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The switch between cataract surgical settings: Evidence from a time series analysis across 20 EU countries.

ABSTRACT: To analyze trajectories of cataract surgery rates and to confirm the switch between inpatient cases and day surgery or outpatient cases.Pooled, cross-sectional, time series analysis.Data on 20 European countries from 2004 to 2014 retrieved from the OECD.The number of cataract surgery cases per 100,000 population has increased since 2004 (b = 31.1, p < 0.001, 95% CI = 26.7, 35.6). A reversal of the inpatient cases and same-day cases was found: the first ones decreased (b = -14.7, p < 0.001, 95% CI = -17.7, -11.8) while day surgery and outpatient cases increased (b = 37.5, p < 0.001, 95% CI = 31.6, 43.4, and b = 8.3, p = 0.001, 95% CI = 3.6, 13.1, respectively). Since 2004, the ratio of day surgery and outpatient cases to inpatient cases has grown significantly (b = 3.3, p < 0.001, 95% CI = 2.5, 4.0), reaching a share of 31.7 in 2014. However, this slope of 3.3 was not constant and slowed over the years: from 4.5 per year during the first five years to 1.9 in the second five. No association was found between cataract surgery rate and two regressors: elderly people, and health care expenditure per capita.EU countries have preserved cataract surgery, and this preservation is probably affected by the switch from inpatient to same-day surgery, thanks to the decrease in the cost and equivalent clinical outcomes. However, the slope of the switch slowed over time. Consequently, health care systems must support this process of change especially through reforms in financial and organizational fields.

SUBMITTER: Gianino MM

PROVIDER: S-EPMC5831096 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectivesTo analyse trajectories of retail pharmaceutical expenditures from 2010 to 2019 in Italy to investigate whether there was a switch from public to private expenditure, how the composition of private and public expenditure changed, and whether there are correlations with supply/demand variables. Answering these questions is important to assure pharmaceutical care to all citizens in a public health system where expenditure containment is the issue of pharmaceutical policies.Design and settingTime-trend analysis was carried out in the Italian National Health System (NHS), between 2010 and 2019. We considered the following: public pharmaceutical expenditure with/without direct distribution of drugs, copayments, household out-of-pocket payments for drugs reimbursable/non-reimbursable by the NHS, and for drugs without prescription requirement. Correlations were tested between expenditure items and relevant statistics (Gini coefficient, resident population demographics, ages and categories of physicians, and current expenditure on health).ResultsThe switch feared between public and private pharmaceutical expenditures was not found: private expenditure increased (average annual per cent change 1.5%; 95% CI 0.3% to 2.6%), but public spending remained stable (-1.0%; 95% CI -3.0% to 1.1%). Single items of expenditure exhibited significant pattern changes over the study period. A switch from public expenditure without direct distribution of drugs (-3.9%) to expenditure with direct distribution was found (+8.4%). Unexpected increases in household out-of-pocket payments for drugs reimbursable by the NHS (+6.1%) and in copayments (+4.9%) were shown. No notable correlations were found.ConclusionsThis study offers insights into Italian experience that can be applied to other contexts and the results provide policy-makers issues to reflect on. The findings suggest that policies of pharmaceutical-expenditure management may have multiple effects and unexpected combined effects over time that should be considered when they are designed, and suggest that health policies must be adopted with a systematic logic and a broad and unified vision.

Project description:Soil solution chemistry is influenced by atmospheric deposition of air pollutants, exchange processes with the soil matrix and soil-rhizosphere-plant interactions. In this study we present the results of the long-term Intercantonal Forest Observation Program in Switzerland with soil solution measurements since 1998 on a current total of 47 plots. The forest sites comprise two major forest types of Switzerland including a wide range of ecological gradients such as different nitrogen (N) deposition and soil conditions. The long-term data set of 20 years of soil solution measurements revealed an ongoing, but site-specific soil acidification. In strongly acidified soils (soil pH below 4.2), acidification indicators changed only slowly over the measured period, possibly due to high buffering capacity of the aluminum buffer (pH 4.2-3.8). In contrast, in less acidified sites we observed an increasing acidification rate over time, reflected, for example, by the continuous decrease in the ratio of base cations to aluminum (BC/Al ratio). Nowadays, the main driver of soil acidification is the high rate of N deposition, causing cation losses and hampering sustainable nutrient balances for tree nutrition. Mean nitrate leaching rates for the years 2005-2017 were 9.4 kg N ha-1 yr-1, ranging from 0.04 to 53 kg N ha-1 yr-1. Three plots with high N input had a remarkable low nitrate leaching. Both N deposition and nitrate leaching have decreased since 2000. However, the latter trend may be partly explained due to increased drought in recent years. Nonetheless, those high N depositions are still affecting the majority of the forest sites. Taken together, this study gives evidence of anthropogenic soil acidification in Swiss forest stands. The underlying long-term measurements of soil solution provides important information on nutrient leaching losses and the impact climate change effects such as droughts. Furthermore, this study improves the understanding of forest management and tree mortality regarding varying nitrate leaching rates.

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The switch between cataract surgical settings: Evidence from a time series analysis across 20 EU countries.

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