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Health Economics And Comparative Health

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Question:

Discuss about the Health Economics and Comparative Health.

 

Answer:

Introduction

The burden of asthma is fur felt not only in Australia but also globally with many countries developing strategies to tackle this economic challenge. The economics of asthma is related to the cost that is attributed to management, medication and other indirect costs that also contributes to the economic impact of asthma felt on the population of Australia. This is also similar to other countries and globally as asthma becomes global disease (National Heart, Lung, and Blood Institute, 2014). Asthma cause lifelong condition that needs high medical attention in the life of a person diagnosed with uncontrolled asthma. Studies indicate that asthma affects people from all walks of life cutting across all genders and age groups within a population. For instance, data shows that children under the age of 5 years experience the incidence of asthma at the rate of 23 per 1000 each year. This is also true to those aged between 12 and 17 that has an incidence of 44 per 1000 annually. Given these number of patients suffering from asthma the productivity of such individuals is related to their health status at the workplace.   This is based on the fact that those patients affected with the burden of asthma are unproductive as compared those healthy ones. When making a comparison with other countries, there are similarities in terms of cost related to management of uncontrolled asthma and the challenges it poses to the productivity of each individual (National Health and Medical Research Council, 2015).

 

Body

Economics of asthma in Australia

The economic burden of asthma can be explored based on the cost that can be attributed to asthma. This cost can be categorized into direct cost, indirect cost and intangible cost that is also associated with the burden of uncontrolled asthma.

Direct cost

The direct cost of uncontrolled asthma includes the cost of asthma management, treatment cost, and other direct costs. The cost of asthma management refers to all the cost that is attributed to the cost that is required for medication when the patient visited the doctor for medical services. The economics of asthma in Australia indicates that asthma is one of the diseases that have overburden patients leading to loss of funds through management. For instance, the data available indicates that the cost for prescribed pharmaceuticals in 2015 alone total to $263 per person in Australia (NHIS, 2012). This statistics also differs depending on different age groups across the population that affected by the burden of asthma.

The direct cost associated with asthma can also be studied based on the cost incurred when patients are admitted to the hospital. Many Australians suffering from asthma often spend a huge amount of money for inpatients. Patients are admitted to hospitals that may be private or public hospitals under high expenditure that is estimated to be more than $102 per person within Australia annually. The cost of hospital admission is also high given that about 3.8% of the adults are admitted with asthma-related complications as compared to 4.9% cases of children. This cost also considers the number of admissions experienced within the emergency departments where most patients sometimes are admitted as primary care. Of the total number of patients admitted in the emergency department children mostly age between o-18 years account for 3.5 % (Reddel et al, 2012).

Indirect cost associated with uncontrolled asthma

The burden of uncontrolled asthma can also be studied based on the indirect cost include work-related costs, early mortality costs. Firstly, asthma patients have work-related problems that are also connected frequent hospital admission and medication. Work-related issues as an indirect cost of the asthma burden are felt in many sectors throughout Australia leading to low productivity of those patients. The reduction of productivity of those people diagnosed with asthma especially due to continuous medication results in economic challenges not only at the family level but also at the industry level. Secondly, the early mortality rate is also common among those patients diagnosed with acute asthma. The mortality of asthma reduces the number of people that would otherwise productive leading to the economic sabotage. Moreover, the mortality of the patients with uncontrolled asthma causes the families to lose a huge amount of funds in the event that patients under heavy medication die (Marks et al, 2007).

 

Intangible cost of uncontrolled asthma

Intangible costs of uncontrolled asthma include quality of life, pain, limited physical activities and job changes. Firstly, one of the intangible costs that are associated with asthma is the poor quality of life that indirectly affects the economic productivity of the patient. Uncontrolled asthma generally attached to the poor quality of life as patients continuously under medication and often are under emergency hospital admission. The poor quality of life is also common due to other health-related problems. Secondly, asthma complications are also associated with pain as patients require frequent hospitalization and medication. Thirdly, limited physical activities are another intangible cost that is also associated with the burden of asthma. Asthma reduces the physical body activities that also make the patient experience other health-related problems. The reduced body activities are also characterized by the low economic productivity of those individuals with uncontrolled asthma (Lai et al, 2013).

