Predictability of drug expenditures: An application using morbidity data

The growth of pharmaceutical expenditure and its prediction is a major concern for policy makers and health care managers. This paper explores different predictive models to estimate future drug expenses, using demographic and morbidity individual information from an integrated healthcare delivery organization in Catalonia for years 2002 and 2003. The morbidity information consists of codified health encounters grouped through the Clinical Risk Groups (CRGs). We estimate pharmaceutical costs using several model specifications, and CRGs as risk adjusters, providing an alternative way of obtaining high predictive power comparable to other estimations of drug expenditures in the literature. These results have clear implications for the use of risk adjustment and CRGs in setting the premiums for pharmaceutical benefits.

Second ESMO consensus conference on lung cancer: pathology and molecular biomarkers for non-small-cell lung cancer.

To complement the existing treatment guidelines for all tumour types, ESMO organises consensus conferences to focus on specific issues in each type of tumour. The Second ESMO Consensus Conference on Lung Cancer was held on 11-12 May 2013 in Lugano. A total of 35 experts met to address several questions on management of patients with non-small-cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, early stage disease, locally advanced disease and advanced (metastatic) disease. For each question, recommendations were made including reference to the grade of recommendation and level of evidence. This consensus paper focuses on recommendations for pathology and molecular biomarkers in relation to the diagnosis of lung cancer, primarily non-small-cell carcinomas.

Population based resource allocation: The use of hybrid risk adjustment

The emphasis on integrated care implies new incentives that promote coordinationbetween levels of care. Considering a population as a whole, the resource allocation systemhas to adapt to this environment. This research is aimed to design a model that allows formorbidity related prospective and concurrent capitation payment. The model can be applied inpublicly funded health systems and managed competition settings.Methods: We analyze the application of hybrid risk adjustment versus either prospective orconcurrent risk adjustment formulae in the context of funding total health expenditures for thepopulation of an integrated healthcare delivery organization in Catalonia during years 2004 and2005.Results: The hybrid model reimburses integrated care organizations avoiding excessive risktransfer and maximizing incentives for efficiency in the provision. At the same time, it eliminatesincentives for risk selection for a specific set of high risk individuals through the use ofconcurrent reimbursement in order to assure a proper classification of patients.Conclusion: Prospective Risk Adjustment is used to transfer the financial risk to the healthprovider and therefore provide incentives for efficiency. Within the context of a National HealthSystem, such transfer of financial risk is illusory, and the government has to cover the deficits.Hybrid risk adjustment is useful to provide the right combination of incentive for efficiency andappropriate level of risk transfer for integrated care organizations.

A genetic isolation gradient of populations of the Balearic green toad (Bufo balearicus) follows rising eastward fragmentation of the rural landscapes on the island of Menorca.

We present the first approach to the genetic diversity and structure of the Balearic toad (Bufo balearicus Boettger, 1880) for the island of Menorca. Forty-one individ- uals from 21 localities were analyzed for ten microsatellite loci. We used geo-refer- enced individual multilocus genotypes and a model-based clustering method for the inference of the number of populations and of the spatial location of genetic dis- continuities between those populations.¦Only six of the microsatellites analyzed were polymorphic. We revealed a northwest- ern area inhabited by a single population with several well-connected localities and another set of populations in the southeast that includes a few unconnected small units with genetically significant differences among them as well as with the individ- uals from the northwest of the island. The observed fragmentation may be explained by shifts from agricultural to tourism practices that have been taking place on the island of Menorca since the 1960s. The abandonment of rural activities in favor of urbanization and concomitant service areas has mostly affected the southeast of the island and is currently threatening the overall geographic connectivity between the different farming areas of the island that are inhabited by the Balearic toad.

Estimates of patient costs related with population morbidity: Can indirect costs affect the results?

A number of health economics works require patient cost estimates as a basic information input.However the accuracy of cost estimates remains in general unspecified. We propose to investigate howthe allocation of indirect costs or overheads can affect the estimation of patient costs in order to allow forimprovements in the analysis of patient costs estimates. Instead of focusing on the costing method, thispaper proposes to highlight changes in variance explained observed when a methodology is chosen. Wecompare three overhead allocation methods for a specific Spanish population adjusted using the ClinicalRisk Groups (CRG), and we obtain different series of full-cost group estimates. As a result, there aresignificant gains in the proportion of the variance explained, depending upon the methodology used.Furthermore, we find that the global amount of variation explained by risk adjustment models dependsmainly on direct costs and is independent of the level of aggregation used in the classification system.

