On privilege and fragility.

MP70-08 DISPARITIES IN SIZE OF SYMPTOMATIC AND ASYMPTOMATIC RENAL TUMORS AT DIAGNOSIS: A PUBLIC VS. PRIVATE HEALTHCARE SYSTEM ANALYSIS IN NORTHEAST MEXICO

Introduction: Most studies about surgical treatment of carpal tunnel syndrome (CTS) focus on specific population subgroups, worker’s compensation patients, or specific types of surgical treatment. There are no general population studies about epidemiological characterization of surgically treated patients with CTS. Factors such as gender, age, and health insurance status may influence the rate of surgical treatment of CTS. Purpose: Evaluate the influence of epidemiological factors such as gender, age, and health insurance status in the rate of CTS surgery in a mixed health care system. Materials and Methods: Nationwide transversal study of total surgically treated patients with CTS in Chile during 2012. The rate of CTS surgeries was estimated using data collected from Chile’s National Hospital Discharge Records, Public and Private Health Care Systems’ yearly reports on population coverage. Chile’s mixed health care system has a distribution of its population of 81% public, 12.9% private, and 6.1% other insurance. Inclusion criteria: Surgical treatment of CTS (ICD-10 International Statistical Classification of Diseases and Related Health Problems diagnosis G560), age older than 20 years. We analyzed the influence of epidemiological factors such as age, gender, and health insurance status on the rate of CTS surgery. The rate of CTS surgeries was estimated per 1000 habitants in each groups, with their confidence intervals (CI) of 95%. Results: National rate of surgical CTS in patients over 20 years during 2012 was of 0.191 (95% CI, 0.184-0.199). Gender distribution showed higher rate of surgeries in female patients, 0.302 (95% CI, 0.289-0.316), compared with males, 0.077 (95% CI, 0.070-0.084). The age distribution of female patients shows a higher rate of surgeries in the 50- to 59-year group, 0.671 (95% CI, 0.622-0.721). Male patients have a later surgical peak in the 60- to 69-year group, 0.126 (95% CI, 0.098-0.154). The rate of surgical CTS is lower in the public health care system, 0.123 (95% CI, 0.116-0.130), than private insurance, 0.406 (95% CI, 0.379-0.433). The gender distribution was similar in both groups. Conclusions: Health insurance status is the most important factor in the rate of surgical CTS. The access to surgical treatment is 3.3 times higher in private insurance than public system. Gender and age show a higher rate of surgery in female patients in the 50- to 59-year group. This distribution is not influenced by insurance status. National rates of surgical CTS are comparable with reports from the literature. These new data can help understand the population’s behavior and plan resources distribution. It also shows the breach that still has to be covered by the public health care system in terms of surgical treatment of CTS.

Purpose: The purpose of this study is to discern the prospects and challenges of integrating Internet of Things (IoT) into the public healthcare sector of Bangladesh. This is timely because the present public healthcare status of the country needs dire improvement. Hence, this study explores the future scope of IoT-based public healthcare systems to be introduced to the Directorate General of Health Services (DGHS) of Bangladesh henceforth recommends how the country can integrate the implementation of this technology to deliver better public healthcare services to its population. Methodology: The authors reviewed extensively literature from several reputed sources to identify the current public healthcare conditions, as well as the benefits and impediments of IoT-based public healthcare system in Bangladesh. Based on the searches pertaining to the data base, this study then outlines appropriate future scopes of IoT in the public healthcare of Bangladesh. Findings: This research identified major impediments such as lack of infrastructure, low motivation, awareness and acceptance as well as poor healthcare startups prevalent in the public health services of Bangladesh. To surmount the inefficiencies of the current services, the authors deliberated how IoT based public healthcare system could foster better monitoring; management and rehabilitation thereby improve the overall Bangladesh’s public healthcare system. Practical Implications: IoT healthcare organizations can also use technology to improve patient outcomes and increase efficiencies, which will lower the cost of treatment, reduce death rates and make it possible to give public healthcare to people who live in rural areas. Originality/Value: The researchers of this study are confident that the findings of this study will benefit other researchers, policymakers, healthcare service providers/designers and professionals to realize the potentials of IoT-based public healthcare system that could overcome the challenges faced and finally could deliver sound public healthcare facilities and services for Bangladeshis in the near future. Limitations: In the future, we plan to develop the Central Repository of patient database system using blockchain technology.

