73 per person per annum in India. This cost would be 24% higher, if branded drugs are used. Extrapolation of these costs to entire country indicates that Indian government needs to spend 3.8% (2.1%-6.8% of the GDP for universalizing health care services. CONCLUSION: The cost of universal health care delivered through a combination of public and private providers is estimated to be INR 1713 per capita per year in India. Important issues such as delivery strategy for ensuring quality, reducing inequities in access, and managing the growth of health care demand need be explored.

  9. Cost-effectiveness and public health impact of alternative influenza vaccination strategies in high-risk adults.

    Science.gov (United States)

    Raviotta, Jonathan M; Smith, Kenneth J; DePasse, Jay; Brown, Shawn T; Shim, Eunha; Nowalk, Mary Patricia; Wateska, Angela; France, Glenson S; Zimmerman, Richard K

    2017-10-09

    High-dose trivalent inactivated influenza vaccine (HD-IIV3) or recombinant trivalent influenza vaccine (RIV) may increase influenza vaccine effectiveness (VE) in adults with conditions that place them at high risk for influenza complications. This analysis models the public health impact and cost-effectiveness (CE) of these vaccines for 50-64year-olds. Markov model CE analysis compared 5 strategies in 50-64year-olds: no vaccination; only standard-dose IIV3 offered (SD-IIV3 only), only quadrivalent influenza vaccine offered (SD-IIV4 only); high-risk patients receiving HD-IIV3, others receiving SD-IIV3 (HD-IIV3 & SD-IIV3); and high-risk patients receiving HD-IIV3, others receiving SD-IIV4 (HD-IIV3 & SD-IIV4). In a secondary analysis, RIV replaced HD-IIV3. Parameters were obtained from U.S. databases, the medical literature and extrapolations from VE estimates. Effectiveness was measured as 3%/year discounted quality adjusted life year (QALY) losses avoided. The least expensive strategy was SD-IIV3 only, with total costs of $99.84/person. The SD-IIV4 only strategy cost an additional $0.91/person, or $37,700/QALY gained. The HD-IIV3 & SD-IIV4 strategy cost $1.06 more than SD-IIV4 only, or $71,500/QALY gained. No vaccination and HD-IIV3 & SD-IIV3 strategies were dominated. Results were sensitive to influenza incidence, vaccine cost, standard-dose VE in the entire population and high-dose VE in high-risk patients. The CE of RIV for high-risk patients was dependent on as yet unknown parameter values. Based on available data, using high-dose influenza vaccine or RIV in middle-aged, high-risk patients may be an economically favorable vaccination strategy with public health benefits. Clinical trials of these vaccines in this population may be warranted. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Cost-effectiveness and the socialization of health care.

    Science.gov (United States)

    Musgrove, P

    1995-01-01

    The more health care is socialized, the more cost-effectiveness is an appropriate criterion for expenditure. Utility-maximizing individuals, facing divisibility of health care purchases and declining marginal health gains, and complete information about probable health improvements, should buy health care according to its cost-effectiveness. Absent these features, individual health spending will not be cost-effective; and in any case, differences in personal utilities and risk aversion will not lead to the same ranking of health care interventions for everyone. Private insurance frees consumers from concern for cost, which undermines cost-effectiveness, but lets them emphasize effectiveness, which favors value for money. This is most important for costly and cost-effective interventions, especially for poor people. Cost-effectiveness is more appropriate and easier to achieve under second-party insurance. More complete socialization of health care, via public finance, can yield greater efficiency by making insurance compulsory. Cost-effectiveness is also more attractive when taxpayers subsidize others' care: needs (effectiveness) take precedence over wants (utility). The gain in effectiveness may be greater, and the welfare loss from Pareto non-optimality smaller, in poor countries than in rich ones.

  11. The household costs of health care in rural South Africa with free public primary care and hospital exemptions for the poor.

    Science.gov (United States)

    Goudge, Jane; Gilson, Lucy; Russell, Steve; Gumede, Tebogo; Mills, Anne

    2009-04-01

    To measure the direct cost burdens (health care expenditure as a percent of total household expenditure) for households in rural South Africa, and examine the expenditure and use patterns driving those burdens, in a setting with free public primary health care and hospital exemptions for the poor. Data on illness events, treatment patterns and health expenditure in the previous month were assessed from a cross-sectional survey of 280 households conducted in the Agincourt Health and Demographic Surveillance site, South Africa. On average, a household experiencing illness incurred a direct cost burden of 4.5% of total household expenditure. A visit to a public clinic generated a mean burden of 1.3%. Complex sequences of treatments led 20% of households to incur a burden over 10%, with transport costs generating 42% of this burden. An outpatient public hospital visit generated a burden of 8.2%, as only 58% of those eligible obtained an exemption; inpatient stays incurred a burden of 45%. Consultations with private providers incurred a mean burden of 9.5%. About 38% of individuals who reported illness did not take any treatment action, 55% of whom identified financial and perceived supply-side barriers as reasons. The low overall mean cost burden of 4.5% suggests that free primary care and hospital exemptions provided financial protection. However, transport costs, the difficulty of obtaining hospital exemptions, use of private providers, and complex treatment patterns meant state-provided protection had limitations. The significant non-use of care shows the need for other measures such as more outreach services and more exemptions in rural areas. The findings also imply that fee removal anywhere must be accompanied by wider measures to ensure improved access.

  12. 42 CFR 100.2 - Average cost of a health insurance policy.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Average cost of a health insurance policy. 100.2... VACCINE INJURY COMPENSATION § 100.2 Average cost of a health insurance policy. For purposes of determining..., less certain deductions. One of the deductions is the average cost of a health insurance policy, as...

  13. Bed Bug Epidemic: A Challenge to Public Health

    Science.gov (United States)

    Ratnapradipa, Dhitinut; Ritzel, Dale O.; Haramis, Linn D.; Bliss, Kadi R.

    2011-01-01

    In recent years, reported cases of bed bug infestations in the U.S. and throughout the world have escalated dramatically, posing a global public health problem. Although bed bugs are not known to transmit disease to humans, they pose both direct and indirect public health challenges in terms of health effects, treatment, cost, and resource…

  14. Creating training opportunities for public health practitioners.

    Science.gov (United States)

    Greene, D; Healton, C; Hamburg, M; Rosenfield, A; Cagan, E; Van Wie, W; Haviland, M L

    1999-04-01

    In response to several reports issued by the federal government and private foundations on the under-training of public health practitioners, Joseph L. Mailman School of Public Health of Columbia University (SPH) and the New York City Department of Health (NYC DOH) initiated the Public Health Scholars program (SPH-PHS) to make degree-level public health training available to NYC DOH employees. Public Health Scholars receive a 50% tuition scholarship and enroll part-time while working full-time at NYC DOH. Sixteen scholars have enrolled during the past three years. The SPH-PHS program is considered a success by both SPH and NYC DOH. This article details the history of the collaboration between the two agencies and the structure of the program and provides a critical analysis of the SPH-PHS program based on interviews with 16 scholars. It also examines the cost and benefit to other schools of public health of implementing such a program.

  15. Containing costs in public sector hospitals - a strategy for the future ...

    African Journals Online (AJOL)

    Containing costs in public sector hospitals - a strategy for the future. ... is increasing concern about expenditure in the public and the private health care sectors. ... at the micro-level comparison of expenditure over a 14-year period in one major ...

  16. Public health economics: a systematic review of guidance for the economic evaluation of public health interventions and discussion of key methodological issues.

    Science.gov (United States)

    Edwards, Rhiannon Tudor; Charles, Joanna Mary; Lloyd-Williams, Huw

    2013-10-24

    If Public Health is the science and art of how society collectively aims to improve health, and reduce inequalities in health, then Public Health Economics is the science and art of supporting decision making as to how society can use its available resources to best meet these objectives and minimise opportunity cost. A systematic review of published guidance for the economic evaluation of public health interventions within this broad public policy paradigm was conducted. Electronic databases and organisation websites were searched using a 22 year time horizon (1990-2012). References of papers were hand searched for additional papers for inclusion. Government reports or peer-reviewed published papers were included if they; referred to the methods of economic evaluation of public health interventions, identified key challenges of conducting economic evaluations of public health interventions or made recommendations for conducting economic evaluations of public health interventions. Guidance was divided into three categories UK guidance, international guidance and observations or guidance provided by individual commentators in the field of public health economics. An assessment of the theoretical frameworks underpinning the guidance was made and served as a rationale for categorising the papers. We identified 5 international guidance documents, 7 UK guidance documents and 4 documents by individual commentators. The papers reviewed identify the main methodological challenges that face analysts when conducting such evaluations. There is a consensus within the guidance that wider social and environmental costs and benefits should be looked at due to the complex nature of public health. This was reflected in the theoretical underpinning as the majority of guidance was categorised as extra-welfarist. In this novel review we argue that health economics may have come full circle from its roots in broad public policy economics. We may find it useful to think in this broader

  17. Johns Hopkins Bloomberg School of Public Health OpenCourseWare

    Science.gov (United States)

    Kanchanaraksa, Sukon; Gooding, Ira; Klaas, Brian; Yager, James D.

    2009-01-01

    The need for public health knowledge is ever increasing, but the educational options have been limited to coursework delivered by academics to individuals who can afford the cost of tuition at public health institutions. To overcome this disparity, Johns Hopkins Bloomberg School of Public Health (JHSPH) has joined the Massachusetts Institute of…

  18. Community views and public health priority setting: how do health department priorities, community views, and health indicator data compare?

    Science.gov (United States)

    Earle-Richardson, Giulia; Scribani, Melissa; Wyckoff, Lynae; Strogatz, David; May, John; Jenkins, Paul

    2015-01-01

    New York, like many other states, provides county-level health statistics for use in local priority settings but does not provide any data on public views about priority health issues. This study assessed whether health department priorities are notably different from community concerns about health, and how both groups' priorities compare with local health statistics. Data from a 2009 rural survey on community health concerns were compared to priorities named by the seven area county health departments, and to local health indicator data. Health care/insurance cost (60%), obesity (53%), and prescription cost (41%) were leading community concerns, regardless of age, education, sex, or Internet in the home. Six of seven county health departments selected access to quality health care (which includes health care/insurance cost) as a leading public health priority, but only three identified obesity. The following leading local health issues were suggested by health indicators: Physical activity and nutrition, Smoking, and Unintentional injury. Health departments diverged from community priorities, from health indicator data, and from one another in choosing priorities. Adding a question about community health priorities to existing state telephone surveys on health behavior and lifestyle would provide an important tool to local health departments. © 2014 Society for Public Health Education.

  19. Shopping on the Public and Private Health Insurance Marketplaces: Consumer Decision Aids and Plan Presentation.

    Science.gov (United States)

    Wong, Charlene A; Kulhari, Sajal; McGeoch, Ellen J; Jones, Arthur T; Weiner, Janet; Polsky, Daniel; Baker, Tom

    2018-05-29

    The design of the Affordable Care Act's (ACA) health insurance marketplaces influences complex health plan choices. To compare the choice environments of the public health insurance exchanges in the fourth (OEP4) versus third (OEP3) open enrollment period and to examine online marketplace run by private companies, including a total cost estimate comparison. In November-December 2016, we examined the public and private online health insurance exchanges. We navigated each site for "real-shopping" (personal information required) and "window-shopping" (no required personal information). Public (n = 13; 12 state-based marketplaces and HealthCare.gov ) and private (n = 23) online health insurance exchanges. Features included consumer decision aids (e.g., total cost estimators, provider lookups) and plan display (e.g., order of plans). We examined private health insurance exchanges for notable features (i.e., those not found on public exchanges) and compared the total cost estimates on public versus private exchanges for a standardized consumer. Nearly all studied consumer decision aids saw increased deployment in the public marketplaces in OEP4 compared to OEP3. Over half of the public exchanges (n = 7 of 13) had total cost estimators (versus 5 of 14 in OEP3) in window-shopping and integrated provider lookups (window-shopping: 7; real-shopping: 8). The most common default plan orders were by premium or total cost estimate. Notable features on private health insurance exchanges were unique data presentation (e.g., infographics) and further personalized shopping (e.g., recommended plan flags). Health plan total cost estimates varied substantially between the public and private exchanges (average difference $1526). The ACA's public health insurance exchanges offered more tools in OEP4 to help consumers select a plan. While private health insurance exchanges presented notable features, the total cost estimates for a standardized consumer varied widely on public

  20. National guidelines for high-cost drugs in Brazil: achievements and constraints of an innovative national evidence-based public health policy.

    Science.gov (United States)

    Picon, Paulo D; Beltrame, Alberto; Banta, David

    2013-04-01

    The translation of best evidence into practice has become an important purpose of policy making in health care. In Brazil, a country of continental dimensions with widespread regional and social inequalities, the dissemination and use of the best-evidence in policy making is a critical issue for the healthcare system. The main purpose of this study is to describe an evidence-based public health policy with special emphasis on guidelines creation for high-cost medicines. We also describe how that strategy was diffused to the judiciary system and to other parts of the healthcare system. We present an 11-year follow-up of a national project for creating and updating guidelines for high-cost medicines in Brazil. A total of 109 national guidelines were published (new or updated versions) for 66 selected diseases, the first such effort in Brazilian history. The project influenced the Brazilian legislature, which has recently established a Federal Law requiring national guidelines for any new technology listed for payment by the Brazilian public healthcare system. We were able to involve many different stakeholders in a partnership between academia and policy makers, which made possible the widespread dissemination of the clinical practice guidelines. Problems and constraints were also encountered. This evolving public health strategy might be useful for other developing countries.

  1. Cost effectiveness and quality of life assessment on dental filling and tooth extraction in Balongsari Public Health Center

    Directory of Open Access Journals (Sweden)

    Taufan Bramantoro

    2011-03-01

    Full Text Available Background: Dental health services program implementation in Balongsari Public Health Center during three years, 2006 until 2008, have a high average ratio of filling treatment compared to tooth extraction treatment (1:1.79 as compared to the standard set by the Ministry of Health (1:1. Cost effectiveness analysis and quality of life is needed as a form of economic evaluation of costs incurred by the consequences or impacts of health care programs, especially dental filling and tooth extraction, use to help in supporting the process of policy making in health care. The objective of this study was to assess cost effectiveness analysis (CEA and quality of life (QoL on dental filling and extraction treatment in Public Health Center. Methods: The study was conducted on 31 respondents who received filling treatment and 38 respondents who received tooth extraction. All of the respondents carried out to evaluate the total costs incurred in obtaining treatment and QoL between before and after treatment, which consist of the physical aspects, psychological, social, and economic. Results: The average total cost of dental filling treatment of the 31 respondents was Rp. 27,934.45, and in tooth extraction of the 38 respondents at Rp. 22,406.83. The average difference in the QoL, before and after dental filling treatment amounted to 121.25. In extractions, QoL difference in value before and after treatment at 132.36. Cost effectiveness ratio value in dental filling treatment amounted to 230.37, and in tooth extraction at 169.63. Conclusion: It is concluded that cost effectiveness ratio in the filling treatment is higher than the extraction, that the tooth extraction treatment is considered more cost effective than filling treatment.Latar belakang: Pelaksanaan program pelayanan kesehatan gigi di Puskesmas Balongsari selama tiga tahun, yaitu tahun 2006 hingga 2008, memiliki rata-rata rasio perbandingan perawatan tumpatan dengan pencabutan gigi (1:1,79 yang

  2. Applying Behavioral Economics to Public Health Policy

    Science.gov (United States)

    Matjasko, Jennifer L.; Cawley, John H.; Baker-Goering, Madeleine M.; Yokum, David V.

    2016-01-01

    Behavioral economics provides an empirically informed perspective on how individuals make decisions, including the important realization that even subtle features of the environment can have meaningful impacts on behavior. This commentary provides examples from the literature and recent government initiatives that incorporate concepts from behavioral economics in order to improve health, decision making, and government efficiency. The examples highlight the potential for behavioral economics to improve the effectiveness of public health policy at low cost. Although incorporating insights from behavioral economics into public health policy has the potential to improve population health, its integration into government public health programs and policies requires careful design and continual evaluation of such interventions. Limitations and drawbacks of the approach are discussed. PMID:27102853

  3. Public health economics: a systematic review of guidance for the economic evaluation of public health interventions and discussion of key methodological issues

    Science.gov (United States)

    2013-01-01

    Background If Public Health is the science and art of how society collectively aims to improve health, and reduce inequalities in health, then Public Health Economics is the science and art of supporting decision making as to how society can use its available resources to best meet these objectives and minimise opportunity cost. A systematic review of published guidance for the economic evaluation of public health interventions within this broad public policy paradigm was conducted. Methods Electronic databases and organisation websites were searched using a 22 year time horizon (1990–2012). References of papers were hand searched for additional papers for inclusion. Government reports or peer-reviewed published papers were included if they; referred to the methods of economic evaluation of public health interventions, identified key challenges of conducting economic evaluations of public health interventions or made recommendations for conducting economic evaluations of public health interventions. Guidance was divided into three categories UK guidance, international guidance and observations or guidance provided by individual commentators in the field of public health economics. An assessment of the theoretical frameworks underpinning the guidance was made and served as a rationale for categorising the papers. Results We identified 5 international guidance documents, 7 UK guidance documents and 4 documents by individual commentators. The papers reviewed identify the main methodological challenges that face analysts when conducting such evaluations. There is a consensus within the guidance that wider social and environmental costs and benefits should be looked at due to the complex nature of public health. This was reflected in the theoretical underpinning as the majority of guidance was categorised as extra-welfarist. Conclusions In this novel review we argue that health economics may have come full circle from its roots in broad public policy economics. We may

  4. Social media in public health care

    DEFF Research Database (Denmark)

    Andersen, Kim Normann; Medaglia, Rony; Henriksen, Helle Zinner

    2012-01-01

    This paper investigates the impacts of social media use in Danish public health care with respect to capabilities, interactions, orientations, and value distribution. Taking an exploratory approach, the paper draws on an array of quantitative and qualitative data, and puts forward four propositions......: social media transform the access to health-related information for patients and general practitioners, the uptake of social media can be a cost driver rather than a cost saver, social media provide empowerment to patients, and the uptake of social media is hindered by legal and privacy concerns...

  5. Risk tradeoffs and public health protection

    International Nuclear Information System (INIS)

    Charnley, G.

    1998-01-01

    Full text of publication follows: over the last 25 years, the traditional command-and-control, chemical-by-chemical environmental medium-by-environmental medium, risk-by-risk approach to protecting public health from environmental risks has worked well to greatly improve the quality of our food, air, water, and workplaces, but we are now left with the more complex problems, like urban air pollution or personal dietary behavior, that a chemical-by-chemical approach is not going to solve. Because current environmental regulatory programs have curbed the 'low-hanging fruit' and because of today's emphasis on achieving risk reductions cost-effectively, new and creative public health-based approaches to risk management are needed. Since public concern about pollution-related disease become serious in the 1960's and 1970's and regulatory agencies and laws began to proliferate, the public health goals of environmental protection have been obscured. As a society, we have made a tradeoff between environmental health and public health. The public health foundation of environmental health protection has been obscured by legalistic, technical, centralized decision-making processes that have often mistaken hazard for risk. A greater focus on public health would help us to assess aggregate risks and to target risk management resources by focusing on a problem and then identifying what is causing the problem as a guide to determining how best to solve it. Most of our current approaches start with a cause and then try to eliminate it without determining the extent to which it actually may contribute to a problem, making it difficult to set priorities among risks or to evaluate the impact of risk management actions on public health. (author)

  6. [Financing, organization, costs and services performance of the Argentinean health sub-systems.

    Science.gov (United States)

    Yavich, Natalia; Báscolo, Ernesto Pablo; Haggerty, Jeannie

    2016-01-01

    To analyze the relationship between health system financing and services organization models with costs and health services performance in each of Rosario's health sub-systems. The financing and organization models were characterized using secondary data. Costs were calculated using the WHO/SHA methodology. Healthcare quality was measured by a household survey (n=822). Public subsystem:Vertically integrated funding and primary healthcare as a leading strategy to provide services produced low costs and individual-oriented healthcare but with weak accessibility conditions and comprehensiveness. Private subsystem: Contractual integration and weak regulatory and coordination mechanisms produced effects opposed to those of the public sub-system. Social security: Contractual integration and strong regulatory and coordination mechanisms contributed to intermediate costs and overall high performance. Each subsystem financing and services organization model had a strong and heterogeneous influence on costs and health services performance.

  7. The right to public health.

    Science.gov (United States)

    Wilson, James

    2016-06-01

    Much work in public health ethics is shaped by an 'autonomy first' view, which takes it to be axiomatic that it is difficult to justify state interference in the lives of competent adults unless the behaviours interfered with are compromised in terms of their autonomy, or would wrongfully infringe on the autonomy of others. However, such an approach is difficult to square with much of traditional public heath practice. Recent years have seen running battles between those who assume that an 'autonomy first' approach is basically sound (and so much the worse for public health practice) and those who assume that public health practice is basically sound (and so much the worse for the 'autonomy first' approach). This paper aims to reconcile in a normatively satisfying way what is best about the 'autonomy first' approach with what is best about a standard public health approach. It develops a positive case for state action to promote and protect health as a duty that is owed to each individual. According to this view, the state violates individuals' rights if it fails to take cost-effective and proportionate measures to remove health threats from the environment. It is thus a mistake to approach public health in the way that 'autonomy first' accounts do, as primarily a matter of individual entitlements versus the common good. Too little state intervention in the cause of improving population health can violate individuals' rights, just as too much can. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  8. Why invest in a national public health program for stroke? An example using Australian data to estimate the potential benefits and cost implications.

    Science.gov (United States)

    Cadilhac, Dominique A; Carter, Robert C; Thrift, Amanda G; Dewey, Helen M

    2007-10-01

    Stroke is the world's second leading cause of death in people aged over 60 years. Approximately 50,000 strokes occur annually in Australia with numbers predicted to increase by about one third over 10-years. Our objectives were to assess the economic implications of a public health program for stroke by: (1) predicting what potential health-gains and cost-offsets could be achieved; and (2) determining the net level of annual investment that would offer value-for-money. Lifetime costs and outcomes were calculated for additional cases that would benefit if 'current practice' was feasibly improved, estimated for one indicative year using: (i) local epidemiological data, coverage rates and costs; and (ii) pooled effect sizes from systematic reviews. blood pressure lowering; warfarin for atrial fibrillation; increased access to stroke units; intravenous thrombolysis and aspirin for ischemic events; and carotid endarterectomy. Value-for-money threshold: AUD$30,000/DALY recovered. Improved, prevention and management could prevent about 27,000 (38%) strokes in 2015. In present terms (2004), about 85,000 DALYs and AUD$1.06 billion in lifetime cost-offsets could be recovered. The net level of annual warranted investment was AUD$3.63 billion. Primary prevention, in particular blood pressure lowering, was most effective. A public health program for stroke is warranted.

  9. Public health and primary care: struggling to "win friends and influence people".

    Science.gov (United States)

    Mayes, Rick; McKenna, Sean

    2011-01-01

    Why are the goals of public health and primary care less politically popular and financially supported than those of curative medicine? A major part of the answer to this question lies in the fact that humans often worry wrongly by assessing risk poorly. This reality is a significant obstacle to the adequate promotion of and investment in public health, primary care, and prevention. Also, public health's tendency to infringe on personal privacy-as well as to call for difficult behavioral change-often sparks intense controversy and interest group opposition that discourage broader political support. Finally, in contrast to curative medicine, both the cost-benefit structure of public health (costs now, benefits later) and the way in which the profession operates make it largely invisible to and, thus, underappreciated by the general public. When curative medicine works well, most everybody notices. When public health and primary care work well, virtually nobody notices.

  10. Knowledge-based public health situation awareness

    Science.gov (United States)

    Mirhaji, Parsa; Zhang, Jiajie; Srinivasan, Arunkumar; Richesson, Rachel L.; Smith, Jack W.

    2004-09-01

    There have been numerous efforts to create comprehensive databases from multiple sources to monitor the dynamics of public health and most specifically to detect the potential threats of bioterrorism before widespread dissemination. But there are not many evidences for the assertion that these systems are timely and dependable, or can reliably identify man made from natural incident. One must evaluate the value of so called 'syndromic surveillance systems' along with the costs involved in design, development, implementation and maintenance of such systems and the costs involved in investigation of the inevitable false alarms1. In this article we will introduce a new perspective to the problem domain with a shift in paradigm from 'surveillance' toward 'awareness'. As we conceptualize a rather different approach to tackle the problem, we will introduce a different methodology in application of information science, computer science, cognitive science and human-computer interaction concepts in design and development of so called 'public health situation awareness systems'. We will share some of our design and implementation concepts for the prototype system that is under development in the Center for Biosecurity and Public Health Informatics Research, in the University of Texas Health Science Center at Houston. The system is based on a knowledgebase containing ontologies with different layers of abstraction, from multiple domains, that provide the context for information integration, knowledge discovery, interactive data mining, information visualization, information sharing and communications. The modular design of the knowledgebase and its knowledge representation formalism enables incremental evolution of the system from a partial system to a comprehensive knowledgebase of 'public health situation awareness' as it acquires new knowledge through interactions with domain experts or automatic discovery of new knowledge.

  11. Indirect costs of diabetes and its impact on the public finance: the case of Poland.

    Science.gov (United States)

    Torój, Andrzej; Mela, Aneta

    2018-02-01

    Growing public and private expenditure on healthcare results i.a. from the spreading of chronic diseases. Diabetes belongs to the most frequent ones, beyond neoplasms and cardiological diseases, and hence generates a significant burden for the public finance in terms of the direct costs. However, the economy suffers also from the indirect cost of diabetes that manifests itself in the loss in Gross Domestic Product (GDP) and general government revenues. This paper aims to measure this indirect cost, both in terms of GDP drop (social perspective) and public revenue drop (public finance perspective), in the case of Poland in 2012-2014. We use a modified human capital approach and unique dataset provided by the Social Security institution in Poland and the Polish Central Statistical Office. Diabetes is a substantial and growing burden for the Polish economy. In the years 2012, 2013 and 2014 the indirect cost (output loss) amounted to 1.85 bn USD, 1.94 bn USD and 2.00 bn USD respectively. Estimated indirect cost of diabetes can be a useful input for health technology analyses of drugs or economic impact assessments of public health programmes.

  12. Health care costs matter: a review of nutrition economics – is there a role for nutritional support to reduce the cost of medical health care?

    Directory of Open Access Journals (Sweden)

    Naberhuis JK

    2017-08-01

    Full Text Available Jane K Naberhuis,1 Vivienne N Hunt,2 Jvawnna D Bell,3 Jamie S Partridge,3 Scott Goates,3 Mark JC Nuijten4 1Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA; 2Abbott Nutrition, Research and Development, Singapore; 3Abbott Nutrition, Research and Development, Columbus, OH, USA; 4A2M (Ars Accessus Medica, Amsterdam, The Netherlands Background and aims: As policy-makers assess the value of money spent on health care, research in the field of health economics is expanding rapidly. This review covers a period of 10 years and seeks to characterize the publication of papers at the intersection of health economics and nutrition. Methods: Relevant publications on nutrition care were identified in the medical literature databases using predetermined search criteria. These included nutritional interventions linked to health economic terms with inclusion criteria requiring original research that included clinical outcomes and cost analyses, subjects’ ages ≥18 years, and publications in English between January 2004 and October 2014. Results: Of the 5,646 publications identified in first-round searches, 274 met the specified inclusion criteria. The number of publications linking nutrition to economic outcomes has increased markedly over the 10-year period, with a growing number of studies in both developed and developing countries. Most studies were undertaken in Europe (39% and the USA and Canada (28%. The most common study setting was hospital (62% followed by community/noninstitutional care (30%. Of all the studies, 12% involved the use of oral nutritional supplements, and 13% involved parenteral nutrition. The economic outcomes consistently measured were medical care costs (53% of the studies, hospital length of stay (48%, hospital readmission rates (9%, and mortality (25%. Conclusion: The number of publications focused on the economics of nutrition interventions has increased dramatically in recent years

  13. A school-based public health model to reduce oral health disparities.

    Science.gov (United States)

    Dudovitz, Rebecca N; Valiente, Jonathan E; Espinosa, Gloria; Yepes, Claudia; Padilla, Cesar; Puffer, Maryjane; Slavkin, Harold C; Chung, Paul J

    2018-12-01

    Although dental decay is preventable, it remains the most common pediatric chronic disease. We describe a public health approach to implementing a scalable and sustainable school-based oral health program for low-income urban children. The Los Angeles Trust for Children's Health, a nonprofit affiliated with the Los Angeles Unified School District, applied a public health model and developed a broad-based community-coalition to a) establish a District Oral Health Nurse position to coordinate oral health services, and b) implement a universal school-based oral health screening and fluoride varnishing program, with referral to a dental home. Key informant interviews and focus groups informed program development. Parent surveys assessed preventative oral health behaviors and access to oral health services. Results from screening exams, program costs and rates of reimbursement were recorded. From 2012 to 2015, six elementary schools and three dental provider groups participated. Four hundred ninety-one parents received oral health education and 89 served as community oral health volunteers; 3,399 screenings and fluoride applications were performed on 2,776 children. Sixty-six percent of children had active dental disease, 27 percent had visible tooth decay, and 6 percent required emergent care. Of the 623 students who participated for two consecutive years, 56 percent had fewer or no visible caries at follow-up, while only 17 percent had additional disease. Annual program cost was $69.57 per child. Using a broad based, oral health coalition, a school-based universal screening and fluoride varnishing program can improve the oral health of children with a high burden of untreated dental diseases. © 2017 American Association of Public Health Dentistry.

  14. Health care inequities in north India: role of public sector in universalizing health care.

    Science.gov (United States)

    Prinja, Shankar; Kanavos, Panos; Kumar, Rajesh

    2012-09-01

    Income inequality is associated with poor health. Inequities exist in service utilization and financing for health care. Health care costs push high number of households into poverty in India. We undertook this study to ascertain inequities in health status, service utilization and out-of-pocket (OOP) health expenditures in two States in north India namely, Haryana and Punjab, and Union Territory of Chandigarh. Data from National Sample Survey 60 th Round on Morbidity and Health Care were analyzed by mean consumption expenditure quintiles. Indicators were devised to document inequities in the dimensions of horizontal and vertical inequity; and redistribution of public subsidy. Concentration index (CI), and equity ratio in conjunction with concentration curve were computed to measure inequity. Reporting of morbidity and hospitalization rate had a pro-rich distribution in all three States indicating poor utilization of health services by low income households. Nearly 57 and 60 per cent households from poorest income quintile in Haryana and Punjab, respectively faced catastrophic OOP hospitalization expenditure at 10 per cent threshold. Lower prevalence of catastrophic expenditure was recorded in higher income groups. Public sector also incurred high costs for hospitalization in selected three States. Medicines constituted 19 to 47 per cent of hospitalization expenditure and 59 to 86 per cent OPD expenditure borne OOP by households in public sector. Public sector hospitalizations had a pro-poor distribution in Haryana, Punjab and Chandigarh. Our analysis indicates that public sector health service utilization needs to be improved. OOP health care expenditures at public sector institutions should to be curtailed to improve utilization of poorer segments of population. Greater availability of medicines in public sector and regulation of their prices provide a unique opportunity to reduce public sector OOP expenditure.

  15. Costs in Swedish Public Transport : An analysis of cost drivers and cost efficiency in public transport contracts

    OpenAIRE

    Vigren, Andreas

    2015-01-01

    During the last seven years, the total cost for Swedish public transport provision has increased by over 30 percent in real terms according to figures from the government agency Transport Analysis. A similar pattern is found if considering a longer time span. Part of the cost increase can be attributed to an increased supply, and part is due to price increases on input factors that are measured by an industry index produced by the public transport industry. The fact that about half of the cos...

  16. [Health services research for the public health service (PHS) and the public health system].

    Science.gov (United States)

    Hollederer, A; Wildner, M

    2015-03-01

    There is a great need for health services research in the public health system and in the German public health service. However, the public health service is underrepresented in health services research in Germany. This has several structural, historical and disciplinary-related reasons. The public health service is characterised by a broad range of activities, high qualification requirements and changing framework conditions. The concept of health services research is similar to that of the public health service and public health system, because it includes the principles of multidisciplinarity, multiprofessionalism and daily routine orientation. This article focuses on a specified system theory based model of health services research for the public health system and public health service. The model is based on established models of the health services research and health system research, which are further developed according to specific requirements of the public health service. It provides a theoretical foundation for health services research on the macro-, meso- and microlevels in public health service and the public health system. Prospects for public health service are seen in the development from "old public health" to "new public health" as well as in the integration of health services research and health system research. There is a significant potential for development in a better linkage between university research and public health service as is the case for the "Pettenkofer School of Public Health Munich". © Georg Thieme Verlag KG Stuttgart · New York.

  17. The Problem With Estimating Public Health Spending.

    Science.gov (United States)

    Leider, Jonathon P

    2016-01-01

    Accurate information on how much the United States spends on public health is critical. These estimates affect planning efforts; reflect the value society places on the public health enterprise; and allows for the demonstration of cost-effectiveness of programs, policies, and services aimed at increasing population health. Yet, at present, there are a limited number of sources of systematic public health finance data. Each of these sources is collected in different ways, for different reasons, and so yields strikingly different results. This article aims to compare and contrast all 4 current national public health finance data sets, including data compiled by Trust for America's Health, the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO), and the Census, which underlie the oft-cited National Health Expenditure Account estimates of public health activity. In FY2008, ASTHO estimates that state health agencies spent $24 billion ($94 per capita on average, median $79), while the Census estimated all state governmental agencies including state health agencies spent $60 billion on public health ($200 per capita on average, median $166). Census public health data suggest that local governments spent an average of $87 per capita (median $57), whereas NACCHO estimates that reporting LHDs spent $64 per capita on average (median $36) in FY2008. We conclude that these estimates differ because the various organizations collect data using different means, data definitions, and inclusion/exclusion criteria--most notably around whether to include spending by all agencies versus a state/local health department, and whether behavioral health, disability, and some clinical care spending are included in estimates. Alongside deeper analysis of presently underutilized Census administrative data, we see harmonization efforts and the creation of a standardized expenditure reporting system as a way to

  18. Costs of medically assisted reproduction treatment at specialized fertility clinics in the Danish public health care system: results from a 5-year follow-up cohort study.

    Science.gov (United States)

    Christiansen, Terkel; Erb, Karin; Rizvanovic, Amra; Ziebe, Søren; Mikkelsen Englund, Anne L; Hald, Finn; Boivin, Jacky; Schmidt, Lone

    2014-01-01

    To examine the costs to the public health care system of couples in medically assisted reproduction. Longitudinal cohort study of infertile couples initiating medically assisted reproduction treatment. Specialized public fertility clinics in Denmark. Seven hundred and thirty-nine couples having no child at study entry and with data on kind of treatment and live birth (yes/no) for each treatment attempt at the specialized public fertility clinic. Treatment data for medically assisted reproduction attempts conducted at the public fertility clinics were abstracted from medical records. Flow diagrams were drawn for different standard treatment cycles and direct costs at each stage in the flow charts were measured and valued by a bottom-up procedure. Indirect costs were distributed to each treatment cycle on the basis of number of visits as basis. Costs were adjusted to 2012 prices using a constructed medical price index. Live birth, costs. Total costs per live birth in 2012 prices were estimated to 10,755€. Costs per treated couple - irrespective of whether the treatment was terminated by a live birth or not - were estimated at 6607€. Costs per live birth of women <35 years at treatment initiation were 9338€ and 15,040€ for women ≥35 years. The public costs for live births after conception with medically assisted reproduction treatment are relatively modest. The results can be generalized to public fertility treatment in Denmark and to other public treatment settings with similar limitations in numbers of public treatment cycles offered. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  19. Obesity, stigma and public health planning.

    Science.gov (United States)

    MacLean, Lynne; Edwards, Nancy; Garrard, Michael; Sims-Jones, Nicki; Clinton, Kathryn; Ashley, Lisa

    2009-03-01

    Given the rise in obesity rates in North America, concerns about obesity-related costs to the health care system are being stressed in both the popular media and the scientific literature. With such constant calls to action, care must be taken not to increase stigmatization of obese people, particularly of children. While there is much written about stigma and how it is exacerbated, there are few guidelines for public health managers and practitioners who are attempting to design and implement obesity prevention programs that minimize stigma. We examine stigmatization of obese people and the consequences of this social process, and discuss how stigma is manifest in health service provision. We give suggestions for designing non-stigmatizing obesity prevention public health programs. Implications for practice and policy are discussed.

  20. Costs of implementing and maintaining comprehensive school health: the case of the Annapolis Valley Health Promoting Schools program.

    Science.gov (United States)

    Ohinmaa, Arto; Langille, Jessie-Lee; Jamieson, Stuart; Whitby, Caroline; Veugelers, Paul J

    2011-01-01

    Comprehensive school health (CSH) is increasingly receiving renewed interest as a strategy to improve health and learning. The present study estimates the costs associated with implementing and maintaining CSH. We reviewed the accounting information of all schools in the Annapolis Valley Health Promoting Schools (AVHPS) program in 2008/2009. We considered support for nutrition and physical activity programs by the public system, grants, donations, fundraising and volunteers. The annual public funding to AVHPS to implement and maintain CSH totaled $344,514, which translates, on average, to $7,830 per school and $22.67 per student. Of the public funding, $140,500 was for CSH, $86,250 for breakfast programs, $28,750 for school food policy programs, and the remainder for other subsidized programs. Grants, donations and fundraising were mostly locally acquired. They totaled $127,235, which translates, on average, to $2,892 per school or $8.37 per student. The value of volunteer support was estimated to be equivalent to the value of grants, donations and fundraising combined. Of all grants, donations, fundraising and volunteers, 20% was directed to physical activity programs and 80% to nutrition programs. The public costs to implement and maintain CSH are modest. They leveraged substantial local funding and in-kind contributions, underlining community support for healthy eating and active living. Where CSH is effective in preventing childhood overweight, it is most likely cost-effective too, as costs for future chronic diseases are mounting. CSH programs that are proven effective and cost-effective have enormous potential for broad implementation and for reducing the public health burden associated with obesity.

  1. Mobile Health Insurance System and Associated Costs: A Cross-Sectional Survey of Primary Health Centers in Abuja, Nigeria.

    Science.gov (United States)

    Chukwu, Emeka; Garg, Lalit; Eze, Godson

    2016-05-17

    Nigeria contributes only 2% to the world's population, accounts for 10% of the global maternal death burden. Health care at primary health centers, the lowest level of public health care, is far below optimal in quality and grossly inadequate in coverage. Private primary health facilities attempt to fill this gap but at additional costs to the client. More than 65% Nigerians still pay out of pocket for health services. Meanwhile, the use of mobile phones and related services has risen geometrically in recent years in Nigeria, and their adoption into health care is an enterprise worth exploring. The purpose of this study was to document costs associated with a mobile technology-supported, community-based health insurance scheme. This analytic cross-sectional survey used a hybrid of mixed methods stakeholder interviews coupled with prototype throw-away software development to gather data from 50 public primary health facilities and 50 private primary care centers in Abuja, Nigeria. Data gathered documents costs relevant for a reliable and sustainable mobile-supported health insurance system. Clients and health workers were interviewed using structured questionnaires on services provided and cost of those services. Trained interviewers conducted the structured interviews, and 1 client and 1 health worker were interviewed per health facility. Clinic expenditure was analyzed to include personnel, fixed equipment, medical consumables, and operation costs. Key informant interviews included a midmanagement staff of a health-management organization, an officer-level staff member of a mobile network operator, and a mobile money agent. All the 200 respondents indicated willingness to use the proposed system. Differences in the cost of services between public and private facilities were analyzed at 95% confidence level (Phealth care facilities is significantly higher than at public primary health care facilities. Key informant interviews with a health management organizations

  2. Cost-effectiveness thresholds in health care: a bookshelf guide to their meaning and use.

    Science.gov (United States)

    Culyer, Anthony J

    2016-10-01

    There is misunderstanding about both the meaning and the role of cost-effectiveness thresholds in policy decision making. This article dissects the main issues by use of a bookshelf metaphor. Its main conclusions are as follows: it must be possible to compare interventions in terms of their impact on a common measure of health; mere effectiveness is not a persuasive case for inclusion in public insurance plans; public health advocates need to address issues of relative effectiveness; a 'first best' benchmark or threshold ratio of health gain to expenditure identifies the least effective intervention that should be included in a public insurance plan; the reciprocal of this ratio - the 'first best' cost-effectiveness threshold - will rise or fall as the health budget rises or falls (ceteris paribus); setting thresholds too high or too low costs lives; failure to set any cost-effectiveness threshold at all also involves avertable deaths and morbidity; the threshold cannot be set independently of the health budget; the threshold can be approached from either the demand side or the supply side - the two are equivalent only in a health-maximising equilibrium; the supply-side approach generates an estimate of a 'second best' cost-effectiveness threshold that is higher than the 'first best'; the second best threshold is the one generally to be preferred in decisions about adding or subtracting interventions in an established public insurance package; multiple thresholds are implied by systems having distinct and separable health budgets; disinvestment involves eliminating effective technologies from the insured bundle; differential weighting of beneficiaries' health gains may affect the threshold; anonymity and identity are factors that may affect the interpretation of the threshold; the true opportunity cost of health care in a community, where the effectiveness of interventions is determined by their impact on health, is not to be measured in money - but in health

  3. Museums as a venue for public health intervention.

    Science.gov (United States)

    Ickovics, Jeannette R

    2013-12-01

    Big Food: Health, Culture, and the Evolution of Eating broke numerous records for museum attendance, highlighting the public's appetite for public health. During its 10-month run at the Yale Peabody Museum of Natural History, more than 120 000 visitors attended Big Food, including 25 000 students through the museum's public education program, an increase of 30% more than the average student attendance in the past decade. Big Food cost approximately $100 000 to build, comprising printed panels and objects, installation displays (e.g., custom-built cases to house such objects as sugar-sweetened beverages and healthy and diseased organs), temporary walls, video monitors, food products, and more. At less than $1 per visitor, this provided extraordinary public health value.

  4. Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa

    DEFF Research Database (Denmark)

    Phillips, Andrew N; Cambiano, Valentina; Nakagawa, Fumiyo

    2018-01-01

    BACKGROUND: There is concern over increasing prevalence of non-nucleoside reverse-transcriptase inhibitor (NNRTI) resistance in people initiating antiretroviral therapy (ART) in low-income and middle-income countries. We assessed the effectiveness and cost-effectiveness of alternative public health...... sources and considers specific drugs and resistance mutations. We used this model to generate multiple setting scenarios mimicking those in sub-Saharan Africa and considered the prevalence of pretreatment NNRTI drug resistance in 2017. We then compared effectiveness and cost-effectiveness of alternative...... policy options. We took a 20 year time horizon, used a cost effectiveness threshold of US$500 per DALY averted, and discounted DALYs and costs at 3% per year. FINDINGS: A transition to use of a dolutegravir as a first-line regimen in all new ART initiators is the option predicted to produce the most...

  5. Discrete Choice Experiments in Public Health

    NARCIS (Netherlands)

    Veldwijk, J.

    2015-01-01

    One approach to improve public health is to implement preventive programs that have been proven effective and cost-effective. For any preventive program to be successful, it is of paramount importance that a large majority of the target population participates. Unfortunately, it is not self-evident

  6. Estimating the mental health costs of racial discrimination

    Directory of Open Access Journals (Sweden)

    Amanuel Elias

    2016-11-01

    Full Text Available Abstract Background Racial discrimination is a pervasive social problem in several advanced countries such as the U.S., U.K., and Australia. Public health research also indicates a range of associations between exposure to racial discrimination and negative health, particularly, mental health including depression, anxiety, and post-traumatic stress disorder (PTSD. However, the direct negative health impact of racial discrimination has not been costed so far although economists have previously estimated indirect non-health related productivity costs. In this study, we estimate the burden of disease due to exposure to racial discrimination and measure the cost of this exposure. Methods Using prevalence surveys and data on the association of racial discrimination with health outcomes from a global meta-analysis, we apply a cost of illness method to measure the impact of racial discrimination. This estimate indicates the direct health cost attributable to racial discrimination and we convert the estimates to monetary values based on conventional parameters. Results Racial discrimination costs the Australian economy 235,452 in disability adjusted life years lost, equivalent to $37.9 billion per annum, roughly 3.02% of annual gross domestic product (GDP over 2001–11, indicating a sizeable loss for the economy. Conclusion Substantial cost is incurred due to increased prevalence of racial discrimination as a result of its association with negative health outcomes (e.g. depression, anxiety and PTSD. This implies that potentially significant cost savings can be made through measures that target racial discrimination. Our research contributes to the debate on the social impact of racial discrimination, with implications for policies and efforts addressing it.

  7. Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review.

    Science.gov (United States)

    de la Torre-Díez, Isabel; López-Coronado, Miguel; Vaca, Cesar; Aguado, Jesús Saez; de Castro, Carlos

    2015-02-01

    A systematic review of cost-utility and cost-effectiveness research works of telemedicine, electronic health (e-health), and mobile health (m-health) systems in the literature is presented. Academic databases and systems such as PubMed, Scopus, ISI Web of Science, and IEEE Xplore were searched, using different combinations of terms such as "cost-utility" OR "cost utility" AND "telemedicine," "cost-effectiveness" OR "cost effectiveness" AND "mobile health," etc. In the articles searched, there were no limitations in the publication date. The search identified 35 relevant works. Many of the articles were reviews of different studies. Seventy-nine percent concerned the cost-effectiveness of telemedicine systems in different specialties such as teleophthalmology, telecardiology, teledermatology, etc. More articles were found between 2000 and 2013. Cost-utility studies were done only for telemedicine systems. There are few cost-utility and cost-effectiveness studies for e-health and m-health systems in the literature. Some cost-effectiveness studies demonstrate that telemedicine can reduce the costs, but not all. Among the main limitations of the economic evaluations of telemedicine systems are the lack of randomized control trials, small sample sizes, and the absence of quality data and appropriate measures.

  8. Public health emergencies and the public health/managed care challenge.

    Science.gov (United States)

    Rosenbaum, Sara; Skivington, Skip; Praeger, Sandra

    2002-01-01

    The relationship between insurance and public health is an enduring topic in public health policy and practice. Insurers share certain attributes with public health. But public health agencies operate in relation to the entire community that they are empowered by public law to serve and without regard to the insurance status of community residents; on the other hand, insurers (whether managed care or otherwise) are risk-bearing entities whose obligations are contractually defined and limited to enrolled members and sponsors. Public insurers such as Medicare and Medicaid operate under similar constraints. The fundamental characteristics that distinguish managed care-style insurance and public health become particularly evident during periods of public health emergency, when a public health agency's basic obligations to act with speed and flexibility may come face to face with the constraints on available financing that are inherent in the structure of insurance. Because more than 70% of all personal health care in the United States is financed through insurance, public health agencies effectively depend on insurers to finance necessary care and provide essential patient-level data to the public health system. Critical issues of state and federal policy arise in the context of the public health/insurance relations during public health emergencies. These issues focus on coverage and the power to make coverage decisions, as well as the power to define service networks and classify certain data as exempt from public reporting. The extent to which a formal regulatory approach may become necessary is significantly affected by the extent to which private entities themselves respond to the problem with active efforts to redesign their services and operations to include capabilities and accountability in the realm of public health emergency response.

  9. Training public health superheroes: five talents for public health leadership.

    Science.gov (United States)

    Day, Matthew; Shickle, Darren; Smith, Kevin; Zakariasen, Ken; Moskol, Jacob; Oliver, Thomas

    2014-12-01

    Public health leaders have been criticized for their policy stances, relationships with governments and failure to train the next generation. New approaches to the identification and training of public health leaders may be required. To inform these, lessons can be drawn from public health 'superheroes'; public health leaders perceived to be the most admired and effective by their peers. Members and Fellows of the UK Faculty of Public Health were contacted via e-newsletter and magazine and asked to nominate their 'Public Health Superhero'. Twenty-six responses were received, nominating 40 different people. Twelve semi-structured interviews were conducted. Thematic analysis, based on 'grounded theory', was conducted. Five leadership 'talents' for public health were identified: mentoring-nurturing, shaping-organizing, networking-connecting, knowing-interpreting and advocating-impacting. Talent-based approaches have been effective for leadership development in other sectors. These talents are the first specific to the practice of public health and align with some aspects of existing frameworks. An increased focus on identifying and developing talents during public health training, as opposed to 'competency'-based approaches, may be effective in strengthening public health leadership. Further research to understand the combination and intensity of talents across a larger sample of public health leaders is required. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. [Evaluating cost/equity in the Colombian health system, 1998-2005].

    Science.gov (United States)

    Eslava-Schmalbach, Javier; Barón, Gilberto; Gaitán-Duarte, Hernando; Alfonso, Helman; Agudelo, Carlos; Sánchez, Carolina

    2008-01-01

    An economic analysis of cost-equity (from society's viewpoint) for evaluating the impact of Law 100/93 in Colombia between 1998 and 2005. An economic analysis compared costs and equity in health in Colombia between 1998 and 2005. Data was taken from the Colombian Statistics' Administration Department ( Departamento Administrativo Nacional de Estadistica - DANE) and from national demographic and health surveys carried out in 2000 and 2005. Information regarding costs was taken from the National Health Accounts' System. Inequity in Health was considered in line with the Inequity in Health Index (IHI). Incremental and average cost-equity analysis covered three sub-periods; 1998-1999 (during which time per capita gross internal product became reduced in Colombia ), 2000-2001 (during which time total health expense became reduced) and 2001 -2005. An unstable tendency for inequity in health becoming reduced during the period was revealed. There was an inverse relationship between IHI and public health spending and a direct relationship between out-of-pocket spending on health and equity in health (Spearman, p<0.05). The second period had the best incremental cost-equity ratio. Fluctuations in IHI and marginal cost-equity during the periods being analysed suggested that health spending depended on equity in health in Colombia during the period being studied.

  11. [Public health services between "new public health" and "new public management"].

    Science.gov (United States)

    Oppen, M

    1996-04-01

    Today, a substantial reorientation of the Public Health services in the Federal Republic of Germany is broadly seen necessary. Patterns of functional and organisational restructuring of Public Health services on the regional and the communal level are closely linked with concepts of prevention and health promotion. Hence, a number of agencies have already adopted new tasks and functions like comprehensive and transorganizational planning, coordination and evaluation as well as the establishment of new reporting systems. Presently, the transformation process from the bureaucratic mode of administering matters of health to a new Public Health orientation receives new impacts from the international "New Public Management" movement. Comparatively late, with the beginning of the 1990s, a growing number of German municipalities has introduced new concepts of administration. Local government administrations, of which the Public Health services are a part, follow the model of modern service organizations producing services in a more efficient, professionalized and consumer-oriented way. Specific elements of economising modernisation programmes like re-distribution of tasks, de-centralisation, extension of managerial capacities, setting of stimulating working conditions that provide employees with greater independence of action as well as career opportunities, are at the same time prerequisites for innovative strategies of health protection and coordination policies of Public Health services.

  12. Public Health Economic Burden Associated with Two Single Measles Case Investigations - Colorado, 2016-2017.

    Science.gov (United States)

    Marx, Grace E; Chase, Jennifer; Jasperse, Joseph; Stinson, Kaylan; McDonald, Carol E; Runfola, Janine K; Jaskunas, Jillian; Hite, Donna; Barnes, Meghan; Askenazi, Michele; Albanese, Bernadette

    2017-11-24

    During July 2016-January 2017, two unrelated measles cases were identified in the Denver, Colorado area after patients traveled to countries with endemic measles transmission. Each case resulted in multiple exposures at health care facilities and public venues, and activated an immediate and complex response by local and state public health agencies, with activities led by the Tri-County Health Department (TCHD), which serves Adams, Arapahoe, and Douglas counties. To track the economic burden associated with investigating and responding to single measles cases, personnel hours and supply costs incurred during each investigation were tracked prospectively. No secondary cases of measles were identified in either investigation. Postexposure prophylaxis (PEP) was administered to 31 contacts involving the first case; no contacts of the second case were eligible for PEP because of a delay in diagnosing measles disease. Public health costs of disease investigation in the first and second case were estimated at $49,769 and $18,423, respectively. Single measles cases prompted coordinated public health action and were costly and resource-intensive for local public health agencies.

  13. The health system cost of post-abortion care in Rwanda

    Science.gov (United States)

    Vlassoff, Michael; Musange, Sabine F; Kalisa, Ina R; Ngabo, Fidele; Sayinzoga, Felix; Singh, Susheela; Bankole, Akinrinola

    2015-01-01

    Based on research conducted in 2012, we estimate the cost to the Rwandan health-care system of providing post-abortion care (PAC) due to unsafe abortions, a subject of policy importance not studied before at the national level. Thirty-nine public and private health facilities representing three levels of health care were randomly selected for data collection from key care providers and administrators for all five regions. Using an ingredients approach to costing, data were gathered on drugs, supplies, material, personnel time and hospitalization. Additionally, direct non-medical costs such as overhead and capital costs were also measured. We found that the average annual PAC cost per client, across five types of abortion complications, was $93. The total cost of PAC nationally was estimated to be $1.7 million per year, 49% of which was expended on direct non-medical costs. Satisfying all demands for PAC would raise the national cost to $2.5 million per year. PAC comprises a significant share of total expenditure in reproductive health in Rwanda. Investing more resources in provision of contraceptive services to prevent unwanted or mistimed pregnancies would likely reduce health systems costs. PMID:24548846

  14. Patterns in PARTNERing across Public Health Collaboratives

    Science.gov (United States)

    Bevc, Christine A.; Retrum, Jessica H.; Varda, Danielle M.

    2015-01-01

    Inter-organizational networks represent one of the most promising practice-based approaches in public health as a way to attain resources, share knowledge, and, in turn, improve population health outcomes. However, the interdependencies and effectiveness related to the structure, management, and costs of these networks represents a critical item to be addressed. The objective of this research is to identify and determine the extent to which potential partnering patterns influence the structure of collaborative networks. This study examines data collected by PARTNER, specifically public health networks (n = 162), to better understand the structured relationships and interactions among public health organizations and their partners, in relation to collaborative activities. Combined with descriptive analysis, we focus on the composition of public health collaboratives in a series of Exponential Random Graph (ERG) models to examine the partnerships between different organization types to identify the attribute-based effects promoting the formation of network ties within and across collaboratives. We found high variation within and between these collaboratives including composition, diversity, and interactions. The findings of this research suggest common and frequent types of partnerships, as well as opportunities to develop new collaborations. The result of this analysis offer additional evidence to inform and strengthen public health practice partnerships. PMID:26445053

  15. Patterns in PARTNERing across Public Health Collaboratives.

    Science.gov (United States)

    Bevc, Christine A; Retrum, Jessica H; Varda, Danielle M

    2015-10-05

    Inter-organizational networks represent one of the most promising practice-based approaches in public health as a way to attain resources, share knowledge, and, in turn, improve population health outcomes. However, the interdependencies and effectiveness related to the structure, management, and costs of these networks represents a critical item to be addressed. The objective of this research is to identify and determine the extent to which potential partnering patterns influence the structure of collaborative networks. This study examines data collected by PARTNER, specifically public health networks (n = 162), to better understand the structured relationships and interactions among public health organizations and their partners, in relation to collaborative activities. Combined with descriptive analysis, we focus on the composition of public health collaboratives in a series of Exponential Random Graph (ERG) models to examine the partnerships between different organization types to identify the attribute-based effects promoting the formation of network ties within and across collaboratives. We found high variation within and between these collaboratives including composition, diversity, and interactions. The findings of this research suggest common and frequent types of partnerships, as well as opportunities to develop new collaborations. The result of this analysis offer additional evidence to inform and strengthen public health practice partnerships.

  16. Patterns in PARTNERing across Public Health Collaboratives

    Directory of Open Access Journals (Sweden)

    Christine A. Bevc

    2015-10-01

    Full Text Available Inter-organizational networks represent one of the most promising practice-based approaches in public health as a way to attain resources, share knowledge, and, in turn, improve population health outcomes. However, the interdependencies and effectiveness related to the structure, management, and costs of these networks represents a critical item to be addressed. The objective of this research is to identify and determine the extent to which potential partnering patterns influence the structure of collaborative networks. This study examines data collected by PARTNER, specifically public health networks (n = 162, to better understand the structured relationships and interactions among public health organizations and their partners, in relation to collaborative activities. Combined with descriptive analysis, we focus on the composition of public health collaboratives in a series of Exponential Random Graph (ERG models to examine the partnerships between different organization types to identify the attribute-based effects promoting the formation of network ties within and across collaboratives. We found high variation within and between these collaboratives including composition, diversity, and interactions. The findings of this research suggest common and frequent types of partnerships, as well as opportunities to develop new collaborations. The result of this analysis offer additional evidence to inform and strengthen public health practice partnerships.

  17. Big Data's Role in Precision Public Health.

    Science.gov (United States)

    Dolley, Shawn

    2018-01-01

    Precision public health is an emerging practice to more granularly predict and understand public health risks and customize treatments for more specific and homogeneous subpopulations, often using new data, technologies, and methods. Big data is one element that has consistently helped to achieve these goals, through its ability to deliver to practitioners a volume and variety of structured or unstructured data not previously possible. Big data has enabled more widespread and specific research and trials of stratifying and segmenting populations at risk for a variety of health problems. Examples of success using big data are surveyed in surveillance and signal detection, predicting future risk, targeted interventions, and understanding disease. Using novel big data or big data approaches has risks that remain to be resolved. The continued growth in volume and variety of available data, decreased costs of data capture, and emerging computational methods mean big data success will likely be a required pillar of precision public health into the future. This review article aims to identify the precision public health use cases where big data has added value, identify classes of value that big data may bring, and outline the risks inherent in using big data in precision public health efforts.

  18. Leprosy: International Public Health Policies and Public Health Eras

    Directory of Open Access Journals (Sweden)

    Niyi Awofeso

    2011-09-01

    Full Text Available Public health policies continue to play important roles in national and international health reforms. However, the influence and legacies of the public health eras during which such policies are formulated remain largely underappreciated. The limited appreciation of this relationship may hinder consistent adoption of public health policies by nation-states, and encumber disinvestment from ineffective or anachronistic policies. This article reviews seven public health eras and highlights how each era has influenced international policy formulation for leprosy control—“the fertile soil for policy learning”. The author reiterates the role of health leadership and health activism in facilitating consistency in international health policy formulation and implementation for leprosy control.

  19. Conceptual framework of public health surveillance and action and its application in health sector reform

    Directory of Open Access Journals (Sweden)

    Alemu Wondi

    2002-01-01

    Full Text Available Abstract Background Because both public health surveillance and action are crucial, the authors initiated meetings at regional and national levels to assess and reform surveillance and action systems. These meetings emphasized improved epidemic preparedness, epidemic response, and highlighted standardized assessment and reform. Methods To standardize assessments, the authors designed a conceptual framework for surveillance and action that categorized the framework into eight core and four support activities, measured with indicators. Results In application, country-level reformers measure both the presence and performance of the six core activities comprising public health surveillance (detection, registration, reporting, confirmation, analyses, and feedback and acute (epidemic-type and planned (management-type responses composing the two core activities of public health action. Four support activities – communications, supervision, training, and resource provision – enable these eight core processes. National, multiple systems can then be concurrently assessed at each level for effectiveness, technical efficiency, and cost. Conclusions This approach permits a cost analysis, highlights areas amenable to integration, and provides focused intervention. The final public health model becomes a district-focused, action-oriented integration of core and support activities with enhanced effectiveness, technical efficiency, and cost savings. This reform approach leads to sustained capacity development by an empowerment strategy defined as facilitated, process-oriented action steps transforming staff and the system.

