Health Economics, Health Policy and Healthcare Management

Biography:

Ashoke Bose is involved in many diverse areas; spanning from heat transfer, turbulence to storage technology to market research. He found they are all connected as our global economy. At present, He is working on Near Zero Carbon (NZC) technology at SEAT, LLC, which is an extension of his Thesis on Natural Convection Heat Transfer in Phase Change Materials at McGill University, Montreal Canada Also; he is working on Elastic Coupon-Data Distribution Database technology.

Abstract:

An innovative algorithm for finding pairing members in a P2P healthcare payment network was proposed by the author in 2020. It has been claimed that the proposed P2P payment platform could eliminate the high administrative cost of the commercial health insurance system in USA. This could be accomplished by allowing the Patients without Insurance (PwI) to have access to a Primary Care Provider (PCP) in an early stage of their illness. By having access to a PCP at an early stage would prevent the PwI population from revisiting Emergency Room (ER) services in a community hospital. Further, this P2P strategy, if adopted by the community health systems, would reduce the economic stress on the health systems by lowering the cost of ER services due to reduction in ER visits by PwI population.

In 2021-2022, the author had the opportunity to work at St. Joseph’s Health (SJH) in Syracuse, NY, a wholly owned member of Trinity Health. An investigation was carried out by analyzing the publicly available Annual Reports of SJH before and during COVID to determine the feasibility of spending part of the Annual Expense budget, which is commonly known as “charity care”, for the proposed P2P healthcare payment strategy. A preliminary report on this investigation is presented in the paper.

Biography:

Ayesha Dimali Samankula did her post graduate studies in Health Sector Disaster Management in Sri Lanka in 2019-2020. She was a National COVID Coordinator in the Ministry of Health Sri Lanka from 2020-2022. She actively engaged in COVID-19 management and prevention tasks during this period. She currently works as a Vitreo Retinal Medical Officer in National Eye Hospital, Colombo, Sri Lanka. She Plans to do more studies on diabetes prevention and diabetes retinopathy prevention around the world in future.

Abstract:

Sri Lanka is a lower-middle income country in the South Asian region. Sri Lanka’s COVID-19 response is characterized by a strong preventive approach with rational utilization of available resources. All patients who tested positive were managed at healthcare institutions initially. Asymptomatic or mildly symptomatic patients were admitted to Intermediate Care Centres for monitoring, management and discharged in 14 days. The patients with critical symptoms, uncontrolled comorbidities and other complications were admitted to hospitals for closer monitoring and specialized management.

Increase in number of cases and deaths were unprecedented. The number of healthcare workers available for the functioning of the system too declined with a significant proportion acquiring the infection and the remaining workforce on the verge of physical and mental exhaustion. The priority shifted towards triaging and identifying those who need immediate medical intervention at the earliest stage of the disease to reduce severe disease and death.

A virtual triaging system for the identification and evacuation of those who needed hospitalization and to facilitate home management for mild and asymptomatic patients was proposed. Telemedicine system was introduced and an integrated patient management system was established via Short Message Services (SMSs) and telephone helplines. Four key stakeholders, the National Operation Centre for Prevention of COVID-19 Outbreak (NOCPCO), Sri Lanka Medical Association (SLMA), the Ministry of Health and National Ambulance Service were brought together with the cooperation and support of national telecommunication service providers.

This system had a major impact on the management the pandemic in the country. Within two weeks of commencement, an increase the number of available beds in both the government and private sector was observed reduction in hospital admissions, oxygen dependency, comorbidities and death counts were noted. It also reduced the unnecessary exposure of healthcare workers to infected individuals.

This innovative initiative from Sri Lanka utilized the volunteerism in a resource-constrained scenario during COVID-19 pandemic and harnessed the support from all stakeholders including underutilized sectors in the provision of healthcare, including information and communication systems.

Biography:

Esperança is Veterinarian by training, Master in Animal Science (focus in Epidemiology) and PhD candidate in Tropical Diseases and Global Health. She works at National Institute of Health (INS) as Project Assistant of a capacity building project, Researcher in the fields of Enteric Infections, Immunization and Health Economics and as member of the Institutional Review Board.

Abstract:

Statement of the problem: Mozambique has one of the highest rates of cervical cancer in the world. Human papillomavirus vaccination was introduced for pre-adolescent girls in November 2021. This study evaluated the health and economic impact of the current HPV vaccine (GARDASIL-4) and two other vaccines (CECOLIN and CERVARIX) that could be used in the future.

Methodology & theoretical orientation: A proportionate outcomes static cohort model was used to estimate the lifetime costs and benefits of vaccination with CECOLIN, CERVARIX and GARDASIL-4 in 10 cohorts of girls aged 9 years (2022-2031) and 5 cohorts of girls aged 10-14 years in the year 2022. The primary outcome measure was the incremental cost per Disability-Adjusted Life-Year (DALY) averted from a government perspective. Each vaccine was compared to no vaccination and to each other. We assessed uncertainty through deterministic and probabilistic sensitivity analyses.