From 1975 to 2007, Alberta’s real per capita government health expenditures grew from $1,679 to $3,696 (in 2007 dollars), at a median annual growth rate of 3.5%. Over the same period, Alberta’s real per capita gross domestic product and real per capita total government revenues grew at median annual rates of 2.2% and 1.7%, respectively. This difference between the growth rates of health care spending on the one hand and government revenues and the economy on the other gives rise to concern about the fiscal sustainability of the province’s public health care system. This study presents projections of real per capita spending on public health care in Alberta over the medium term out to 2030. They suggest that, by then, real per capita spending could reach anywhere between $5,339 and $14,215, soaking up between 32% and 87% of total government revenues; more worrying, the high end of these ranges reflects a continuation of the policy settings that guide current provincial public health spending. Alberta is fortunate to have a wealthy economy that can support a high level of public health spending. But that support is precarious given the cyclical nature of non-renewable natural resource revenues and Alberta’s past tendency to experience periods of boom and bust. Basing the financing of key spending programs such as health care on a volatile revenue base is not advisable, for it puts them at risk should economic conditions turn unfavourable, as they have recently. Indeed, adjusting government revenues in our projections to match a more reasonable measure of what might be relied upon with a degree of certainty simply enhances the precariousness of the fiscal sustainability of the public health care system. Not all categories of provincial government health care spending — in particular, the traditional core medicare areas of physician services and hospitals — are growing faster than either the revenue base or the economy. The growth of spending on non-medicare categories such as drugs, capital, and all other health expenditures, however, is a particular source of concern. Options for sustaining provincial government health expenditures include choosing what other government programs could be allowed to grow more slowly over time, what tax rates could be increased to cause the revenue base to grow more quickly, and what health programs currently provided by the public sector instead could be provided privately. These approaches need not exist in watertight compartments, however, and a portfolio of policies that combines these solutions likely would be a pragmatic policy outcome. Such a strategy would help to ensure the fiscal sustainability of Alberta’s public health care system and responsibly provide for the future welfare of its citizens.

e18045 Background: In the neoadjuvant setting (NAC) of HER2-positive breast cancer (BC), the addition of pertuzumab (P) to trastuzumab (T) and chemotherapy (chemo) has increased pathological complete response (pCR) from 40-50% to over 70%. Recent data has shown that pCR is a reliable surrogate marker of disease-free (DFS) and overall survival (OS). In Brazil, there is an important gap between cancer drugs approved in the public health care system (PHCS) vs. the private setting. Although P approval for NAC (Aug/2016) and metastatic setting (Sep/2015) in the private health system, it is not approved for any indication in the PHCS. Likewise, T is not approved for use as NAC at the PHCS. We aim to compare private practice experience of T + P + chemo in the NAC vs. HER2-positive advanced BC patients treated at the PHCS. Methods: Retrospective analysis of 95 patients diagnosed with locally advanced HER2-positive BC by immunohistochemistry 3+ or FISH according to ASCO/CAP definition. We evaluated 17 consecutive patients at the COAEM private cancer center in Brazil since Feb/2014 (cohort 1). Neoadjuvant therapy was T and P plus docetaxel-based chemo. A cohort of 78 patients with locally advanced HER2-positive BC treated in a PHCS cancer center was analyzed (cohort 2). They received standard NAC regimen according to PHCS guidance: anthracycline and taxane-based therapy without anti-HER2 therapy. Results: Cohort 1: 17 patients with median age of 50 years (range 34-70); Four patients had clinical stage IIA; 2 patients IIB; 7 patients IIIA; 3 patients IIIB; one patient IIIC. The pCR rate was 70.5% (12 patients). Cohort 2: 78 patients with median age of 48 years (range 26-79). One patient IIB; 33 patients IIIA; 37 patients IIIB; 7 patients IIIC. The pCR rate was 16.7% (13 patients); 29 patients (37.2%) had clinical complete response. Only 26 patients (33.3%) received T in the adjuvant setting. Conclusions: Neoadjuvant P and T combined with chemo has shown pCR rates superior to 70% in clinical trials, which is a surrogate marker for DFS and OS in HER2-positive BC. The absence of anti-HER2 therapy in the PHCS must be urgently reviewed not just in light of double-blockage strategy but also in T monotherapy use.

