Amount Of Health Care Spending Research Articles

US Health Care Spending by Payer and Health Condition, 1996-2016

US health care spending has continued to increase and now accounts for 18% of the US economy, although little is known about how spending on each health condition varies by payer, and how these amounts have changed over time. To estimate US spending on health care according to 3 types of payers (public insurance [including Medicare, Medicaid, and other government programs], private insurance, or out-of-pocket payments) and by health condition, age group, sex, and type of care for 1996 through 2016. Government budgets, insurance claims, facility records, household surveys, and official US records from 1996 through 2016 were collected to estimate spending for 154 health conditions. Spending growth rates (standardized by population size and age group) were calculated for each type of payer and health condition. Ambulatory care, inpatient care, nursing care facility stay, emergency department care, dental care, and purchase of prescribed pharmaceuticals in a retail setting. National spending estimates stratified by health condition, age group, sex, type of care, and type of payer and modeled for each year from 1996 through 2016. Total health care spending increased from an estimated $1.4 trillion in 1996 (13.3% of gross domestic product [GDP]; $5259 per person) to an estimated $3.1 trillion in 2016 (17.9% of GDP; $9655 per person); 85.2% of that spending was included in this study. In 2016, an estimated 48.0% (95% CI, 48.0%-48.0%) of health care spending was paid by private insurance, 42.6% (95% CI, 42.5%-42.6%) by public insurance, and 9.4% (95% CI, 9.4%-9.4%) by out-of-pocket payments. In 2016, among the 154 conditions, low back and neck pain had the highest amount of health care spending with an estimated $134.5 billion (95% CI, $122.4-$146.9 billion) in spending, of which 57.2% (95% CI, 52.2%-61.2%) was paid by private insurance, 33.7% (95% CI, 30.0%-38.4%) by public insurance, and 9.2% (95% CI, 8.3%-10.4%) by out-of-pocket payments. Other musculoskeletal disorders accounted for the second highest amount of health care spending (estimated at $129.8 billion [95% CI, $116.3-$149.7 billion]) and most had private insurance (56.4% [95% CI, 52.6%-59.3%]). Diabetes accounted for the third highest amount of the health care spending (estimated at $111.2 billion [95% CI, $105.7-$115.9 billion]) and most had public insurance (49.8% [95% CI, 44.4%-56.0%]). Other conditions estimated to have substantial health care spending in 2016 were ischemic heart disease ($89.3 billion [95% CI, $81.1-$95.5 billion]), falls ($87.4 billion [95% CI, $75.0-$100.1 billion]), urinary diseases ($86.0 billion [95% CI, $76.3-$95.9 billion]), skin and subcutaneous diseases ($85.0 billion [95% CI, $80.5-$90.2 billion]), osteoarthritis ($80.0 billion [95% CI, $72.2-$86.1 billion]), dementias ($79.2 billion [95% CI, $67.6-$90.8 billion]), and hypertension ($79.0 billion [95% CI, $72.6-$86.8 billion]). The conditions with the highest spending varied by type of payer, age, sex, type of care, and year. After adjusting for changes in inflation, population size, and age groups, public insurance spending was estimated to have increased at an annualized rate of 2.9% (95% CI, 2.9%-2.9%); private insurance, 2.6% (95% CI, 2.6%-2.6%); and out-of-pocket payments, 1.1% (95% CI, 1.0%-1.1%). Estimates of US spending on health care showed substantial increases from 1996 through 2016, with the highest increases in population-adjusted spending by public insurance. Although spending on low back and neck pain, other musculoskeletal disorders, and diabetes accounted for the highest amounts of spending, the payers and the rates of change in annual spending growth rates varied considerably.

