Severe anaemia and malaria are among the leading causes of childhood hospital admissions in Africa south of the Sahara. For children being discharged from hospital, readmissions often occur raising the costs for inpatient care. This study aims to estimate healthcare provider costs for children under-five diagnosed with severe anaemia and severe malaria at Zomba and Kamuzu Central Hospitals in Malawi, Kisumu Referral Hospital in Kenya and Jinja Children’s Referral Hospital in Uganda. This is a sub-study of the clinical trial “Dihydroartemisinin-piperaquine and azithromycin for the post-discharge management of children with severe anaemia in Malawi, Kenya and Uganda”. Cost data were collected from January 2024 to October 2024. Using bottom-up costing, we estimated annual economic costs for personnel, supplies and overheads required for a paediatric medical admission, referral, and blood transfusion processes. Individual cost components were identified, measured and valued for the services of in-patient and outpatient care, laboratory processing and ambulance referrals. The cost to healthcare providers for one bed-day for a general paediatric medical admission was 18 at Zomba Central Hospital,50 at Kisumu County Referral Hospital, and 15 at Jinja Children’s Referral Hospital. When accounting for laboratory services, blood transfusions, and malaria medication for the duration of the entire hospital stay, the total costs of care were:118 in Zomba, 427 in Kisumu and167 in Jinja. At Kamuzu Central Hospital, a bed-day costs 9 in the main children’s medical ward, and24 in the High Dependency Unit. The costs of providing for the entire hospital admission were 79 and310, respectively. Personnel and operational costs were the main cost drivers for admissions costs, while laboratory supplies were the main cost component when providing blood testing services. This study demonstrates how the costs of providing health care are influenced by fixed and variable cost components, health service utilization, and country-specific investments in health care. Our findings contribute to an evidence base to inform resource allocation and cost-effectiveness analyses of interventions targeting severe anaemia and malaria in children in Malawi, Kenya, and Uganda. Registry: pactr.samrc.ac.za Date of Registration: 8th March 2023, Trial Registration Number: PACTR202303630742194.
Basic medical insurance is a key institutional arrangement for unlocking the latent consumption capacity of households in China. Drawing on panel data from the China Family Panel Studies (CFPS), this paper systematically examines the impact of basic medical insurance on household consumption and its underlying mechanisms. The study finds the following: Basic medical insurance has a significant positive effect on household consumption. Its mechanism of action is primarily manifested through three channels: first, the income effect, which improves residents’ health capital stock and enhances their earning capacity; second, the substitution effect, which reduces the uncertainty of out-of-pocket medical expenses and releases precautionary savings; and third, the trust effect, which strengthens residents’ institutional trust in the government and improves their future expectations. This study provides new micro-level evidence for understanding how universal social security systems unlock residents’ consumption potential, and offers targeted policy insights for deepening the reform of the basic medical insurance system and enhancing the precision and effectiveness of social security for the people.
Common mental disorders (CMDs), including depression, anxiety, and stress-related disorders, affect approximately 20
Telehealth utilization expanded during the COVID-19 pandemic, but nationally representative evidence on its persistence, distribution across insurance groups, and relationship with office-based expenditures remains limited. This study examined telehealth use in U.S. office-based care from 2020 through 2023 and described visit-level payments and charges for telehealth and in-person encounters. A pooled cross-sectional analysis of 543,537 office-based visit events from the Medical Expenditure Panel Survey (MEPS), 2020–2023 was conducted. Analyses accounted for the MEPS complex survey design. Insurance was grouped into employer-sponsored insurance (ESI), Medicare only, Medicaid/SCHIP only, Medicare–Medicaid dual coverage, other private coverage, uninsured, and other/unknown coverage. Survey-weighted logistic regression with a year-by-insurance interaction was used to examine telehealth utilization, with adjusted probabilities and average marginal effects (AMEs) reported with 95
Post-surgical hypoparathyroidism is a rare chronic endocrine disorder associated with substantial clinical and economic burden. Evidence on its costs within the Italian National Health Service (NHS) is limited. This study provides a guideline-informed micro-costing estimate of the direct and indirect costs of managing persistent post-surgical hypoparathyroidism in Italy, including pregnancy and early postpartum care. An Activity-Based Costing (ABC) approach was applied from NHS and partial societal perspectives. Resource use was estimated through a structured survey among 14 members of the guideline (GL) panel. Two clinical questions were addressed: PICO 1 used a one-year horizon for adults; PICO 2 covered pregnancy and the first three months postpartum. Costs were valued using the most recent source available for each component; no adjustment to a single common price year was applied. The one-off initial assessment cost was €327.43 per patient. Annual follow-up costs were €223.85 for men and women of childbearing age and €206.29 for postmenopausal women. The utilisation-weighted conventional regimen cost €240.55 in annual drugs. The modelled palopegteriparatide component cost €32,197.80 for six months of treatment; rhPTH 1–84 cost €39,262.50 for four months and was retained solely as a historical reference scenario. First-year total costs, including initial assessment and estimated productivity losses, were €5,750.13–€5,767.69 with the conventional regimen without complications and €9,649.38–€9,666.94 with complications. Assuming unchanged conventional treatment alongside palopegteriparatide, corresponding first-year costs were €37,947.93–€37,965.49 without complications. Over pregnancy and the first three months postpartum, estimated direct costs and productivity losses totalled €3,036.04 excluding pharmacological treatment and initial assessment, including €1,038.71 for maternal follow-up and €353.55 for neonatal follow-up. Productivity losses represented approximately 54
