1.Development of health service in Hunan Province.
Min HU ; Gong GUO ; Xiaohua ZHAO ; Zhenqiu SUN ; Hai GUO ; Min GAO ; Dan XU ; Yazhou XIAO ; Fang ZENG ; Youzhe ZENG
Journal of Central South University(Medical Sciences) 2011;36(7):692-696
OBJECTIVE:
To study the health service development in Hunan Province, and to find out the advantages and disadvantages, and to make tentative specific suggestions.
METHODS:
Comparison was made in Yunnan, Hunan, and Zhejiang Provinces in 4 major areas: health institutions, personnels, facilities, and funding.
RESULTS:
The overall health service of Hunan Province was good: The health resources increased, the allocations were reasonable, and the health expenditure decreased. Some problems appeared, such as backward primary health, shortage of medical talents, inefficient use of hospital beds, deducted government investment, increased business income, and large urban-rural gap.
CONCLUSION
There is urgent need to further develop health institutions and increase personnels, particularly improving the primary health care and making use of traditional Chinese medicine; improving the management of hospital beds to increase efficiency, increasing financial support to reduce the patients' burden, and ensuring the need of rural health care.
China
;
Delivery of Health Care
;
trends
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Health Services
;
economics
;
statistics & numerical data
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Health Services Administration
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Humans
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Rural Health
;
economics
2.The analysis of drug cost and direct medical expense in community health management of hypertensive patients.
Xiao-hua LIANG ; Dong-feng GU ; Huan ZHANG ; Kun ZHU ; Ying DENG ; Jie CAO ; Zheng-yuan ZHOU ; Yi WANG ; Guo-sheng WAN ; Chuan ZHAO ; Quan-cheng MU ; Fang-hong LU
Chinese Journal of Preventive Medicine 2011;45(8):732-736
OBJECTIVETo investigate the current situation of drug cost, hospitalization cost and direct medical expense in community health management of hypertensive patients, in order to lay foundation for evaluating whether the community health management in basic public health service has cost-effect in Health Economics.
METHODSA total of 8326 hypertensive patients from 10 survey pilots in 5 provinces were selected by cluster sampling methods, including 3967 patients who took part in community health management for over 1 year as management group and 4359 cases who have never taken part in community health management as control group. The essential information of research objects were collected by questionnaire; and the medical cost information in the last year (from November 2009 to November 2010) were collected retrospectively. The different annual medical treatment cost, hospitalization cost and direct medical expense in the two groups were compared and analyzed.
RESULTSThe average annual drug cost in hypertension was (621.50 ± 1337.78) yuan per patient; while the cost was (616.13 ± 1248.40) yuan in management group and (626.44 ± 1414.30) yuan in control group respectively. The average annual drug cost of hypertensive patients who took medicine therapy was (702.05 ± 1401.79) yuan per person, while the cost in the management group ((688.50 ± 1300.70) yuan) was much lower than it in control group ((714.64 ± 1489.60) yuan). The annual average drug cost in urban was (731.88 ± 1403.31) yuan per person, which was higher than it in rural as (407.44 ± 1171.44) yuan per person. The average hospitalized rate was 12.2% (1014/8326), and the average annual cost among the hospitalized patients was (9264.47 ± 18 088.49) yuan per person; while the cost was (7583.70 ± 13 267.00) yuan in management group, which was lower than it in control group as (11 028.00 ± 21 919.00) yuan. The average annual hospitalized cost in hypertension was (1064.87 ± 6804.83) yuan per person; while the cost was (936.73 ± 5284.90) yuan in management group, which was lower than it in control group as (1181.50 ± 7937.90) yuan. The average annual direct medical expense in hypertension was (2275.08 ± 8225.66) yuan per person; while the expense was (2165.10 ± 6564.60) yuan in management group and (2375.20 ± 9487.60) yuan in control group. The average annual direct medical expense in urban ((2801.06 ± 9428.54) yuan per person) was higher than it in rural ((1254.70 ± 4990.27) yuan per person).
CONCLUSIONThe community health or standardized management of hypertensive patients can reduce the average annual drug cost and hospitalization cost (around 26 yuan and 245 yuan separately); and thereby save the annual direct medical expense per capita in hypertension (around 210 yuan). In the reform and development of national medical health system, we should enhance and promote the standardized community health management of hypertensive patients.