DISPARITY IN HEALTHCARE COSTS AMONG AFRICAN AMERICANS AND CAUCASIANS WITH TRALI COMPLICATED WITH UNDERLYING CKD

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: In 2016, the US spent 17.8% of its gross domestic product on healthcare, much higher compared to other countries. Despite this, health care costs continue to rise without much improvements in outcomes. Transfusion related acute lung injury (TRALI) is a type of blood transfusion adverse reaction that usually develops within 6 hours of transfusion and is a leading cause of morbidity and mortality [2]. It occurs due to the presence of donors antibodies recognizing leukocyte antigens in the recipient. Millions of blood transfusions take place in the US within hospitalized patients with underlying co-morbidities including chronic kidney disease (CKD), comprising 0.9%-6.8% of all admitted patients in the intensive care unit. Patients with CKD are more likely to require transfusions given decreased erythropoietin synthesis. To our knowledge, there is insufficient evidence looking at the racial differences between healthcare costs for patients with TRALI. We propose to look at healthcare cost differences between Caucasians and African Americans admitted for TRALI with underlying CKD. METHODS: The National Inpatient Sample (NIS) was used to query the prevalence of TRALI with the International Classification of Disease (ICD) Code 518.7 in all discharge diagnoses. ICD codes of 585.x were used to identify the various stages of CKD and those without CKD. Comparisons in subgroup analysis were also looked at with patients with CKD vs without. Analysis was carried out via the software SAS using multivariate analysis. Variables that were looked at included age, length of stay (LOS), mortality, number of procedures, mean charges, mean income quartile by zip code. RESULTS: During the years of 2003 and 2014 there were a total of 9,844 hospitalizations for TRALI in the United States. Of these, 8241 were of Caucasian descent and 1603 were of African American. Results for Caucasians vs African Americans, respectively, are as follows: average age 64 years vs 50 years (p =0.5); LOS 15.37 days vs 17.19 days (p = 0.95); mortality 19.71% vs 15.88%, (p = 0.79); number of procedures 6.53 vs 6.57 (p = 0.74); total charges $191,320 vs $215, 550 (p = < 0.05). CONCLUSIONS: Healthcare costs and disparities are a major concern in the current practice of medicine despite large amount of health care spending in the United States. In the data that was analyzed there was no mortality difference between Caucasians and African Americans with TRALI. Additionally, age, length of stay and number of procedures were of no statistical significance. Despite no major differences, African Americans paid $24,000 more for the admission in spite of making less income based off the income quartile. CLINICAL IMPLICATIONS: Further research is needed to further elucidate the discrepancy of cost and racial healthcare disparities in patients who experience TRALI. DISCLOSURES: No relevant relationships by Nikhila Kethireddy, source=Web Response No relevant relationships by Shashank Sama, source=Web Response No relevant relationships by Varun Tandon, source=Web Response

Wednesday, September 26, 2018 2:00 PM – 3:00 PM Integrating Technology into Practice: 2016 Research Grant: Effects of telemedicine triage on efficiency and cost-effectiveness in spinal care

