Introduction: The Non-Invasive Prenatal Testing (NIPT) guideline was issued and applied in 2013 by the Japanese Medical Association. Since being issued, the NIPT practice in Japan still has some problems related to indication, access, cost coverage and uniformity. Therefore, our study aimed to identify the Japanese challenges of adopting NIPT into prenatal diagnosis by comparing the system and process with other countries. Method: The United Kingdom, Germany, Italy, Sweden, and Taiwan were purposefully selected for comparison. All the countries, including Japan, introduced NIPT. The literature and information searches were conducted using PubMed, SCOPUS, Google Scholar, CiNii and Google searching engine. Results: The process of NIPT in Japan was very different from the other countries. Japan is the only country that indicated NIPT for only pregnant women over 35 years old in certificated facilities and did not have a policy regarding providing information on prenatal screening and NIPT to all women. Japan also did not have a policy regarding abortion due to fetal abnormalities. The practice of NIPT guidelines is different between non-certified and certified facilities. NIPT fee was the highest in Japan and was not covered by insurance. Conclusion: Pregnant women in Japan suffered from disparities in information access, economic burden, geographic location, and practice of NIPT guidelines between the certified and the non-certified facilities. Pregnant women-centered prenatal diagnosis policy, including NIPT, should be established in Japan by learning cases from other countries. Full article

The Chinese community-acquired pneumonia (CAP) Diagnosis and Treatment Guideline 2020 recommends quinolone antibiotics as the initial empirical treatment options for CAP. However, patients with pulmonary tuberculosis (PTB) are often misdiagnosed with CAP because of the similarity of symptoms. Moxifloxacin and levofloxacin have inhibitory effects on mycobacterium tuberculosis as compared with nemonoxacin, resulting in delayed diagnosis of PTB. Hence, the aim of this study is to compare the cost-effectiveness of nemonoxacin, moxifloxacin and levofloxacin in the treatment of CAP and to determine the value of these treatments in the differential diagnosis of PTB. Primary efficacy data were collected from phase II-III randomized, double-blind, multi-center clinical trials comparing nemonoxacin to moxifloxacin (CTR20130195) and nemonoxacin to levofloxacin (CTR20140439) for the treatment of Chinese CAP patients. A decision tree was constructed to compare the cost-utility among three groups under the perspective of healthcare system. The threshold for willingness to pay (WTP) is 1–3 times GDP per capita ($11,174–33,521). Scenarios including efficacy and cost for CAP patients with a total of 6% undifferentiated PTB. Sensitivity and scenario analyses were performed to test the robustness of basic analysis. The costs of nemonoxacin, moxifloxacin, and levofloxacin were $903.72, $1053.59, and $1212.06 and the outcomes were 188.7, 188.8, and 188.5 quality-adjusted life days (QALD), respectively. Nemonoxacin and moxifloxacin were dominant compared with levofloxacin, and the ICER of moxifloxacin compared with nemonoxacin was $551,643, which was much greater than WTP; therefore, nemonoxacin was the most cost-effective option. Regarding patients with PTB who were misdiagnosed with CAP, taking nemonoxacin could save $290.76 and $205.51 when compared with moxifloxacin and levofloxacin and resulted in a gain of 2.83 QALDs. Our findings demonstrate that nemonoxacin is the more economical compared with moxifloxacin and levofloxacin, and non-fluoroquinolone antibiotics are cost-saving and utility-increasing compared to fluoroquinolones in the differential diagnosis of PTB, which can help healthcare system in making optimal policies and help clinicians in the medication of patients. Full article

In Poland, often for economic reasons, the staffing of medical rescue teams is limited to the legally required minimum. This gives rise to problems related to the effectiveness and efficiency of medical rescue teams. A literature review did not find any sources addressing the issue of the verification of the effectiveness of paramedic teams depending on the personnel composition of units. The aim of the study was to analyze the effectiveness of resuscitation depending on the size of the medical rescue team, comparing the work of two- and three-person teams. In total, 100 two-person teams and an analogous number of three-person units were studied. Statistical analyses were performed using the IBM SPSS Statistics 24 package. The results showed that the assessment of the condition of the victim as well as the ability to assess the heart rhythm and monitor the condition during advanced measures were more effective in three-person teams; three-person teams also used oxygen more frequently during advanced life support (ALS). Most of the elements influenced the quality of resuscitation and it can be unequivocally stated that the work of three rescuers is more efficient and definitely more effective. Full article

