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Niyibitegeka F, Riewpaiboon A, Youngkong S, Thavorncharoensap M. Economic burden of childhood diarrhea in Burundi. Glob Health Res Policy 2021; 6:13. [PMID: 33845920 PMCID: PMC8042854 DOI: 10.1186/s41256-021-00194-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In 2016, diarrhea killed around 7 children aged under 5 years per 1000 live births in Burundi. The objective of this study was to estimate the economic burden associated with diarrhea in Burundi and to examine factors affecting the cost to provide economic evidence useful for the policymaking about clinical management of diarrhea. METHODS The study was designed as a prospective cost-of-illness study using an incidence-based approach from the societal perspective. The study included patients aged under 5 years with acute non-bloody diarrhea who visited Buyenzi health center and Prince Regent Charles hospital from November to December 2019. Data were collected through interviews with patients' caregivers and review of patients' medical and financial records. Multiple linear regression was performed to identify factors affecting cost, and a cost model was used to generate predictions of various clinical and care management costs. All costs were converted into international dollars for the year 2019. RESULTS One hundred thirty-eight patients with an average age of 14.45 months were included in this study. Twenty-one percent of the total patients included were admitted. The average total cost per episode of diarrhea was Int$109.01. Outpatient visit and hospitalization costs per episode of diarrhea were Int$59.87 and Int$292, respectively. The costs were significantly affected by the health facility type, patient type, health insurance scheme, complications with dehydration, and duration of the episode before consultation. Our model indicates that the prevention of one case of dehydration results in savings of Int$16.81, accounting for approximately 11 times of the primary treatment cost of one case of diarrhea in the community-based management program for diarrhea in Burundi. CONCLUSION Diarrhea is associated with a substantial economic burden to society. Evidence from this study provides useful information to support health interventions aimed at prevention of diarrhea and dehydration related to diarrhea in Burundi. Appropriate and timely care provided to patients with diarrhea in their communities and primary health centers can significantly reduce the economic burden of diarrhea. Implementing a health policy to provide inexpensive treatment to prevent dehydration can save significant amount of health expenditure.
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Affiliation(s)
- Fulgence Niyibitegeka
- Master of Science Program in Social, Economic, and Administrative Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Arthorn Riewpaiboon
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayuthaya Road, Rajathevi, Bangkok, Thailand.
| | - Sitaporn Youngkong
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayuthaya Road, Rajathevi, Bangkok, Thailand
| | - Montarat Thavorncharoensap
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayuthaya Road, Rajathevi, Bangkok, Thailand
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SWETHA N, SHOBHA S, SRIRAM S. Prevalence of catastrophic health expenditure and its associated factors, due to out-of-pocket health care expenses among households with and without chronic illness in Bangalore, India: a longitudinal study. J Prev Med Hyg 2020; 61:E92-E97. [PMID: 32490274 PMCID: PMC7225654 DOI: 10.15167/2421-4248/jpmh2020.61.1.1191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 12/04/2019] [Indexed: 12/18/2022]
Abstract
Background India, one of the economic powerhouses of the world, is lacking in health development.Moreover, it is facing 'Triple burden of disease'. Indians have one of highest proportion of out-of-pocket (OOP) health expenses. Salient reasons are poor quality public health care, costly private care and lack of health insurance. This has led to catastrophic health expenditure (CHE). Another contributor to this CHE is the chronic illness, which require long-term follow-up. It is estimated that catastrophic health expenditure impoverishes 3.3% of Indians every year. This study was undertaken with an aim to estimate the prevalence of catastrophic health expenditure and its associated factors. Methods A longitudinal study with one-year follow-up period was conducted among 350 households of an urban area in Bangalore city. Simple random sampling method was used to select the study sample. Data collection done using pre-tested, semi-structured questionnaire by interview method. Results Chronic illness mean health expenditure was 1155.67 INR (56.09% of the direct cost was spent on drugs). In acute illness, mean health expenditure was 567.45 INR (59.54% of the direct cost was spent on drugs). Fourty eight (14.86%) of the households experienced CHE in the one year Statistically significant association was found between socio-economic status and catastrophic health expenditure. Eighty-five 42% of the households who experienced CHE had a member with chronic illness in it. Conclusion Reducing the financial burden of high health care expenses is possible by improving the government health care system, free quality regular supply of medications to chronic disease patients and to improve the beneficiaries under insurance schemes.
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Affiliation(s)
- N.B. SWETHA
- Department of Community Medicine, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
- Correspondence: N.B. Swetha, Department of Community Medicine, Sree Balaji Medical College and Hospital, No.36, Narmadha street, Balaji Nagar, Irumbuliyur, Tambaram East Chennai-600059, Tamil Nadu, India - Tel. 8951238983 - E-mail:
| | - S. SHOBHA
- Department of Community Medicine, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - S. SRIRAM
- Department of Pharmacology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
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Jin H, Tappenden P, MacCabe JH, Robinson S, Byford S. Evaluation of the Cost-effectiveness of Services for Schizophrenia in the UK Across the Entire Care Pathway in a Single Whole-Disease Model. JAMA Netw Open 2020; 3:e205888. [PMID: 32459356 PMCID: PMC7254180 DOI: 10.1001/jamanetworkopen.2020.5888] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE The existing economic models for schizophrenia often have 3 limitations; namely, they do not cover nonpharmacologic interventions, they report inconsistent conclusions for antipsychotics, and they have poor methodologic quality. OBJECTIVES To develop a whole-disease model for schizophrenia and use it to inform resource allocation decisions across the entire care pathway for schizophrenia in the UK. DESIGN, SETTING, AND PARTICIPANTS This decision analytical model used a whole-disease model to simulate the entire disease and treatment pathway among a simulated cohort of 200 000 individuals at clinical high risk of psychoses or with a diagnosis of psychosis or schizophrenia being treated in primary, secondary, and tertiary care in the UK. Data were collected March 2016 to December 2018 and analyzed December 2018 to April 2019. EXPOSURES The whole-disease model used discrete event simulation; its structure and input data were informed by published literature and expert opinion. Analyses were conducted from the perspective of the National Health Service and Personal Social Services over a lifetime horizon. Key interventions assessed included cognitive behavioral therapy, antipsychotic medication, family intervention, inpatient care, and crisis resolution and home treatment team. MAIN OUTCOMES AND MEASURES Life-time costs and quality-adjusted life-years. RESULTS In the simulated cohort of 200 000 individuals (mean [SD] age, 23.5 [5.1] years; 120 800 [60.4%] men), 66 400 (33.2%) were not at risk of psychosis, 69 800 (34.9%) were at clinical high risk of psychosis, and 63 800 (31.9%) had psychosis. The results of the whole-disease model suggest the following interventions are likely to be cost-effective at a willingness-to-pay threshold of £20 000 ($25 552) per quality-adjusted life-year: practice as usual plus cognitive behavioral therapy for individuals at clinical high risk of psychosis (probability vs practice as usual alone, 0.96); a mix of hospital admission and crisis resolution and home treatment team for individuals with acute psychosis (probability vs hospital admission alone, 0.99); amisulpride (probability vs all other antipsychotics, 0.39), risperidone (probability vs all other antipsychotics, 0.30), or olanzapine (probability vs all other antipsychotics, 0.17) combined with family intervention for individuals with first-episode psychosis (probability vs family intervention or medication alone, 0.58); and clozapine for individuals with treatment-resistant schizophrenia (probability vs other medications, 0.81). CONCLUSIONS AND RELEVANCE The results of this study suggest that the current schizophrenia service configuration is not optimal. Cost savings and/or additional quality-adjusted life-years may be gained by replacing current interventions with more cost-effective interventions.