  20. Machine-Learning Algorithms to Code Public Health Spending Accounts.

    Science.gov (United States)

    Brady, Eoghan S; Leider, Jonathon P; Resnick, Beth A; Alfonso, Y Natalia; Bishai, David

    Government public health expenditure data sets require time- and labor-intensive manipulation to summarize results that public health policy makers can use. Our objective was to compare the performances of machine-learning algorithms with manual classification of public health expenditures to determine if machines could provide a faster, cheaper alternative to manual classification. We used machine-learning algorithms to replicate the process of manually classifying state public health expenditures, using the standardized public health spending categories from the Foundational Public Health Services model and a large data set from the US Census Bureau. We obtained a data set of 1.9 million individual expenditure items from 2000 to 2013. We collapsed these data into 147 280 summary expenditure records, and we followed a standardized method of manually classifying each expenditure record as public health, maybe public health, or not public health. We then trained 9 machine-learning algorithms to replicate the manual process. We calculated recall, precision, and coverage rates to measure the performance of individual and ensembled algorithms. Compared with manual classification, the machine-learning random forests algorithm produced 84% recall and 91% precision. With algorithm ensembling, we achieved our target criterion of 90% recall by using a consensus ensemble of ≥6 algorithms while still retaining 93% coverage, leaving only 7% of the summary expenditure records unclassified. Machine learning can be a time- and cost-saving tool for estimating public health spending in the United States. It can be used with standardized public health spending categories based on the Foundational Public Health Services model to help parse public health expenditure information from other types of health-related spending, provide data that are more comparable across public health organizations, and evaluate the impact of evidence-based public health resource allocation.

  1. Dementia care in public health in Brazil and the world: A systematic review

    Directory of Open Access Journals (Sweden)

    Bianca Bolzan Cieto

    Full Text Available ABSTRACT OBJECTIVE: This study aimed to identify in the recent scientific literature, information on health care provided to people with dementia, dementia costs and its resource implications for public health. METHODS: This was a systematic review of the literature in which the articles were consulted from the databases PubMed/MEDLINE, LILACS and SciELO. The review sample consisted of 45 articles. RESULTS: Examination of the studies identified the current scenario of dementia in relation to public health and public policy in Brazil and the world. The analyzed studies revealed key information on aspects of dementia in the world. There was consensus on the high prevalence of the syndrome and on the significant cost of health care and public policy for assisting the elderly with dementia. CONCLUSION: The importance of planning and implementing new public policies was recognized, since these are essential for the organization and management of health services and directly influence the country's ability to provide health care for people with dementia.

  2. The Foundational Public Health Services as a Framework for Estimating Spending.

    Science.gov (United States)

    Resnick, Beth A; Fisher, Jessica S; Colrick, Ian P; Leider, Jonathon P

    2017-11-01

    In support of the nation's effort to address rising healthcare costs and improve healthcare outcomes, the National Academy of Medicine called for a minimum package of public health services available in every community to protect and improve population health and identification of the resources needed to make these services universally available. In response, the Foundational Public Health Services (FPHS) framework was developed to outline a basic set of public health programs and capabilities. Although the FPHS is considered a useful public health practice tool, cost estimation for providing the FPHS is in its infancy. This is in part due to inability to estimate total costs of individual public health services and programs. This research begins to address this knowledge gap. FPHS formed the basis of a coding framework used in 2013-2016 to code 1.9 million U.S. Census Bureau State Finance non-hospital expenditure records from 49 states from 2000 to 2013. Results were used to develop estimates of state governmental FPHS spending. FPHS spending constituted 36% of total state governmental non-hospital health spending from 2008 to 2013. The largest proportion of FPHS spending was on maternal/child health and the smallest proportion of spending was on access and linkage to clinical care. This research is an important step in response to the National Academy of Medicine's call for estimating the resources needed to provide the FPHS. Such estimates allow for spending comparisons across states and may inform future research to assess and evaluate FPHS spending impacts. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  3. Cost and cost-effectiveness of smear-positive tuberculosis treatment by Health Extension Workers in Southern Ethiopia: a community randomized trial.

    Directory of Open Access Journals (Sweden)

    Daniel G Datiko

    Full Text Available UNLABELLED: Treatments by HEWs in the health posts and general health workers at health facility were compared along a community-randomized trial. Costs were analysed from societal perspective in 2007 in US $ using standard methods. We prospectively enrolled smear positive patients, and calculated cost-effectiveness as the cost per patient successfully treated. The total cost for each successfully treated smear-positive patient was higher in health facility ($158.9 compared with community ($61.7. Community-based treatment reduced the total, patient and caregiver cost by 61.2%, 68.1% and 79.8%, respectively. Involving HEWs added a total cost of $8.80 (14.3% of total cost on health service per patient treated in the community. CONCLUSIONS/SIGNIFICANCE: Community-based treatment by HEWs costs only 39% of what treatment by general health workers costs for similar outcomes. Involving HEWs in TB treatment is a cost effective treatment alternative to the health service, to the patients and the family. There is an economic and public health reason to consider involving HEWs in TB treatment in Ethiopia. However, community-based treatment requires initial investment to start its implementation, training and supervision. TRIAL REGISTRATION: ClinicalTrials.gov NCT00803322.

  4. A unique funding opportunity for public health in Texas.

    Science.gov (United States)

    Schlenker, Thomas; Huber, Carol A

    2015-01-01

    In addition to the Affordable Care Act, states are more frequently turning to Medicaid waivers to achieve the "Triple Aim" goals of improving the experience of care, improving population health, and reducing per capita costs. These demonstration waivers provide opportunities to test innovative ways to finance and deliver care. Texas is currently implementing a waiver known as the Transformation and Quality Improvement Program. Its inclusion of public health agencies is a unique approach to a system typically limited to traditional providers. San Antonio Metropolitan Health District is one public health agency taking advantage of this new funding opportunity to implement 6 new or expanded programs targeting health issues of highest priority in this south Texas region. This article discusses the use of Medicaid waivers and the advantages and challenges of public health agency participation.

  5. The public health implications of asthma.

    Science.gov (United States)

    Bousquet, Jean; Bousquet, Philippe J; Godard, Philippe; Daures, Jean-Pierre

    2005-07-01

    Asthma is a very common chronic disease that occurs in all age groups and is the focus of various clinical and public health interventions. Both morbidity and mortality from asthma are significant. The number of disability-adjusted life years (DALYs) lost due to asthma worldwide is similar to that for diabetes, liver cirrhosis and schizophrenia. Asthma management plans have, however, reduced mortality and severity in countries where they have been applied. Several barriers reduce the availability, affordability, dissemination and efficacy of optimal asthma management plans in both developed and developing countries. The workplace environment contributes significantly to the general burden of asthma. Patients with occupational asthma have higher rates of hospitalization and mortality than healthy workers. The surveillance of asthma as part of a global WHO programme is essential. The economic cost of asthma is considerable both in terms of direct medical costs (such as hospital admissions and the cost of pharmaceuticals) and indirect medical costs (such as time lost from work and premature death). Direct costs are significant in most countries. In order to reduce costs and improve quality of care, employers and health plans are exploring more precisely targeted ways of controlling rapidly rising health costs. Poor control of asthma symptoms is a major issue that can result in adverse clinical and economic outcomes. A model of asthma costs is needed to aid attempts to reduce them while permitting optimal management of the disease. This paper presents a discussion of the burden of asthma and its socioeconomic implications and proposes a model to predict the costs incurred by the disease.

  6. Six challenges in modelling for public health policy

    Directory of Open Access Journals (Sweden)

    C.J.E. Metcalf

    2015-03-01

    Full Text Available The World Health Organisation's definition of public health refers to all organized measures to prevent disease, promote health, and prolong life among the population as a whole (World Health Organization, 2014. Mathematical modelling plays an increasingly important role in helping to guide the most high impact and cost-effective means of achieving these goals. Public health programmes are usually implemented over a long period of time with broad benefits to many in the community. Clinical trials are seldom large enough to capture these effects. Observational data may be used to evaluate a programme after it is underway, but have limited value in helping to predict the future impact of a proposed policy. Furthermore, public health practitioners are often required to respond to new threats, for which there is little or no previous data on which to assess the threat. Computational and mathematical models can help to assess potential threats and impacts early in the process, and later aid in interpreting data from complex and multifactorial systems. As such, these models can be critical tools in guiding public health action. However, there are a number of challenges in achieving a successful interface between modelling and public health. Here, we discuss some of these challenges.

  7. Public power costs less

    International Nuclear Information System (INIS)

    Moody, D.

    1993-01-01

    The reasons why residential customers of public power utilities paid less for power than private sector customers is discussed. Residential customers of investor-owned utilities (IOU's) paid average rates that were 28% above those paid by customers by possibly owned systems during 1990. The reasons for this disparity are that management costs faced by public power systems are below those of private power companies, indicating a greater efficiency of management among public power systems, and customer accounts expenses averaged $33.00 per customer for publicly owned electric utilities compared to $39.00 per customer for private utilities

  8. Partners in Public Health: Public Health Collaborations With Schools of Pharmacy, 2015.

    Science.gov (United States)

    DiPietro Mager, Natalie A; Ochs, Leslie; Ranelli, Paul L; Kahaleh, Abby A; Lahoz, Monina R; Patel, Radha V; Garza, Oscar W; Isaacs, Diana; Clark, Suzanne

    To collect data on public health collaborations with schools of pharmacy, we sent a short electronic survey to accredited and preaccredited pharmacy programs in 2015. We categorized public health collaborations as working or partnering with local and/or state public health departments, local and/or state public health organizations, academic schools or programs of public health, and other public health collaborations. Of 134 schools, 65 responded (49% response rate). Forty-six (71%) responding institutions indicated collaborations with local and/or state public health departments, 34 (52%) with schools or programs of public health, and 24 (37%) with local and/or state public health organizations. Common themes of collaborations included educational programs, community outreach, research, and teaching in areas such as tobacco control, emergency preparedness, chronic disease, drug abuse, immunizations, and medication therapy management. Interdisciplinary public health collaborations with schools of pharmacy provide additional resources for ensuring the health of communities and expose student pharmacists to opportunities to use their training and abilities to affect public health. Examples of these partnerships may stimulate additional ideas for possible collaborations between public health organizations and schools of pharmacy.

  9. Public Health Services for Foreign Workers in Malaysia.

    Science.gov (United States)

    Noh, Normah Awang; Wahab, Haris Abd; Bakar Ah, Siti Hajar Abu; Islam, M Rezaul

    2016-01-01

    The objective of this study was to know the status of the foreign workers' access to public health services in Malaysia based on their utilization pattern. The utilization pattern covered a number of areas, such as frequency of using health services, status of using health services, choice and types of health institutions, and cost of health treatment. The study was conducted on six government hospitals in the Klang Valley area in Kuala Lumpur, Malaysia. Data were collected from 600 foreign patients working in the country, using an interview method with a structured questionnaire. The results showed that the foreign workers' access to public health services was very low. The findings would be an important guideline to formulate an effective health service policy for the foreign workers in Malaysia.

  10. Periodontal health through public health - the case for oral health promotion

    DEFF Research Database (Denmark)

    Watt, Richard G; Petersen, Poul E

    2012-01-01

    these factors but also must recognize and act upon the distal underlying influences that determine and pattern these identified risks. Recognition also needs to be placed on the interlinking and common risk factors shared by periodontal diseases and other chronic conditions. A complementary range of public......Periodontal diseases are highly prevalent, particularly amongst socially disadvantaged populations, impact on quality of life and are costly to treat. Clinical treatments and chairside preventive approaches alone will never adequately address this problem. Indeed in many parts of the developing...... world clinical care and chairside prevention are both unaffordable and inappropriate for the control of periodontal diseases. A paradigm shift away from the individualized treatment approach to a population public health model is needed to promote periodontal health and, in particular to address social...

  11. Shadow Cost of Public Funds and Privatization Policies

    OpenAIRE

    Sato, Susumu; Matsumura, Toshihiro

    2017-01-01

    We investigate the optimal privatization policy in mixed oligopolies with shadow cost of public funds (excess burden of taxation). The government is concerned with both the total social surplus and the revenue obtained by the privatization of a public firm. We find that the relationship between the shadow cost of public funds and the optimal privatization policy is non-monotone. When the cost is moderate, then higher the cost is, the lower is the optimal degree of privatization. ...

  12. The Cost of Health Service Waste Management of (HSWM: A Case Study of Intensive Care Unit of Infectious Diseases at a Public Hospital in São Paulo.

    Directory of Open Access Journals (Sweden)

    Chennyfer Dobbins Paes da Rosa

    2015-08-01

    Full Text Available The Health Service Waste Management is a set of technical and legal procedures for waste management in any type of health facilities. It is known about the limited resources, so reducing environmental costs can contribute to the management of hospital costs. The objective was to estimate the cost of the phases of HSWM to the Intensive Care Unit for public service. Data collecting was done through a script of questions and observations on site at the Emilio Ribas Infectious Diseases Institute in Sao Paulo. The ABC costing method was used. The most costly step was wrapping (40.68%, followed by segregation (40.17%, which is justified by both being associated with health workers’ salaries. The daily cost of the management of health care waste from segregation to final disposal in the ICU was R$ 4,288.81 a day, being R$ 314.80/bed-patient/day. To know the cost of an activity allows for the analysis of strategies for price negotiation. Health care waste is little remembered when pricing a daily ICU, many managers believe this value to be irrelevant; but< if not measured, it may bring losses to the institution.

  13. WHO global consultation on public health intervention against early childhood caries

    DEFF Research Database (Denmark)

    Phantumvanit, Prathip; Makino, Yuka; Ogawa, Hiroshi

    2018-01-01

    of caries in their primary teeth (usually extractions), and this has considerable cost and social implications. A WHO Global Consultation with oral health experts on "Public Health Intervention against Early Childhood Caries" was held on 26-28 January 2016 in Bangkok (Thailand) to identify public health...... solutions and to highlight their applicability to low- and middle-income countries. After a 3-day consultation, participants agreed on specific recommendations for further action. National health authorities should develop strategies and implement interventions aimed at preventing and controlling ECC......-directed and individual fluoride administration for the prevention and control of ECC is essential. Surveillance and research, including cost-effectiveness studies, should be conducted to evaluate interventions aimed at preventing ECC in different population groups....

  14. Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China.

    Science.gov (United States)

    Zhao, Lue-Ping; Yu, Guo-Pei; Liu, Hui; Ma, Xie-Min; Wang, Jing; Kong, Gui-Lan; Li, Yi; Ma, Wen; Cui, Yong; Xu, Beibei; Yu, Na; Bao, Xiao-Yuan; Guo, Yu; Wang, Fei; Zhang, Jun; Li, Yan; Xie, Xue-Qin; Jiang, Bao-Guo; Ke, Yang

    2013-01-01

    With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS), cost per day (CPD), inpatient mortality rate (IMR), and length of stay (LOS), using a generalized additive model. There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (Phospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role. However, purely market-oriented health-care reform could also misguide future healthcare reform.

  15. Undergraduate Public Health Majors: Why They Choose Public Health or Medicine?

    Science.gov (United States)

    Hilton, Warren

    2013-01-01

    This mixed methods study examined the relationship between the motivations for attending college of undergraduate students with a focus on students with a public health major, and their desire to pursue graduate training in public health and subsequently, public health careers. The study highlighted the current public health workforce shortage and…

  16. Keeping the "public" in schools of public health.

    Science.gov (United States)

    Freudenberg, Nicholas; Klitzman, Susan; Diamond, Catherine; El-Mohandes, Ayman

    2015-03-01

    In this article, we compared the characteristics of public and private accredited public health training programs. We analyzed the distinct opportunities and challenges that publicly funded schools of public health face in preparing the nation's public health workforce. Using our experience in creating a new, collaborative public school of public health in the nation's largest urban public university system, we described efforts to use our public status and mission to develop new approaches to educating a workforce that meets the health needs of our region and contributes to the goal of reducing health inequalities. Finally, we considered policies that could protect and strengthen the distinct contributions that public schools of public health make to improving population health and reducing health inequalities.

  17. Cost Efficiency in Public Higher Education.

    Science.gov (United States)

    Robst, John

    This study used the frontier cost function framework to examine cost efficiency in public higher education. The frontier cost function estimates the minimum predicted cost for producing a given amount of output. Data from the annual Almanac issues of the "Chronicle of Higher Education" were used to calculate state level enrollments at two-year and…

  18. Six challenges in modelling for public health policy.

    Science.gov (United States)

    Metcalf, C J E; Edmunds, W J; Lessler, J

    2015-03-01

    The World Health Organisation's definition of public health refers to all organized measures to prevent disease, promote health, and prolong life among the population as a whole (World Health Organization, 2014). Mathematical modelling plays an increasingly important role in helping to guide the most high impact and cost-effective means of achieving these goals. Public health programmes are usually implemented over a long period of time with broad benefits to many in the community. Clinical trials are seldom large enough to capture these effects. Observational data may be used to evaluate a programme after it is underway, but have limited value in helping to predict the future impact of a proposed policy. Furthermore, public health practitioners are often required to respond to new threats, for which there is little or no previous data on which to assess the threat. Computational and mathematical models can help to assess potential threats and impacts early in the process, and later aid in interpreting data from complex and multifactorial systems. As such, these models can be critical tools in guiding public health action. However, there are a number of challenges in achieving a successful interface between modelling and public health. Here, we discuss some of these challenges. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

  19. Big Data’s Role in Precision Public Health

    Science.gov (United States)

    Dolley, Shawn

    2018-01-01

    Precision public health is an emerging practice to more granularly predict and understand public health risks and customize treatments for more specific and homogeneous subpopulations, often using new data, technologies, and methods. Big data is one element that has consistently helped to achieve these goals, through its ability to deliver to practitioners a volume and variety of structured or unstructured data not previously possible. Big data has enabled more widespread and specific research and trials of stratifying and segmenting populations at risk for a variety of health problems. Examples of success using big data are surveyed in surveillance and signal detection, predicting future risk, targeted interventions, and understanding disease. Using novel big data or big data approaches has risks that remain to be resolved. The continued growth in volume and variety of available data, decreased costs of data capture, and emerging computational methods mean big data success will likely be a required pillar of precision public health into the future. This review article aims to identify the precision public health use cases where big data has added value, identify classes of value that big data may bring, and outline the risks inherent in using big data in precision public health efforts. PMID:29594091

  20. Incremental cost-effectiveness of percutaneous versus surgical closure of atrial septal defects in children under a public health system perspective in Brazil.

    Science.gov (United States)

    Costa, Rodrigo; Pedra, Carlos A C; Ribeiro, Marcelo; Pedra, Simone; Ferreira-Da-Silva, André Luis; Polanczyk, Carisi; Berwanger, Otávio; Biasi, Alexandre; Ribeiro, Rodrigo

    2014-11-01

    Cost-effectiveness (CE) studies of percutaneous (PC) versus surgical (SC) atrial septal defect closure are lacking. A systematic literature review in children and a CE analysis based on a model of long-term outcomes were performed. Direct costs of PC and SC were US$8700 (defined arbitrarily) and US$5700 (actually paid), respectively. Three-times the Brazilian GDI (US$28,700) per year of life saved (with a discount rate of 5%) was used as a limit for willingness-to-pay. PC had a high (US$104,500) incremental CE ratio despite lower complication rates, shorter hospital stay and better (nonsignificant) adjusted life expectancy. PC would be cost-effective if it cost US$6400 or SC had an 8% loss of utility or its indirect costs were US$2250. Costs of PC should be reduced to be cost-effective in the Brazilian public health system. Indirect costs and impact on quality of life should be further assessed.

  1. The Effect of Publicized Quality Information on Home Health Agency Choice.

    Science.gov (United States)

    Jung, Jeah Kyoungrae; Wu, Bingxiao; Kim, Hyunjee; Polsky, Daniel

    2016-12-01

    We examine consumers' use of publicized quality information in Medicare home health care markets, where consumer cost sharing and travel costs are absent. We report two findings. First, agencies with high quality scores are more likely to be preferred by consumers after the introduction of a public reporting program than before. Second, consumers' use of publicized quality information differs by patient group. Community-based patients have slightly larger responses to public reporting than hospital-discharged patients. Patients with functional limitations at the start of their care, at least among hospital-discharged patients, have a larger response to the reported functional outcome measure than those without functional limitations. In all cases of significant marginal effects, magnitudes are small. We conclude that the current public reporting approach is unlikely to have critical impacts on home health agency choice. Identifying and releasing quality information that is meaningful to consumers may help increase consumers' use of public reports. © The Author(s) 2015.

  2. An extended cost-effectiveness analysis of schizophrenia treatment in India under universal public finance.

    Science.gov (United States)

    Raykar, Neha; Nigam, Aditi; Chisholm, Dan

    2016-01-01

    Schizophrenia remains a priority condition in mental health policy and service development because of its early onset, severity and consequences for affected individuals and households. This paper reports on an 'extended' cost-effectiveness analysis (ECEA) for schizophrenia treatment in India, which seeks to evaluate through a modeling approach not only the costs and health effects of intervention but also the consequences of a policy of universal public finance (UPF) on health and financial outcomes across income quintiles. Using plausible values for input parameters, we conclude that health gains from UPF are concentrated among the poorest, whereas the non-health gains in the form of out-of-pocket private expenditures averted due to UPF are concentrated among the richest income quintiles. Value of insurance is the highest for the poorest quintile and declines with income. Universal public finance can play a crucial role in ameliorating the adverse economic and social consequences of schizophrenia and its treatment in resource-constrained settings where health insurance coverage is generally poor. This paper shows the potential distributional and financial risk protection effects of treating schizophrenia.

  3. Evaluating Public Health Interventions: 1. Examples, Definitions, and a Personal Note.

    Science.gov (United States)

    Spiegelman, Donna

    2016-01-01

    In the first contribution to a new section in AJPH that will address critical methodological issues in evaluations of public health interventions, I will discuss topics in study design and analysis, covering the most innovative emerging methodologies and providing an overview of best practices. The methods considered are motivated by public health evaluations, both domestic and global. In this first contribution, I also define implementation science, program evaluation, impact evaluation, and cost-effectiveness research, disciplines that have tremendous methodological and substantive overlap with evaluation of public health interventions--the focus of this section.

  4. Impact of cost sharing on utilization of primary health care Services ...

    African Journals Online (AJOL)

    impact of cost sharing on health-care utilization as viewed from both the providers and beneficiary ... Policy reform for user fees in public health care in poor countries was derived ..... 10,000 (equivalent to US$ 6.25) annually. In return, one gets.

  5. Active and retired public employees' health insurance: potential data sources.

    Science.gov (United States)

    Morrill, Melinda Sandler

    2014-12-01

    Employer-provided health insurance for public sector workers is a significant public policy issue. Underfunding and the growing costs of benefits may hinder the fiscal solvency of state and local governments. Findings from the private sector may not be applicable because many public sector workers are covered by union contracts or salary schedules and often benefit modifications require changes in legislation. Research has been limited by the difficulty in obtaining sufficiently large and representative data on public sector employees. This article highlights data sources researchers might utilize to investigate topics concerning health insurance for active and retired public sector employees. Copyright © 2014 Elsevier B.V. All rights reserved.

  6. Exploring public attitudes towards approaches to discussing costs in the clinical encounter.

    Science.gov (United States)

    Danis, Marion; Sommers, Roseanna; Logan, Jean; Weidmer, Beverly; Chen, Shirley; Goold, Susan; Pearson, Steven; Donley, Greer; McGlynn, Elizabeth

    2014-01-01

    Patients' willingness to discuss costs of treatment alternatives with their physicians is uncertain. To explore public attitudes toward doctor-patient discussions of insurer and out-of-pocket costs and to examine whether several possible communication strategies might enhance patient receptivity to discussing costs with their physicians. Focus group discussions and pre-discussion and post-discussion questionnaires. Two hundred and eleven insured individuals with mean age of 48 years, 51 % female, 34 % African American, 27 % Latino, and 50 % with incomes below 300 % of the federal poverty threshold, participated in 22 focus groups in Santa Monica, CA and in the Washington, DC metro area. Attitudes toward discussing out-of-pocket and insurer costs with physicians, and towards physicians' role in controlling costs; receptivity toward recommended communication strategies regarding costs. Participants expressed more willingness to talk to doctors about personal costs than insurer costs. Older participants and sicker participants were more willing to talk to the doctor about all costs than younger and healthier participants (OR = 1.8, p = 0.004; OR = 1.6, p = 0.027 respectively). Participants who face cost-related barriers to accessing health care were in greater agreement than others that doctors should play a role in reducing out-of-pocket costs (OR = 2.4, p = 0.011). Participants did not endorse recommended communication strategies for discussing costs in the clinical encounter. In contrast, participants stated that trust in one's physician would enhance their willingness to discuss costs. Perceived impediments to discussing costs included rushed, impersonal visits, and clinicians who are insufficiently informed about costs. This study suggests that trusting relationships may be more conducive than any particular discussion strategy to facilitating doctor-patient discussions of health care costs. Better public understanding of how medical

  7. Tobacco litter costs and public policy: a framework and methodology for considering the use of fees to offset abatement costs.

    Science.gov (United States)

    Schneider, John E; Peterson, N Andrew; Kiss, Noemi; Ebeid, Omar; Doyle, Alexis S

    2011-05-01

    Growing concern over the costs, environmental impact and safety of tobacco product litter (TPL) has prompted states and cities to undertake a variety of policy initiatives, of which litter abatement fees are part. The present work describes a framework and methodology for calculating TPL costs and abatement fees. Abatement is associated with four categories of costs: (1) mechanical and manual abatement from streets, sidewalks and public places, (2) mechanical and manual abatement from storm water and sewer treatment systems, (3) the costs associated with harm to the ecosystem and harm to industries dependent on clean and healthy ecosystems, and (4) the costs associated with direct harm to human health. The experiences of the City of San Francisco's recently proposed tobacco litter abatement fee serve as a case study. City and municipal TPL costs are incurred through manual and mechanical clean-up of surfaces and catchment areas. According to some studies, public litter abatement costs to US cities range from US$3 million to US$16 million. TPL typically comprises between 22% and 36% of all visible litter, implying that total public TPL direct abatement costs range from about US$0.5 million to US$6 million for a city the size of San Francisco. The costs of mitigating the negative externalities of TPL in a city the size of San Francisco can be offset by implementing a fee of approximately US$0.20 per pack. Tobacco litter abatement costs to cities can be substantial, even when the costs of potential environmental pollution and tourism effects are excluded. One public policy option to address tobacco litter is levying of fees on cigarettes sold. The methodology described here for calculating TPL costs and abatement fees may be useful to state and local authorities who are considering adoption of this policy initiative.

  8. Impact of quadrivalent influenza vaccine on public health and influenza-related costs in Australia

    Directory of Open Access Journals (Sweden)

    Aurélien Jamotte

    2016-07-01

    Full Text Available Abstract Background Annual trivalent influenza vaccines (TIV containing three influenza strains (A/H1N1, A/H3N2, and one B have been recommended for the prevention of influenza. However, worldwide co-circulation of two distinct B lineages (Victoria and Yamagata and difficulties in predicting which lineage will predominate each season have led to the development of quadrivalent influenza vaccines (QIV, which include both B lineages. Our analysis evaluates the public health benefit and associated influenza-related costs avoided which would have been obtained by using QIV rather than TIV in Australia over the period 2002–2012. Methods A static model stratified by age group was used, focusing on people at increased risk of influenza as defined by the Australian vaccination recommendations. B-lineage cross-protection was accounted for. We calculated the potential impact of QIV compared with TIV over the seasons 2002–2012 (2009 pandemic year excluded using Australian data on influenza circulation, vaccine coverage, hospitalisation and mortality rates as well as unit costs, and international data on vaccine effectiveness, influenza attack rate, GP consultation rate and working days lost. Third-party payer and societal influenza-related costs were estimated in 2014 Australian dollars. Sensitivity analyses were conducted. Results Using QIV instead of TIV over the period 2002–2012 would have prevented an estimated 68,271 additional influenza cases, 47,537 GP consultations, 3,522 hospitalisations and 683 deaths in the population at risk of influenza. These results translate into influenza-related societal costs avoided of $46.5 million. The estimated impact of QIV was higher for young children and the elderly. The overall impact of QIV depended mainly on vaccine effectiveness and the influenza attack rate attributable to the mismatched B lineage. Conclusion The broader protection offered by QIV would have reduced the number of influenza infections

  9. Costs of genetic testing: Supporting Brazilian Public Policies for the incorporating of molecular diagnostic technologies

    Directory of Open Access Journals (Sweden)

    Rosane Paixão Schlatter

    2015-09-01

    Full Text Available This study identifies and describes the operating costs associated with the molecular diagnosis of diseases, such as hereditary cancer. To approximate the costs associated with these tests, data informed by Standard Operating Procedures for various techniques was collected from hospital software and a survey of market prices. Costs were established for four scenarios of capacity utilization to represent the possibility of suboptimal use in research laboratories. Cost description was based on a single site. The results show that only one technique was not impacted by rising costs due to underutilized capacity. Several common techniques were considerably more expensive at 30% capacity, including polymerase chain reaction (180%, microsatellite instability analysis (181%, gene rearrangement analysis by multiplex ligation probe amplification (412%, non-labeled sequencing (173%, and quantitation of nucleic acids (169%. These findings should be relevant for the definition of public policies and suggest that investment of public funds in the establishment of centralized diagnostic research centers would reduce costs to the Public Health System.

  10. Costo-efectividad de prácticas en salud pública: revisión bibliográfica de las intervenciones de la Iniciativa Mesoamericana de Salud Cost-effectiveness of public health practices: A literature review of public health interventions from the Mesoamerican Health Initiative

    Directory of Open Access Journals (Sweden)

    Atanacio Valencia-Mendoza

    2011-01-01

    Full Text Available OBJETIVO: Presentar y analizar información de costo-efectividad de intervenciones propuestas por la Iniciativa Mesoamericana de Salud (IMS en las áreas de nutrición infantil, inmunizaciones, paludismo, dengue y salud materno-infantil y reproductiva. MATERIAL Y MÉTODOS: Se llevó a cabo una revisión sistemática de la literatura de evaluaciones económicas publicadas entre el año 2000 y agosto 2009 sobre intervenciones en las áreas de la salud mencionadas, en los idiomas inglés y español. RESULTADOS: Las intervenciones en nutrición y de salud materno-infantil mostraron ser altamente costo-efectivas (con rangos menores a US$200 por año de vida ajustado por discapacidad [AVAD] evitado para nutrición y US$100 para materno-infantil. En dengue sólo se encontró información sobre la aplicación de larvicidas, cuya razón de costo efectividad estimada fue de US$40.79 a US$345.06 por AVAD evitado. Respecto al paludismo, las intervenciones estudiadas resultaron costo-efectivas (OBJECTIVE: Present and analyze cost-effectiveness information of public health interventions proposed by the Mesoamerican Health Initiative in child nutrition, vaccination, malaria, dengue, and maternal, neonatal, and reproductive health. MATERIAL AND METHODS: A systematic literature review was conducted on cost-effectiveness studies published between January 2000 and August 2009 on interventions related to the health areas previously mentioned. Studies were included if they measured effectiveness in terms of Disability-Adjusted Life Year (DALY or death averted. RESULTS: Child nutrition and maternal and neonatal health interventions were found to be highly cost-effective (most of them below US$200 per DALY averted for nutritional interventions and US$100 for maternal and neonatal health. For dengue, information on cost-effectiveness was found just for application of larvicides, which resulted in a cost per DALY averted ranking from US$40.79 to US$345.06. Malarial

  11. The 2009 Health Confidence Survey: public opinion on health reform varies; strong support for insurance market reform and public plan option, mixed response to tax cap.

    Science.gov (United States)

    Fronstin, Paul; Helman, Ruth

    2009-07-01

    PUBLIC SUPPORT FOR HEALTH REFORM: Findings from the 2009 Health Confidence Survey--the 12th annual HCS--indicate that Americans have already formed strong opinions regarding various aspects of health reform, even before details have been released regarding various key factors. These issues include health insurance market reform, the availability of a public plan option, mandates on employers and individuals, subsidized coverage for the low-income population, changes to the tax treatment of job-based health benefits, and regulatory oversight of health care. These opinions may change as details surface, especially as they concern financing options. In the absence of such details, the 2009 HCS finds generally strong support for the concepts of health reform options that are currently on the table. U.S. HEALTH SYSTEM GETS POOR MARKS, BUT SO DOES A MAJOR OVERHAUL: A majority rate the nation's health care system as fair (30 percent) or poor (29 percent). Only a small minority rate it excellent (6 percent) or very good (10 percent). While 14 percent of Americans think the health care system needs a major overhaul, 51 percent agree with the statement "there are some good things about our health care system, but major changes are needed." NATIONAL HEALTH PLAN ELEMENTS RATED HIGHLY: Between 68 percent and 88 percent of Americans either strongly or somewhat support health reform ideas such as national health plans, a public plan option, guaranteed issue, expansion of Medicare and Medicaid, and employer and individual mandates. MIXED REACTION TO HEALTH BENEFITS TAX CAP: Reaction to capping the current tax exclusion of employment-based health benefits is mixed. Nearly one-half of Americans (47 percent) would switch to a lower-cost plan if the tax exclusion were capped, 38 percent would stay on their current plan and pay the additional taxes, and 9 percent don't know. CONTINUED FAITH IN EMPLOYMENT-BASED BENEFITS, BUT DOUBTS ON AFFORDABILITY: Individuals with employment

  12. The problem of lesser evil within the context of public health

    Directory of Open Access Journals (Sweden)

    Janusz Sytnik-Czetwertyński

    2016-10-01

    Szkoła Zdrowia Publicznego w Warszawie, Poland     Abstract   The issue of public health also includes broad ethical questions. It is here for instance that we find so-called decisions of conscience. Since medical practice is full of moral dilemmas, transferred into the domain of public health, for instance when a doctor decides to provide, in individual cases, costly medical procedures while being simultaneously aware that the funds used for these procedures, could save many more people whose ailments are less costly. These situations force the medical practitioner into making a decision, despite the fact that all the possible choices are morally reprehensible . There exist many moral dilemmas, where the person making the decision cannot find a satisfactory solution, while also being forced to make a decision. Normally, the decision maker then calls upon the category of so-called lesser evil. But this category is no justification – lesser evil is still evil. Which is why it is worth asking what the situation of lesser evil is for the decision maker . What is a moral choice within a public health policy?   Key words: public health, the ethical dilemma, naturalism

  13. Prioritising public health: a qualitative study of decision making to reduce health inequalities

    Directory of Open Access Journals (Sweden)

    O'Flaherty Martin

    2011-10-01

    Full Text Available Abstract Background The public health system in England is currently facing dramatic change. Renewed attention has recently been paid to the best approaches for tackling the health inequalities which remain entrenched within British society and across the globe. In order to consider the opportunities and challenges facing the new public health system in England, we explored the current experiences of those involved in decision making to reduce health inequalities, taking cardiovascular disease (CVD as a case study. Methods We conducted an in-depth qualitative study employing 40 semi-structured interviews and three focus group discussions. Participants were public health policy makers and planners in CVD in the UK, including: Primary Care Trust and Local Authority staff (in various roles; General Practice commissioners; public health academics; consultant cardiologists; national guideline managers; members of guideline development groups, civil servants; and CVD third sector staff. Results The short term target- and outcome-led culture of the NHS and the drive to achieve "more for less", combined with the need to address public demand for acute services often lead to investment in "downstream" public health intervention, rather than the "upstream" approaches that are most effective at reducing inequalities. Despite most public health decision makers wishing to redress this imbalance, they felt constrained due to difficulties in partnership working and the over-riding influence of other stakeholders in decision making processes. The proposed public health reforms in England present an opportunity for public health to move away from the medical paradigm of the NHS. However, they also reveal a reluctance of central government to contribute to shifting social norms. Conclusions It is vital that the effectiveness and cost effectiveness of all new and existing policies and services affecting public health are measured in terms of their impact on the

  14. Prioritising public health: a qualitative study of decision making to reduce health inequalities.

    Science.gov (United States)

    Orton, Lois C; Lloyd-Williams, Ffion; Taylor-Robinson, David C; Moonan, May; O'Flaherty, Martin; Capewell, Simon

    2011-10-20

    The public health system in England is currently facing dramatic change. Renewed attention has recently been paid to the best approaches for tackling the health inequalities which remain entrenched within British society and across the globe. In order to consider the opportunities and challenges facing the new public health system in England, we explored the current experiences of those involved in decision making to reduce health inequalities, taking cardiovascular disease (CVD) as a case study. We conducted an in-depth qualitative study employing 40 semi-structured interviews and three focus group discussions. Participants were public health policy makers and planners in CVD in the UK, including: Primary Care Trust and Local Authority staff (in various roles); General Practice commissioners; public health academics; consultant cardiologists; national guideline managers; members of guideline development groups, civil servants; and CVD third sector staff. The short term target- and outcome-led culture of the NHS and the drive to achieve "more for less", combined with the need to address public demand for acute services often lead to investment in "downstream" public health intervention, rather than the "upstream" approaches that are most effective at reducing inequalities. Despite most public health decision makers wishing to redress this imbalance, they felt constrained due to difficulties in partnership working and the over-riding influence of other stakeholders in decision making processes. The proposed public health reforms in England present an opportunity for public health to move away from the medical paradigm of the NHS. However, they also reveal a reluctance of central government to contribute to shifting social norms. It is vital that the effectiveness and cost effectiveness of all new and existing policies and services affecting public health are measured in terms of their impact on the social determinants of health and health inequalities. Researchers

  15. A cost management model for hospital food and nutrition in a public hospital.

    Science.gov (United States)

    Neriz, Liliana; Núñez, Alicia; Ramis, Francisco

    2014-11-13

    In Chile, the use of costing systems in the public sector is limited. The Ministry of Health requires hospitals to manage themselves with the aim of decentralizing health care services and increasing their quality. However, self-management with a lack of accounting information is almost impossible. On the other hand, nutrition department costs have barely been studied before, and there are no studies specifically for activity based costing (ABC) systems. ABC focuses on the process and traces health care activities to gain a more accurate measurement of the object costs and the financial performance of an organization. This paper uses ABC in a nutrition unit of a public hospital of high complexity to determine costs associated with the different meals for inpatients. The paper also provides an activity based management (ABM) analysis for this unit. The results show positive effects on the reduction of costs for the nutrition department after implementing ABC/ABM. Therefore, there are opportunities to improve the profitability of the area and the results could also be replicated to other areas in the hospital. ABC shed light on the amount of nutritionist time devoted to completing paperwork, and as a result, system changes were introduced to reduce this burden and allow them to focus on more relevant activities. Additional efficiencies were achieved through the elimination of non-value adding activities and automation of reports. ABC reduced the cost of the nutrition department and could produce similar results in other areas of the hospital. This is a practical application of a financial management tool, ABC, which would be useful for hospital managers to reduce costs and improve the management of the unit. This paper takes ABC and examines its use in an area, which has had little exposure to the benefits of this tool.

  16. Long-term socioeconomic consequences and health care costs of childhood and adolescent-onset epilepsy

    DEFF Research Database (Denmark)

    Jennum, Poul; Christensen, Jakob; Ibsen, Rikke

    2016-01-01

    . Income was lower from employment, which in part was compensated by social security, sick pay, disability pension and unemployment benefit, sick pay (public-funded), disability pension, and other public transfers. Predicted health care costs 30 years after epilepsy onset were significantly higher among......Objective: To estimate long-term socioeconomic consequences and health care costs of epilepsy with onset in childhood and adolescence. Methods: A historical prospective cohort study of Danish individuals with epilepsy, age up to 20 years at time of diagnosis between January 1981 and December 2012....... Information about marital status, parenthood, educational level, employment status, income, use of the health care system, and cost of medicine was obtained from nationwide administrative and health registers. Results: We identified 12,756 and 28,319 people with diagnosed with epilepsy, ages 0–5 and 6...

  17. Can naturopathy provide answers to the escalating health care costs in India?

    Directory of Open Access Journals (Sweden)

    Jaya Prasad Tripathy

    2015-04-01

    Full Text Available There are substantial areas of overlap between naturopathy and public health, which include a focus on health rather than disease, a preventive approach, and an emphasis on health promotion and health education. Public health can look to naturopathy for answers to the emergence of chronic disease through natural therapies, many of which can take the role of primordial and primary prevention of several diseases. Some selected naturopathic therapies include nutrition, hydrotherapy, fasting therapy, yoga, behavioral therapy, and health promotion. We must reorient our focus on prevention and wellness to make a true impact on escalating health care costs. With the National Health Policy in India emphasizing the need for integrating the Indian Systems of Medicines with modern medicine, now is the right time for naturopathy and public health to come together to provide a holistic health care system.

  18. The Oregon Public Health Policy Institute: Building Competencies for Public Health Practice

    Science.gov (United States)

    Yoon, Jangho; Bernell, Stephanie; Tynan, Michael; Alvarado, Carla Sarai; Eversole, Tom; Mosbaek, Craig; Beathard, Candice

    2015-01-01

    The Oregon Public Health Policy Institute (PHPI) was designed to enhance public health policy competencies among state and local health department staff. The Oregon Health Authority funded the College of Public Health and Human Sciences at Oregon State University to develop the PHPI curriculum in 2012 and offer it to participants from 4 state public health programs and 5 local health departments in 2013. The curriculum interspersed short instructional sessions on policy development, implementation, and evaluation with longer hands-on team exercises in which participants applied these skills to policy topics their teams had selected. Panel discussions provided insights from legislators and senior Oregon health experts. Participants reported statistically significant increases in public health policy competencies and high satisfaction with PHPI overall. PMID:26066925

  19. [Brazilian bibliographical output on public oral health in public health and dentistry journals].

    Science.gov (United States)

    Celeste, Roger Keller; Warmling, Cristine Maria

    2014-06-01

    The scope of this paper is to describe characteristics of the scientific output in the area of public oral health in journals on public health and dentistry nationwide. The Scopus database of abstracts and quotations was used and eight journals in public health, as well as ten in dentistry, dating from 1947 to 2011 were selected. A research strategy using key words regarding oral health in public health and key words about public health in dentistry was used to locate articles. The themes selected were based on the frequency of key words. Of the total number of articles, 4.7% (n = 642) were found in oral health journals and 6.8% (n = 245) in public health journals. Among the authors who published most, only 12% published in both fields. There was a percentile growth of public oral health publications in dentistry journals, though not in public health journals. In dentistry, only studies indexed as being on the topic of epidemiology showed an increase. In the area of public health, planning was predominant in all the phases studied. Research to evaluate the impact of research and postgraduate policies in scientific production is required.

  20. An analysis of the cost of incomplete abortion to the public health ...

    African Journals Online (AJOL)

    The total estimated cost of treatment for 1994 is the sum ... urban and rural practice settings located in 7 of the 9 ..... likely to be related to the size of hospital and its staff (data .... comprehensive, pro-active strategy on reproductive health.

  1. Refining estimates of public health spending as measured in national health expenditure accounts: the Canadian experience.

    Science.gov (United States)

    Ballinger, Geoff

    2007-01-01

    The recent focus on public health stemming from, among other things, severe acute respiratory syndrome and avian flu has created an imperative to refine health-spending estimates in the Canadian Health Accounts. This article presents the Canadian experience in attempting to address the challenges associated with developing the needed taxonomies for systematically capturing, measuring, and analyzing the national investment in the Canadian public health system. The first phase of this process was completed in 2005, which was a 2-year project to estimate public health spending based on a more classic definition by removing the administration component of the previously combined public health and administration category. Comparing the refined public health estimate with recent data from the Organization for Economic Cooperation and Development still positions Canada with the highest share of total health expenditure devoted to public health than any other country reporting. The article also provides an analysis of the comparability of public health estimates across jurisdictions within Canada as well as a discussion of the recommendations for ongoing improvement of public health spending estimates. The Canadian Institute for Health Information is an independent, not-for-profit organization that provides Canadians with essential statistics and analysis on the performance of the Canadian health system, the delivery of healthcare, and the health status of Canadians. The Canadian Institute for Health Information administers more than 20 databases and registries, including Canada's Health Accounts, which tracks historically 40 categories of health spending by 5 sources of finance for 13 provincial and territorial jurisdictions. Until 2005, expenditure on public health services in the Canadian Health Accounts included measures to prevent the spread of communicable disease, food and drug safety, health inspections, health promotion, community mental health programs, public

  2. Opportunities for Public Relations Research in Public Health.

    Science.gov (United States)

    Wise, Kurt

    2001-01-01

    Considers how communication researchers have developed a solid body of knowledge in the health field but know little about the activities of public relations practitioners in public health bodies. Suggests that public relations scholarship and practice have much to offer the field of public health in helping public health bodies meet their…

  3. What does pritnary health care cost and can we afford to find out?

    African Journals Online (AJOL)

    cost infonnation is a critical management tool for both public and private sector providers. Without ... COSt infonnation is also vital if appropriate user charges are to be levied.2. Effons to generate accurate cost accounting informa- tion are obviously the primary responsibility of health planners and managers, who require this ...

  4. Paternity leave in Sweden: costs, savings and health gains.

    Science.gov (United States)

    Månsdotter, Anna; Lindholm, Lars; Winkvist, Anna

    2007-06-01

    The initial objective is to examine the relationship between paternity leave in 1978-1979 and male mortality during 1981-2001, and the second objective is to calculate the cost-effectiveness of the 1974 parental insurance reform in Sweden. Based on a population of all Swedish couples who had their first child together in 1978 (45,801 males), the risk of death for men who took paternity leave, compared with men who did not, was estimated by odds ratios. The cost-effectiveness analysis considered costs for information, administration and production losses, minus savings due to decreased sickness leave and inpatient care, compared to health gains in life-years and quality-adjusted life-years (QALYs). It is demonstrated that fathers who took paternity leave have a statistically significant decreased death risk of 16%. Costs minus savings (discounted values) stretch from a net cost of EUR 19 million to a net saving of EUR 11 million, and the base case cost-effectiveness is EUR 8000 per QALY. The study indicates that that the right to paternity leave is a desirable reform based on commonly stated public health, economic, and feminist goals. The critical issue in future research should be to examine impact from health-related selection.

  5. Public health impact and cost effectiveness of routine childhood vaccination for hepatitis a in Jordan: a dynamic model approach.

    Science.gov (United States)

    Hayajneh, Wail A; Daniels, Vincent J; James, Cerise K; Kanıbir, Muhammet Nabi; Pilsbury, Matthew; Marks, Morgan; Goveia, Michelle G; Elbasha, Elamin H; Dasbach, Erik; Acosta, Camilo J

    2018-03-07

    As the socioeconomic conditions in Jordan have improved over recent decades the disease and economic burden of Hepatitis A has increased. The purpose of this study is to assess the potential health and economic impact of a two-dose hepatitis A vaccine program covering one-year old children in Jordan. We adapted an age-structured population model of hepatitis A transmission dynamics to project the epidemiologic and economic impact of vaccinating one-year old children for 50 years in Jordan. The epidemiologic model was calibrated using local data on hepatitis A in Jordan. These data included seroprevalence and incidence data from the Jordan Ministry of Health as well as hospitalization data from King Abdullah University Hospital in Irbid, Jordan. We assumed 90% of all children would be vaccinated with the two-dose regimen by two years of age. The economic evaluation adopted a societal perspective and measured benefits using the quality-adjusted life-year (QALY). The modeled vaccination program reduced the incidence of hepatitis A in Jordan by 99%, 50 years after its introduction. The model projected 4.26 million avoided hepatitis A infections, 1.42 million outpatient visits, 22,475 hospitalizations, 508 fulminant cases, 95 liver transplants, and 76 deaths over a 50 year time horizon. In addition, we found, over a 50 year time horizon, the vaccination program would gain 37,502 QALYs and save over $42.6 million in total costs. The vaccination program became cost-saving within 6 years of its introduction and was highly cost-effective during the first 5 years. A vaccination program covering one-year old children is projected to be a cost-saving intervention that will significantly reduce the public health and economic burden of hepatitis A in Jordan.

  6. Cost system design and cost management in the Spanish public sector

    OpenAIRE

    Boned, Josep Lluís; Bagur, Llorenç; Tayles, Mike

    2006-01-01

    Cost systems have been shown to have developed considerably in recent years and activity-based costing (ABC) has been shown to be a contribution to cost management, particularly in service businesses. The public sector is composed to a very great extent of service functions, yet considerably less has been reported of the use of ABC to support cost management in this sector. In Spain, cost systems are essential for city councils as they are obliged to calculate the cost of the services subject...

  7. Solidarity and cost management: Swiss citizens' reasons for priorities regarding health insurance coverage.

    Science.gov (United States)

    Schindler, Mélinée; Danis, Marion; Goold, Susan D; Hurst, Samia A

    2018-04-14

    Approaches to priority-setting for scarce resources have shifted to public deliberation as trade-offs become more difficult. We report results of a qualitative analysis of public deliberation in Switzerland, a country with high health-care costs, an individual health insurance mandate and a strong tradition of direct democracy with frequent votes related to health care. We adapted the Choosing Healthplans All Together (CHAT) tool, an exercise developed to transform complex health-care allocation decisions into easily understandable choices, for use in Switzerland. We conducted focus groups in twelve Swiss cities, recruiting from a range of socio-economic backgrounds in the three language regions. Participants developed strategic arguments based on the importance of basic coverage for all, and of cost-benefit evaluation. They also expressed arguments relying on a principle of solidarity, in particular the importance of protection for vulnerable groups, and on the importance of medical care. They struggled with the place of personal responsibility in coverage decisions. In commenting on the exercise, participants found the degree of consensus despite differing opinions surprising and valuable. The Swiss population is particularly attentive to the costs of health care and means of reducing these costs. Swiss citizens are capable of making trade-offs and setting priorities for complex health issues. © 2018 The Authors Health Expectations published by John Wiley & Sons Ltd.

  8. Quality comparisons between privately and publicly managed health care centres in a suburban area of Stockholm, Sweden.

    Science.gov (United States)

    Hansagi, H; Calltorp, J; Andréasson, S

    1993-03-01

    As in many other countries, the health care system in Sweden is currently undergoing rapid changes. Within a framework of public financing, the delivery of health care is to an increasing extent being transferred to various entrepreneurs; private, public or cooperatives. A privately run, but publicly financed, health care centre was evaluated with regard to quality and costs. Quality was defined in terms of the central guidelines for Swedish primary health care: first level responsibility, accessibility, a holistic view of the patient, and continuity of care and safety. The services offered by the private health care centre were evaluated by different methods--questionnaires, health care utilization data and economic analyses--and found to be of similar quality but produced at a lower cost than by three publicly managed health care centres.

  9. Workplace health promotion in the context of public health

    Directory of Open Access Journals (Sweden)

    Giuseppe M. Masanotti

    2010-12-01

    Full Text Available

    In modern societies, work is the source of most individual, corporate and community wealth. The level of each society’s health is therefore particularly vulnerable to disruption caused by employee illness. Today healthy workplaces are one of the most important determinants of health. However, public health has tended to completely ignore health in the workplace and occupational medicine has tended to ignore it in part. This article refers to the Italian and European context and, through a review of international recommendations, research and direct field experiences, presents workplace health promotion as an important tool in the field of public health.

    Through the years, several initiatives have been tested. One of the platforms that has demonstrated to be cost effective is based on the principles included in the Ottawa Charter which, when applied to the workplace, define workplace health promotion. In the last twelve years, the European Commission has recognized the workplace as a key determinant of health and has outlined a methodology of workplace health promotion as defined in the Luxemburg Declaration. The basis of this methodology is planning. Without correct strategy and policy development it will not be possible to create a sustainable society. The enforcement of Lisbon treaty seems to be a substantial step forward for Europe.

  10. Public health impact and cost effectiveness of mass vaccination with live attenuated human rotavirus vaccine (RIX4414) in India: model based analysis.

    Science.gov (United States)

    Rose, Johnie; Hawthorn, Rachael L; Watts, Brook; Singer, Mendel E

    2009-09-25

    To examine the public health impact of mass vaccination with live attenuated human rotavirus vaccine (RIX4414) in a birth cohort in India, and to estimate the cost effectiveness and affordability of such a programme. Decision analytical Markov model encompassing all direct medical costs. Infection risk and severity depended on age, number of previous infections, and vaccination history; probabilities of use of inpatient and outpatient health services depended on symptom severity. Published clinical, epidemiological, and economic data. When possible, parameter estimates were based on data specific for India. Population Simulated Indian birth cohort followed for five years. Decrease in rotavirus gastroenteritis episodes (non-severe and severe), deaths, outpatient visits, and admission to hospital; incremental cost effectiveness ratio of vaccination expressed as net cost in 2007 rupees per life year saved. In the base case, vaccination prevented 28,943 (29.7%) symptomatic episodes, 6981 (38.2%) severe episodes, 164 deaths (41.0%), 7178 (33.3%) outpatient visits, and 812 (34.3%) admissions to hospital per 100,000 children. Vaccination cost 8023 rupees (about pound100, euro113, $165) per life year saved, less than India's per capita gross domestic product, a common criterion for cost effectiveness. The net programme cost would be equivalent to 11.6% of the 2006-7 budget of the Indian Department of Health and Family Welfare. Model results were most sensitive to variations in access to outpatient care for those with severe symptoms. If this parameter was increased to its upper limit, the incremental cost effectiveness ratio for vaccination still fell between one and three times the per capita gross domestic product, meeting the World Health Organization's criterion for "cost effective" interventions. Uncertainty analysis indicated a 94.7% probability that vaccination would be cost effective according to a criterion of one times per capita gross domestic product per life

  11. Peak Oil, Food Systems, and Public Health

    Science.gov (United States)

    Parker, Cindy L.; Kirschenmann, Frederick L.; Tinch, Jennifer; Lawrence, Robert S.

    2011-01-01

    Peak oil is the phenomenon whereby global oil supplies will peak, then decline, with extraction growing increasingly costly. Today's globalized industrial food system depends on oil for fueling farm machinery, producing pesticides, and transporting goods. Biofuels production links oil prices to food prices. We examined food system vulnerability to rising oil prices and the public health consequences. In the short term, high food prices harm food security and equity. Over time, high prices will force the entire food system to adapt. Strong preparation and advance investment may mitigate the extent of dislocation and hunger. Certain social and policy changes could smooth adaptation; public health has an essential role in promoting a proactive, smart, and equitable transition that increases resilience and enables adequate food for all. PMID:21778492

  12. Ethics in public health research: privacy and public health at risk: public health confidentiality in the digital age.

    Science.gov (United States)

    Myers, Julie; Frieden, Thomas R; Bherwani, Kamal M; Henning, Kelly J

    2008-05-01

    Public health agencies increasingly use electronic means to acquire, use, maintain, and store personal health information. Electronic data formats can improve performance of core public health functions, but potentially threaten privacy because they can be easily duplicated and transmitted to unauthorized people. Although such security breaches do occur, electronic data can be better secured than paper records, because authentication, authorization, auditing, and accountability can be facilitated. Public health professionals should collaborate with law and information technology colleagues to assess possible threats, implement updated policies, train staff, and develop preventive engineering measures to protect information. Tightened physical and electronic controls can prevent misuse of data, minimize the risk of security breaches, and help maintain the reputation and integrity of public health agencies.

  13. Challenges to the census: international trends and a need to consider public health benefits.

    Science.gov (United States)

    Wilson, R T; Hasanali, S H; Sheikh, M; Cramer, S; Weinberg, G; Firth, A; Weiss, S H; Soskolne, C L

    2017-10-01

    The Canadian government decision to cancel the mandatory long-form census in 2010 (subsequently restored in 2015), along with similar discussions in the United Kingdom (UK) and the United States of America (USA), have brought the purpose and use of census data into focus for epidemiologists and public health professionals. Policy decision-makers should be well-versed in the public health importance of accurate and reliable census data for emergency preparedness planning, controlling disease outbreaks, and for addressing health concerns among vulnerable populations including the elderly, low-income, racial/ethnic minorities, and special residential groups (e.g., nursing homes). Valid census information is critical to ensure that policy makers and public health practitioners have the evidence needed to: (1) establish incidence rates, mortality rates, and prevalence for the full characterization of emerging health issues; (2) address disparities in health care, prevention strategies and health outcomes among vulnerable populations; and (3) plan and effectively respond in times of disaster and emergency. At a time when budget and sample size cuts have been implemented in the UK, a voluntary census is being debated in the US. In Canada, elimination of the mandatory long-form census in 2011 resulted in unreliable population enumeration, as well as a substantial waste of money and resources for taxpayers, businesses and communities. The purpose of this article is to provide a brief overview of recent international trends and to review the foundational role of the census in public health management and planning using historical and current examples of environmental contamination, cancer clusters and emerging infections. Citing a general absence of public health applications of the census in cost-benefit analyses, we call on policy makers to consider its application to emergency preparedness, outbreak response, and chronic disease prevention efforts. At the same time, we

  14. Health care and lost productivity costs of overweight and obesity in New Zealand.

    Science.gov (United States)

    Lal, Anita; Moodie, Marj; Ashton, Toni; Siahpush, Mohammad; Swinburn, Boyd

    2012-12-01

    To estimate the costs of health care and lost productivity attributable to overweight and obesity in New Zealand (NZ) in 2006. A prevalence-based approach to costing was used in which costs were calculated for all cases of disease in the year 2006. Population attributable fractions (PAFs) were calculated based on the relative risks obtained from large cohort studies and the prevalence of overweight and obesity. For each disease, the PAF was multiplied by the total health care cost. The costs of lost productivity associated with premature mortality were estimated using both the Human Capital approach (HCA) and Friction Cost approach (FCA). Health care costs attributable to overweight and obesity were estimated to be NZ$686m or 4.5% of New Zealand's total health care expenditure in 2006. The costs of lost productivity using the FCA were estimated to be NZ$98m and NZ$225m using the HCA. The combined costs of health care and lost productivity using the FCA were $784m and $911m using the HCA. The cost burden of overweight and obesity in NZ is considerable. Policies and interventions are urgently needed to reduce the prevalence of obesity thereby decreasing these substantial costs. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

  15. Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China.

    Directory of Open Access Journals (Sweden)

    Lue-Ping Zhao

    Full Text Available BACKGROUND: With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. METHODS: We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS, cost per day (CPD, inpatient mortality rate (IMR, and length of stay (LOS, using a generalized additive model. FINDINGS: There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (P<0.001, from CNY 1,531 in 2006 to CNY 2,169 in 2010. The increasing CPD seemed synchronous with the steady rising of the national annual income per capita. Surgical cost was the main contributor to the temporal change of CPD, while medicine and examination costs tended to be stable over time. From 2006 and 2010, IMR decreased by 36%, while LOS reduced by 25%. Increasing hospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. INTERPRETATIONS: These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role

  16. [Terrorism, public health and health services].