Aged ; Community Health Services ; economics ; Cost-Benefit Analysis ; Drug Costs ; Female ; Health Care Costs ; statistics & numerical data ; Humans ; Hypertension ; drug therapy ; economics ; Male ; Middle Aged ; Public Health ; economics
3.Effect of Allergic Rhinitis on the Use and Cost of Health Services by Children with Asthma.
Hye Young KANG ; Choon Seon PARK ; Hye Ryun BANG ; Vasilisa SAZONOV ; Chul Joon KIM
Yonsei Medical Journal 2008;49(4):521-529
PURPOSE: Allergic rhinitis (AR) is common among children with asthma and exacerbates asthma symptoms. To assess the incremental utilization and cost of asthma-related health services due to concomitant AR among asthmatic children. MATERIALS and METHODS: Asthma-related claims were extracted from the Korean National Health Insurance (NHI) claims database, which covers 97% of the population. Per-capita utilization and costs of asthma-related services were determined from the societal perspective. RESULTS: Of 319,714 children (1-14 years old) with chronic asthma in 2003, 195,026 had concomitant AR (prevalence 610 per 1,000 asthmatic children). Children with AR had 1.14 times more outpatient visits, 1.30 times more emergency department (ED) visits, and 1.49 times more hospitalizations than children without AR. More children with AR used general hospitals (7.17%) than children without AR (3.23%). The ratios of unit pharmaceutical costs per outpatient visit, ED visit, and admission between children with and without AR were 1.27, 1.20, and 1.14. Total annual expenditure combining direct health care, transportation, and caregivers' costs, were dollar 273 and dollar 217 for children with and without AR, respectively. CONCLUSION: Health service utilization and costs for asthma were greater for asthmatic children with AR. More frequent ED visits and admissions among asthmatic children with AR suggest poorer control and more frequent exacerbations. Higher unit cost of pharmaceuticals during visits, tendency to receive asthma care from a higher-level facility, and greater risk of ED visit or admission all contributed to the additional economic burden of AR.
Adolescent
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Asthma/*economics/*epidemiology
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Child
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Child, Preschool
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Female
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Health Services/economics/statistics & numerical data
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Humans
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Hypersensitivity/economics/epidemiology
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Infant
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Male
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Rhinitis/*economics/*epidemiology
4.Equity of outpatient service utilization for hypertensive patients in community.
Min XU ; Xiaowan WANG ; Zengwu WANG ; Jian LI ; Ruihua FENG ; Yueying CUI
Journal of Central South University(Medical Sciences) 2018;43(6):668-678
To analyze the equity of outpatient service utilization for hypertensive patients (HPs) under 3 kinds of social medical insurance, and to explore its influential factors.
Methods: A total of 8 670 HPs (aged at 15 years old from 28 sub-centers) in 14 provinces were selected. Indirectly standardized method and concentration index were used to analyze the equity of outpatient utilization in HPs, and decomposition analysis was used to explore the impact factors of outpatient treatment among the whole sample population, population with urban employees' basic medical insurance (UEBMI), and population with urban residents' basic medical insurance (URBMI) and new rural cooperative medical systems (NCMS).
Results: The overall concentration index (CI) for the whole sample population was 0.2378. After the standardizing "need" variable, horizontal inequity (HI) was 0.2360, indicating that the outpatient service of HPs was inequity and that the higher economic level, the more outpatient services received. The decomposition of overall CI results showed that the positive factors for contribution were gross domestic product (GDP) level, retired, UEBMI and URBMI, and the negative factors for contribution were NCMS. The CI of UEBMI, URBMI and NCMS was 0.2017, 0.1208 and 0.0288, respectively; the HI was 0.1889, 0.1215 and 0.0219, respectively. The inequity in UEBMI is the most serious, followed by NRCMS and URBMI. The economic level was the main factor that caused inequity in the outpatient services utilization in three social medical insurance. In addition to the economic level, a common positive factor for the contribution to UEBMI and URBMI was district of residence, and the age was the positive factor to UEBMI as well.