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Affiliation(s)
- Huajie Jin
- King’s Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Paul Tappenden
- Health Economics and Decision Science, University of Sheffield School of Health and Related Research, Sheffield, United Kingdom
| | - James H. MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Stewart Robinson
- Loughborough University School of Business and Economics, Loughborough, United Kingdom
| | - Sarah Byford
- King’s Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
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de Oliveira C, Cheng J, Kurdyak P. Determining preventable acute care spending among high-cost patients in a single-payer public health care system. Eur J Health Econ 2019; 20:869-878. [PMID: 30953217 DOI: 10.1007/s10198-019-01051-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/01/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Research has shown that a small proportion of patients account for the majority of health care spending. The objective of this analysis was to determine the amount and proportion of preventable acute care spending among high-cost patients. METHODS We examined a population-based sample of all adult high-cost patients using linked administrative health care data housed at ICES in Toronto, Ontario. High-cost patients were defined as those in and above the 90th percentile of the cost distribution. Preventable acute care (emergency department visits and hospitalisations) was defined using validated algorithms. We estimated costs of preventable and non-preventable acute care for high- and non-high-cost patients by category of visit/condition. We replicated our analysis for persistent high-cost patients and high-cost patients under 65 years and those 65 years and older. RESULTS We found that 10% of all acute care spending among high-cost patients was considered preventable; this figure was higher for non-high-cost patients (25%). The proportion of preventable acute care spending was higher for persistent high-cost patients (14%) and those 65 years and older (12%). Among ED visits, the largest portion of preventable care spending was for primary care treatable conditions; for hospitalisations, the highest proportions of preventable care spending were for COPD, bacterial pneumonia and urinary tract infections. CONCLUSIONS Although high-cost patients account for a substantial proportion of health care costs, there seems to be limited scope to prevent acute care spending among this patient population. Nonetheless, care coordination and improved access to primary care, and disease prevention may prevent some acute care.
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Affiliation(s)
- Claire de Oliveira
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 33 Russell Street, Room T414, Toronto, ON, M5S 2S1, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
- ICES, Toronto, Canada.
| | - Joyce Cheng
- ICES, Toronto, Canada
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 33 Russell Street, Room T304, Toronto, ON, M5S 2S1, Canada
| | - Paul Kurdyak
- ICES, Toronto, Canada
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 33 Russell Street, Room T305, Toronto, ON, M5S 2S1, Canada
- Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Montgomery JR, Cain-Nielsen AH, Jenkins PC, Regenbogen SE, Hemmila MR. Prevalence and Payments for Traumatic Injury Compared With Common Acute Diseases by Episode of Care in Medicare Beneficiaries, 2008-2014. JAMA 2019; 321:2129-2131. [PMID: 31162560 PMCID: PMC6549280 DOI: 10.1001/jama.2019.1146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study uses Medicare Parts A and B claims data to compare hospitalizations for and spending on traumatic injury vs heart failure, pneumonia, stroke, and acute myocardial infarction in older adults between 2008 and 2014.
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Guy H, Laskier V, Fisher M, Neuman WR, Bucior I, Deitelzweig S, Cohen AT. Cost-Effectiveness of Betrixaban Compared with Enoxaparin for Venous Thromboembolism Prophylaxis in Nonsurgical Patients with Acute Medical Illness in the United States. Pharmacoeconomics 2019; 37:701-714. [PMID: 30578462 DOI: 10.1007/s40273-018-0757-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Studies show that the risk of venous thromboembolism (VTE) continues post-discharge in nonsurgical patients with acute medical illness. Betrixaban is the first anticoagulant approved in the United States (US) for VTE prophylaxis extending beyond hospitalization. OBJECTIVE The aim was to establish whether betrixaban for VTE prophylaxis in nonsurgical patients with acute medical illness at risk of VTE in the US is cost-effective compared with enoxaparin. METHODS A cost-effectiveness analysis was conducted, estimating the cost per quality-adjusted life-year (QALY) gained with betrixaban (35-42 days) compared with enoxaparin (6-14 days) from a US payer perspective over a lifetime horizon. A decision tree (DT) estimated primary VTE events, thrombotic events, and treatment complications in the first 3 months based on data from the phase III Acute Medically Ill VTE Prevention with Extended Duration Betrixaban study. A Markov model estimated recurrent events and long-term complication risks from published literature. EuroQoL-5 Dimensions utility data and costs inflated to 2017 US dollars (US$) were from published literature. Results were discounted at 3.0% per annum. Deterministic and probabilistic sensitivity analyses explored uncertainty. RESULTS Betrixaban dominated enoxaparin, with savings of US$784 and increased QALYs of 0.017 per patient. In addition, betrixaban dominated enoxaparin across all sensitivity analyses, but was most sensitive to utilities and DT probabilities. Furthermore, probabilistic sensitivity analysis found that betrixaban was more cost-effective than enoxaparin at all willingness-to-pay thresholds. CONCLUSION Betrixaban can be considered cost-effective for nonsurgical patients with acute medical illness at risk of VTE, requiring longer VTE prophylaxis from hospitalization through post-discharge.
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Affiliation(s)
- Holly Guy
- FIECON Ltd, 3 College Yard, Lower Dagnall Street, Hertfordshire, St Albans, AL3 4PA, UK.
| | - Vicki Laskier
- FIECON Ltd, 3 College Yard, Lower Dagnall Street, Hertfordshire, St Albans, AL3 4PA, UK
| | - Mark Fisher
- FIECON Ltd, 3 College Yard, Lower Dagnall Street, Hertfordshire, St Albans, AL3 4PA, UK
| | | | - Iwona Bucior
- Portola Pharmaceuticals, Inc, South San Francisco, CA, USA
| | - Steven Deitelzweig
- Ochsner Clinic Foundation and The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, USA
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Bethea E, Chen Q, Hur C, Chung RT, Chhatwal J. Should we treat acute hepatitis C? A decision and cost-effectiveness analysis. Hepatology 2018; 67:837-846. [PMID: 29059461 PMCID: PMC5826841 DOI: 10.1002/hep.29611] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/12/2017] [Accepted: 10/19/2017] [Indexed: 12/20/2022]
Abstract
It is not standard practice to treat patients with acute hepatitis C virus (HCV) infection. However, as the incidence of HCV in the United States continues to rise, it may be time to re-evaluate acute HCV management in the era of direct-acting antiviral (DAA) agents. In this study, a microsimulation model was developed to analyze the trade-offs between initiating HCV therapy in the acute versus chronic phase of infection. By simulating the lifetime clinical course of patients with acute HCV infection, we were able to project long-term outcomes such as quality-adjusted life years (QALYs) and costs. We found that treating acute HCV versus deferring treatment until the chronic phase increased QALYs by 0.02 and increased costs by $483 in patients not at risk of transmitting HCV. The resulting incremental cost-effectiveness ratio was $19,991 per QALY, demonstrating that treatment of acute HCV was cost-effective using a willingness-to-pay threshold of $100,000 per QALY. In patients at risk of transmitting HCV, treating acute HCV became cost-saving, increasing QALYs by 0.03 and decreasing costs by $3,655. CONCLUSION Immediate treatment of acute HCV with DAAs can improve clinical outcomes and be highly cost-effective or cost-saving compared with deferring treatment until the chronic phase of infection. If future studies continue to demonstrate effective HCV cure with shorter 6-week treatment duration, then it may be time to revisit current HCV guidelines to incorporate recommendations that account for the clinical and economic benefits of treating acute HCV in the era of DAAs. (Hepatology 2018;67:837-846).