    Science.gov (United States)

    Arcos González, Pedro; Castro Delgado, Rafael; Cuartas Alvarez, Tatiana; Pérez-Berrocal Alonso, Jorge

    2009-01-01

    Today the terrorism is a problem of global distribution and increasing interest for the international public health. The terrorism related violence affects the public health and the health care services in an important way and in different scopes, among them, increase mortality, morbidity and disability, generates a context of fear and anxiety that makes the psychopathological diseases very frequent, seriously alters the operation of the health care services and produces important social, political and economic damages. These effects are, in addition, especially intense when the phenomenon takes place on a chronic way in a community. The objective of this paper is to examine the relation between terrorism and public health, focusing on its effects on public health and the health care services, as well as to examine the possible frames to face the terrorism as a public health concern, with special reference to the situation in Spain. To face this problem, both the public health systems and the health care services, would have to especially adapt their approaches and operational methods in six high-priority areas related to: (1) the coordination between the different health and non health emergency response agencies; (2) the reinforcement of the epidemiological surveillance systems; (3) the improvement of the capacities of the public health laboratories and response emergency care systems to specific types of terrorism as the chemical or biological terrorism; (3) the mental health services; (4) the planning and coordination of the emergency response of the health services; (5) the relations with the population and mass media and, finally; (6) a greater transparency in the diffusion of the information and a greater degree of analysis of the carried out health actions in the scope of the emergency response.

  17. Genetics, health care, and public policy: an introduction to public health genetics

    National Research Council Canada - National Science Library

    Stewart, Alison

    2007-01-01

    ... initiative About this book Further reading and resources Principles of public health The emergence of public health genetics The human genome project and 'genomic medicine' Community genetics Current developments in public health genetics Genomics and global health 2 Genetic science and technology Basic molecular genetics Genes and the geno...

  18. Health Outcomes and Costs of Social Work Services: A Systematic Review.

    Science.gov (United States)

    Steketee, Gail; Ross, Abigail M; Wachman, Madeline K

    2017-12-01

    -based care. Public Health Implications. The economic and health benefits reported in these studies suggest that the broad health perspective taken by the social work profession for patient, personal, and environmental needs may be particularly valuable for achieving goals of cost containment, prevention, and population health. Novel approaches that move beyond cost savings to articulate the specific value-added of social work are much needed. As health service delivery focuses increasingly on interprofessional training, practice, and integrated care, more research testing the impact of social work prevention and intervention efforts on the health and well-being of vulnerable populations while also measuring societal costs and benefits is essential.

  19. Hidden costs of antiretroviral treatment: the public health efficiency of drug packaging.

    Science.gov (United States)

    Andreu-Crespo, Àngels; Llibre, Josep M; Cardona-Peitx, Glòria; Sala-Piñol, Ferran; Clotet, Bonaventura; Bonafont-Pujol, Xavier

    2015-01-01

    While the overall percentage of unused antiretroviral medicines returned to the hospital pharmacy is low, their cost is quite high. Adverse events, treatment failure, pharmacokinetic interactions, pregnancy, or treatment simplification are common reasons for unplanned treatment changes. Socially inefficient antiretroviral packages prevent the reuse of drugs returned to the hospital pharmacy. We defined antiretroviral package categories based on the excellence of drug packaging and analyzed the number of pills and costs of drugs returned during a period of 1 year in a hospital-based HIV unit attending to 2,413 treated individuals. A total of 6,090 pills (34% of all returned antiretrovirals) - with a cost of 47,139.91 € - would be totally lost, mainly due to being packed up in the lowest efficiency packages. Newer treatments are packaged in low-excellence categories of packages, thus favoring the maintenance of these hidden costs in the near future. Therefore, costs of this low-efficiency drug packaging, where medication packages are started but not completed, in high-cost medications are substantial and should be properly addressed. Any improvement in the packaging by the manufacturer, and favoring the choice of drugs supplied through efficient packages (when efficacy, toxicity, and convenience are similar), should minimize the treatment expenditures paid by national health budgets.

  20. Health Services Cost Analyzing in Tabriz Health Centers 2008

    Directory of Open Access Journals (Sweden)

    Massumeh gholizadeh

    2015-08-01

    Full Text Available Background and objectives : Health Services cost analyzing is an important management tool for evidence-based decision making in health system. This study was conducted with the purpose of cost analyzing and identifying the proportion of different factors on total cost of health services that are provided in urban health centers in Tabriz. Material and Methods : This study was a descriptive and analytic study. Activity Based Costing method (ABC was used for cost analyzing. This cross–sectional survey analyzed and identified the proportion of different factors on total cost of health services that are provided in Tabriz urban health centers. The statistical population of this study was comprised of urban community health centers in Tabriz. In this study, a multi-stage sampling method was used to collect data. Excel software was used for data analyzing. The results were described with tables and graphs. Results : The study results showed the portion of different factors in various health services. Human factors by 58%, physical space 8%, medical equipment 1.3% were allocated with high portion of expenditures and costs of health services in Tabriz urban health centers. Conclusion : Based on study results, since the human factors included the highest portion of health services costs and expenditures in Tabriz urban health centers, balancing workload with staff number, institutionalizing performance-based management and using multidisciplinary staffs may lead to reduced costs of services. ​

  1. Towards a public health profession

    DEFF Research Database (Denmark)

    Foldspang, Anders

    2015-01-01

    in the theoretical as well as the practical potential of the public health professional. Thus, he and she must be able to perform, what WHO Europe has developed as Essential Public Health Operations (EPHOs).3 This, in turn, implies that the public health professional possesses the set of intellectual (knowledge...... endorsed by WHO Europe’s member states as the basis for the public health education in Europe.5 The sections of the lists include: Public health methods; Population health and: Its social and economic determinants, and: Its material environmental determinants; Man-made interventions and systems, namely...... Health policy, health economics, organizational theory, health legislation, and public health leadership and management; Health promotion—health education, health protection, disease prevention; public health ethics. This should form the central part of the basis for all public health professionals...

  2. 42 CFR 423.6 - Cost-sharing in beneficiary education and enrollment-related costs.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Cost-sharing in beneficiary education and enrollment-related costs. 423.6 Section 423.6 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... BENEFIT General Provisions § 423.6 Cost-sharing in beneficiary education and enrollment-related costs. The...

  3. Financing and cost-effectiveness analysis of public-private partnerships: provision of tuberculosis treatment in South Africa

    Directory of Open Access Journals (Sweden)

    Kumaranayake Lilani

    2006-06-01

    Full Text Available Abstract Background Public-private partnerships (PPP could be effective in scaling up services. We estimated cost and cost-effectiveness of different PPP arrangements in the provision of tuberculosis (TB treatment, and the financing required for the different models from the perspective of the provincial TB programme, provider, and the patient. Methods Two different models of TB provider partnerships are evaluated, relative to sole public provision: public-private workplace (PWP and public-private non-government (PNP. Cost and effectiveness data were collected at six sites providing directly observed treatment (DOT. Effectiveness for a 12-month cohort of new sputum positive patients was measured using cure and treatment success rates. Provider and patient costs were estimated, and analysed according to sources of financing. Cost-effectiveness is estimated from the perspective of the provider, patient and society in terms of the cost per TB case cured and cost per case successfully treated. Results Cost per case cured was significantly lower in PNP (US $354–446, and comparable between PWP (US $788–979 and public sites (US $700–1000. PPP models could significantly reduce costs to the patient by 64–100%. Relative to pure public sector provision and financing, expansion of PPPs could reduce government financing required per TB patient treated from $609–690 to $130–139 in PNP and $36–46 in PWP. Conclusion There is a strong economic case for expanding PPP in TB treatment and potentially for other types of health services. Where PPPs are tailored to target groups and supported by the public sector, scaling up of effective services could occur at much lower cost than solely relying on public sector models.

  4. [Health impact and treatment costs of community-acquired pneumonia in children in the first level of public attention in Argentina].

    Science.gov (United States)

    Bernztein, Ricardo; Drake, Ignacio

    2009-04-01

    Community acquired pneumonia in children remains an important cause of childhood deaths throughout the world that can be prevented by the use of antibiotics and access to medical care. Both were reduced in 2001 when Argentina suffered a severe social crisis. Among the responses to the crisis, the Remediar Program provided free essential medicines to the socially vulnerable population. Assess the health impact and costs of the provision of free medicines at the first level of public attention for childhood pneumonia. Three designs: 1. Ecological study with cross comparisons of diagnoses, prescriptions, beneficiaries by individual provinces of Remediar forms. children under 15 years old attended at 6 thousand health centres in Argentina, encompassing 24 Argentine provinces from March 2005 until February 2006. 2. Counterfactual approach. 3. Calculation of drug costs per unit of outcome. Over 15 million prescriptions were identified, 2,420 children under 1 year, 19,205 of 1 to 4 years and 15,977 from 5 to 14 years old with pneumonia. 90% of beneficiaries received antibiotics, most often amoxicillin. In children's under 5 years of age, Remediar coverage was 27.8%, with greater impact in the poorest provinces. The likely impact was 4,322 lives saved or 310,325 years of life lost avoided if mortality without antibiotics was 20%. Indigents who had children with pneumonia saved by medicines 14.3% of their income. Each life saved could have cost US $ 6.46 and each year of life lost averted US $ 0.09. This work highlights the impact of a low-cost health program for the treatment of vulnerable populations with childhood pneumonia in Argentina.

  5. Public strategies for improving eHealth integration and long‐term sustainability in public health care systems: Findings from an Italian case study

    Science.gov (United States)

    Nuti, Sabina

    2017-01-01

    Summary eHealth is expected to contribute in tackling challenges for health care systems. However, it also imposes challenges. Financing strategies adopted at national as well regional levels widely affect eHealth long‐term sustainability. In a public health care system, the public actor is among the main “buyers” eHealth. However, public interventions have been increasingly focused on cost containment. How to match these 2 aspects? This article explores some central issues, mainly related to financial aspects, in the development of effective and valuable eHealth strategies in a public health care system: How can the public health care system (as a “buyer”) improve long‐term success and sustainability of eHealth solutions? What levers are available to match in the long period different interests of different stakeholders in the eHealth field? A case study was performed in the Region of Tuscany, Italy. According to our results, win‐win strategies should be followed. Investments should take into account the need to long‐term finance solutions, for sustaining changes in health care organizations for obtaining benefits. To solve the interoperability issues, the concept of the “platform approach” emerged, based on collaboration within and between organizations. Private sector as well as beneficiaries and final users of the eHealth solutions should participate in their design, provision, and monitoring. For creating value for all, the evidence gap and the financial needs could be addressed with a pull mechanism of funding, aimed at paying according to the outcomes produced by the eHealth solution, on the base of an ongoing monitoring, measurement, and evaluation of the outcomes. PMID:28791771

  6. Estimating the Reference Incremental Cost-Effectiveness Ratio for the Australian Health System.

    Science.gov (United States)

    Edney, Laura Catherine; Haji Ali Afzali, Hossein; Cheng, Terence Chai; Karnon, Jonathan

    2018-02-01

    Spending on new healthcare technologies increases net population health when the benefits of a new technology are greater than their opportunity costs-the benefits of the best alternative use of the additional resources required to fund a new technology. The objective of this study was to estimate the expected incremental cost per quality-adjusted life-year (QALY) gained of increased government health expenditure as an empirical estimate of the average opportunity costs of decisions to fund new health technologies. The estimated incremental cost-effectiveness ratio (ICER) is proposed as a reference ICER to inform value-based decision making in Australia. Empirical top-down approaches were used to estimate the QALY effects of government health expenditure with respect to reduced mortality and morbidity. Instrumental variable two-stage least-squares regression was used to estimate the elasticity of mortality-related QALY losses to a marginal change in government health expenditure. Regression analysis of longitudinal survey data representative of the general population was used to isolate the effects of increased government health expenditure on morbidity-related, QALY gains. Clinical judgement informed the duration of health-related quality-of-life improvement from the annual increase in government health expenditure. The base-case reference ICER was estimated at AUD28,033 per QALY gained. Parametric uncertainty associated with the estimation of mortality- and morbidity-related QALYs generated a 95% confidence interval AUD20,758-37,667. Recent public summary documents suggest new technologies with ICERs above AUD40,000 per QALY gained are recommended for public funding. The empirical reference ICER reported in this article suggests more QALYs could be gained if resources were allocated to other forms of health spending.

  7. Health care costs, wages, and aging

    OpenAIRE

    Louise Sheiner

    1999-01-01

    While economists generally agree that workers pay for their health insurance costs through reduced wages, there has been little thought devoted to the level at which these costs are passed on: Is each employee's wage reduced by the amount of his or her own health costs, by the average health costs of employees in the firm, or by some amount in between? This paper analyzes one dimension of the question of how firms pass health costs to workers. Using cross-city variation in health costs, I tes...

  8. Pigs in Public Health

    DEFF Research Database (Denmark)

    Svendsen, Mette N.

    2017-01-01

    of public health, made me re-evaluate both what ‘public’ and what ‘health’ means in public health. In this commentary I provide a short personal account of that intellectual journey. I argue that entanglements between species make it urgent that public health scholars investigate the moral, socio......Animals are rare topics in public health science texts and speech despite the fact that animal bodies and lives are woven into the health of human populations, and vice versa. Years of ethnographic and documentary research – following pigs and their humans in and out of biomedical research – made......-economic, material, and bacterial passages between humans and animals that constitute the various publics of public health and profoundly shape the health of human and animal populations in a globalized world....

  9. Basing care reforms on evidence: the Kenya health sector costing model.

    Science.gov (United States)

    Flessa, Steffen; Moeller, Michael; Ensor, Tim; Hornetz, Klaus

    2011-05-27

    The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap. Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007. The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals. The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health care costs proportionally. Instead

  10. Basing care reforms on evidence: The Kenya health sector costing model

    Science.gov (United States)

    2011-01-01

    Background The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap. Methods Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007. Results The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals. Conclusions The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health

  11. Farmers sun exposure, skin protection and public health campaigns: An Australian perspective.

    Science.gov (United States)

    Smit-Kroner, Christel; Brumby, Susan

    2015-01-01

    Non-melanoma skin cancer is a common and costly cancer in agricultural populations. Prevention and early detection are an effective way to decrease the burden of disease and associated costs. To examine sun exposure and skin protection practices in agricultural workers and farmers a thematic review of the literature between 1983 and 2014 was undertaken. Comparison between studies was complicated by differences in study design, definitions of skin protection, and analytic methods used. Farmers are the most exposed to harmful ultraviolet (UV) radiation of all outdoor workers and the level of reported skin protection by farmers is suboptimal. Years of public health campaigns have failed to adequately address farmers' specific needs. Increased rates of skin cancer and subsequent higher costs are expected. Estimates of sun exposure and skin protection practice indicate that protective clothing is the most promising avenue to improve on farmers' skin protection. Early detection needs to be part of public health campaigns. This review explores the quantitative data about Australian farmers and their skin protective behaviours. We investigate what the documented measurable effect of the public health campaign Slip!Slop!Slap! has had on agricultural workers and farmers and make recommendations for future focus.

  12. Mental health services costs within the Alberta criminal justice system.

    Science.gov (United States)

    Jacobs, Philip; Moffatt, Jessica; Dewa, Carolyn S; Nguyen, Thanh; Zhang, Ting; Lesage, Alain

    2016-01-01

    Mental illness has been widely cited as a driver of costs in the criminal justice system. The objective of this paper is to estimate the additional mental health service costs incurred within the criminal justice system that are incurred because of people with mental illnesses who go through the system. Our focus is on costs in Alberta. We set up a model of the flow of all persons through the criminal justice system, including police, court, and corrections components, and for mental health diversion, review, and forensic services. We estimate the transitional probabilities and costs that accrue as persons who have been charged move through the system. Costs are estimated for the Alberta criminal justice system as a whole, and for the mental illness component. Public expenditures for each person diverted or charged in Alberta in the criminal justice system, including mental health costs, were $16,138. The 95% range of this estimate was from $14,530 to $19,580. Of these costs, 87% were for criminal justice services and 13% were for mental illness-related services. Hospitalization for people with mental illness who were reviewed represented the greatest additional cost associated with mental illnesses. Treatment costs stemming from mental illnesses directly add about 13% onto those in the criminal justice system. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Economics of One Health: Costs and benefits of integrated West Nile virus surveillance in Emilia-Romagna.

    Directory of Open Access Journals (Sweden)

    Giulia Paternoster

    Full Text Available Since 2013 in Emilia-Romagna, Italy, surveillance information generated in the public health and in the animal health sectors has been shared and used to guide public health interventions to mitigate the risk of West Nile virus (WNV transmission via blood transfusion. The objective of the current study was to identify and estimate the costs and benefits associated with this One Health surveillance approach, and to compare it to an approach that does not integrate animal health information in blood donations safety policy (uni-sectoral scenario. Costs of human, animal, and entomological surveillance, sharing of information, and triggered interventions were estimated. Benefits were quantified as the averted costs of potential human cases of WNV neuroinvasive disease associated to infected blood transfusion. In the 2009-2015 period, the One Health approach was estimated to represent a cost saving of €160,921 compared to the uni-sectoral scenario. Blood donation screening was the main cost for both scenarios. The One Health approach further allowed savings of €1.21 million in terms of avoided tests on blood units. Benefits of the One Health approach due to short-term costs of hospitalization and compensation for transfusion-associated disease potentially avoided, were estimated to range from €0 to €2.98 million according to the probability of developing WNV neuroinvasive disease after receiving an infected blood transfusion.

  14. Public health and economic impact of dampness and mold

    Energy Technology Data Exchange (ETDEWEB)

    Mudarri, David; Fisk, William J.

    2007-06-01

    The public health risk and economic impact of dampness and mold exposures was assessed using current asthma as a health endpoint. Individual risk of current asthma from exposure to dampness and mold in homes from Fisk et al. (2007), and asthma risks calculated from additional studies that reported the prevalence of dampness and mold in homes were used to estimate the proportion of U.S. current asthma cases that are attributable to dampness and mold exposure at 21% (95% confidence internal 12-29%). An examination of the literature covering dampness and mold in schools, offices, and institutional buildings, which is summarized in the appendix, suggests that risks from exposure in these buildings are similar to risks from exposures in homes. Of the 21.8 million people reported to have asthma in the U.S., approximately 4.6 (2.7-6.3) million cases are estimated to be attributable to dampness and mold exposure in the home. Estimates of the national cost of asthma from two prior studies were updated to 2004 and used to estimate the economic impact of dampness and mold exposures. By applying the attributable fraction to the updated national annual cost of asthma, the national annual cost of asthma that is attributable to dampness and mold exposure in the home is estimated to be $3.5 billion ($2.1-4.8 billion). Analysis indicates that exposure to dampness and mold in buildings poses significant public health and economic risks in the U.S. These findings are compatible with public policies and programs that help control moisture and mold in buildings.

  15. Retiree Health Insurance for Public School Employees: Does it Affect Retirement?

    Science.gov (United States)

    Fitzpatrick, Maria D.

    2014-01-01

    Despite the widespread provision of retiree health insurance for public sector workers, little attention has been paid to its effects on employee retirement. This is in contrast to the large literature on health-insurance-induced “job-lock” in the private sector. I use the introduction of retiree health insurance for public school employees in combination with administrative data on their retirement to identify the effects of retiree health insurance. As expected, the availability of retiree health insurance for older workers allows employees to retire earlier. These behavioral changes have budgetary implications, likely making the programs self-financing rather than costly to taxpayers. PMID:25479889

  16. Commentary: public disclosure in the health field: is there a relevant option?

    Science.gov (United States)

    Weil, T P

    2001-01-01

    Steadily increasing numbers of private, not-for-profit, and public agencies are releasing quality of care and financial information to enhance the market power of those purchasing America's health services. These sources range widely from the Health Plan Employer Data and Information Set (HEDIS) to the federal Securities and Exchange Commission (SEC). A growing interest in publicly disclosing performance information that concerns providers, as recently recommended by the Institute of Medicine (IOM) report on patient safety, until now has only achieved a modest impact. A major exception is in those metropolitan areas where acute-care facilities experience intense competition for patient admissions. Although the comparative quality and cost information currently available is for the most part in the public interest, it is concluded that, in the foreseeable future, these report cards as now structured will not result in any significant enhancement in access, improvement in quality, or reduction in cost. Options to encourage more public disclosure explored in this paper are Congress potentially passing legislation (a) to establish a Center for Patient Safety within the US Department of Health and Human Services as recommended by the recent Institute of IOM study, or (b) empowering the SEC beyond its current mandate to collect and disseminate all pertinent quality of care and cost information on every provider in the United States. The latter alternative would include user-friendly, comparative analyses to be provided on the Internet and elsewhere and would make readily available information from HEDIS, the Joint Commission on the Accreditation of Healthcare Organization (JCAHO), coronary artery bypass graft (CABG) surgery studies, cost comparisons based on Medicare cost reports and SEC filings, and other similar sources.

  17. Monetary burden of health impacts of air pollution in Mumbai, India: implications for public health policy.

    Science.gov (United States)

    Patankar, A M; Trivedi, P L

    2011-03-01

    Mumbai, a mega city with a population of more than 12 million, is experiencing acute air pollution due to commercial activity, a boom in construction and vehicular traffic. This study was undertaken to investigate the link between air pollution and health impacts for Mumbai, and estimate the monetary burden of these impacts. Cross-sectional data were subjected to logistic regression to analyse the link between air pollution and health impacts, and the cost of illness approach was used to measure the monetary burden of these impacts. Data collected by the Environmental Pollution Research Centre at King Edward Memorial Hospital in Mumbai were analysed using logistic regression to investigate the link between air pollution and morbidity impacts. The monetary burden of morbidity was estimated through the cost of illness approach. For this purpose, information on treatment costs and foregone earnings due to illness was obtained through the household survey and interviews with medical practitioners. Particulate matter (PM(10)) and nitrogen dioxide (NO(2)) emerged as the critical pollutants for a range of health impacts, including symptoms such as cough, breathlessness, wheezing and cold, and illnesses such as allergic rhinitis and chronic obstructive pulmonary disease (COPD). This study developed the concentration-response coefficients for these health impacts. The total monetary burden of these impacts, including personal burden, government expenditure and societal cost, is estimated at 4522.96 million Indian Rupees (INR) or US$ 113.08 million for a 50-μg/m(3) increase in PM(10), and INR 8723.59 million or US$ 218.10 million for a similar increase in NO(2). The estimated monetary burden of health impacts associated with air pollution in Mumbai mainly comprises out-of-pocket expenses of city residents. These expenses form a sizable proportion of the annual income of individuals, particularly those belonging to poor households. These findings have implications for public

  18. Profile of Public Health Leadership.

    Science.gov (United States)

    Little, Ruth Gaskins; Greer, Annette; Clay, Maria; McFadden, Cheryl

    2016-01-01

    Public health leaders play pivotal roles in ensuring the population health for our nation. Since 2000, the number of schools of public health has almost doubled. The scholarly credentials for leaders of public health in academic and practice are important, as they make decisions that shape the future public health workforce and important public health policies. This research brief describes the educational degrees of deans of schools of public health and state health directors, as well as their demographic profiles, providing important information for future public health leadership planning. Data were extracted from a database containing information obtained from multiple Web sites including academic institution Web sites and state government Web sites. Variables describe 2 sets of public health leaders: academic deans of schools of public health and state health directors. Deans of schools of public health were 73% males and 27% females; the PhD degree was held by 40% deans, and the MD degree by 33% deans. Seventy percent of deans obtained their terminal degree more than 35 years ago. State health directors were 60% males and 40% females. Sixty percent of state health directors had an MD degree, 4% a PhD degree, and 26% no terminal degree at all. Sixty-four percent of state health directors received their terminal degree more than 25 years ago. In addition to terminal degrees, 56% of deans and 40% of state health directors held MPH degrees. The findings call into question competencies needed by future public health professionals and leadership and the need to clarify further the level of public health training and degree type that should be required for leadership qualifications in public health.

  19. 42 CFR 417.542 - Reinsurance costs.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Reinsurance costs. 417.542 Section 417.542 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... PLANS Medicare Payment: Cost Basis § 417.542 Reinsurance costs. Reinsurance costs are not allowable. ...

  20. Public Health Departments

    Data.gov (United States)

    Department of Homeland Security — State and Local Public Health Departments in the United States Governmental public health departments are responsible for creating and maintaining conditions that...

  1. [Calculation of workers' health care costs].

    Science.gov (United States)

    Rydlewska-Liszkowska, Izabela

    2006-01-01

    In different health care systems, there are different schemes of organization and principles of financing activities aimed at ensuring the working population health and safety. Regardless of the scheme and the range of health care provided, economists strive for rationalization of costs (including their reduction). This applies to both employers who include workers' health care costs into indirect costs of the market product manufacture and health care institutions, which provide health care services. In practice, new methods of setting costs of workers' health care facilitate regular cost control, acquisition of detailed information about costs, and better adjustment of information to planning and control needs in individual health care institutions. For economic institutions and institutions specialized in workers' health care, a traditional cost-effect calculation focused on setting costs of individual products (services) is useful only if costs are relatively low and the output of simple products is not very high. But when products form aggregates of numerous actions like those involved in occupational medicine services, the method of activity based costing (ABC), representing the process approach, is much more useful. According to this approach costs are attributed to the product according to resources used during different activities involved in its production. The calculation of costs proceeds through allocation of all direct costs for specific processes in a given institution. Indirect costs are settled on the basis of resources used during the implementation of individual tasks involved in the process of making a new product. In this method, so called map of processes/actions consisted in the manufactured product and their interrelations are of particular importance. Advancements in the cost-effect for the management of health care institutions depend on their managerial needs. Current trends in this regard primarily depend on treating all cost reference

  2. Buying Health: The Costs of Commercialization and an Alternative Philosophy

    Directory of Open Access Journals (Sweden)

    Larry Churchill

    2013-01-01

    Full Text Available This paper argues that commercial forces have steadily encroached into our understanding of medicine and health in modern industrial societies. The impact on the delivery of personal medical services and on common ideas about food and nutrition is profound and largely deleterious to public health. A key component of commercialization is reductionism of medical services, health products and nutritional components into small, marketable units. This reductive force makes both medical services and nutritional components more costly and is corrosive to more holistic concepts of health. We compare commercial and holistic approaches to nutrition in detail and offer an alternative philosophy. Adopting this alternative will require sound public policies that rely less on marketing as a distribution system and that enfranchise individuals to be reflective on their use of medical services, their food and nutrition choices, and their larger health needs.

  3. The application of cost-benefit analysis to the radiological protection of the public

    International Nuclear Information System (INIS)

    1980-03-01

    The subject of this document is the quantification of the potential harm caused to the general public by ionising radiation in normal operating circumstances. The object is to enable the health detriment from a practice involving exposure to ionising radiation to be directly compared with the costs of keeping the ensuing doses as low as reasonably achievable. Chapter headings include: development of radiological protection criteria; principles underlying the valuation of harm from radiation exposure; risk evaluation approach to costing of detriment; monetary valuations; distribution of costs and risk in time. Appendices cover the following: cost benefit analysis (principles); recommendations of ICRP on the use of cost benefit analysis; life valuation studies (review); application of cost benefit analysis to the value of the man sievert. (U.K.)

  4. Direct health care costs associated with obesity in Chinese population in 2011.

    Science.gov (United States)

    Shi, Jingcheng; Wang, Yao; Cheng, Wenwei; Shao, Hui; Shi, Lizheng

    2017-03-01

    Overweight and obesity are established major risk factors for type 2 diabetes, and major public health concerns in China. This study aims to assess the economic burden associated with overweight and obesity in the Chinese population ages 45 and older. The Chinese Health and Retirement Longitudinal Study (CHARLS) in 2011 included 13,323 respondents of ages 45 and older living in 450 rural and urban communities across China. Demographic information, height, weight, direct health care costs for outpatient visits, hospitalization, and medications for self-care were extracted from the CHARLS database. Health Care costs were calculated in 2011 Chinese currency. The body mass index (BMI) was used to categorize underweight, normal weight, overweight, and obese populations. Descriptive analyses and a two-part regression model were performed to investigate the association of BMI with health care costs. To account for non-normality of the cost data, we applied a non-parametric bootstrap approach using the percentile method to estimate the 95% confidence intervals (95% CIs). Overweight and obese groups had significantly higher total direct health care costs (RMB 2246.4, RMB 2050.7, respectively) as compared with the normal-weight group (RMB 1886.0). When controlling for demographic characteristics, overweight and obese adults were 15.0% and 35.9% more likely to incur total health care costs, and obese individuals had 14.2% higher total health care costs compared with the normal-weight group. Compared with the normal-weight counterparts, the annual total direct health care costs were significantly higher among obese adults in China. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. The Public Health Innovation Model: Merging Private Sector Processes with Public Health Strengths.

    Science.gov (United States)

    Lister, Cameron; Payne, Hannah; Hanson, Carl L; Barnes, Michael D; Davis, Siena F; Manwaring, Todd

    2017-01-01

    Public health enjoyed a number of successes over the twentieth century. However, public health agencies have arguably been ill equipped to sustain these successes and address the complex threats we face today, including morbidity and mortality associated with persistent chronic diseases and emerging infectious diseases, in the context of flat funding and new and changing health care legislation. Transformational leaders, who are not afraid of taking risks to develop innovative approaches to combat present-day threats, are needed within public health agencies. We propose the Public Health Innovation Model (PHIM) as a tool for public health leaders who wish to integrate innovation into public health practice. This model merges traditional public health program planning models with innovation principles adapted from the private sector, including design thinking, seeking funding from private sector entities, and more strongly emphasizing program outcomes. We also discuss principles that leaders should consider adopting when transitioning to the PHIM, including cross-collaboration, community buy-in, human-centered assessment, autonomy and creativity, rapid experimentation and prototyping, and accountability to outcomes.

  6. The Public Health Innovation Model: Merging Private Sector Processes with Public Health Strengths

    Directory of Open Access Journals (Sweden)

    Cameron Lister

    2017-08-01

    Full Text Available Public health enjoyed a number of successes over the twentieth century. However, public health agencies have arguably been ill equipped to sustain these successes and address the complex threats we face today, including morbidity and mortality associated with persistent chronic diseases and emerging infectious diseases, in the context of flat funding and new and changing health care legislation. Transformational leaders, who are not afraid of taking risks to develop innovative approaches to combat present-day threats, are needed within public health agencies. We propose the Public Health Innovation Model (PHIM as a tool for public health leaders who wish to integrate innovation into public health practice. This model merges traditional public health program planning models with innovation principles adapted from the private sector, including design thinking, seeking funding from private sector entities, and more strongly emphasizing program outcomes. We also discuss principles that leaders should consider adopting when transitioning to the PHIM, including cross-collaboration, community buy-in, human-centered assessment, autonomy and creativity, rapid experimentation and prototyping, and accountability to outcomes.

  7. WHO Global Consultation on Public Health Intervention against Early Childhood Caries.

    Science.gov (United States)

    Phantumvanit, Prathip; Makino, Yuka; Ogawa, Hiroshi; Rugg-Gunn, Andrew; Moynihan, Paula; Petersen, Poul Erik; Evans, Wendell; Feldens, Carlos Alberto; Lo, Edward; Khoshnevisan, Mohammad H; Baez, Ramon; Varenne, Benoit; Vichayanrat, Tippanart; Songpaisan, Yupin; Woodward, Margaret; Nakornchai, Siriruk; Ungchusak, Chantana

    2018-01-30

    Early Childhood Caries (ECC) is prevalent around the world, but in particular the disease is growing rapidly in low- and middle-income countries in parallel with changing diet and lifestyles. In many countries, ECC is often left untreated, a condition which leads to pain and adversely affects general health, growth and development, and quality of life of children, their families and their communities. Importantly, ECC is also a global public health burden, medically, socially and economically. In many countries, a substantial number of children require general anaesthesia for the treatment of caries in their primary teeth (usually extractions), and this has considerable cost and social implications. A WHO Global Consultation with oral health experts on "Public Health Intervention against Early Childhood Caries" was held on 26-28 January 2016 in Bangkok (Thailand) to identify public health solutions and to highlight their applicability to low- and middle-income countries. After a 3-day consultation, participants agreed on specific recommendations for further action. National health authorities should develop strategies and implement interventions aimed at preventing and controlling ECC. These should align with existing international initiatives such as the Sixtieth World Health Assembly Resolution WHA 60.17 Oral health: action plan for promotion and integrated disease prevention, WHO Guideline on Sugars and WHO breastfeeding recommendation. ECC prevention and control interventions should be integrated into existing primary healthcare systems. WHO public health principles must be considered when tackling the effect of social determinants in ECC. Initiatives aimed at modifying behaviour should focus on families and communities. The involvement of communities in health promotion, and population-directed and individual fluoride administration for the prevention and control of ECC is essential. Surveillance and research, including cost-effectiveness studies, should be

  8. Melanoma screening: Informing public health policy with quantitative modelling.

    Directory of Open Access Journals (Sweden)

    Stephen Gilmore

    Full Text Available Australia and New Zealand share the highest incidence rates of melanoma worldwide. Despite the substantial increase in public and physician awareness of melanoma in Australia over the last 30 years-as a result of the introduction of publicly funded mass media campaigns that began in the early 1980s -mortality has steadily increased during this period. This increased mortality has led investigators to question the relative merits of primary versus secondary prevention; that is, sensible sun exposure practices versus early detection. Increased melanoma vigilance on the part of the public and among physicians has resulted in large increases in public health expenditure, primarily from screening costs and increased rates of office surgery. Has this attempt at secondary prevention been effective? Unfortunately epidemiologic studies addressing the causal relationship between the level of secondary prevention and mortality are prohibitively difficult to implement-it is currently unknown whether increased melanoma surveillance reduces mortality, and if so, whether such an approach is cost-effective. Here I address the issue of secondary prevention of melanoma with respect to incidence and mortality (and cost per life saved by developing a Markov model of melanoma epidemiology based on Australian incidence and mortality data. The advantages of developing a methodology that can determine constraint-based surveillance outcomes are twofold: first, it can address the issue of effectiveness; and second, it can quantify the trade-off between cost and utilisation of medical resources on one hand, and reduced morbidity and lives saved on the other. With respect to melanoma, implementing the model facilitates the quantitative determination of the relative effectiveness and trade-offs associated with different levels of secondary and tertiary prevention, both retrospectively and prospectively. For example, I show that the surveillance enhancement that began in

  9. Feminism and public health nursing: partners for health.

    Science.gov (United States)

    Leipert, B D

    2001-01-01

    It is a well-known fact that nursing and feminism have enjoyed an uneasy alliance. In recent years, however, nursing has begun to recognize the importance of feminism. Nevertheless, the literature still rarely addresses the relevance of feminism for public health nursing. In this article, I articulate the relevance of feminism for public health nursing knowledge and practice. First, I define and describe feminism and public health nursing and then I discuss the importance of feminism for public health nursing practice. The importance of feminism for the metaparadigm concepts of public health nursing is then reviewed. Finally, I examine several existing challenges relating to feminism and public health nursing research, education, and practice. The thesis of this article is that feminism is vitally important for the development of public health nursing and for public health care.

  10. Public financing of the Medicare program will make its uniform structure increasingly costly to sustain.

    Science.gov (United States)

    Baicker, Katherine; Shepard, Mark; Skinner, Jonathan

    2013-05-01

    The US Medicare program consumes an ever-rising share of the federal budget. Although this public spending can produce health and social benefits, raising taxes to finance it comes at the cost of slower economic growth. In this article we describe a model incorporating the benefits of public programs and the cost of tax financing. The model implies that the "one-size-fits-all" Medicare program, with everyone covered by the same insurance policy, will be increasingly difficult to sustain. We show that a Medicare program with guaranteed basic benefits and the option to purchase additional coverage could lead to more unequal health spending but slower growth in taxation, greater overall well-being, and more rapid growth of gross domestic product. Our framework highlights the key trade-offs between Medicare spending and economic prosperity.

  11. Cost Savings From the Provision of Specific Methods of Contraception in a Publicly Funded Program

    Science.gov (United States)

    Rostovtseva, Daria P.; Brindis, Claire D.; Biggs, M. Antonia; Hulett, Denis; Darney, Philip D.

    2009-01-01

    Objectives. We examined the cost-effectiveness of contraceptive methods dispensed in 2003 to 955 000 women in Family PACT (Planning, Access, Care and Treatment), California's publicly funded family planning program. Methods. We estimated the number of pregnancies averted by each contraceptive method and compared the cost of providing each method with the savings from averted pregnancies. Results. More than half of the 178 000 averted pregnancies were attributable to oral contraceptives, one fifth to injectable methods, and one tenth each to the patch and barrier methods. The implant and intrauterine contraceptives were the most cost-effective, with cost savings of more than $7.00 for every $1.00 spent in services and supplies. Per $1.00 spent, injectable contraceptives yielded savings of $5.60; oral contraceptives, $4.07; the patch, $2.99; the vaginal ring, $2.55; barrier methods, $1.34; and emergency contraceptives, $1.43. Conclusions. All contraceptive methods were cost-effective—they saved more in public expenditures for unintended pregnancies than they cost to provide. Because no single method is clinically recommended to every woman, it is medically and fiscally advisable for public health programs to offer all contraceptive methods. PMID:18703437

  12. Universal public finance of tuberculosis treatment in India: an extended cost-effectiveness analysis.

    Science.gov (United States)

    Verguet, Stéphane; Laxminarayan, Ramanan; Jamison, Dean T

    2015-03-01

    Universal public finance (UPF)-government financing of an intervention irrespective of who is receiving it-for a health intervention entails consequences in multiple domains. First, UPF increases intervention uptake and hence the extent of consequent health gains. Second, UPF generates financial consequences including the crowding out of private expenditures. Finally, UPF provides insurance either by covering catastrophic expenditures, which would otherwise throw households into poverty or by preventing diseases that cause them. This paper develops a method-extended cost-effectiveness analysis (ECEA)-for evaluating the consequences of UPF in each of these domains. It then illustrates ECEA with an evaluation of UPF for tuberculosis treatment in India. Using plausible values for key parameters, our base case ECEA concludes that the health gains and insurance value of UPF would accrue primarily to the poor. Reductions in out-of-pocket expenditures are more uniformly distributed across income quintiles. A variant on our base case suggests that lowering costs of borrowing for the poor could potentially achieve some of the health gains of UPF, but at the cost of leaving the poor more deeply in debt. © 2014 The Authors. Health Economics published by John Wiley Ltd.

  13. Moche CAPE Formula: Cost Analysis of Public Education.

    Science.gov (United States)

    Moche, Joanne Spiers

    The Moche Cost Analysis of Public Education (CAPE) formula was developed to identify total and per pupil costs of regular elementary education, regular secondary education, elementary special education, and secondary special education. Costs are analyzed across five components: (1) comprehensive costs (including transportation and supplemental…

  14. Opportunity costs and local health service spending decisions: a qualitative study from Wales.

    Science.gov (United States)

    Karlsberg Schaffer, Sarah; Sussex, Jon; Hughes, Dyfrig; Devlin, Nancy

    2016-03-25

    All health care systems face the need to find the resources to meet new demands such as a new, cost-increasing health technology. In England and Wales, when a health technology is recommended by the National Institute for Health and Care Excellence (NICE), the National Health Service (NHS) is mandated to provide the funding to accommodate it within three months of publication of the recommendation. Identifying what, in practice, is foregone when new cost-increasing technologies are introduced is important for understanding the effects of health technology assessment (HTA) decisions on the NHS or any other health care system. Our objective was to investigate how in practice local NHS commissioners in Wales accommodated financial "shocks" arising from technology appraisals (TAs) issued by NICE and from other cost pressures. Semi-structured interviews were conducted with Finance Directors and Medical Directors from all seven Local Health Boards (LHBs) in NHS Wales. These interviews covered prioritisation processes, as well as methods of financing NICE TAs and other financial shocks at each LHB. We then undertook a systematic identification of themes and topics from the information recorded. The study relates to the period October 2010 to March 2013. The financial impact of NICE TAs is generally anticipated and planned for in advance and the majority of LHBs have contingency funds available to cope with these and other financial shocks within-period. Efficiency savings (defined as reductions in costs with no assumed reductions in quality) were a source of funds for cost pressures of all kinds. Service displacements were not linkable to particular NICE TAs and there appears to be a general lack of explicit prioritisation activities. The Welsh Government has, on occasion, explicitly or implicitly acted as the funder of last resort. Services may be displaced as part of a response to the cumulative impact of all types of cost pressures, including cost-increasing health

  15. Digital age and the public eHealth perspective: Prevailing health app use among Austrian Internet users.

    Science.gov (United States)

    Naszay, Marlene; Stockinger, Andreas; Jungwirth, David; Haluza, Daniela

    2017-12-19

    New technological developments affect almost every sector of our daily lives including the healthcare sector. Successful adoption and sustainable integration of eHealth and telemedicine in Public Health strategies (also known as Public eHealth) depend on knowledge and constant evaluation of consumers' needs, proficiencies, and preferences. We therefore assessed how the general Austrian population perceived innovative Public eHealth solutions. The online survey on 562 Austrian adults (58.9% females) collected self-reported data on current and expected use of smartphone-based health applications (apps) of digital natives (35 years and younger) and digital immigrants (aged 35+). In total, 26.7% (95% CI 23.0-30.4) of participants already used health apps, especially lifestyle-associated apps for monitoring exercise habits and nutritional habits. We found substantial digital age group differences; compared to digital immigrants digital natives were more likely to use mobile devices and health apps. Health apps have the potential to improve community health and prevent lifestyle diseases cost-effectively and efficiently, and thus build an important pillar of Public eHealth. With regard to aging societies, healthcare providers could take advantage of consumer-oriented health apps by assessing individual needs of specific target groups such as elderly people.

  16. Mobile health in China: a review of research and programs in medical care, health education, and public health.

    Science.gov (United States)

    Corpman, David W

    2013-01-01

    There are nearly 1 billion mobile phone subscribers in China. Health care providers, telecommunications companies, technology firms, and Chinese governmental organizations use existing mobile technology and social networks to improve patient-provider communication, promote health education and awareness, add efficiency to administrative practices, and enhance public health campaigns. This review of mobile health in China summarizes existing clinical research and public health text messaging campaigns while highlighting potential future areas of research and program implementation. Databases and search engines served as the primary means of gathering relevant resources. Included material largely consists of scientific articles and official reports that met predefined inclusion criteria. This review includes 10 reports of controlled studies that assessed the use of mobile technology in health care settings and 17 official reports of public health awareness campaigns that used text messaging. All source material was published between 2006 and 2011. The controlled studies suggested that mobile technology interventions significantly improved an array of health care outcomes. However, additional efforts are needed to refine mobile health research and better understand the applicability of mobile technology in China's health care settings. A vast potential exists for the expansion of mobile health in China, especially as costs decrease and increasingly sophisticated technology becomes more widespread.

  17. Health Outcomes and Costs of Social Work Services: A Systematic Review

    Science.gov (United States)

    Ross, Abigail M.; Wachman, Madeline K.

    2017-01-01

    examine the health and cost effects of specific services delivered by social workers independently and through interprofessional team-based care. Public Health Implications. The economic and health benefits reported in these studies suggest that the broad health perspective taken by the social work profession for patient, personal, and environmental needs may be particularly valuable for achieving goals of cost containment, prevention, and population health. Novel approaches that move beyond cost savings to articulate the specific value-added of social work are much needed. As health service delivery focuses increasingly on interprofessional training, practice, and integrated care, more research testing the impact of social work prevention and intervention efforts on the health and well-being of vulnerable populations while also measuring societal costs and benefits is essential. PMID:29236534

  18. The next public health revolution: public health information fusion and social networks.

    Science.gov (United States)

    Khan, Ali S; Fleischauer, Aaron; Casani, Julie; Groseclose, Samuel L

    2010-07-01

    Social, political, and economic disruptions caused by natural and human-caused public health emergencies have catalyzed public health efforts to expand the scope of biosurveillance and increase the timeliness, quality, and comprehensiveness of disease detection, alerting, response, and prediction. Unfortunately, efforts to acquire, render, and visualize the diversity of health intelligence information are hindered by its wide distribution across disparate fields, multiple levels of government, and the complex interagency environment. Achieving this new level of situation awareness within public health will require a fundamental cultural shift in methods of acquiring, analyzing, and disseminating information. The notion of information "fusion" may provide opportunities to expand data access, analysis, and information exchange to better inform public health action.

  19. Feminism and public health ethics.

    Science.gov (United States)

    Rogers, W A

    2006-06-01

    This paper sketches an account of public health ethics drawing upon established scholarship in feminist ethics. Health inequities are one of the central problems in public health ethics; a feminist approach leads us to examine not only the connections between gender, disadvantage, and health, but also the distribution of power in the processes of public health, from policy making through to programme delivery. The complexity of public health demands investigation using multiple perspectives and an attention to detail that is capable of identifying the health issues that are important to women, and investigating ways to address these issues. Finally, a feminist account of public health ethics embraces rather than avoids the inescapable political dimensions of public health.

  20. Public health and Plowshare

    Energy Technology Data Exchange (ETDEWEB)

    Terrill, Jr, J G [Consumer Protection and Environmental Health Service, U.S. PubIic Health Service, Washington, DC (United States)

    1969-07-01

    The protection of public health and safety is a principal area of concern in any application of nuclear energy. A health and safety analysis must be conducted and reviewed by appropriate agencies and the final results made available to interested agencies and groups, both public and private, prior to the application. This is especially important for the Plowshare Program - the peaceful uses of nuclear explosives - where the public is to be the ultimate beneficiary. Because public health must be a primary concern in the Plowshare Program, it is essential that the potential risk be weighed against the expected benefits to the public. Public health agencies must play an increasingly important role in the planning and operational stages of the peaceful applications of nuclear explosives and in the final stage of consumer use of Plowshare-generated products. There are many long term and long distance ramifications of the Plowshare Program, such a the potential radiological contamination of consumer products that may reach the consumer at long times after the event or at great distances from the site of the event. Criteria for evaluating public exposure to radiation from these products need to be developed based on sound scientific research. Standards for radioactivity in consumer products must be developed in relation to potential exposure of the public. Above all, a clear benefit to the public with a minimum of risk must be shown. The major purpose of this Symposium on the Public Health Aspects of Peaceful Uses of Nuclear-Explosives is to focus attention on the health and safety aspects, present the results of safety analyses accomplished to date and other information necessary to an understanding of the public health aspects, and to identify areas where additional research is required. A general overview of the total symposium content is presented with emphasis on the relationship of the topics to public health. (author)

  1. Public health and Plowshare

    International Nuclear Information System (INIS)

    Terrill, J.G. Jr.

    1969-01-01

    The protection of public health and safety is a principal area of concern in any application of nuclear energy. A health and safety analysis must be conducted and reviewed by appropriate agencies and the final results made available to interested agencies and groups, both public and private, prior to the application. This is especially important for the Plowshare Program - the peaceful uses of nuclear explosives - where the public is to be the ultimate beneficiary. Because public health must be a primary concern in the Plowshare Program, it is essential that the potential risk be weighed against the expected benefits to the public. Public health agencies must play an increasingly important role in the planning and operational stages of the peaceful applications of nuclear explosives and in the final stage of consumer use of Plowshare-generated products. There are many long term and long distance ramifications of the Plowshare Program, such a the potential radiological contamination of consumer products that may reach the consumer at long times after the event or at great distances from the site of the event. Criteria for evaluating public exposure to radiation from these products need to be developed based on sound scientific research. Standards for radioactivity in consumer products must be developed in relation to potential exposure of the public. Above all, a clear benefit to the public with a minimum of risk must be shown. The major purpose of this Symposium on the Public Health Aspects of Peaceful Uses of Nuclear-Explosives is to focus attention on the health and safety aspects, present the results of safety analyses accomplished to date and other information necessary to an understanding of the public health aspects, and to identify areas where additional research is required. A general overview of the total symposium content is presented with emphasis on the relationship of the topics to public health. (author)

  2. Multimorbidity in chronic disease: impact on health care resources and costs

    Directory of Open Access Journals (Sweden)

    McPhail SM

    2016-07-01

    Full Text Available Steven M McPhail1,2 1Centre for Functioning and Health Research, Metro South Health, 2Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia Abstract: Effective and resource-efficient long-term management of multimorbidity is one of the greatest health-related challenges facing patients, health professionals, and society more broadly. The purpose of this review was to provide a synthesis of literature examining multimorbidity and resource utilization, including implications for cost-effectiveness estimates and resource allocation decision making. In summary, previous literature has reported substantially greater, near exponential, increases in health care costs and resource utilization when additional chronic comorbid conditions are present. Increased health care costs have been linked to elevated rates of primary care and specialist physician occasions of service, medication use, emergency department presentations, and hospital admissions (both frequency of admissions and bed days occupied. There is currently a paucity of cost-effectiveness information for chronic disease interventions originating from patient samples with multimorbidity. The scarcity of robust economic evaluations in the field represents a considerable challenge for resource allocation decision making intended to reduce the burden of multimorbidity in resource-constrained health care systems. Nonetheless, the few cost-effectiveness studies that are available provide valuable insight into the potential positive and cost-effective impact that interventions may have among patients with multiple comorbidities. These studies also highlight some of the pragmatic and methodological challenges underlying the conduct of economic evaluations among people who may have advanced age, frailty, and disadvantageous socioeconomic circumstances, and where long-term follow-up may be required to

  3. Cost-Effectiveness Thresholds in Global Health: Taking a Multisectoral Perspective.

    Science.gov (United States)

    Remme, Michelle; Martinez-Alvarez, Melisa; Vassall, Anna

    2017-04-01

    Good health is a function of a range of biological, environmental, behavioral, and social factors. The consumption of quality health care services is therefore only a part of how good health is produced. Although few would argue with this, the economic framework used to allocate resources to optimize population health is applied in a way that constrains the analyst and the decision maker to health care services. This approach risks missing two critical issues: 1) multiple sectors contribute to health gain and 2) the goods and services produced by the health sector can have multiple benefits besides health. We illustrate how present cost-effectiveness thresholds could result in health losses, particularly when considering health-producing interventions in other sectors or public health interventions with multisectoral outcomes. We then propose a potentially more optimal second best approach, the so-called cofinancing approach, in which the health payer could redistribute part of its budget to other sectors, where specific nonhealth interventions achieved a health gain more efficiently than the health sector's marginal productivity (opportunity cost). Likewise, other sectors would determine how much to contribute toward such an intervention, given the current marginal productivity of their budgets. Further research is certainly required to test and validate different measurement approaches and to assess the efficiency gains from cofinancing after deducting the transaction costs that would come with such cross-sectoral coordination. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  4. Gambling and the Health of the Public: Adopting a Public Health Perspective.

    Science.gov (United States)

    Korn, David A.; Shaffer, Howard J.

    1999-01-01

    During the last decade there has been an unprecedented expansion of legalized gambling throughout North America. Three primary forces appear to be motivating this growth: (1) the desire of governments to identify new sources of revenue without invoking new or higher taxes; (2) tourism entrepreneurs developing new destinations for entertainment and leisure; and (3) the rise of new technologies and forms of gambling (e.g., video lottery terminals, powerball mega-lotteries, and computer offshore gambling). Associated with this phenomenon, there has been an increase in the prevalence of problem and pathological gambling among the general adult population, as well as a sustained high level of gambling-related problems among youth. To date there has been little dialogue within the public health sector in particular, or among health care practitioners in general, about the potential health impact of gambling or gambling-related problems. This article encourages the adoption of a public health perspective towards gambling. More specifically, this discussion has four primary objectives:1. Create awareness among health professionals about gambling, its rapid expansion and its relationship with the health care system;2. Place gambling within a public health framework by examining it from several perspectives, including population health, human ecology and addictive behaviors;3. Outline the major public health issues about how gambling can affect individuals, families and communities;4. Propose an agenda for strengthening policy, prevention and treatment practices through greater public health involvement, using the framework of The Ottawa Charter for Health Promotion as a guide.By understanding gambling and its potential impacts on the public's health, policy makers and health practitioners can minimize gambling's negative impacts and appreciate its potential benefits.

  5. The cost of health professionals' brain drain in Kenya

    Directory of Open Access Journals (Sweden)

    Gbary Akpa

    2006-07-01

    Full Text Available Abstract Background Past attempts to estimate the cost of migration were limited to education costs only and did not include the lost returns from investment. The objectives of this study were: (i to estimate the financial cost of emigration of Kenyan doctors to the United Kingdom (UK and the United States of America (USA; (ii to estimate the financial cost of emigration of nurses to seven OECD countries (Canada, Denmark, Finland, Ireland, Portugal, UK, USA; and (iii to describe other losses from brain drain. Methods The costs of primary, secondary, medical and nursing schools were estimated in 2005. The cost information used in this study was obtained from one non-profit primary and secondary school and one public university in Kenya. The cost estimates represent unsubsidized cost. The loss incurred by Kenya through emigration was obtained by compounding the cost of educating a medical doctor and a nurse over the period between the average age of emigration (30 years and the age of retirement (62 years in recipient countries. Results The total cost of educating a single medical doctor from primary school to university is US$ 65,997; and for every doctor who emigrates, a country loses about US$ 517,931 worth of returns from investment. The total cost of educating one nurse from primary school to college of health sciences is US$ 43,180; and for every nurse that emigrates, a country loses about US$ 338,868 worth of returns from investment. Conclusion Developed countries continue to deprive Kenya of millions of dollars worth of investments embodied in her human resources for health. If the current trend of poaching of scarce human resources for health (and other professionals from Kenya is not curtailed, the chances of achieving the Millennium Development Goals would remain bleak. Such continued plunder of investments embodied in human resources contributes to further underdevelopment of Kenya and to keeping a majority of her people in the vicious

  6. Integration of health care organizations: using the power strategies of horizontal and vertical integration in public and private health systems.

    Science.gov (United States)

    Thaldorf, Carey; Liberman, Aaron

    2007-01-01

    Integration in health care attempts to provide all elements in a seamless continuum of care. Pressures influencing development of system-wide integration primarily come from unsustainable cost increases in the United States over the later part of the 20th century and the early 21st century. Promoters of health care integration assume that it will lead to increased effectiveness and quality of care while concurrently increasing cost-effectiveness and possibly facilitating cost savings. The primary focus of this literature review is on the Power Strategies of Horizontal and Vertical Integration. The material presented suggests that vertical integration is most effective in markets where the partners involved are larger and dominant in the regions they serve. The research has also found that integrating health care networks had little or no significant effect on improving overall organizational efficiencies or profits. Capital investment in information technologies still is cost prohibitive and outweighs its benefits to integration efficiencies in the private sector; however, there are some indications of improvements in publicly provided health care. Further research is needed to understand the reasons the public sector has had greater success in improving effectiveness and efficiency through integration than the private sector.

  7. THE BUSINESS OF WELLNESS: THE HEALTH INSURANCE INDUSTRY’S RESPONSE TO PUBLIC HEALTH CAMPAIGNS, 1960-1990

    Directory of Open Access Journals (Sweden)

    Christiane Diehl-Taylor

    1999-01-01

    Full Text Available This paper examines the health insurance industry’s response to the welliness movement between 1960 and 1990. Based primarily on insurance and personnel management trade publications, it argues that the health insurance industry cautiously joined the weliness campaigns of the 70s and 80s despite its on-going reservations regarding the actuarial basis for rate differentials. The industry’s business-like conservatism was overcome by its recognition of wellness promotion as a cost-control measure, public relations tool, and means to stave off the threat of further governmental oversight and regulation.

  8. Development of an online tool for public health: the European Public Health Law Network.

    Science.gov (United States)

    Basak, P

    2011-09-01

    The European Public Health Law Network was established in 2007 as part of the European Union (EU) co-funded Public Health Law Flu project. The aims of the website consisted of designing an interactive network of specialist information and encouraging an exchange of expertise amongst members. The website sought to appeal to academics, public health professionals and lawyers. The Public Health Law Flu project team designed and managed the website. Registered network members were recruited through publicity, advertising and word of mouth. Details of the network were sent to health organizations and universities throughout Europe. Corresponding website links attracted many new visitors. Publications, news, events and a pandemic glossary became popular features on the site. Although the website initially focused only on pandemic diseases it has grown into a multidisciplinary website covering a range of public health law topics. The network contains over 700 publications divided into 28 public health law categories. News, events, front page content, legislation and the francophone section are updated on a regular basis. Since 2007 the website has received over 15,000 views from 156 countries. Newsletter subscribers have risen to 304. There are now 723 followers on the associated Twitter site. The European Public Health Law Network has been a successful and innovative site in the area of public health law. Interest in the site continues to grow. Future funding can contribute to a bigger site with interactive features and pages in a wider variety of languages to attract a wider global audience. Copyright © 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  9. Health-care costs of underweight, overweight and obesity: Australian population-based study.

    Science.gov (United States)

    Clifford, Susan A; Gold, Lisa; Mensah, Fiona K; Jansen, Pauline W; Lucas, Nina; Nicholson, Jan M; Wake, Melissa

    2015-12-01

    Child health varies with body mass index (BMI), but it is unknown by what age or how much this attracts additional population health-care costs. We aimed to determine the (1) cross-sectional relationships between BMI and costs across the first decade of life and (2) in longitudinal analyses, whether costs increase with duration of underweight or obesity. Baby (n = 4230) and Kindergarten (n = 4543) cohorts in the nationally representative Longitudinal Study of Australian Children. Medicare Benefits Scheme (including all general practitioner plus a large proportion of paediatrician visits) plus prescription medication costs to federal government from birth to sixth (Baby cohort) and fourth to tenth (Kindergarten cohort) birthdays. biennial BMI measurements over the same period. Among Australian children under 10 years of age, 5-6% were underweight, 11-18% overweight and 5-6% obese. Excess costs with low and high BMI became evident from age 4-5 years, with normal weight accruing the least, obesity the most, and underweight and overweight intermediate costs. Relative to overall between-child variation, these excess costs per child were very modest, with a maximum of $94 per year at age 4-5 years. Nonetheless, this projects to a substantial cost to government of approximately $13 million per annum for all Australian children aged less than 10 years. Substantial excess population costs provide further economic justification for promoting healthy body weight. However, obese children's low individual excess health-care costs mean that effective treatments are likely to increase short-term costs to the public health purse during childhood. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  10. Public health and peace.

    Science.gov (United States)

    Laaser, Ulrich; Donev, Donco; Bjegović, Vesna; Sarolli, Ylli

    2002-04-01

    The modern concept of public health, the New Public Health, carries a great potential for healthy and therefore less aggressive societies. Its core disciplines are health promotion, environmental health, and health care management based on advanced epidemiological methodologies. The main principles of living together in healthy societies can be summarized as four ethical concepts of the New Public Health essential to violence reduction equity, participation, subsidiarity, and sustainability. The following issues are discussed as violence determinants: the process of urbanization; type of neighborhood and accommodation, and consequent stigmatization; level of education; employment status; socialization of the family; women's status; alcohol and drug consumption; availability of the firearms; religious, ethnic, and racial prejudices; and poverty. Development of the health systems has to contribute to peace, since aggression, violence, and warfare are among the greatest risks for health and the economic welfare. This contribution can be described as follows: 1) full and indiscriminate access to all necessary services, 2) monitoring of their quality, 3) providing special support to vulnerable groups, and 4) constant scientific and public accountability of the evaluation of the epidemiological outcome. Violence can also destroy solidarity and social cohesion of groups, such as family, team, neighborhood, or any other social organization. Durkheim coined the term anomie for a state in which social disruption of the community results in health risks for individuals. Health professionals can make a threefold contribution to peace by 1) analyzing the causal interrelationships of violence phenomena, 2) curbing the determinants of violence according to the professional standards, and 3) training professionals for this increasingly important task. Because tolerance is an essential part of an amended definition of health, monitoring of the early signs of public intolerance is

  11. Public Health's Falling Share of US Health Spending.

    Science.gov (United States)

    Himmelstein, David U; Woolhandler, Steffie

    2016-01-01

    We examined trends in US public health expenditures by analyzing historical and projected National Health Expenditure Accounts data. Per-capita public health spending (inflation-adjusted) rose from $39 in 1960 to $281 in 2008, and has fallen by 9.3% since then. Public health's share of total health expenditures rose from 1.36% in 1960 to 3.18% in 2002, then fell to 2.65% in 2014; it is projected to fall to 2.40% in 2023. Public health spending has declined, potentially undermining prevention and weakening responses to health inequalities and new health threats.