The cost of comorbidities

The asthma is also characterized by many comorbidities that also has similar cost as the cost of asthma itself. The impact due to comorbidity is highly felt in areas with minimal or limited primary health care. This due to the inability of the patient to treat or have medication to tackle the diseases related to asthma. Some of the comorbidity that is linked to asthma includes psychiatric diseases, rhinitis, cardiac diseases and sleep apnea. For instance, 10% of asthma patients have sinusitis while 60% of these asthma patients also have rhinitis. In order to control asthma, there is need to control the comorbidity thereby affecting the cost of managing asthma. Moreover, asthma complications often result in high treatments that are similar or reaching the cost of asthma. This implies control of comorbidity to the level of less than 50% will control  asthma to the same level (Yelin, et al, 2007).

 

Parties that bear the cost of asthma

This cost or burden of asthma is distributed across various parties within the stakeholder's categories. Firstly, the federal government bears the cost or burden of asthma diseases based on the MBS and PBS programs run by the government. It is estimated that the two programs cost a total of $515.6 million per year to fund this initiative (Masoli, Fabian, Holt & Beasley, 2008). Secondly, the cost of asthma is also felt by the state or territory governments that fund various hospitals bearing the cost of treating asthma-related disease. This is estimated to cost over $335 million annually depending on the number of hospitals funded each year. Thirdly, individuals and families of those patients also bear the cost through spending on medications and hospital admissions co-payments. This is also a huge payment that can be estimated to near $221.7 million per year. Lastly, another group that also bears the cost that attributed to asthma are private health insurance and charities that also take part in funding asthma-related expenditures and this can be estimated to cost more than $173.1 million per year (Stow et al, 2007).

Economic of impact of asthma

Based on the evidence of asthma burden on both the family and economy, in general, all the direct, indirect and intangible cost of asthma burden or cost has an impact on the economy of Australia. This economic impact can be felt at personal, family and at national (Masoli, Fabian, Holt & Beasley, 2008).

At the personal level, the economic impact of asthma is very severe that leaves some individual facing high economic challenges. The cost of management and medication of asthma poses an economic threat to personal finances as many funds are directed to treatment and management of asthma. Asthma mortality has a high economic impact on the country’s economy since the mortality causes the death of productive and economically viable population (National Asthma Council Australia, 2015).

At the family level, the economic impact of asthma is heavily felt as most family members normally contribute their finance to the last penny. For instance, it is projected that asthma kills more than 180000 annually. This has a high impact on the overall productivity since some this people dying from asthma or asthma-related deaths reduce the number of employees (Masoli, Fabian, Holt & Beasley, 2008).

At the national level, the impact of asthma is severe due to a reduction in the productivity resulting from more absenteeism. The reduction of the number of absenteeism resulting from asthma-related hospital admission or asthma-related complications. Data indicate that asthma patients normally report high absenteeism from work and this has a high economic impact on the overall productivity. Based on the evidence on the cost of asthma in case of limited finance, most of the families that are unable to manage asthma resulting to poverty and economic challenges to such families and individuals.  At the national level, the impact of asthma can also be extended to the global level where the disease has been expressed as a matter of concern. And this is due to its economic impact at the global level.  

 

The burden of asthma in the United States of America is quite similar to Australia

A data from the United States of America shows a similar case of asthma to Australia though the number is a little different. In America, the number of patients diagnosed with asthma is estimated to be over 40 million translating to 8% of the total population. The prevalence of asthma is currently around 18% and this number is almost the same globally (Mukherjee et al, 2014). The asthma is associated with an economic burden that cut across the entire age groups. The number of those patients with uncontrolled is worrying due to the continuously increasing number of those patients. By 2011 the total expenditure on asthma-related complications or medications is estimated to be $56 billion increasing from $12 billion in 1994. This in general shows that the medical expenditure for asthma patients is much higher as compared to patients with other diseases. This is due to continuous spending that is common for those patients with asthma as compared to those patients with other diseases (Sullivan et al, 2014). 