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Affiliation(s)
- Emily Bethea
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA
- Harvard Medical School, Boston, MA
- Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA
| | - Qiushi Chen
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA
- Harvard Medical School, Boston, MA
| | - Chin Hur
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA
- Harvard Medical School, Boston, MA
- Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA
| | - Raymond T. Chung
- Harvard Medical School, Boston, MA
- Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA
| | - Jagpreet Chhatwal
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA
- Harvard Medical School, Boston, MA
- Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA
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Schmutz C, Bless PJ, Mäusezahl D, Jost M, Mäusezahl-Feuz M. Acute gastroenteritis in primary care: a longitudinal study in the Swiss Sentinel Surveillance Network, Sentinella. Infection 2017; 45:811-824. [PMID: 28779435 PMCID: PMC5696444 DOI: 10.1007/s15010-017-1049-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/19/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Acute gastroenteritis (AG) leads to considerable burden of disease, health care costs and socio-economic impact worldwide. We assessed the frequency of medical consultations and work absenteeism due to AG at primary care level, and physicians' case management using the Swiss Sentinel Surveillance Network "Sentinella". METHODS During the 1-year, longitudinal study in 2014, 172 physicians participating in "Sentinella" reported consultations due to AG including information on clinical presentation, stool diagnostics, treatment, and work absenteeism. RESULTS An incidence of 2146 first consultations due to AG at primary care level per 100,000 inhabitants in Switzerland was calculated for 2014 based on reported 3.9 thousand cases. Physicians classified patients' general condition at first consultation with a median score of 7 (1 = poor, 10 = good). The majority (92%) of patients received dietary recommendations and/or medical prescriptions; antibiotics were prescribed in 8.5%. Stool testing was initiated in 12.3% of cases; more frequently in patients reporting recent travel. Among employees (15-64 years), 86.3% were on sick leave. Median duration of sick leave was 4 days. CONCLUSIONS The burden of AG in primary care is high and comparable with that of influenza-like illness (ILI) in Switzerland. Work absenteeism is substantial, leading to considerable socio-economic impact. Mandatory infectious disease surveillance underestimates the burden of AG considering that stool testing is not conducted routinely. While a national strategy to reduce the burden of ILI exists, similar comprehensive prevention efforts should be considered for AG.
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Affiliation(s)
- Claudia Schmutz
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Philipp Justus Bless
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Daniel Mäusezahl
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
| | - Marianne Jost
- Federal Office of Public Health, Schwarzenburgstrasse 157, 3003, Bern, Switzerland
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Abstract
This paper addresses the question of whether Medicaid is in fact a high-cost program after adjusting for the health of the people it covers. We compare and simulate annual per capita medical spending for lower-income people (families with incomes under 200% of poverty) covered for a full year by either Medicaid or private insurance. We first show that low-income privately insured enrollees and Medicaid enrollees have very different socioeconomic and health characteristics. We then present simulated comparisons based on multivariate statistical models that estimate the effects of private and Medicaid coverage on the likelihood of using services, and the level of expenditures, given any use, holding constant demographic, economic, and health status characteristics. The simulations demonstrate that if people with Medicaid coverage—with their health status, disability, and chronic conditions—were given private coverage, they would cost considerably more than they do today. Conversely, if the privately insured were given Medicaid coverage, spending would be lower. We find no evidence that spending differences between Medicaid and private coverage for low-income people are due to lower service use by Medicaid beneficiaries. We conclude that most of the difference in expenditures is due to differences in provider payment rates.
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Abstract
OBJECTIVES Catastrophic health expenditure (CHE) means that the medical spending of a household exceeds a certain level of capacity to pay. Previous studies of CHE have focused on benefits supported by the public sector or high medical cost incurred by treating diseases in South Korea. This study examines variance of CHE in these households according to changes in employment status. We also determine whether a relationship exists according to income level. DESIGN A longitudinal study. SETTING We used the Korean Welfare Panel Study (KOWEPS) conducted by the Korea Institute. PARTICIPANTS The data came from 5335 households during 2009-2012. OUTCOME MEASURE CHE, defined as health expenditures that were 40% greater than the ability of the household to pay. RESULTS Households with people who experienced changes in job status from employed to unemployed (OR 2.79, 95% CI 2.06 to 3.78) or were unemployed with no status change (OR 1.57, 95% CI 1.28 to 1.92) were more likely to incur CHE than those containing people who were consistently employed. In addition, low-income families with members who had either lost a job (OR 3.52, 95% CI 2.44 to 5.10) or were already unemployed (OR 1.67, 95% CI 1.29 to 2.16) were more likely to incur CHE than those with family members with a consistent job. CONCLUSIONS Given the insecure employment status of people with low income, they are more likely to face barriers in obtaining needed health services. Meeting their healthcare needs is an important consideration.
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Affiliation(s)
- Jae Woo Choi
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hyun Kim
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
- Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Sung In Jang
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Suk Yong Jang
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Woo-Rim Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Cheol Park
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
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Centers for Disease Control and Prevention, HHS. World Trade Center Health Program; Addition of New-Onset Chronic Obstructive Pulmonary Disease and WTC-Related Acute Traumatic Injury to the List of WTC-Related Health Conditions. Final rule. Fed Regist 2016; 81:43510-23. [PMID: 27382662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The World Trade Center (WTC) Health Program conducted a review of published, peer-reviewed epidemiologic studies regarding potential evidence of chronic obstructive pulmonary disease (COPD) and acute traumatic injury among individuals who were responders to or survivors of the September 11, 2001, terrorist attacks. The Administrator of the WTC Health Program (Administrator) found that these studies provide substantial evidence to support a causal association between each of these health conditions and 9/11 exposures. As a result, the Administrator is publishing a final rule to add both new-onset COPD and WTC-related acute traumatic injury to the List of WTC-Related Health Conditions eligible for treatment coverage in the WTC Health Program.
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Sruamsiri R, Wagner AK, Ross-Degnan D, Lu CY, Dhippayom T, Ngorsuraches S, Chaiyakunapruk N. Expanding access to high-cost medicines through the E2 access program in Thailand: effects on utilisation, health outcomes and cost using an interrupted time-series analysis. BMJ Open 2016; 6:e008671. [PMID: 26988346 PMCID: PMC4800146 DOI: 10.1136/bmjopen-2015-008671] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE In 2008, the Thai government introduced the 'high-cost medicines E2 access program' as a part of the National List of Essential Medicines to increase patient access to medicines, improve clinical outcomes and make medicines more affordable. Our objective was to examine whether the 'high-cost medicines E2 access program' achieved its goals. DESIGN Interrupted time-series design study. SETTING 3 tertiary hospitals in different regions of Thailand, January 2006 to December 2012. PARTICIPANTS Patients with target acute and chronic disease diagnoses who newly met E2 program criteria for selected study medicines. INTERVENTION High-cost medicines E2 access program. MAIN OUTCOMES MEASURES Level and trend changes over time in the proportions of eligible patients who received the indicated E2 medicines and who improved clinically, as well as in costs of treatment. RESULTS A total of 2024 patients were included in utilisation analyses and 1375 patients with selected acute diseases contributed to analyses of clinical outcome. After 1 year of the E2 program implementation, the percentage of eligible patients receiving the indicated E2 program medicines increased significantly (relative change 12.7% (95% CI 4.4% to 21.0%), especially among those insured by the government's universal coverage scheme (relative change 19.9% (95% CI 9.5% to 30.5%)). The increase in the proportion of clinically improved patients with acute conditions was not significant (relative change 6.2% (95% CI -1.9% to 15.1%)). Quarterly healthcare costs per patient dropped significantly (relative change -13.5% (95% CI -26.9% to -1.7%)). CONCLUSIONS In the study hospitals, the E2 access program seems to have facilitated patient access to specialty medicines, may have contributed to improved health outcomes, and decreased treatment costs. Routine monitoring is needed to assess effects of expanding the programme, including effects on quality of care and financial sustainability.
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Affiliation(s)
- Rosarin Sruamsiri
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research, Naresuan University, Phitsanulok, Thailand
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Anita K Wagner
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Teerapon Dhippayom
- Pharmaceutical Care Research Unit, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | | | - Nathorn Chaiyakunapruk
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research, Naresuan University, Phitsanulok, Thailand
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- School of Population Health, University of Queensland, Brisbane, Australia
- School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Affiliation(s)
- David A Asch
- From the Perelman School of Medicine (D.A.A., R.W.M.) and the Wharton School (D.A.A., M.V.P.), University of Pennsylvania, and the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center (D.A.A.) - both in Philadelphia
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Recurrent acute and chronic pancreatitis in children has high disease burden. Community Pract 2016; 89:23. [PMID: 27164796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
Clostridium difficile infection (CDI) is the most common cause of infectious health care-associated diarrhea and is a major burden to patients and the health care system. The incidence and severity of CDI remain at historically high levels. This article reviews the morbidity, mortality, and costs associated with CDI.
