Health policy
-
Smoking cessation is usually mentioned last in the chain of established measures to improve Tobacco Control. This seems logical, as smoking cessation is a secondary or tertiary preventative measure only. In the recently proposed Tobacco Control Scale (TCS) using 6 Tobacco Control measures pricing is considered most important, and smoking cessation least important. ⋯ There is also strong evidence that smoking cessation is cost-effective, especially when comparing costs involved in addressing other important health risk factors, such as hyperlipidemia and arterial hypertension. Finally, the role of smoking cessation in helping to decrease social acceptability of smoking should not be underrated as every smoker who quits sets an example for other smokers to follow or for children not to start. In summary, smoking cessation continues to be of paramount importance among Tobacco Control measures, and should get more emphasis especially in health care settings.
-
Comparative Study
Comparison of outcomes and costs after hip fracture surgery in three hospitals that have different care systems in Japan.
Hip fracture is a medical and socioeconomic problem among the 65 years and older population in Japan. Length of hospital stay in Japan is much longer than other developed countries, and the Japanese government has tried to reduce length of stay in order to reduce medical expenditures. The objective of this study was to compare outcomes and costs of health care services for patients with hip fracture surgery among three hospitals with different care systems in Japan. ⋯ Patients' outcomes (mortality and ambulatory ability) after discharge were comparable. Hospitals that had shorter lengths of stay reduced costs to themselves, but did not reduce overall costs including care after discharge; however, costs were even higher because patients stayed in subsequent hospitals longer and/or used more elders' care services. Reducing the length of stay in the initial acute care hospitals could be just a method of cost-shifting to subsequent care services and is unlikely to bring an overall cost-savings to the Japanese health care system.