Conclusion: There are different levels of inequity in the HPs covered by 3 kinds of social medical insurance, and the inequity of UEBMI is the highest one among 3 kinds social medical insurance. The economic level is the main factor that affects the equity of outpatient in the HPs under 3 kinds of social medical insurance.
Adolescent
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Ambulatory Care
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economics
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statistics & numerical data
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China
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Healthcare Disparities
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economics
;
statistics & numerical data
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Humans
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Hypertension
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therapy
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Insurance, Health
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economics
;
statistics & numerical data
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Outpatients
;
statistics & numerical data
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Rural Health Services
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economics
;
statistics & numerical data
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Socioeconomic Factors
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Urban Health Services
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economics
;
statistics & numerical data
5.Effects of Private Health Insurance on Health Care Utilization and Expenditures in Korean Cancer Patients: Focused on 5 Major Cancers in One Cancer Center.
Jin Hwa LIM ; Kui Son CHOI ; Sung Gyeong KIM ; Eun Cheol PARK ; Jae Hyun PARK
Journal of Preventive Medicine and Public Health 2007;40(4):329-335
OBJECTIVES: To identify the effects of supplemental private health insurance on health care utilization and expenditure under the mandatory National Health Insurance(NHI) system in Korea. METHODS: The data were collected by the National Cancer Center in Korea. Cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer were included as study subjects. Data were gathered using a structured questionnaire from face-to-face interviews, the hospital Order Communication System (OCS) and medical records. Clinical, socio-demographic and private health insurance related factors were also gathered. The differences of health care utilization and expenditure were compared between those who have private health insurance and those who do not using t-test and multivariable regression analysis. RESULTS: Individuals with private health insurance spent larger inpatient costs than those without, but no differences were found in utilization in other service such as hospital admissions, hospital days and physician visits. CONCLUSIONS: We found that private health insurance exerts a significant effect on the health care expenditure in inpatient service. These study results can provide a rational basis to plan a national health policy regarding private health insurance. Further studies are needed to investigate the impacts of private health insurance on cancer patients' outcomes and survival rates.
Adult
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Aged
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Female
;
Health Expenditures
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Health Services/economics/*utilization
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Humans
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Insurance, Health/*statistics & numerical data
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Korea/epidemiology
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Male
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Middle Aged
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Neoplasms/economics/*therapy
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*Private Sector
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Socioeconomic Factors
6.Educational Differences in Health Care Utilization in the Last Year of Life among South Korean Cancer Patients.
Soo Young CHOO ; Sang Yi LEE ; Chul Woung KIM ; Su Young KIM ; Tae Ho YOON ; Hai Rim SHIN ; Ok Ryun MOON
Journal of Preventive Medicine and Public Health 2007;40(1):36-44
OBJECTIVES: There have been few studies examining the differences in health care utilization across social classes during the last year of life. Therefore, in this study we analyzed the quantitative and qualitative differences in health care utilization among cancer patients across educational classes in their last year of life, and derived from it implications for policy. METHODS: To evaluate health care utilization by cancer patients in the last year of life, Death certificate data from 2004 were merged with National Health Insurance data (n=60,088). In order to use educational level as a social class index, we selected the individuals aged 40 and over as study subjects (n=57,484). We analyzed the differences in the medical expenditures, admission days, and rates of admission experience across educational classes descriptively. Multiple regression analysis was conducted to evaluate the association between medical expenditures and independent variables such as sex, age, education class, site of death and type of cancer. RESULTS: The upper educational class spent much more on medical expenditures in the last one year of life, particularly during the last month of life, than the lower educational class did. The ratio of monthly medical expenditures per capita between the college class and no education class was 2.5 in the last 6-12 months of life, but the ratio was 1.6 in the last 1 month. Also, the lower the educational class, the higher the proportion of medical expenditures during the last one month of life, compared to total medical expenditures in the last one year of life. The college educational class had a much higher rate of admission experiences in tertiary hospitals within Seoul than the other education classes did. CONCLUSIONS: This study shows that the lower educational classes had qualitative and quantitative disadvantages in utilizing health care services for cancer in the last year of life.