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Affiliation(s)
- Jennie H Kwon
- Division of Infectious Diseases, Washington University School of Medicine, 660 South Euclid Avenue, Box 8051, St Louis, MO 63110, USA.
| | - Margaret A Olsen
- Divisions of Infectious Diseases and Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Box 8051, St Louis, MO 63110, USA
| | - Erik R Dubberke
- Division of Infectious Diseases, Section of Transplant Infectious Diseases, Washington University School of Medicine, 660 South Euclid Avenue, Box 8051, St Louis, MO 63110, USA
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Yang NH, Dharmar M, Yoo BK, Leigh JP, Kuppermann N, Romano PS, Nesbitt TS, Marcin JP. Economic Evaluation of Pediatric Telemedicine Consultations to Rural Emergency Departments. Med Decis Making 2015; 35:773-783. [PMID: 25952744 PMCID: PMC9727838 DOI: 10.1177/0272989x15584916] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 03/13/2015] [Indexed: 11/04/2023]
Abstract
BACKGROUND Comprehensive economic evaluations have not been conducted on telemedicine consultations to children in rural emergency departments (EDs). OBJECTIVE We conducted an economic evaluation to estimate the cost, effectiveness, and return on investment (ROI) of telemedicine consultations provided to health care providers of acutely ill and injured children in rural EDs compared with telephone consultations from a health care payer prospective. METHODS We built a decision model with parameters from primary programmatic data, national data, and the literature. We performed a base-case cost-effectiveness analysis (CEA), a probabilistic CEA with Monte Carlo simulation, and ROI estimation when CEA suggested cost-saving. The CEA was based on program effectiveness, derived from transfer decisions following telemedicine and telephone consultations. RESULTS The average cost for a telemedicine consultation was $3641 per child/ED/year in 2013 US dollars. Telemedicine consultations resulted in 31% fewer patient transfers compared with telephone consultations and a cost reduction of $4662 per child/ED/year. Our probabilistic CEA demonstrated telemedicine consultations were less costly than telephone consultations in 57% of simulation iterations. The ROI was calculated to be 1.28 ($4662/$3641) from the base-case analysis and estimated to be 1.96 from the probabilistic analysis, suggesting a $1.96 return for each dollar invested in telemedicine. Treating 10 acutely ill and injured children at each rural ED with telemedicine resulted in an annual cost-savings of $46,620 per ED. LIMITATIONS Telephone and telemedicine consultations were not randomly assigned, potentially resulting in biased results. CONCLUSIONS From a health care payer perspective, telemedicine consultations to health care providers of acutely ill and injured children presenting to rural EDs are cost-saving (base-case and more than half of Monte Carlo simulation iterations) or cost-effective compared with telephone consultations.
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Affiliation(s)
- Nikki H Yang
- Department of Pediatrics, University of California, Davis, CA, USA (NHY, MD, NK, PSR, JPM)
| | - Madan Dharmar
- Department of Pediatrics, University of California, Davis, CA, USA (NHY, MD, NK, PSR, JPM)
| | - Byung-Kwang Yoo
- Department of Public Health Sciences, University of California, Davis, CA, USA (BKY, JPL)
| | - J Paul Leigh
- Department of Public Health Sciences, University of California, Davis, CA, USA (BKY, JPL)
| | - Nathan Kuppermann
- Department of Pediatrics, University of California, Davis, CA, USA (NHY, MD, NK, PSR, JPM)
- Department of Emergency Medicine, University of California, Davis, CA, USA (NK)
| | - Patrick S Romano
- Department of Pediatrics, University of California, Davis, CA, USA (NHY, MD, NK, PSR, JPM)
- Department of Internal Medicine, University of California, Davis, CA, USA (PSR)
| | - Thomas S Nesbitt
- Department of Family Practice and Community Medicine, University of California, Davis, CA, USA (TSN)
| | - James P Marcin
- Department of Pediatrics, University of California, Davis, CA, USA (NHY, MD, NK, PSR, JPM)
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Shulan M, Gao K. Revisiting hospital length of stay: what matters? Am J Manag Care 2015; 21:e71-e77. [PMID: 25880270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To explore actionable information that can be used to reduce hospital acute care length of stay (LOS) and to assess racial and income disparities in LOS in an integrated healthcare network. STUDY DESIGN AND METHODS Retrospective analysis of 8718 inpatients in an integrated healthcare network. The LOS was examined by using linear, log-linear, Poisson, generalized Poisson, and negative binomial (NB) models to control for confounding factors. The performances of the 5 models were compared, and the NB model was selected for the final analysis and report. RESULTS Over 50% of the inpatients were not married. The LOS was 22% longer for the unmarried patients compared with their married counterparts after controlling for confounding factors. No income or racial disparities were found. CONCLUSIONS The prolonged LOS of the unmarried patients and the potential lack of post discharge care support warrant greater attention from discharge planners at hospital level and from policy makers at both the national and local levels. Racial and income disparities are not unavoidable; the way in which care is paid for and delivered may play a role.
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Affiliation(s)
- Mollie Shulan
- Department of Veterans Affairs, Stratton VA Medical Center, 113 Holland Ave, Albany, NY 12208. E-mail:
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Mathias JM. CMS issues proposed hospital inpatient payment rule. OR Manager 2014; 30:5. [PMID: 25004605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Wald HL, Leykum LK, Mattison MLP, Vasilevskis EE, Meltzer DO. Road map to a patient-centered research agenda at the intersection of hospital medicine and geriatric medicine. J Gen Intern Med 2014; 29:926-31. [PMID: 24557516 PMCID: PMC4026510 DOI: 10.1007/s11606-014-2777-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As the United States ages, the patient population in acute care hospitals is increasingly older and more medically complex. Despite evidence of a high burden of disease, high costs, and often poor outcomes of care, there is limited understanding of the presentation, diagnostic strategies, and management of acute illness in older adults. In this paper, we present a strategy for the development of a research agenda at the intersection of hospital and geriatric medicine. This approach is informed by the Patient-Centered Outcomes Research Institute (PCORI) framework for identification and prioritization of research areas, emphasizing input from patients and caregivers. The framework's four components are: 1) Topic generation, 2) Gap Analysis in Systematic Review, 3) Value of information (VOI) analysis, and 4) Peer Review. An inclusive process for topic generation requiring the systematic engagement of multiple stakeholders, especially patients, is emphasized. In subsequent steps, researchers and stakeholders prioritize research topics in order to identify areas that optimize patient-centeredness, population impact, impact on clinical decision making, ease of implementation, and durability. Finally, next steps for dissemination of the research agenda and evaluation of the impact of the patient-centered research prioritization process are described.
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Affiliation(s)
- Heidi L Wald
- University of Colorado School of Medicine, Division of Health Care Policy and Research, Campus Box F480 13199 E. Montview Blvd, Suite 400, Aurora, CO, 80024, USA,
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Affiliation(s)
- Judith Feder
- Health Policy Center, the Urban Institute, Washington, DC, USA
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Koutsakos G. Measuring cost when inpatient service acuity varies. Healthc Financ Manage 2011; 65:52-56. [PMID: 22128595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Equivalent acute patient days (EAPDs) offer a more accurate means than adjusted patient days (APDs) to analyze a hospital's overall cost increases from one period to another in situations where there are significant differences among inpatient types in terms of acuity.
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Verma V, Vasudevan V, Jinnur P, Nallagatla S, Majumdar A, Arjomand F, Reminick MS. The utility of routine admission chest X-ray films on patient care. Eur J Intern Med 2011; 22:286-8. [PMID: 21570649 DOI: 10.1016/j.ejim.2010.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Revised: 11/10/2010] [Accepted: 12/13/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Routine chest X-rays are the most widely obtained radiological studies during hospital admissions. In this study, we evaluated the utility of routine admission chest X-rays on patient care in patients admitted to The Brooklyn Hospital center. METHODS We included consecutive patients admitted to the medical floors during a 4-month period who had a chest X-ray done on admission. The medical records of patients who had chest X-ray on admission were reviewed to identify any impact of chest X-ray on patient care during the course of hospitalization. RESULTS Chest X-ray was noted to be done in 229 patients on admission. Chest X-rays of 100 (43.6%) patients were deemed medically necessary because of the presenting complaints which included cough (15.2%), fever (13.1%), dyspnea (6.1%), hemoptysis (1.7%), and combined symptoms (7.4%). Routine chest X-rays were done in 129 (56.3%) patients to rule out occult findings in the absence of any symptoms. Chest X-ray abnormalities were noted in 56 of 129 (43.4%) patients. In 51 of 56 patients, abnormalities were chronic, stable and previously known and did not contribute to patient care. In only 5 of 129 (3.87%) patients, there were findings which necessitated a change in patient care. CONCLUSION We conclude that routine chest films rarely reveal clinically unsuspected findings. The overall impact on patient care based on these findings is small when compared to the risks associated with repeated exposure to radiation. We recommend that routine chest X-ray films should not be ordered solely because of hospital admission.