Hospital emergency departments are units of the State Medical Rescue system in Poland, which was established to help people in a state of a health emergency. The aim of this study is to develop an optimal method of financing emergency departments in Poland. The study used Polish data from 2016–2019 on the financing of services at the Clinical Emergency Department of the University Clinical Center in Gdańsk. For benchmarking and mathematical modeling, data for the Czech Republic, Germany and Latvia was used. The results of the analysis shows significant differences, to the disadvantage of Clinical Emergency Department, between the potential contract values in the tested models and the actual amounts of funds transferred by the National Health Fund Pomeranian Voivodeship Branch for the activities of Clinical Emergency Department under the concluded contracts. The introduction of co-payment on the part of patients reporting to the emergency departments with minor ailments that do not require hospitalization generates financial revenues, but does not significantly improve the financial results of the analyzed ward. However, it may be educational for patients in terms of raising their awareness of the correct place to seek assistance in the event of a sudden illness. Full article

The purpose of this paper is to investigate the determinants influencing the costs of cardiovascular disease in the regional health service in Italy’s Apulia region from 2014 to 2016. Data for patients with acute myocardial infarction (AMI), heart failure (HF), and atrial fibrillation (AF) were collected from the hospital discharge registry. Generalized linear models (GLM), and generalized linear mixed models (GLMM) were used to identify the role of random effects in improving the model performance. The study was based on socio-demographic variables and disease-specific variables (diagnosis-related group, hospitalization type, hospital stay, surgery, and economic burden of the hospital discharge form). Firstly, both models indicated an increase in health costs in 2016, and lower spending values for women (p < 0.001) were shown. GLMM indicates a significant increase in health expenditure with increasing age (p < 0.001). Day-hospital has the lowest cost, surgery increases the cost, and AMI is the most expensive pathology, contrary to AF (p < 0.001). Secondly, AIC and BIC assume the lowest values for the GLMM model, indicating the random effects’ relevance in improving the model performance. This study is the first that considers real data to estimate the economic burden of CVD from the regional health service’s perspective. It appears significant for its ability to provide a large set of estimates of the economic burden of CVD, providing information to managers for health management and planning. Full article

This study develops a theoretical framework to describe brand images and customer behaviors in relation to the eco-friendly activities of hotels. These eco-friendly activities were divided into environmentally sustainable development and green innovation. In this study, a survey was conducted on customers who had used a hotel in the past year, and a total of 329 valid samples were obtained. The empirical analysis was conducted using SPSS 22.0 and AMOS 22.0. The empirical analysis results showed that hotels’ eco-friendly activities formed a positive brand image, which in turn had a positive effect on brand love and respect. It was also found that environmental concern, as perceived by customers, did not play a significant moderating role. Therefore, out of a total of eight hypotheses presented in this study, six hypotheses were supported, and two hypotheses were rejected. The findings of this study confirm that hotels’ eco-friendly activities have a positive influence on their performance and provide meaningful insights, based on which strategies for the long-term development and growth of hotels can be established. Full article

Background: There has been a widespread debate about the overall impact of globalization on population, not just economically, but also in terms of health status. Moreover, the current health crisis is going to force governments to review the structure of the public budget to most effectively alleviate the negative economic and health effects on the population. Objective: The aim of this paper is to analyze the relative importance of globalization and the public budget composition—specifically the participation of public expenditure on healthcare, social services and environment in gross domestic product (GDP)—on life expectancy at birth in European countries during the period 1995–2017. Methods: The Multivariate Adaptive Regression Splines (MARS) methodology was applied to analyze the socioeconomic determinants of life expectancy at birth. Results: Our findings show that globalization has no relative importance as an explanatory variable of life expectancy in European countries, while government expenditure on social protection is the most relevant followed by public expenditure on health, gross national income per capita, education level of the population and public expenditure on environmental protection. Conclusion: European strategies intended to impact on health outcome should spend more attention to the composition of public budget. Full article