  12. How health care reform can lower the costs of insurance administration.

    Science.gov (United States)

    Collins, Sara R; Nuzum, Rachel; Rustgi, Sheila D; Mika, Stephanie; Schoen, Cathy; Davis, Karen

    2009-07-01

    The United States leads all industrialized countries in the share of national health care expenditures devoted to insurance administration. The U.S. share is over 30 percent greater than Germany's and more than three times that of Japan. This issue brief examines the sources of administrative costs and describes how a private-public approach to health care reform--with the central feature of a national insurance exchange (largely replacing the present individual and small-group markets)--could substantially lower such costs. In three variations on that approach, estimated administrative costs would fall from 12.7 percent of claims to an average of 9.4 percent. Savings--as much as $265 billion over 2010-2020--would be realized through less marketing and underwriting, reduced costs of claims administration, less time spent negotiating provider payment rates, and fewer or standardized commissions to insurance brokers.

  13. Public hospital spending in England: Evidence from National Health Service administrative records

    OpenAIRE

    Kelly, Elaine; Stoye, George; Vera-Hernández, Marcos

    2015-01-01

    Health spending per capita in England has more than doubled since 1997, yet relatively little is known about how that spending is distributed across the population. This paper uses administrative National Health Service (NHS) hospital records to examine key features of public hospital spending in England. We describe how costs vary across the lifecycle, and the concentration of spending among people and over time. We find that costs per person start to increase after age 50 and escalate after...

  14. Prioritising health service innovation investments using public preferences: a discrete choice experiment.

    Science.gov (United States)

    Erdem, Seda; Thompson, Carl

    2014-08-28

    Prioritising scarce resources for investment in innovation by publically funded health systems is unavoidable. Many healthcare systems wish to foster transparency and accountability in the decisions they make by incorporating the public in decision-making processes. This paper presents a unique conceptual approach exploring the public's preferences for health service innovations by viewing healthcare innovations as 'bundles' of characteristics. This decompositional approach allows policy-makers to compare numerous competing health service innovations without repeatedly administering surveys for specific innovation choices. A Discrete Choice Experiment (DCE) was used to elicit preferences. Individuals chose from presented innovation options that they believe the UK National Health Service (NHS) should invest the most in. Innovations differed according to: (i) target population; (ii) target age; (iii) implementation time; (iv) uncertainty associated with their likely effects; (v) potential health benefits; and, (vi) cost to a taxpayer. This approach fosters multidimensional decision-making, rather than imposing a single decision criterion (e.g., cost, target age) in prioritisation. Choice data was then analysed using scale-adjusted Latent Class models to investigate variability in preferences and scale and valuations amongst respondents. Three latent classes with considerable heterogeneity in the preferences were present. Each latent class is composed of two consumer subgroups varying in the level of certainty in their choices. All groups preferred scientifically proven innovations, those with potential health benefits that cost less. There were, however, some important differences in their preferences for innovation investment choices: Class-1 (54%) prefers innovations benefitting adults and young people and does not prefer innovations targeting people with 'drug addiction' and 'obesity'. Class- 2 (34%) prefers innovations targeting 'cancer' patients only and has

  15. Applying Behavioral Economics to Public Health Policy: Illustrative Examples and Promising Directions.

    Science.gov (United States)

    Matjasko, Jennifer L; Cawley, John H; Baker-Goering, Madeleine M; Yokum, David V

    2016-05-01

    Behavioral economics provides an empirically informed perspective on how individuals make decisions, including the important realization that even subtle features of the environment can have meaningful impacts on behavior. This commentary provides examples from the literature and recent government initiatives that incorporate concepts from behavioral economics in order to improve health, decision making, and government efficiency. The examples highlight the potential for behavioral economics to improve the effectiveness of public health policy at low cost. Although incorporating insights from behavioral economics into public health policy has the potential to improve population health, its integration into government public health programs and policies requires careful design and continual evaluation of such interventions. Limitations and drawbacks of the approach are discussed. Copyright © 2016 American Journal of Preventive Medicine. All rights reserved.

  16. Transportation and public health.

    Science.gov (United States)

    Litman, Todd

    2013-01-01

    This article investigates various ways that transportation policy and planning decisions affect public health and better ways to incorporate public health objectives into transport planning. Conventional planning tends to consider some public health impacts, such as crash risk and pollution emissions measured per vehicle-kilometer, but generally ignores health problems resulting from less active transport (reduced walking and cycling activity) and the additional crashes and pollution caused by increased vehicle mileage. As a result, transport agencies tend to undervalue strategies that increase transport system diversity and reduce vehicle travel. This article identifies various win-win strategies that can help improve public health and other planning objectives.

  17. Economic impact of malignant mesothelioma in Italy: an estimate of the public and social costs.

    Science.gov (United States)

    Buresti, Giuliana; Colonna, Fabrizio; Corfiati, Marisa; Valenti, Antonio; Persechino, Benedetta; Marinaccio, Alessandro; Rondinone, Bruna Maria; Iavicoli, Sergio

    2017-10-27

    Despite their considerable interest for public health policies and for occupational disease management and assessment, the economic costs of asbestos-related diseases (ARDs) for society have not been fully estimated or even frequently discussed. The aim of this study was to estimate the economic burden of mesothelioma in Italy by assessing the overall societal cost of the disease, applying an econometric model. We analyzed two main cost groups, public and social. The first includes expenditure borne by the State and other public bodies (medical care costs, insurance, tax and benefits), while the latter uses the human capital approach to measure the loss of productivity suffered by the economy as a whole. We provide an estimate of euro 33,000 per patient for medical care costs and euro 25,000 for insurance and compensation; tax and benefits seem to roughly compensate. We estimated a loss of more than euro 200,000 per patient, in terms of loss of production. This study offers a practical approach for estimating the economic impact of mesothelioma, and provides empirical evidence of the huge economic burden linked to this disease, with its high etiologic fraction.

  18. [Social marketing and public health].

    Science.gov (United States)

    Arcaro, P; Mannocci, A; Saulle, R; Miccoli, S; Marzuillo, C; La Torre, G

    2013-01-01

    Social marketing uses the principles and techniques of commercial marketing by applying them to the complex social context in order to promote changes (cognitive; of action; behavioral; of values) among the target population in the public interest. The advent of Internet has radically modified the communication process, and this transformation also involved medical-scientific communication. Medical journals, health organizations, scientific societies and patient groups are increasing the use of the web and of many social networks (Twitter, Facebook, Google, YouTube) as channels to release scientific information to doctors and patients quickly. In recent years, even Healthcare in Italy reported a considerable application of the methods and techniques of social marketing, above all for health prevention and promotion. Recently the association for health promotion "Social marketing and health communication" has been established to promote an active dialogue between professionals of social marketing and public health communication, as well as among professionals in the field of communication of the companies involved in the "health sector". In the field of prevention and health promotion it is necessary to underline the theme of the growing distrust in vaccination practices. Despite the irrefutable evidence of the efficacy and safety of vaccines, the social-cultural transformation together with the overcoming of compulsory vaccination and the use of noninstitutional information sources, have generated confusion among citizens that tend to perceive compulsory vaccinations as needed and safe, whereas recommended vaccinations as less important. Moreover, citizens scarcely perceive the risk of disease related to the effectiveness of vaccines. Implementing communication strategies, argumentative and persuasive, borrowed from social marketing, also for the promotion of vaccines is a priority of the health system. A typical example of the application of social marketing, as

  19. Public health systems under attack in Canada: Evidence on public health system performance challenges arbitrary reform.

    Science.gov (United States)

    Guyon, Ak'ingabe; Perreault, Robert

    2016-10-20

    Public health is currently being weakened in several Canadian jurisdictions. Unprecedented and arbitrary cuts to the public health budget in Quebec in 2015 were a striking example of this. In order to support public health leaders and citizens in their capacity to advocate for evidence-informed public health reforms, we propose a knowledge synthesis of elements of public health systems that are significantly associated with improved performance. Research consistently and significantly associates four elements of public health systems with improved productivity: 1) increased financial resources, 2) increased staffing per capita, 3) population size between 50,000 and 500,000, and 4) specific evidence-based organizational and administrative features. Furthermore, increased financial resources and increased staffing per capita are significantly associated with improved population health outcomes. We contend that any effort at optimization of public health systems should at least be guided by these four evidence-informed factors. Canada already has existing capacity in carrying out public health systems and services research. Further advancement of our academic and professional expertise on public health systems will allow Canadian public health jurisdictions to be inspired by the best public health models and become stronger advocates for public health's resources, interventions and outcomes when they need to be celebrated or defended.

  20. Performance indicators and decision making for outsourcing public health laboratory services.

    Science.gov (United States)

    Santos, Maria Angelica Borges dos; Moraes, Ricardo Montes de; Passos, Sonia Regina Lambert

    2012-06-01

    To develop performance indicators for outsourcing clinical laboratory services, based on information systems and public administrative records. In the municipality of Rio de Janeiro, Southern Brazil, the public health laboratory network comprised 33 laboratories with automated equipment (but no integrated information system), 90 primary care units (where sample collection was performed) and 983 employees. Information records were obtained from the administrative records of the Budget Information System for Public Health and the Outpatient and Hospital Information System of the Unified Health System. Performance indicators (production, productivity, usage and costs) were generated from data collected routinely from 2006 to 2008. The variations in production, costs and unit prices for tests were analyzed by Laspeyres and Paasche indices, which specifically measure laboratory activity, and by the Consumer Price Index from the Brazilian Institute of Geography and Statistics. A total of 10,359,111 tests were performed in 2008 (10.6% increase over 2006), and the test/employee ratio grew by 8.6%. The costs of supplies, wages and providers increased by 2.3%, 45.4% and 18.3%, respectively. The laboratory tests per visit and hospitalizations increased by 10% and 20%, respectively. The direct costs totaled R$ 63.2 million in 2008, representing an increase of 22.2% in current values during the period analyzed. The direct costs deflated by the Brazilian National Consumer Price Index (9.5% for the period) showed an 11.6% increase in production volumes. The activity-specific volume index, which considers changes in the mix of tests, showed increases of 18.5% in the test price and 3.1% in the production volume. The performance indicators, particularly the specific indices for volume and price of activity, constitute a baseline of performance potential for monitoring private laboratories and contractors. The economic performance indicators demonstrated the need for network

  1. Health Care Spending: Changes in the Perceptions of the Australian Public.

    Directory of Open Access Journals (Sweden)

    Jane Robertson

    Full Text Available Increasing demand for services and rising health care costs create pressures within the Australian health care system and result in higher health insurance premiums and out-of-pocket costs for consumers.To measure changes in consumer views on the quality of the Australian health care system, contributors to rising costs and attitudes towards managing these costs.Two computer-assisted telephone interviews were conducted in 2006 (533 respondents and 2015 (1318 respondents and results compared.More respondents in 2015 rated the Australian health care system 'very adequate' than in 2006 (22.3% vs 8.3%; Odds Ratio OR 3.2, 99% CI 2.1, 5.1 with fewer 'concerned' or 'fairly concerned' about the health care costs (69.0% vs 85.7%; OR 0.37, 99% CI 0.25, 0.53. The 2015 respondents were more likely to identify new treatments for cancer (77% vs 65.7%; OR 1.75, 99% CI 1.30, 2.35 and community expectations for access to the latest technologies (73.8% vs 67%; OR 1.39, 99% CI 1.04, 1.86 as contributors to rising health care costs. While more 2015 respondents agreed that patients should pay a greater part of the health care costs, this remained a minority view (37.9% vs 31.7%; OR 1.32, 99% CI 0.99, 1.76. They were less likely to agree that doctors should offer medical treatments regardless of the cost and chance of benefit (63.6% vs 82.9%; OR 0.36, 99% CI 0.25, 0.50.Satisfaction with the Australian health care system has increased over time. Consumers recognise the cost pressures and have lower expectations that all services should be provided regardless of their costs and potential benefit. Public consultation on the allocation of health care resources and involvement in health care decision-making remains important. There should be community consultation about the principles and values that should guide resource allocation decisions.

  2. Health Care Spending: Changes in the Perceptions of the Australian Public.

    Science.gov (United States)

    Robertson, Jane; Newby, David A; Walkom, Emily J

    2016-01-01

    Increasing demand for services and rising health care costs create pressures within the Australian health care system and result in higher health insurance premiums and out-of-pocket costs for consumers. To measure changes in consumer views on the quality of the Australian health care system, contributors to rising costs and attitudes towards managing these costs. Two computer-assisted telephone interviews were conducted in 2006 (533 respondents) and 2015 (1318 respondents) and results compared. More respondents in 2015 rated the Australian health care system 'very adequate' than in 2006 (22.3% vs 8.3%; Odds Ratio OR 3.2, 99% CI 2.1, 5.1) with fewer 'concerned' or 'fairly concerned' about the health care costs (69.0% vs 85.7%; OR 0.37, 99% CI 0.25, 0.53). The 2015 respondents were more likely to identify new treatments for cancer (77% vs 65.7%; OR 1.75, 99% CI 1.30, 2.35) and community expectations for access to the latest technologies (73.8% vs 67%; OR 1.39, 99% CI 1.04, 1.86) as contributors to rising health care costs. While more 2015 respondents agreed that patients should pay a greater part of the health care costs, this remained a minority view (37.9% vs 31.7%; OR 1.32, 99% CI 0.99, 1.76). They were less likely to agree that doctors should offer medical treatments regardless of the cost and chance of benefit (63.6% vs 82.9%; OR 0.36, 99% CI 0.25, 0.50). Satisfaction with the Australian health care system has increased over time. Consumers recognise the cost pressures and have lower expectations that all services should be provided regardless of their costs and potential benefit. Public consultation on the allocation of health care resources and involvement in health care decision-making remains important. There should be community consultation about the principles and values that should guide resource allocation decisions.

  3. The health and social costs of chronic kidney disease in Italy

    Directory of Open Access Journals (Sweden)

    Americo Cicchetti

    2011-03-01

    Full Text Available Chronic kidney disease is growing as a global public health problem throughout the world. In Italy, CKD is becoming increasingly common with 52,777 patients treated with dialysis in 2010, about 10,000 new patients/years in dialysis from 2010.  The impact on the health care system includes € 2.1 billion/year for dialysis plus € 338 million for indirect costs. Aim of the present analysis was to explore socio-economical variables in the management of CKD, and assess direct and indirect health costs and NHS resources consumption. The overall cost for patients in dialysis is about 44,000 €/years for hemodialysis and 30,000 €/years for peritoneal dialysis with different resources consumption over the different stage disease. The possibility of reducing the progression of renal damaging and beginning of dialysis may induce a low expenditure for the Italian NHS.

  4. Better health at work? An evaluation of the effects and cost-benefits of a structured workplace health improvement programme in reducing sickness absence.

    Science.gov (United States)

    Braun, T; Bambra, C; Booth, M; Adetayo, K; Milne, E

    2015-03-01

    This paper presents the results of an evaluation of the Better Health at Work Award-a structured regional workplace health programme which combined changes to the work environment with lifestyle interventions. Baseline and follow-up data on sickness-absence rates and programme costs were collected retrospectively via a web survey of all participating organizations. Changes over time were calculated using 95% confidence intervals of the mean, supplemented by hypothesis testing using a t-test. The indicative cost-benefits of the intervention were also calculated. Participation was associated with a mean reduction in sickness absence of 0.26-1.6 days per employee per year depending on the length and level of participation in the programme. The estimated cost for the programme was £3 per sickness-absence day saved. These results suggest that the Better Health at Work Award could be a cost-effective way of improving health and reducing sickness absence particularly in the public sector. However, controlled evaluations of future interventions are needed. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. Barriers to partnership working in public health: a qualitative study.

    Directory of Open Access Journals (Sweden)

    David Carlton Taylor-Robinson

    Full Text Available Public health provision in England is undergoing dramatic changes. Currently established partnerships are thus likely to be significantly disrupted by the radical reforms outlined in the Public Health White Paper. We therefore explored the process of partnership working in public health, in order to better understand the potential opportunities and threats associated with the proposed changes.70 participants took part in an in-depth qualitative study involving 40 semi-structured interviews and three focus group discussions. Participants were senior and middle grade public health decision makers working in Primary Care Trusts, Local Authorities, Department of Health, academia, General Practice and Hospital Trusts and the third sector in England. Despite mature arrangements for partnership working in many areas, and much support for joint working in principle, many important barriers exist. These include cultural issues such as a lack of shared values and language, the inherent complexity of intersectoral collaboration for public health, and macro issues including political and resource constraints. There is particular uncertainty and anxiety about the future of joint working relating to the availability and distribution of scarce and diminishing financial resources. There is also the concern that existing effective collaborative networks may be completely disrupted as the proposed changes unfold. The extent to which the proposed reforms might mitigate or potentiate these issues remains unclear. However the threats currently remain more salient than opportunities.The current re-organisation of public health offers real opportunity to address some of the barriers to partnership working identified in this study. However, significant threats exist. These include the breakup of established networks, and the risk of cost cutting on effective public health interventions.

  6. 48 CFR 231.205-1 - Public relations and advertising costs.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Public relations and... PROCEDURES Contracts With Commercial Organizations 231.205-1 Public relations and advertising costs. (e) See... public relations and advertising costs also include monies paid to the Government associated with the...

  7. Effects of Health-Care Services and Commodities Cost on the ...

    African Journals Online (AJOL)

    2017-09-14

    Sep 14, 2017 ... services and commodities cost on the patients at the primary health facilities in Zaria .... This is a social security system that guarantees the provision of needed ..... tourism to India, Dubai, London, America, and even to some other ..... Mudyarabikwa O. An examination of public sector subsidies to the private ...

  8. Transitions in state public health law: comparative analysis of state public health law reform following the Turning Point Model State Public Health Act.

    Science.gov (United States)

    Meier, Benjamin Mason; Hodge, James G; Gebbie, Kristine M

    2009-03-01

    Given the public health importance of law modernization, we undertook a comparative analysis of policy efforts in 4 states (Alaska, South Carolina, Wisconsin, and Nebraska) that have considered public health law reform based on the Turning Point Model State Public Health Act. Through national legislative tracking and state case studies, we investigated how the Turning Point Act's model legal language has been considered for incorporation into state law and analyzed key facilitating and inhibiting factors for public health law reform. Our findings provide the practice community with a research base to facilitate further law reform and inform future scholarship on the role of law as a determinant of the public's health.

  9. Hidden costs of antiretroviral treatment: the public health efficiency of drug packaging

    Directory of Open Access Journals (Sweden)

    Andreu-Crespo À

    2015-08-01

    Full Text Available Àngels Andreu-Crespo,1,* Josep M Llibre,2,3,* Glòria Cardona-Peitx,1 Ferran Sala-Piñol,1 Bonaventura Clotet,2,4 Xavier Bonafont-Pujol1 1Pharmacy Department, 2HIV Unit and “Lluita contra la SIDA” Foundation, University Hospital Germans Trias i Pujol, Badalona, 3Universitat Autònoma de Barcelona, 4Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC, Vic, Barcelona, Spain *These authors contributed equally to the work Abstract: While the overall percentage of unused antiretroviral medicines returned to the hospital pharmacy is low, their cost is quite high. Adverse events, treatment failure, pharmacokinetic interactions, pregnancy, or treatment simplification are common reasons for unplanned treatment changes. Socially inefficient antiretroviral packages prevent the reuse of drugs returned to the hospital pharmacy. We defined antiretroviral package categories based on the excellence of drug packaging and analyzed the number of pills and costs of drugs returned during a period of 1 year in a hospital-based HIV unit attending to 2,413 treated individuals. A total of 6,090 pills (34% of all returned antiretrovirals – with a cost of 47,139.91€ – would be totally lost, mainly due to being packed up in the lowest efficiency packages. Newer treatments are packaged in low-excellence categories of packages, thus favoring the maintenance of these hidden costs in the near future. Therefore, costs of this low-efficiency drug packaging, where medication packages are started but not completed, in high-cost medications are substantial and should be properly addressed. Any improvement in the packaging by the manufacturer, and favoring the choice of drugs supplied through efficient packages (when efficacy, toxicity, and convenience are similar, should minimize the treatment expenditures paid by national health budgets. Keywords: antiretroviral treatment, cost efficacy, drug packaging, treatment change

  10. Obesity-related health impacts of fuel excise taxation- an evidence review and cost-effectiveness study.

    Science.gov (United States)

    Brown, V; Moodie, M; Cobiac, L; Mantilla Herrera, A M; Carter, R

    2017-05-04

    Reducing automobile dependence and improving rates of active transport may reduce the impact of obesogenic environments, thereby decreasing population prevalence of obesity and other diseases where physical inactivity is a risk factor. Increasing the relative cost of driving by an increase in fuel taxation may therefore be a promising public health intervention for obesity prevention. A scoping review of the evidence for obesity or physical activity effect of changes in fuel price or taxation was undertaken. Potential health benefits of an increase in fuel excise taxation in Australia were quantified using Markov modelling to simulate obesity, injury and physical activity related health impacts of a fuel excise taxation intervention for the 2010 Australian population. Health adjusted life years (HALYs) gained and healthcare cost savings from diseases averted were estimated. Incremental cost-effectiveness ratios (ICERs) were reported and results were tested through sensitivity analysis. Limited evidence on the effect of policies such as fuel taxation on health-related behaviours currently exists. Only three studies were identified reporting associations between fuel price or taxation and obesity, whilst nine studies reported associations specifically with physical activity, walking or cycling. Estimates of the cross price elasticity of demand for public transport with respect to fuel price vary, with limited consensus within the literature on a probable range for the Australian context. Cost-effectiveness modelling of a AUD0.10 per litre increase in fuel excise taxation using a conservative estimate of cross price elasticity for public transport suggests that the intervention would be cost-effective from a limited societal perspective (237 HALYs gained, AUD2.6 M in healthcare cost savings), measured against a comparator of no additional increase in fuel excise. Under "best case" assumptions, the intervention would be more cost-effective (3181 HALYs gained, AUD34.2

  11. Cost of delivering secondary-level health care services through public sector district hospitals in India

    Directory of Open Access Journals (Sweden)

    Shankar Prinja

    2017-01-01

    Interpretation & conclusions: The estimates obtained in our study can be used for Fiscal planning of scaling up secondary-level health services. Further, these may be particularly useful for future research such as benefit-incidence analysis, cost-effectiveness analysis and national health accounts including disease-specific accounts in India.

  12. Health Clinic Cost Reports

    Data.gov (United States)

    U.S. Department of Health & Human Services — Healthcare Cost Report Information System (HCRIS) Dataset - Independent Rural Health Clinic and Freestanding Federally Qualified Health Center (HCLINIC).This data...

  13. Public health care providers and market competition: the case of Finnish occupational health services.

    Science.gov (United States)

    Kankaanpää, Eila; Linnosmaa, Ismo; Valtonen, Hannu

    2011-02-01

    As reforms in publicly funded health systems rely heavily on competition, it is important to know if and how public providers react to competition. In many European countries, it is empirically difficult to study public providers in different markets, but in Finnish occupational health services, both public and private for-profit and non-profit providers co-exist. We studied possible differences in public providers' performance (price, intensity of services, service mix-curative medical services/prevention, productivity and revenues) according to the competitiveness of the market. The Finnish Institute of Occupational Health (FIOH) collected data on clients, services and personnel for 1992, 1995, 1997, 2000 and 2004 from occupational health services (OHS) providers. Employers defray the costs of OHS and apply for reimbursement from the Social Insurance Institution (SII). The SII data was merged with FIOH's questionnaire. The unbalanced panel consisted of about 230 public providers, totalling 1,164 observations. Local markets were constructed from several municipalities based on commuting practices and regional collaboration. Competitiveness of the market was measured by the number of providers and by the Herfindahl index. The effect of competition was studied by ordinary least square regression analysis and panel models. The more competitive the environment was for a public provider the higher were intensity, productivity and the share of medical care. Fixed panel models showed that these differences were not due to differences and changes in the competitiveness of the market. Instead, in more competitive markets public providers had higher unit prices and higher revenues.

  14. Cost-of-illness of cholera to households and health facilities in rural Malawi.

    Directory of Open Access Journals (Sweden)

    Patrick G Ilboudo

    Full Text Available Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients' households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$ 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera.

  15. Cost-of-illness of cholera to households and health facilities in rural Malawi.

    Science.gov (United States)

    Ilboudo, Patrick G; Huang, Xiao Xian; Ngwira, Bagrey; Mwanyungwe, Abel; Mogasale, Vittal; Mengel, Martin A; Cavailler, Philippe; Gessner, Bradford D; Le Gargasson, Jean-Bernard

    2017-01-01

    Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients' households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$) 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera.

  16. The stigmatization dilemma in public health policy - the case of MRSA in Denmark

    DEFF Research Database (Denmark)

    Ploug, Thomas; Holm, Søren; Gjerris, Mickey

    2015-01-01

    -resistant Staphylococcus aureus (MRSA) within pig production. Summary We argue that using stigmatization as a direct means to achieve public health outcomes is almost always ethically illegitimate. Autonomy and dignity considerations count against it, and the cost-benefit analysis that might by some be taken to outweigh......Background Multi-resistant bacteria pose an increasing and significant public health risk. As awareness of the severity of the problem grows, it is likely that it will become the target for a range of public health interventions. Some of these can intentionally or unintentionally lead...... to stigmatization of groups of citizens. Discussion The article describes the phenomenon of stigmatization within the health care area by discussing the concept in relation to AIDS and psychiatric diagnosis. It unfolds the ethical aspects of using stigmatization as a public health instrument to affect unwanted...

  17. Interim monitoring of cost dynamics for publicly supported energy technologies

    Energy Technology Data Exchange (ETDEWEB)

    Nemet, Gregory F. [La Follette School of Public Affairs, University of Wisconsin, 1225 Observatory Drive, Madison, WI 53706 (United States)]|[Nelson Institute for Environmental Studies, University of Wisconsin, Madison, WI 53726 (United States)

    2009-03-15

    The combination of substantial public funding of nascent energy technologies and recent increases in the costs of those that have been most heavily supported has raised questions about whether policy makers should sustain, alter, enhance, or terminate such programs. This paper uses experience curves for photovoltaics (PV) and wind to (1) estimate ranges of costs for these public programs and (2) introduce new ways of evaluating recent cost dynamics. For both technology cases, the estimated costs of the subsidies required to reach targets are sensitive to the choice of time period on which cost projections are based. The variation in the discounted social cost of subsidies exceeds an order of magnitude. Vigilance is required to avoid the very expensive outcomes contained within these distributions of social costs. Two measures of the significance of recent deviations are introduced. Both indicate that wind costs are within the expected range of prior forecasts but that PV costs are not. The magnitude of the public funds involved in these programs heightens the need for better analytical tools with which to monitor and evaluate cost dynamics. (author)

  18. Educating the future public health workforce: do schools of public health teach students about the private sector?

    Science.gov (United States)

    Rutkow, Lainie; Traub, Arielle; Howard, Rachel; Frattaroli, Shannon

    2013-01-01

    Recent surveys indicate that approximately 40% of graduates from schools of public health are employed within the private sector or have an employer charged with regulating the private sector. These data suggest that schools of public health should provide curricular opportunities for their students--the future public health workforce--to learn about the relationship between the private sector and the public's health. To identify opportunities for graduate students in schools of public health to select course work that educates them about the relationship between the private sector and public health. We systematically identified and analyzed data gathered from publicly available course titles and descriptions on the Web sites of accredited schools of public health. Data were collected in the United States. The sample consisted of accredited schools of public health. Descriptions of the number and types of courses that schools of public health offer about the private sector and identification of how course descriptions frame the private sector relative to public health. We identified 104 unique courses with content about the private sector's relationship to public health. More than 75% of accredited schools of public health offered at least 1 such course. Nearly 25% of identified courses focused exclusively on the health insurance industry. Qualitative analysis of the data revealed 5 frames used to describe the private sector, including its role as a stakeholder in the policy process. Schools of public health face a curricular gap, with relatively few course offerings that teach students about the relationship between the private sector and the public's health. By developing new courses or revising existing ones, schools of public health can expose the future public health workforce to the varied ways public health professionals interact with the private sector, and potentially influence students' career paths.

  19. The costs of overweight and obesity-related diseases in the Brazilian public health system: cross-sectional study

    Directory of Open Access Journals (Sweden)

    Bahia Luciana

    2012-06-01

    Full Text Available Abstract Background Obesity is a major global epidemic and a burden to society and health systems. It is well known risk factor for a number of chronic medical conditions with high morbidity and mortality. This study aimed to provide an estimate of the direct costs associated to outpatient and inpatient care of overweight and obesity related diseases in the perspective of the Brazilian Health System (SUS. Methods Population attributable risk (PAR was calculated for selected diseases related to overweight and obesity and with the following parameters: Relative risk (RR ≥ 1.20 or RR ≥1.10 and  Results The estimated total costs in one year with all diseases related to overweight and obesity are US$ 2,1 billion; US$ 1,4 billion (68.4% of total costs due to hospitalizations and US$ 679 million due to ambulatory procedures. Approximately 10% of these cost is attributable to overweight and obesity. Conclusion The results confirm that overweight and obesity carry a great economic burden for Brazilian health system and for the society. The knowledge of these costs will be useful for future economic analysis of preventive and treatment interventions.

  20. [The ALANAM statement on public health policy].

    Science.gov (United States)

    Goic, Alejando; Armas, Rodolfo

    2010-12-01

    The ALANAM (Association of Latin American National Academies of Medicine) statement on public health policy, issued following its 19th Congress, held October 28–30, 2010, in Santiago, Chile, declares that cardiovascular diseases, cancer, accidents and violence are the leading causes of death in the region, while in several of its member nations, emergent and re-emergent infectious diseases, malnutrition, and mother-child illnesses remain prevalent. The statement calls attention to the lack of functioning water supply and sewage systems in many villages and rural areas. After describing the social causes of the present state of public health in Latin America (poverty levels reaching upwards of 44% of the total population, or some 110 million people), it calls on governments, first, to spare no efforts in the task of eradicating extreme poverty in the short-term, and poverty in the long-term. Second, considering that about 15 million 3-to-6 year-olds have no access to education, it recommends extending educational services to these children, and to improve the quality of existing pre-school and primary education. Third, the statement calls for universal health care coverage and for equal access to good quality medical care for everyone, and for programs aimed at promoting healthy personal habits and self-care. In this regard, it also recommends that disease prevention programs be sustained over time, that national sanitary objectives be defined, and that its results be periodically reviewed. Fourth, it recommends that primary health care be extended to everyone, and that it be enhanced by improving coverage and coordination with secondary and tertiary level health care institutions. The statement lays special stress on the need for adopting public health policies aimed at lowering the cost of medicines; to this end, it calls for the creation of an official list of generic drugs. The statement ends by calling on governments to support public health research as a

  1. Getting sports injury prevention on to public health agendas - addressing the shortfalls in current information sources.

    Science.gov (United States)

    Finch, Caroline F

    2012-01-01

    Public health policy is a successful population-level strategy for injury prevention but it is yet to be widely applied to the sports sector. Such policy is generally coordinated by government health departments concerned with the allocation of limited resources to health service delivery and preventive programs for addressing large community health issues. Prioritisation of sports injury prevention (SIP) requires high-quality evidence about the size of the problem and its public health burden; identification of at-risk vulnerable groups; confirmed effective prevention solutions; evidence of intervention cost-effectiveness; and quantification of both financial and policy implications of inaction. This paper argues that the major reason for a lack of sports injury policy by government departments for health or sport to date is a lack of relevant information available for policy makers to make their decisions. Key information gaps evident in Australia are used to highlight this problem. SIP policy does not yet rank highly because, relative to other health/injury issues, there is very little hard evidence to support: claims for its priority ranking, the existence of solutions that can be implemented and which will work, and potential cost-savings to government agencies. Moreover, policy action needs to be integrated across government portfolios, including sport, health and others. Until sports medicine research generates high-quality population-level information of direct relevance and importance to policy makers, especially intervention costing and implementation cost-benefit estimates, and fully engage in policy-informing partnerships, SIP will continue to be left off the public health agenda.

  2. Why Do People Work in Public Health? Exploring Recruitment and Retention Among Public Health Workers.

    Science.gov (United States)

    Yeager, Valerie A; Wisniewski, Janna M; Amos, Kathleen; Bialek, Ron

    2016-01-01

    The public health workforce is critical to the functioning of the public health system and protection of the population's health. Ensuring a sufficient workforce depends on effectively recruiting and retaining workers. This study examines factors influencing decisions to take and remain in jobs within public health, particularly for workers employed in governmental public health. This cross-sectional study employed a secondary data set from a 2010 national survey of US public health workers. Survey respondents were included in this study if they responded to at least 1 survey item related to recruitment and retention. A total of 10 859 survey responses fit this criterion. Data examined demographics of public health workers and factors that influenced decisions to take jobs in and remain in public health. Job security (β = 0.42; 95% confidence interval [CI], 0.28-0.56) and competitive benefits (β = 0.49; 95% CI, 0.28-0.70) were significantly and positively associated with governmental employees' decisions to take positions with their current employers compared with public health workers employed by other types of organizations. The same finding held with regard to retention: job security (β = 0.40; 95% CI, 0.23-0.57) and competitive benefits (β = 0.53; 95% CI, 0.24-0.83). Two personal factors, personal commitment to public service (β = 0.30; 95% CI, 0.17-0.42) and wanted a job in the public health field (β = 0.44; 95% CI, 0.18-0.69), were significantly and positively related to governmental employees deciding to remain with their current employers. It is important to recognize the value of competitive benefits for both current and potential employees. Public health agencies should maintain these if possible and make the value of these benefits known to policy makers or other agencies setting these benefit policies. Job security associated with governmental public health jobs also appears to offer public health an advantage in recruiting and retaining employees.

  3. Public mental health.

    Science.gov (United States)

    Lindert, Jutta; Bilsen, Johan; Jakubauskiene, Marija

    2017-10-01

    Public mental health (PMH) is a major challenge for public health research and practice. This article is organized in six parts. First, we will highlight the significance of PMH; second, we will define mental health and mental disorders; third, we identify and describe determinants of mental health and mental disorders on which we worked in the past 10 years since the establishment of the PMH section such as social determinants and violence. Fourth, we will describe the development of the EUPHA PMH section and provide details on vulnerable groups in the field of PMH, on violence as a main determinant and on suicide as an outcome which affects all countries in the European region. Fifth, we describe policy and practice implications of the development of PMH and highlight the European dimension of PMH. We will conclude this article by providing an outlook on potential further development of PMH as regards research and policy and practice. Finally, we hope that the EUPHA PMH section will contribute to public health in the next 25 years and we can contribute to improvement of PMH in Europe. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  4. Social media in public health.

    Science.gov (United States)

    Kass-Hout, Taha A; Alhinnawi, Hend

    2013-01-01

    While social media interactions are currently not fully understood, as individual health behaviors and outcomes are shared online, social media offers an increasingly clear picture of the dynamics of these processes. Social media is becoming an increasingly common platform among clinicians and public health officials to share information with the public, track or predict diseases. Social media can be used for engaging the public and communicating key public health interventions, while providing an important tool for public health surveillance. Social media has advantages over traditional public health surveillance, as well as limitations, such as poor specificity, that warrant additional study. Social media can provide timely, relevant and transparent information of public health importance; such as tracking or predicting the spread or severity of influenza, west nile virus or meningitis as they propagate in the community, and, in identifying disease outbreaks or clusters of chronic illnesses. Further work is needed on social media as a valid data source for detecting or predicting diseases or conditions. Also, whether or not it is an effective tool for communicating key public health messages and engaging both, the general public and policy-makers.

  5. Public health impact and cost-effectiveness of intranasal live attenuated influenza vaccination of children in Germany.

    Science.gov (United States)

    Damm, Oliver; Eichner, Martin; Rose, Markus Andreas; Knuf, Markus; Wutzler, Peter; Liese, Johannes Günter; Krüger, Hagen; Greiner, Wolfgang

    2015-06-01

    In 2011, intranasally administered live attenuated influenza vaccine (LAIV) was approved in the EU for prophylaxis of seasonal influenza in 2-17-year-old children. Our objective was to estimate the potential epidemiological impact and cost-effectiveness of an LAIV-based extension of the influenza vaccination programme to healthy children in Germany. An age-structured dynamic model of influenza transmission was developed and combined with a decision-tree to evaluate different vaccination strategies in the German health care system. Model inputs were based on published literature or were derived by expert consulting using the Delphi technique. Unit costs were drawn from German sources. Under base-case assumptions, annual routine vaccination of children aged 2-17 years with LAIV assuming an uptake of 50% would prevent, across all ages, 16 million cases of symptomatic influenza, over 600,000 cases of acute otitis media, nearly 130,000 cases of community-acquired pneumonia, nearly 1.7 million prescriptions of antibiotics and over 165,000 hospitalisations over 10 years. The discounted incremental cost-effectiveness ratio was 1,228 per quality-adjusted life year gained from a broad third-party payer perspective (including reimbursed direct costs and specific transfer payments), when compared with the current strategy of vaccinating primarily risk groups with the conventional trivalent inactivated vaccine. Inclusion of patient co-payments and indirect costs in terms of productivity losses resulted in discounted 10-year cost savings of 3.4 billion. In conclusion, adopting universal influenza immunisation of healthy children and adolescents would lead to a substantial reduction in influenza-associated disease at a reasonable cost to the German statutory health insurance system. On the basis of the epidemiological and health economic simulation results, a recommendation of introducing annual routine influenza vaccination of children 2-17 years of age might be taken into

  6. A Comparison of Two Methods for Measuring Land Use in Public Health Research

    Directory of Open Access Journals (Sweden)

    Katherine E. King

    2015-06-01

    Full Text Available Public health researchers have identified numerous health implications associated with land use. However, it is unclear which of multiple methods of data collection most accurately captures land use, and “gold standard” methods vary by discipline. Five desirable features of environmental data sources are presented and discussed (cost, coverage, availability, construct validity, and accuracy. Potential accuracy issues are discussed by using Kappa statistics to evaluate the level of agreement between data sets collected by two methods (systematic social observation [SSO] by trained raters and publicly available data from aerial photography coded using administrative records from the same blocks in Chicago, Illinois. Significant Kappa statistics range from 0.19 to 0.60, indicating varying levels of intersource agreement. Most land uses are more likely to be reported by researcher-designed direct observation than in the publicly available data derived from aerial photography. However, when cost, coverage, and availability outweigh a marginal improvement in accuracy and flexibility in land-use categorization, coded aerial photography data may be a useful data source for health researchers. Greater interdisciplinary and interorganization collaboration in the production of ecological data is recommended to improve cost, coverage, availability, and accuracy, with implications for construct validity.

  7. 42 CFR 417.802 - Allowable costs.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Allowable costs. 417.802 Section 417.802 Public... PLANS Health Care Prepayment Plans § 417.802 Allowable costs. (a) General rule. The costs that are considered allowable for HCPP reimbursement are the same as those for reasonable cost HMOs and CMPs specified...

  8. Public health genomics and personalized prevention: lessons from the COGS project.

    Science.gov (United States)

    Pashayan, N; Hall, A; Chowdhury, S; Dent, T; Pharoah, P D P; Burton, H

    2013-11-01

    Using the principles of public health genomics, we examined the opportunities and challenges of implementing personalized prevention programmes for cancer at the population level. Our model-based estimates indicate that polygenic risk stratification can potentially improve the effectiveness and cost-effectiveness of screening programmes. However, compared with 'one-size-fits-all' screening programmes, personalized screening adds further layers of complexity to the organization of screening services and raises ethical, legal and social challenges. Before polygenic inheritance is translated into population screening strategy, evidence from empirical research and engagement with and education of the public and the health professionals are needed. © 2013 The Association for the Publication of the Journal of Internal Medicine.

  9. Assessing the public health impact of using poison center data for public health surveillance.

    Science.gov (United States)

    Wang, Alice; Law, Royal; Lyons, Rebecca; Choudhary, Ekta; Wolkin, Amy; Schier, Joshua

    2017-12-13

    The National Poison Data System (NPDS) is a database and surveillance system for US poison centers (PCs) call data. The Centers for Disease Control and Prevention (CDC) and American Association of Poison Control Centers (AAPCC) use NPDS to identify incidents of potential public health significance. State health departments are notified by CDC of incidents identified by NPDS to be of potential public health significance. Our objective was to describe the public health impact of CDC's notifications and the use of NPDS data for surveillance. We described how NPDS data informed three public health responses: the Deepwater Horizon incident, national exposures to laundry detergent pods, and national exposures to e-cigarettes. Additionally, we extracted survey results of state epidemiologists regarding NPDS incident notification follow-up from 1 January 2015 to 31 December 2016 to assess current public health application of NPDS data using Epi Info 7.2 and analyzed data using SAS 9.3. We assessed whether state health departments were aware of incidents before notification, what actions were taken, and whether CDC notifications contributed to actions. NPDS data provided evidence for industry changes to improve laundry detergent pod containers safety and highlighted the need to regulate e-cigarette sale and manufacturing. NPDS data were used to improve situational awareness during the 2010 Deepwater Horizon oil spill. Of 59 health departments and PCs who responded to CDC notifications about anomalies (response rate = 49.2%), 27 (46%) reported no previous awareness of the incident, and 20 (34%) said that notifications contributed to public health action. Monitoring NPDS data for anomalies can identify emerging public health threats and provide evidence-based science to support public health action and policy changes.

  10. The impact of globalization on public health: implications for the UK Faculty of Public Health Medicine.

    Science.gov (United States)

    Lee, K

    2000-09-01

    There has been substantial discussion of globalization in the scholarly and popular press yet limited attention so far among public health professionals. This is so despite the many potential impacts of globalization on public health. Defining public health broadly, as focused on the collective health of populations requiring a range of intersectoral activities, globalization can be seen to have particular relevance. Globalization, in turn, can be defined as a process that is changing the nature of human interaction across a wide range of spheres and along at least three dimensions. Understanding public health and globalization in these ways suggests the urgent need for research to better understand the linkages between the two, and effective policy responses by a range of public health institutions, including the UK Faculty of Public Health Medicine. The paper is based on a review of secondary literature on globalization that led to the development of a conceptual framework for understanding potential impacts on the determinants of health and public health. The paper then discusses major areas of public health in relation to these potential impacts. It concludes with recommendations on how the UK Faculty of Public Health Medicine might contribute to addressing these impacts through its various activities. Although there is growing attention to the importance of globalization to public health, there has been limited research and policy development in the United Kingdom. The UK Faculty of Public Health Medicine needs to play an active role in bringing relevant issues to the attention of policy makers, and encourage its members to take up research, teaching and policy initiatives. The potential impacts of globalization support a broader understanding and practice of public health that embraces a wide range of health determinants.

  11. Ramsey waits: allocating public health service resources when there is rationing by waiting.

    Science.gov (United States)

    Gravelle, Hugh; Siciliani, Luigi

    2008-09-01

    The optimal allocation of a public health care budget across treatments must take account of the way in which care is rationed within treatments since this will affect their marginal value. We investigate the optimal allocation rules for public health care systems where user charges are fixed and care is rationed by waiting. The optimal waiting time is higher for treatments with demands more elastic to waiting time, higher costs, lower charges, smaller marginal welfare loss from waiting by treated patients, and smaller marginal welfare losses from under-consumption of care. The results hold for a wide range of welfarist and non-welfarist objective functions and for systems in which there is also a private health care sector. They imply that allocation rules based purely on cost effectiveness ratios are suboptimal because they assume that there is no rationing within treatments.

  12. The public health leadership certificate: a public health and primary care interprofessional training opportunity.

    Science.gov (United States)

    Matson, Christine C; Lake, Jeffrey L; Bradshaw, R Dana; Matson, David O

    2014-03-01

    This article describes a public health leadership certificate curriculum developed by the Commonwealth Public Health Training Center for employees in public health and medical trainees in primary care to share didactic and experiential learning. As part of the program, trainees are involved in improving the health of their communities and thus gain a blended perspective on the effectiveness of interprofessional teams in improving population health. The certificate curriculum includes eight one-credit-hour didactic courses offered through an MPH program and a two-credit-hour, community-based participatory research project conducted by teams of trainees under the mentorship of health district directors. Fiscal sustainability is achieved by sharing didactic courses with MPH degree students, thereby enabling trainees to take advantage of a reduced, continuing education tuition rate. Public health employee and primary care trainees jointly learn knowledge and skills required for community health improvement in interprofessional teams and gain an integrated perspective through opportunities to question assumptions and broaden disciplinary approaches. At the same time, the required community projects have benefited public health in Virginia.

  13. Beacon communities' public health initiatives: a case study analysis.

    Science.gov (United States)

    Massoudi, Barbara L; Marcial, Laura H; Haque, Saira; Bailey, Robert; Chester, Kelley; Cunningham, Shellery; Riley, Amanda; Soper, Paula

    2014-01-01

    The Beacon Communities for Public Health (BCPH) project was launched in 2011 to gain a better understanding of the range of activities currently being conducted in population- and public health by the Beacon Communities. The project highlighted the successes and challenges of these efforts with the aim of sharing this information broadly among the public health community. The Beacon Community Program, designed to showcase technology-enabled, community-based initiatives to improve outcomes, focused on: building and strengthening health information technology (IT) infrastructure and exchange capabilities; translating investments in health IT to measureable improvements in cost, quality, and population health; and, developing innovative approaches to performance measurement, technology, and care delivery. Four multimethod case studies were conducted based on a modified sociotechnical framework to learn more about public health initiative implementation and use in the Beacon Communities. Our methodological approach included using document review and semistructured key informant interviews. NACCHO Model Practice Program criteria were used to select the public health initiatives included in the case studies. Despite differences among the case studies, common barriers and facilitators were found to be present in all areas of the sociotechnical framework application including structure, people, technology, tasks, overarching considerations, and sustainability. Overall, there were many more facilitators (range = 7-14) present for each Beacon compared to barriers (range = 4-6). Four influential promising practices were identified through the work: forging strong and sustainable partnerships; ensuring a good task-technology fit and a flexible and iterative design; fostering technology acceptance; and, providing education and demonstrating value. A common weakness was the lack of a framework or model for the Beacon Communities evaluation work. Sharing a framework or approach

  14. Beacon Communities’ Public Health Initiatives: A Case Study Analysis

    Science.gov (United States)

    Massoudi, Barbara L.; Marcial, Laura H.; Haque, Saira; Bailey, Robert; Chester, Kelley; Cunningham, Shellery; Riley, Amanda; Soper, Paula

    2014-01-01

    Introduction: The Beacon Communities for Public Health (BCPH) project was launched in 2011 to gain a better understanding of the range of activities currently being conducted in population- and public health by the Beacon Communities. The project highlighted the successes and challenges of these efforts with the aim of sharing this information broadly among the public health community. Background: The Beacon Community Program, designed to showcase technology-enabled, community-based initiatives to improve outcomes, focused on: building and strengthening health information technology (IT) infrastructure and exchange capabilities; translating investments in health IT to measureable improvements in cost, quality, and population health; and, developing innovative approaches to performance measurement, technology, and care delivery. Methods: Four multimethod case studies were conducted based on a modified sociotechnical framework to learn more about public health initiative implementation and use in the Beacon Communities. Our methodological approach included using document review and semistructured key informant interviews. NACCHO Model Practice Program criteria were used to select the public health initiatives included in the case studies. Findings: Despite differences among the case studies, common barriers and facilitators were found to be present in all areas of the sociotechnical framework application including structure, people, technology, tasks, overarching considerations, and sustainability. Overall, there were many more facilitators (range = 7–14) present for each Beacon compared to barriers (range = 4–6). Discussion: Four influential promising practices were identified through the work: forging strong and sustainable partnerships; ensuring a good task-technology fit and a flexible and iterative design; fostering technology acceptance; and, providing education and demonstrating value. Conclusions: A common weakness was the lack of a framework or model for

  15. Economic costs of obesity in Thailand: a retrospective cost-of-illness study.

    Science.gov (United States)

    Pitayatienanan, Paiboon; Butchon, Rukmanee; Yothasamut, Jomkwan; Aekplakorn, Wichai; Teerawattananon, Yot; Suksomboon, Naeti; Thavorncharoensap, Montarat

    2014-04-02

    Over the last decade, the prevalence of obesity (BMI ≥ 25 kg/m2) in Thailand has been rising rapidly and consistently. Estimating the cost of obesity to society is an essential step in setting priorities for research and resource use and helping improve public awareness of the negative economic impacts of obesity. This prevalence-based, cost-of-illness study aims to estimate the economic costs of obesity in Thailand. The estimated costs in this study included health care cost, cost of productivity loss due to premature mortality, and cost of productivity loss due to hospital-related absenteeism. The Obesity-Attributable Fraction (OAF) was used to estimate the extent to which the co-morbidities were attributable to obesity. The health care cost of obesity was further estimated by multiplying the number of patients in each disease category attributable to obesity by the unit cost of treatment. The cost of productivity loss was calculated using the human capital approach. The health care cost attributable to obesity was estimated at 5,584 million baht or 1.5% of national health expenditure. The cost of productivity loss attributable to obesity was estimated at 6,558 million baht - accounting for 54% of the total cost of obesity. The cost of hospital-related absenteeism was estimated at 694 million baht, while the cost of premature mortality was estimated at 5,864 million baht. The total cost of obesity was then estimated at 12,142 million baht (725.3 million US$PPP, 16.74 baht =1 US$PPP accounting for 0.13% of Thailand's Gross Domestic Product (GDP). Obesity imposes a substantial economic burden on Thai society especially in term of health care costs. Large-scale comprehensive interventions focused on improving public awareness of the cost of and problems associated with obesity and promoting a healthy lifestyle should be regarded as a public health priority.

  16. Developing an academia-based public health observatory: the new global public health observatory with emphasis on urban health at Johns Hopkins Bloomberg School of Public Health

    Directory of Open Access Journals (Sweden)

    Carlos Castillo-Salgado

    2015-11-01

    Full Text Available Abstract Health observatories may differ according to their mission, institutional setting, topical emphasis or geographic coverage. This paper discusses the development of a new urban-focused health observatory, and its operational research and training infrastructure under the academic umbrella of the Department of Epidemiology and the Institute of Urban Health at the Johns Hopkins Bloomberg School of Public Health (BSPH in Baltimore, USA. Recognizing the higher education mission of the BSPH, the development of a new professional training in public health was an important first step for the development of this observatory. This new academia-based observatory is an innovative public health research and training platform offering faculty, investigators, professional epidemiology students and research partners a physical and methodological infrastructure for their operational research and training activities with both a local urban focus and a global reach. The concept of a public health observatory and its role in addressing social health inequalities in local urban settings is discussed.

  17. Developing an academia-based public health observatory: the new global public health observatory with emphasis on urban health at Johns Hopkins Bloomberg School of Public Health.

    Science.gov (United States)

    Castillo-Salgado, Carlos

    2015-11-01

    Health observatories may differ according to their mission, institutional setting, topical emphasis or geographic coverage. This paper discusses the development of a new urban-focused health observatory, and its operational research and training infrastructure under the academic umbrella of the Department of Epidemiology and the Institute of Urban Health at the Johns Hopkins Bloomberg School of Public Health (BSPH) in Baltimore, USA. Recognizing the higher education mission of the BSPH, the development of a new professional training in public health was an important first step for the development of this observatory. This new academia-based observatory is an innovative public health research and training platform offering faculty, investigators, professional epidemiology students and research partners a physical and methodological infrastructure for their operational research and training activities with both a local urban focus and a global reach. The concept of a public health observatory and its role in addressing social health inequalities in local urban settings is discussed.

  18. Methodological aspects of accounting production cost of public sector entities

    Directory of Open Access Journals (Sweden)

    Людмила Геннадіївна Ловінська

    2015-09-01

    Full Text Available The necessity of obtaining objective information about the activities of the public sector in various areas of the production is defined. It is proved an expediency of development the Project of «Guidelines for the structure of production costs» on the basis of the approved in the public sector NP(SAPS 135 "Costs". The need for accounting costs by type of activity (operational, financial and investment is marked. The composition of production costs is defined

  19. Advances in dental public health.

    Science.gov (United States)

    Holt, R D

    2001-07-01

    Dental public health has been defined as 'the science and art of preventing oral diseases, promoting oral health and improving the quality of life through the organised efforts of society'. Dental practitioners most often have the oral health of individual patients as their primary focus but the aim of public health is to benefit populations. Early developments in dental public health were concerned largely with demonstrating levels of disease and with treatment services. With greater appreciation of the nature of oral health and disease, and of their determinants has come recognition of the need for wider public health action if the effects of prevention and oral health promotion are to be maximized.

  20. Health needs and public health functions addressed in scientific publications in Francophone sub-Saharan Africa.

    Science.gov (United States)

    Benie-Bi, J; Cambon, L; Grimaud, O; Kivits, J; Alla, F

    2013-09-01

    To describe the reporting of public health research in Francophone sub-Saharan Africa (FSA). A bibliometric research study of scientific public health publications in FSA, which includes 24 countries and approximately 260 million people. Two researchers analysed original articles published in 2007 in the medical or social sciences fields and indexed in Scopus. At least one co-author of articles had to be based in FSA. The analysis focused on research field, public health function (WHO classification), FSA country author's affiliation, language, journal type and global burden of disease (WHO classification). Of 1047 articles retrieved by the search, 212 were from the public health field. The number of articles per country varied from 0 to 36. Public health functions examined were health service research (24.5%), health monitoring (27.4%), prevention (15%) and legislation (0.5%). The distribution of health needs described in the articles was close to that of the WHO data for Africa for 2004: infectious and parasitic diseases (70% vs 54%), maternal and perinatal conditions (15% vs 17%), non-communicable diseases (15.6% vs 21%), and injuries (0.5% vs 8%). The areas reported in published articles from sub-Saharan Africa reflect the health needs distribution in Africa; however, the number of publications is low, particularly for prevention. In light of the current focus on evidence-based public health, this study questions whether the international scientific community adequately considers the expertise and perspectives of African researchers and professionals. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  1. Assessing entrepreneurship in governmental public health.

    Science.gov (United States)

    Jacobson, Peter D; Wasserman, Jeffrey; Wu, Helen W; Lauer, Johanna R

    2015-04-01

    We assessed the feasibility and desirability of public health entrepreneurship (PHE) in governmental public health. Using a qualitative case study approach with semistructured interview protocols, we conducted interviews between April 2010 and January 2011 at 32 local health departments (LHDs) in 18 states. Respondents included chief health officers and senior LHD staff, representatives from national public health organizations, health authorities, and public health institutes. Respondents identified PHE through 3 overlapping practices: strategic planning, operational efficiency, and revenue generation. Clinical services offer the strongest revenue-generating potential, and traditional public health services offer only limited entrepreneurial opportunities. Barriers include civil service rules, a risk-averse culture, and concerns that PHE would compromise core public health values. Ongoing PHE activity has the potential to reduce LHDs' reliance on unstable general public revenues. Yet under the best of circumstances, it is difficult to generate revenue from public health services. Although governmental public health contains pockets of entrepreneurial activity, its culture does not sustain significant entrepreneurial activity. The question remains as to whether LHDs' current public revenue sources are sustainable and, if not, whether PHE is a feasible or desirable alternative.

  2. A study of the importance of education and cost incentives on individual food choices at the Harvard School of Public Health cafeteria.

    Science.gov (United States)

    Michels, Karin B; Bloom, Barry R; Riccardi, Paul; Rosner, Bernard A; Willett, Walter C

    2008-02-01

    To investigate the importance of cost and awareness of health- or disease-promoting properties of foods and meals for choices by customers of a cafeteria. A non-randomized intervention study. A medium size cafeteria in the Harvard School of Public Health. Customers of the cafeteria mainly consisting of public health students, faculty, and school staff and workers from the medical campus. The purchase of healthy foods and dishes was subsidized and their prices reduced by 20%. This promotion was accompanied by the distribution of educational material. Change in consumption of healthy and less healthy foods. The geometric mean was used to calculate the change in consumption. During the intervention, we observed a 6% increase in the consumption of healthy foods (95% confidence interval [CI]; 5% to 8%), and a 2% decline in the consumption of less-healthy foods (95% CI; -1% to -4%). After the prices returned to their original levels, the consumption of healthy foods increased further to 17% (95% CI; 13% to 20%) and a 2% decline in the consumption of less-healthy foods (95% CI; % 1 to -5%) persisted. Subsidizing healthful meals and educating consumers about the importance of a healthy diet can result in a modest increase in the selection of healthy foods and meals that can be maintained beyond the periods of subsidy and promotion.

  3. Public health safety and environment in inadequate hospital and healthcare settings: a review.

    Science.gov (United States)

    Baguma, D

    2017-03-01

    Public health safety and environmental management are concerns that pose challenges worldwide. This paper briefly assesses a selected impact of the environment on public health. The study used an assessment of environmental mechanism to analyse the underlying different pathways in which the health sector is affected in inadequate hospital and health care settings. We reviewed the limited available evidence of the association between the health sector and the environment, and the likely pathways through which the environment influences health. The paper also models the use of private health care as a function of costs and benefits relative to public care and no care. The need to enhancing policies to improve the administration of health services, strengthening interventions on environment using international agreements, like Rio Conventions, including measures to control hospital-related infection, planning for human resources and infrastructure construction development have linkage to improve environment care and public health. The present study findings partly also demonstrate the influence of demand for health on the environment. The list of possible interventions includes enhancing policies to improve the administration of health services, strengthening Rio Conventions implementation on environmental concerns, control of environmental hazards and public health. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  4. Public Attitudes about Health Information Technology, and Its Relationship to Health Care Quality, Costs, and Privacy

    Science.gov (United States)

    Gaylin, Daniel S; Moiduddin, Adil; Mohamoud, Shamis; Lundeen, Katie; Kelly, Jennifer A

    2011-01-01

    Objective To understand Americans' attitudes concerning health information technology's (IT's) potential to improve health care and differences in those attitudes based on demographics and technological affinity. Data Sources/Study Setting A random-digit-dial sample with known probability of selection for every household in the United States with a telephone, plus a supplemental sample of cell phone users. Telephone interviews were conducted from August 2009 through November 2009. Study Design Data were analyzed to present univariate estimates of Americans' opinions of health IT, as well as multivariate logistic regressions to assess hypotheses relating individuals' characteristics to their opinions. Characteristics used in our model include age, race, ethnicity, gender, income, and affinity to technology. Findings A large majority (78 percent) favor use of electronic medical records (EMRs); believe EMRs could improve care and reduce costs (78 percent and 59 percent, respectively); believe benefits of EMR use outweigh privacy risks (64 percent); and support health care information sharing among providers (72 percent). Regression analyses show more positive attitudes among those with higher incomes and greater comfort using electronic technologies. Conclusion The findings suggest that American's believe that health IT adoption is an effective means to improve the quality and safety of health care. PMID:21275986

  5. Value of Public Health Funding in Preventing Hospital Bloodstream Infections in the United States.

    Science.gov (United States)

    Whittington, Melanie D; Bradley, Cathy J; Atherly, Adam J; Campbell, Jonathan D; Lindrooth, Richard C

    2017-11-01

    To estimate the association of 1 activity of the Prevention and Public Health Fund with hospital bloodstream infections and calculate the return on investment (ROI). The activity was funded for 1 year (2013). A difference-in-differences specification evaluated hospital standardized infection ratios (SIRs) before funding allocation (years 2011 and 2012) and after funding allocation (years 2013 and 2014) in the 15 US states that received the funding compared with hospital SIRs in states that did not receive the funding. We estimated the association of the funded public health activity with SIRs for bloodstream infections. We calculated the ROI by dividing cost offsets from infections averted by the amount invested. The funding was associated with a 33% (P < .05) reduction in SIRs and an ROI of $1.10 to $11.20 per $1 invested in the year of funding allocation (2013). In 2014, after the funding stopped, significant reductions were no longer evident. This activity was associated with a reduction in bloodstream infections large enough to recoup the investment. Public health funding of carefully targeted areas may improve health and reduce health care costs.