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Affiliation(s)
- Vishal Verma
- Department of Pulmonary Medicine, The Brooklyn Hospital Center, Affiliate New York Presbyterian Healthcare System, Brooklyn, NY 11201, USA.
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Abstract
OBJECTIVE To categorize national medical expenditures into patient-centered categories. DATA SOURCES The 2007 Medical Expenditure Panel Survey (MEPS), a nationally representative annual survey of the civilian noninstitutionalized population. STUDY DESIGN Descriptive statistics categorizing expenditures into seven patient-centered care categories: chronic conditions, acute illness, trauma/injury or poisoning, dental, pregnancy/birth-related, routine preventative health care, and other. DATA COLLECTION METHODS MEPS cohort. PRINCIPAL FINDINGS Nearly half of expenditures were for chronic conditions. The remaining expenditures were as follows: acute illness (25 percent), trauma/poisoning (8 percent), dental (7 percent), routine preventative health care (6 percent), pregnancy/birth-related (4 percent), and other (3 percent). Hospital-based expenditures accounted for the majority for acute illness, trauma/injury, and pregnancy/birth and over a third for chronic conditions. CONCLUSIONS This patient-centered viewpoint may complement other methods to examine health care expenditures and may better represent how patients interact with the health care system and expend resources.
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Affiliation(s)
- Patrick Conway
- Division of General Pediatrics, Hospital Medicine, Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Massimo LM, Wiley TJ, Baron A, Caprino D. Health inequities and health migration: the high burden paid by an Italian Children's Hospital. Minerva Pediatr 2010; 62:423-424. [PMID: 20940676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Blustein J, Borden WB, Valentine M. Hospital performance, the local economy, and the local workforce: findings from a US National Longitudinal Study. PLoS Med 2010; 7:e1000297. [PMID: 20613863 PMCID: PMC2893955 DOI: 10.1371/journal.pmed.1000297] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 05/19/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pay-for-performance is an increasingly popular approach to improving health care quality, and the US government will soon implement pay-for-performance in hospitals nationwide. Yet hospital capacity to perform (and improve performance) likely depends on local resources. In this study, we quantify the association between hospital performance and local economic and human resources, and describe possible implications of pay-for-performance for socioeconomic equity. METHODS AND FINDINGS We applied county-level measures of local economic and workforce resources to a national sample of US hospitals (n = 2,705), during the period 2004-2007. We analyzed performance for two common cardiac conditions (acute myocardial infarction [AMI] and heart failure [HF]), using process-of-care measures from the Hospital Quality Alliance [HQA], and isolated temporal trends and the contributions of individual resource dimensions on performance, using multivariable mixed models. Performance scores were translated into net scores for hospitals using the Performance Assessment Model, which has been suggested as a basis for reimbursement under Medicare's "Value-Based Purchasing" program. Our analyses showed that hospital performance is substantially associated with local economic and workforce resources. For example, for HF in 2004, hospitals located in counties with longstanding poverty had mean HQA composite scores of 73.0, compared with a mean of 84.1 for hospitals in counties without longstanding poverty (p<0.001). Hospitals located in counties in the lowest quartile with respect to college graduates in the workforce had mean HQA composite scores of 76.7, compared with a mean of 86.2 for hospitals in the highest quartile (p<0.001). Performance on AMI measures showed similar patterns. Performance improved generally over the study period. Nevertheless, by 2007--4 years after public reporting began--hospitals in locationally disadvantaged areas still lagged behind their locationally advantaged counterparts. This lag translated into substantially lower net scores under the Performance Assessment Model for hospital reimbursement. CONCLUSIONS Hospital performance on clinical process measures is associated with the quantity and quality of local economic and human resources. Medicare's hospital pay-for-performance program may exacerbate inequalities across regions, if implemented as currently proposed. Policymakers in the US and beyond may need to take into consideration the balance between greater efficiency through pay-for-performance and socioeconomic equity.
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Affiliation(s)
- Jan Blustein
- Robert F. Wagner Graduate School and Division of General Medicine, NYU Medical School, New York University, New York, New York, United States of America.
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Abstract
OBJECTIVE To examine whether the introduction of payment by results (a fixed tariff case mix based payment system) was associated with changes in key outcome variables measuring volume, cost, and quality of care between 2003/4 and 2005/6. SETTING Acute care hospitals in England. DESIGN Difference-in-differences analysis (using a control group created from trusts in England and providers in Scotland not implementing payment by results in the relevant years); retrospective analysis of patient level secondary data with fixed effects models. DATA SOURCES English hospital episode statistics and Scottish morbidity records for 2002/3 to 2005/6. MAIN OUTCOME MEASURES Changes in length of stay and proportion of day case admissions as a proxy for unit cost; growth in number of spells to measure increases in output; and changes in in-hospital mortality, 30 day post-surgical mortality, and emergency readmission after treatment for hip fracture as measures of impact on quality of care. RESULTS Length of stay fell more quickly and the proportion of day cases increased more quickly where payment by results was implemented, suggesting a reduction in the unit costs of care associated with payment by results. Some evidence of an association between the introduction of payment by results and growth in acute hospital activity was found. Little measurable change occurred in the quality of care indicators used in this study that can be attributed to the introduction of payment by results. CONCLUSION Reductions in unit costs may have been achieved without detrimental impact on the quality of care, at least in as far as these are measured by the proxy variables used in this study.
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Affiliation(s)
- Shelley Farrar
- Health Economics Research Unit, University of Aberdeen, Aberdeen AB25 2ZD.
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Fonkych K, O'Leary JF, Melnick GA, Keeler EB. Medicare HMO impact on utilization at the end of life. Am J Manag Care 2008; 14:505-512. [PMID: 18690766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To estimate the effect of independent practice association (IPA) model HMOs and the Kaiser Foundation Health Plan's group model on inpatient utilization of Medicare beneficiaries in the last 2 years of life, compared with traditional fee-for-service (FFS) coverage. STUDY DESIGN Data from the Centers for Medicare & Medicaid Services were linked to inpatient discharge data from the California Office of Statewide Health Planning and Development for 1991-2001. A sample of aged Medicare beneficiaries who died between January 1998 and June 2001 and were continuously enrolled during the 2 years before death in (1) FFS (n = 234,498), (2) an IPA (n = 109,577), or (3) Kaiser (n = 29,434) were selected. METHODS The probability of at least 1 hospitalization, number of inpatient days given at least 1 hospitalization, and total inpatient days per year in the last 2 years of life were estimated for each subgroup. A 2-part regression model, which adjusted for age, sex, Medicaid status, race, ethnicity, and chronic condition associated with the last hospitalization, was applied to determine the HMO-FFS difference in inpatient utilization during the last 2 years of life. RESULTS During their last 2 years of life, decedents in IPAs and Kaiser used approximately 34% and 51% fewer inpatient days, respectively, than decedents in FFS. CONCLUSIONS Medicare beneficiaries who died while enrolled in an HMO, particularly Kaiser, had many fewer hospital days during the 2 years before death than beneficiaries who died with FFS coverage.
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Affiliation(s)
- Kateryna Fonkych
- RAND Health Pro gram, 1776 Main St, PO Box 2138, Santa Monica, CA 90407-2138, USA.