Terminal Care/economics/*utilization
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*Social Class
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Patient Admission/statistics & numerical data
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*Neoplasms/economics/epidemiology/therapy
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Middle Aged
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Male
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Korea/epidemiology
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Humans
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Health Services/economics/*utilization
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Health Expenditures/*statistics & numerical data/trends
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Educational Status
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Death Certificates
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Aged
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Adult
7.Oral health services utilization and influencing factors in downtown community residents older than 15 years in Beijing.
Chao YUAN ; Ling ZHU ; Yu-ling LI ; Min LIU ; Yan SI ; Fan ZHANG
Chinese Journal of Stomatology 2011;46(3):182-185
OBJECTIVETo investigate the utilization of oral health services and to analyze the factors associated with oral health services for the community residents.
METHODSHousehold health interview and oral health condition survey were conducted to obtain information about oral health services. The respondents were recruited by a multi-stage random cluster sampling procedure. Multiple dummy regression analyses were performed for the assessment of the relative effect of behavioural factors on dental attendance.
RESULTSA total of 2003 families, 4459 people participated in this study. The people seeking dental treatment accounted for 11.3% (502/4459) per year. Young people (OR = 2.072), having medical insurance system (OR = 2.835), short distance to see dentist (OR = 3.535), oral health awareness (OR = 2.595), poor self-assessment of oral health status (OR = 2.014) were the main factors which influenced dental attendance of community residents.
CONCLUSIONSThe utilization of oral health service was low, particularly for middle-aged people and the elderly. Oral health education and medical insurance system should be strengthened.
Adolescent ; Adult ; Aged ; Dental Care ; economics ; utilization ; Dental Health Services ; economics ; utilization ; Health Services Accessibility ; statistics & numerical data ; Health Services Needs and Demand ; Humans ; Income ; statistics & numerical data ; Insurance, Dental ; statistics & numerical data ; Logistic Models ; Middle Aged ; Sampling Studies ; Self-Assessment ; Surveys and Questionnaires ; Urban Health Services ; utilization ; Urban Population ; Young Adult
8.Pharmacist review and its impact on Singapore nursing homes.
Hui Shan CHIA ; John Aik Hui HO ; Bernadette Daolin LIM
Singapore medical journal 2015;56(9):493-501
INTRODUCTIONThere is a high prevalence of polypharmacy and inappropriate medication use in Singapore nursing homes. This study primarily explored the benefits of pharmacist reviews in local nursing homes. The secondary aims were to review the potential cost savings gained from following the pharmacists' recommendations and to identify the possible risks associated with polypharmacy and inappropriate medication use.
METHODSA retrospective period prevalence study was performed. We analysed the pharmacotherapy problems highlighted by pharmacists in three nursing homes and the rate of acceptance of pharmacists' recommendations. Data was collected in two phases: (a) a one-month pre-setup period, during which 480 patients were reviewed (i.e. one-time review before weekly pharmacist visits); and (b) a six-month post-setup period, during which the 480 patients were reviewed again. Pharmacotherapy problems were classified according to a clinical pharmacist recommendation taxonomy and potential risks were identified. Monthly cost savings were calculated and compared with the monthly costs of pharmacist reviews.
RESULTSA total of 392 pharmacotherapy problems were identified, with pharmacist recommendations noted for each problem. Among the 392 recommendations, 236 (60.2%) were accepted. The pharmacotherapy problems were analysed for potential risks, including falls (16.0%) and constipation (13.1%). The acceptance rates were higher during the post-setup period compared to the pre-setup period (p < 0.0001). Total direct acquisition cost savings during the pre- and post-setup periods were SGD 388.30 and SGD 876.69, respectively.
CONCLUSIONThe provision of pharmaceutical care to nursing home residents resulted in improved medication safety and quality of care.
Aged ; Drug Costs ; Drug Utilization Review ; economics ; statistics & numerical data ; Female ; Health Care Costs ; Humans ; Inappropriate Prescribing ; economics ; statistics & numerical data ; Male ; Nursing Homes ; Pharmaceutical Services ; economics ; Pharmacists ; Polypharmacy ; Prevalence ; Retrospective Studies ; Risk ; Singapore
9.Analysis on oral health care utilization and expenditure of residents in Beijing.
