Cost of illness in the Netherlands

Health care professionals, policy makers and politicians have urgent needs for systematic information about national health care expenditure. The study Cost of Illness in the Netherlands has been performed for the third time and presents information about the relationship between health care use, measured as costs, and what matters most: the health of the population. Previous studies reported cost of illness estimates for the years 1988 en 1994. This study provides a comprehensive overview of Dutch health care costs in 1999. Total health care costs were attributed to health care sectors and providers, diseases, age groups and gender. The results of this analysis can be used for answering questions such as: 'On what type of health care do we spend our money?' And: 'how are these costs distributed among various illnesses and diseases?' But also: 'how much money do we need for healthcare in the future and for resolving waiting lists?' Researchers and policy makers may use the information of this study as a tool to explore the desired future characteristics and volumes of the Dutch health care system.In Nederland werd in 1999 ongeveer 36 miljard euro aan gezondheidszorg uitgegeven. Dat bedrag zal de komende jaren stijgen onder invloed van toenemende medische mogelijkheden en de vergrijzing van de bevolking. Om vast te stellen of al dat geld zo goed mogelijk wordt besteed, moet eerst bekend zijn waar dat geld precies aan wordt besteed. Dit rapport geeft een antwoord op die laatste vraag. Beschreven wordt hoe het zorggebruik van de Nederlandse gezondheidszorg in 1999 was verdeeld over ziekten, mannen en vrouwen, verschillende leeftijdsgroepen en zorgsectoren. Ook wordt beschreven hoe de kosten van de gezondheidszorg zich in de afgelopen jaren hebben ontwikkeld, en hoe zij zich in de toekomst naar verwachting zullen ontwikkelen. In dit rapport wordt tevens een eerste aanzet gegeven om de kosten ook te verdelen naar risicofactoren achter de ziekten. Verder wordt een vergelijking gemaakt met andere kosten van ziektenstudies uit binnen- en buitenland. Voor de interpretatie van verschillen tussen KVZ-cijfers wordt een algemene checklist van 10 punten gepresenteerd. Tenslotte worden de uitkomsten in een breder perspectief geplaatst door een vergelijking van de kosten met andere gevolgen van ziekte zoals sterfte, ziekteverzuim en arbeidsongeschiktheid

Social differences in health care utilisation and costs in the Netherlands 2003

Within the Netherlands, there are substantial social inequalities in care consumption and health care costs. People differ in terms of their use of care facilities. This is influenced by factors such as their socio-economic position, mode of cohabitation and country of origin. The present study reveals that this effect is even more pronounced than previous research has indicated. Social inequalities were identified in the use of virtually all types of care facilities. These inequalities are also substantial when translated into health care costs. In terms of costs per resident, it is estimated that individuals with an HBO qualification (professionally oriented higher education) or a university degree are 11% below the national average, while those who only received a primary-school education are 21% above that level. The average care costs of widowed individuals and divorcees are 31% and 48% above the national average, respectively. Conversely, the cost of care for people of non-Western origin are relatively low, but they are still 15% above the national average. It is worth noting that the same percentage applies to non-indigenous individuals of Western (mainly European) origin. The main reason for this is that lower socio-economic groups have more health problems. So, this study concludes that each euro spent on health care generally ends up in the right place, i.e. where there is the greatest need for care. This underscores the enormous importance of risk solidarity in the Dutch health service. This study also illustrate the fact that combating health deprivation can help us to manage the level of care expenditure in the Netherlands.Ieder jaar wordt in Nederland veel geld uitgegeven aan de gezondheidszorg. In 2003 ging het om een bedrag van 57,5 miljard euro. De serie Zorg voor euro's beschrijft waaraan dit geld werd uitgegeven, hoeveel gezondheid we ervoor hebben teruggekregen en ook hoe de zorguitgaven zich in de toekomst zullen ontwikkelen. Dit rapport laat in detail zien hoe gebruik en kosten van zorg in Nederland samenhangen met de sociaal-economische positie, de samenlevingsvorm en het land van herkomst van mensen. Zo blijkt dat mensen uit lagere sociaal-economische groepen aanzienlijk meer zorg gebruiken dan mensen uit andere groepen. Dit verschil komt vooral doordat mensen in lagere sociaal-economische groepen meer gezondheidsproblemen hebben. Tegelijkertijd blijken mensen uit deze groepen bij ziekte ook langer beroep te doen op zorgvoorzieningen. Dit betekent dat de bestrijding van gezondheidsachterstanden een bijdrage kan leveren aan de beheersing van de zorguitgaven

Individual differences in the use of the response scale determine valuations of hypothetical health states: an empirical study

ABSTRACT: BACKGROUND: The literature remains inconclusive about the effects of socio-demographic characteristics of the respondent, including age, on valuation scores of hypothetical health states. We analyzed data from a study designed to discriminate between the effects of respondents age and time preference on valuations of health states to get insight in the contribution of individual response patterns to the variance in valuation scores. METHODS: 212 respondents from different age groups valued six hypothetical health states with three methods: a Visual Analogue Scale (VAS) and two variants of the Time trade-off (TTO). Analyses included a generalizability study, principal components analysis and cluster analysis. RESULTS: Valuation scores differed significantly but not systematically between valuation methods. A total of 36.8% of variance was explained by health states, 1.6% by elicitation method and 0.2% by age group. Individual differences in the use of the response scales, e.g. a tendency to give either high or low TTO-scores, or a high or low scoring tendency on the VAS were the main source of remaining variance. These response patterns were not related to age or other identifiable respondent characteristics. CONCLUSIONS: We conclude that individual response patterns were more important determinants of TTO or VAS valuations of health states than age or other measured respondent characteristics. Further valuation research should focus on explaining individual response patterns as a possible key to understanding the determinants of health state valuations

Non-specialist health worker interventions for mental health care in low- and middle- income countries.