Background Interventions directed to system features of public health and health care should increase health and welfare of patients and population.Aims To build a new framework for studies aiming to assess the impact of public health or health care system, and to consider the role of Randomized Controlled Trials (RCTs) and of Benchmarking Controlled Trials (BCTs).Methods The new concept is partly based on the author's previous paper on the Benchmarking Controlled Trial. The validity and generalizability considerations were based on previous methodological studies on RCTs and BCTs.Results The new concept System Impact Research (SIR) covers all the studies which aim to assess the impact of the public health system or of the health care system on patients or on population. There are two kinds of studies in System Impact Research: Benchmarking Controlled Trials (observational) and Randomized Controlled Trials (experimental). The term impact covers in particular accessibility, quality, effectiveness, safety, efficiency, and equality.Conclusions System Impact Research – creating the scientific basis for policy decision making - should be given a high priority in medical, public health and health economic research, and should also be used for improving performance. Leaders at all levels of health and social care can use the evidence from System Impact Research for the benefit of patients and population.Key messagesThe new concept of SIR is defined as a research field aiming at assessing the impacts on patients and on populations of features of public health and health and social care systems or of interventions trying to change these features.SIR covers all features of public health and health and social care system, and actions upon these features. The term impact refers to all effects caused by the public health and health and social care system or parts of it, with particular emphasis on accessibility, quality, effectiveness, adverse effects, efficiency, and equality of services.SIR creates the scientific basis for policy decisions. Leaders at all levels of health and social care can use the evidence from SIR for the benefit of the patients and the population.

Endocrine therapy (ET) plus CDK4/6 inhibitors has become the standard first-line therapy for hormone receptor-positive/HER2-negative metastatic breast cancer (MBC). Utilizing real-world data, we aimed to characterize treatment patterns, assess the impact of health insurance type, and evaluate outcomes among Brazilian MBC patients with this subtype treated in the first-line setting. This is an observational retrospective study assessing female patients aged ≥ 18 years diagnosed with HR+/HER2- MBC between January/2018 and December/2020 at 13 sites in Brazil. The primary objective was to describe the treatment patterns within both the public and private healthcare systems. Secondary outcomes were progression-free survival (PFS) and overall survival (OS). In total, 307 patients were included. The most frequent treatment was ET alone (42.4%), followed by chemotherapy (31.6%), and ET plus CDK4/6 inhibitors (25.1%). The greatest difference in access to treatment was observed in the use of ET plus CDK4/6 inhibitors between the private (48.3%) and public healthcare systems (2.6%), (P < .0001). Of the 84 patients that received CDK4/6 inhibitors, ribociclib was the most used (56.0%). With a median follow-up of 32.2 months (95% CI, 29.4-34.4), the median progression-free survival (PFS) was 24.2 months (95% CI, 18.6-30.4) in the public and 23.80 months (95% CI, 18.3-34.2) in the private healthcare system (P = .9294). The median OS was 52.7 months (95% CI, 49.4-NR) in the overall population. ET remains the most used first-line treatment in Brazil. However, access to therapies varies significantly between public and private healthcare sectors. This disparity highlights inequality in access to treatment.

Since 1988, Brazil has reorganized and expanded its public health care system, defining access to health care as a right of every citizen. In parallel, the private health care sector grew rapidly to become one of the largest in the world. We explore the use of public and private health care by a low-income population living in a favela, Rio das Pedras, in Rio de Janeiro. At the time of data collection, only part of the community was covered by the primary health care program. We conducted semistructured interviews with 14 adults, both with and without access to the public primary care program. Regardless of program coverage, participants noted barriers and negative experiences while accessing public health care. The perceived inability of health professionals to deal compassionately with a low-income population was prominent in their narratives, and in the expressed motivation for pursuing private sector health care alternatives. We explore the tension arising from the more recent rights-based health care provision and historic social control and assistentialist framing of state intervention in Brazilian favelas.

Septorhinoplasty (SR) is one of the most complex surgical procedures of the head and neck. As an elective procedure aiming to enhance patient quality of life, it can be difficult to perform in single-payer healthcare systems due to capacity pressures from acute and oncological surgical demand. We aimed to review national trends in the practice of SR to inform future healthcare planning. This was a cross-sectional, population-based, longitudinal study of SR cases in Ireland's single-payer (public) healthcare system from 2005 to 2021. Time-series analysis using a linear regression model was performed to analyse trends by operation type, revision rates and length of stay. The impact of the COVID-19 pandemic and introduction of national surgical guidelines was analysed. 1952 SR were performed. Annual mean cases declined in both real (r = -0.76, p < 0.01) and relative (r = -0.87, p < 0.01) terms by 31% and 43%, respectively. Ambulatory SR, while initially rarely performed, increased to account for 55% of cases performed. The mean hospital length of stay declined significantly (r = -0.84, p < 0.01) by 44%. SR increasingly struggles to find its place in Ireland's public healthcare system. New changes in SR practices including the rapid growth of ambulatory surgery and shorter lengths of hospital stay indicate positive responses to the mounting pressures faced by healthcare systems.

Healthcare-Related Determinants of Breast Cancer Prognosis in São Paulo, Brazil: A Population-Based Cohort.