Hybrid risk adjustment for pharmaceutical benefits

This paper analyses the application of hybrid risk adjustment versus either prospective orconcurrent risk adjustment formulae in the context of funding pharmaceutical benefits for thepopulation of an integrated healthcare delivery organization in Catalonia during years 2002 and2003. We apply a mixed formula and find that a hybrid risk adjustment model increasesincentives for efficiency in the provision of low risk individuals at health organizations not only asa whole but also at each internal department compared to only prospective models by reducingwithin-group variation of drug expenditures.

Desmontemos rumores para fomentar la convivencia

Este artículo describe y analiza desde una perspectiva crítica el proyecto “Desmontemos rumores para fomentar la convivencia”, desarrollado en los últimos años en Sant Boi de Llobregat como parte del “Programa de convivencia”, impulsado por la Unidad de Educación Comunitaria y Civismo del ayuntamiento local. Se pone especial énfasis en las actividades realizadas en el marco de la Red de educadores y alumnos por la convivencia, que ha sido una pieza clave para impulsar el proyecto entre los adolescentes y los jóvenes de la ciudad.

Sociedad de la información y del conocimiento: personas, tecnología y cambio social

La Humanidad siempre ha trasladado, almacenado y difundido información; en este sentido podríamos afirmar que la sociedad de la información es una característica de la sociedad humana. Lo que ha cambiado en los últimos años es fruto de la incorporación de nuevas tecnologías en el tratamiento de la información. La separación que, tradicionalmente, existía entre una época para aprender y una época para trabajar ha terminado. En un momento en que la información es tan caduca, lo que necesitan los ciudadanos no es tanto acumular información como saber obtener buena información. A todos los cambios hay que incorporar, además, el hecho de que las personas cada vez recibimos más información por medios audiovisuales que escritos. Esto conlleva también cambios en la forma de incorporar la información, de entenderla y producirla.

La Cultura de la caritat: inventari dels béns de l'Hospital de la Seu (Girona, 31 de gener 1342)

L'any 1342 el rector de l'Hospital de la Seu de Girona, Pere Miquel, encarrega la redacció d'un inventari detallat dels béns d'aquesta institució, relació que s'acompanya de la valoració d'aquests per a un possible encant o subhasta pública; el seu càrrec, nomenat pel capítol catedralici, l'obliga a vetllar per la conservació d'aquests béns. És per aquest motiu que ordena aquesta escripturació davant notari i testimonis: registra el patrimoni moble i immoble de l'hospital i jura davant els Evangelis guardar- lo i mantenir-lo fins que s'esgoti el seu mandat; promet protegir aquestes possessions dels actu malorum hominum i respondre de qualsevol pèrdua. [...]

Roles y competencias de los profesionales de la salud laboral para promover la integración de la prevención en la empresa. Un estudio Delphi

Objetivo: Conocer el punto de vista de docentes que forman prevencionistas acerca de cuáles son los roles y competencias necesarios en los profesionales de la salud laboral para promover la integración de la prevención en la empresa.

Contribución al conocimiento de la Font d'en Pi

Descripció des d'un punt de vista geològic d'una font subterrània descoberta en construir-se la nova variant de la carretera de Sant Feliu de Guíxols a Girona l'any 1972, entre els punts quilomètrics 31 i 32

A propòsit de les suposades pintures i gravats prehistòrics de la cova d'en Dayna (Romanyà de la Selva, Baix Empordà)

Descripció dels gravats i pintures prehistòriques del Dolmen de la Cova d'en Dayna, a Romanyà de la Selva (Baix Empordà)

Las fuentes naturales del término municipal de Sant Feliu de Guíxols (Girona)

The behaviour of 21 natural springs in a granític massif is studied in this survey. Geomorphological features of the zone are described as well as water circulation and rising 25 parametres of each of them are analysed ans conclusions are withdrawn regarding geological conditions of rising, course, chemism and potability

Nota sobre la surgencia de Cinc-Claus, l'Escala

Sobre la surgència d'aigua entre materials calcaris a la població de Cinc Claus (L' Escala)