Zuo-min WANG ; Hong-ying WANG ; Cai-fang CAO
Chinese Journal of Stomatology 2003;38(2):147-150
OBJECTIVETo analyze the dental care utilization and expenditure of residents in Beijing, and to provide some basis on the policy of oral health insurance system.
METHODSA cross-sectional survey was conducted among 1,517 subjects (urban area) and 1,878 subjects (rural area) of all age groups in Beijing selected by stratified, clustering, random sampling. The data of oral health care utilization and expenditure were collected in their home.
RESULTSThe number of the people who visited a dentist in a year were low both in urban area and in rural area, but the expenditure for oral health care per visit were quite high. The value of utilization of dental care in rural residents was 1/3 of that in urban residents, while the value of expenditure in rural people was about 1/2 of that in urban people. 2.07% incomes of rural residents were used for dental care per year, the corresponding value of urban residents was 1.77%. There was significant difference on the expenditure among those with different demographic, socio-economic backgrounds.
CONCLUSIONSThe expenditure for oral health care was high in Beijing, which accounted for quite a lot in average incomes per year. The burden of expenditure for dental care on rural residents was heavier than that on urban residents. The level of expenditure for dental care could provide some references for oral health insurance system in Beijing.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; China ; Dental Health Services ; economics ; statistics & numerical data ; Fees, Dental ; Female ; Health Services Accessibility ; statistics & numerical data ; Humans ; Infant ; Infant, Newborn ; Insurance, Dental ; Male ; Middle Aged ; Rural Health Services ; statistics & numerical data ; Urban Health Services ; statistics & numerical data
10.Home-based advance care programme is effective in reducing hospitalisations of advanced heart failure patients: a clinical and healthcare cost study.
Raymond Cc WONG ; Poh Tin TAN ; Yen Hoon SEOW ; Suzana AZIZ ; Nilar OO ; Swee Chong SEOW ; Angeline SEAH ; Ping CHAI
Annals of the Academy of Medicine, Singapore 2013;42(9):466-471
INTRODUCTIONIn end-stage heart failure (HF) that is not eligible for mechanical assist device or heart transplant, palliative care serves to maximise symptom control and quality of life. We sought to evaluate the impact of home-based advance care programme (ACP) on healthcare utilisation in end-stage HF patients.
MATERIALS AND METHODSProspectively collected registry data on all end-stage HF recruited into ACP between July 2008 and July 2010 were analysed. Chart reviews were conducted on HF database and hospital electronic records. Phone interview and home visit details by ACP team were extracted to complete data entry. HF and all-cause hospitalisations 1 year before, and any time after ACP inception were defined as events. For the latter analysis, follow-up duration adjustment to event episodes was performed to account for death less than a year.
RESULTSForty-four patients (mean age 79 years, 39% men) were followed up for 15±8 months. Fifty-seven percent had diabetes, 80% ischaemic heart disease, and 60% chronic kidney disease. All reported functional class III/IV at enrolment. Mean serum sodium was 136±6 mmol/L, and creatinine 186±126 mmol/L. Thirty (68%) died within the programme. Mean time to death was 5.5 months. Mean all-cause and HF hospitalisations were 3.6 and 2.0 per patient before enrolment, but improved to 1.0 and 0.6 respectively after ACP. Thirty-six (71%) patients had fewer HF hospitalisations. When only those who survived more than a year were considered (n = 14), 10 (71%) and 9 (64%) experienced reduced HF (mean: 1.4 episodes per patient) and all-cause hospitalisations (mean: 2.2 episodes per patient) respectively.
CONCLUSIONHome-based advance care programme is potentially effective in reducing healthcare utilisation of end-stage HF patients, primarily by reducing HF rehospitalisations, and in probably saving costs as well.
Aged ; Aged, 80 and over ; Diabetes Mellitus ; Female ; Health Care Costs ; Health Services ; economics ; utilization ; Heart Failure ; complications ; economics ; therapy ; Home Care Services, Hospital-Based ; economics ; Hospitalization ; economics ; statistics & numerical data ; Humans ; Male ; Myocardial Ischemia ; complications ; Palliative Care ; economics ; methods ; Prospective Studies ; Registries ; Renal Insufficiency, Chronic ; complications ; Tertiary Care Centers