The tourism industry has been seriously suffering from the coronavirus disease (COVID-19) crisis ever since its outbreak. Given this pandemic situation, the major aim of this study is to develop a conceptual framework that clearly explains the US international tourists’ post-pandemic travel behaviors by expanding the theory of planned behavior (TPB). By utilizing a quantitative process, the TPB was successfully broadened by incorporating the travelers’ perceived knowledge of COVID-19, and it has been deepened by integrating the psychological risk. Our theoretical framework sufficiently accounted for the US tourists’ post-pandemic travel intentions for safer international destinations. In addition, the perceived knowledge of COVID-19 contributed to boosting the prediction power for the intentions. The associations among the subjective norm, the attitude, and the intentions are under the significant influence of the tourists’ psychological risks regarding international traveling. The comparative criticality of the subjective norm is found. Overall, the findings of this study considerably enhanced our understanding of US overseas tourists’ post-pandemic travel decision-making processes and behaviors. Full article

In revenue management practice, customers’ perceived fairness is a critical issue. Prior research examined the effect of revenue management on customers’ perceptions of fairness by implementing two different conditions: fencing and framing. In this study, the authors evaluated the role of a service firm’s environmentally friendly reputation under the conditions of fencing and framing. Results indicated that an environmentally friendly reputation only moderated the effect of framing on perceived fairness. In particular, when the firm had a poor reputation, framing as a discount rather than framing as a surcharge increased customers’ fairness perceptions. When the firm had a good reputation, however, customers’ perception of fairness did not differ across two framing conditions. The findings of this study help firms to understand how customers perceive fairness in revenue management practice. Full article

Macro-economic development of China’s health industry is essential to the sustainable development and growth momentum of the national economy. Strategies to promote the development and rebalancing of the industrial structure need to be improved in order to transform China’s health industry and drive development. Based on panel data of 25 regions in China from 2004 to 2016, this paper analyzes the linear and non-linear relationship between Chinese government health expenditure (GHE), GHE efficiency, and the macro-economic development of the health industry. It uses a novel index of industrial structure to measure the transformation of industrial sectors in China, based on a semi-parametric generalized additive model. The model shows that per capita GHE and its efficiency have a significant positive linear and comprehensive non-linear effect on the development of health industry structure. By analyzing the interaction of GHE and its efficiency, we show that high expenditure with low-efficiency regimes and high expenditure with high-efficiency regimes have a positive impact on the development of industrial structure. Following the empirical results, the paper puts forward corresponding policy suggestions for the role of fiscal policy in promoting the development of the health industry in China. Full article

In view of an efficient use of the Italian National Health Service-funded healthcare resources, a novel data-processing strategy combining information from multiple sources was developed in a regional cancer network of northern Italy. The goal was to calculate the annual overall cost of care pathways of six disease groups in 10,486 patients. The evaluation was conceived as a population-based cost description from the perspective of the Italian National Health Service. Costs occurred during a defined time period for a cross-section of patients at varying stages of their disease were measured. The total cancer care cost was €81,170,121 (11.1% of total local health expenditure), with a cost per patient of €7741.17 and a cost per capita of €204.62. Surgical, inpatient and day-hospital medical admissions, radiotherapy, drugs, outpatient care, emergency admissions, and home and hospice care accounted for 21.2%, 24.1%, 6.2%, 28.2%, 14.0%, 0.9%, and 5.4% of the total cost, respectively. The highest cost items included drugs (cost per capita, €22.95; 11.2% of total cost) and medical admissions (€14.51; 7.1%) for blood cancer, and surgical (€14.56; 7.1%) and medical admissions (€13.60; 6.6%) for gastrointestinal cancer. The information extracted allows multidisciplinary cancer care teams to be more aware of the costs of their clinical decisions. Full article

The healthcare and welfare policies of nations, as well as the amount of investments put into these areas, vary across countries. Investments in healthcare and welfare have been increasing worldwide which brings the question of assessing the efficiency of these investments. There are, however, difficulties in evaluating the effectiveness of such investments due to differences in countries’ economic development levels and due to the differences in data definition issues. There are only a limited number of studies in the literature that employ consistent and comparable indicators across countries. This study evaluates the healthcare investment efficiency and health competitiveness efficiency of 34 developing countries in Asia using a two-stage dynamic data envelopment analysis approach. Furthermore, we employ a broader measure of indicators on national healthcare and welfare policies and outcomes, in addition to the investment data on healthcare and welfare expenditures. Our findings indicate that the establishment of an investment environment with a consolidated approach and management is an important factor that increases the efficiency of investments in healthcare and welfare sectors. A consistent delivery of the national policy strategy is also crucial for reaching the medium-and long-term targets for each country. For example, if a country establishes healthcare and welfare policies that focus on improving its indicators with low efficiencies, the output will be improved and a better return on investment will be ensured in a long-term perspective. Full article

