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Understanding overall and private hospital utilisation patterns is imperative for implementing universal health care and associated resource planning and fulfilling policy recommendations.Due to severe financial conditions and unmet medical needs, the Japanese government must prioritize both R&D incentives and drug prices/expenditures. However, increasing reimbursement drug prices to strengthen R&D incentives also increases the financial burden on patients and the National Health Insurance, wherein virtually all prescription drugs are reimbursed, with prices determined and controlled by the government. Hence, it is important to find ways to achieve higher R&D incentives without raising drug prices/expenditures. To seek such policies, we focus on the reimbursement drug price risk of pharmaceutical firms. learn more An original questionnaire survey is used to collect data on the price-risk attitudes of R&D-oriented pharmaceutical firms in Japan. With this data, we conduct numerical simulations to quantify the effect of reducing the reimbursement drug price risk on firms' R&D incentives. Then, we check the robustness of our results. We find that many R&D-oriented pharmaceutical firms in Japan are risk averse. Thus, to enhance R&D incentives, reducing price risk is effective. The simulated impact of removing a ±10% price risk is equivalent to winning a 5% premium, which is substantial. These results are robust to changes in utility form, price/sales patterns and market size, while increased price risk enhances the simulated impact.Background Informal out-of-pocket (OOP) payments for healthcare services are not unusual in Greece. Aim This study estimates the association between respondent and incident-level characteristics and informal payments. Methods A survey of 4218 households was conducted from November 2016 to February 2017. We analyzed healthcare incidents by all household members within the past four months. Multivariate negative binomial regression analysis was used to estimate the association between respondents and incident-level characteristics and informal OOP payments to providers. Results A total of 3494 healthcare incidents were reported by 3183 household-representatives. More-than-half (63 %) of all incidents involved informal activity (median=€150). About 30 % of those were related to provider requested payments. Using hospital, dental, diagnostic/screening, and emergency department services compared to primary care services and having oncological and surgical conditions were among the strongest predictors of higher rates for informal payments. The use of specific providers for reasons related to trust, reputation, referral, and lack of alternatives was also associated with higher rates of informal payments. Provider requested and skip the line payments were associated with larger OOP amounts compared to gratitude payments. Conclusion This survey reveals that informal payments occur for higher-need and less cost-responsive healthcare services particularly in areas where patients lack alternatives. Health policy and regulatory interventions, including stricter control of the financial reporting system are essential to limit informal payments.Background and objectives The profunda femoris artery perforator (PAP) flap is gaining popularity in microsurgical reconstruction. The complications that can occur after the PAP flap harvest include donor-site lymphedema, seroma, or cellulitis. The aim of this study was to evaluate and establish a safer technique for the elevation of lymphatic vessels preserving profunda femoris artery perforator (LpPAP) flap using pre- and intraoperative ICG lymphography. In this article, we also evaluate the anatomical relationship between the PAP flap and lymph-collecting vessels. Methods From July of 2018 to January of 2019, 24 patients with soft tissue defects after tumor resection underwent reconstruction using PAP flaps. The lymph-collecting vessels at the medial thigh area were identified using pre- and intraoperative ICG lymphography. A PAP flap was elevated taking care not to damage lymph-collecting vessels. After flap elevation, the anatomical correlation between lymph-collecting vessels and the anterior edge of the gracilis muscle was measured. The postoperative complications were assessed. Results PAP flaps survived completely in all cases. In all cases, using intraoperative ICG lymphography, surgeons confirmed that the lymph-collecting vessels in the medial thigh region were left intact. There were no donor site complications such as lymphedema, lymphorrhea, or cellulitis. Conclusion The elevation technique of an LpPAP flap is effective in reducing the risk of damage to lymph-collecting vessels, and thus reducing chances of postoperative lymphorrhea or iatrogenic lower limb lymphedema.Laparoscopic harvest method to obtain gastro-epiploic lymph node flaps for lymphedema treatment has been previously described. In this article, the technical details of an alternative method - open approach via mini-laparotomy incision - for harvesting gastro-epiploic lymph node flaps and preparation of the flaps for the inset is presented. A total of 17 patients were included in this series of the mini-laparotomy approach. Blood loss was minimal during the surgery. The average duration of lymph node flap harvest was 65 min. The average length of hospital stay was 10 days. The period of the restricted diet was 1.5 days. The upper abdominal scar was acceptable, there were no postoperative hernia or bulging, and there were no complications related to bowel obstruction during the follow-up. The open approach harvest method via mini-laparotomy incision offers similar results to laparoscopic harvest method, and it is safe when applied with the right technique.Introduction Vascularised composite allotransplantation (VCA) permits like-for-like reconstruction following extensive soft tissue injuries. The initial management of extensive soft tissue injury can lead to the development of anti-HLA antibodies through injury-related factors, transfusion and cadaveric grafting. The role of antibody-mediated rejection, donor-specific antibody formation and graft rejection in the context of VCA remains unclear. This systematic review aimed to determine whether pre-transplant management strategies influence immunological outcome following VCA. Methods A systematic review of MEDLINE, EMBASE and CINAHL using a PRISMA-compliant methodology up to February 2019 was conducted. Pre-transplant, procedural and long-term outcome data were collected and recorded for all VCA recipients on an individual patient basis. Results The search revealed 3,847 records of which 114 met inclusion criteria and reported clinical data related to 100 patients who underwent 129 VCA transplants. Trauma (50%) and burns (15%) were the most frequent indications for VCA.