  6. 42 CFR 90.9 - Public health advisory.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Public health advisory. 90.9 Section 90.9 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS AND HEALTH... PROCEDURES § 90.9 Public health advisory. ATSDR may issue a public health advisory based on the findings of a...

  7. Determinants of evidence use in Public Health Policy making

    DEFF Research Database (Denmark)

    van de Goor, Ien; Hämäläinen, Riitta-Maija; Syed, Ahmed

    2017-01-01

    The knowledge-practice gap in public health is widely known. The importance of using different types of evidence for the development of effective health promotion has also been emphasized. Nevertheless, in practice, intervention decisions are often based on perceived short-term opportunities...... evidence, evidence on costs, and a lack of joint understanding were specific hindrances. Also users' characteristics and the role media play were identified as factors of influence. Attention for individual and social factors within the policy context might provide the key to enhance more sustainable...

  8. Cost-Benefit Analysis and the Marginal Cost of Public Funds

    OpenAIRE

    Lundholm, Michael

    2005-01-01

    The marginal cost of public funds defined as the ratio between the shadow price of tax revenues and the population average of the social marginal utility of income, is analysed within an explicit cost–benefit context. It is shown that for an optimal tax system the measure is always equal to one. Benefit and cost measures congruent with this definition are derived. Under optimal taxes a positive net social benefit is a necessary and sufficient condition for a project that passes the cost–benef...

  9. Obesity-related health impacts of fuel excise taxation- an evidence review and cost-effectiveness study

    Directory of Open Access Journals (Sweden)

    V. Brown

    2017-05-01

    Full Text Available Abstract Background Reducing automobile dependence and improving rates of active transport may reduce the impact of obesogenic environments, thereby decreasing population prevalence of obesity and other diseases where physical inactivity is a risk factor. Increasing the relative cost of driving by an increase in fuel taxation may therefore be a promising public health intervention for obesity prevention. Methods A scoping review of the evidence for obesity or physical activity effect of changes in fuel price or taxation was undertaken. Potential health benefits of an increase in fuel excise taxation in Australia were quantified using Markov modelling to simulate obesity, injury and physical activity related health impacts of a fuel excise taxation intervention for the 2010 Australian population. Health adjusted life years (HALYs gained and healthcare cost savings from diseases averted were estimated. Incremental cost-effectiveness ratios (ICERs were reported and results were tested through sensitivity analysis. Results Limited evidence on the effect of policies such as fuel taxation on health-related behaviours currently exists. Only three studies were identified reporting associations between fuel price or taxation and obesity, whilst nine studies reported associations specifically with physical activity, walking or cycling. Estimates of the cross price elasticity of demand for public transport with respect to fuel price vary, with limited consensus within the literature on a probable range for the Australian context. Cost-effectiveness modelling of a AUD0.10 per litre increase in fuel excise taxation using a conservative estimate of cross price elasticity for public transport suggests that the intervention would be cost-effective from a limited societal perspective (237 HALYs gained, AUD2.6 M in healthcare cost savings, measured against a comparator of no additional increase in fuel excise. Under “best case” assumptions, the intervention

  10. Wealth and Health Behavior: Testing the Concept of a Health Cost.

    Science.gov (United States)

    van Kippersluis, Hans; Galama, Titus J

    2014-11-01

    Wealthier individuals engage in healthier behavior. This paper seeks to explain this phenomenon by exploiting both inheritances and lottery winnings to test a theory of health behavior. We distinguish between the direct monetary cost and the indirect health cost (value of health lost) of unhealthy consumption. The health cost increases with wealth and the degree of unhealthiness, leading wealthier individuals to consume more healthy and moderately unhealthy, but fewer severely unhealthy goods. The empirical evidence presented suggests that differences in health costs may indeed partially explain behavioral differences, and ultimately health outcomes, between wealth groups.

  11. Cost of delivering health care services at primary health facilities in Ghana

    Directory of Open Access Journals (Sweden)

    Maxwell Ayindenaba Dalaba

    2017-11-01

    Full Text Available Abstract Background There is limited knowledge on the cost of delivering health services at primary health care facilities in Ghana which is posing a challenge in resource allocations. This study therefore estimated the cost of providing health care in primary health care facilities such as Health Centres (HCs and Community-based Health Planning and Services (CHPS in Ghana. Methods The study was cross-sectional and quantitative data was collected from the health provider perspective. Data was collected between July and August, 2016 at nine primary health facilities (six CHPS and three HCs from the Upper West region of Ghana. All health related costs for the year 2015 and revenue generated for the period were collected. Data were captured and analysed using Microsoft excel. Costs of delivery health services were estimated. In addition, unit costs such as cost per Outpatient Department (OPD attendance were estimated. Results The average annual cost of delivering health services through CHPS and HCs was US$10,923 and US$44,638 respectively. Personnel cost accounted for the largest proportion of cost (61% for CHPS and 59% for HC. The cost per OPD attendance was higher at CHPS (US$8.79 than at HCs (US$5.16. The average Internally Generated Funds (IGF recorded for the period at CHPS and HCs were US$2327 and US$ 15,795 respectively. At all the facilities, IGFs were greatly lower than costs of running the health facilities. Also, at both the CHPS and HCs, the National Health Insurance Scheme (NHIS reimbursement was the main source of revenue accounting for over 90% total IGF. Conclusions The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. The government should be guided by these findings in their financial planning, decision making and resource allocation in order to improve primary health care in the country. However, more similar

  12. GIS and Public Health

    Directory of Open Access Journals (Sweden)

    Stefania Bertazzon

    2014-06-01

    Full Text Available This Special Issue on GIS and public health is the result of a highly selective process, which saw the participation of some 20 expert peer-reviewers and led to the acceptance of one half of the high-quality submissions received over the past year. Many threads link these papers to each other and, indeed, to our original call for papers, but the element that most clearly emerges from these works is the inextricable connection between public health and the environment. Indeed, GIS analysis of public health simply cannot disregard the geospatial dimension of environmental resources and risks. What consistently emerges from these analyses is that current geospatial research can only scratch the surface of the complex interactions of spatial resources, risks, and public health. In today’s world, or at least in the developed world, researchers and practitioners can count on virtually endless data, on inexpensive computational power, and on seamless connectivity. In this research environment, these papers point to the need for improved analytical tools, covering concepts, representation, modeling and reliability. These works are important contributions that help us to identify what advances in geospatial analysis can better address the complex interactions of public health with our physical and cultural environment, and bridge research and practice, so that geospatial analyses can inform public health policy making. [...

  13. 48 CFR 1631.205-70 - FEHBP public relations and advertising costs.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true FEHBP public relations and... COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 1631.205-70 FEHBP public relations and advertising costs. (a) The cost of media messages that are directed at advising current FEHBP...

  14. Mental health in prisons: A public health agenda.

    Science.gov (United States)

    Fraser, A

    2009-01-01

    Mental illness affects the majority of prisoners. Mental health issues are beginning to take a central position in the development of prison health services, reflecting this burden of disease. This change in focus is not before time. But prison mental health services cannot exist in isolation. Public health systems should lead provision of care for patients with acute and severe illness. A whole prison approach to health and, specifically, mental health will offer the greatest likelihood that offenders will thrive, benefit from imprisonment, and lead law-abiding lives after release. Public awareness of the scale and commitment of prisons to mental health and illness, and understanding of prisons' role in society, are necessary developments that would protect and enhance public mental health, as well as creating a healthier and safer society. This article draws on recent reviews, information and statements to set out a public health agenda for mental health in prisons.

  15. Cost-benefit comparison of nuclear and nonnuclear health and safety protective measures and regulations

    International Nuclear Information System (INIS)

    O'Donnell, E.P.; Mauro, J.J.

    1979-01-01

    This article compares the costs and benefits of health and safety measures and regulations in the nuclear and nonnuclear fields. A cost-benefit methodology for nuclear safety concerns is presented and applied to existing nuclear plant engineered safety features. Comparisons in terms of investment costs to achieve reductions in mortality rates are then made between nuclear plant safety features and the protective measures and regulations associated with nonnuclear risks, particularly with coal-fired power plants. These comparisons reveal a marked inconsistency in the cost effectiveness of health and safety policy, in which nuclear regulatory policy requires much greater investments to reduce the risk of public mortality than is required in nonnuclear areas where reductions in mortality rates could be achieved at much lower cost. A specific example of regulatory disparity regarding gaseous effluent limits for nuclear and fossil-fuel power plants is presented. It is concluded that a consistent health and safety regulatory policy based on uniform risk and cost-benefit criteria should be adopted and that future proposed Nuclear Regulatory Commission regulatory requirements should be critically evaluated from a cost-benefit viewpoint

  16. Academic dental public health diplomates: their distribution and recommendations concerning the predoctoral dental public health faculty.

    Science.gov (United States)

    Kaste, L M; Sadler, Z E; Hayes, K L; Narendran, S; Niessen, L C; Weintraub, J A

    1998-01-01

    The purpose of this study was to assess the representation of academically based diplomates of the American Board of Dental Public Health (ABDPH) and to identify their perceptions on the training of dental public health predoctoral faculty. Data were collected by a mailed, self-administered, 13-item questionnaire. The population was the 48 diplomates of the ABDPH as of March 1997 associated with academic institutions. Twenty of the 55 US dental schools had a diplomate of the ABDPH with a mean of 1.8 diplomates per school with a diplomate. An average of 4.5 full-time faculty members per school were associated with teaching dental public health. A master's degree in public health (MPH) was the most frequently suggested educational requirement for dental public health faculty. Continuing education courses were training needs perceived for dental public health faculty. The lack of time, money, and incentives, along with perceived rigidity of requirements for board certification, were reported as major barriers for faculty becoming dental public health board certified. Numerous challenges confront the development of a strong dental public health presence in US dental schools. These challenges include, among others, insufficient numbers of academic dental public health specialists and insufficient motivations to encourage promising candidates to pursue specialty status.

  17. Who deserves health care? The effects of causal attributions and group cues on public attitudes about responsibility for health care costs.

    Science.gov (United States)

    Gollust, Sarah E; Lynch, Julia

    2011-12-01

    This research investigates the impact of cues about ascriptive group characteristics (race, class, gender) and the causes of ill health (health behaviors, inborn biological traits, social systemic factors) on beliefs about who deserves society's help in paying for the costs of medical treatment. Drawing on data from three original vignette experiments embedded in a nationally representative survey of American adults, we find that respondents are reluctant to blame or deny societal support in response to explicit cues about racial attributes--but equally explicit cues about the causal impact of individual behaviors on health have large effects on expressed attitudes. Across all three experiments, a focus on individual behavioral causes of illness is associated with increased support for individual responsibility for health care costs and lower support for government-financed health insurance. Beliefs about social groups and causal attributions are, however, tightly intertwined. We find that when groups suffering ill health are defined in racial, class, or gender terms, Americans differ in their attribution of health disparities to individual behaviors versus biological or systemic factors. Because causal attributions also affect health policy opinions, varying patterns of causal attribution may reinforce group stereotypes and undermine support for universal access to health care.

  18. Costs of publicly provided maternity services in Rosario, Argentina

    Directory of Open Access Journals (Sweden)

    Borghi Josephine

    2003-01-01

    Full Text Available OBJECTIVE: This study estimates the costs of maternal health services in Rosario, Argentina. MATERIAL AND METHODS: The provider costs (US$ 1999 of antenatal care, a normal vaginal delivery and a caesarean section, were evaluated retrospectively in two municipal hospitals. The cost of an antenatal visit was evaluated in two health centres and the patient costs associated with the visit were evaluated in a hospital and a health centre. RESULTS: The average cost per hospital day is $114.62. The average cost of a caesarean section ($525.57 is five times greater than that of a normal vaginal delivery ($105.61. A normal delivery costs less at the general hospital and a c-section less at the maternity hospital. The average cost of an antenatal visit is $31.10. The provider cost is lower at the health centre than at the hospital. Personnel accounted for 72-94% of the total cost and drugs and medical supplies between 4-26%. On average, an antenatal visit costs women $4.70. Direct costs are minimal compared to indirect costs of travel and waiting time. CONCLUSIONS: These results suggest the potential for increasing the efficiency of resource use by promoting antenatal care visits at the primary level. Women could also benefit from reduced travel and waiting time. Similar benefits could accrue to the provider by encouraging normal delivery at general hospitals, and complicated deliveries at specialised maternity hospitals.

  19. Utility and justice in public health.

    Science.gov (United States)

    MacKay, Kathryn

    2017-12-11

    Many public health practitioners and organizations view themselves as engaged in the promotion or achievement of equity. However, discussions around public health frequently assume that practitioners and policy-makers take a utilitarian approach to this work. I argue that public health is better understood as a social justice endeavor. I begin by presenting the utility view of public health and then discuss the equity view. This is a theoretical argument, which should help public health to justify interventions for communicable and non-communicable diseases equally, and which contributes to breaking down the 'old/new' public health divide. This argument captures practitioners' views of the work they are engaged in and allows for the moral and policy justification of important interventions in communicable and non-communicable diseases. Systemic interventions are necessary to remedy high rates of disease among certain groups and, generally, to improve the health of entire populations. By viewing diseases as partly the result of failures of health protective systems in society, public health may justify interventions in communicable and non-communicable diseases equally. Public health holds a duty to improve the health of the worst-off in society; by prioritizing this group, the health of the whole community may improve. © The Author(s) 2017. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  20. Public health

    NARCIS (Netherlands)

    Berg, van den A.E.

    2007-01-01

    Agnes van den Berg wrote an essay about human health and nature, establishing that subject as an important policy argument in developing (urban) nature in the Netherlands. She studied the public balance of fear and fascination for nature, summarising benefits on human health. In this chapter, she

  1. Objectives, Budgets, Thresholds, and Opportunity Costs-A Health Economics Approach: An ISPOR Special Task Force Report [4].

    Science.gov (United States)

    Danzon, Patricia M; Drummond, Michael F; Towse, Adrian; Pauly, Mark V

    2018-02-01

    The fourth section of our Special Task Force report focuses on a health plan or payer's technology adoption or reimbursement decision, given the array of technologies, on the basis of their different values and costs. We discuss the role of budgets, thresholds, opportunity costs, and affordability in making decisions. First, we discuss the use of budgets and thresholds in private and public health plans, their interdependence, and connection to opportunity cost. Essentially, each payer should adopt a decision rule about what is good value for money given their budget; consistent use of a cost-per-quality-adjusted life-year threshold will ensure the maximum health gain for the budget. In the United States, different public and private insurance programs could use different thresholds, reflecting the differing generosity of their budgets and implying different levels of access to technologies. In addition, different insurance plans could consider different additional elements to the quality-adjusted life-year metric discussed elsewhere in our Special Task Force report. We then define affordability and discuss approaches to deal with it, including consideration of disinvestment and related adjustment costs, the impact of delaying new technologies, and comparative cost effectiveness of technologies. Over time, the availability of new technologies may increase the amount that populations want to spend on health care. We then discuss potential modifiers to thresholds, including uncertainty about the evidence used in the decision-making process. This article concludes by discussing the application of these concepts in the context of the pluralistic US health care system, as well as the "excess burden" of tax-financed public programs versus private programs. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  2. Understanding your health care costs

    Science.gov (United States)

    ... ency/patientinstructions/000878.htm Understanding your health care costs To use the sharing features on this page, ... on out-of-pocket costs. Out-of-Pocket Costs The good news is there is a limit ...

  3. External Cost Assessment of Nuclear Power Plant Accident considering Public Risk Aversion Behavior: the Korean Case

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Hun; Kang, Hyun Gook [KAIST, Daejeon (Korea, Republic of)

    2016-05-15

    The conventional approach for monetary valuation of NPP accident consequence consists of calculating the expected value of various accident scenarios. However, the main criticism of the conventional approach is that there is a discrepancy between the social acceptability of the risk and the estimated expected value of NPP accident. Therefore, an integrated framework for the estimation of the external cost associated with an NPP accident considering the public risk aversion behavior was proposed in this study based on the constructed theoretical framework for estimating both the value of statistical life (VSL) and the risk aversion coefficient associated with an NPP accident to take account of the accident cost into the unit electricity generation cost of NPP. To estimate both parameters, an individual-level survey was conducted on a sample of 1,364 participants in Korea. Based on the collected survey responses, both parameters were estimated based on the proposed framework and the external cost of NPP accident was estimated based on the consequence analysis and considering the direct cost factors for NPP accident. Internalization of external costs into the comprehensive energy production cost has been considered as a potentially efficient policy instrument for a more sustainable energy supply and use. However, the internalization of externalities, such as public health damage, have raised a number of generic policy issues in a nuclear energy sector, with specific challenges resulting from the distinct characteristics of external cost estimation. Especially, the major challenge remained to address the public safety concerns regarding a nuclear accident, which can be specified as low-probability high-consequence accident, driven by the aspects of public risk aversion.

  4. External Cost Assessment of Nuclear Power Plant Accident considering Public Risk Aversion Behavior: the Korean Case

    International Nuclear Information System (INIS)

    Lee, Sang Hun; Kang, Hyun Gook

    2016-01-01

    The conventional approach for monetary valuation of NPP accident consequence consists of calculating the expected value of various accident scenarios. However, the main criticism of the conventional approach is that there is a discrepancy between the social acceptability of the risk and the estimated expected value of NPP accident. Therefore, an integrated framework for the estimation of the external cost associated with an NPP accident considering the public risk aversion behavior was proposed in this study based on the constructed theoretical framework for estimating both the value of statistical life (VSL) and the risk aversion coefficient associated with an NPP accident to take account of the accident cost into the unit electricity generation cost of NPP. To estimate both parameters, an individual-level survey was conducted on a sample of 1,364 participants in Korea. Based on the collected survey responses, both parameters were estimated based on the proposed framework and the external cost of NPP accident was estimated based on the consequence analysis and considering the direct cost factors for NPP accident. Internalization of external costs into the comprehensive energy production cost has been considered as a potentially efficient policy instrument for a more sustainable energy supply and use. However, the internalization of externalities, such as public health damage, have raised a number of generic policy issues in a nuclear energy sector, with specific challenges resulting from the distinct characteristics of external cost estimation. Especially, the major challenge remained to address the public safety concerns regarding a nuclear accident, which can be specified as low-probability high-consequence accident, driven by the aspects of public risk aversion

  5. Critical perspectives in public health

    National Research Council Canada - National Science Library

    Green, Judith; Labonte, Ronald N

    2008-01-01

    ... the contemporary roles of 'critical voices' in public health research and practice from a range of disciplines and contexts. The book covers many of the pressing concerns for public health practitioners and researchers, including: * * * * * the implications of new genetic technologies for public health; the impact of globalisation on local practice...

  6. Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: a modelling study.

    Science.gov (United States)

    Phillips, Andrew N; Cambiano, Valentina; Nakagawa, Fumiyo; Revill, Paul; Jordan, Michael R; Hallett, Timothy B; Doherty, Meg; De Luca, Andrea; Lundgren, Jens D; Mhangara, Mutsa; Apollo, Tsitsi; Mellors, John; Nichols, Brooke; Parikh, Urvi; Pillay, Deenan; Rinke de Wit, Tobias; Sigaloff, Kim; Havlir, Diane; Kuritzkes, Daniel R; Pozniak, Anton; van de Vijver, David; Vitoria, Marco; Wainberg, Mark A; Raizes, Elliot; Bertagnolio, Silvia

    2018-03-01

    There is concern over increasing prevalence of non-nucleoside reverse-transcriptase inhibitor (NNRTI) resistance in people initiating antiretroviral therapy (ART) in low-income and middle-income countries. We assessed the effectiveness and cost-effectiveness of alternative public health responses in countries in sub-Saharan Africa where the prevalence of pretreatment drug resistance to NNRTIs is high. The HIV Synthesis Model is an individual-based simulation model of sexual HIV transmission, progression, and the effect of ART in adults, which is based on extensive published data sources and considers specific drugs and resistance mutations. We used this model to generate multiple setting scenarios mimicking those in sub-Saharan Africa and considered the prevalence of pretreatment NNRTI drug resistance in 2017. We then compared effectiveness and cost-effectiveness of alternative policy options. We took a 20 year time horizon, used a cost effectiveness threshold of US$500 per DALY averted, and discounted DALYs and costs at 3% per year. A transition to use of a dolutegravir as a first-line regimen in all new ART initiators is the option predicted to produce the most health benefits, resulting in a reduction of about 1 death per year per 100 people on ART over the next 20 years in a situation in which more than 10% of ART initiators have NNRTI resistance. The negative effect on population health of postponing the transition to dolutegravir increases substantially with higher prevalence of HIV drug resistance to NNRTI in ART initiators. Because of the reduced risk of resistance acquisition with dolutegravir-based regimens and reduced use of expensive second-line boosted protease inhibitor regimens, this policy option is also predicted to lead to a reduction of overall programme cost. A future transition from first-line regimens containing efavirenz to regimens containing dolutegravir formulations in adult ART initiators is predicted to be effective and cost-effective in

  7. Development of Systematic Knowledge Management for Public Health: A Public Health Law Ontology

    Science.gov (United States)

    Keeling, Jonathan

    2012-01-01

    The Institute of Medicine has stated that legal structures and the authority vested in health agencies and other partners within the public health system are essential to improving the public's health. Variation between the laws of different jurisdictions within the United States allows for natural experimentation and research into their…

  8. Use of communication technology among public health professionals in New South Wales, Australia.

    Science.gov (United States)

    Naylor, Carlie-Jane; Madden, D Lynne; Oong, Deborah J

    2007-01-01

    We explored how six forms of communication technology (teleconferencing, web bulletin boards, web conferencing, videoconferencing, media streaming and satellite television) are currently being used in public health work in NSW. Twelve public health professionals working in the NSW health service were interviewed. Teleconferencing and videoconferencing were the most commonly used forms of communication technology. Factors that facilitated use included ease of access to facilities and assistance in organising and setting up the technique. Barriers to use included cost and the perception that the equipment was hard to set up and operate. Participants identified factors that assisted them to engage with these techniques.

  9. 48 CFR 2131.205-1 - Public relations and advertising costs.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Public relations and... REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 2131.205-1 Public relations and advertising costs. The provisions of FAR 31.205-1 shall be modified to include the following...

  10. Public health leadership education in North America

    OpenAIRE

    Uno, Hideo; Zakariasen,Kenneth

    2010-01-01

    Hideo Uno, Kenneth ZakariasenDepartment of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, AB, CanadaAbstract: Public health leadership is one of the priority disciplines public health professionals need to learn well if they are to deal with demanding public health issues effectively and efficiently. This article looks at the trends in public health leadership education by reviewing the literature and using the Internet to explore the public health leadershi...

  11. 48 CFR 30.102 - Cost Accounting Standards Board publication.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost Accounting Standards... REGULATION GENERAL CONTRACTING REQUIREMENTS COST ACCOUNTING STANDARDS ADMINISTRATION General 30.102 Cost Accounting Standards Board publication. Copies of the CASB Standards and Regulations are printed in title 48...

  12. Conceptualizing ORGANIZATIONAL HEALTH - Public health management and leadership perspectives

    OpenAIRE

    Orvik, Arne

    2016-01-01

    The thesis introduces a new conceptual model of organizational health and discusses its implications for public health management and leadership. It is developed with reference to organizational theories and ideologies, including New Public Management, the use of which has coincided with increasing workplace health problems in health care organizations. The model is based on empirical research and theories in the fields of public health, health care organization and management, and institutio...

  13. Job-based health insurance: costs climb at a moderate pace.

    Science.gov (United States)

    Claxton, Gary; DiJulio, Bianca; Whitmore, Heidi; Pickreign, Jeremy; McHugh, Megan; Finder, Benjamin; Osei-Anto, Awo

    2009-01-01

    Each year the Kaiser/HRET Survey of Employer Health Benefits takes a snapshot of the state of employee benefits in the United States, based on interviews with public and private employers. Our findings for 2009 show that families continue to face higher premiums, up about 5 percent from last year, and that cost sharing in the form of deductibles and copayments for office visits is greater as well. Average annual premiums in 2009 were $4,824 for single coverage and $13,375 for family coverage. Enrollment in high-deductible health plans held steady. We offer new insights about health risk assessments and how firms responded to the economic downturn.

  14. TERLIPRESSIN VERSUS NORADRENALINE FOR HEPATORENAL SYNDROME. Economic evaluation under the perspective of the Brazilian Public Health System

    Directory of Open Access Journals (Sweden)

    Ângelo Zambam de MATTOS

    Full Text Available ABSTRACT Background - Terlipressin and noradrenaline are the best studied treatments for hepatorenal syndrome, and there is no evidence of superiority of one over the other regarding to efficacy. While the former drug is more costly, the latter requires admission into an intensive care unit. Objective - The aim of this study was to perform an economic evaluation, comparing treatments for hepatorenal syndrome with terlipressin and noradrenaline. Methods - For the economic evaluation, a cost-minimization analysis was performed. Direct medical costs of the two treatment strategies were compared under the perspective of the Brazilian Public Health System as the third-party payer. A probabilistic sensitivity analysis was performed. Results - The costs of treatments with terlipressin or noradrenaline were 287.77 and 2,960.45 International Dollars (Int$ respectively. Treatment using terlipressin would save Int$2,672.68 for the Public Health System for each hospital admission related to hepatorenal syndrome. In the probabilistic sensitivity analysis, it was verified that the cost of the treatment with noradrenaline could vary between Int$2,326.53 and Int$3,644.16, while costs related to the treatment using terlipressin are not variable. Conclusion - The treatment strategy using terlipressin was more economical than that using noradrenaline under the perspective of the Brazilian Public Health System as the third-party payer.

  15. Public Choices, Private Costs: An Analysis of Spending and Achievement in Ohio Public Schools.

    Science.gov (United States)

    Damask, James; Lawson, Robert

    This report sets up a structure for examining the real costs of public education. It defines three approaches of gathering and reporting cost information: narrow (salaries and current expenditures, excluding capital outlays); generally accepted accounting principles (GAAP) (costs are recorded during the period in which they occur); and broad (all…

  16. The hidden costs of nuclear power

    International Nuclear Information System (INIS)

    Keough, C.

    1981-01-01

    The two basic hidden costs of nuclear power are public money and public health. Nuclear power appears to be economical because many of the costs of producins electricity in these plants are paid by the federal government. So, like it or not, the citizens are footing the bill with their taxes. Design and development of plants have been paid for with public money, and disposal and cleanup costs will also be paid in this manner. The economic and health costs associated with nuclear accidents are staggering

  17. Social Return on Investment (SROI) methodology to account for value for money of public health interventions: a systematic review.

    Science.gov (United States)

    Banke-Thomas, Aduragbemi Oluwabusayo; Madaj, Barbara; Charles, Ameh; van den Broek, Nynke

    2015-06-24

    Increased scarcity of public resources has led to a concomitant drive to account for value-for-money of interventions. Traditionally, cost-effectiveness, cost-utility and cost-benefit analyses have been used to assess value-for-money of public health interventions. The social return on investment (SROI) methodology has capacity to measure broader socio-economic outcomes, analysing and computing views of multiple stakeholders in a singular monetary ratio. This review provides an overview of SROI application in public health, explores lessons learnt from previous studies and makes recommendations for future SROI application in public health. A systematic review of peer-reviewed and grey literature to identify SROI studies published between January 1996 and December 2014 was conducted. All articles describing conduct of public health SROI studies and which reported a SROI ratio were included. An existing 12-point framework was used to assess study quality. Data were extracted using pre-developed codes: SROI type, type of commissioning organisation, study country, public health area in which SROI was conducted, stakeholders included in study, discount rate used, SROI ratio obtained, time horizon of analysis and reported lessons learnt. 40 SROI studies, of varying quality, including 33 from high-income countries and 7 from low middle-income countries, met the inclusion criteria. SROI application increased since its first use in 2005 until 2011, declining afterwards. SROI has been applied across different public health areas including health promotion (12 studies), mental health (11), sexual and reproductive health (6), child health (4), nutrition (3), healthcare management (2), health education and environmental health (1 each). Qualitative and quantitative methods have been used to gather information for public health SROI studies. However, there remains a lack of consensus on who to include as beneficiaries, how to account for counterfactual and appropriate study

  18. Act No. 1989.003 of 23 March 1989 fixing the general principles of public health in the Central African Republic.

    Science.gov (United States)

    1989-01-01

    This Central African Republic Act provides the following with respect to the right to health care: "1. All citizens have the right to health. 2. All citizens shall be entitled to a free choice of physician. 3. The rights referred to in Sections 1 and 2 shall be conditional on the financial contribution of the citizen in question for the various health benefits made available to him by the public health services as a whole. 4. The Government shall define general policy, determine the organization and functioning of the public and private health services, and improvement of the health of the population, and to improve the lot of the individuals and social groups making up the national community. 5. In order to ensure that establishments in the public sector function properly, their administration shall be carried out either within the normal framework of the financial system of the public sector or in partial independence. 6. The tariffs for all of the services provided in establishments in the public sector shall be fixed within the framework of the Law on finance. 7. In the payment of health costs, the practice of payment by a third party shall be authorized. To this end, contracts to meet the costs of health services for employees in the private or public sectors may be concluded between, on the one hand, the department responsible for public health, and, on the other, private corporations and undertakings, quasi-public corporations, associations and corporations, and mutual social welfare associations. 8. Civil servants and other employees of the State and their families and other social and economic categories shall contribute to health costs in accordance with a proportion which shall be defined by a decree adopted in the Council of Ministers. 9. The State shall meet the health costs of patients recognized as welfare cases. Only patients holding a welfare card may have their expenses met in this way. The card shall be issued by the State or local authorities in

  19. The Carter Center Mental Health Program: addressing the public health crisis in the field of mental health through policy change and stigma reduction.

    Science.gov (United States)

    Palpant, Rebecca G; Steimnitz, Rachael; Bornemann, Thomas H; Hawkins, Katie

    2006-04-01

    Some of the most pervasive and debilitating illnesses are mental illnesses, according to World Health Organization's The World Health Report 2001--Mental Health: New Understanding, New Hope. Neuropsychiatric conditions account for four of the top five leading causes of years of life lived with disability in people aged 15 to 44 in the Western world. Many barriers prevent people with mental illnesses from seeking care, such as prohibitive costs, lack of insurance, and the stigma and discrimination associated with mental illnesses. The Carter Center Mental Health Program, established in 1991, focuses on mental health policy issues within the United States and internationally. This article examines the public health crisis in the field of mental health and focuses on The Carter Center Mental Health Program's initiatives, which work to increase public knowledge of and decrease the stigma associated with mental illnesses through their four strategic goals: reducing stigma and discrimination against people with mental illnesses; achieving equity of mental health care comparable with other health services; advancing early promotion, prevention, and early intervention services for children and their families; and increasing public awareness about mental illnesses and mental health issues.

  20. 42 CFR 417.540 - Enrollment costs.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Enrollment costs. 417.540 Section 417.540 Public... PLANS Medicare Payment: Cost Basis § 417.540 Enrollment costs. (a) Principle. Enrollment costs are... of costs included. Enrollment costs include, but are not limited to, reasonable costs incurred in...

  1. PPACA and public health: creating a framework to focus on prevention and wellness and improve the public's health.

    Science.gov (United States)

    Majette, Gwendolyn Roberts

    2011-01-01

    PPACA epitomizes comprehensive health care reform legislation. Public health, disease prevention, and wellness were integral considerations in its development. This article reveals the author's personal experiences while working on the framework for health care reform in the United States Senate and reviews activity in the United States House of Representatives. This insider's perspective delineates PPACA's positive effect on public health by examining the infrastructure Congress designed to focus on prevention, wellness, and public health, with a particular focus on the National Prevention, Health Promotion and Public Health Council; the National Prevention, Health Promotion, Public Health, and Integrative Health Care Strategy; and the Prevention and Public Health Fund. The Council, strategy, and fund are especially important because they reflect compliance with some of the Institute of Medicine's recommendations to improve public health in the United States, as well as international health and human rights norms that protect the right to health. © 2011 American Society of Law, Medicine & Ethics, Inc.

  2. One Health Perspectives on Emerging Public Health Threats

    Directory of Open Access Journals (Sweden)

    Sukhyun Ryu

    2017-11-01

    Full Text Available Antimicrobial resistance and emerging infectious diseases, including avian influenza, Ebola virus disease, and Zika virus disease have significantly affected humankind in recent years. In the premodern era, no distinction was made between animal and human medicine. However, as medical science developed, the gap between human and animal science grew deeper. Cooperation among human, animal, and environmental sciences to combat emerging public health threats has become an important issue under the One Health Initiative. Herein, we presented the history of One Health, reviewed current public health threats, and suggested opportunities for the field of public health through better understanding of the One Health paradigm.

  3. A Study of the Importance of Education and Cost Incentives on Individual Food Choices at the Harvard School of Public Health Cafeteria

    Science.gov (United States)

    Michels, Karin B.; Bloom, Barry R.; Riccardi, Paul; Rosner, Bernard A.; Willett, Walter C.

    2013-01-01

    Objectives To investigate the importance of cost and awareness of health- or disease-promoting properties of foods and meals for choices by customers of a cafeteria. Design A non-randomized intervention study. Setting A medium size cafeteria in the Harvard School of Public Health. Participants Customers of the cafeteria mainly consisting of public health students, faculty, and school staff and workers from the medical campus. Intervention The purchase of healthy foods and dishes was subsidized and their prices reduced by 20%. This promotion was accompanied by the distribution of educational material. Main Outcome Measures Change in consumption of healthy and less healthy foods. Analysis The geometric mean was used to calculate the change in consumption. Results During the intervention, we observed a 6% increase in the consumption of healthy foods (95% confidence interval [CI]; 5% to 8%), and a 2% decline in the consumption of less-healthy foods (95% CI; −1% to −4%). After the prices returned to their original levels, the consumption of healthy foods increased further to 17% (95% CI; 13% to 20%) and a 2% decline in the consumption of less-healthy foods (95% CI; % 1 to −5%) persisted. Conclusions Subsidizing healthful meals and educating consumers about the importance of a healthy diet can result in a modest increase in the selection of healthy foods and meals that can be maintained beyond the periods of subsidy and promotion. PMID:18460476

  4. Climate Change and Public Health.

    Science.gov (United States)

    Ciesielski, Timothy

    2017-05-01

    It is clear that the public health community is concerned about the human health impacts of climate change, but are we inadvertently underestimating the scope of the problem and obfuscating potentially useful interventions by using a narrow intellectual frame in our discussions with policy makers? If we take a more holistic approach, we see that the public health impacts of climate change are only one subset of the enormous public health impacts of fossil fuel burning. This broader perspective can provide a more accurate and comprehensive assessment that is more useful for decision making in public policy settings.

  5. Liberalism and Public Health Ethics.

    Science.gov (United States)

    Rajczi, Alex

    2016-02-01

    Many public health dilemmas involve a tension between the promotion of health and the rights of individuals. This article suggests that we should resolve the tension using our familiar liberal principles of government. The article considers the common objections that (i) liberalism is incompatible with standard public health interventions such as anti-smoking measures or intervention in food markets; (2) there are special reasons for hard paternalism in public health; and (3) liberalism is incompatible with proper protection of the community good. The article argues that we should examine these critiques in a larger methodological framework by first acknowledging that the right theory of public health ethics is the one we arrive at in reflective equilibrium. Once we examine the arguments for and against liberalism in that light, we can see the weaknesses in the objections and the strength of the case for liberalism in public health. © 2015 John Wiley & Sons Ltd.

  6. The marginal cost of public funds

    DEFF Research Database (Denmark)

    Kleven, Henrik Jacobsen; Kreiner, Claus Thustrup

    2006-01-01

    This paper extends the theory and measurement of the marginal cost of public funds (MCF) to account for labor force participation responses. Our work is motivated by the emerging consensus in the empirical literature that extensive (participation) responses are more important than intensive (hours...... of work) responses. In the modelling of extensive responses, we argue that it is crucial to account for the presence of non-convexities created by fixed work costs. In a non-convex framework, tax and transfer reforms give rise to discrete participation responses generating first-order effects...

  7. Enhancing crisis leadership in public health emergencies.

    Science.gov (United States)

    Deitchman, Scott

    2013-10-01

    Reviews of public health emergency responses have identified a need for crisis leadership skills in health leaders, but these skills are not routinely taught in public health curricula. To develop criteria for crisis leadership in public health, published sources were reviewed to identify attributes of successful crisis leadership in aviation, public safety, military operations, and mining. These sources were abstracted to identify crisis leadership attributes associated with those disciplines and compare those attributes with crisis leadership challenges in public health. Based on this review, the following attributes are proposed for crisis leadership in public health: competence in public health science; decisiveness with flexibility; ability to maintain situational awareness and provide situational assessment; ability to coordinate diverse participants across very different disciplines; communication skills; and the ability to inspire trust. Of these attributes, only competence in public health science is currently a goal of public health education. Strategies to teach the other proposed attributes of crisis leadership will better prepare public health leaders to meet the challenges of public health crises.

  8. Criteria for Drug Reimbursement Decision-Making: An Emerging Public Health Challenge in Bulgaria

    Directory of Open Access Journals (Sweden)

    Georgi Iskrov

    2016-02-01

    Full Text Available Background: During times of fiscal austerity, means of reimbursement decision-making are of particular interest for public health theory and practice. Introduction of advanced health technologies, growing health expenditures and increased public scrutiny over drug reimbursement decisions have pushed governments to consider mechanisms that promote the use of effective health technologies, while constraining costs. Aims: The study’s aim was to explore the current rationale of the drug reimbursement decision-making framework in Bulgaria. Our pilot research focused on one particular component of this process – the criteria used – because of the critical role that criteria are known to have in setting budgets and priorities in the field of public health. The analysis pursued two objectives: to identify important criteria relevant to drug reimbursement decision-making and to unveil relationships between theory and practice. Study Design: Cross-sectional study. Methods: The study was realized through a closed-ended survey on reimbursement criteria among four major public health stakeholders – medical professionals, patients, health authorities, and industry. Empirical outcomes were then cross-compared with the theoretical framework, as defined by current Bulgarian public health legislation. Analysis outlined what is done and what needs to be done in the field of public health reimbursement decision-making. Results: Bulgarian public health stakeholders agreed on 15 criteria to form a tentative optimal framework for drug reimbursement decision-making. The most apparent gap between the empirically found preferences and the official legislation is the lack of consideration for the strength of evidence in reimbursement decisions. Conclusion: Bulgarian policy makers need to address specific gaps, such as formal consideration for strength of evidence, explicit role of efficiency criteria, and means to effectively empower patient and citizen

  9. Conceptualizing ORGANIZATIONAL HEALTH - Public health management and leadership perspectives

    DEFF Research Database (Denmark)

    Orvik, Arne

    The thesis introduces a new conceptual model of organizational health and discusses its implications for public health management and leadership. It is developed with reference to organizational theories and ideologies, including New Public Management, the use of which has coincided with increasing...... as the disintegration of such values. Possible implications for public health management and leadership include four different forms. The application of the conceptual model can potentially draw attention to value conflicts and help to clarify contradictory, institutional logics. It can also potentially support health...... workplace health problems in health care organizations. The model is based on empirical research and theories in the fields of public health, health care organization and management, and institutional theory. It includes five dimensions and defines organizational health in terms of how an organization...

  10. Socio-economic costs of indoor air pollution: A tentative estimation for some pollutants of health interest in France.

    Science.gov (United States)

    Boulanger, Guillaume; Bayeux, Thomas; Mandin, Corinne; Kirchner, Séverine; Vergriette, Benoit; Pernelet-Joly, Valérie; Kopp, Pierre

    2017-07-01

    An evaluation of the socio-economic costs of indoor air pollution can facilitate the development of appropriate public policies. For the first time in France, such an evaluation was conducted for six selected pollutants: benzene, trichloroethylene, radon, carbon monoxide, particles (PM 2.5 fraction), and environmental tobacco smoke (ETS). The health impacts of indoor exposure were either already available in published works or were calculated. For these calculations, two approaches were followed depending on the available data: the first followed the principles of quantitative health risk assessment, and the second was based on concepts and methods related to the health impact assessment. For both approaches, toxicological data and indoor concentrations related to each target pollutant were used. External costs resulting from mortality, morbidity (life quality loss) and production losses attributable to these health impacts were assessed. In addition, the monetary costs for the public were determined. Indoor pollution associated with the selected pollutants was estimated to have cost approximately €20 billion in France in 2004. Particles contributed the most to the total cost (75%), followed by radon. Premature death and the costs of the quality of life loss accounted for approximately 90% of the total cost. Despite the use of different methods and data, similar evaluations previously conducted in other countries yielded figures within the same order of magnitude. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. How Automation Can Help Alleviate the Budget Crunch in Public Health Research.

    Science.gov (United States)

    Muennig, Peter A

    2015-09-01

    In an era of severe funding constraints for public health research, more efficient means of conducting research will be needed if scientific progress is to continue. At present major funders, such as the National Institutes of Health, do not provide specific instructions to grant authors or to reviewers regarding the cost efficiency of the research that they conduct. Doing so could potentially allow more research to be funded within current budgetary constraints and reduce waste. I describe how a blinded randomized trial was conducted for $ 275,000 by completely automating the consent and data collection processes. The study used the participants' own computer equipment, relied on big data for outcomes, and outsourced some costly tasks, potentially saving $1 million in research costs.

  12. Unpacking the financial costs of "bariatric tourism" gone wrong: Who holds responsibility for costs to the Canadian health care system?

    Science.gov (United States)

    Snyder, Jeremy C; Silva, Diego S; Crooks, Valorie A

    2016-12-01

    Canadians are motivated to travel abroad for bariatric surgery owing to wait times for care and restrictions on access at home for various reasons. While such surgery abroad is typically paid for privately, if "bariatric tourists" experience complications or have other essential medical needs upon their return to Canada, these costs are borne by the publicly funded health system. In this commentary, we discuss why assigning responsibility for the costs of complications stemming from bariatric tourism is complicated and contextual.

  13. The Laugh Model: Reframing and Rebranding Public Health Through Social Media.

    Science.gov (United States)

    Lister, Cameron; Royne, Marla; Payne, Hannah E; Cannon, Ben; Hanson, Carl; Barnes, Michael

    2015-11-01

    We examined the use of low-cost social media platforms in communicating public health messages and outline the laugh model, a framework through which public health organizations can reach and engage communities. In August 2014, we developed an online campaign (Web site and social media) to help promote healthy family meals in Utah in conjunction with the state and local health departments. By the end of September 2014, a total of 3641 individuals had visited the Utahfamilymeals.org Web site. Facebook ads reached a total of 29 078 people, and 56 900 people were reached through Twitter ads. The per-person price of the campaign was 0.2 cents, and the total estimated target population reach was between 10% and 12%. There are 3 key takeaways from our campaign: use of empowering and engaging techniques may be more effective than use of educational techniques; use of social media Web sites and online marketing tactics can enhance collaboration, interdisciplinary strategies, and campaign effectiveness; and use of social media as a communication platform is often preferable to use of mass media in terms of cost-effectiveness, more precise evaluations of campaign success, and increased sustainability.

  14. Public sector cost management practices in The Netherlands

    NARCIS (Netherlands)

    Verbeeten, Frank H.m.

    2011-01-01

    Purpose – The purpose of this research project is to validate the claim that recent developments in the public sector have increased the demand for and use of cost management information in public sector organizations. Design/methodology/approach – The approach taken is a survey of financial

  15. Surfing the net for public health resources.

    Science.gov (United States)

    Angell, C; Hemingway, A; Hartwell, H

    2011-08-01

    To identify public health open educational resources (OER) available online, map the identified OER to The Public Health Skills and Career Framework (PHSCF), and triangulate these findings with public health practitioners. Systematic online search for public health OER. An online search was undertaken using a pre-defined set of search terms and inclusion/exclusion criteria. Public health OER were then mapped against the UK PHSCF. The findings of the search were discussed with public health specialists to determine whether or not they used these resources. A number of public health OER were identified, located on 42 websites from around the world. Mapping against the UK PHSCF demonstrated a lack of coverage in some areas of public health education. It was noted that many of the OER websites identified were not those generally used in practice, and those sites preferred by public health specialists were not identified by the online search. Public health OER are available from a number of providers, frequently universities and government organizations. However, these reflect a relatively small pool of original OER providers. Tagging of websites does not always identify their public health content. In addition, users of public health OER may not use search engines to identify resources but locate them using other means. Copyright © 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  16. High and rising health care costs.

    Science.gov (United States)

    Ginsburg, Paul B

    2008-10-01

    The U.S. is spending a growing share of the GDP on health care, outpacing other industrialized countries. This synthesis examines why costs are higher in the U.S. and what is driving their growth. Key findings include: health care inefficiency, medical technology and health status (particularly obesity) are the primary drivers of rising U.S. health care costs. Health payer systems that reward inefficiencies and preempt competition have impeded productivity gains in the health care sector. The best evidence indicates medical technology accounts for one-half to two-thirds of spending growth. While medical malpractice insurance and defensive medicine contribute to health costs, they are not large enough factors to significantly contribute to a rise in spending. Research is consistent that demographics will not be a significant factor in driving spending despite the aging baby boomers.

  17. Intercultural competency in public health: a call for action to incorporate training into public health education

    Directory of Open Access Journals (Sweden)

    Julia eFleckman

    2015-09-01

    Full Text Available Due to increasing national diversity, programs addressing cultural competence have multiplied in U.S. medical training institutions. Little progress has been made to translate cultural competency training from the clinical setting into the public health setting where the focus is on population-based health, preventative programming, and epidemiological and behavioral research. The need for culturally relevant public health programming and culturally sensitive public health research is more critical than ever. Awareness of differing cultural roles needs to be included in all processes of planning, implementation and evaluation. In focusing on community-based health program planning and research, cultural competence implies that it is possible for public health professionals to completely know another culture, whereas intercultural competence implies it is a dual-sided process. Public health professionals need a commitment toward intercultural competence and skills that demonstrate flexibility, openness and self-reflection so that cultural learning is possible. In this article, the authors recommend a number of elements to develop, adapt and strengthen intercultural competence education in public health educational institutions.

  18. Teratogens: a public health issue – a Brazilian overview

    Directory of Open Access Journals (Sweden)

    Thiago Mazzu-Nascimento

    2017-05-01

    Full Text Available Abstract Congenital anomalies are already the second cause of infant mortality in Brazil, as in many other middle-income countries in Latin America. Birth defects are a result of both genetic and environmental factors, but a multifactorial etiology has been more frequently observed. Here, we address the environmental causes of birth defects – or teratogens – as a public health issue and present their mechanisms of action, categories and their respective maternal-fetal deleterious effects. We also present a survey from 2008 to 2013 of Brazilian cases involving congenital anomalies (annual average of 20,205, fetal deaths (annual average of 1,530, infant hospitalizations (annual average of 82,452, number of deaths of hospitalized infants (annual average of 2,175, and the average cost of hospitalizations (annual cost of $7,758. Moreover, we report on Brazilian cases of teratogenesis due to the recent Zika virus infection, and to the use of misoprostol, thalidomide, alcohol and illicit drugs. Special attention has been given to the Zika virus infection, now proven to be responsible for the microcephaly outbreak in Brazil, with 8,039 cases under investigation (from October 2015 to June 2016. From those cases, 1,616 were confirmed and 324 deaths occurred due to microcephaly complications or alterations on the central nervous system. Congenital anomalies impact life quality and raise costs in specialized care, justifying the classification of teratogens as a public health issue.

  19. Teratogens: a public health issue – a Brazilian overview

    Science.gov (United States)

    Mazzu-Nascimento, Thiago; Melo, Débora Gusmão; Morbioli, Giorgio Gianini; Carrilho, Emanuel; Vianna, Fernanda Sales Luiz; da Silva, André Anjos; Schuler-Faccini, Lavinia

    2017-01-01

    Abstract Congenital anomalies are already the second cause of infant mortality in Brazil, as in many other middle-income countries in Latin America. Birth defects are a result of both genetic and environmental factors, but a multifactorial etiology has been more frequently observed. Here, we address the environmental causes of birth defects – or teratogens – as a public health issue and present their mechanisms of action, categories and their respective maternal-fetal deleterious effects. We also present a survey from 2008 to 2013 of Brazilian cases involving congenital anomalies (annual average of 20,205), fetal deaths (annual average of 1,530), infant hospitalizations (annual average of 82,452), number of deaths of hospitalized infants (annual average of 2,175), and the average cost of hospitalizations (annual cost of $7,758). Moreover, we report on Brazilian cases of teratogenesis due to the recent Zika virus infection, and to the use of misoprostol, thalidomide, alcohol and illicit drugs. Special attention has been given to the Zika virus infection, now proven to be responsible for the microcephaly outbreak in Brazil, with 8,039 cases under investigation (from October 2015 to June 2016). From those cases, 1,616 were confirmed and 324 deaths occurred due to microcephaly complications or alterations on the central nervous system. Congenital anomalies impact life quality and raise costs in specialized care, justifying the classification of teratogens as a public health issue. PMID:28534929

  20. The State Public Health Laboratory System.

    Science.gov (United States)

    Inhorn, Stanley L; Astles, J Rex; Gradus, Stephen; Malmberg, Veronica; Snippes, Paula M; Wilcke, Burton W; White, Vanessa A

    2010-01-01

    This article describes the development since 2000 of the State Public Health Laboratory System in the United States. These state systems collectively are related to several other recent public health laboratory (PHL) initiatives. The first is the Core Functions and Capabilities of State Public Health Laboratories, a white paper that defined the basic responsibilities of the state PHL. Another is the Centers for Disease Control and Prevention National Laboratory System (NLS) initiative, the goal of which is to promote public-private collaboration to assure quality laboratory services and public health surveillance. To enhance the realization of the NLS, the Association of Public Health Laboratories (APHL) launched in 2004 a State Public Health Laboratory System Improvement Program. In the same year, APHL developed a Comprehensive Laboratory Services Survey, a tool to measure improvement through the decade to assure that essential PHL services are provided.

  1. Public health financial management needs: report of a national survey.

    Science.gov (United States)

    Costich, Julia F; Honoré, Peggy A; Scutchfield, F Douglas

    2009-01-01

    The work reported here builds on the identification of public health financial management practice competencies by a national expert panel. The next logical step was to provide a validity check for the competencies and identify priority areas for educational programming. We developed a survey for local public health finance officers based on the public health finance competencies and field tested it with a convenience sample of officials. We asked respondents to indicate the importance of each competency area and the need for training to improve performance; we also requested information regarding respondent education, jurisdiction size, and additional comments. Our local agency survey sample drew on the respondent list from the National Association of County and City Health Officials 2005 local health department survey, stratified by agency size and limited to jurisdiction populations of 25,000 to 1,000,000. Identifying appropriate respondents was a major challenge. The survey was fielded electronically, yielding 112 responses from 30 states. The areas identified as most important and needing most additional training were knowledge of budget activities, financial data interpretation and communication, and ability to assess and correct the organization's financial status. The majority of respondents had some postbaccalaureate education. Many provided additional comments and recommendations. Health department finance officers demonstrated a high level of general agreement regarding the importance of finance competencies in public health and the need for training. The findings point to a critical need for additional training opportunities that are accessible, cost-effective, and targeted to individual needs.

  2. Ethics in public health: call for shared moral public health literacy.

    Science.gov (United States)

    Maeckelberghe, Els L M; Schröder-Bäck, Peter

    2017-10-01

    Public Health (PH) in Europe has become much more vocal about its moral understandings since 1992. The rising awareness that PH issues were inseparable from issues of human rights and social justice almost self-evidently directed the agenda of EUPHA and the European Public Health (EPH)-conferences. Problems of cultural and behavioural change, and environmental issues on a global scale were also added. The Section Ethics in PH invited the EPH community to join in 'arm chair thinking': coming together at conferences not only to share the 'how' and 'what' of PH research, practices and policies but also the 'why'. Time has been reserved to genuinely discuss what moral values are at stake in the work of PH and to actively develop a moral language and framework for PH Ethics. The challenge for the next decades is to find ways to involve the general public in the cultivation of a shared moral PH literacy. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  3. Intercultural Competency in Public Health: A Call for Action to Incorporate Training into Public Health Education.

    Science.gov (United States)

    Fleckman, Julia M; Dal Corso, Mark; Ramirez, Shokufeh; Begalieva, Maya; Johnson, Carolyn C

    2015-01-01

    Due to increasing national diversity, programs addressing cultural competence have multiplied in U.S. medical training institutions. Although these programs share common goals for improving clinical care for patients and reducing health disparities, there is little standardization across programs. Furthermore, little progress has been made to translate cultural competency training from the clinical setting into the public health setting where the focus is on population-based health, preventative programming, and epidemiological and behavioral research. The need for culturally relevant public health programming and culturally sensitive public health research is more critical than ever. Awareness of differing cultures needs to be included in all processes of planning, implementation and evaluation. By focusing on community-based health program planning and research, cultural competence implies that it is possible for public health professionals to completely know another culture, whereas intercultural competence implies it is a dual-sided process. Public health professionals need a commitment toward intercultural competence and skills that demonstrate flexibility, openness, and self-reflection so that cultural learning is possible. In this article, the authors recommend a number of elements to develop, adapt, and strengthen intercultural competence education in public health educational institutions.

  4. Identifying an Australian ‘Shadow’ Benefit / Cost Ratio for Public Projects

    OpenAIRE

    Lawrence, Craig

    2009-01-01

    This paper examines the social opportunity cost of a hypothetical public project in Australia and compares these values with the cost of the project as measured by factor prices. Since 2001, the Australian taxation system has included an ad valorem tax, the Goods and Services Tax, however relatively little analysis of the impact of this tax on public project evaluation methods has been undertaken. This tax creates divergences between social opportunity cost and conventional cost measures. The...

  5. Conventional and ecological public health.

    Science.gov (United States)

    Rayner, G

    2009-09-01

    This paper suggests that current models of public health are no longer sufficient as a means for understanding the health challenges of the anthropogenic age, and argues for an alternative based upon an ecological model. The roots of this perspective originated within the Victorian era, although it found only limited expression at that time. Ecological thinking in public health has only been revived relatively recently. Derived from an analysis of obesity, this paper proposes the development of an approach to ecological public health based on four dimensions of existence: the material, the physiological, the social and the cultural-cognitive. The implications for public policy are considered.

  6. A health impact assessment of proposed public transportation service cuts and fare increases in Boston, Massachusetts (U.S.A.).

    Science.gov (United States)

    James, Peter; Ito, Kate; Buonocore, Jonathan J; Levy, Jonathan I; Arcaya, Mariana C

    2014-08-07

    Transportation decisions have health consequences that are often not incorporated into policy-making processes. Health Impact Assessment (HIA) is a process that can be used to evaluate health effects of transportation policy. We present a rapid HIA, conducted over eight weeks, evaluating health and economic effects of proposed fare increases and service cuts to Boston, Massachusetts' public transportation system. We used transportation modeling in concert with tools allowing for quantification and monetization of multiple pathways. We estimated health and economic costs of proposed public transportation system changes to be hundreds of millions of dollars per year, exceeding the budget gap the public transportation authority was required to close. Significant health pathways included crashes, air pollution, and physical activity. The HIA enabled stakeholders to advocate for more modest fare increases and service cuts, which were eventually adopted by decision makers. This HIA was among the first to quantify and monetize multiple pathways linking transportation decisions with health and economic outcomes, using approaches that could be applied in different settings. Including health costs in transportation decisions can lead to policy choices with both economic and public health benefits.

  7. A Health Impact Assessment of Proposed Public Transportation Service Cuts and Fare Increases in Boston, Massachusetts (U.S.A.

    Directory of Open Access Journals (Sweden)

    Peter James

    2014-08-01

    Full Text Available Transportation decisions have health consequences that are often not incorporated into policy-making processes. Health Impact Assessment (HIA is a process that can be used to evaluate health effects of transportation policy. We present a rapid HIA, conducted over eight weeks, evaluating health and economic effects of proposed fare increases and service cuts to Boston, Massachusetts’ public transportation system. We used transportation modeling in concert with tools allowing for quantification and monetization of multiple pathways. We estimated health and economic costs of proposed public transportation system changes to be hundreds of millions of dollars per year, exceeding the budget gap the public transportation authority was required to close. Significant health pathways included crashes, air pollution, and physical activity. The HIA enabled stakeholders to advocate for more modest fare increases and service cuts, which were eventually adopted by decision makers. This HIA was among the first to quantify and monetize multiple pathways linking transportation decisions with health and economic outcomes, using approaches that could be applied in different settings. Including health costs in transportation decisions can lead to policy choices with both economic and public health benefits.

  8. Understanding the Political Economy of the Evolution and Future of Single-Payer Public Health Insurance in Canada (Technical Paper

    Directory of Open Access Journals (Sweden)

    J.C. Herbert Emery

    2010-02-01

    Full Text Available Surprisingly little attention has been paid to how we pay for health care affects how much we spend on health care. In this paper, the author discusses how non-contributory finance and effective subsidization of public health care spending with federal cost sharing crowded out demand for private insurance as voters opted for high levels of public health spending.

  9. Public and private hospital services reform using data envelopment analysis to measure technical, scale, allocative, and cost efficiencies.

    Science.gov (United States)

    Sheikhzadeh, Yaghoub; Roudsari, Abdul V; Vahidi, Reza Gholi; Emrouznejad, Ali; Dastgiri, Saeed

    2012-01-01

    The aim of this study was to suggest a suitable context to develop efficient hospital systems while maintaining the quality of care at minimum expenditures. This research aimed to present a model of efficiency for selected public and private hospitals of East Azerbaijani Province of Iran by making use of Data Envelopment Analysis approach in order to recognize and suggest the best practice standards. Among the six inefficient hospitals, 2 (33%) had a technical efficiency score of less than 50% (both private), 2 (33%) between 51 and 74% (one private and one public) and the rest (2, 33%) between 75 and 99% (one private and one public). In general, the public hospitals are relatively more efficient than private ones; it is recommended for inefficient hospitals to make use of the followings: transferring, selling, or renting idle/unused beds; transferring excess doctors and nurses to the efficient hospitals or other health centers; pensioning off, early retirement clinic officers, technicians/technologists, and other technical staff. The saving obtained from the above approaches could be used to improve remuneration for remaining staff and quality of health care services of hospitals, rural and urban health centers, support communities to start or sustain systematic risk and resource pooling and cost sharing mechanisms for protecting beneficiaries against unexpected health care costs, compensate the capital depreciation, increasing investments, and improve diseases prevention services and facilities in the provincial level.