BACKGROUND CONTEXT Low back pain and neck pain are second only to ischemic heart disease for the greatest disability-adjusted life-years in rich nations. It also accounts for the third highest amount of health care spending within the United States. In 2013, there were over 57.1 million ambulatory visits for back pain, yet very few cases are surgical. Providers and health systems must optimize efficient triage while improving access to specialists. PURPOSE The purpose of this study was to evaluate our model of telemedicine/electronic-triage for ambulatory spinal complaints for quantitative and qualitative measures of cost savings and efficiency. STUDY DESIGN/SETTING This study was performed at the West Virginia University (WVU) Spine Center. PATIENT SAMPLE All patient referrals made to the WVU Spine Center between 2011–2014. OUTCOME MEASURES Cost-savings and efficiency data were collected from electronic medical record (EMR) systems and analyzed for time from intake to appointment, rate of referral to surgeons versus nonoperative providers, and additional testing required. We extrapolated cost savings based on estimated avoidance of unnecessary office visits and travel. METHODS All new referrals between January 2011 and December 2014 were included. All referrals undergo “intake” to collect history, disease symptoms, prior treatment, imaging and test results, and data are then entered into queue within our electronic triage system (Cordata Healthcare Innovations, Cincinnati, OH). Cases are then electronically reviewed/triaged, by a spine surgeon, to a surgical provider, nonoperative spine provider, or other provider. The Cordata database was mined for data from intake until triage completion. Hospital EMR (Epic Systems Corporation, Verona, WI, USA) were then mined for data on initial clinic visit, tests ordered, follow-up appointments, and presence of surgical encounters. Financial savings were estimated from the number of “trips saved” and based on the cost of visit and mileage. RESULTS There were 16,174 records created between 2011-2014 of which 10,832 records (in 10,271 patients) were triaged by a spine surgeon. Average time from referral to surgeon review was 11 days (pre-Cordata, wait time for the first clinic visit/opportunity for a surgeon to review patient information was 2.5 to 8 months). After E-triage, 4,446 (43%) patients were offered an appointment with a spine surgeon, 4,959 patients (48%) were directed to a provider other than the spine surgeon, and 6,723 patients (65%) received recommendations for additional testing or conservative treatment. In patients with complaints consistent with spinal etiology but no initial treatment, diversion to a nonoperative spine provider generated 3,718 ambulatory visits in 2,444 patients. This diversion resulted in an estimated savings of $793,835 ($649,572 for unnecessary appointment with a surgeon and $144,263 in travel costs), or $325 per patient ($266 for clinic visit, $59 for travel). After E-triage, 4,446 patients were deemed to have surgical problems and were offered an appointment with a spine surgeon. Under the current system, average wait time for a surgeon appointment was 44 days. This is compared to historical wait times prior to Cordata of 2.5 to 8 months. Among patients directed to surgical appointments, 40% were “expedited” appointments, and 15% were felt to need “urgent” appointments (not including patients “fast-tracked” to clinic or emergency department for presence of “red flag” symptoms identified during intake). Of the 4,446 surgical patients, 3,528 arrived within 6 months of their most recent telemedicine review. Once seen, 2,331 (66%) did not require any further workup (indicating they already had a complete set of images/tests required for full surgical assessment at the initial visit) and 1,197 (34%) patients required additional testing/treatment ordered during the index visit. Among this cohort, 745 patients (26%) underwent spine surgery within 2 years of the index visit. CONCLUSIONS Appropriate triage and management of spine patients improves access and quality of care. This study is our attempt to quantify the anecdotally vast affect E-triage has had on our health care system and patient population. By appropriately funneling patients to the most appropriate provider utilizing an E-triage system, we showed decreased wait-times, nearly $800,000 of cost savings to the patients, and more effective use of surgeon time on surgical patients (26% surgical conversion rate in new patients). Further studies are required to fully evaluate the effects of an E-triage system on ambulatory spinal care. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Health Care Spending on Diabetes in the U.S., 1996-2013.

Health care spending on diabetes in the U.S. has increased dramatically over the past several decades. This research describes health care spending on diabetes to quantify how that spending has changed from 1996 to 2013 and to determine what drivers are increasing spending. Spending estimates were extracted from the Institute for Health Metrics and Evaluation's Disease Expenditure 2013 database. Estimates were produced for each year from 1996 to 2013 for each of 38 age and sex groups and six types of care. Data on disease burden were extracted from the Global Burden of Disease 2016 study. We analyzed the drivers of spending by measuring the impact of population growth and aging and changes in diabetes prevalence, service utilization, and spending per encounter. Spending on diabetes in the U.S. increased from $37 billion (95% uncertainty interval $32-$42 billion) in 1996 to $101 billion ($97-$107 billion) in 2013. The greatest amount of health care spending on diabetes in 2013 occurred in prescribed retail pharmaceuticals (57.6% [53.8-62.1%] of spending growth) followed by ambulatory care (23.5% [21.7-25.7%]). Between 1996 and 2013, pharmaceutical spending increased by 327.0% (222.9-456.6%). This increase can be attributed to changes in demography, increased disease prevalence, increased service utilization, and, especially, increases in spending per encounter, which increased pharmaceutical spending by 144.0% (87.3-197.3%) between 1996 and 2013. Health care spending on diabetes in the U.S. has increased, and spending per encounter has been the biggest driver. This information can help policy makers who are attempting to control future spending on diabetes.