Findings: Without cross-protection all three vaccines had similar health benefits (48% reduction in cervical cancer cases and deaths). With cross-protection CERVARIX could have substantially more health benefits than the other two products (62% versus 48% reduction). Without Gavi donor support, discounted vaccine program costs were $43 m for CECOLIN, $61 m for GARDASIL-4 and $69 m for CERVARIX. With Gavi donor support all vaccines had similar discounted vaccine program costs (US $27 million). In scenarios without cross-protection CECOLIN was dominant; CECOLIN was cost saving with Gavi support and still very cost-effective without Gavi support. In scenarios with cross-protection and Gavi support CERVARIX was dominant and cost-saving. With cross-protection and no Gavi support, CECOLIN had the most favorable cost-effectiveness.

Biography:

Yossef Lomnicky is the head of the Pharmacy Department at Maccabi Health Services (MHS) which is a large health maintenance organization in Israel. He has attended several conferences around the globe.

Abstract:

Background: Drug expenditure has been growing at an accelerated rate in developed countries at an annual increase of 2-10%. The Maccabi Health Services (MHS), the second largest health maintenance organization in Israel has implemented a “smart policy” that includes a wide range of steps aimed to reduce non-essential drug costs while maintaining maximum quality of health services.

Methods: We evaluated the contribution of the implemented methods on the annual drug expenditure values from 2007 to 2019. The expenditures were evaluated and standardized to the "Israeli Health value index" of 2019 and calculated per insured per MHS member. The main steps were implemented in three levels, physicians, drugs companies and the patients.

The policy was implemented using "preferred drugs" which the physicians were directed to prescribe in most therapeutic groups (example: Statins, Ace I, ARBs, Steroids for inhalation etc.). Start to use generics as soon as they are marketed. Renewing drug purchasing contracts, Restricting the use of expensive drug via preauthorization, setting higher co-payments for "non-preferred drugs" and revising contracts with pharmacies that provide service for the MHS members in order to achieve better terms for the MHS.

Results: Figure 1 displays the MHS’s drug expenditures from 2007 through 2019. It can be seen that drug expenditures were elevated by a total of 5% that presents an average of 0.4% per year. The overall outcomes of implementing the drugs cost containment steps, demonstrated an average increase rate of 0.4% in annual drugs expenditures (in the period 2007 to 2020) per standardized MHS member. This increase rate is relatively low compared to most developed countries, despite the fact that Israel is among the early adapter of new pharmaceutical technologies.

Biography:

Rafia Rahma works as an assistant professor at the Institute of Health Economics, University of Dhaka. She has published several articles and attended various conferences centered on Health Economics.

Abstract:

Considering health as a regular consumer product, people are careless regarding health. The pandemic era discovers, to cure disease we need value-based healthcare service instead of value-money for health. In the pandemic era 2020 breaks healthcare service delivery systems across the world.

Aim of the study was to explore a method of way-out to achieve value-based healthcare services. Here, the term “value” is defined as either cure from diseases or reduced suffering from diseases. Likewise, “value-based healthcare services” is defined as providing appropriate services to either cure diseases or reduce the suffering of diseases. It was a piloting, cross sectional and mix method type of study. It was conducted to see the feasibility. Objectives of the study were;

1. To explore the current status of value-based health service.
2. To discover the factors influencing value-based health services.
3. To determine client perception and suggestions for improvement of value-based services.
4. To determine management perception and suggestions for improvement of value-based services.

A conceptual framework is prepared and followed during research [Figure 1]. One hundred and five (105) outdoor patients of a district hospital (Madaripur) at Dhaka division in Bangladesh was the study place, sample size and respondent. Regarding supply-side, four managers of four district hospitals (designated as civil surgeons) in Bangladesh were interviewed. The convenience sampling technique was used here. A total of sixty-six (66) dependable variables were addressed twenty-three (23) independent variables. To fulfill the objectives and aim of the study a total of forty-six (46) questions for demand-side (patient) and sixty-seven (67) questions for supply-side (healthcare manager) was asked. Primary data was collected from the survey.

Biography:

Dmytro Babelyuk is a PhD student at Bangor University. He has attended several conferences and workshops in the field of Health Economics all around the globe.

Abstract:

Background: Post pandemic challenges exacerbated and created more demands for smart visionary health economics decisions regarding modern medical workforce planning, especially in rural regions in Wales. The NHS currently has a shortage of around 100,000 full-time medical staff in the United Kingdom (UK). Only 36% of consultant physician posts in Wales were filled in 2021. The reason for 71% of unsuccessful appointments was the absence of applicants.

Objective: The objective of this doctoral research is to identify approaches to training and recruiting medical professionals within the framework of the current model which is moving to a more community-based model. The aim of this reform strategy is to assist Hywel Dda University Health Board (HDUHB) to recruit the qualified and well-trained medical professionals in a cost-effective way.

Methods: During this doctoral research different methods will be used. The key one is PBMA, which will be supplied by systematic literature review, targeted surveys and personal interviews. Programme Budgeting and Marginal Analysis (PBMA) is an approach that assists decision-makers optimise the influence of healthcare resources on the health demands of a local population by analysing the current financial allocations and thinking for improvements.

Expected results: Using the health economics toolbox, this doctoral thesis will provide economic evidence regarding the cost-benefits and cost-effectiveness of operationalising HDUHBs strategy of training future medical professionals from the local community. Current training and recruitment practices will be described in detail along with costs to the NHS in Wales. Findings from this thesis will be disseminated to the other Health Boards in Wales as well as internationally.

Discussion: The results of this doctoral thesis will benefit decision-makers and policymakers with future workforce planning by gaining a deeper understanding of a staffing issue in terms of local education and retaining medical professionals in rural areas in the UK and internationally.