Background: The French Universal Health Cover (CMU) aims to compensate for inequalities between precarious and non-precarious populations, enabling the former to access to free healthcare. These measures rely on the principle that precarious populations’ health improves if healthcare is free. We designed a study to examine whether CMU fails to compensate for inequalities in reimbursed drugs prescriptions in precarious populations. Material and method: This retrospective pharmaco-epidemiological study compared the Defined Daily Dose relative to different reimbursed drugs prescribed by general practitioners (GPs) to precarious and non-precarious patients in France in 2015. Data were analysed using Mann–Whitney tests. Findings: 6 out of 20 molecules were significantly under-reimbursed in precarious populations. 2 were over-reimbursed. The 12 remaining molecules did not differ between groups. Interpretation: The under-reimbursement of atorvastatin, rosuvastatin, tamsulosine and timolol reflects well-documented epidemiological differences between these populations. In contrast, the equal reimbursement of amoxicillin, pyostacine, ivermectin, salbutamol and tiopropium is likely an effect of lack of compensation for inequalities. Precarious patients are more affected by diseases that these molecules target (e.g., chronic bronchitis, bacterial pneumonia, cutaneous infections). This could also be the case for the equal and under-reimbursement of insulin glargine and metformin (targeting diabetes), respectively, although this has to be considered with caution. In conclusion, the French free healthcare cover does not fail to compensate for all but only for some selective inequalities in access to reimbursed drugs prescriptions. These results are discussed with respect to the interaction of the doctor–patient relationship and the holistic nature of primary care, potentially triggering burnout and empathy decrease and negatively impacting the quality of care in precarious populations. Full article

Rising CO₂ emission constitute a great threat to the world environment and public health. This study examines the major determinants of CO₂ emissions in Far East countries in the period of 1980 to 2017. We adopt a panel data-fixed effect model that accounts for time-invariant country-specific characteristics that may create omitted-variable bias. We also additionally take care of the time trend by applying an annual fixed effect into our model. The study finds that urbanization, economic growth and trade openness significantly determine CO₂ emission in the selected countries. Thus, the main policy suggestions are (a) to encourage green and sustainable urbanization, as it helps in economic progress but not at the expense of environmental deterioration; (b) to strategically regulate and improve industrial structure; and (c) enhance sharing of renewable energy in total energy consumption. Full article

Background: Entrepreneurship education has demonstrated positive impacts in low-resource contexts. However, there is limited evidence of such programs evaluated among Native American (NA) youth in a rural reservation. Methods: A 2:1 randomized controlled trial evaluated the impact of the Arrowhead Business Group (ABG) entrepreneurship education program on entrepreneurship knowledge, economic empowerment, and social well-being among 394 NA youth. An intent to treat analysis using mixed effects regression models examined within and between study group differences from baseline to 24 months. An interaction term measured change in the intervention relative to change in the control. ABG participants were purposively sampled to conduct focus groups and in-depth interviews. Results: Significant intervention vs. control group improvements were sustained at 12 months for entrepreneurship knowledge and economic confidence/security. Significant within-group improvements were sustained for ABG participants at 24 months for connectedness to parents, school, and awareness of connectedness. Qualitative data endorses positive impacts on social well-being among ABG participants. Conclusion: Observed effects on entrepreneurship knowledge, economic empowerment, and connectedness, supplemented by the experiences and changes as described by the youth themselves, demonstrates how a strength-based youth entrepreneurship intervention focused on developing assets and resources may be an innovative approach to dually address health and economic disparities endured in Native American communities. Full article