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Willey VJ, Kopenski F, Lawless GD. Beyond the myths: finding benefit design solutions that address the true costs of high healthcare use. Am J Manag Care 2008; 14:S252-S263. [PMID: 18672956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Chronic and severe health problems place an enormous financial burden on individuals, employers, and health plan providers, requiring all to make tough decisions about healthcare. Specialty pharmaceuticals are increasingly attractive treatment options, but employers need tangible ways to incorporate these medications into benefit plans. Benefit managers can take a proactive role in addressing cost and compliance issues, using evidence-based data about true patient costs to develop policies that encourage employees to seek appropriate care. Achieving savings in direct and indirect costs will require more than shifting coverage, which can lead to nonadherence and increase costs elsewhere.
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Lubell J. Revenue, costs rise 7% annually. Census data, AHRQ report sicker patients add to costs. Mod Healthc 2007; 37:8-9. [PMID: 18203364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Rosner AL. Re: Eisenberg DM, Post DE, Davis RB, et al. Addition of choice of complementary therapies to usual care for acute low back pain. Spine 2007;32:151-8. Spine (Phila Pa 1976) 2007; 32:1799-800. [PMID: 17632402 DOI: 10.1097/brs.0b013e3180ca7166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Chuma J, Gilson L, Molyneux C. Treatment-seeking behaviour, cost burdens and coping strategies among rural and urban households in Coastal Kenya: an equity analysis. Trop Med Int Health 2007; 12:673-86. [PMID: 17445135 DOI: 10.1111/j.1365-3156.2007.01825.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ill-health can inflict costs on households directly through spending on treatment and indirectly through impacting on labour productivity. The financial burden can be high and, for poor households, contributes significantly to declining welfare. We investigated socio-economic inequities in self-reported illnesses, treatment-seeking behaviour, cost burdens and coping strategies in a rural and urban setting along the Kenyan coast. We conducted a survey of 294 rural and 576 urban households, 9 FGDs and 9 in-depth interviews in each setting. Key findings were significantly higher levels of reported chronic and acute conditions in the rural setting, differences in treatment-seeking patterns by socio-economic status (SES) and by setting, and regressive cost burdens in both areas. These data suggest the need for greater governmental and non-governmental efforts towards protecting the poor from catastrophic illness cost burdens. Promising health sector options are elimination of user fees, at least in targeted hardship areas, developing more flexible charging systems, and improving quality of care in all facilities. The data also strongly support the need for a multi-sectoral approach to protecting households. Potential interventions beyond the health sector include supporting the social networks that are key to household livelihood strategies and promoting micro-finance schemes that enable small amounts of credit to be accessed with minimal interest rates.
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Affiliation(s)
- Jane Chuma
- Kenya Medical Research Institute, Kilifi, Kenya.
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Xu KT, Borders TF. Racial and ethnic disparities in the financial burden of prescription drugs among older Americans. J Health Hum Serv Adm 2007; 30:28-49. [PMID: 17557695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
This study examines racial and ethnic disparities in the financial burden of prescription drugs among older Americans using a market and an egalitarian model. A nationally representative data set, the Medical Expenditure Panel Survey 2002, was used. The financial burden of prescription drugs was measured by the out-of-pocket expenditure and proportion. In the market model (utilization adjustment)., utilization was measured at the annual aggregate level by the total number of prescription drugs, the average refills and the average quantity per prescription drug. In the egalitarian model (need adjustment)., health was measured by 15 chronic and costly diseases and the SF-12. Individuals 65 years or older were included. Nationally representative estimates were calculated. Raw racial and ethnic disparities were observed in the bivariate analyses between non-Hispanic whites and Hispanics in the out-of-pocket expenditure and proportion, and between non-Hispanic whites and non-Hispanic blacks in the out-of-pocket proportion. However, these disparities disappeared after controlling for utilization or health needs. Insurance status contributed the most to the disparities in the financial burden of prescription drugs. In conclusion, The disparities in the financial burden of prescription drugs between non-Hispanic elderly whites and Hispanics may be attributable to differences in utilization patterns. However, whether health disparities contribute to disparities in the financial burden of prescription drugs requires studies of specific diseases.
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Affiliation(s)
- K Tom Xu
- School of Medicine, Texas Tech University Health Sciences Center, USA
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O'Reilly J, Lowson K, Young J, Forster A, Green J, Small N. A cost effectiveness analysis within a randomised controlled trial of post-acute care of older people in a community hospital. BMJ 2006; 333:228. [PMID: 16861254 PMCID: PMC1523497 DOI: 10.1136/bmj.38887.558576.7c] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the cost effectiveness of post-acute care for older people in a locality based community hospital compared with a department for care of elderly people in a district general hospital, which admits patients aged over 76 years with acute medical conditions. DESIGN Cost effectiveness analysis within a randomised controlled trial. SETTING Community hospital and district general hospital in Yorkshire, England. PARTICIPANTS 220 patients needing rehabilitation after an acute illness for which they required admission to hospital. INTERVENTIONS Multidisciplinary care in the district general hospital or prompt transfer to the community hospital. MAIN OUTCOME MEASURES EuroQol EQ-5D scores transformed into quality adjusted life years (QALYs), and health and social service costs over six months from randomisation. RESULTS The mean QALY score for the community hospital group was marginally non-significantly higher than that for the district general hospital group (0.38 v 0.35) at six months after recruitment. The mean (standard deviation) costs per patient of the health and social services resources used were similar for both groups: community hospital group 7233 pounds sterling (euros 10,567; 13,341 dollars) (5031 pounds sterling), district general hospital group 7351 pounds sterling(6229 pounds sterling), and these findings were robust to several sensitivity analyses. The incremental cost effectiveness ratio for community hospital care dominated. A cost effectiveness acceptability curve, based on bootstrapped simulations, suggests that at a willingness to pay threshold of 10,000 pounds sterling per QALY, 51% of community hospital cases will be cost effective, which rises to 53% of cases when the threshold is 30,000 pounds sterling per QALY. CONCLUSION Post-acute care for older people in a locality based community hospital is of similar cost effectiveness to that of an elderly care department in a district general hospital.
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Affiliation(s)
- Jacqueline O'Reilly
- York Health Economics Consortium, University of York, Heslington, York YO10 5NH
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Abstract
OBJECTIVE In this study we compared the readmissions, medical care cost, and health resource utilization (HRU) of acute care elderly (ACE) unit patients and usual medical care patients. METHODS Retrospective case-control design was used. Patients admitted to ACE unit (n = 680) between 1999 and 2002 with primary admitting diagnosis of pneumonia, congestive heart failure, or urinary tract infection were randomly selected from the health-care system's administrative database. Equal number controls (n = 680) were selected from usual medical care services and were matched by DRG, age, ethnicity, and Charlson comorbidity score. Data on HRU, annual number of admissions before and after index admission, length of stay (LOS), and medical care cost were obtained. Bootstrap, t-test, and Wilcoxon test were used to compare cost, LOS, and number of readmissions between ACE and non-ACE unit. Multivariate log-linear and Poisson regressions were used to assess the impact of ACE unit on incremental cost and number of readmissions, respectively. RESULTS Mean LOS was 1 day shorter for ACE unit (4.9 vs. 5.9 P = 0.01). Mean cost of ACE unit was 9.7% lower than that of non-ACE unit (Dollars 13,586 vs. Dollars 15,040, P = 0.012). Both groups had similar costs of pharmacy, diagnostic and therapeutic procedures. Multiple log-linear and Poisson regression models indicated that ACE unit patients had 21% lower cost and 11% lower annual readmissions. CONCLUSIONS Our results confirm the hypotheses that ACE unit patients have lower medical care cost, shorter LOS, and fewer readmissions. Thus, ACE unit may be a beneficial model for improved inpatient care of elderly.