Background The elderly population of India has been growing exponentially over the past few decades, caused by a decline in fertility and an increase in life expectancy. The growth eventually has transcended the disease burden on the public healthcare system. This calls for a need to evaluate the healthcare utilization pattern of the elderly based on their socioeconomic and working condition. Methods Study used access to public and private healthcare services to measure healthcare utilization. Descriptive analysis and multivariable logistic regression were used to understand utilization patterns by working status and some selected sociodemographic parameters. All the results were reported at a 95% confidence interval. Results Using the data from the first wave of Longitudinal Ageing Study in India (LASI) with a sample of 22,680 older persons 60 years and above. The study identified that 50% of the working elderly access private services; however, 26% access public healthcare services. It was found that the working status of the elderly alone did not influence access to healthcare services, but education is also an essential indicator for utilizing healthcare services. Further, factors such as gender, marital status, religion, wealth, tobacco usage, self-rated health, ADL and IADL were significant predictors of healthcare services’ utilization for the elderly. Conclusion This study suggests that there are not many differences found among working and non-working status with healthcare utilization, although some sociodemographic indicators are associated with the utilization of healthcare services, highlighting that increasing health needs among the elderly requires strengthening the quality and appropriate public investment in health.

Introduction: Public healthcare systems in India face persistent inefficiencies, including delays in financial workflows, lack of transparency, and fraud, particularly in rural and underserved areas. Blockchain and machine learning (ML) technologies offer transformative potential to address these challenges by enhancing transparency, efficiency, and accountability in healthcare supply chains.Methods: A mixed-methods approach was adopted, combining structured surveys, semi-structured interviews, and secondary data analysis. Quantitative data were analysed using techniques such as descriptive statistics, predictive modelling (Random Forest), clustering (K-means), and anomaly detection (Isolation Forest). Qualitative data from stakeholder interviews were analysed using Natural Language Processing (NLP) to identify recurring themes and sentiment trends.Results: The analysis revealed significant inefficiencies and readiness disparities among stakeholders. Blockchain was identified as a critical tool for improving transparency, with readiness levels being the strongest predictor of adoption success. ML demonstrated robust capabilities in fraud detection, with 5% of transactions flagged as anomalies, and predictive modelling identified key factors influencing readiness. Clustering analysis revealed distinct groups of stakeholders, highlighting the need for tailored interventions to bridge readiness gaps. Sentiment analysis indicated 65% of stakeholders held positive views on blockchain and ML adoption.Conclusion: Blockchain and ML technologies have the potential to transform public healthcare financing by addressing inefficiencies, enhancing transparency, and optimizing resource allocation. However, disparities in stakeholder readiness necessitate targeted capacity-building and phased implementation strategies. These findings provide a roadmap for integrating blockchain and ML into public healthcare systems, fostering financial resilience and improving service delivery in rural and underserved areas.

PUK6 AN EVALUATION OF THE BRAZILIAN POLICY FOR THE MANAGEMENT OF CHRONIC KIDNEY DISEASE UNDER THE PERSPECTIVE OF THE PUBLIC HEALTH CARE SYSTEM: WAS IT EFFECTIVE?

Seed localization uses a radioactive source to identify nonpalpable breast lesions for excision; it is an emerging alternative to wire localization (WL). Previous single health system studies report decreased rates of re-excision and improved patient convenience with this technique. This study is the first to implement this procedure in a public health care delivery system composed of a primarily minority and low-income population. A multidisciplinary team was formed to create a protocol for breast seed localization (BSL) and monitor the results. After 50 seed localizations were successfully completed, a retrospective matched-pair analysis with patients who had undergone WL during the same period was performed. Overall experience with the BSL protocol is reviewed, along with the occurrence of a seed loss. Processes necessary to reactivate the BSL protocol and prevent future losses are delineated. BSL is associated with decreased rates of re-excision and can be successfully implemented in a public health care system. BSL is an attractive alternative to WL in a high-volume, county-based population. It allows increased efficiency in the operating room and has a low rate of complications. Cautionary measures must be taken to ensure proper seed chain of custody to prevent seed loss.

Recent trends in Canadian public health care expenditure are reviewed and evidence on the sustainability of public health spending examined. Provincial-territorial government health spending over the entire period 1975–2012 has generally grown faster than GDP, provincial own-source revenues and federal transfers. However, expenditure growth has been the least sustainable in the areas of public drug expenditures, capital, public health programs, and all other health spending and the most sustainable in the areas of administration and the traditional core public health care areas of hospitals and physicians. Federal transfer payments are a crucial variable when it comes to the growth rate of provincial/territorial government health expenditures and their future restraint will be a factor in moderating public health expenditure growth.