Background: The American family structure has changed in the past few decades due to a rise in the divorce rate and unmarried women with children. Research suggests a salary disparity between men and women, especially for those women after pregnancy. However, these studies were confined to individuals within traditional families, and there is a lack of information of income disparity and poverty status between single mothers and fathers. The current study explored the disparities in single-parent families based on the household income and the poverty status using a set of nationwide censor data. Methods: The current study used data from the 2011 and 2013 Panel Study of Income Dynamics (N = 1135). Multivariate regression models were used in the analysis. Results: The demographic characteristics of the weighted population showed that taxable income, total income, and poverty status were higher for single fathers than mothers, while non-work income was higher for single mothers than fathers. Single mothers were much more likely to be at the crisis category than single fathers. Multivariate analyses showed that gender, age, marital status, years of experience, and geographic region had effects on taxable income, and only gender, marital status, and region had effects on poverty status. Conclusions: The results suggest that vulnerable group of single mothers was acknowledged according to income and poverty status. Age, marital status, years of experience, and region would be the critical factors for predicting the income and poverty status for single parenthood. Full article

Objective: With the participation of private hospitals in the health system, improving hospital efficiency becomes more important. This study aimed to evaluate the technical efficiency of public and private hospitals in Beijing, China, and analyze the influencing factors of hospitals’ technical efficiency, and thus provide policy implications to improve the efficiency of public and private hospitals. Method: This study used a data set of 154–232 hospitals from “Beijing’s Health and Family Planning Statistical Yearbooks” in 2012–2017. The data envelopment analysis (DEA) model was employed to measure technical efficiency. The propensity score matching (PSM) method was used for matching “post-randomization” to directly compare the efficiency of public and private hospitals, and the Tobit regression was conducted to analyze the influencing factors of technical efficiency in public and private hospitals. Results: The technical efficiency, pure technical efficiency and scale efficiency of public hospitals were higher than those of private hospitals during 2012–2017. After matching propensity scores, although the scale efficiency of public hospitals remained higher than that of their private counterparts, the pure technical efficiency of public hospitals was lower than that of private hospitals. Panel Tobit regression indicated that many hospital characteristics such as service type, level, and governance body affected public hospitals’ efficiency, while only the geographical location had an impact on private hospitals’ efficiency. For public hospitals in Beijing, those with lower average outpatient and inpatient costs per capita had better performance in technical efficiency, and bed occupancy rate, annual visits per doctor, and the ratio of doctors to nurses also showed a positive sign with technical efficiency. For private hospitals, the average length of stay was negatively associated with technical efficiency, but the bed occupancy rate, annual visits per doctor, and average outpatient cost were positively associated with technical efficiency. Conclusions: To improve technical efficiency, public hospitals should focus on improving the management standards, including the rational structure of doctors and nurses as well as appropriate reduction of hospitalization expenses. Private hospitals should expand their scale with proper restructuring, mergers, and acquisitions, and pay special attention to shortening the average length of stay and increasing the bed occupancy rate. Full article

Changes in a population’s average stature are virtuous pointers of wellbeing which are sensitive to improvements in psychosocial environments during childhood. A major structural change that could have altered an environment during childhood is the transition from communist to a liberal democracy, and, more specifically, the meltdown of the Soviet bloc provides for a quasi-natural experiment. This paper examines the trends in heights in the Czech Republic and Slovakia before and after the transition and the subsequent break-up of the Czechoslovakian federation. We find that one additional year of exposure to a liberal democracy while growing up is associated with an increasing population stature of 0.28 cm among Slovaks and 0.15 cm among Czechs. We only find changes in stature among men who are more sensitive to environmental stress, especially at the lower end of the current socio-economic status. Results are robust to alternative datasets and measures of democracy. Full article

Background: The Greek National Health System (NHS) has been profoundly affected by the synergy of the economic and refugee crises. We aimed at evaluating the public interest regarding refugee and healthcare issues in Greece. Methods: Google Trends was employed to normalize traffic data on a scale from 0 to 100, presented as monthly relative search volume (RSV) for the search term queries: “refugees”, “health”, “diseases”, “hospital”, and “economic crisis” in Greece, from the period 2008 to 2020. Cross-country comparisons in selected European countries were made. Results: The analysis of RSV data showed an upward trend for the keyword “refugee”, in Greece, in the last five years, with two remarkable peaks from 2015 to 2016 and from 2019 to the present. Interest regarding refugees was more prevalent in the Aegean islands compared to the mainland. The mass influx of refugees has been linked to disease-related concerns. The search terms “hospital” and “health” have been the most popular and constantly quested topics since the beginning of the economic crisis in Greece, in 2009. Similar trends existed across Europe. Conclusion: There is an urgent need for effective public awareness of current politico-ethical and social-economic conditions. The patterns of public interest can formulate public policy. Full article