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Engström SG, Carlsson L, Östgren CJ, Nilsson GH, Borgquist LA. The importance of comorbidity in analysing patient costs in Swedish primary care. BMC Public Health 2006; 6:36. [PMID: 16483369 PMCID: PMC1459136 DOI: 10.1186/1471-2458-6-36] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Accepted: 02/16/2006] [Indexed: 11/22/2022] Open
Abstract
Background The objective was to explore the usefulness of the morbidity risk adjustment system Adjusted Clinical Groups® (ACG), in comparison with age and gender, in explaining and estimating patient costs on an individual level in Swedish primary health care. Data were retrieved from two primary health care centres in southeastern Sweden. Methods A cross-sectional observational study. Data from electronic patient registers from the two centres were retrieved for 2001 and 2002, and patients were grouped into ACGs, expressing the individual combination of diagnoses and thus the comorbidity. Costs per patient were calculated for both years in both centres. Cost data from one centre were used to create ACG weights. These weights were then applied to patients at the other centre. Correlations between individual patient costs, age, gender and ACG weights were studied. Multiple linear regression analyses were performed in order to explain and estimate patient costs. Results The variation in individual patient costs was substantial within age groups as well as within ACG weight groups. About 37.7% of the individual patient costs could be explained by ACG weights, and age and gender added about 0.8%. The individual patient costs in 2001 estimated 22.0% of patient costs in 2002, whereas ACG weights estimated 14.3%. Conclusion ACGs was an important factor in explaining and estimating individual patient costs in primary health care. Costs were explained to only a minor extent by age and gender. However, the usefulness of the ACG system appears to be sensitive to the accuracy of classification and coding of diagnoses by physicians.
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Affiliation(s)
- Sven G Engström
- Ryd primary health care centre, Linköping, Sweden
- General Practice, Department of Health and Society, Faculty of Health Sciences, Linköping University, Sweden
| | - Lennart Carlsson
- The Neurotec Department, Center for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carl-Johan Östgren
- General Practice, Department of Health and Society, Faculty of Health Sciences, Linköping University, Sweden
- Ödeshög primary health care centre, Ödeshög, Sweden
| | - Gunnar H Nilsson
- The Neurotec Department, Center for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars A Borgquist
- General Practice, Department of Health and Society, Faculty of Health Sciences, Linköping University, Sweden
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Macstravic S. A new "loyalty rewards" program in health care customer relationships. Manag Care Q 2006; 14:10-2. [PMID: 17590970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
"Loyalty rewards" in sponsored DM and HRM programs can apply to both providers and consumers. Physicians and hospitals can be paid to "loyally" adhere to payers' guidelines for managing diseases and risks. Many payer and their outsourced vendor programs include significant efforts to create collaborations between payer and provider, rather than relying on unilateral efforts. And growing numbers are rewarding providers for their efforts and results achieved.
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Caletti MG, Petetta D, Jaitt M, Casaliba S, Gimenez A. [Hemolytic uremic syndrome (HUS): medical and social costs of treatment]. Medicina (B Aires) 2006; 66 Suppl 3:22-6. [PMID: 17354473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
Hemolytic Uremic Syndrome (HUS) is the most frequent cause of renal failure in children, and the second cause of renal transplant. Argentina has the highest incidence of the world. Direct and indirect costs of HUS in its different clinical phases were studied. A retrospective review of all clinical notes of patients attending the hospital during the period 1987-2003 was carried out. Cost of every medical intervention, including diagnostic and therapeutic actions were calculated by the Hospital Department of Costs, according to two criteria: cost per process and cost per patient (considering total processes received each). Indirect costs were estimated according to guidelines established by the National Institute of Statistics and Census (INDEC): 1) family costs 2) social expenses afforded by the state, 3) cost of health services. Out of a total sample size of 525 patients, 231 clinical notes of children were selected and studied. The direct cost per patient in the acute period was US dollar 1 500, the total direct cost of care for each patient per year was US dollar 15 399,53; indirect costs per patient and for all year were US dollar 3 004,33 and US dollar 7 354,98 respectively. Total costs during 2005 per patient and per year was US dollar 17 553,39 and US dollar 2 170 477,37 respectively. Our study provides valuable information not only for purposes of health care planning, but also for helping authorities to set priorities in health, and to support the idea of developing preventive actions in a totally preventable condition in Argentina.
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Affiliation(s)
- María Gracia Caletti
- Servicio de Nefrología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires.
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Mantone J. Two in one. The CMS' strict admissions criteria make long-term acute-care hospitals consider co-locating with skilled-nursing facilities. Mod Healthc 2005; 35:26-8. [PMID: 16299986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Walsh B, Steiner A, Pickering RM, Ward-Basu J. Economic evaluation of nurse led intermediate care versus standard care for post-acute medical patients: cost minimisation analysis of data from a randomised controlled trial. BMJ 2005; 330:699. [PMID: 15757959 PMCID: PMC555630 DOI: 10.1136/bmj.38397.633588.8f] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To undertake an economic evaluation of nurse led intermediate care compared with standard hospital care for post-acute medical patients. DESIGN Cost minimisation analysis from an NHS perspective, comprising secondary care, primary care, and community care, using data from a pragmatic randomised controlled trial. SETTING Nurse led unit and acute general medical wards in large, urban, UK teaching hospital. PARTICIPANTS 238 patients. OUTCOME MEASURE Costs to acute hospital trusts and to the NHS over six months. RESULTS On an intention to treat basis, nurse led care was associated with higher costs during the initial admission period (nurse led care 7892 pounds sterling (14,970 dollars; 11,503 euros), standard care 4810 pounds sterling, difference 3082 pounds sterling (95% confidence interval 1161 pounds sterling to 5002 pounds sterling)). During the readmission period, costs were similar (nurse led care 1444 pounds sterling, standard care 1879 pounds sterling, difference -435 pounds sterling, -1406 pounds sterling to 536 pounds sterling). Total costs at six months were significantly higher (nurse led care 10,529 pounds sterling , standard care 7819 pounds sterling, difference 2710 pounds sterling, 518 pounds sterling to 4903 pounds sterling). Sensitivity analyses suggested that the trend for nurse led care to be more expensive was maintained even with substantial cost reductions, although differences were no longer significant. CONCLUSION Acute hospitals may not be cost effective settings for nurse led intermediate care. Both inpatient and total costs were significantly higher for nurse led care than for standard care of post-acute medical patients, suggesting that this model of care should not be pursued unless clinical or organisational benefits justify the increased investment.
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Affiliation(s)
- Bronagh Walsh
- School of Nursing and Midwifery, University of Southampton, Southampton SO17 1BJ.
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Hanning BWT. Combining DRGs and per diem payments in the private sector: the Equitable Payment Model. AUST HEALTH REV 2005; 29:80-6. [PMID: 15683359 DOI: 10.1071/ah050080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2004] [Accepted: 11/23/2004] [Indexed: 11/23/2022]
Abstract
The many types of payment models used in the Australian private sector are reviewed. Their features are compared and contrasted to those desirable in an optimal private sector payment model. The EPM(TM) (Equitable Payment Model) is discussed and its consistency with the desirable features of an optimal private sector payment model outlined. These include being based on a robust classification system, nationally benchmarked length of stay (LOS) results, nationally benchmarked relative cost and encouraging continual improvement in efficiency to the benefit of both health funds and private hospitals. The advantages in the context of the private sector of EPM(TM) being a per diem model, albeit very different to current per diem models, are discussed. The advantages of EPM(TM) for hospitals and health funds are outlined.
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Affiliation(s)
- Brian W T Hanning
- Australian Health Service Alliance, 979 Burke Road, Camberwell, VIC 3124, Australia.