  10. Costs and benefits with public and investor-owned electric systems

    International Nuclear Information System (INIS)

    Bronner, K.M.

    1990-01-01

    This article discusses the analysis of the costs and benefits associated with public ownership of major utility projects and systems as opposed to private ownership. The topics discussed include the alleged benefits of public power systems, principles of cost benefit analysis, tax-exempt debt, state and local taxes and federal income taxes, benefit of 100 percent debt financing

  11. THE EU’S COSTS OF SOCIOECONOMIC “HEALTH GAPS”

    Directory of Open Access Journals (Sweden)

    Unita Lucian

    2008-05-01

    Full Text Available During the past two decades, socioeconomic inequalities in health have increasingly been recognized as an important public health issue throughout Europe. As a result, there has been a considerable research effort which has permitted the emphasis of academic research to gradually shift from description to explanation. And as a consequence of that, entry-points for interventions and policies have been identified, providing the building-blocks with which policy-makers and practitioners have begun to design strategies to reduce socioeconomic inequalities in health. Although relatively little is known yet about the effectiveness of these strategies, it is possible to make some educated guesses about their potential impact on the economic implications of health inequalities in the European Union. And this way, investing in health should not only be seen as a cost to society, but also as a potential driver of economic growth.

  12. Why feminism in public health?

    Science.gov (United States)

    Hammarström, A

    1999-12-01

    The issues raised in this editorial and exemplified within a number of the studies reported in this issue indicate new directions for public health, directions which take feminist scholarship, both outside and within the medical framework, into account. The changing potential of feminist public health, as derived from the articles in this issue, can be summarised within the following issues: new research areas, positioning women as actors, development of theoretical frameworks, reflexive theory of science, interplay between sex and gender, gender-sensitive methods, diversities among women/men, pro-feminist research on men's health and using the results for change. Thus, feminist public health represents a shift towards the new public health, with holistic and multidisciplinary activities, based on theoretical pluralism, multiple perspectives and collective actions with the aim of improving the health of gender-subordinated groups.

  13. Education Improves Public Health and Promotes Health Equity.

    Science.gov (United States)

    Hahn, Robert A; Truman, Benedict I

    2015-01-01

    This article describes a framework and empirical evidence to support the argument that educational programs and policies are crucial public health interventions. Concepts of education and health are developed and linked, and we review a wide range of empirical studies to clarify pathways of linkage and explore implications. Basic educational expertise and skills, including fundamental knowledge, reasoning ability, emotional self-regulation, and interactional abilities, are critical components of health. Moreover, education is a fundamental social determinant of health - an upstream cause of health. Programs that close gaps in educational outcomes between low-income or racial and ethnic minority populations and higher-income or majority populations are needed to promote health equity. Public health policy makers, health practitioners and educators, and departments of health and education can collaborate to implement educational programs and policies for which systematic evidence indicates clear public health benefits. © The Author(s) 2015.

  14. Cost Comparison Model: Blended eLearning versus traditional training of community health workers.

    Science.gov (United States)

    Sissine, Mysha; Segan, Robert; Taylor, Mathew; Jefferson, Bobby; Borrelli, Alice; Koehler, Mohandas; Chelvayohan, Meena

    2014-01-01

    Another one million community healthcare workers are needed to address the growing global population and increasing demand of health care services. This paper describes a cost comparison between two training approaches to better understand costs implications of training community health workers (CHWs) in Sub-Saharan Africa. Our team created a prospective model to forecast and compare the costs of two training methods as described in the Dalburge Report - (1) a traditional didactic training approach ("baseline") and (2) a blended eLearning training approach ("blended"). After running the model for training 100,000 CHWs, we compared the results and scaled up those results to one million CHWs. A substantial difference exists in total costs between the baseline and blended training programs. RESULTS indicate that using a blended eLearning approach for training community health care workers could provide a total cost savings of 42%. Scaling the model to one million CHWs, the blended eLearning training approach reduces total costs by 25%. The blended eLearning savings are a result of decreased classroom time, thereby reducing the costs associated with travel, trainers and classroom costs; and using a tablet with WiFi plus a feature phone rather than a smartphone with data plan. The results of this cost analysis indicate significant savings through using a blended eLearning approach in comparison to a traditional didactic method for CHW training by as much as 67%. These results correspond to the Dalberg publication which indicates that using a blended eLearning approach is an opportunity for closing the gap in training community health care workers.

  15. Investing in health: is social housing value for money? A cost-utility analysis.

    Science.gov (United States)

    Lawson, K D; Kearns, A; Petticrew, M; Fenwick, E A L

    2013-10-01

    There is a healthy public policy agenda investigating the health impacts of improving living conditions. However, there are few economic evaluations, to date, assessing value for money. We conducted the first cost-effectiveness analysis of a nationwide intervention transferring social and private tenants to new-build social housing, in Scotland. A quasi-experimental prospective study was undertaken involving 205 intervention households and 246 comparison households, over 2 years. A cost-utility analysis assessed the average cost per change in health utility (a single score summarising overall health-related quality of life), generated via the SF-6D algorithm. Construction costs for new builds were included. Analysis was conducted for all households, and by family, adult and elderly households; with estimates adjusted for baseline confounders. Outcomes were annuitised and discounted at 3.5%. The average discounted cost was £18, 708 per household, at a national programme cost of £ 28.4 million. The average change in health utility scores in the intervention group attributable to the intervention were +0.001 for all households, +0.001 for family households, -0.04 for adult households and -0.03 for elderly households. All estimates were statistically insignificant. At face value, the interventions were not value for money in health terms. However, because the policy rationale was the amenity provision of housing for disadvantaged groups, impacts extend beyond health and may be fully realised over the long term. Before making general value-for-money inferences, economic evaluation should attempt to estimate the full social value of interventions, model long-term impacts and explicitly incorporate equity considerations.

  16. Cost Accounting as a Possible Solution for Financial Sustainability of Croatian Public Hospitals

    Directory of Open Access Journals (Sweden)

    Ivana Dražić Lutilsky

    2016-12-01

    Full Text Available The purpose of this paper is to present the current usage of cost accounting methodology in Croatian public hospitals through conducted empirical research and to provide opinions of accountants and financial officers regarding possible implementation of cost accounting methodology in public hospitals. In the paper, the authors analyze the accounting system in Croatian public hospitals, identifying the flaws of the current accounting system with regard to the recording and allocation of costs. National healthcare systems of different European countries provide a theoretical background for the usage of accrual accounting basis and cost accounting methodologies, showing better governance and financial sustainability of public hospitals which have introduced cost accounting methodology. The conducted empirical research shows that accountants and financial officers believe that the healthcare system in Croatia is ready for a change in the current accounting system based on the modified accrual basis through the implementation of accrual accounting basis and full costing approach to cost allocation. Full costing approach is also known as activity-based accounting method for cost allocation. The authors also recommend some initial steps for implementation of the new cost accounting system in Croatian public hospitals.

  17. African Programme For Onchocerciasis Control 1995-2015: model-estimated health impact and cost.

    Science.gov (United States)

    Coffeng, Luc E; Stolk, Wilma A; Zouré, Honorat G M; Veerman, J Lennert; Agblewonu, Koffi B; Murdoch, Michele E; Noma, Mounkaila; Fobi, Grace; Richardus, Jan Hendrik; Bundy, Donald A P; Habbema, Dik; de Vlas, Sake J; Amazigo, Uche V

    2013-01-01

    Onchocerciasis causes a considerable disease burden in Africa, mainly through skin and eye disease. Since 1995, the African Programme for Onchocerciasis Control (APOC) has coordinated annual mass treatment with ivermectin in 16 countries. In this study, we estimate the health impact of APOC and the associated costs from a program perspective up to 2010 and provide expected trends up to 2015. With data on pre-control prevalence of infection and population coverage of mass treatment, we simulated trends in infection, blindness, visual impairment, and severe itch using the micro-simulation model ONCHOSIM, and estimated disability-adjusted life years (DALYs) lost due to onchocerciasis. We assessed financial costs for APOC, beneficiary governments, and non-governmental development organizations, excluding cost of donated drugs. We estimated that between 1995 and 2010, mass treatment with ivermectin averted 8.2 million DALYs due to onchocerciasis in APOC areas, at a nominal cost of about US$257 million. We expect that APOC will avert another 9.2 million DALYs between 2011 and 2015, at a nominal cost of US$221 million. Our simulations suggest that APOC has had a remarkable impact on population health in Africa between 1995 and 2010. This health impact is predicted to double during the subsequent five years of the program, through to 2015. APOC is a highly cost-effective public health program. Given the anticipated elimination of onchocerciasis from some APOC areas, we expect even more health gains and a more favorable cost-effectiveness of mass treatment with ivermectin in the near future.

  18. African Programme For Onchocerciasis Control 1995-2015: model-estimated health impact and cost.

    Directory of Open Access Journals (Sweden)

    Luc E Coffeng

    Full Text Available Onchocerciasis causes a considerable disease burden in Africa, mainly through skin and eye disease. Since 1995, the African Programme for Onchocerciasis Control (APOC has coordinated annual mass treatment with ivermectin in 16 countries. In this study, we estimate the health impact of APOC and the associated costs from a program perspective up to 2010 and provide expected trends up to 2015.With data on pre-control prevalence of infection and population coverage of mass treatment, we simulated trends in infection, blindness, visual impairment, and severe itch using the micro-simulation model ONCHOSIM, and estimated disability-adjusted life years (DALYs lost due to onchocerciasis. We assessed financial costs for APOC, beneficiary governments, and non-governmental development organizations, excluding cost of donated drugs. We estimated that between 1995 and 2010, mass treatment with ivermectin averted 8.2 million DALYs due to onchocerciasis in APOC areas, at a nominal cost of about US$257 million. We expect that APOC will avert another 9.2 million DALYs between 2011 and 2015, at a nominal cost of US$221 million.Our simulations suggest that APOC has had a remarkable impact on population health in Africa between 1995 and 2010. This health impact is predicted to double during the subsequent five years of the program, through to 2015. APOC is a highly cost-effective public health program. Given the anticipated elimination of onchocerciasis from some APOC areas, we expect even more health gains and a more favorable cost-effectiveness of mass treatment with ivermectin in the near future.

  19. Applications of health information exchange information to public health practice.

    Science.gov (United States)

    Kierkegaard, Patrick; Kaushal, Rainu; Vest, Joshua R

    2014-01-01

    Increased information availability, timeliness, and comprehensiveness through health information exchange (HIE) can support public health practice. The potential benefits to disease monitoring, disaster response, and other public health activities served as an important justification for the US' investments in HIE. After several years of HIE implementation and funding, we sought to determine if any of the anticipated benefits of exchange participation were accruing to state and local public health practitioners participating in five different exchanges. Using qualitative interviews and template analyses, we identified public health efforts and activities that were improved by participation in HIE. HIE supported public health activities consistent with expectations in the literature. However, no single department realized all the potential benefits of HIE identified. These findings suggest ways to improve HIE usage in public health.

  20. A scoping review of the public health impact of vitamin D-fortified dairy products for fracture prevention.

    Science.gov (United States)

    Hiligsmann, Mickael; Neuprez, Audrey; Buckinx, Fanny; Locquet, Médéa; Reginster, Jean-Yves

    2017-12-01

    Dairy products are rich in nutrients that positively influence bone health and hence fracture risk, and have therefore been recommended and used for fracture prevention. To help decision makers to efficiently allocate scare resources, it is further important to assess the public health and economic impact of any health intervention. In recent years, several studies have been conducted to estimate the public health and/or economic impact of dairy products but no overview is currently available. This article aims therefore to summarize evidence and review articles that estimated the public health and/or economic impact of vitamin D-fortified dairy products for fracture prevention. A literature review was conducted using PubMed to identify original studies that assessed the public health and/or economic impact of dairy products (or of calcium/vitamin D supplementation) for fracture prevention up to January 15, 2017. Seven articles were identified. Different strategies were used by the authors to model the economic/public health impact of dairy products. The four studies assessing the public health impact of dairy products revealed a substantial benefit in terms of fracture prevented, life years, disability-adjusted life years and/or quality-adjusted life years gained. Studies assessing the cost-effectiveness revealed that the use of dairy products is generally cost-effective in the general population aged above 70 years, and from the age of 60 years in populations at high risk of fractures. This systematic review suggests that the use of dairy products could substantially reduce the burden of osteoporotic fractures and seem to be an economically beneficial strategy.

  1. The NIHR Public Health Research Programme: responding to local authority research needs in the United Kingdom.

    Science.gov (United States)

    Dorling, Hannah; Cook, Andrew; Ollerhead, Liz; Westmore, Matt

    2015-12-11

    The remit of the National Institute for Health Research Public Health Research (PHR) Programme is to evaluate public health interventions, providing new knowledge on the benefits, costs, acceptability and wider impacts of interventions, set outside of the National Health Service, intended to improve the health of the public and reduce inequalities. This paper illustrates how the PHR Programme is providing new knowledge for public health decision makers, based on the nine key areas for local authority public health action, described by the King's Fund. Many funded PHR projects are evaluating interventions, applied in a range of settings, across the identified key areas for local authority influence. For example, research has been funded on children and young people, and for some of the wider determinants of health, such as housing and travel. Other factors, such as spatial planning, or open and green spaces and leisure, are less represented in the PHR Programme. Further opportunities in research include interventions to improve the health of adolescents, adults in workplaces, and communities. Building evidence for public health interventions at local authority level is important to prioritise and implement effective changes to improve population health.

  2. The Great Recession And Increased Cost Sharing In European Health Systems.

    Science.gov (United States)

    Palladino, Raffaele; Lee, John Tayu; Hone, Thomas; Filippidis, Filippos T; Millett, Christopher

    2016-07-01

    European health systems are increasingly adopting cost-sharing models, potentially increasing out-of-pocket expenditures for patients who use health care services or buy medications. Government policies that increase patient cost sharing are responding to incremental growth in cost pressures from aging populations and the need to invest in new health technologies, as well as to general constraints on public expenditures resulting from the Great Recession (2007-09). We used data from the Survey of Health, Ageing and Retirement in Europe to examine changes from 2006-07 to 2013 in out-of-pocket expenditures among people ages fifty and older in eleven European countries. Our results identify increases both in the proportion of older European citizens who incurred out-of-pocket expenditures and in mean out-of-pocket expenditures over this period. We also identified a significant increase over time in the percentage of people who incurred catastrophic health expenditures (greater than 30 percent of the household income) in the Czech Republic, Italy, and Spain. Poorer populations were less likely than those in the highest income quintile to incur an out-of-pocket expenditure and reported lower mean out-of-pocket expenditures, which suggests that measures are in place to provide poorer groups with some financial protection. These findings indicate the substantial weakening of financial protection for people ages fifty and older in European health systems after the Great Recession. Project HOPE—The People-to-People Health Foundation, Inc.

  3. Public health emergencies in urban India

    Directory of Open Access Journals (Sweden)

    Bhabani Prasad Acharya

    2018-03-01

    Full Text Available Public health emergencies in urban India can be caused by natural or man-made disasters. Occurrence of a public health emergency adds to the already stretched health system. This paper looks into the public health emergency conditions in urban India, and our preparedness to tackle them. To address this composite threat to nation’s health and development, a concerted public health response is needed, that can ensure efficient delivery in emergency situations Public health emergency is an occurrence or eminent threat of an illness or health condition caused by bio-terrorism, epidemic or pandemic disease, or novel and highly fatal infectious agent or biological toxin, that possess a substantial risk of a significant number of human facilities or incidents or permanent or long–term disability (1. It is a condition that requires the government to declare a state of public health emergency. The declaration of a state of public health emergency permits the government to suspend state regulations,and change the functions of state agencies (2. Term “Urban” refers to perplexing variety of environments.  Health circumstances of small cities and town differ in many ways from larger cities and metros. Within cities, change in lifestyle of residents is observed. The urban system is often present with full array of health providers ranging from traditional healer, street drug seller to highly –trained surgeons (3.

  4. Influencing public health without authority.

    Science.gov (United States)

    Suresh, K

    2012-01-01

    This paper analyzes the present processes, products and needs of post-graduate public health education for the health programming, implementation and oversight responsibilities at field level and suggests some solutions for the institutes to adopt or adapt for improving the quality of their scholars. Large number of institutions has cropped up in India in the recent years to meet the growing demand of public health specialists/practitioners in various national health projects, international development partners, national and international NGOs. Throwing open MPH courses to multi-disciplinary graduate's is a new phenomenon in India and may be a two edged sword. On one hand it is advantageous to produce multi-faceted Public health postgraduates to meet the multi tasking required, on the other hand getting all of them to a common basic understanding, demystifying technical teaching and churning out products that are acceptable to the traditional health system. These Institutions can and must influence public health in the country through producing professionals of MPH/ MD degree with right attitude and skill-mix. Engaging learners in experimentation, experience sharing projects, stepping into health professionals' roles and similar activities lead to development of relatively clear and permanent neural traces in the brain. The MPH institutes may not have all efficient faculties, for which they should try to achieve this by inviting veterans in public health and professionals from corporate health industry for interface with students on a regular basis. The corporate and public health stalwarts have the capacities to transmit the winning skills and knowledge and also inspire them to adopt or adapt in order to achieve the desired goals.

  5. Role of information systems in public health services.

    Science.gov (United States)

    Hartshorne, J E; Carstens, I L

    1990-07-01

    The purpose of this review is to establish a conceptual framework on the role of information systems in public health care. Information is indispensable for effective management and development of health services and therefore considered as an important operational asset or resource. A Health Information System is mainly required to support management and operations at four levels: namely transactional and functional; operational control; management planning and control; and strategic planning. To provide the necessary information needs of users at these levels of management in the health care system, a structured information system coupled with appropriate information technology is required. Adequate and relevant information is needed regarding population characteristics, resources available and expended, output and outcome of health care activities. Additionally information needs to be reliable, accurate, timely, easily accessible and presented in a compact and meaningful form. With a well-planned health information system health authorities would be in a position to provide a quality, cost-effective and efficient health service for as many people as need it, optimal utilisation of resources and to maintain and improve the community's health status.

  6. Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program.

    Science.gov (United States)

    Frost, Jennifer J; Sonfield, Adam; Zolna, Mia R; Finer, Lawrence B

    2014-12-01

    Policy Points: The US publicly supported family planning effort serves millions of women and men each year, and this analysis provides new estimates of its positive impact on a wide range of health outcomes and its net savings to the government. The public investment in family planning programs and providers not only helps women and couples avoid unintended pregnancy and abortion, but also helps many thousands avoid cervical cancer, HIV and other sexually transmitted infections, infertility, and preterm and low birth weight births. This investment resulted in net government savings of $13.6 billion in 2010, or $7.09 for every public dollar spent. Each year the United States' publicly supported family planning program serves millions of low-income women. Although the health impact and public-sector savings associated with this program's services extend well beyond preventing unintended pregnancy, they never have been fully quantified. Drawing on an array of survey data and published parameters, we estimated the direct national-level and state-level health benefits that accrued from providing contraceptives, tests for the human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), Pap tests and tests for human papillomavirus (HPV), and HPV vaccinations at publicly supported family planning settings in 2010. We estimated the public cost savings attributable to these services and compared those with the cost of publicly funded family planning services in 2010 to find the net public-sector savings. We adjusted our estimates of the cost savings for unplanned births to exclude some mistimed births that would remain publicly funded if they had occurred later and to include the medical costs for births through age 5 of the child. In 2010, care provided during publicly supported family planning visits averted an estimated 2.2 million unintended pregnancies, including 287,500 closely spaced and 164,190 preterm or low birth weight (LBW) births, 99

  7. The cost-effectiveness and public health benefit of nalmefene added to psychosocial support for the reduction of alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels: a Markov model

    Science.gov (United States)

    Laramée, Philippe; Brodtkorb, Thor-Henrik; Rahhali, Nora; Knight, Chris; Barbosa, Carolina; François, Clément; Toumi, Mondher; Daeppen, Jean-Bernard; Rehm, Jürgen

    2014-01-01

    Objectives To determine whether nalmefene combined with psychosocial support is cost-effective compared with psychosocial support alone for reducing alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels (DRLs) as defined by the WHO, and to evaluate the public health benefit of reducing harmful alcohol-attributable diseases, injuries and deaths. Design Decision modelling using Markov chains compared costs and effects over 5 years. Setting The analysis was from the perspective of the National Health Service (NHS) in England and Wales. Participants The model considered the licensed population for nalmefene, specifically adults with both alcohol dependence and high/very high DRLs, who do not require immediate detoxification and who continue to have high/very high DRLs after initial assessment. Data sources We modelled treatment effect using data from three clinical trials for nalmefene (ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941)). Baseline characteristics of the model population, treatment resource utilisation and utilities were from these trials. We estimated the number of alcohol-attributable events occurring at different levels of alcohol consumption based on published epidemiological risk-relation studies. Health-related costs were from UK sources. Main outcome measures We measured incremental cost per quality-adjusted life year (QALY) gained and number of alcohol-attributable harmful events avoided. Results Nalmefene in combination with psychosocial support had an incremental cost-effectiveness ratio (ICER) of £5204 per QALY gained, and was therefore cost-effective at the £20 000 per QALY gained decision threshold. Sensitivity analyses showed that the conclusion was robust. Nalmefene plus psychosocial support led to the avoidance of 7179 alcohol-attributable diseases/injuries and 309 deaths per 100 000 patients compared to psychosocial support alone over the course of 5 years. Conclusions

  8. A practical approach for calculating reliable cost estimates from observational data: application to cost analyses in maternal and child health.

    Science.gov (United States)

    Salemi, Jason L; Comins, Meg M; Chandler, Kristen; Mogos, Mulubrhan F; Salihu, Hamisu M

    2013-08-01

    Comparative effectiveness research (CER) and cost-effectiveness analysis are valuable tools for informing health policy and clinical care decisions. Despite the increased availability of rich observational databases with economic measures, few researchers have the skills needed to conduct valid and reliable cost analyses for CER. The objectives of this paper are to (i) describe a practical approach for calculating cost estimates from hospital charges in discharge data using publicly available hospital cost reports, and (ii) assess the impact of using different methods for cost estimation in maternal and child health (MCH) studies by conducting economic analyses on gestational diabetes (GDM) and pre-pregnancy overweight/obesity. In Florida, we have constructed a clinically enhanced, longitudinal, encounter-level MCH database covering over 2.3 million infants (and their mothers) born alive from 1998 to 2009. Using this as a template, we describe a detailed methodology to use publicly available data to calculate hospital-wide and department-specific cost-to-charge ratios (CCRs), link them to the master database, and convert reported hospital charges to refined cost estimates. We then conduct an economic analysis as a case study on women by GDM and pre-pregnancy body mass index (BMI) status to compare the impact of using different methods on cost estimation. Over 60 % of inpatient charges for birth hospitalizations came from the nursery/labor/delivery units, which have very different cost-to-charge markups (CCR = 0.70) than the commonly substituted hospital average (CCR = 0.29). Using estimated mean, per-person maternal hospitalization costs for women with GDM as an example, unadjusted charges ($US14,696) grossly overestimated actual cost, compared with hospital-wide ($US3,498) and department-level ($US4,986) CCR adjustments. However, the refined cost estimation method, although more accurate, did not alter our conclusions that infant/maternal hospitalization costs

  9. Twitter and Public Health (Part 1): How Individual Public Health Professionals Use Twitter for Professional Development.

    Science.gov (United States)

    Hart, Mark; Stetten, Nichole E; Islam, Sabrina; Pizarro, Katherine

    2017-09-20

    The use of social networking sites is increasingly being adopted in public health, in part, because of the barriers to funding and reduced resources. Public health professionals are using social media platforms, specifically Twitter, as a way to facilitate professional development. The objective of this study was to identify public health professionals using Twitter and to analyze how they use this platform to enhance their formal and informal professional development within the context of public health. Keyword searches were conducted to identify and invite potential participants to complete a survey related to their use of Twitter for public health and professional experiences. Data regarding demographic attributes, Twitter usage, and qualitative information were obtained through an anonymous Web-based survey. Open-response survey questions were analyzed using the constant comparison method. "Using Twitter makes it easier to expand my networking opportunities" and "I find Twitter useful for professional development" scored highest, with a mean score of 4.57 (standard deviation [SD] 0.74) and 4.43 (SD 0.76) on a 5-point Likert scale. Analysis of the qualitative data shows the emergence of the following themes for why public health professionals mostly use Twitter: (1) geography, (2) continuing education, (3) professional gain, and (4) communication. For public health professionals in this study, Twitter is a platform best used for their networking and professional development. Furthermore, the use of Twitter allows public health professionals to overcome a series of barriers and enhances opportunities for growth. ©Mark Hart, Nichole E Stetten, Sabrina Islam, Katherine Pizarro. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 20.09.2017.

  10. Public health terminology: Hindrance to a Health in All Policies approach?

    Science.gov (United States)

    Synnevåg, Ellen S; Amdam, Roar; Fosse, Elisabeth

    2018-02-01

    National public health policies in Norway are based on a Health in All Policies (HiAP) approach. At the local level, this means that public health, as a cross-sectional responsibility, should be implemented in all municipal sectors by integrating public health policies in municipal planning and management systems. The paper investigates these local processes, focusing on the use of public health terminology and how this terminology is translated from national to local contexts. We ask whether the terms 'public health' and 'public health work' are suitable when implementing an HiAP approach. A qualitative case study based on analyses of interviews and planning documents was performed in three Norwegian municipalities. The results present dilemmas associated with using public health terminology when implementing an HiAP approach. On the one hand, the terms are experienced as wide, complex, advanced and unnecessary. On the other hand, the terms are experienced as important for a systematic approach towards understanding public health ideology and cross-sectional responsibility. One municipality used alternative terminology. This paper promotes debate about the appropriateness of using the terms 'public health' and 'public health work' at the local level. It suggests that adaptation is suitable and necessary, unless it compromises knowledge, responsibility and a systematic approach. This study concludes that the use of terminology is a central factor when implementing the Norwegian Public Health Act at the local level.

  11. Public health challenges in sun protection.

    Science.gov (United States)

    Eide, Melody J; Weinstock, Martin A

    2006-01-01

    Sunscreens are a popular choice for protection from ultraviolet radiation, and hence, important components in the public health campaign to reduce the burden of skin cancer. Public health messages in skin cancer prevention have been used effectively in educational campaigns. The benefits of sunscreen extend beyond skin cancer prevention into other aspects of health and disease prevention: sunscreen decreases the risk for sunburn during physical activity outdoors and seems not to increase the risk for osteoporosis. Public health efforts have laid a solid foundation on which to face the continuing challenge of promoting and developing effective public health campaigns and health policies that encourage sunscreen use, sun protection, and the primary prevention of skin cancer. In this article, the controversies, concerns, and challenges of sunscreen use as it relates to public health are discussed.

  12. Periodontal health and global public health

    DEFF Research Database (Denmark)

    Petersen, Poul E; Baehni, Pierre C

    2012-01-01

    Chronic diseases are a growing burden to people, to health-care systems and to societies across the world. The rapid increase in the burden of chronic diseases is particularly prevalent in the developing countries. Periodontal disease is one of the two most important oral diseases contributing...... to the global burden of chronic disease. In addition to social determinants, periodontal health status is related to several proximal factors. Modifiable risk factors, such as tobacco use, excessive alcohol consumption, poor diet and nutrition, obesity, psychological stress and insufficient personal....../oral hygiene, are important and these principal risk factors for periodontal disease are shared by other chronic diseases. The present monograph is devoted to the existing evidence on the practice of public health related to periodontal health. Public health is defined as the process of mobilizing and engaging...

  13. Cost benefit for assessment of intermediate coronary stenosis with fractional flow reserve in public and private sectors in australia.

    Science.gov (United States)

    Murphy, J C; Hansen, P S; Bhindi, R; Figtree, G A; Nelson, G I C; Ward, M R

    2014-09-01

    Fractional Flow Reserve (FFR) is a proven technology for guiding percutaneous coronary intervention (PCI), but is not reimbursed despite the fact that it is frequently used to defer PCI. Costs incurred with use of FFR were compared in both the public and private sectors with the costs that would have been incurred if the technology was not available using consecutive cases over a two year period in a public teaching hospital and its co-located private hospital. FFR was performed on 143 lesions in 120 patients. FFR was cost of $A1200 per wire, FFR actually saved money. Mean savings in the public sector were $1200 per patient while in the private sector the savings were $5000 per patient. FFR use saves money for the Federal Government in the public sector and for the Private Health Funds in the private sector. These financial benefits are seen in addition to the improved outcomes seen with this technology. Copyright © 2014. Published by Elsevier B.V.

  14. Assessment of Health Care and Economic Costs Due to Episodes of Acute Pesticide Intoxication in Workers of Rural Areas of the Coquimbo Region, Chile.

    Science.gov (United States)

    Ramírez-Santana, Muriel; Iglesias-Guerrero, Juan; Castillo-Riquelme, Marianela; Scheepers, Paul T J

    2014-12-01

    The increase in agricultural activity that Chile experienced in the past 20 years resulted in a boost in the use of pesticides. Despite pesticides' productivity benefits, they caused health problems such as the increased frequency of episodes of acute poisoning, which constitutes a relevant problem in terms of occupational health. The Chilean authorities require several preventive measures at workplaces, which are not always implemented, increasing the risk of intoxications in farmers. So far in Chile, there are no studies concerning the public health care expenses associated with acute work-related pesticide intoxications. From the societal perspective, there are costs involved if the worker needs to take sick leave and families incur costs to take care of their sick members. This study aimed to determine the costs associated with health care services used by people who suffered from work-related acute pesticide poisoning, as well as the economic costs for the families of the workers involved, and finally the costs of these episodes for the employer/industrial sector. This study considered a 3-year period (January 2009 to December 2011). Three sources of data were reviewed: reported cases at the Regional Health Authority, for the profile of the intoxications; registers of patients attended in public hospitals, for data on costs of health care services; and public information of living conditions nationwide. The overall costs of a single case depend on the severity of intoxication, days of sick leave, and type of health care needed. Most cases (77%) would be ambulatory and would be assisted at an emergency room, with an average cost of US $330 per case. Those cases that might need hospitalization (23%) and, therefore, more days off work have an average cost of US $1158 per case. Taking into account the number of patients reported each year in the country, the cost per annum would be about US $185,000, but considering the underreporting of intoxications and

  15. Application of an Original Wildfire Smoke Health Cost Benefits Transfer Protocol to the Western US, 2005-2015

    Science.gov (United States)

    Jones, Benjamin A.; Berrens, Robert P.

    2017-11-01

    Recent growth in the frequency and severity of US wildfires has led to more wildfire smoke and increased public exposure to harmful air pollutants. Populations exposed to wildfire smoke experience a variety of negative health impacts, imposing economic costs on society. However, few estimates of smoke health costs exist and none for the entire Western US, in particular, which experiences some of the largest and most intense wildfires in the US. The lack of cost estimates is troublesome because smoke health impacts are an important consideration of the overall costs of wildfire. To address this gap, this study provides the first time series estimates of PM2.5 smoke costs across mortality and several morbidity measures for the Western US over 2005-2015. This time period includes smoke from several megafires and includes years of record-breaking acres burned. Smoke costs are estimated using a benefits transfer protocol developed for contexts when original health data are not available. The novelty of our protocol is that it synthesizes the literature on choices faced by researchers when conducting a smoke cost benefit transfer. On average, wildfire smoke in the Western US creates 165 million in annual morbidity and mortality health costs.

  16. Identifying evidence for public health guidance: a comparison of citation searching with Web of Science and Google Scholar.

    Science.gov (United States)

    Levay, Paul; Ainsworth, Nicola; Kettle, Rachel; Morgan, Antony

    2016-03-01

    To examine how effectively forwards citation searching with Web of Science (WOS) or Google Scholar (GS) identified evidence to support public health guidance published by the National Institute for Health and Care Excellence. Forwards citation searching was performed using GS on a base set of 46 publications and replicated using WOS. WOS and GS were compared in terms of recall; precision; number needed to read (NNR); administrative time and costs; and screening time and costs. Outcomes for all publications were compared with those for a subset of highly important publications. The searches identified 43 relevant publications. The WOS process had 86.05% recall and 1.58% precision. The GS process had 90.7% recall and 1.62% precision. The NNR to identify one relevant publication was 63.3 with WOS and 61.72 with GS. There were nine highly important publications. WOS had 100% recall, 0.38% precision and NNR of 260.22. GS had 88.89% recall, 0.33% precision and NNR of 300.88. Administering the WOS results took 4 h and cost £88-£136, compared with 75 h and £1650-£2550 with GS. WOS is recommended over GS, as citation searching was more effective, while the administrative and screening times and costs were lower. Copyright © 2015 John Wiley & Sons, Ltd.

  17. Public Health Autonomy: A Critical Reappraisal.

    Science.gov (United States)

    Zimmerman, Frederick J

    2017-11-01

    The ethical principle of autonomy is among the most fundamental in ethics, and it is particularly salient for those in public health, who must constantly balance the desire to improve health outcomes by changing behavior with respect for individual freedom. Although there are some areas in which there is a genuine tension between public health and autonomy-childhood vaccine mandates, for example-there are many more areas where not only is there no tension, but public health and autonomy come down to the same thing. These areas of overlap are often rendered invisible by a thin understanding of autonomy. Better integrating newer theoretical insights about autonomy into applied ethics can make discussions of public health ethics more rigorous, incisive, and effective. Even more importantly, bringing modern concepts of autonomy into public health ethics can showcase the many areas in which public health and autonomy have the same goals, face the same threats, and can be mutually advanced by the same kinds of solutions. This article provides a schema for relational autonomy in a public health context and gives concrete examples of how autonomy can be served through public-health interventions. It marshals insights from sociology, psychology, and philosophy to advance a theory of autonomy and coercion that recognizes three potential threats to autonomy: threats to choice sets, threats to knowledge, and threats to preferences. © 2017 The Hastings Center.

  18. (Public) Health and Human Rights in Practice.

    Science.gov (United States)

    Annas, George J; Mariner, Wendy K

    2016-02-01

    Public health's reliance on law to define and carry out public activities makes it impossible to define a set of ethical principles unique to public health. Public health ethics must be encompassed within--and consistent with--a broader set of principles that define the power and limits of governmental institutions. These include human rights, health law, and even medical ethics. The human right to health requires governments not only to respect individual human rights and personal freedoms, but also, importantly, to protect people from harm from external sources and third parties, and to fulfill the health needs of the population. Even if human rights are the natural language for public health, not all public health professionals are comfortable with the language of human rights. Some argue that individual human rights--such as autonomy and privacy--unfairly limit the permissible means to achieve the goal of health protection. We argue that public health should welcome and promote the human rights framework. In almost every instance, this will make public health more effective in the long run, because the goals of public health and human rights are the same: to promote human flourishing. Copyright © 2016 by Duke University Press.

  19. The spillover effects of health insurance benefit mandates on public insurance coverage: Evidence from veterans.

    Science.gov (United States)

    Li, Xiaoxue; Ye, Jinqi

    2017-09-01

    This study examines how regulations in private health insurance markets affect coverage of public insurance. We focus on mental health parity laws, which mandate private health insurance to provide equal coverage for mental and physical health services. The implementation of mental health parity laws may improve a quality dimension of private health insurance but at increased costs. We graphically develop a conceptual framework and then empirically examine whether the regulations shift individuals from private to public insurance. We exploit state-by-year variation in policy implementation in 1999-2008 and focus on a sample of veterans, who have better access to public insurance than non-veterans. Using data from the Current Population Survey, we find that the parity laws reduce employer-sponsored insurance (ESI) coverage by 2.1% points. The drop in ESI is largely offset by enrollment gains in public insurance, namely through the Veterans Affairs (VA) benefit and Medicaid/Medicare programs. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Primary health care and public health: foundations of universal health systems.

    Science.gov (United States)

    White, Franklin

    2015-01-01

    The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable. © 2015 S. Karger AG, Basel.

  1. Chiropractic care and public health

    DEFF Research Database (Denmark)

    Johnson, Claire; Rubinstein, Sidney M; Côté, Pierre

    2012-01-01

    The purpose of this collaborative summary is to document current chiropractic involvement in the public health movement, reflect on social ecological levels of influence as a profession, and summarize the relationship of chiropractic to the current public health topics of: safety, health issues...... disorders? How can chiropractic use cognitive behavioral therapy to address chronic low back pain as a public health problem? What opportunities exist for doctors of chiropractic to more effectively serve the aging population? What is the role of ethics and the contribution of the chiropractic profession...

  2. Public health medicine: the constant dilemma.

    Science.gov (United States)

    Eskin, Frada

    2002-03-01

    There is a well-known quotation by the nineteenth-century sociologist Virchow (quoted in Ref. 1) that aptly captures the dilemma that has confronted public health medicine since the specialty was created as a discrete entity in 1848. Virchow said: 'Medicine is politics and social medicine is politics writ large!' What does this mean in relation to effective public health medicine practice and how is it likely to affect its future? There is increasingly limited freedom of expression within the current context of political correctness, central control and a rapidly burgeoning litigious climate. The purpose of this paper is to explore these issues and to propose a means of maintaining public health medicine integrity within a working environment where action is becoming rapidly constrained by political rigidity. An additional factor to be included in the dialogue is the current context within which public health physicians work. Because the majority of public health doctors are employed within the National Health Service (NHS), they are finding themselves being expected to take on tasks and responsibilities marginal to their essential purpose and function. For example, public health physicians spend a great deal of time involved in detailed deliberations about health service provision. Although there is a great deal of evidence to show that good quality health care provision positively affects the health of the individual, there is no evidence to show that this activity has any effect on the population's health status. The essence of public health medicine practice is the prevention of ill-health and the promotion of the health of the population and, consequently, attention needs to be focused on the root causes of disease. However, as these are outside the aegis of the NHS, public health medicine involvement in such issues as education, nutrition, housing, transport and poverty is regarded as marginal to the NHS corporate agenda.

  3. Public and private health insurance premiums: how do they affect the health insurance status of low-income childless adults?

    Science.gov (United States)

    Guy, Gery P; Adams, E Kathleen; Atherly, Adam

    2012-01-01

    The Patient Protection and Affordable Care Act (ACA) will substantially increase public health insurance eligibility and alter the costs of insurance coverage. Using Current Population Survey (CPS) data from the period 2000-2008, we examine the effects of public and private health insurance premiums on the insurance status of low-income childless adults, a population substantially affected by the ACA. Results show higher public premiums to be associated with a decrease in the probability of having public insurance and an increase in the probability of being uninsured, while increased private premiums decrease the probability of having private insurance. Eligibility for premium assistance programs and increased subsidy levels are associated with lower rates of uninsurance. The magnitudes of the effects are quite modest and provide important implications for insurance expansions for childless adults under the ACA.

  4. Child public health

    National Research Council Canada - National Science Library

    Blair, Mitch

    2010-01-01

    "Despite children making up around a quarter of the population, the first edition of this book was the first to focus on a public health approach to the health and sickness of children and young people...

  5. Does Prevention Pay? Costs and Potential Cost-savings of School Interventions Targeting Children with Mental Health Problems.

    Science.gov (United States)

    Wellander, Lisa; Wells, Michael B; Feldman, Inna

    2016-06-01

    -savings due to a reduction in the prevalence of mental health problems and averted additional support required. The school district was comprised of 6,256 students, with 310 students receiving additional support for their mental health problems. Of these, 143 received support in their original school due to either having ADHD (n = 111), psychosocial problems (n = 26), or anxiety/depression (n = 6). The payers' total cost of additional support was 2,637,850 Euro per school year (18,447 Euro per student). The cost of running both interventions for the school district was 953,643 Euro for one year, while the potential savings for these interventions were estimated to be 627,150 Euro. The estimated effects showed that there would be a reduction of students needing additional support (25 for ADHD, eight for psychosocial problems, and one for anxiety/depression), and the payer would receive a return on their invested resources in less than two years (1.5 years) after implementation. Preventive school interventions can both improve some children's mental health problems and be financially beneficial for the payer. However, they are still limited in their scope of reducing all students' mental health statuses to below clinical cut-offs; therefore, the preventive school interventions should be used as a supplement, but not a replacement, to current practices. The findings have political and societal implications, in that payers can reallocate their funds toward preventive measures targeting students' mental health problems, while reducing the costs. When evaluating public health actions, it is necessary to consider their economic impact. The resources are scarce and the decision makers need knowledge on how to allocate their resources in an efficient way. Cost-offset analysis is seen as one way for decision makers to comprehend research findings; however, such analyses tend to not include the full benefits of the interventions, and actual impacts need to be fully evaluated in routine

  6. Cost evaluation of clinical laboratory in Taiwan's National Health System by using activity-based costing.

    Science.gov (United States)

    Su, Bin-Guang; Chen, Shao-Fen; Yeh, Shu-Hsing; Shih, Po-Wen; Lin, Ching-Chiang

    2016-11-01

    To cope with the government's policies to reduce medical costs, Taiwan's healthcare service providers are striving to survive by pursuing profit maximization through cost control. This article aimed to present the results of cost evaluation using activity-based costing performed in the laboratory in order to throw light on the differences between costs and the payment system of National Health Insurance (NHI). This study analyzed the data of costs and income of the clinical laboratory. Direct costs belong to their respective sections of the department. The department's shared costs, including public expenses and administrative assigned costs, were allocated to the department's respective sections. A simple regression equation was created to predict profit and loss, and evaluate the department's break-even point, fixed cost, and contribution margin ratio. In clinical chemistry and seroimmunology sections, the cost per test was lower than the NHI payment and their major laboratory tests had revenues with the profitability ratio of 8.7%, while the other sections had a higher cost per test than the NHI payment and their major tests were in deficit. The study found a simple linear regression model as follows: "Balance=-84,995+0.543×income (R2=0.544)". In order to avoid deficit, laboratories are suggested to increase test volumes, enhance laboratory test specialization, and become marginal scale. A hospital could integrate with regional medical institutions through alliances or OEM methods to increase volumes to reach marginal scale and reduce laboratory costs, enhancing the level and quality of laboratory medicine.

  7. Childhood constipation as an emerging public health problem.

    Science.gov (United States)

    Rajindrajith, Shaman; Devanarayana, Niranga Manjuri; Crispus Perera, Bonaventure Jayasiri; Benninga, Marc Alexander

    2016-08-14

    Functional constipation (FC) is a significant health problem in children and contrary to common belief, has serious ramifications on the lives of children and their families. It is defined by the Rome criteria which encourage the use of multiple clinical features for diagnosis. FC in children has a high prevalence (0.7%-29%) worldwide, both in developed and developing countries. Biopsychosocial risk factors such as psychological stress, poor dietary habits, obesity and child maltreatment are commonly identified predisposing factors for FC. FC poses a significant healthcare burden on the already overstretched health budgets of many countries in terms of out-patient care, in-patient care, expenditure for investigations and prescriptions. Complications are common and range from minor psychological disturbances, to lower health-related quality of life. FC in children also has a significant impact on families. Many paediatric clinical trials have poor methodological quality, and drugs proved to be useful in adults, are not effective in relieving symptoms in children. A significant proportion of inadequately treated children have similar symptoms as adults. These factors show that constipation is an increasing public health problem across the world with a significant medical, social and economic impact. This article highlights the potential public health impact of FC and the possibility of overcoming this problem by concentrating on modifiable risk factors rather than expending resources on high cost investigations and therapeutic modalities.

  8. 48 CFR 31.205-1 - Public relations and advertising costs.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Public relations and... Organizations 31.205-1 Public relations and advertising costs. (a) Public relations means all functions and...; or (2) Maintaining or promoting reciprocal understanding and favorable relations with the public at...

  9. Effects of County Public Hospital Reform on Procurement Costs and Volume of Antibiotics: A Quasi-Natural Experiment in Hubei Province, China.

    Science.gov (United States)

    Tang, Yuqing; Liu, Chaojie; Liu, Junjie; Zhang, Xinping; Zuo, Keyuan

    2018-04-18

    The overuse of antibiotics has become a major public health challenge worldwide, especially in low- and middle-income countries, including China. In 2009, the Chinese government launched a series of measures to de-incentivise over-prescription in public health facilities, including decoupling the link between facility income and the sale of medicines. We evaluated the effects of these measures on procurement costs and the volume of antibiotics in county public hospitals. The study was undertaken in the Hubei province of China, where 64 county public hospitals implemented the reform in sequence at three different stages. A quasi-natural experiment design was employed. We performed generalised linear regressions with a difference-in-differences approach using 22,713 procurement records of antibiotics from November 2014 to December 2016. The regression results showed that the reform contributed to a 14.79% increase in total costs for antibiotics (p = 0.013), particularly costs for injectable antibiotics (p = 0.022) and first-line antibiotics (p = 0.030). The procurement prices for antibiotics remained largely comparable to those in the control group, but the reform led to a 17.30% increase in the procurement volume (expressed as defined daily doses) of second-line antibiotics (p = 0.032). County public hospitals procured more antibiotics and greater numbers of expensive antibiotics, such as those administered via injection, to compensate for the loss of income from the sale of medicines, leading to an increased total cost of antibiotics.

  10. Employer Health Benefit Costs and Demand for Part-Time Labor

    OpenAIRE

    Jennifer Feenstra Schultz; David Doorn

    2009-01-01

    The link between rising employer costs for health insurance benefits and demand for part-time workers is investigated using non-public data from the Medical Expenditure Panel Survey- Insurance Component (MEPS-IC). The MEPS-IC is a nationally representative, annual establishment survey from the Agency for Healthcare Research and Quality (AHRQ). Pooling the establishment level data from the MEPS-IC from 1996-2004 and matching with the Longitudinal Business Database and supplemental economic dat...

  11. Are Public Health Organizations Tweeting to the Choir? Understanding Local Health Department Twitter Followership

    Science.gov (United States)

    Choucair, Bechara; Maier, Ryan C; Jolani, Nina; Bernhardt, Jay M

    2014-01-01

    Background One of the essential services provided by the US local health departments is informing and educating constituents about health. Communication with constituents about public health issues and health risks is among the standards required of local health departments for accreditation. Past research found that only 61% of local health departments met standards for informing and educating constituents, suggesting a considerable gap between current practices and best practice. Objective Social media platforms, such as Twitter, may aid local health departments in informing and educating their constituents by reaching large numbers of people with real-time messages at relatively low cost. Little is known about the followers of local health departments on Twitter. The aim of this study was to examine characteristics of local health department Twitter followers and the relationship between local health department characteristics and follower characteristics. Methods In 2013, we collected (using NodeXL) and analyzed a sample of 4779 Twitter followers from 59 randomly selected local health departments in the United States with Twitter accounts. We coded each Twitter follower for type (individual, organization), location, health focus, and industry (eg, media, government). Local health department characteristics were adopted from the 2010 National Association of City and County Health Officials Profile Study data. Results Local health department Twitter accounts were followed by more organizations than individual users. Organizations tended to be health-focused, located outside the state from the local health department being followed, and from the education, government, and non-profit sectors. Individuals were likely to be local and not health-focused. Having a public information officer on staff, serving a larger population, and “tweeting” more frequently were associated with having a higher percentage of local followers. Conclusions Social media has the

  12. [Survey on public health nursing education-in the comparison of nursing education courses, universities, advanced courses for public health nurse with junior nursing colleges, and public health nursing school].

    Science.gov (United States)

    Hirano, Kayoko; Ikeda, Nobuko; Kanagawa, Katuko; Shiomi, Sigeki; Suzuki, Akira; Hirayama, Tomoko; Furuya, Akie; Ymazaki, Kyoko; Yasumura, Seiji

    2005-08-01

    Changes in public health nursing education have been consideration. Theses changes include a dramatic increase in the number of public health nurses (PHNs) who have enrolled for nursing courses at university. This study was conducted to assess the current status and future of public health nursing education as perceived by teachers and students at three types of schools: universities offering nursing courses, advanced courses for PHNs with junior nursing colleges, and public health nursing schools. Questionnaires were distributed to teachers and students by mail. The questions that were sent to teachers asked which subjects were required to become a certified PHN, which lecture methods were employed to teach public health-particularly community health assessment methods, and what was the level of awareness of the activities of PHNs. Students were asked about their motivation to be a PHN, their understanding of public health, their views of public health activities and their images of PHNs. Responses were analyzed and differences between questionnaires from different schools were noted. These included the number of subjects and the total number of hours spent doing practical training and field experience in universities and the other types of schools, and the number of teachers. Differences also were noted among students at three types of schools about their age, methods of public health activities, knowledge about activities undertaken by PHNs, and their images of PHNs. No differences were observed among the schools with respect to the students' conceptual understanding of public health. Student age, practical training and field experience were found to contribute to their level of understanding of public health and public health nursing. It is thus necessary to consider the teaching methods employed by universities that administer nursing courses and the effectiveness of courses offered by graduate schools.

  13. Protecting Health and Saving Lives: The Part-Time/Internet-Based Master of Public Health Program at the Johns Hopkins Bloomberg School of Public Health

    Science.gov (United States)

    Bruce, Linda; Gresh, Kathy; Vanchiswaran, Rohini; Werapitiya, Deepthi

    2007-01-01

    This article discusses the part-time/Internet-based Master of Public Health (MPH) program at the Johns Hopkins Bloomberg School of Public Health (JHSPH). The Johns Hopkins Bloomberg School of Public Health was the first school of public health in the United States to offer a Master of Public Health program via the Internet. The JHSPH MPH Program…

  14. Citizen Science for public health.

    Science.gov (United States)

    Den Broeder, Lea; Devilee, Jeroen; Van Oers, Hans; Schuit, A Jantine; Wagemakers, Annemarie

    2016-12-23

    Community engagement in public health policy is easier said than done. One reason is that public health policy is produced in a complex process resulting in policies that may appear not to link up to citizen perspectives. We therefore address the central question as to whether citizen engagement in knowledge production could enable inclusive health policy making. Building on non-health work fields, we describe different types of citizen engagement in scientific research, or 'Citizen Science'. We describe the challenges that Citizen Science poses for public health, and how these could be addressed. Despite these challenges, we expect that Citizen Science or similar approaches such as participatory action research and 'popular epidemiology' may yield better knowledge, empowered communities, and improved community health. We provide a draft framework to enable evaluation of Citizen Science in practice, consisting of a descriptive typology of different kinds of Citizen Science and a causal framework that shows how Citizen Science in public health might benefit both the knowledge produced as well as the 'Citizen Scientists' as active participants. © The Author 2016. Published by Oxford University Press.

  15. 77 FR 38296 - Draft Public Health Action Plan-A National Public Health Action Plan for the Detection...

    Science.gov (United States)

    2012-06-27

    ... Prevention and Health Promotion, Division of Reproductive Health, Attn: National Public Health Action Plan... Disease Prevention and Health Promotion, Division of Reproductive Health, 4770 Buford Highway NE... topic's public health importance, existing challenges, and opportunities for action to decrease the...

  16. Estimating the financial resources needed for local public health departments in Minnesota: a multimethod approach.

    Science.gov (United States)

    Riley, William; Briggs, Jill; McCullough, Mac

    2011-01-01

    This study presents a model for determining total funding needed for individual local health departments. The aim is to determine the financial resources needed to provide services for statewide local public health departments in Minnesota based on a gaps analysis done to estimate the funding needs. We used a multimethod analysis consisting of 3 approaches to estimate gaps in local public health funding consisting of (1) interviews of selected local public health leaders, (2) a Delphi panel, and (3) a Nominal Group Technique. On the basis of these 3 approaches, a consensus estimate of funding gaps was generated for statewide projections. The study includes an analysis of cost, performance, and outcomes from 2005 to 2007 for all 87 local governmental health departments in Minnesota. For each of the methods, we selected a panel to represent a profile of Minnesota health departments. The 2 main outcome measures were local-level gaps in financial resources and total resources needed to provide public health services at the local level. The total public health expenditure in Minnesota for local governmental public health departments was $302 million in 2007 ($58.92 per person). The consensus estimate of the financial gaps in local public health departments indicates that an additional $32.5 million (a 10.7% increase or $6.32 per person) is needed to adequately serve public health needs in the local communities. It is possible to make informed estimates of funding gaps for public health activities on the basis of a combination of quantitative methods. There is a wide variation in public health expenditure at the local levels, and methods are needed to establish minimum baseline expenditure levels to adequately treat a population. The gaps analysis can be used by stakeholders to inform policy makers of the need for improved funding of the public health system.

  17. Population mental health: evidence, policy, and public health practice

    National Research Council Canada - National Science Library

    Cohen, Neal L; Galea, Sandro

    2011-01-01

    ... on population mental health with public mental health policy and practice. Issues covered in the book include the influence of mental health policies on the care and well-­ being of individuals with mental illness, the interconnectedness of physical and mental disorders, the obstacles to adopting a public health orientation to mental health/mental ill...

  18. Is periodontal disease a public health problem?

    Science.gov (United States)

    Batchelor, P

    2014-10-01

    Clinically defined periodontal disease is highly prevalent, has considerable impacts on individuals and society and is costly to treat; the cost of dental care is the fourth highest costs of all diseases and consuming between 5 and 10% of all healthcare resources. Changes in the epidemiology of clinically defined periodontal diseases suggest that the prevalence of severe periodontal disease is low and rates of progression of periodontal destruction tend to be relatively slow. Current periodontal care modalities have a remarkably weak evidence base, with considerable resources allocated to fund interventions that include oral hygiene instruction, scale and polishes through to surgical interventions. The public health problem lies more in the failure in design of a contract between dental professionals and the state. Such a contract needs to recognise both the wider determinants of disease and the role that dental professionals could play: a contract that concentrated on rewarding outcomes, namely a diminution in treatment need, as opposed to one based simply on the number of interventions would be a major step forward.

  19. Setting priorities for the health care sector in Zimbabwe using cost-effectiveness analysis and estimates of the burden of disease

    Directory of Open Access Journals (Sweden)

    Hansen Kristian

    2008-07-01

    Full Text Available Abstract Background This study aimed at providing information for priority setting in the health care sector of Zimbabwe as well as assessing the efficiency of resource use. A general approach proposed by the World Bank involving the estimation of the burden of disease measured in Disability-Adjusted Life Years (DALYs and calculation of cost-effectiveness ratios for a large number of health interventions was followed. Methods Costs per DALY for a total of 65 health interventions were estimated. Costing data were collected through visits to health centres, hospitals and vertical programmes where a combination of step-down and micro-costing was applied. Effectiveness of health interventions was estimated based on published information on the efficacy adjusted for factors such as coverage and compliance. Results Very cost-effective interventions were available for the major health problems. Using estimates of the burden of disease, the present paper developed packages of health interventions using the estimated cost-effectiveness ratios. These packages could avert a quarter of the burden of disease at total costs corresponding to one tenth of the public health budget in the financial year 1997/98. In general, the analyses suggested that there was substantial potential for improving the efficiency of resource use in the public health care sector. Discussion The proposed World Bank approach applied to Zimbabwe was extremely data demanding and required extensive data collection in the field and substantial human resources. The most important limitation of the study was the scarcity of evidence on effectiveness of health interventions so that a range of important health interventions could not be included in the cost-effectiveness analysis. This and other limitations could in principle be overcome if more research resources were available. Conclusion The present study showed that it was feasible to conduct cost-effectiveness analyses for a large number

  20. Investments and costs of oral health care for Family Health Care

    Directory of Open Access Journals (Sweden)

    Márcia Stefânia Ribeiro Macêdo

    2016-01-01

    Full Text Available ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities, besides the indirect fixed costs (cleaning, security, energy, and water. The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76. The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82 a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding

  1. Investments and costs of oral health care for Family Health Care

    Science.gov (United States)

    Macêdo, Márcia Stefânia Ribeiro; Chaves, Sônia Cristina Lima; Fernandes, Antônio Luis de Carvalho

    2016-01-01

    ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables) and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities), besides the indirect fixed costs (cleaning, security, energy, and water). The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76). The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82) a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding, especially to cover the

  2. European health research and globalisation: is the public-private balance right?

    Science.gov (United States)

    McCarthy, Mark

    2011-03-22

    The creation and exchange of knowledge between cultures has benefited world development for many years. The European Union now puts research and innovation at the front of its economic strategy. In the health field, biomedical research, which benefits the pharmaceutical and biotechnology industries, has been well supported, but much less emphasis has been given to public health and health systems research. A similar picture is emerging in European support for globalisation and health Two case-studies illustrate the links of European support in global health research with industry and biomedicine. The European Commission's directorates for (respectively) Health, Development and Research held an international conference in Brussels in June 2010. Two of six thematic sessions related to research: one was solely concerned with drug development and the protection of intellectual property. Two European Union-supported health research projects in India show a similar trend. The Euro-India Research Centre was created to support India's participation in EU research programmes, but almost all of the health research projects have been in biotechnology. New INDIGO, a network led by the French national research agency CNRS, has chosen 'Biotechnology and Health' and funded projects only within three laboratory sciences. Research for commerce supports only one side of economic development. Innovative technologies can be social as well as physical, and be as likely to benefit society and the economy. Global health research agendas to meet the Millenium goals need to prioritise prevention and service delivery. Public interest can be voiced through civil society organisations, able to support social research and public-health interventions. Money for health research comes from public budgets, or indirectly through healthcare costs. European 'Science in Society' programme contrasts research for 'economy', using technical solutions, commercialisation and a passive consumer voice for

  3. Home modification to reduce falls at a health district level: Modeling health gain, health inequalities and health costs.

    Directory of Open Access Journals (Sweden)

    Nick Wilson

    Full Text Available There is some evidence that home safety assessment and modification (HSAM is effective in reducing falls in older people. But there are various knowledge gaps, including around cost-effectiveness and also the impacts at a health district-level.A previously established Markov macro-simulation model built for the whole New Zealand (NZ population (Pega et al 2016, Injury Prevention was enhanced and adapted to a health district level. This district was Counties Manukau District Health Board, which hosts 42,000 people aged 65+ years. A health system perspective was taken and a discount rate of 3% was used for both health gain and costs. Intervention effectiveness estimates came from a systematic review, and NZ-specific intervention costs were extracted from a randomized controlled trial. In the 65+ age-group in this health district, the HSAM program was estimated to achieve health gains of 2800 quality-adjusted life-years (QALYs; 95% uncertainty interval [UI]: 547 to 5280. The net health system cost was estimated at NZ$8.44 million (95% UI: $663 to $14.3 million. The incremental cost-effectiveness ratio (ICER was estimated at NZ$5480 suggesting HSAM is cost-effective (95%UI: cost saving to NZ$15,300 [equivalent to US$10,300]. Targeting HSAM only to people age 65+ or 75+ with previous injurious falls was estimated to be particularly cost-effective (ICERs: $700 and $832, respectively with the latter intervention being cost-saving. There was no evidence for differential cost-effectiveness by sex or by ethnicity: Māori (Indigenous population vs non-Māori.This modeling study suggests that a HSAM program could produce considerable health gain and be cost-effective for older people at a health district level. Nevertheless, comparisons may be desirable with other falls prevention interventions such as group exercise programs, which also provide social contact and may prevent various chronic diseases.

  4. Applications of health information exchange information to public health practice

    DEFF Research Database (Denmark)

    Kierkegaard, Patrick; Kaushal, Rainu; Vest, Joshua R.

    2014-01-01

    Health information exchange (HIE) can support several aspects of public health practice by increasing the availability, timeliness, and comprehensiveness individual-level patient information. The potential benefits to disease monitoring, disaster response, and other public health activities served...... as an important justification for the US’ investments in HIE. After several years of HIE implementation and funding, we sought to determine if any of the anticipated benefits of exchange participation were accruing to state and local public health practitioners participating in five different exchanges. Using...... qualitative interviews and template analyses, we identified public health efforts and activities that were improved by participation in HIE. We derived the codes for the template analysis through a literature review. HIE supported public health activities consistent with expectations in the literature...