Direct cost for asthma

The expenditure of asthma within the United States can be broken down based on different periods of time. The expenditure for each year includes increases by $5322 from $3802 during the period between 2004 and 2006 as compared to between 1996 and 1998 (Jang, Gary, Huang & Sullivan, 2013). This was represented by actual costs of $861 to $1174 as compared to $974 to $ 2010. The cost of burden resulting from asthma continues to increase each year in a huge amount. Increasing spending due to medication is cited in all instances as the driver for the high cost of asthma management. This is also different when compared to the cost attributed to emergency or hospitalization cost in general. The direct cost when hospital admission is evaluated shows that 20% of patients with asthma get admitted into hospital facilities at the rate of 3.6 days per hospital (Qin et al, 2012).

Indirect cost associated with asthma

The indirect cost that is associated with asthma is common with a reduced number of days that most employees are absent from work each year. For instance, during the period of 2002 to 2007, a total of $56 billion productivity losses were lost due to morbidity coupled with another $3.8 billion loss due to mortality of employees. This show the tremendous loses due to absenteeism or mortality of the employee caused by asthmatic related complications in the United States. The poor quality of life is another indirect cost that is associated with asthma medication or management. A life full of comorbidity and exacerbation of asthma symptoms that necessitate the need for medication hospital visits. This reduces the productivity of such individual thereby reducing company’s production as employees suffering from asthma are paid though has limited hospital commitments (Lee et al, 2011).

United Kingdom

The United Kingdom is another country that can be compared to Australia when comparing the burden of asthma. The economics of asthma in the United Kingdom differs abet from that of Australia since the health structure in the UK can allow the patient to restrict constraints resulting from the cost of diseases such as asthma.  In the United Kingdom, asthma is treated as the primary cause of budget burden witnessed within the primary health care system. This cost is also coupled with over 4 million consultations by medical personnel each year. In the UK it is estimated that over 400 patients are admitted to the hospital facilities with asthma-related issues that require medication and subsequently huge payment. This number translates to combine effort of over 330000 people affected by patients with asthma annually. Upon evaluating the economic implication of the number, nearly over $5 billion is dedicated to treatment or management of asthma and asthma-related complications. The government, on the other hand, is estimated to fund the health service through the amount estimated to cost over $ billion. Similarly, 50% of the total expenditure on the management of uncontrolled asthma among the population is contributed by patients and their families (Mukherjee et al, 2014).

The indirect cost of asthma

The effect of asthma and the economics of asthma within the United Kingdom can be directly compared to that of Australia though the two countries are dissimilar. The economics of asthma reveals a worrying trend in the employment sectors as many employees with asthma have reduced the number of working days per year. When calculated in terms of working days the number of working days that are lost each year total to about 20 million. Secondly, patients with asthma sometimes show an inability to work or premature disabilities despite the low mortality rate in the United Kingdom. Early mortality is also common in the country as compared to Australia. The overage absenteeism is 5.6 days for those patients treated at home as compared to 13 days that are lost due to hospitalization (GBD 2015 Mortality and Causes of Death, Collaborators, 2016).

Comparison health analysis

 There are many similarities on the economic impact of asthma in Australia and United States. Firstly, both direct costs are similar and this shows that direct cost includes medication that is felt on the treatment of asthma patients (Miles & Peters, 2014). Secondly, the structure laid out in the health management of asthma in American presents many similarities. However, the United Kingdom being another country facing the similar economic impact of asthma has a dissimilar structure as most of the asthma medication is directed using insurance and funding organizations that offload the burden of asthma (Azevedo et al, 2014). For instance, in the United Kingdom, a reasonable amount of money is devoted to the consultation services as compared to the Australian asthma economics that has the huge amount of money devoted to treatment and management of asthma.

Rebuttal

Despite the economic challenges caused by asthma, there are also ways to reduce these economic impacts of asthma on health system and country in general. Two strategies to ensure that there is reduction of the economic impact of asthma on population include prevention and early treatment (GINA, 2014). Firstly, early treatment for patients diagnosed with asthma is one way to reduce economic impact of asthma since it reduces the number of comorbidities associated with asthma. Secondly, there are a number of preventive strategies that are been laid down to reduce the economic impact of asthma that is felt due to uncontrolled asthma. This strategy has been developed by the government through health care department though the overall plan remains a challenge to implement (Stow et al, 2007).