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Campbell MK, Silver RW, Hoch JS, Østbye T, Stewart M, Barnsley J, Hutchison B, Mathews M, Tyrrell C. Re-utilization outcomes and costs of minor acute illness treated at family physician offices, walk-in clinics, and emergency departments. Can Fam Physician 2005; 51:82-3. [PMID: 16926958 PMCID: PMC1479579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To examine factors associated with re-utilization of health services and to estimate and compare costs of treatment for minor acute illnesses in family physicians' offices (FPOs), walk-in clinics (WICs), and emergency departments (EDs). DESIGN Prospective cohort study using questionnaires, telephone follow up, medical chart data, and costs according to Ontario Health Insurance Plan (OHIP) schedules. SETTING 16 FPOs, 12 WICs, and 13 EDs in three Ontario cities. PARTICIPANTS Consecutive patients with one of eight predefined minor acute illnesses found in all three settings (upper respiratory infection, pharyngitis, acute bronchitis, acute otitis media, serous otitis media, low back pain, gastroenteritis, and urinary tract infection). MAIN OUTCOME MEASURES "Early" (< 3 days) versus "later" (3 days to 2 weeks) re-utilization of health services after initial encounter and direct cost to OHIP. RESULTS The overall rate of re-utilization of health services for the same episode of illness was 11.3% for early and 20.6% for later re-utilization. Factors associated with early re-utilization were initial evaluation in ED setting (odds ratio [OR] = 6.5, confidence interval [CI] = 2.2-19.2) and, regardless of setting, less satisfaction with patient-centred care (OR = 1.7 for each one-point decrease on a four-point scale; CI = 1.1-2.7). Factors associated with later re-utilization were ED setting (OR = 4.9; CI = 2.4-9.9) and diagnosis of urinary tract infection (OR = 2.4; CI = 1.1-5.2). Factors tested and found not signifcantly associated with rate of re-utilization were patients' age, sex, responses to a variety of questions assessing psychosocial factors (stress, social support, independence), and opinions on health care. Cost of care was similar for FPOs and WICs and higher for EDs for all diagnoses. The initial visit was the largest component of cost in all settings, and this component (as well as total cost) was consistently higher in EDs. CONCLUSION Both re-utilization rates and costs are higher for those seeking care in EDs for minor acute illness. Patient-centred care, an important feature of health care encounters regardless of setting, can reduce re-utilization rates.
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Affiliation(s)
- M Karen Campbell
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON.
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Krushat WM, Bhatia AJ. Estimating payment error for Medicare acute care inpatient services. Health Care Financ Rev 2005; 26:39-49. [PMID: 17288067 PMCID: PMC4194916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CMS recently assumed responsibility for estimating the Medicare fee-for-service (FFS) error rate from the Office of the Inspector General (OIG). Here, the method used to calculate national, by State, and by error type, estimates for the inpatient acute care portion of this rate is presented. For fiscal years (FYs) 1998 and 2000 discharges, national estimates for the net error rate were 2.6 and 2.8 percent, respectively, about $2 billion annually. Wide variation in State rates illustrates that estimates to the State level are essential for targeting and monitoring interventions to reduce improper Medicare inpatient acute care reimbursements.
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Affiliation(s)
- W Mark Krushat
- Centers for Medicare & Medicaid Services, Baltimore, MD 21244, USA
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43
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Revere L, Large J, Langland-Orban B. A comparison of inpatient severity, average length of stay, and cost for traditional fee-for-service medicare and medicare HMOs in Florida. Health Care Manage Rev 2004; 29:320-8. [PMID: 15600110 DOI: 10.1097/00004010-200410000-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This research compares the mean severity level, length of stay, and cost of Medicare health maintenance organization (HMO) and Medicare fee-for-service (FFS) inpatients. The results suggest Medicare HMOs have healthier inpatients and shorter lengths of stay, but more costly per-day utilization. These findings are contrary to the assumption that HMOs reduce daily utilization.
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Affiliation(s)
- Lee Revere
- Decision Sciences, School of Business and Public Administration, University of Houston-Clear Lake, Texas, USA.
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44
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Kaufman N. What's the financial impact? Hosp Health Netw 2004; 78:8, 10. [PMID: 15609446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Yu TSI, Wong TW. Socioeconomic distribution of health and health care utilization in a new town in Hong Kong, China. Biomed Environ Sci 2004; 17:234-245. [PMID: 15386950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To assess the association of socioeconomic indicators with various chronic and acute illnesses and the utilization of public health care in a new town in Hong Kong, China. METHODS Illness experience and socioeconomic and demographic data of 7570 residents from 2022 randomly selected households were collected through telephone interviews. The relationships between socioeconomic indicators and illnesses/choice of health care were explored using stepwise logistic regressions after adjusting for sex and age. RESULTS Significant positive associations were noted between low household income and diabetes mellitus, any chronic illnesses among adults and flu among younger subjects; low educational level and accident-related illness among adults; being born in Chinese mainland and flu, any acute illness in adults. For the utilization of public health care, low household income was the most consistent risk factor. CONCLUSION This study did not demonstrate a unidirectional socioeconomic gradient in health but supported the hypothesis that socioeconomic deprivation was associated with the utilization of public health care.
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Affiliation(s)
- Tak Sun Ignatius Yu
- Department of Community and Family Medicine, the Chinese University of Hong Kong, Shatin, N T, Hong Kong SAR, China.
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47
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Doctors use web tool to compare practice based on case mix, acuity. Perform Improv Advis 2004; 8:16-20, 13. [PMID: 15027155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Physicians are still learning the ins and outs of using their own practice data to perform a range of functions, from validating their population case mix to monitoring their care patterns across a patient population. CareAdvantage, Inc. uses inpatient, outpatient, and pharmacy claims and encounter data to offer a vast array of reporting capabilities through a web-based portal. The company's RightPath Navigator is designed to help provider groups and health plans understand and forecast resource consumption, risks, and costs associated with their member populations.
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Plumridge N. Finance. Out for the count. Health Serv J 2003; 113:38. [PMID: 14655396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Dewey HM, Thrift AG, Mihalopoulos C, Carter R, Macdonell RAL, McNeil JJ, Donnan GA. Lifetime cost of stroke subtypes in Australia: findings from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke 2003; 34:2502-7. [PMID: 12970517 DOI: 10.1161/01.str.0000091395.85357.09] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Little is known about any variations in resource use and costs of care between stroke subtypes, especially nonhospital costs. The purpose of this study was to describe the patterns of resource use and to estimate the first-year and lifetime costs for stroke subtypes. METHODS A cost-of-illness model was used to estimate the total first-year costs and lifetime costs of stroke subtypes for all strokes (subarachnoid hemorrhages excluded) that occurred in Australia during 1997. For each subtype, average cost per case during the first year and the present value of average cost per case over a lifetime were calculated. Resource use data obtained in the North East Melbourne Stroke Incidence Study (NEMESIS) were used. RESULTS The present value of total lifetime costs for all strokes was Aus 1.3 billion dollars (US 985 million dollars). Total lifetime costs were greatest for ischemic stroke (72%; Aus 936.8 million dollars; US 709.7 million dollars), followed by intracerebral hemorrhage (26%; Aus 334.5 million dollars; US 253.4 million dollars) and unclassified stroke (2%; Aus 30 million dollars; US 22.7 million dollars). The average cost per case during the first year was greatest for total anterior circulation infarction (Aus 28 266 dollars). Over a lifetime, the present value of average costs was greatest for intracerebral hemorrhage (Aus 73 542 dollars), followed by total anterior circulation infarction (Aus 53 020 dollars), partial anterior circulation infarction (Aus 50 692 dollars), posterior circulation infarction (Aus 37 270 dollars), lacunar infarction (Aus 34 470 dollars), and unclassified stroke (Aus 12 031 dollars). CONCLUSIONS First-year and lifetime costs vary considerably between stroke subtypes. Variation in average length of total hospital stay is the main explanation for differences in first-year costs.
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Affiliation(s)
- Helen M Dewey
- National Stroke Research Institute, Level 1, Neurosciences Bldg, Repatriation Campus, Austin & Repatriation Medical Centre, 300 Waterdale Rd, Heidelberg Heights, Victoria 3081, Australia. au
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Abstract
This study uses microdata from the 1972-1981 National Health Interview Surveys (NHIS) to examine how health status and medical care utilization fluctuate with state macroeconomic conditions. Personal characteristics, location fixed-effects, general time effects and (usually) state-specific time trends are controlled for. The major finding is that there is a counter-cyclical variation in physical health that is especially pronounced for individuals of prime-working age, employed persons, and males. The negative health effects of economic expansions persist or accumulate over time, are larger for acute than chronic ailments, and occur despite a protective effect of income and a possible increase in the use of medical care. Finally, there is some suggestion that mental health may be procyclical, in sharp contrast to physical well-being.
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Affiliation(s)
- Christopher J Ruhm
- Department of Economics, Bryan School, University of North Carolina Greensboro (UNCG), P.O. Box 26165, Greensboro, NC 27402-6165, USA.
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