  5. Mind the public health leadership gap: the opportunities and challenges of engaging high-profile individuals in the public health agenda.

    Science.gov (United States)

    Shickle, Darren; Day, Matthew; Smith, Kevin; Zakariasen, Ken; Moskol, Jacob; Oliver, Thomas

    2014-12-01

    Public health leadership has been criticized as being ineffective. The public health profession is relatively small. Critics have argued that there is over-emphasis on technical aspects and insufficient use of the 'community as a source of public health actions'. The paper analyses the resources, motivations and skills utilized by high-profile individuals who have made contributions to the public health agenda. The phenomenon of celebrity diplomacy is critiqued. Two exemplars are discussed: Jamie Oliver and Michael Bloomberg. The risks of involving celebrities are also considered. Leaders for public health demonstrate 'a paradoxical blend of personal humility and professional will' to make the 'right decisions happen'. While they may have ego or self-interest, in this context, at least, they channel their ambition for the public health cause, not themselves. Leaders from outside public health may have no understanding of what public health is nor consider their work as part of a wider public health agenda. It is important to understand why they become leaders for public health. This will inform a strategy for how others may be encouraged to collaborate for public health causes. Some key points for working with high-profile leaders for public health are identified. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. The Public Health Responsibility Deal: brokering a deal for public health, but on whose terms?

    Science.gov (United States)

    Panjwani, Clare; Caraher, Martin

    2014-02-01

    Coalitions of multinational food and drink businesses have pledged to reformulate their products and to market them responsibly. Largely business-led and self-regulated, the integrity of these voluntary initiatives has been questioned. The Public Health Responsibility Deal in England is an example of a voluntary initiative that is government-led. Does this approach provide evidence that with public leadership there is potential for voluntary actions to deliver meaningful results for public health? The subject of the research is the calorie reduction initiative of the Responsibility Deal. Source material was obtained primarily through a series of UK Freedom of Information requests and comprises previously unpublished Department of Health documentation relating to relevant meetings held during 2011 and 2012. The Responsibility Deal approach to calorie reduction deliberately involves the food industry in the specification of the measures it is to implement (reformulation and portion control). Finding the common ground between private and public interests has resulted in the deflection of public health objectives and the preclusion of adequate monitoring and evaluation. The Responsibility Deal approach is fundamentally flawed in its expectation that industry will take voluntary actions that prioritise public health interests above its own. Being government-led counts for little in the absence of sanctions to drive compliance. Instead the initiative affords private interests the opportunity to influence in their favour the public health policies and strategies that affect their products. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  7. Understanding Price Elasticities to Inform Public Health Research and Intervention Studies: Key Issues

    Science.gov (United States)

    Nghiem, Nhung; Genç, Murat; Blakely, Tony

    2013-01-01

    Pricing policies such as taxes and subsidies are important tools in preventing and controlling a range of threats to public health. This is particularly so in tobacco and alcohol control efforts and efforts to change dietary patterns and physical activity levels as a means of addressing increases in noncommunicable diseases. To understand the potential impact of pricing policies, it is critical to understand the nature of price elasticities for consumer products. For example, price elasticities are key parameters in models of any food tax or subsidy that aims to quantify health impacts and cost-effectiveness. We detail relevant terms and discuss key issues surrounding price elasticities to inform public health research and intervention studies. PMID:24028228

  8. Understanding price elasticities to inform public health research and intervention studies: key issues.

    Science.gov (United States)

    Nghiem, Nhung; Wilson, Nick; Genç, Murat; Blakely, Tony

    2013-11-01

    Pricing policies such as taxes and subsidies are important tools in preventing and controlling a range of threats to public health. This is particularly so in tobacco and alcohol control efforts and efforts to change dietary patterns and physical activity levels as a means of addressing increases in noncommunicable diseases. To understand the potential impact of pricing policies, it is critical to understand the nature of price elasticities for consumer products. For example, price elasticities are key parameters in models of any food tax or subsidy that aims to quantify health impacts and cost-effectiveness. We detail relevant terms and discuss key issues surrounding price elasticities to inform public health research and intervention studies.

  9. Public health legal preparedness in Indian country.

    Science.gov (United States)

    Bryan, Ralph T; Schaefer, Rebecca McLaughlin; DeBruyn, Lemyra; Stier, Daniel D

    2009-04-01

    American Indian/Alaska Native tribal governments are sovereign entities with inherent authority to create laws and enact health regulations. Laws are an essential tool for ensuring effective public health responses to emerging threats. To analyze how tribal laws support public health practice in tribal communities, we reviewed tribal legal documentation available through online databases and talked with subject-matter experts in tribal public health law. Of the 70 tribal codes we found, 14 (20%) had no clearly identifiable public health provisions. The public health-related statutes within the remaining codes were rarely well integrated or comprehensive. Our findings provide an evidence base to help tribal leaders strengthen public health legal foundations in tribal communities.

  10. Systematic review of public health branding.

    Science.gov (United States)

    Evans, W Douglas; Blitstein, Jonathan; Hersey, James C; Renaud, Jeanette; Yaroch, Amy L

    2008-12-01

    Brands build relationships between consumers and products, services, or lifestyles by providing beneficial exchanges and adding value to their objects. Brands can be measured through associations that consumers hold for products and services. Public health brands are the associations that individuals hold for health behaviors, or lifestyles that embody multiple health behaviors. We systematically reviewed the literature on public health brands; developed a methodology for describing branded health messages and campaigns; and examined specific branding strategies across a range of topic areas, campaigns, and global settings. We searched the literature for published studies on public health branding available through all relevant, major online publication databases. Public health branding was operationalized as any manuscripts in the health, social science, and business literature on branding or brands in health promotion marketing. We developed formalized decision rules and applied them in identifying articles for review. We initially identified 154 articles and reviewed a final set of 37, 10 from Africa, Australia, and Europe. Branded health campaigns spanned most of the major domains of public health and numerous communication strategies and evaluation methodologies. Most studies provided clear information on planning, development, and evaluation of the branding effort, while some provided minimal information. Branded health messages typically are theory based, and there is a body of evidence on their behavior change effectiveness, especially in nutrition, tobacco control, and HIV/AIDS. More rigorous research is needed, however, on how branded health messages impact specific populations and behaviors.

  11. The Laugh Model: Reframing and Rebranding Public Health Through Social Media

    Science.gov (United States)

    Royne, Marla; Payne, Hannah E.; Cannon, Ben; Hanson, Carl; Barnes, Michael

    2015-01-01

    Objectives. We examined the use of low-cost social media platforms in communicating public health messages and outline the laugh model, a framework through which public health organizations can reach and engage communities. Methods. In August 2014, we developed an online campaign (Web site and social media) to help promote healthy family meals in Utah in conjunction with the state and local health departments. Results. By the end of September 2014, a total of 3641 individuals had visited the Utahfamilymeals.org Web site. Facebook ads reached a total of 29 078 people, and 56 900 people were reached through Twitter ads. The per-person price of the campaign was 0.2 cents, and the total estimated target population reach was between 10% and 12%. Conclusions. There are 3 key takeaways from our campaign: use of empowering and engaging techniques may be more effective than use of educational techniques; use of social media Web sites and online marketing tactics can enhance collaboration, interdisciplinary strategies, and campaign effectiveness; and use of social media as a communication platform is often preferable to use of mass media in terms of cost-effectiveness, more precise evaluations of campaign success, and increased sustainability. PMID:26378824

  12. How to characterize the public health workforce based on essential public health operations? environmental public health workers in the Netherlands as an example

    NARCIS (Netherlands)

    Jambroes, M.; van Honschooten, R.; Doosje, J.; Stronks, K.; Essink-Bot, M. L.

    2015-01-01

    Public health workforce planning and policy development require adequate data on the public health workforce and the services provided. If existing data sources do not contain the necessary information, or apply to part of the workforce only, primary data collection is required. The aim of this

  13. Personalism for public health ethics

    Directory of Open Access Journals (Sweden)

    Carlo Petrini

    2010-06-01

    Full Text Available In public health ethics, as in bioethics, utilitarian approaches usually prevail, followed by Kantian and communitarian foundations. If one considers the nature and core functions of public health, which are focused on a population perspective, utilitarianism seems still more applicable to public health ethics. Nevertheless, faulting additional protections towards the human person, utilitarianism doesn't offer appropriate solutions when conflicts among values do arise. Further criteria must be applied to protect the fundamental principles of respect for human life. Personalism offers similar advantages to utilitarianism but warrants more protection to the human person. We suggest a possible adaptation of personalism in the specific field of public health by means of four principles: absolute respect for life or principle of inviolability; subsidiarity and the "minimum" mandatory principle; solidarity; justice and non discrimination.

  14. Personalism for public health ethics.

    Science.gov (United States)

    Petrini, Carlo; Gainotti, Sabina; Requena, Pablo

    2010-01-01

    In public health ethics, as in bioethics, utilitarian approaches usually prevail, followed by Kantian and communitarian foundations. If one considers the nature and core functions of public health, which are focused on a population perspective, utilitarianism seems still more applicable to public health ethics. Nevertheless, faulting additional protections towards the human person, utilitarianism doesn't offer appropriate solutions when conflicts among values do arise. Further criteria must be applied to protect the fundamental principles of respect for human life. Personalism offers similar advantages to utilitarianism but warrants more protection to the human person. We suggest a possible adaptation of personalism in the specific field of public health by means of four principles: absolute respect for life or principle of inviolability; subsidiarity and the "minimum" mandatory principle; solidarity; justice and non discrimination.

  15. Petroleum Scarcity and Public Health: Considerations for Local Health Departments

    Science.gov (United States)

    Parker, Cindy L.; Caine, Virginia A.; McKee, Mary; Shirley, Lillian M.; Links, Jonathan M.

    2011-01-01

    Recognition of petroleum as a finite global resource has spurred increasing interest in the intersection between petroleum scarcity and public health. Local health departments represent a critical yet highly vulnerable component of the public health infrastructure. These frontline agencies currently face daunting resource constraints and rely heavily on petroleum for vital population-based health services. Against this backdrop, petroleum scarcity may necessitate reconfiguring local public health service approaches. We describe the anticipated impacts of petroleum scarcity on local health departments, recommend the use of the 10 Essential Public Health Services as a framework for examining attendant operational challenges and potential responses to them, and describe approaches that local health departments and their stakeholders could consider as part of timely planning efforts. PMID:21778471

  16. Public health and the Australian Constitution.

    Science.gov (United States)

    Reynolds, C

    1995-06-01

    The powers vested in the Commonwealth Government by the Constitution contain the basis of much public health law in Australia. Yet this is not often recognised; public health law is generally, and historically, seen as the states' responsibility. This article surveys the broad range of constitutional powers that the Commonwealth Government can rely upon to make public health laws. It considers areas of power specified in the Constitution, such as those with respect to external affairs and corporations. Decisions of the High Court have interpreted the various heads of power very broadly and have significantly enhanced the potential of the Commonwealth to pass detailed and far-reaching public health law. To this fact must be added the taxation arrangements in Australia and, with these, the very extensive control that the Commonwealth can exercise through its monopoly of major taxation sources. Its power to make financial arrangements can tie dependent states into specific policies (including public health policies) as a condition of the grants made to them. However, these broad powers may be limited in some important respects: the High Court is increasingly identifying rights and freedoms in the Constitution that may increasingly bring both state and Commonwealth public health law under challenge. Despite this possibility, the Commonwealth may prove to be our most significant source of public health law, and public health policy makers should recognise the full potential of its power to make such laws.

  17. Unpacking the financial costs of “bariatric tourism” gone wrong: Who holds responsibility for costs to the Canadian health care system?

    Science.gov (United States)

    Snyder, Jeremy C.; Silva, Diego S.; Crooks, Valorie A.

    2016-01-01

    Summary Canadians are motivated to travel abroad for bariatric surgery owing to wait times for care and restrictions on access at home for various reasons. While such surgery abroad is typically paid for privately, if “bariatric tourists” experience complications or have other essential medical needs upon their return to Canada, these costs are borne by the publicly funded health system. In this commentary, we discuss why assigning responsibility for the costs of complications stemming from bariatric tourism is complicated and contextual. PMID:28234613

  18. Wealth and health behavior: Testing the concept of a health cost

    NARCIS (Netherlands)

    J.L.W. van Kippersluis (Hans); T.J. Galama (Titus)

    2014-01-01

    textabstractWealthier individuals engage in healthier behavior. This paper seeks to explain this phenomenon by exploiting both inheritances and lottery winnings to test a theory of health behavior. We distinguish between the direct monetary cost and the indirect health cost (value of health lost) of

  19. Publication ethics in public health emergencies.

    Science.gov (United States)

    Shaw, David; Elger, Bernice S

    2017-09-01

    In this article, we describe and analyse three issues in publication ethics that are raised when conducting research in emergencies and disasters. These include reluctance to share data and samples because of concerns about publications, loss of individual authorship in high high-profile multi-entity publications, and the deaths of authors during dangerous research projects. An emergency research pledge may be useful in avoiding some of these issues. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. An ecological public health approach to understanding the relationships between sustainable urban environments, public health and social equity.

    Science.gov (United States)

    Bentley, Michael

    2014-09-01

    The environmental determinants of public health and social equity present many challenges to a sustainable urbanism-climate change, water shortages and oil dependency to name a few. There are many pathways from urban environments to human health. Numerous links have been described but some underlying mechanisms behind these relationships are less understood. Combining theory and methods is a way of understanding and explaining how the underlying structures of urban environments relate to public health and social equity. This paper proposes a model for an ecological public health, which can be used to explore these relationships. Four principles of an ecological public health-conviviality, equity, sustainability and global responsibility-are used to derive theoretical concepts that can inform ecological public health thinking, which, among other things, provides a way of exploring the underlying mechanisms that link urban environments to public health and social equity. Theories of more-than-human agency inform ways of living together (conviviality) in urban areas. Political ecology links the equity concerns about environmental and social justice. Resilience thinking offers a better way of coming to grips with sustainability. Integrating ecological ethics into public health considers the global consequences of local urban living and thus attends to global responsibility. This way of looking at the relationships between urban environments, public health and social equity answers the call to craft an ecological public health for the twenty-first century by re-imagining public health in a way that acknowledges humans as part of the ecosystem, not separate from it, though not central to it. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  1. Analyzing public health policy: three approaches.

    Science.gov (United States)

    Coveney, John

    2010-07-01

    Policy is an important feature of public and private organizations. Within the field of health as a policy arena, public health has emerged in which policy is vital to decision making and the deployment of resources. Public health practitioners and students need to be able to analyze public health policy, yet many feel daunted by the subject's complexity. This article discusses three approaches that simplify policy analysis: Bacchi's "What's the problem?" approach examines the way that policy represents problems. Colebatch's governmentality approach provides a way of analyzing the implementation of policy. Bridgman and Davis's policy cycle allows for an appraisal of public policy development. Each approach provides an analytical framework from which to rigorously study policy. Practitioners and students of public health gain much in engaging with the politicized nature of policy, and a simple approach to policy analysis can greatly assist one's understanding and involvement in policy work.

  2. What makes health public?: a critical evaluation of moral, legal, and political claims in public health

    National Research Council Canada - National Science Library

    Coggon, John

    2012-01-01

    .... Covering important works from legal, moral, and political theory, public health, public health law and ethics, and bioethics, this is a foundational text for scholars, practitioners and policy bodies interested in freedoms, rights and responsibilities relating to health"--

  3. African Programme for Onchocerciasis Control 1995–2015: Model-Estimated Health Impact and Cost

    Science.gov (United States)

    Coffeng, Luc E.; Stolk, Wilma A.; Zouré, Honorat G. M.; Veerman, J. Lennert; Agblewonu, Koffi B.; Murdoch, Michele E.; Noma, Mounkaila; Fobi, Grace; Richardus, Jan Hendrik; Bundy, Donald A. P.; Habbema, Dik; de Vlas, Sake J.; Amazigo, Uche V.

    2013-01-01

    Background Onchocerciasis causes a considerable disease burden in Africa, mainly through skin and eye disease. Since 1995, the African Programme for Onchocerciasis Control (APOC) has coordinated annual mass treatment with ivermectin in 16 countries. In this study, we estimate the health impact of APOC and the associated costs from a program perspective up to 2010 and provide expected trends up to 2015. Methods and Findings With data on pre-control prevalence of infection and population coverage of mass treatment, we simulated trends in infection, blindness, visual impairment, and severe itch using the micro-simulation model ONCHOSIM, and estimated disability-adjusted life years (DALYs) lost due to onchocerciasis. We assessed financial costs for APOC, beneficiary governments, and non-governmental development organizations, excluding cost of donated drugs. We estimated that between 1995 and 2010, mass treatment with ivermectin averted 8.2 million DALYs due to onchocerciasis in APOC areas, at a nominal cost of about US$257 million. We expect that APOC will avert another 9.2 million DALYs between 2011 and 2015, at a nominal cost of US$221 million. Conclusions Our simulations suggest that APOC has had a remarkable impact on population health in Africa between 1995 and 2010. This health impact is predicted to double during the subsequent five years of the program, through to 2015. APOC is a highly cost-effective public health program. Given the anticipated elimination of onchocerciasis from some APOC areas, we expect even more health gains and a more favorable cost-effectiveness of mass treatment with ivermectin in the near future. PMID:23383355

  4. Working toward financial sustainability of integrated behavioral health services in a public health care system.

    Science.gov (United States)

    Monson, Samantha Pelican; Sheldon, J Christopher; Ivey, Laurie C; Kinman, Carissa R; Beacham, Abbie O

    2012-06-01

    The need, benefit, and desirability of behavioral health integration in primary care is generally accepted and has acquired widespread positive regard. However, in many health care settings the economics, business aspects, and financial sustainability of practice in integrated care settings remains an unsolved puzzle. Organizational administrators may be reluctant to expand behavioral health services without evidence that such programs offer clear financial benefits and financial sustainability. The tendency among mental health professionals is to consider positive clinical outcomes (e.g., reduced depression) as being globally valued indicators of program success. Although such outcomes may be highly valued by primary care providers and patients, administrative decision makers may require demonstration of more tangible financial outcomes. These differing views require program developers and evaluators to consider multiple outcome domains including clinical/psychological symptom reduction, potential cost benefit, and cost offset. The authors describe a process by which a pilot demonstration project is being implemented to demonstrate programmatic outcomes with a focus on the following: 1) clinician efficiency, 2) improved health outcomes, and 3) direct revenue generation associated with the inclusion of integrated primary care in a public health care system. The authors subsequently offer specific future directions and commentary regarding financial evaluation in each of these domains.

  5. Social marketing and public health intervention.

    Science.gov (United States)

    Lefebvre, R C; Flora, J A

    1988-01-01

    The rapid proliferation of community-based health education programs has out-paced the knowledge base of behavior change strategies that are appropriate and effective for public health interventions. However, experiences from a variety of large-scale studies suggest that principles and techniques of social marketing may help bridge this gap. This article discusses eight essential aspects of the social marketing process: the use of a consumer orientation to develop and market intervention techniques, exchange theory as a model from which to conceptualize service delivery and program participation, audience analysis and segmentation strategies, the use of formative research in program design and pretesting of intervention materials, channel analysis for devising distribution systems and promotional campaigns, employment of the "marketing mix" concept in intervention planning and implementation, development of a process tracking system, and a management process of problem analysis, planning, implementation, feedback and control functions. Attention to such variables could result in more cost-effective programs that reach larger numbers of the target audience.

  6. [Cost effectiveness and budget impact analysis of inhaled nitric oxide in a neonatal unit from the perspective of the public health system].

    Science.gov (United States)

    Kilchemmann Fuentes, Carlos; Vallejos Vallejos, Carlos; Román Navarro, Andrés

    Inhaled nitric oxide (iNO) is currently the first-line therapy in severe hypoxaemic respiratory failure of the newborn. Most of regional neonatal centres in Chile do not have this therapeutic alternative. To determine the cost effectiveness of inhaled nitric oxide in the treatment of respiratory failure associated with pulmonary hypertension of the newborn compared to the usual care, including the transfer to a more complex unit. A clinical decision tree was designed from the perspective of Chilean Public Health Service. Incremental cost effectiveness rates (ICER) were calculated, deterministic sensitivity analysis was performed, and probabilistic budget impact was estimated using: TreeAge Pro Healthcare 2014 software. The iNO option leads to an increase in mean cost of $ 11.7 million Chilean pesos (€15,000) per patient treated, with an ICER compared with the usual care of $23 million pesos (€30,000) in case of death or ECMO avoided. By sensitising the results by incidence, it was found that from 7 cases and upwards treated annually, inhaled nitric oxide is less costly than the transfer to a more complex unit. From the perspective of a Chilean regional hospital, incorporating inhaled nitric oxide into the management of neonatal respiratory failure is the optimal alternative in most scenarios. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Toxoplasmosis and Toxocariasis: An Assessment of Human Immunodeficiency Virus Comorbidity and Health-Care Costs in Canada.

    Science.gov (United States)

    Schurer, Janna M; Rafferty, Ellen; Schwandt, Michael; Zeng, Wu; Farag, Marwa; Jenkins, Emily J

    2016-07-06

    Toxoplasma gondii and Toxocara spp. are zoonotic parasites with potentially severe long-term consequences for those infected. We estimated incidence and investigated distribution, risk factors, and costs associated with these parasites by examining hospital discharge abstracts submitted to the Canadian Institute for Health Information (2002-2011). Annual incidence of serious toxoplasmosis and toxocariasis was 0.257 (95% confidence interval [CI]: 0.254-0.260) and 0.010 (95% CI: 0.007-0.014) cases per 100,000 persons, respectively. Median annual health-care costs per serious case of congenital, adult-acquired, and human immunodeficiency virus (HIV)-associated toxoplasmosis were $1,971, $763, and $5,744, respectively, with an overall cost of C$1,686,860 annually (2015 Canadian dollars). However, the total economic burden of toxoplasmosis is likely much higher than these direct health-care cost estimates. HIV was reported as a comorbidity in 40% of toxoplasmosis cases and accounted for over half of direct health-care costs associated with clinical toxoplasmosis. A One Health approach, integrating physician and veterinary input, is recommended for increasing public awareness and decreasing the economic burden of these preventable zoonoses. © The American Society of Tropical Medicine and Hygiene.

  8. East African Journal of Public Health

    African Journals Online (AJOL)

    The East African Journal of Public Health is a multi-disciplinary journal publishing scientific research work from a range of public health related disciplines including community medicine, epidemiology, nutrition, behavioural sciences, health promotion, health education, communicable and non-communicable disease.

  9. Gender issues in medical and public health education.

    Science.gov (United States)

    Wong, Y L

    2000-01-01

    There is no doubt that gender bias has been inherent in medical and public health education, research, and clinical practice. This paper discusses the central question for medical and public health educators viz. whether women's health concerns and needs could be best addressed by the conventional biomedical approach to medical and public health education, research, and practice. Gender inequalities in health and gender bias in medical and public health education are revealed. It is found that in most public health and prevention issues related to women's health, the core issue is male-female power relations, and not merely the lack of public health services, medical technology, or information. There is, thus, an urgent need to gender-sensitize public health and medical education. The paper proposes a gender analysis of health to distinguish between biological causes and social explanations for the health differentials between men and women. It also assessed some of the gender approaches to public health and medical education currently adopted in the Asia-Pacific region. It poses the pressing question of how medical and public health educators integrate the gender perspective into medical and public health education. The paper exhorts all medical and public health practitioners to explore new directions and identify innovative strategies to formulate a gender-sensitive curriculum towards the best practices in medicine and public health that will meet the health needs of women and men in the 21st century.

  10. Estimating the benefits of public health policies that reduce harmful consumption.

    Science.gov (United States)

    Ashley, Elizabeth M; Nardinelli, Clark; Lavaty, Rosemarie A

    2015-05-01

    For products such as tobacco and junk food, where policy interventions are often designed to decrease consumption, affected consumers gain utility from improvements in lifetime health and longevity but also lose utility associated with the activity of consuming the product. In the case of anti-smoking policies, even though published estimates of gross health and longevity benefits are up to 900 times higher than the net consumer benefits suggested by a more direct willingness-to-pay estimation approach, there is little recognition in the cost-benefit and cost-effectiveness literature that gross estimates will overstate intrapersonal welfare improvements when utility losses are not netted out. This paper presents a general framework for analyzing policies that are designed to reduce inefficiently high consumption and provides a rule of thumb for the relationship between net and gross consumer welfare effects: where there exists a plausible estimate of the tax that would allow consumers to fully internalize health costs, the ratio of the tax to the per-unit long-term cost can provide an upper bound on the ratio of net to gross benefits. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

  11. Tests to evaluate public health disease reporting systems in local public health agencies

    National Research Council Canada - National Science Library

    Dausey, David J

    2005-01-01

    ... to evaluate the ability to receive and respond to case reports 24 hours a day, 7 days a week. We refined these tests by beta-testing them at 20 metropolitan area local public health agencies across the country over the course of 10 months. The contents of this manual will be of interest to public health professionals at the state and local l...

  12. The development and evaluation of a PDA-based method for public health surveillance data collection in developing countries

    DEFF Research Database (Denmark)

    Yu, Ping; de Courten, Maximilian; Pan, Elaine

    2009-01-01

    EpiData and Epi Info are often used together by public health agencies around the world, particularly in developing countries, to meet their needs of low-cost public health data management; however, the current open source data management technology lacks a mobile component to meet the needs...... of mobile public health data collectors. The goal of this project is to explore the opportunity of filling this gap through developing and trial of a personal digital assistant (PDA) based data collection/entry system. It evaluated whether such a system could increase efficiency and reduce data...

  13. 24 CFR Appendix to Part 972 - Methodology of Comparing Cost of Public Housing With the Cost of Tenant-Based Assistance

    Science.gov (United States)

    2010-04-01

    ... useful life. The estimated cost for the continued operation of the development as public housing shall be... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Methodology of Comparing Cost of Public Housing With the Cost of Tenant-Based Assistance Appendix to Part 972 Housing and Urban...

  14. The Price per Prospective Consumer of Providing Therapist Training and Consultation in Seven Evidence-Based Treatments within a Large Public Behavioral Health System: An Example Cost-Analysis Metric

    Directory of Open Access Journals (Sweden)

    Kelsie H. Okamura

    2018-01-01

    Full Text Available ObjectivePublic-sector behavioral health systems seeking to implement evidence-based treatments (EBTs may face challenges selecting EBTs given their limited resources. This study describes and illustrates one method to calculate cost related to training and consultation to assist system-level decisions about which EBTs to select.MethodsTraining, consultation, and indirect labor costs were calculated for seven commonly implemented EBTs. Using extant literature, we then estimated the diagnoses and populations for which each EBT was indicated. Diagnostic and demographic information from Medicaid claims data were obtained from a large behavioral health payer organization and used to estimate the number of covered people with whom the EBT could be used and to calculate implementation-associated costs per consumer.ResultsFindings suggest substantial cost to therapists and service systems related to EBT training and consultation. Training and consultation costs varied by EBT, from Dialectical Behavior Therapy at $238.07 to Cognitive Behavioral Therapy at $0.18 per potential consumer served. Total cost did not correspond with the number of prospective consumers served by an EBT.ConclusionA cost-metric that accounts for the prospective recipients of a given EBT within a given population may provide insight into how systems should prioritize training efforts. Future policy should consider the financial burden of EBT implementation in relation to the context of the population being served and begin a dialog in creating incentives for EBT use.

  15. The Cost of Health Services Delivery in Health Houses of Alborz: A Case Study

    Directory of Open Access Journals (Sweden)

    Javad Ghoddousinejad

    2015-07-01

    Full Text Available Background and Objectives : Health houses play an active role to improve health status of rural population.Furthermore, it is important to know the costs of provided services. This research was designed to determine the costs of healthcare delivery in health houses of ALBORZ district. Material and Methods : In this cross-sectional descriptive study, Activity Based Costing (ABC was used to analyze the costs of services. Results : The average Direct Costs (DC of healthcare delivery in health houses was estimated 37033365 Rials. Direct and Indirect Costs (IC of service delivery in health houses were 65.91% and 34.09% of Total Costs (TC respectively. Conclusion : Since human resources play the most important role in determining the costs of health services delivery in healthcare, reforming payment mechanisms would be a suitable solution to reduce extra costs. Moreover, in order to decrease extra costs, it is essential to modify activities and eliminate parallel tasks.

  16. The pull of public health studies

    OpenAIRE

    Braine, Theresa

    2007-01-01

    Public health has burgeoned over the past 100 years, from the study of tropical diseases in the 19th century to national public health systems after World War One and, more recently, to include international public health. Education has kept up with these trends, and today there are hundreds of schools around the world, many flourishing in developing countries.

  17. Public health nursing, ethics and human rights.

    Science.gov (United States)

    Ivanov, Luba L; Oden, Tami L

    2013-05-01

    Public health nursing has a code of ethics that guides practice. This includes the American Nurses Association Code of Ethics for Nurses, Principles of the Ethical Practice of Public Health, and the Scope and Standards of Public Health Nursing. Human rights and Rights-based care in public health nursing practice are relatively new. They reflect human rights principles as outlined in the Universal Declaration of Human Rights and applied to public health practice. As our health care system is restructured and there are new advances in technology and genetics, a focus on providing care that is ethical and respects human rights is needed. Public health nurses can be in the forefront of providing care that reflects an ethical base and a rights-based approach to practice with populations. © 2013 Wiley Periodicals, Inc.

  18. Iran's Experience of Health Cooperatives as a Public-Private Partnership Model in Primary Health Care: A Comparative Study in East Azerbaijan.

    Science.gov (United States)

    Farahbakhsh, Mostafa; Sadeghi-Bazargani, Homayoun; Nikniaz, Alireza; Tabrizi, Jafar Sadegh; Zakeri, Akram; Azami, Saber

    2012-01-01

    Iran started a new public-private partnership model in form of health coopera¬tives which is somehow different from other types of health cooperatives throughout the world. In this study we compared the performance and quality of health services in public health cen¬ters (PHCs) and cooperative health centers (CHCs). In this comparative study performance quality of two cohorts of public and coopera¬tive health centers were compared in several health service delivery programs over the time pe¬riod of 2001- 2002. Screening program: the rate of visited population during screening program was higher in CHCs. Maternal health care program: In some of studied programs CHCs had better results. Child health care: Most indicators were better or similar in CHCs. School health program and Health education: All indices were better or similar in CHCs. Environmental health: population based positive function was not significantly different for the population covered by CHCs compared to population covered by PHCs. Client and staff satisfaction as well as participation and attitudes of personnel towards management was better in CHCs. Mean annual cost per capita of the covered population by PHCs was higher. CHCs as a public private partnership model in Iran may deliver preventive health care services as effective as PHCs in many fields and even better in some areas.

  19. What does social justice require for the public's health? Public health ethics and policy imperatives.

    Science.gov (United States)

    Gostin, Lawrence O; Powers, Madison

    2006-01-01

    Justice is so central to the mission of public health that it has been described as the field's core value. This account of justice stresses the fair disbursement of common advantages and the sharing of common burdens. It captures the twin moral impulses that animate public health: to advance human well-being by improving health and to do so particularly by focusing on the needs of the most disadvantaged. This Commentary explores how social justice sheds light on major ongoing controversies in the field, and it provides examples of the kinds of policies that public health agencies, guided by a robust conception of justice, would adopt.

  20. Do we develop public health leaders?- association between public health competencies and emotional intelligence: a cross-sectional study.

    Science.gov (United States)

    Czabanowska, Katarzyna; Malho, André; Schröder-Bäck, Peter; Popa, Daniela; Burazeri, Genc

    2014-04-17

    Professional development of public health leaders requires a form of instruction which is competency-based to help them develop the abilities to address complex and evolving demands of health care systems. Concurrently, emotional intelligence (EI) is a key to organisational success. Our aim was twofold: i) to assess the relationship between the level of self-assessed public health and EI competencies among Master of European Public Health (MEPH) students and graduates at Maastricht University, and; ii) to determine the relationship between different groups of public health competencies and specific EI skills. A cross-sectional study was conducted including all recent MEPH graduates and students from 2009-2012, out of 67 eligible candidates N = 51 were contacted and N = 33 responded (11 males and 22 females; overall response: 64.7%).Two validated tools were employed: i) public health competencies self-assessment questionnaire, and; ii) Assessing Emotions Scale. Females scored higher than males in all seven domains of the self-assessed key public health competencies (NS) and emotional intelligence competences (P = 0.022). Overall, the mean value of public health competencies was the lowest in students with "staff" preferences and the highest among students with mixed job preferences (P leadership.

  1. Global public health today: connecting the dots

    Directory of Open Access Journals (Sweden)

    Marta Lomazzi

    2016-02-01

    Full Text Available Background: Global public health today faces new challenges and is impacted by a range of actors from within and outside state boundaries. The diversity of the actors involved has created challenges and a complex environment that requires a new context-tailored global approach. The World Federation of Public Health Associations has embarked on a collaborative consultation with the World Health Organization to encourage a debate on how to adapt public health to its future role in global health. Design: A qualitative study was undertaken. High-level stakeholders from leading universities, multilateral organizations, and other institutions worldwide participated in the study. Inductive content analyses were performed. Results: Stakeholders underscored that global public health today should tackle the political, commercial, economic, social, and environmental determinants of health and social inequalities. A multisectoral and holistic approach should be guaranteed, engaging public health in broad dialogues and a concerted decision-making process. The connection between neoliberal ideology and public health reforms should be taken into account. The WHO must show leadership and play a supervising and technical role. More and better data are required across many programmatic areas of public health. Resources should be allocated in a sustainable and accountable way. Public health professionals need new skills that should be provided by a collaborative global education system. A common framework context-tailored to influence governments has been evaluated as useful. Conclusions: The study highlighted some of the main public health challenges currently under debate in the global arena, providing interesting ideas. A more inclusive integrated vision of global health in its complexity, shared and advocated for by all stakeholders involved in decision-making processes, is crucial. This vision represents the first step in innovating public health at the

  2. Global public health today: connecting the dots

    Science.gov (United States)

    Lomazzi, Marta; Jenkins, Christopher; Borisch, Bettina

    2016-01-01

    Background Global public health today faces new challenges and is impacted by a range of actors from within and outside state boundaries. The diversity of the actors involved has created challenges and a complex environment that requires a new context-tailored global approach. The World Federation of Public Health Associations has embarked on a collaborative consultation with the World Health Organization to encourage a debate on how to adapt public health to its future role in global health. Design A qualitative study was undertaken. High-level stakeholders from leading universities, multilateral organizations, and other institutions worldwide participated in the study. Inductive content analyses were performed. Results Stakeholders underscored that global public health today should tackle the political, commercial, economic, social, and environmental determinants of health and social inequalities. A multisectoral and holistic approach should be guaranteed, engaging public health in broad dialogues and a concerted decision-making process. The connection between neoliberal ideology and public health reforms should be taken into account. The WHO must show leadership and play a supervising and technical role. More and better data are required across many programmatic areas of public health. Resources should be allocated in a sustainable and accountable way. Public health professionals need new skills that should be provided by a collaborative global education system. A common framework context-tailored to influence governments has been evaluated as useful. Conclusions The study highlighted some of the main public health challenges currently under debate in the global arena, providing interesting ideas. A more inclusive integrated vision of global health in its complexity, shared and advocated for by all stakeholders involved in decision-making processes, is crucial. This vision represents the first step in innovating public health at the global level and should lead

  3. Putting the public (back) into public health: leadership, evidence and action.

    Science.gov (United States)

    South, J; Connolly, A M; Stansfield, J A; Johnstone, P; Henderson, G; Fenton, K A

    2018-03-13

    There is a strong evidence-based rationale for community capacity building and community empowerment as part of a strategic response to reduce health inequalities. Within the current UK policy context, there are calls for increased public engagement in prevention and local decision-making in order to give people greater control over the conditions that determine health. With reference to the challenges and opportunities within the English public health system, this essay seeks to open debate about what is required to mainstream community-centred approaches and ensure that the public is central to public health. The essay sets out the case for a reorientation of public health practice in order to build impactful action with communities at scale leading to a reduction in the health gap. National frameworks that support local practice are described. Four areas of challenge that could potentially drive an implementation gap are discussed: (i) achieving integration and scale, (ii) effective community mobilization, (iii) evidencing impact and (iv) achieving a shift in power. The essay concludes with a call to action for developing a contemporary public health practice that is rooted in communities and offers local leadership to strengthen local assets, increase community control and reduce health inequalities.

  4. A knowledge management tool for public health: health-evidence.ca

    Directory of Open Access Journals (Sweden)

    Dobbins Maureen

    2010-08-01

    Full Text Available Abstract Background The ultimate goal of knowledge translation and exchange (KTE activities is to facilitate incorporation of research knowledge into program and policy development decision making. Evidence-informed decision making involves translation of the best available evidence from a systematically collected, appraised, and analyzed body of knowledge. Knowledge management (KM is emerging as a key factor contributing to the realization of evidence-informed public health decision making. The goal of health-evidence.ca is to promote evidence-informed public health decision making through facilitation of decision maker access to, retrieval, and use of the best available synthesized research evidence evaluating the effectiveness of public health interventions. Methods The systematic reviews that populate health evidence.ca are identified through an extensive search (1985-present of 7 electronic databases: MEDLINE, EMBASE, CINAHL, PsycINFO, Sociological Abstracts, BIOSIS, and SportDiscus; handsearching of over 20 journals; and reference list searches of all relevant reviews. Reviews are assessed for relevance and quality by two independent reviewers. Commonly-used public health terms are used to assign key words to each review, and project staff members compose short summaries highlighting results and implications for policy and practice. Results As of June 2010, there are 1913 reviews in the health-evidence.ca registry in 21 public health and health promotion topic areas. Of these, 78% have been assessed as being of strong or moderate methodological quality. Health-evidence.ca receives approximately 35,000 visits per year, 20,596 of which are unique visitors, representing approximately 100 visits per day. Just under half of all visitors return to the site, with the average user spending six minutes and visiting seven pages per visit. Public health nurses, program managers, health promotion workers, researchers, and program coordinators are

  5. Analyzing transmission dynamics of cholera with public health interventions.

    Science.gov (United States)

    Posny, Drew; Wang, Jin; Mukandavire, Zindoga; Modnak, Chairat

    2015-06-01

    Cholera continues to be a serious public health concern in developing countries and the global increase in the number of reported outbreaks suggests that activities to control the diseases and surveillance programs to identify or predict the occurrence of the next outbreaks are not adequate. These outbreaks have increased in frequency, severity, duration and endemicity in recent years. Mathematical models for infectious diseases play a critical role in predicting and understanding disease mechanisms, and have long provided basic insights in the possible ways to control infectious diseases. In this paper, we present a new deterministic cholera epidemiological model with three types of control measures incorporated into a cholera epidemic setting: treatment, vaccination and sanitation. Essential dynamical properties of the model with constant intervention controls which include local and global stabilities for the equilibria are carefully analyzed. Further, using optimal control techniques, we perform a study to investigate cost-effective solutions for time-dependent public health interventions in order to curb disease transmission in epidemic settings. Our results show that the basic reproductive number (R0) remains the model's epidemic threshold despite the inclusion of a package of cholera interventions. For time-dependent controls, the results suggest that these interventions closely interplay with each other, and the costs of controls directly affect the length and strength of each control in an optimal strategy. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Building and Sustaining Strong Public Health Agencies: Determinants of Workforce Turnover.

    Science.gov (United States)

    Pourshaban, Deena; Basurto-Dávila, Ricardo; Shih, Margaret

    2015-01-01

    Workforce shortages have been identified as a priority for US public health agencies. Voluntary turnover results in loss of expertise and institutional knowledge as well as high costs to recruit and train replacement workers. To analyze patterns and predictors of voluntary turnover among public health workers. Descriptive analysis and linear probability regression models. Employees of state health agencies in the United States who participated in the Public Health Workforce Interests and Needs Survey (PH WINS). Intended retirement and voluntary departure; pay satisfaction; job satisfaction. Nearly 25% of workers reported plans to retire before 2020, and an additional 18% reported the intention to leave their current organization within 1 year. Four percent of staff are considering leaving their organization in the next year for a job at a different health department. There was significant heterogeneity by demographic, socioeconomic, and job characteristics. Areas such as administration/management, health education, health services, social services, and epidemiology may be particularly vulnerable to turnover. The strongest predictors of voluntary departure were pay and job satisfaction, which were associated with 9 (P salary levels, higher levels of education and longer work experience were associated with lower pay satisfaction, except for physicians, who were 11 percentage points (P = .02) more likely to be satisfied with their pay than employees with doctoral degrees. Several workplace characteristics related to relationships with supervisors, workplace environment, and employee motivation/morale were significantly associated with job satisfaction. Our findings suggest that public health agencies may face significant pressure from worker retirement and voluntary departures in coming years. Although retirement can be addressed through recruitment efforts, addressing other voluntary departures will require focusing on improving pay and job satisfaction.

  7. The Economic Crisis and Public Health

    Directory of Open Access Journals (Sweden)

    Victor Sidel

    2009-06-01

    Full Text Available The current global economic crisis seriously threatens the health of the public. Challenges include increases in malnutrition; homelessness and inadequate housing; unemployment; substance abuse, depression, and other mental health problems; mortality; child health problems; violence; environmental and occupational health problems; and social injustice and violation of human rights; as well as decreased availability, accessibility, and affordability of quality medical and dental care. Health professionals can respond by promoting surveillance and documentation of human needs, reassessing public health priorities, educating the public and policymakers about health problems worsened by the economic crisis, advocating for sound policies and programs to address these problems, and directly providing necessary programs and services.

  8. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector

    Directory of Open Access Journals (Sweden)

    Edejer Tessa

    2003-12-01

    Full Text Available Abstract Cost-effectiveness analysis (CEA is potentially an important aid to public health decision-making but, with some notable exceptions, its use and impact at the level of individual countries is limited. A number of potential reasons may account for this, among them technical shortcomings associated with the generation of current economic evidence, political expediency, social preferences and systemic barriers to implementation. As a form of sectoral CEA, Generalized CEA sets out to overcome a number of these barriers to the appropriate use of cost-effectiveness information at the regional and country level. Its application via WHO-CHOICE provides a new economic evidence base, as well as underlying methodological developments, concerning the cost-effectiveness of a range of health interventions for leading causes of, and risk factors for, disease. The estimated sub-regional costs and effects of different interventions provided by WHO-CHOICE can readily be tailored to the specific context of individual countries, for example by adjustment to the quantity and unit prices of intervention inputs (costs or the coverage, efficacy and adherence rates of interventions (effectiveness. The potential usefulness of this information for health policy and planning is in assessing if current intervention strategies represent an efficient use of scarce resources, and which of the potential additional interventions that are not yet implemented, or not implemented fully, should be given priority on the grounds of cost-effectiveness. Health policy-makers and programme managers can use results from WHO-CHOICE as a valuable input into the planning and prioritization of services at national level, as well as a starting point for additional analyses of the trade-off between the efficiency of interventions in producing health and their impact on other key outcomes such as reducing inequalities and improving the health of the poor.

  9. [Notes for understanding the problem of "public" health in the health sector].

    Science.gov (United States)

    Guimarães, Cristian Fabiano; da Silva, Rosane Azevedo Neves

    2015-03-01

    This paper presents a theoretical review of how the public health concept has been perceived in health practices, based on the problematic field introduced in Italian and Brazilian health reforms, in order to understand the construction of public health and the meanings that this term acquires in the health arena. The main goal is to understand how public health appears in the context of health movements in Italy and Brazil, as well as its movement of variation. In this sense, an attempt is made to identify elements that contribute to the composition of a genealogy of public health. From the investigation of public health practices, the tensions produced by this concept are analyzed, giving visibility to those practices that demonstrate the public health experience as a force in the world of health.

  10. Soil and public health: invisible bridges

    Science.gov (United States)

    Pachepsky, Yakov

    2017-04-01

    Public health institutions, as ancient as civilizations itself, are intrinsically connected with soils. The massive body of the empirical knowledge about this connection has been accumulated. Recently unraveling the underlying mechanisms of this link has begun, and many of them appear to have the microbiological origin. The impressive progress in understanding the nexus between soil and health has been achieved by experimentation with preserved soil microbial systems functioning along with the metagenomic characterization. The objective of this work is to present an overview of some recent onsets. In the food safety arena, survival of human pathogens in soils has been related to the degree of soil eutrophication and/or related structure of soil microbial communities. Soil microbial systems affect the affinity of plants to internalizing pathogenic organisms. Pharmaceutical arsenals benefit from using field soil environment for developing antibiotics. Enzyme production by soil bacteria is used as the signal source for drug activation. Sanitary functions of sols are dependent on soil microbial system workings. The healthy living can be enhanced by the human immune system training received from direct contact with soils. The hygiene hypothesis considers the microbial input due to exposure to soil as the essential ecosystem service. The invisible links between soil and public health result in large-scale consequences. Examples of concurrent degradation of soil and public health are worth scrutinizing. Public health records can provide valuable sources of 'soil-public health' interactions. It may be worthwhile to examine current assessments of soil health from the public health standpoint. Soil management can be an efficient instrument of public health control.

  11. Expert and Advocacy Group Consensus Findings on the Horizon of Public Health Genetic Testing

    Directory of Open Access Journals (Sweden)

    Stephen M. Modell

    2016-01-01

    Full Text Available Description: Among the two leading causes of death in the United States, each responsible for one in every four deaths, heart disease costs Americans $300 billion, while cancer costs Americans $216 billion per year. They also rank among the top three causes of death in Europe and Asia. In 2012 the University of Michigan Center for Public Health and Community Genomics and Genetic Alliance, with the support of the Centers for Disease Control and Prevention Office of Public Health Genomics, hosted a conference in Atlanta, Georgia to consider related action strategies based on public health genomics. The aim of the conference was consensus building on recommendations to implement genetic screening for three major heritable contributors to these mortality and cost figures: hereditary breast and ovarian cancer (HBOC, familial hypercholesterolemia (FH, and Lynch syndrome (LS. Genetic applications for these three conditions are labeled with a “Tier 1” designation by the U.S. Centers for Disease Control and Prevention because they have been fully validated and clinical practice guidelines based on systematic review support them. Methodology: The conference followed a deliberative sequence starting with nationally recognized clinical and public health presenters for each condition, followed by a Patient and Community Perspectives Panel, working group sessions for each of the conditions, and a final plenary session. The 74 conference participants represented disease research and advocacy, public health, medicine and nursing, genetics, governmental health agencies, and industry. Participants drew on a public health framework interconnecting policy, clinical intervention, surveillance, and educational functions for their deliberations. Results: Participants emphasized the importance of collaboration between clinical, public health, and advocacy groups in implementing Tier 1 genetic screening. Advocacy groups could help with individual and institutional

  12. REFLECTIONS ABOUT NURSES WORK IN PUBLIC HEALTH

    Directory of Open Access Journals (Sweden)

    Maria Alves Barbosa

    2006-12-01

    Full Text Available ABSTRACT: This research is a part of CIPESC (Classification of Nursing Practice in Public Health project, with national coordination by ABEn (Brazilian Nursing Association witch purpose was to elaborate an inventory of activities developed by Public Health Nurses. It sough to analyze the contribution of the nurses in public health in the South Sanitary District in the city of Goiânia (GO – Brazil, and to identify the meaning of nurses work contribution at Public Health Services, by users and managers. The study was developed by a descriptive-analytical investigation in a qualitative approach. The subjects were managers and users of the Public Health System. Data was collected by individual semi-structured interview directed to the managers and controlling and the Technique of Focal Group. The results had been grouped in three categories: "Performance of the professional", "Education Perspective of Nurses Work”, and "Health-care attendance". As conclusion was found that the nurses give great contribution in the implantation and maintenance of the health politics; that it has concern with the professional formation, that many times is responsible for the incompatibility between the service and the expected potential; it is stand out performance of the nurse as health education professional in the inserted activities in the public health, being intense its contact with the community. KEY WORDS: Public Health; Nursing; Public Health Nursing.

  13. The case for transforming governmental public health.

    Science.gov (United States)

    Salinsky, Eileen; Gursky, Elin A

    2006-01-01

    Changing threats to the public's health necessitate a profound transformation of the public health enterprise. Despite recent attention to the biodefense role of public health, policymakers have not developed a clear, realistic vision for the structure and functionality of the governmental public health system. Lack of leadership and organizational disconnects across levels of government have prevented strategic alignment of resources and undermined momentum for meaningful change. A transformed public health system is needed to address the demands of emergency preparedness and health protection. Such transformation should include focused, risk-based resource allocation; regional planning; technological upgrades; workforce restructuring; improved integration of private-sector assets; and better performance monitoring.

  14. Targeting the probability versus cost of feared outcomes in public speaking anxiety.

    Science.gov (United States)

    Nelson, Elizabeth A; Deacon, Brett J; Lickel, James J; Sy, Jennifer T

    2010-04-01

    Cognitive-behavioral theory suggests that social phobia is maintained, in part, by overestimates of the probability and cost of negative social events. Indeed, empirically supported cognitive-behavioral treatments directly target these cognitive biases through the use of in vivo exposure or behavioral experiments. While cognitive-behavioral theories and treatment protocols emphasize the importance of targeting probability and cost biases in the reduction of social anxiety, few studies have examined specific techniques for reducing probability and cost bias, and thus the relative efficacy of exposure to the probability versus cost of negative social events is unknown. In the present study, 37 undergraduates with high public speaking anxiety were randomly assigned to a single-session intervention designed to reduce either the perceived probability or the perceived cost of negative outcomes associated with public speaking. Compared to participants in the probability treatment condition, those in the cost treatment condition demonstrated significantly greater improvement on measures of public speaking anxiety and cost estimates for negative social events. The superior efficacy of the cost treatment condition was mediated by greater treatment-related changes in social cost estimates. The clinical implications of these findings are discussed. Published by Elsevier Ltd.

  15. The cost-effectiveness and public health benefit of nalmefene added to psychosocial support for the reduction of alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels: a Markov model.

    Science.gov (United States)

    Laramée, Philippe; Brodtkorb, Thor-Henrik; Rahhali, Nora; Knight, Chris; Barbosa, Carolina; François, Clément; Toumi, Mondher; Daeppen, Jean-Bernard; Rehm, Jürgen

    2014-09-16

    To determine whether nalmefene combined with psychosocial support is cost-effective compared with psychosocial support alone for reducing alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels (DRLs) as defined by the WHO, and to evaluate the public health benefit of reducing harmful alcohol-attributable diseases, injuries and deaths. Decision modelling using Markov chains compared costs and effects over 5 years. The analysis was from the perspective of the National Health Service (NHS) in England and Wales. The model considered the licensed population for nalmefene, specifically adults with both alcohol dependence and high/very high DRLs, who do not require immediate detoxification and who continue to have high/very high DRLs after initial assessment. We modelled treatment effect using data from three clinical trials for nalmefene (ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941)). Baseline characteristics of the model population, treatment resource utilisation and utilities were from these trials. We estimated the number of alcohol-attributable events occurring at different levels of alcohol consumption based on published epidemiological risk-relation studies. Health-related costs were from UK sources. We measured incremental cost per quality-adjusted life year (QALY) gained and number of alcohol-attributable harmful events avoided. Nalmefene in combination with psychosocial support had an incremental cost-effectiveness ratio (ICER) of £5204 per QALY gained, and was therefore cost-effective at the £20,000 per QALY gained decision threshold. Sensitivity analyses showed that the conclusion was robust. Nalmefene plus psychosocial support led to the avoidance of 7179 alcohol-attributable diseases/injuries and 309 deaths per 100,000 patients compared to psychosocial support alone over the course of 5 years. Nalmefene can be seen as a cost-effective treatment for alcohol dependence, with substantial public

  16. Public Hospital Spending in England: Evidence from National Health Service Administrative Records

    OpenAIRE

    Kelly, E.; Stoye, G.; Vera-Hernández, M.

    2016-01-01

    © 2016 The Authors. Fiscal Studies published by John Wiley & Sons Ltd. on behalf of Institute for Fiscal StudiesHealth spending per capita in England has almost doubled since 1997, yet relatively little is known about how that spending is distributed across the population. This paper uses administrative National Health Service (NHS) hospital records to examine key features of public hospital spending in England. We describe how costs vary across the life cycle, and the concentration of spendi...

  17. Perceived Need Versus Current Spending: Gaps in Providing Foundational Public Health Services in Communities.

    Science.gov (United States)

    Bekemeier, Betty; Marlowe, Justin; Squires, Linda Sharee; Tebaldi, Jennifer; Park, Seungeun

    Our objective was to estimate the gap between the costs for local health jurisdictions (LHJs) to provide foundational public health services (FPHS) and actual spending on FPHS and to examine factors associated with that gap. We employed resource-based cost estimation methods for this observational study and conducted multivariate analyses with measures derived from secondary administrative data. We used primary data collected from LHJ leaders that depicted 2014 spending and perceived need. We also included secondary administrative data depicting annual 2000-2013 expenditures organized into categories containing key elements of FPHS areas. We included primary data from a representative sample of 10 LHJs in Washington State and secondary data for all 35 LHJs in Washington. Participants were public health practice leaders from each sample LHJ. Our main outcome of interest was the gap identified between current spending and the perceived spending needed to provide FPHS in a jurisdiction. Actual FPHS spending was approximately 65% of spending needed to provide overall FPHS for our sample LHJs, but the size of the gap varied substantially by program. Some gaps also varied widely by LHJ, with spending gaps widest among rural and high poverty communities. Percent poverty and the metropolitan nature of a jurisdiction were factors significantly related to FPHS spending in our multivariate analyses. Actual spending lags far behind local officials' estimates of spending needed to provide FPHS and is likely influenced by local conditions. Major apparent gaps between spending and need, particularly in areas such as costly Business Competencies, underscore the need for cross-cutting capabilities to support public health system responsiveness and for attention to be paid to local conditions.

  18. Institutional racism in public health contracting: Findings of a nationwide survey from New Zealand.

    Science.gov (United States)

    Came, H; Doole, C; McKenna, B; McCreanor, T

    2018-02-01

    Public institutions within New Zealand have long been accused of mono-culturalism and institutional racism. This study sought to identify inconsistencies and bias by comparing government funded contracting processes for Māori public health providers (n = 60) with those of generic providers (n = 90). Qualitative and quantitative data were collected (November 2014-May 2015), through a nationwide telephone survey of public health providers, achieving a 75% response rate. Descriptive statistical analyses were applied to quantitative responses and an inductive approach was taken to analyse data from open-ended responses in the survey domains of relationships with portfolio contract managers, contracting and funding. The quantitative data showed four sites of statistically significant variation: length of contracts, intensity of monitoring, compliance costs and frequency of auditing. Non-significant data involved access to discretionary funding and cost of living adjustments, the frequency of monitoring, access to Crown (government) funders and representation on advisory groups. The qualitative material showed disparate provider experiences, dependent on individual portfolio managers, with nuanced differences between generic and Māori providers' experiences. This study showed that monitoring government performance through a nationwide survey was an innovative way to identify sites of institutional racism. In a policy context where health equity is a key directive to the health sector, this study suggests there is scope for New Zealand health funders to improve their contracting practices. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Public Health Intelligence: Learning From the Ebola Crisis

    Science.gov (United States)

    Weber, David Jay

    2015-01-01

    Today’s public health crises, as exemplified by the Ebola outbreak, lead to dramatic calls to action that typically include improved electronic monitoring systems to better prepare for, and respond to, similar occurrences in the future. Even a preliminary public health informatics evaluation of the current Ebola crisis exposes the need for enhanced coordination and sharing of trustworthy public health intelligence. We call for a consumer-centric model of public health intelligence and the formation of a national center to guide public health intelligence gathering and synthesis. Sharing accurate and actionable information with government agencies, health care practitioners, policymakers, and, critically, the general public, will mark a shift from doing public health surveillance on people to doing public health surveillance for people. PMID:26180978

  20. Does corruption undermine trust in health care? Results from public opinion polls in Croatia.

    Science.gov (United States)

    Radin, Dagmar

    2013-12-01

    Health and health care provision are one of the most important topics in public policy, and often a highly debated topic in the political arena. The importance of considering trust in the health care sector is highlighted by studies showing that trust is associated, among others, with poor self-related health, and poorer health outcomes. Similarly, corruption has shown to create economic costs and inefficiencies in the health care sector. This is particularly important for a newly democratized country such as Croatia, where a policy responsive government indicates a high level of quality of democracy (Roberts, 2009) and where a legacy of corruption in the health care sector has been carried over from the previous regime. In this study, I assess the relationship between health care corruption and trust in public health care and hypothesize that experience with health care corruption as well as perception of corruption has a negative effect on trust in public care facilities. Data were collected in two surveys, administered in 2007 and 2009 in Croatia. Experience with corruption and salience with corruption has a negative effect on trust in public health care in the 2007 survey, but not in the 2009 survey. While the results are mixed, they point to the importance of further studying this relationship. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Cost-Effectiveness Analysis of Systemic Therapies in Advanced Pancreatic Cancer in the Canadian Health Care System.

    Science.gov (United States)

    Coyle, Doug; Ko, Yoo-Joung; Coyle, Kathryn; Saluja, Ronak; Shah, Keya; Lien, Kelly; Lam, Henry; Chan, Kelvin K W

    2017-04-01

    To assess the cost-effectiveness of gemcitabine (G), G + 5-fluorouracil, G + capecitabine, G + cisplatin, G + oxaliplatin, G + erlotinib, G + nab-paclitaxel (GnP), and FOLFIRINOX in the treatment of advanced pancreatic cancer from a Canadian public health payer's perspective, using data from a recently published Bayesian network meta-analysis. Analysis was conducted through a three-state Markov model and used data on the progression of disease with treatment from the gemcitabine arms of randomized controlled trials combined with estimates from the network meta-analysis for the newer regimens. Estimates of health care costs were obtained from local providers, and utilities were derived from the literature. The model estimates the effect of treatment regimens on costs and quality-adjusted life-years (QALYs) discounted at 5% per annum. At a willingness-to-pay (WTP) threshold of greater than $30,666 per QALY, FOLFIRINOX would be the most optimal regimen. For a WTP threshold of $50,000 per QALY, the probability that FOLFIRINOX would be optimal was 57.8%. There was no price reduction for nab-paclitaxel when GnP was optimal. From a Canadian public health payer's perspective at the present time and drug prices, FOLFIRINOX is the optimal regimen on the basis of the cost-effectiveness criterion. GnP is not cost-effective regardless of the WTP threshold. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  2. Predictors of mental health-related acute service utilisation and treatment costs in the 12 months following an acute psychiatric admission.

