Health care services utilization

Reuveni H, Simon T, Tal A, Elhayany A, Tarasiuk A. Health care services utilization in children with obstructive sleep apnea syndrome. Pediatrics 2002 110(1 pt l) 68-72. 

Many patients are turning to dietary supplements in an effort to take a more active part in the management of their health. Whether or not health care practitioners condone this practice, pharmacists must be familiar with these products. Pharmacists should be aware of the safety and toxicity issues surrounsding these products. They cannot afford to jeopardize patients trust and respect by dismissing the potential utility of dietary supplements. Rather, pharmacists need to encourage patients to be open and honest about their dietary supplement use so the highest degree of health care service may be provided. 

In a cost-benefit analysis, both costs and consequences are valued in dollars and the ratio of cost to benefit (or more commonly benefit to cost) is computed. Cost-benefit analysis has been used for many years to assess the value of investing in a number of different opportunities, including investments (or expenditure) for health care services. Cost-effectiveness analysis attempts to overcome (or avoid) the difficulties in cost-benefit analysis of valuing health outcomes in dollars by using nonmonetary outcomes such as life-years saved or percentage change in biomarkers like serum cholesterol levels. Cost-minimization analysis is a special case of cost-effectiveness analysis in which the outcomes are considered to be identical or clinically equivalent. In this case, the analysis defaults to selecting the lowest-cost treatment alternative. Cost-utility analysis is another special case of cost-effectiveness analysis in which the value of the outcome is adjusted for differences in patients preferences (utilities) for the outcomes. Cost-utility analyses are most appropriate when quality of life is a very important consideration in the therapeutic decision. 

Professionals working with a suicidal drug client may wish to determine whether the person meets criteria for Borderline Personality Disorder. Borderline clients often have a history of suicidal behavior and high utilization of health and mental health care services. Most people who meet criteria for Borderline Personality Disorder are women, but not all. As mentioned, some professionals find it difficult to work with borderline clients without becoming very upset or cynical. If you cannot work with such a client respectfully, then it is recommended that a referral be made to someone who can (see Chapter 3). Treating the client with dignity is important if trust and a solid therapeutic alliance are to develop. 

Pediatric OSAS patients demonstrated a similar pattern in Israel (52). Of 287 consecutive children with OSAS, there was at least a two fold increase in utilization of health care services compared to 149 controls 1 year before diagnosis. The high-cost contributors were hospital days, medications, and emergency-room visits. Subjects with untreated OSAS have many more sleepiness-related motor vehicle accidents as compared to a control group. However, the loss of productivity and opportunity loss have not yet been estimated for OSAS patients. 

The increased utilization of health care services by the elderly is expected to put additional strains on an already besieged health care system. Increasing the life span, either through preventive measures or through other acts of distributive justice, solves some problems while creating others. This astounding paradox will assuredly complicate the political and social processes of decision making. Equally likely will be the burdens these phenomena add to an already overburdened national economy. 

There are, however, those who have no specific financial support or capacity to pay for health care services and who are not eligible for any type of entitlements. These individuals must rely on some form of charity care or services. In addition, there are those who, for reasons of geographic remoteness or total inability to gain access, have no access to health care services. This group represents a complex, resource-based demand model, which also has an equally complex pattern of health care system and services-utilization requirements. 

Fee waivers for essential services, health care, schooling, utilities, or transport... 

School enrollment and attendance Utilization of health care services Coverage of target group, targeting accuracy... 

South Africa. In 1994, the new African National Congress government, fulfilling its mandate to remove the inequities of the apartheid era, introduced free health services for pregnant women and children under five. In 1998, the government extended fee provision to all those using public primary health care services. The removal of fees led to an increase in service utilization, but health workers felt that they were not prepared for the changes, which resulted in unnecessary tensions between workers and patients. 

The practice of health care service at hospitals and clinics is mostly geared to process compliance and resource utilization. A shift from routine compliance to outcomes that emphasizes the final result would induce changes throughout the care-delivery system. For example, the provider-structure may have to be based on patient-centric concepts, requiring a major reengineering of operations. An outcome-oriented organization will focus on patient pathways and configuration of clinical processes that lead to desirable outcomes. Processes will be evaluated based on its positive contribution to the outcome and not the productivity (e.g., number of lab tests per week) of individual processes (Bohmer and Lee 2009). 

Extrapolation to other countries is not easy. Canada has a very different health-care system to the USA. A small-scale study involving 466 anxiety disorder patients in Quebec established a clear relationship between the severity of the disorder and utilization of health services (McCusker et al, 1997). Patients with obsessive-compulsive disorder were particularly likely to seek treatment. No information on dmg use was presented. 

Cost-effectiveness and cost-benefit analyses are frequently mentioned in academic and policy-analysis circles. These notions center on careful examination of the costs and their corresponding outputs. Eisenberg defines cost-effectiveness analysis as the measure of the net cost of providing service (expenditures minus savings) as well as the results obtained (e.g., clinical results measured singly or a series of results measured on some scale). Cost-benefit analysis determines whether the cost is worth the benefits by measuring both in the same units. Such analyses will be critical, as future policy decisions are made with regard to the collection, allocation, and utilization of finite resources in the health care system for the enhancement of health status of the American people. 

An extensive literature documents persistent differences in health outcomes between ethnic minorities and white Americans. These disparities include differences in health care access and utilization as well as health status and outcomes. Wolinsky showed that differences in access and use of health services by various ethnic groups stems in part from their varying cultural traditions. Pharmacists can assist in closing this gap in health outcomes by providing culturally sensitive patient care. Information about patients cultural health care beliefs and practices is essential for devising interven-... 

Supply-side subsidies, which cover some or all of the costs of health services inputs (infrastructure, staff, drugs, equipment, nonmedical consumables), provide litde incentive to attract patients or increase productivity. As a result, despite relatively low wages, publicly operated services have remarkably high unit costs, and utilization rates are often low. The absence of targeting (restricting benefits to a certain subset of the population) gready dilutes the impact of public expenditure on health care. Middle-class people pay less than they can afford, while the poor often pay more. 

Healthcare services are not normally provided for their own sake. Few people receive any direct satisfaction (utility) from consuming health care. Generally these services are demanded because of an expectation that they will have a positive impact on present or future health. 

Nowadays a drug company has not only to show its paymasters - governments, insurers and so on - that its new prodnct is safe and works, but also that it is cost-effective. In Anstralia, this has been spelled out in legislation. Since 1993, any drng submitted for approval must be accompanied not only by the resnlts of clinical trials bnt also by an economic impact analysis. In 1999, the United Kingdom set np a National Institnte for Clinical Excellence (NICE) to advise the National Health Service on the cost-effectiveness of health care technologies. Other countries ask formally or informally for pharmacoeconomic analysis. Economic impacts can be measured in a variety of ways, for example, cost-effectiveness, cost-utility or full cost-benefit stndies. 

Health Services and Outcomes Research Methodology. Nor-well, MA Kluwer Academic Publishers. Quarterly. ISSN 1387-3741. An international journal devoted to quantitative methods for the study of utilization, quality, cost, and outcomes of health care. Publishes research papers on quantitative method, case studies, and review articles. 

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