Conclusion

In conclusion, the economic burden of the uncontrolled asthma is felt both at the national level and at the global level. Asthma is a condition that results in poor quality of life characterized by continuous medication and hospitalization leading to low economic productivity. Asthma burden is also felt due to its mortality that makes the family lose economically viable individuals. Uncontrolled asthma has direct cost, indirect cost, intangible costs and cost attributed to treating of comorbidity. This cost has both direct and indirect economic impact on the family finances and to some extent the economics of Australia. The comparison analysis indicates that there are many similar costs attributed to uncontrolled asthma that can be felt in Australia and America. The situation is different in the United Kingdom, where there is health care system structure laid down that is different from that of Australia.

 

Reference

Azevedo L.F., et al, (2014), Operational definitions of asthma in recent epidemiological studies are inconsistent. Clin Transl Allergy, 4:24.

Global Initiative for Asthma (GINA), (2014), Global strategy for asthma management and prevention. Update 2014 and Online Appendix. Available at: https://www.ginasthma.org.

Global Asthma Report 2014, (2014), available at https://www.globalasthmareport.org/resources/Global_Asthma_Report_2014N°978-0-473-29126-6. Accessed 12 Nov 2014.

GBD 2015 Mortality and Causes of Death, Collaborators. (2016), Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 388 (10053): 1459–1544.

Jang, J., Gary C.K.C, Huang, H. & Sullivan, S.D. (2013), Trends in cost and outcomes among adult and pediatric patients with asthma: 2000-2009. Ann Allergy Asthma Immunol. 111:516–22.

Lai, C.K., et al, (2013), Asthma Insights and Reality in Asia-Pacific Steering Committee. Asthma control in the Asia-Pacific region: the Asthma Insights and Reality in Asia-Pacific Study. Journal of Allergy Clin Immunol, 111:263–8.

Lee, Y.H., et al, (2011), Economic burden of asthma in Korea. Allergy Asthma Proc. 2011;32:35–40.

Marks, G.B., et al, (2007), Asthma management and outcomes in Australia: a nation -wide telephone interview survey, Respirology, 12(2): 212-219.

Masoli, M., Fabian, D., Holt, S. & Beasley, R. (2008), Global initiative for asthma (GINA) Program. The global burden of asthma: executive summary of the GINA dissemination committee report. Allergy. 2008;59:469–78.

Miles, M.C. & Peters S.P. (2014), Asthma, https://www.msdmanuals.com/en-au/professional/pulmonary-disorders/asthma-and-related-disorders/asthma, accessed July 2015.

Mukherjee M, et al, (2014), Burden and True Cost of Asthma in the UK Research Team. Estimating the incidence, prevalence and true cost of asthma in the UK: secondary analysis of national stand-alone and linked databases in England, Northern Ireland, Scotland and Wales - a study protocol. BioMedical Journal Open. 2014;4:e006647.

National Asthma Council Australia (2015), Australian Asthma Handbook, https://www.asthmahandbook.org.au/, accessed July 2015.

National Health Interview Survey (NHIS) (2012), Data, Statistics, and Surveillance. Available at: https://www.cdc.gov/asthma/nhis/2012/data.htm. Accessed 22 Oct 2014.

National Health and Medical Research Council (2015), Asthma –research funding summary, https://www.nhmrc.gov.au/grants-funding/research-funding-statistics-and-data/asthma-nhpa, accessed August 2015.

National Heart, Lung, and Blood Institute (2014), What is asthma?  https://www.nhlbi.nih.gov/health/health-topics/topics/asthma, accessed July 2015.

Qin, X., et al, (2012), Asthma incidence among children and adults: findings from the behavioral risk factor surveillance system asthma call-back survey—the United States, 2006–2008. Journal of Asthma, 2012; 49:16–22.

Reddel, H.K., et al, (2012), Trends in the prevalence of asthma in Australia, American Journal of Respiratory and Critical Care Medicine, 185: A3241.

Stow, P.J., et al, (2007), improved outcomes from acute severe asthma in Australian intensive care units (1996–2003), Thorax, 62(10): 842-847.

Sullivan, P.W., et al, (2014), The relationship between asthma, asthma control and economic outcomes in the United States. Journal of Asthma, 51:769–78.

Vos, T., et al, (2015), Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013,The Lancet,S0140-6736(15)60692-4.

Yelin, E. et al, (2007), Work life of persons with asthma, rhinitis, and COPD: a study using a national, population-based sample, Journal of Occupational Medicine, 1:2.

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