Nazmi Sari

Physical inactivity and its impact on healthcare utilization.

Physically inactive people are expected to use more healthcare services than active people. This inactivity imposes costs on the collectively funded health insurance programs. In this paper, excess utilization of healthcare services due to physical inactivity is examined using count data models and the Canadian Community Health Survey. The aim of the paper is to estimate utilization of healthcare services associated with inactivity and to estimate its impact on the Canadian healthcare system. The results suggest that physical inactivity increases hospital stays, and use of physician and nurse services. On average, an inactive person spends 38% more days in hospital than an active person. S/he also uses 5.5% more family physician visits, 13% more specialist services, and 12% more nurse visits than an active individual. The subsequent social cost of inactivity for the healthcare system is substantial.

Efficiency outcomes of market concentration and managed care

The paper examines how hospital cost efficiency has reacted to extensive horizontal integrations of hospitals and rapid growth of managed care in the US health care industry. Cost efficiency is estimated by using panel data approaches to relax the assumptions for the hospital effects imposed in earlier studies. The paper shows that higher managed care penetration over time is associated with greater hospital efficiency, and higher market concentration is positively associated with efficiency when markets are highly competitive or highly concentrated.

Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol).

BackgroundLean is a set of operating philosophies and methods that help create a maximum value for patients by reducing waste and waits. It emphasizes the consideration of the customer’s needs, employee involvement and continuous improvement. Research on the application and implementation of lean principles in health care has been limited.MethodsThis is a protocol for a systematic review, following the Cochrane Effective Practice and Organisation of Care (EPOC) methodology. The review aims to document, catalogue and synthesize the existing literature on the effects of lean implementation in health care settings especially the potential effects on professional practice and health care outcomes. We have developed a Medline keyword search strategy, and this focused strategy will be translated into other databases. All search strategies will be provided in the review. The method proposed by the Cochrane EPOC group regarding randomized study designs, non-randomised controlled trials controlled before and after studies and interrupted time series will be followed. In addition, we will also include cohort, case–control studies, and relevant non-comparative publications such as case reports. We will categorize and analyse the review findings according to the study design employed, the study quality (low- versus high-quality studies) and the reported types of implementation in the primary studies. We will present the results of studies in a tabular form.DiscussionOverall, the systematic review aims to identify, assess and synthesize the evidence to underpin the implementation of lean activities in health care settings as defined in this protocol. As a result, the review will provide an evidence base for the effectiveness of lean and implementation methodologies reported in health care.Systematic review registrationPROSPERO CRD42014008853

Recommendations for action on the social determinants of health: a Canadian perspective

we are now well positioned to understand and address health disparities at the global, national, and local levels. The global resurgence of interest in addressing health disparities in the 1990s and 2000s through various movements, such as the WHO Commission on the Social Determinants of Health and their fi nal report with evidence-based recommendations,

Exercise, physical activity and healthcare utilization: A review of literature for older adults.

The impacts of exercise and physical activity on healthcare utilization of older adults have been studied using either (1) clinical trials or retrospective cohort studies focusing on older people who participated in various exercise intervention programs, or (2) survey data. This review focuses on both streams of studies, which cover the topic for adults aged 65 and older. The paper reviews the literature on physical activity and its implications for healthcare system, and discusses potential directions for future research by highlighting the limitations of the existing studies. Although there are significant variations in samples and methods used, both streams of reviewed literature provide evidence that physical activity leads to lower utilization of healthcare services. Given differences in methods and samples in these studies, estimated effect of physical activity on healthcare utilization shows significant variation from one study to another. These results, therefore, cannot be generalized to justify population wide exercise intervention programs for older adults. Additional studies are needed to provide more robust estimates for the effects of exercise, and to examine the feasibility of population wide policies that aim to encourage participation of older adults in physical activity.

Does Physical Exercise Affect Demand for Hospital Services? Evidence from Canadian Panel Data

Including an array of distinguished contributors, this novel book fills a gap in the literature by addressing an important, yet under-researched, issue in the field of sports economics. It places great emphasis on the notion that sport is a significant component for improving the happiness, health and well-being of citizens, communities and society as a whole. In so doing, it addresses whether, in an environment of increasing pressure on public spending, governments should continue to subsidize sporting activities at the expense of other public resources.

Consumer Spending for Pharmaceuticals and Its Implications for Health Care Financing: The Case of Kazakhstan

The health care sector in the countries of the former Soviet Union experienced significant changes in the 1990s and moved away from the principle of providing free care. Kazakhstan experienced a similar trend in financing pharmaceuticals. After the introduction of direct patient contributions for outpatient pharmaceuticals, the economic burden on poor and rural people increased significantly. This article examines various policy changes in promoting equity and analyzes the implications and feasibility of subsidy programs on the health care budget. The simulations from a two-part model suggest that the program covering the poor increases the health care budget by 7.7 percent. This increases to 20 percent when extended to people in rural areas. Instead of adopting a straightforward subsidy program for certain groups, this article identifies policy alternatives that may enhance social welfare by decreasing economic inefficiencies.

An economic analysis of a system wide Lean approach: cost estimations for the implementation of Lean in the Saskatchewan healthcare system for 2012–2014

BackgroundThe costs of investing in health care reform initiatives to improve quality and safety have been underreported and are often underestimated. This paper reports direct and indirect cost estimates for the initial phase of the province-wide implementation of Lean activities in Saskatchewan, Canada.MethodsIn order to obtain detailed information about each type of Lean event, as well as the total number of corresponding Lean events, we used the Provincial Kaizen Promotion Office (PKPO) Kaizen database. While the indirect cost of Lean implementation has been estimated using the corresponding wage rate for the event participants, the direct cost has been estimated using the fees paid to the consultant and other relevant expenses.ResultsThe total cost for implementation of Lean over two years (2012–2014), including consultants and new hires, ranged from

The Saskatchewan/New Brunswick Healthy Start-Départ Santé intervention: implementation cost estimates of a physical activity and healthy eating intervention in early learning centers

44 million CAD to

What Is Lean management in health care? development of an operational definition for a Cochrane Systematic Review

49.6 million CAD, depending upon the assumptions used. Consultant costs accounted for close to 50% of the total. The estimated cost of Lean events alone ranged from