    Science.gov (United States)

    Siskind, Dan; Harris, Meredith; Diminic, Sandra; Carstensen, Georgia; Robinson, Gail; Whiteford, Harvey

    2014-11-01

    A key step in informing mental health resource allocation is to identify the predictors of service utilisation and costs. This project aims to identify the predictors of mental health-related acute service utilisation and treatment costs in the year following an acute public psychiatric hospital admission. A dataset containing administrative and routinely measured outcome data for 1 year before and after an acute psychiatric admission for 1757 public mental health patients was analysed. Multivariate regression models were developed to identify patient- and treatment-related predictors of four measures of service utilisation or cost: (a) duration of index admission; and, in the year after discharge from the index admission (b) acute psychiatric inpatient bed-days; (c) emergency department (ED) presentations; and (d) total acute mental health service costs. Split-sample cross-validation was used. A diagnosis of psychosis, problems with living conditions and prior acute psychiatric inpatient bed-days predicted a longer duration of index admission, while prior ED presentations and self-harm predicted a shorter duration. A greater number of acute psychiatric inpatient bed-days in the year post-discharge were predicted by psychosis diagnosis, problems with living conditions and prior acute psychiatric inpatient admissions. The number of future ED presentations was predicted by past ED presentations. For total acute care costs, diagnosis of psychosis was the strongest predictor. Illness acuity and prior acute psychiatric inpatient admission also predicted higher costs, while self-harm predicted lower costs. The development of effective models for predicting acute mental health treatment costs using existing administrative data is an essential step towards a workable activity-based funding model for mental health. Future studies would benefit from the inclusion of a wider range of variables, including ethnicity, clinical complexity, cognition, mental health legal status

  3. Cost-of-illness studies.

    Science.gov (United States)

    Oderda, Gary M

    2003-01-01

    Cost-of-illness studies measure the overall economic impact of a disease on society. Such studies are important in setting public health priorities and for economic evaluation of new treatments. These studies should take the societal perspective and include both direct and indirect costs. Often indirect costs exceed direct costs. Comparison of cost-of-illness studies from different countries is difficult because of differences in population, currency, the way health care is provided, and other social and political factors.

  4. Radiological protection and public health: crossbreeding

    International Nuclear Information System (INIS)

    Smeesters, Patrick; Pinak, Miroslav

    2008-01-01

    Full text: This paper summarizes the scope of activities, ongoing experience and current results of the Expert Group on the Public Health Perspective in Radiological Protection (EGPH) of the Committee of Radiological Protection and Public Health, OECD Nuclear Energy Agency. While the prime and general task of the EGPH group is looking at how the public health and radiation protection can better take an advantage of their respective perspectives, the following four areas have been explored in detail: a) Exposure to radon; b) Justification of medical exposures; c) Public health judgement and decision making based on new scientific evidence; and d) Management of individual differences. In most of these areas, a targeted telephone survey on public policies in selected countries was used for collecting information from stake holders (public, consumers groups, public health and radiation protection regulators, governmental bodies, medical practitioners, patients, scientific communities, NGOs, etc.). The presented paper also highlights key issues of collected information and summarises existing approaches and policies. The case study on exposure to radon collects national information on approaches to the management of domestic radon risks, focusing on the integration of radiation protection and public health aspects (quality of dwellings, overall quality of indoor air, perception of radon levels, position of radon risk in the pool of other risks). In the case of justification of medical exposures, the Group studies the applications of the justification principle in opportunistic screenings (responsibilities, management of the situation, risk assessment). The precautionary principle and its impact on policy judgement in the light of significant scientific uncertainties can have a large influence on radiological-protection decision making. The case study on public health judgement and decision making based on new scientific evidence is exploring how these uncertainties and

  5. Identifying research priorities for public health research to address health inequalities: use of Delphi-like survey methods.

    Science.gov (United States)

    Turner, S; Ollerhead, E; Cook, A

    2017-10-09

    In the funding of health research and public health research it is vital that research questions posed are important and that funded research meets a research need or a gap in evidence. Many methods are used in the identification of research priorities, however, these can be resource intensive, costly and logistically challenging. Identifying such research priorities can be particularly challenging for complex public health problems as there is a need to consult a number of experts across disciplines and with a range of expertise. This study investigated the use of Delphi-like survey methods in identifying important research priorities relating to health inequalities and framing tractable research questions for topic areas identified. The study was conducted in two phases, both using Delphi-like survey methods. Firstly, public health professionals with an interest in health inequalities were asked to identify research priorities. Secondly academic researchers were asked to frame tractable research questions relating to the priorities identified. These research priorities identified using Delphi-like survey methods were subsequently compared to those identified using different methods. A total of 52 public health professionals and 21 academics across the United Kingdom agreed to take part. The response rates were high, from public health professionals across three survey rounds (69%, 50% and 40%) and from academics across one round (52%), indicating that participants were receptive to the method and motivated to respond. The themes identified as encompassing the most important research priorities were mental health, healthy environment and health behaviours. Within these themes, the topic areas that emerged most strongly included community interventions for prevention of mental health problems and the food and alcohol environment. Some responses received from academic researchers were (as requested) in the form of tractable research questions, whereas others

  6. Public health and the economy could be served by reallocating medical expenditures to social programs

    Directory of Open Access Journals (Sweden)

    Linda Diem Tran

    2017-12-01

    Full Text Available As much as 30% of US health care spending in the United States does not improve individual or population health. To a large extent this excess spending results from prices that are too high and from administrative waste. In the public sector, and particularly at the state level, where budget constraints are severe and reluctance to raise taxes high, this spending crowds out social, educational, and public-health investments. Over time, as spending on medical care increases, spending on improvements to the social determinants of health are starved. In California the fraction of General Fund expenditures spent on public health and social programs fell from 34.8% in fiscal year 1990 to 21.4% in fiscal year 2014, while health care increased from 14.1% to 21.3%. In spending more on healthcare and less on other efforts to improve health and health determinants, the state is missing important opportunities for health-promoting interventions with a strong financial return. Reallocating ineffective medical expenditures to proven and cost-effective public health and social programs would not be easy, but recognizing its potential for improving the public's health while saving taxpayers billions of dollars might provide political cover to those willing to engage in genuine reform. National estimates of the percent of medical spending that does not improve health suggest that approximately $5 billion of California's public budget for medical spending has no positive effect on health. Up to 10,500 premature deaths could be prevented annually by reallocating this portion of medical spending to public health. Alternatively, the same expenditure could help an additional 418,000 high school students to graduate.

  7. Public health and the economy could be served by reallocating medical expenditures to social programs.

    Science.gov (United States)

    Tran, Linda Diem; Zimmerman, Frederick J; Fielding, Jonathan E

    2017-12-01

    As much as 30% of US health care spending in the United States does not improve individual or population health. To a large extent this excess spending results from prices that are too high and from administrative waste. In the public sector, and particularly at the state level, where budget constraints are severe and reluctance to raise taxes high, this spending crowds out social, educational, and public-health investments. Over time, as spending on medical care increases, spending on improvements to the social determinants of health are starved. In California the fraction of General Fund expenditures spent on public health and social programs fell from 34.8% in fiscal year 1990 to 21.4% in fiscal year 2014, while health care increased from 14.1% to 21.3%. In spending more on healthcare and less on other efforts to improve health and health determinants, the state is missing important opportunities for health-promoting interventions with a strong financial return. Reallocating ineffective medical expenditures to proven and cost-effective public health and social programs would not be easy, but recognizing its potential for improving the public's health while saving taxpayers billions of dollars might provide political cover to those willing to engage in genuine reform. National estimates of the percent of medical spending that does not improve health suggest that approximately $5 billion of California's public budget for medical spending has no positive effect on health. Up to 10,500 premature deaths could be prevented annually by reallocating this portion of medical spending to public health. Alternatively, the same expenditure could help an additional 418,000 high school students to graduate.

  8. Shaping and authorising a public health profession

    Directory of Open Access Journals (Sweden)

    Katarzyna Czabanowska

    2015-12-01

    doctors, nurses, lawyers, and architects can enjoy the benefits of the 2005/36/EC Directive amended by 2013/55/EU Directive on the recognition of professional qualifications, public health professionals are left out from these influential (elite professions. Firstly, we use the profession traits theory as a framework in arguing whether public health can be a legitimate profession in itself; secondly, we explain who public health professionals are and what usually is required for shaping the public health profession; and thirdly, we attempt to sketch the road to the authorisation or licensing of public health professionals. Finally, we propose some recommendations.

  9. Health for all: a fundamental goal of public health in our region.

    Science.gov (United States)

    Binns, Colin; Lee, Mi Kyung

    2015-01-01

    Since its foundation 30 years ago, the mission of the Asia-Pacific Academic Consortium for Public Health has been promoting "health for all" through public health. "Health for all" became the theme of Walter Patrick's public health career and inspired his contribution to APACPH. However, the universality of health care is now under threat, more from economists and politicians than public health workers. Health for all remains a continuing challenge for all public health workers in our region. Progress is being made toward this goal as life expectancy in the Western Pacific has increased from 64 to 78 in the past 3 decades. Prof Walter Patrick was strong public health advocate, and this review was written as a tribute to good friend and inspiring colleague who believed in, and worked for "health for all." © 2014 APJPH.

  10. Holistic self-management education and support: a proposed public health model for improving women's health in Zimbabwe.

    Science.gov (United States)

    Kanchense, Jane Handina Murigwa

    2006-08-01

    The primary health care model of public health has been implemented in many countries around the globe since the Declaration of Alma Ata in 1978, without pilot testing the primary health care model. Therefore, many public health researchers have sought methods of improving primary health care by creating evidence-based models. Many of these researchers recognize the role of behavioral models in public health. These offshoots of primary health care include the ecological, care, central human capabilities, and the SPECIES models. Holistic self-management education and support is a capacity-building philosophy that ensures active involvement of consumers of health care in the planning and implementation and evaluation of health care services. It helps consumers of health care to achieve the desired improved quality of health and life in managing and sustaining their health at the grassroots level. The care model addresses disease management ideals of the in the original primary health care model. The SPECIES model addresses those aspects of the primary health care model that include the cultural and social factors, as well as individual health education and support in the original primary health care model. The ecological model offers an improvement of the socioeconomic ideal in the original primary health care model. Improving the health of individuals will prevent illness, thereby reducing health care costs and lessening the current strain on an overburdened health care system in Zimbabwe. Holistic self-management education and support links health care delivery systems with social processes. It is a best practices model that could better serve Zimbabwean girls and women by contributing positively to the national challenges in health care, thereby meeting the Zimbabwean primary health care and safe motherhood goals. It is here recommended that holistic self-management education and support must be pilot tested before being adopted as the most appropriate model for

  11. COST OF PRIMARY HEALTH CARE IN PAKISTAN.

    Science.gov (United States)

    Malik, Muhammad Ashar; Gul, Wahid; Iqbal, Saleem Perwaiz; Abrejo, Farina

    2015-01-01

    Detailed cost analysis is an important tool for review of health policy and reforms. We provide an estimate of cost of service and its detailed breakup on out-door patient visits (OPV) to basic health units (BHU) in Pakistan. Six BHUs were randomly selected from each of the five districts in Khyber Pukhtonkhawa (KPK) and two agencies in Federally Administered Tribal Areas (FATA) of Pakistan for this study. Actual expenditure data and utilization data in the year 2005-06 of 42 BHUs was collected from selected district health offices in KPK and FATA. Costs were estimated for outpatient visits to BHUs. Perspective on cost estimates was district-based health planning and management of BHUs. Average recurring cost was PKR.245 (USD 4.1) per OPV to BHU. Staff salaries constituted 90% of recurrent cost. On the average there were 16 OPV per day to the BHUs. CONCLUDION: Recurrent cost per OPV has doubled from the previous estimates of cost of OPV in Baluchistan. The estimated recurrent cost was six times higher than average consultation charges with the private general practitioner (GP) in the country (i.e., PKR 50/ GP consultation). Performance of majority of the BHUs was much lower than the performance target (50 patients per day) set in the sixth five-year plan of the government of Pakistan. The Government of Pakistan may use these analyses to revisit the performance target, staffinL and location of BHUs.

  12. CONSIDERATIONS REGARDING SOCIAL INSURANCE IN THE ROMANIAN PUBLIC HEALTH SYSTEM

    Directory of Open Access Journals (Sweden)

    Aracsia-Magdalena Benţia

    2017-12-01

    Full Text Available Objectives of the study: the study aims to analyze the issue of social health insurance in Romania and to provide legislative solutions in combating them. The research methods used are the qualitative research method and the observation method. Results and implications of the study: 1 establish a 2020-2030 Strategy to prevent disease by launching national campaigns for healthy eating, reducing smoking and alcohol consumption, and introducing the color scheme for food; 2 decentralizing the system, establishing a public-private partnership, increasing the patient's freedom in choosing doctors and services; 3 limiting the cost of medical care by introducing caps, as well as co-payments; 4 institutional reform of the public sector in this area. In some opinions, "Experience in other countries consistently suggests that introducing a private funding system would create more problems than it would solve. That is why efforts should be focused rather on institutional reform of the public sector"; 5 developing legislation to make differentiated payments for medical services; 6 closure of non-accredited hospitals and their privatization; 7 establishment of private health insurance houses.

  13. Statistical methods used in the public health literature and implications for training of public health professionals.

    Science.gov (United States)

    Hayat, Matthew J; Powell, Amanda; Johnson, Tessa; Cadwell, Betsy L

    2017-01-01

    Statistical literacy and knowledge is needed to read and understand the public health literature. The purpose of this study was to quantify basic and advanced statistical methods used in public health research. We randomly sampled 216 published articles from seven top tier general public health journals. Studies were reviewed by two readers and a standardized data collection form completed for each article. Data were analyzed with descriptive statistics and frequency distributions. Results were summarized for statistical methods used in the literature, including descriptive and inferential statistics, modeling, advanced statistical techniques, and statistical software used. Approximately 81.9% of articles reported an observational study design and 93.1% of articles were substantively focused. Descriptive statistics in table or graphical form were reported in more than 95% of the articles, and statistical inference reported in more than 76% of the studies reviewed. These results reveal the types of statistical methods currently used in the public health literature. Although this study did not obtain information on what should be taught, information on statistical methods being used is useful for curriculum development in graduate health sciences education, as well as making informed decisions about continuing education for public health professionals.

  14. Long-term socioeconomic consequences and health care costs of childhood and adolescent-onset epilepsy.

    Science.gov (United States)

    Jennum, Poul; Christensen, Jakob; Ibsen, Rikke; Kjellberg, Jakob

    2016-07-01

    To estimate long-term socioeconomic consequences and health care costs of epilepsy with onset in childhood and adolescence. A historical prospective cohort study of Danish individuals with epilepsy, age up to 20 years at time of diagnosis between January 1981 and December 2012. Information about marital status, parenthood, educational level, employment status, income, use of the health care system, and cost of medicine was obtained from nationwide administrative and health registers. We identified 12,756 and 28,319 people with diagnosed with epilepsy, ages 0-5 and 6-20 years at onset, respectively. Using follow-up data for a maximum of 30 years, 1,394 of those ages 0-5 years at onset were compared with 2,897 controls persons without epilepsy, and 10,195 of those ages 6-20 years at onset were compared with 20,678 controls without epilepsy. Compared with people without the epilepsy, those with epilepsy tended to have a lower level of education, to be less likely to be married, to be more likely to live alone, and to have higher divorce and unemployment rates, lower employment rates, and people with epilepsy were more likely to receive disability pension and social security. Income was lower from employment, which in part was compensated by social security, sick pay, disability pension and unemployment benefit, sick pay (public-funded), disability pension, and other public transfers. Predicted health care costs 30 years after epilepsy onset were significantly higher among persons with epilepsy onset at 0-5 and 6-20 years, including costs for outpatient and inpatient services (hospital services), emergency room use, primary health care sector (general practice), and use of medication. The long-term negative effects on all aspects of health care and social domains, including marital status, parental socioeconomic status, educational level, employment status, and use of welfare benefits compared with controls without epilepsy calls for increased awareness on

  15. Acceptability of financial incentives for health behaviour change to public health policymakers: a qualitative study.

    Science.gov (United States)

    Giles, Emma L; Sniehotta, Falko F; McColl, Elaine; Adams, Jean

    2016-09-15

    Providing financial incentives contingent on healthy behaviours is one way to encourage healthy behaviours. However, there remains substantial concerns with the acceptability of health promoting financial incentives (HPFI). Previous research has studied acceptability of HPFI to the public, recipients and practitioners. We are not aware of any previous work that has focused particularly on the views of public health policymakers. Our aim was to explore the views of public health policymakers on whether or not HPFI are acceptable; and what, if anything, could be done to maximise acceptability of HPFI. We recruited 21 local, regional and national policymakers working in England via gatekeepers and snowballing. We conducted semi-structured in-depth interviews with participants exploring experiences of, and attitudes towards, HPFI. We analysed data using the Framework approach. Public health policymakers working in England acknowledged that HPFI could be a useful behaviour change tool, but were not overwhelmingly supportive of them. In particular, they raised concerns about effectiveness and cost-effectiveness, potential 'gaming', and whether or not HPFI address the underlying causes of unhealthy behaviours. Shopping voucher rewards, of smaller value, targeted at deprived groups were particularly acceptable to policymakers. Participants were particularly concerned about the response of other stakeholders to HPFI - including the public, potential recipients, politicians and the media. Overall, the interviews reflected three tensions. Firstly, a tension between wanting to trust individuals and promote responsibility; and distrust around the potential for 'gaming the system'. Secondly, a tension between participants' own views about HPFI; and their concerns about the possible views of other stakeholders. Thirdly, a tension between participants' personal distaste of HPFI; and their professional view that they could be a valuable behaviour change tool. There are aspects of

  16. Public finance of rotavirus vaccination in India and Ethiopia: an extended cost-effectiveness analysis.

    Science.gov (United States)

    Verguet, Stéphane; Murphy, Shane; Anderson, Benjamin; Johansson, Kjell Arne; Glass, Roger; Rheingans, Richard

    2013-10-01

    An estimated 4% of global child deaths (approximately 300,000 deaths) were attributed to rotavirus in 2010. About a third of these deaths occurred in India and Ethiopia. Public finance of rotavirus vaccination in these two countries could substantially decrease child mortality and also reduce rotavirus-related hospitalizations, prevent health-related impoverishment and bring significant cost savings to households. We use a methodology of 'extended cost-effectiveness analysis' (ECEA) to evaluate a hypothetical publicly financed program for rotavirus vaccination in India and Ethiopia. We measure program impact along four dimensions: 1) rotavirus deaths averted; 2) household expenditures averted; 3) financial risk protection afforded; 4) distributional consequences across the wealth strata of the country populations. In India and Ethiopia, the program would lead to a substantial decrease in rotavirus deaths, mainly among the poorer; it would reduce household expenditures across all income groups and it would effectively provide financial risk protection, mostly concentrated among the poorest. Potential indirect benefits of vaccination (herd immunity) would increase program benefits among all income groups, whereas potentially decreased vaccine efficacy among poorer households would reduce the equity benefits of the program. Our approach incorporates financial risk protection and distributional consequences into the systematic economic evaluation of vaccine policy, illustrated here with the case study of public finance for rotavirus vaccination. This enables selection of vaccine packages based on the quantitative inclusion of information on equity and on how much financial risk protection is being bought per dollar expenditure on vaccine policy, in addition to how much health is being bought. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Public health aspects of tobacco control revisited

    NARCIS (Netherlands)

    Gallagher, Jennifer E.; Alajbeg, Ivan; Buechler, Silvia; Carrassi, Antonio; Hovius, Marjolijn; Jacobs, Annelies; Jenner, Maryan; Kinnunen, Taru; Ulbricht, Sabina; Zoitopoulos, Liana

    The tobacco epidemic presents a major public health challenge, globally, and within Europe. The aim of the Public Health Work Stream at the 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals was to review the public health aspects of tobacco control and make

  18. Prioritizing Sleep Health: Public Health Policy Recommendations.

    Science.gov (United States)

    Barnes, Christopher M; Drake, Christopher L

    2015-11-01

    The schedules that Americans live by are not consistent with healthy sleep patterns. In addition, poor access to educational and treatment aids for sleep leaves people engaging in behavior that is harmful to sleep and forgoing treatment for sleep disorders. This has created a sleep crisis that is a public health issue with broad implications for cognitive outcomes, mental health, physical health, work performance, and safety. New public policies should be formulated to address these issues. We draw from the scientific literature to recommend the following: establishing national standards for middle and high school start times that are later in the day, stronger regulation of work hours and schedules, eliminating daylight saving time, educating the public regarding the impact of electronic media on sleep, and improving access to ambulatory in-home diagnostic testing for sleep disorders. © The Author(s) 2015.

  19. The Cost of Medicaid Savings: The Potential Detrimental Public Health Impact of Neonatal Circumcision Defunding

    Directory of Open Access Journals (Sweden)

    Annie L. Andrews

    2012-01-01

    Full Text Available Objective. To project the increased incidence of HIV and subsequent costs resulting from the expected decreased rate of circumcision due to Medicaid defunding in one southeastern state. Methods. Using 2009 South Carolina (SC Medicaid birth cohort (n=29,316, we calculated expected heterosexually acquired HIV cases at current circumcision rates. To calculate age/race/gender specific HIV incidence rates, we used 2009 South Carolina Department of Health and Environmental Control reported gender and race specific HIV cases, CDC reported age distribution of HIV cases, and 2009 S.C. population data. Accounting for current circumcision rates, we calculated the change in incidence of heterosexually acquired HIV assuming circumcision provides 60% protection against HIV transmission to males and 46% protection against male to female transmission. Published lifetime cost of HIV was used to calculate the cost of additional HIV cases. Results. Assuming Medicaid circumcision rates decrease from current nationally reported levels to zero secondary to defunding, we project an additional 55 male cases of HIV and 47 female cases of HIV among this birth cohort. The total cost discounted to time of infection of these additional HIV cases is $20,924,400 for male cases and $17,711,400 for female cases. The cost to circumcise males in this birth cohort at currently reported rates is $4,856,000. Conclusions. For every year of decreased circumcision rates due to Medicaid defunding, we project over 100 additional HIV cases and $30,000,000 in net medical costs.

  20. Partially wrong? Partial equilibrium and the economic analysis of public health emergencies of international concern.

    Science.gov (United States)

    Beutels, P; Edmunds, W J; Smith, R D

    2008-11-01

    We argue that traditional health economic analysis is ill-equipped to estimate the cost effectiveness and cost benefit of interventions that aim at controlling and/or preventing public health emergencies of international concern (such as pandemic influenza or severe acute respiratory syndrome). The implicit assumption of partial equilibrium within both the health sector itself and--if a wider perspective is adopted--the economy as a whole would be violated by such emergencies. We propose an alternative, with the specific aim of accounting for the behavioural changes and capacity problems that are expected to occur when such an outbreak strikes. Copyright (c) 2008 John Wiley & Sons, Ltd.

  1. Mapping Rwanda public health research(1975-2014)

    African Journals Online (AJOL)

    Objectives: In this paper, the aim was to map the scientific research on public health in Rwanda ... formed analyses on journals, most cited articles, authors, publication years, ... One of the major areas is public health. In fact, public health represented the needs ... In the advanced ... searches to get the main relevant topics.

  2. Integrating GDM management in public health: Pakistan perspective.

    Science.gov (United States)

    Riaz, Musarrat; Basit, Abdul

    2016-09-01

    Pakistan is a developing country with diverse social, economic and cultural dimensions along with limited resources. Non communicable diseases (NCDS) including diabetes are highly prevalent compromising the already challenged health care system. Gestational diabetes mellitus (GDM) with its associated maternal and foetal complications is increasing with rapidly changing lifestyle pattern. Since Pakistan has limited resources and other health issues compete strongly with gestational diabetes initiatives, the most feasible strategy will be the horizontal integration. This will work with the existing primary health care system integrating NCD control programmes with Maternal and Child health (MCH) programmes. Utilizing the existing health care system is the only implementable cost effective strategy. Antenatal screening and treatment of GDM alone is not sufficient but Post-partum screening (PPS) of women with GDM is an important strategy for prevention of diabetes as the conversion rates of GDM to type 2 diabetes are high. Furthermore, instead of perceiving GDM as a temporary reversible clinical entity, it should be considered as a trans-generational prevention of diabetes that needs to be addressed as a public health issue in order to improve maternal and foetal health.

  3. The Partnership of Public Health and Anthropology.

    Science.gov (United States)

    Jelenc, Marjetka

    2016-06-01

    Public health focuses on health of the population and it is concerned with threats to health based on population health analysis. Anthropology covers most aspects that concern human beings. Both sciences converge on community and this fact represents a foundation for the partnership between public health and anthropology. Biological/medical anthropology is one of the highly developed fi elds of anthropology and the most important for public health.

  4. European health research and globalisation: is the public-private balance right?

    Directory of Open Access Journals (Sweden)

    McCarthy Mark

    2011-03-01

    Full Text Available Abstract Background The creation and exchange of knowledge between cultures has benefited world development for many years. The European Union now puts research and innovation at the front of its economic strategy. In the health field, biomedical research, which benefits the pharmaceutical and biotechnology industries, has been well supported, but much less emphasis has been given to public health and health systems research. A similar picture is emerging in European support for globalisation and health Case studies Two case-studies illustrate the links of European support in global health research with industry and biomedicine. The European Commission's directorates for (respectively Health, Development and Research held an international conference in Brussels in June 2010. Two of six thematic sessions related to research: one was solely concerned with drug development and the protection of intellectual property. Two European Union-supported health research projects in India show a similar trend. The Euro-India Research Centre was created to support India's participation in EU research programmes, but almost all of the health research projects have been in biotechnology. New INDIGO, a network led by the French national research agency CNRS, has chosen 'Biotechnology and Health' and funded projects only within three laboratory sciences. Discussion Research for commerce supports only one side of economic development. Innovative technologies can be social as well as physical, and be as likely to benefit society and the economy. Global health research agendas to meet the Millenium goals need to prioritise prevention and service delivery. Public interest can be voiced through civil society organisations, able to support social research and public-health interventions. Money for health research comes from public budgets, or indirectly through healthcare costs. European 'Science in Society' programme contrasts research for 'economy', using technical

  5. European health research and globalisation: is the public-private balance right?

    Science.gov (United States)

    2011-01-01

    Background The creation and exchange of knowledge between cultures has benefited world development for many years. The European Union now puts research and innovation at the front of its economic strategy. In the health field, biomedical research, which benefits the pharmaceutical and biotechnology industries, has been well supported, but much less emphasis has been given to public health and health systems research. A similar picture is emerging in European support for globalisation and health Case studies Two case-studies illustrate the links of European support in global health research with industry and biomedicine. The European Commission's directorates for (respectively) Health, Development and Research held an international conference in Brussels in June 2010. Two of six thematic sessions related to research: one was solely concerned with drug development and the protection of intellectual property. Two European Union-supported health research projects in India show a similar trend. The Euro-India Research Centre was created to support India's participation in EU research programmes, but almost all of the health research projects have been in biotechnology. New INDIGO, a network led by the French national research agency CNRS, has chosen 'Biotechnology and Health' and funded projects only within three laboratory sciences. Discussion Research for commerce supports only one side of economic development. Innovative technologies can be social as well as physical, and be as likely to benefit society and the economy. Global health research agendas to meet the Millenium goals need to prioritise prevention and service delivery. Public interest can be voiced through civil society organisations, able to support social research and public-health interventions. Money for health research comes from public budgets, or indirectly through healthcare costs. European 'Science in Society' programme contrasts research for 'economy', using technical solutions, commercialisation

  6. Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System

    Directory of Open Access Journals (Sweden)

    David Provenzale Titinger

    2015-01-01

    Full Text Available Abstract Background: Heart surgery has developed with increasing patient complexity. Objective: To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS. Method: All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS were compared between established risk groups. Results: Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001, as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006. Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001. The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001. SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001. However, as the EuroSCORE increased, there was significant difference (p < 0.0001 between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata. Conclusion: Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.

  7. The laboratory efficiencies initiative: partnership for building a sustainable national public health laboratory system.

    Science.gov (United States)

    Ridderhof, John C; Moulton, Anthony D; Ned, Renée M; Nicholson, Janet K A; Chu, May C; Becker, Scott J; Blank, Eric C; Breckenridge, Karen J; Waddell, Victor; Brokopp, Charles

    2013-01-01

    Beginning in early 2011, the Centers for Disease Control and Prevention and the Association of Public Health Laboratories launched the Laboratory Efficiencies Initiative (LEI) to help public health laboratories (PHLs) and the nation's entire PHL system achieve and maintain sustainability to continue to conduct vital services in the face of unprecedented financial and other pressures. The LEI focuses on stimulating substantial gains in laboratories' operating efficiency and cost efficiency through the adoption of proven and promising management practices. In its first year, the LEI generated a strategic plan and a number of resources that PHL directors can use toward achieving LEI goals. Additionally, the first year saw the formation of a dynamic community of practitioners committed to implementing the LEI strategic plan in coordination with state and local public health executives, program officials, foundations, and other key partners.

  8. Migration: a core public health ethics issue.

    Science.gov (United States)

    Wild, V; Dawson, A

    2018-05-01

    In this article, we outline the link between migration, public health and ethics. Discussing relevant arguments about migration from the perspective of public health and public health ethics. Critical review of theories and frameworks, case-based analysis and systematic identification and discussion of challenges. Migration is a core issue of public health ethics and must take a case-based approach: seeking to identify the specific ethical dimensions and vulnerabilities in each particular context. Public health as a practice, built upon the core value of justice, requires the protection and promotion of migrants' well-being (even if this produces tension with immigration services). Ethical analysis should take all phases of migration into account: before, during and after transit. We argue that migration policies, at least as they relate to migrants' well-being, should be founded upon a shared humanity, respect for human rights and on the idea that effective public health cannot and should not be confined within the borders and to the citizens of any host country. We make the case for migration to be seen as a core issue of public health ethics. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  9. Strengthening public health research for improved health

    Directory of Open Access Journals (Sweden)

    Enrique Gea-Izquierdo

    2012-08-01

    Full Text Available Research in public health is a range that includes from fundamental research to research in clinical practice, including novel advances, evaluation of results and their spreading. Actually, public health research is considered multidisciplinary incorporating numerous factors in its development. Establishing as a mainstay the scientific method, deepens in basic research, clinical epidemiological research and health services. The premise of quality and relevance is reflected in international scientific research, and in the daily work and good biomedical practices that should be included in the research as a common task. Therefore, the research must take a proactive stance of inquiry, integrating a concern planned and ongoing development of knowledge. This requires improve international coordination, seeking a balance between basic and applied research as well as science and technology. Thus research cannot be considered without innovation, weighing up the people and society needs. Acting on knowledge of scientific production processes requires greater procedures thoroughness and the effective expression of the results. It is noted as essential to establish explicit principles in review and evaluation of the adjustments of actions, always within the standards of scientific conduct and fairness of the research process. In the biomedical scientific lines it have to be consider general assessments that occur related to the impact and quality of health research, mostly leading efforts to areas that require further attention. However, other subject areas that may be deficient or with lower incidence in the population should not be overlook. Health research as a source of new applications and development provides knowledge, improving well-being. However, it is understandable without considering the needs and social demands. Therefore, in public health research and to improve the health of the population, we must refine and optimize the prevention and

  10. In search of financial sufficiency in the Spanish public university: From financing to the cost control and cost management

    Directory of Open Access Journals (Sweden)

    Santiago Aguilà

    2016-02-01

    Full Text Available Purpose: The current socio-economic context characterized by restrictive budgetary policies in the countries of the European Union has led to a reduction in public funding in the Spanish public university raising the deficit in many universities. That is why, while they are completing the implementation of a cost accounting model (Modelo Canoa to quantify their real financial needs, are also increasing academic rates with the limits established in the Decree-Law 14/2012 of 20 April as practically the only resource. This fact may ultimately affect demand. It is urgent to find therefore new sources of private funding as well as implementing techniques to control and reduce costs justified by the extreme financial situations of some universities. Design/methodology: These new sources of private funding as well as the specific techniques of control and cost management that are used in public universities outside of Spain are described. It has also made a poll to the managers of the Spanish public universities considering the diversification of funding sources and the feasibility of adopting specific techniques of control and cost management to help the achievement of financial sufficiency. Findings: Especially in the US universities, financing is more diversified and not depend so much of the increase in public rates. Specific techniques of control and cost management are also used and they are applicable to the Spanish case according to the opinion of the managers. Research limitations/implications: 82% of managers have completed the proposed poll. Originality/value: Identifying sources of private funding and specific techniques of control and cost management applicable to the Spanish public universities.

  11. History and evolution of surveillance in public health

    Directory of Open Access Journals (Sweden)

    Varun Kumar

    2014-01-01

    Full Text Available The modern concept of surveillance has evolved over the centuries. Public health surveillance provides the scientific database essential for decision making and appropriate public health action. It is considered as the best public health tool to prevent the occurrence of epidemics and is the backbone of public health programs and provides information so that effective action can be taken in controlling and preventing diseases of public health importance. This article reviews the history of evolution of public health surveillance from historical perspective: from Hippocrates, Black Death and quarantine, recording of vital events for the first time, first field investigation, legislations that were developed over time and modern concepts in public health surveillance. Eradication of small pox is an important achievement in public health surveillance but the recent Severe Acute Respiratory Syndrome (SARS and Influenza pandemics suggest still there is a room for improvement. Recently new global disease surveillance networks like FluNet and DengueNet were developed as internet sites for monitoring influenza and dengue information. In spite of these developments, global public health surveillance still remains unevenly distributed. There is a need for increased international cooperation to address the global needs of public health surveillance.

  12. Evaluating community-based public health leadership training.

    Science.gov (United States)

    Ceraso, Marion; Gruebling, Kirsten; Layde, Peter; Remington, Patrick; Hill, Barbara; Morzinski, Jeffrey; Ore, Peggy

    2011-01-01

    Addressing the nation's increasingly complex public health challenges will require more effective multisector collaboration and stronger public health leadership. In 2005, the Healthy Wisconsin Leadership Institute launched an annual, year-long intensive "community teams" program. The goal of this program is to develop collaborative leadership and public health skills among Wisconsin-based multisectoral teams mobilizing their communities to improve public health. To measure the scope of participation and program impacts on individual learning and practice, including application of new knowledge and collective achievements of teams on coalition and short-term community outcomes. End-of-year participant program evaluations and follow-up telephone interviews with participants 20 months after program completion. Community-based public health leadership training program. Sixty-eight participants in the Community Teams Program during the years 2006 to 2007 and 2007 to 2008. Professional diversity of program participants; individual learning and practice, including application of new knowledge; and collective achievements of teams, including coalition and short-term community outcomes. Participants in the Community Teams Program represent a diversity of sectors, including nonprofit, governmental, academic, business, and local public health. Participation increased knowledge across all public health and leadership competency areas covered in the program. Participating teams reported outcomes, including increased engagement of community leadership, expansion of preventive services, increased media coverage, strengthened community coalitions, and increased grant funding. Evaluation of this community-based approach to public health leadership training has shown it to be a promising model for building collaborative and public health leadership skills and initiating sustained community change for health improvement.

  13. Reducing health inequities: the contribution of core public health services in BC

    Science.gov (United States)

    2013-01-01

    Background Within Canada, many public health leaders have long identified the importance of improving the health of all Canadians especially those who face social and economic disadvantages. Future improvements in population health will be achieved by promoting health equity through action on the social determinants of health. Many Canadian documents, endorsed by government and public health leaders, describe commitments to improving overall health and promoting health equity. Public health has an important role to play in strengthening action on the social determinants and promoting health equity. Currently, public health services in British Columbia are being reorganized and there is a unique opportunity to study the application of an equity lens in public health and the contribution of public health to reducing health inequities. Where applicable, we have chosen mental health promotion, prevention of mental disorders and harms of substance use as exemplars within which to examine specific application of an equity lens. Methods/design This research protocol is informed by three theoretical perspectives: complex adaptive systems, critical social justice, and intersectionality. In this program of research, there are four inter-related research projects with an emphasis on both integrated and end of grant knowledge translation. Within an overarching collaborative and participatory approach to research, we use a multiple comparative case study research design and are incorporating multiple methods such as discourse analysis, situational analysis, social network analysis, concept mapping and grounded theory. Discussion An important aim of this work is to help ensure a strong public health system that supports public health providers to have the knowledge, skills, tools and resources to undertake the promotion of health equity. This research will contribute to increasing the effectiveness and contributions of public health in reducing unfair and inequitable differences

  14. Citizen Science for public health

    NARCIS (Netherlands)

    Broeder, Den Lea; Devilee, Jeroen; Oers, Van Hans; Schuit, A.J.; Wagemakers, Annemarie

    2016-01-01

    Community engagement in public health policy is easier said than done. One reason is that public health policy is produced in a complex process resulting in policies that may appear not to link up to citizen perspectives. We therefore address the central question as to whether citizen engagement in

  15. Citizen Science for public health

    NARCIS (Netherlands)

    Den Broeder, Lea; Devilee, Jeroen; Van Oers, J.A.M.; Schuit, A.J.; Wagemakers, Annemarie

    2017-01-01

    Community engagement in public health policy is easier said than done. One reason is that public health policy is produced in a complex process resulting in policies that may appear not to link up to citizen perspectives. We therefore address the central question as to whether citizen engagement in

  16. Electronic health record case studies to advance environmental public health tracking.

    Science.gov (United States)

    Namulanda, Gonza; Qualters, Judith; Vaidyanathan, Ambarish; Roberts, Eric; Richardson, Max; Fraser, Alicia; McVeigh, Katharine H; Patterson, Scott

    2018-03-01

    Data from traditional public health surveillance systems can have some limitations, e.g., timeliness, geographic level, and amount of data accessible. Electronic health records (EHRs) could present an opportunity to supplement current sources of routinely collected surveillance data. The National Environmental Public Health Tracking Program (Tracking Program) sought to explore the use of EHRs for advancing environmental public health surveillance practices. The Tracking Program funded four state/local health departments to obtain and pilot the use of EHR data to address several issues including the challenges and technical requirements for accessing EHR data, and the core data elements required to integrate EHR data within their departments' Tracking Programs. The results of these pilot projects highlighted the potential of EHR data for public health surveillance of rare diseases that may lack comprehensive registries, and surveillance of prevalent health conditions or risk factors for health outcomes at a finer geographic level. EHRs therefore, may have potential to supplement traditional sources of public health surveillance data. Published by Elsevier Inc.

  17. Hospital Adoption of Health Information Technology to Support Public Health Infrastructure.

    Science.gov (United States)

    Walker, Daniel M; Diana, Mark L

    2016-01-01

    Health information technology (IT) has the potential to improve the nation's public health infrastructure. In support of this belief, meaningful use incentives include criteria for hospitals to electronically report to immunization registries, as well as to public health agencies for reportable laboratory results and syndromic surveillance. Electronic reporting can facilitate faster and more appropriate public health response. However, it remains unclear the extent that hospitals have adopted IT for public health efforts. To examine hospital adoption of IT for public health and to compare hospitals capable of using and not using public health IT. Cross-sectional design with data from the 2012 American Hospital Association annual survey matched with data from the 2013 American Hospital Association Information Technology Supplement. Multivariate logistic regression was used to compare hospital characteristics. Inverse probability weights were applied to adjust for selection bias because of survey nonresponse. All acute care general hospitals in the United States that matched across the surveys and had complete data available were included in the analytic sample. Three separate outcome measures were used: whether the hospital could electronically report to immunization registries, whether the hospital could send electronic laboratory results, and whether the hospital can participate in syndromic surveillance. A total of 2841 hospitals met the inclusion criteria. Weighted results show that of these hospitals, 62.7% can electronically submit to immunization registries, 56.6% can electronically report laboratory results, and 54.4% can electronically report syndromic surveillance. Adjusted and weighted results from the multivariate analyses show that small, rural hospitals and hospitals without electronic health record systems lag in the adoption of public health IT capabilities. While a majority of hospitals are using public health IT, the infrastructure still has

  18. Health Advocacy--Counting the Costs

    Science.gov (United States)

    Dyall, Lorna; Marama, Maria

    2010-01-01

    Access to, and delivery of, safe and culturally appropriate health services is increasingly important in New Zealand. This paper will focus on counting the costs of health advocacy through the experience of a small non government charitable organisation, the Health Advocates Trust, (HAT) which aimed to provide advocacy services for a wide range of…

  19. Preventing postnatal maternal mental health problems using a psychoeducational intervention: the cost-effectiveness of What Were We Thinking.

    Science.gov (United States)

    Ride, Jemimah; Lorgelly, Paula; Tran, Thach; Wynter, Karen; Rowe, Heather; Fisher, Jane

    2016-11-18

    Postnatal maternal mental health problems, including depression and anxiety, entail a significant burden globally, and finding cost-effective preventive solutions is a public policy priority. This paper presents a cost-effectiveness analysis of the intervention, What Were We Thinking (WWWT), for the prevention of postnatal maternal mental health problems. The economic evaluation, including cost-effectiveness and cost-utility analyses, was conducted alongside a cluster-randomised trial. 48 Maternal and Child Health Centres in Victoria, Australia. Participants were English-speaking first-time mothers attending participating Maternal and Child Health Centres. Full data were collected for 175 participants in the control arm and 184 in the intervention arm. WWWT is a psychoeducational intervention targeted at the partner relationship, management of infant behaviour and parental fatigue. The evaluation considered public sector plus participant out-of-pocket costs, while outcomes were expressed in the 30-day prevalence of depression, anxiety and adjustment disorders, and quality-adjusted life years (QALYs). Incremental costs and outcomes were estimated using regression analyses to account for relevant sociodemographic, prognostic and clinical characteristics. The intervention was estimated to cost $A118.16 per participant. The analysis showed no statistically significant difference between the intervention and control groups in costs or outcomes. The incremental cost-effectiveness ratios were $A36 451 per QALY gained and $A152 per percentage-point reduction in 30-day prevalence of depression, anxiety and adjustment disorders. The estimate lies under the unofficial cost-effectiveness threshold of $A55 000 per QALY; however, there was considerable uncertainty surrounding the results, with a 55% probability that WWWT would be considered cost-effective at that threshold. The results suggest that, although WWWT shows promise as a preventive intervention for postnatal

  20. Viewpoint: Re-instating a 'public health' system under universal health care in India.

    Science.gov (United States)

    George, Mathew

    2015-02-01

    I examine possibilities for strengthening essential public health functions in the context of India's drive to implement universal health care. In a country where population health outcomes are rooted in social, political, economic, cultural, and ecological conditions, it is important to have a state mediated public health system that can modify the causes of the major public health problems. This calls for strengthening the social epidemiological approach in public health by demarcating public health functions distinct from medical care. This will be a prerequisite for the growth of the public health profession in the country, because it can offer avenues for newly trained professionals within the country to work in 'core' public health.

  1. Public relations effectiveness in public health institutions.

    Science.gov (United States)

    Springston, Jeffrey K; Weaver Lariscy, Ruth Ann

    2005-01-01

    This article explores public relations effectiveness in public health institutions. First, the two major elements that comprise public relations effectiveness are discussed: reputation management and stakeholder relations. The factors that define effective reputation management are examined, as are the roles of issues and crisis management in building and maintaining reputation. The article also examines the major facets of stakeholder relations, including an inventory of stakeholder linkages and key audiences, such as the media. Finally, methods of evaluating public relations effectiveness at both the program level and the institutional level are explored.

  2. Music and Public Health

    DEFF Research Database (Denmark)

    Bonde, Lars Ole; Juel, Knud; Ekholm, Ola

    2016-01-01

    Background: ‘Music and public health’ is a new field of study. Few scientific studies with small samples have documented health implications of musical participation. Research questions in this epidemiological study were: 1) Is there an association between self-rated health and active use of musi......: 57%. Multiple logistic regression analyses were performed to investigate associations between musical background/activities and health-related indicators. Discussion: The study documents that a majority of informants use music to regulate physical and psychological states......Background: ‘Music and public health’ is a new field of study. Few scientific studies with small samples have documented health implications of musical participation. Research questions in this epidemiological study were: 1) Is there an association between self-rated health and active use of music...... in daily life? 2) What associations can be observed between musical background, uses and understanding of music as a health factor, and self-reported health? Method: Data came from the Danish Health and Morbidity Survey 2013, based on a simple random sample of 25.000 adult Danes (16+ years). Response rate...

  3. Keeping the “Public” in Schools of Public Health

    Science.gov (United States)

    Klitzman, Susan; Diamond, Catherine; El-Mohandes, Ayman

    2015-01-01

    In this article, we compared the characteristics of public and private accredited public health training programs. We analyzed the distinct opportunities and challenges that publicly funded schools of public health face in preparing the nation’s public health workforce. Using our experience in creating a new, collaborative public school of public health in the nation’s largest urban public university system, we described efforts to use our public status and mission to develop new approaches to educating a workforce that meets the health needs of our region and contributes to the goal of reducing health inequalities. Finally, we considered policies that could protect and strengthen the distinct contributions that public schools of public health make to improving population health and reducing health inequalities. PMID:25706006

  4. Hawaii's public mental health system.

    Science.gov (United States)

    VanderVoort, Debra J

    2005-03-01

    The following article addresses the nature of and problems with the public mental health system in Hawaii. It includes a brief history of Hawaii's public mental health system, a description and analysis of this system, economic factors affecting mental health, as well as a needs assessment of the elderly, individuals with severe mental illness, children and adolescents, and ethnically diverse individuals. In addition to having the potential to increase suicide rates and unnecessarily prolong personal suffering, problems in the public mental health system such as inadequate services contribute to an increase in social problems including, but not limited to, an increase in crime rates (e.g., domestic violence, child abuse), divorce rates, school failure, and behavioral problems in children. The population in need of mental health services in Hawaii is under served, with this inadequacy of services due to economic limitations and a variety of other factors.

  5. Health care costs: saving in the private sector.

    Science.gov (United States)

    Robeson, F E

    1979-01-01

    Robeson offers a number of options to employers to help reduce the impact of increasing health care costs. He points out that large organizations which employ hundreds of people have considerable market power which can be exerted to contain costs. It is suggested that the risk management departments assume the responsibility for managing the effort to reduce the costs of medical care and of the health insurance programs of these organizations since that staff is experienced at evaluating premiums and negotiating with third-party payors. The article examines a number of short-run strategies for firms to pursue to contain health care costs: (1) use alternative delivery systems such as health maintenance organizations (HMOs) which have cost-cutting potential but require marketing efforts to persuade employees of their desirability; (2) contracts with third-party payors which require a second opinion (peer review), a practice which saved one labor union over $2 million from 1972 to 1976; (3) implementation of insurance coverage for less expensive outpatient care; and (4) the use of claims review. These strategies are compared in terms of four criteria: supply of demand for health services; management effort; cost; and time necessary for realized savings. Robeson concludes that development of a management plan for containing health care costs requires an extensive analysis of alternatives, organizational objectives, existing policies, and resources, and offers a table summarizing the cost-containment strategies that a firm should consider.

  6. Mass-gathering Events: The Public Health Challenge of the Kumbh Mela 2013.

    Science.gov (United States)

    Dwivedi, Suresh; Cariappa, Mudera P

    2015-12-01

    Mass-gathering (MG) events pose challenges to the most adept of public health practitioners in ensuring the health safety of the population. These MGs can be for sporting events, musical festivals, or more commonly, have religious undertones. The Kumbh Mela 2013 at Allahabad, India may have been the largest gathering of humanity in history with nearly 120 million pilgrims having thronged the venue. The scale of the event posed a challenge to the maintenance of public health security and safety. A snapshot of the experience of managing the hygiene and sanitation aspects of this mega event is presented herein, highlighting the importance of proactive public health planning and preparedness. There having been no outbreaks of disease is vindication of the steps undertaken in planning and preparedness, notwithstanding obvious limitations of unsanitary behaviors and traditional beliefs of those attending the festival. The evident flaw on post-event analyses was the failure to cater adequately for environmental mopping-up operations after the festival. Besides, a system of real-time monitoring of disease and morbidity patterns, harnessing low cost technology alternatives, should be planned for at all such future events.

  7. Costs and Performance of English Mental Health Providers.

    Science.gov (United States)

    Moran, Valerie; Jacobs, Rowena

    2017-06-01

    Despite limited resources in mental health care, there is little research exploring variations in cost performance across mental health care providers. In England, a prospective payment system for mental health care based on patient needs has been introduced with the potential to incentivise providers to control costs. The units of payment under the new system are 21 care clusters. Patients are allocated to a cluster by clinicians, and each cluster has a maximum review period. The aim of this research is to explain variations in cluster costs between mental health providers using observable patient demographic, need, social and treatment variables. We also investigate if provider-level variables explain differences in costs. The residual variation in cluster costs is compared across providers to provide insights into which providers may gain or lose under the new financial regime. The main data source is the Mental Health Minimum Data Set (MHMDS) for England for the years 2011/12 and 2012/13. Our unit of observation is the period of time spent in a care cluster and costs associated with the cluster review period are calculated from NHS Reference Cost data. Costs are modelled using multi-level log-linear and generalised linear models. The residual variation in costs at the provider level is quantified using Empirical Bayes estimates and comparative standard errors used to rank and compare providers. There are wide variations in costs across providers. We find that variables associated with higher costs include older age, black ethnicity, admission under the Mental Health Act, and higher need as reflected in the care clusters. Provider type, size, occupancy and the proportion of formal admissions at the provider-level are also found to be significantly associated with costs. After controlling for patient- and provider-level variables, significant residual variation in costs remains at the provider level. The results suggest that some providers may have to increase

  8. The Ariadne's thread in co-payment, primary health care usage and financial crisis: findings from Cyprus public health care sector.

    Science.gov (United States)

    Petrou, P

    2015-11-01

    Cyprus entered a prolonged financial recession in 2011 and by early 2013 it applied for an international bail-out agreement. This presupposed massive reforms in public governance. Health sector was considerably reformed and one of the measures was the introduction of co-payment for outpatient visits to public health care sector. The scope of this study is to assess the impact of financial crisis and co-payment to public outpatient visits in Nicosia urban and greater Nicosia region. An Interrupted time-series analysis. All outpatient visits to public health care family doctor/general practitioners in Nicosia urban and greater Nicosia region from January 2011 until May of 2014 were registered and analysed. Financial crisis did not alter outpatient visits. Introduction of co-payment led to a statistically significant decrease from the second month after its introduction (p = 0.048) (R(2) = 0.329, Q = 23.75, p = 0.137). This decrease was consistent until the end of the observational period and it did not level off. Financial crisis did not affect outpatient visits while co-payment can be considered as a potent cost containment measure during financial recession, by normalising utilisation of healthcare resources. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  9. Issues in public health

    National Research Council Canada - National Science Library

    Sim, Fiona; McKee, Martin

    2011-01-01

    ..., there is increasing understanding of the inevitable limits of individual health care and of the need to complement such services with effective public health strategies. Major improvements in people's health will come from controlling communicable diseases, eradicating environmental hazards, improving people's diets and enhancing the availability ...

  10. How Many Principles for Public Health Ethics?

    Science.gov (United States)

    Coughlin, Steven S.

    2009-01-01

    General moral (ethical) principles play a prominent role in certain methods of moral reasoning and ethical decision-making in bioethics and public health. Examples include the principles of respect for autonomy, beneficence, nonmaleficence, and justice. Some accounts of ethics in public health have pointed to additional principles related to social and environmental concerns, such as the precautionary principle and principles of solidarity or social cohesion. This article provides an overview of principle-based methods of moral reasoning as they apply to public health ethics including a summary of advantages and disadvantages of methods of moral reasoning that rely upon general principles of moral reasoning. Drawing upon the literature on public health ethics, examples are provided of additional principles, obligations, and rules that may be useful for analyzing complex ethical issues in public health. A framework is outlined that takes into consideration the interplay of ethical principles and rules at individual, community, national, and global levels. Concepts such as the precautionary principle and solidarity are shown to be useful to public health ethics to the extent that they can be shown to provide worthwhile guidance and information above and beyond principles of beneficence, nonmaleficence, and justice, and the clusters of rules and maxims that are linked to these moral principles. Future directions likely to be productive include further work on areas of public health ethics such as public trust, community empowerment, the rights of individuals who are targeted (or not targeted) by public health interventions, individual and community resilience and wellbeing, and further clarification of principles, obligations, and rules in public health disciplines such as environmental science, prevention and control of chronic and infectious diseases, genomics, and global health. PMID:20072707

  11. Public Health 3.0: A Call to Action for Public Health to Meet the Challenges of the 21st Century.

    Science.gov (United States)

    DeSalvo, Karen B; Wang, Y Claire; Harris, Andrea; Auerbach, John; Koo, Denise; O'Carroll, Patrick

    2017-09-07

    Public health is what we do together as a society to ensure the conditions in which everyone can be healthy. Although many sectors play key roles, governmental public health is an essential component. Recent stressors on public health are driving many local governments to pioneer a new Public Health 3.0 model in which leaders serve as Chief Health Strategists, partnering across multiple sectors and leveraging data and resources to address social, environmental, and economic conditions that affect health and health equity. In 2016, the US Department of Health and Human Services launched the Public Health 3.0 initiative and hosted listening sessions across the country. Local leaders and community members shared successes and provided insight on actions that would ensure a more supportive policy and resource environment to spread and scale this model. This article summarizes the key findings from those listening sessions and recommendations to achieve Public Health 3.0.

  12. Climate change and ecological public health.

    Science.gov (United States)

    Goodman, Benny

    2015-02-17

    Climate change has been identified as a serious threat to human health, associated with the sustainability of current practices and lifestyles. Nurses should expand their health promotion role to address current and emerging threats to health from climate change and to address ecological public health. This article briefly outlines climate change and the concept of ecological public health, and discusses a 2012 review of the role of the nurse in health promotion.

  13. Bioethics in Public Health Practice

    Directory of Open Access Journals (Sweden)

    Matilde Peguero

    2018-06-01

    Full Text Available The bioethics study method concerns the duties and values that must be fulfilled for respect for life. The aim of this article is to provide a reflection on bioethics in public health actions. It is a review article that includes authors with different positions. Bioethics, despite its apparent individual focus, is vital to fulfil essential functions in public health, and to guarantee the right to health and respect for human dignity.

  14. Contributions of Public Health to nursing practice

    Directory of Open Access Journals (Sweden)

    Káren Mendes Jorge de Souza

    Full Text Available ABSTRACT Objective: Analyze the perceptions of undergraduate nursing students about the contributions of public health to nursing practice in the Unified Health System. Method: Qualitative Descriptive Study. Data collection was carried out through semi-directed interviews with 15 students. The language material was analyzed according to content and thematic analysis. Results: Thematic categories were established, namely: "Perceptions about Public Health" and "Contribution of Public Health to nursing practice in the Unified Health System". Final considerations: Perceptions about Public Health are diversified, but converge to the recognition of this field as the basis for training nurses qualified to work in the SUS with technical competence, autonomy and focusing on the integrality in health care.

  15. Aging in two languages: Implications for public health.

    Science.gov (United States)

    Bialystok, Ellen; Abutalebi, Jubin; Bak, Thomas H; Burke, Deborah M; Kroll, Judith F

    2016-05-01

    With the population aging and a dramatic increase in the number of senior citizens, public health systems will be increasingly burdened with the need to deal with the care and treatment of individuals with dementia. We review evidence demonstrating how a particular experience, bilingualism, has been shown to protect cognitive function in older age and delay onset of symptoms of dementia. This paper describes behavioral and brain studies that have compared monolingual and bilingual older adults on measures of cognitive function or brain structure and reviews evidence demonstrating a protective effect of bilingualism against symptoms of dementia. We conclude by presenting some data showing the potential savings in both human costs in terms of demented patients and economic considerations in terms of public money if symptoms of dementia could be postponed. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Mental health in schools and public health

    OpenAIRE

    Adelman, Howard S; Taylor, Linda

    2006-01-01

    Health policy and practice call for health and mental health parity and for a greater focus on universal interventions to promote, prevent, and intervene as early after problem onset as is feasible. Those in the public health field are uniquely positioned to help promote the mental health of young people and to reshape how the nation thinks about and addresses mental health. And schools are essential partners for doing the work.

  17. The private partners of public health: public-private alliances for public good.

    Science.gov (United States)

    McDonnell, Sharon; Bryant, Carol; Harris, Jeff; Campbell, Marci Kramish; Lobb, Ano; Hannon, Peggy A; Cross, Jeffrey L; Gray, Barbara

    2009-04-01

    We sought to convey lessons learned by the Centers for Disease Control and Prevention's (CDC's) Prevention Research Centers (PRCs) about the value and challenges of private-sector alliances resulting in innovative health promotion strategies. Several PRCs based in a variety of workplace and community settings contributed. We conducted interviews with principal investigators, a literature review, and a review of case studies of private-sector alliances in a microbusiness model, a macrobusiness model, and as multiparty partnerships supporting public health research, implementation, and human resource services. Private-sector alliances provide many advantages, particularly access to specialized skills generally beyond the expertise of public health entities. These skills include manufacturing, distribution, marketing, business planning, and development. Alliances also allow ready access to employee populations. Public health entities can offer private-sector partners funding opportunities through special grants, data gathering and analysis skills, and enhanced project credibility and trust. Challenges to successful partnerships include time and resource availability and negotiating the cultural divide between public health and the private sector. Critical to success are knowledge of organizational culture, values, mission, currency, and methods of operation; an understanding of and ability to articulate the benefits of the alliance for each partner; and the ability and time to respond to unexpected changes and opportunities. Private-public health alliances are challenging, and developing them takes time and resources, but aspects of these alliances can capitalize on partners' strengths, counteract weaknesses, and build collaborations that produce better outcomes than otherwise possible. Private partners may be necessary for program initiation or success. CDC guidelines and support materials may help nurture these alliances.

  18. The public health system in England

    National Research Council Canada - National Science Library

    Hunter, David J; Marks, Linda; Smith, Katherine E

    2010-01-01

    .... The Public Health System in England offers a wide-ranging, provocative and accessible assessment of challenges confronting a public health system, exploring how its parameters have shifted over time...

  19. Aboriginal and Torres Strait Islander public health: online and integrated into core Master of Public Health subjects

    Directory of Open Access Journals (Sweden)

    Lynnell Angus

    2016-04-01

    Full Text Available The Master of Public Health (MPH is an internationally recognised post-graduate qualification for building the public health workforce. In Australia, MPH graduate attributes include six Indigenous public health (IPH competencies. The University of Melbourne MPH program includes five core subjects and ten specialisation streams, of which one is Indigenous health. Unless students complete this specialisation or electives in Indigenous health, it is possible for students to graduate without attaining the IPH competencies. To address this issue in a crowded and competitive curriculum an innovative approach to integrating the IPH competencies in core MPH subjects was developed. Five online modules that corresponded with the learning outcomes of the core public health subjects were developed, implemented and evaluated in 2015. This brief report outlines the conceptualisation, development, and description of the curriculum content; it also provides preliminary student evaluation and staff feedback on the integration project.

  20. Global Disease Detection-Achievements in Applied Public Health Research, Capacity Building, and Public Health Diplomacy, 2001-2016.

    Science.gov (United States)

    Rao, Carol Y; Goryoka, Grace W; Henao, Olga L; Clarke, Kevin R; Salyer, Stephanie J; Montgomery, Joel M

    2017-11-01

    The Centers for Disease Control and Prevention has established 10 Global Disease Detection (GDD) Program regional centers around the world that serve as centers of excellence for public health research on emerging and reemerging infectious diseases. The core activities of the GDD Program focus on applied public health research, surveillance, laboratory, public health informatics, and technical capacity building. During 2015-2016, program staff conducted 205 discrete projects on a range of topics, including acute respiratory illnesses, health systems strengthening, infectious diseases at the human-animal interface, and emerging infectious diseases. Projects incorporated multiple core activities, with technical capacity building being most prevalent. Collaborating with host countries to implement such projects promotes public health diplomacy. The GDD Program continues to work with countries to strengthen core capacities so that emerging diseases can be detected and stopped faster and closer to the source, thereby enhancing global health security.