This is the protocol for a review and there is no abstract. The objectives are as follows: OVERALL OBJECTIVE: In order to assess the impact of delivery by non-specialist health workers (NSHWs) and other professionals with health roles (OPHRs) on the effectiveness of mental healthcare interventions in low- and middle- income countries (LMICs), we will specifically analyse the effectiveness of NSHWs and OPHRS in delivering acute mental health interventions; as well as the effectiveness of NSHWs and OPHRs in delivering long term follow-up and rehabilitation for people with mental disorders; and the effect of the detection of mental disorders by NSHWs and OPHRs on patient and health delivery outcomes. For each of these objectives we will examine the current evidence for the impact of delivery by NSHWs and OPHRs on the resource use and costs associated with mental healthcare provision in LMICs

Societal consequences of falls in the older population: Injuries, healthcare costs, and long-term reduced quality of life

BACKGROUND:: Fall incidents are a major cause of morbidity and mortality in older adults. The aim of this cohort study was to determine the incidence, costs, and quality of life for fall-related injuries in the older Dutch population presenting at the emergency department. METHODS:: Data on fall-related injuries in persons aged 65 years or older were retrieved from the Dutch Injury Surveillance System, which records injuries treated at the emergency department, and a patient follow-up survey conducted between 2003 and 2007. Injury incidence, discharge rates, healthcare costs, and quality of life measures were calculated. RESULTS:: Fall-related injuries were to the upper or lower limb in 70% of cases and consisted mainly of fractures (60%), superficial injuries (21%), and open wounds (8%)

Принципи управління персоналом сільськогосподарських підприємств (на прикладі Луганської області)

У статті проаналізовано сучасний стан сільськогосподарського виробництва в Луганській області та здійснена оцінка перспектив реформування управління персоналом на підприємствах АПК. Регресійним аналізом оцінено ступінь впливу деяких факторів на рентабельність персоналу. Рекомендується використання SWOT-аналізу для дослідження й формування раціонального управління персоналом підприємств АПК.Performed analysis of the current state of agriculture in the Luhansk region, evaluated the prospects for personnel resources reforming for the agricultural enterprises. The degree of factors influencing on profitability of personnel is appraised by the regressive analysis. SWOT-analysis is recommended for research and forming of agrarian enterprises rational management of a personnel

Prevalence and prognostic factors of disability after major trauma

Background: The primary aim of this study was to assess the health-related quality of life of survivors of severe trauma 1 year after injury, specified according to all the separate dimensions of the EuroQol-5D (EQ-5D) and the Health Utilities Index (HUI). Methods: A prospective cohort study was conducted in which all severely injured trauma patients presented at a Level I trauma center were included. After 12 months, the EQ-5D, HUI2 and HUI3 were used to analyze the health status. Results: Follow-up assessments were obtained from 246 patients (response rate, 68%). The overall population EQ-5D (median) utility score was 0.73 (EQ-5D Dutch general population norm, 0.88). HUI2, HUI3, and EQ-5D Visual Analog Scale scores were 0.81, 0.65, and 70, respectively. Eighteen percent had at least one functional limitation 1 year after trauma, and 60% reported functional limitations on two or more domains using the EQ-5D. The female gender and comorbidity were significant independent predictors of disability. Conclusion: Functional outcome and quality of life of survivors of severe injury have not returned to normal 1 year after trauma. The prevalence of specific limitations in this population is very high (40-70%). Female gender and comorbidity are predictors of long-term disability. Copyrigh

Study protocol of cost-effectiveness and cost-utility of a biopsychosocial multidisciplinary intervention in the evolution of non-specific sub-acute low back pain in the working population: cluster randomised trial.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Low back pain (LBP), with high incidence and prevalence rate, is one of the most common reasons to consult the health system and is responsible for a significant amount of sick leave, leading to high health and social costs. The objective of the study is to assess the cost-effectiveness and cost-utility analysis of a multidisciplinary biopsychosocial educational group intervention (MBEGI) of non-specific sub-acute LBP in comparison with the usual care in the working population recruited in primary healthcare centres. Methods/design: The study design is a cost-effectiveness and cost-utility analysis of a MBEGI in comparison with the usual care of non-specific sub-acute LBP.Measures on effectiveness and costs of both interventions will be obtained from a cluster randomised controlled clinical trial carried out in 38 Catalan primary health care centres, enrolling 932 patients between 18 and 65 years old with a diagnosis of non-specific sub-acute LBP. Effectiveness measures are: pharmaceutical treatments, work sick leave (% and duration in days), Roland Morris disability, McGill pain intensity, Fear Avoidance Beliefs (FAB) and Golberg Questionnaires. Utility measures will be calculated from the SF-12. The analysis will be performed from a social perspective. The temporal horizon is at 3 months (change to chronic LBP) and 12 months (evaluate the outcomes at long term. Assessment of outcomes will be blinded and will follow the intention-to-treat principle. Discussion: We hope to demonstrate the cost-effectiveness and cost-utility of MBEGI, see an improvement in the patients' quality of life, achieve a reduction in the duration of episodes and the chronicity of non-specific low back pain, and be able to report a decrease in the social costs. If the intervention is cost-effectiveness and cost-utility, it could be applied to Primary Health Care Centres. Trial registration: ISRCTN: ISRCTN5871969

Describing health and medical costs, and the economic evaluation of health care: applications in injuries and cervical cancer

Since the late nineteenth century, population's health has improved tremendously, at least in wealthy nations. Life expectancy at birth in the Netherlands has increased at an unpr