Current Resources for Evidence-Based Practice, January 2018

Current Resources for Evidence-Based Practice, January 2018

US Spending on Personal Health Care and Public Health, 1996-2013

ImportanceUS health care spending has continued to increase, and now accounts for more than 17% of the US economy. Despite the size and growth of this spending, little is known about how spending on each condition varies by age and across time.ObjectiveTo systematically and comprehensively estimate US spending on personal health care and public health, according to condition, age and sex group, and type of care.Design and SettingGovernment budgets, insurance claims, facility surveys, household surveys, and official US records from 1996 through 2013 were collected and combined. In total, 183 sources of data were used to estimate spending for 155 conditions (including cancer, which was disaggregated into 29 conditions). For each record, spending was extracted, along with the age and sex of the patient, and the type of care. Spending was adjusted to reflect the health condition treated, rather than the primary diagnosis.ExposuresEncounter with US health care system.Main Outcomes and MeasuresNational spending estimates stratified by condition, age and sex group, and type of care.ResultsFrom 1996 through 2013, $30.1 trillion of personal health care spending was disaggregated by 155 conditions, age and sex group, and type of care. Among these 155 conditions, diabetes had the highest health care spending in 2013, with an estimated $101.4 billion (uncertainty interval [UI], $96.7 billion-$106.5 billion) in spending, including 57.6% (UI, 53.8%-62.1%) spent on pharmaceuticals and 23.5% (UI, 21.7%-25.7%) spent on ambulatory care. Ischemic heart disease accounted for the second-highest amount of health care spending in 2013, with estimated spending of $88.1 billion (UI, $82.7 billion-$92.9 billion), and low back and neck pain accounted for the third-highest amount, with estimated health care spending of $87.6 billion (UI, $67.5 billion-$94.1 billion). The conditions with the highest spending levels varied by age, sex, type of care, and year. Personal health care spending increased for 143 of the 155 conditions from 1996 through 2013. Spending on low back and neck pain and on diabetes increased the most over the 18 years, by an estimated $57.2 billion (UI, $47.4 billion-$64.4 billion) and $64.4 billion (UI, $57.8 billion-$70.7 billion), respectively. From 1996 through 2013, spending on emergency care and retail pharmaceuticals increased at the fastest rates (6.4% [UI, 6.4%-6.4%] and 5.6% [UI, 5.6%-5.6%] annual growth rate, respectively), which were higher than annual rates for spending on inpatient care (2.8% [UI, 2.8%–2.8%] and nursing facility care (2.5% [UI, 2.5%-2.5%]).Conclusions and RelevanceModeled estimates of US spending on personal health care and public health showed substantial increases from 1996 through 2013; with spending on diabetes, ischemic heart disease, and low back and neck pain accounting for the highest amounts of spending by disease category. The rate of change in annual spending varied considerably among different conditions and types of care. This information may have implications for efforts to control US health care spending.

Ethical Issues in Managed Care

A PRIMARY concern of medical ethicists for some time has been the absence of any meaningful analysis of the impact of health care delivery marketplace changes and current legislative reforms on the essential tenets of the physician-patient relationship. Although President Clinton's original reform proposal addressed in broad terms the ethical imperatives supporting universal access, it left virtually unexamined the more fundamental question of the role of the physician in a reformed system in which the incentives are dramatically changed and budgets determine the amount of health care spending and services. See also pp 323 and 338. In June 1990, the Council issued a report, "Financial Incentives to Limit Care: Financial Implications for HMOs and IPAs," 1 which described the financial incentives that managed care plans offer physicians to limit their provision of care. The report concluded that patient welfare must remain the first concern of physicians working in health maintenance