Average Health Care Expenditures Research Articles

Household Healthcare Expenditure (Out-of-Pocket) Distribution Pattern in Kenya

Background: This is a retrospective study that examines the household healthcare expenditure (Out-of-pocket) in an African countries-Kenya. Generally, there is a limited body of knowledge in this area of focus in Africa, therefore, this study serves to impact on the available knowledge and inform health policy and program implementation. Methodology: The study was carried out using raw data from 2004/2005 household survey obtained from the Kenyan Bureau of statistics. In all, 1340 households representing a household per cluster of ten out of a total of 13,340 households selected were analyzed. Descriptive data analysis was done. Further results were achieved by analyzing average household income and average household healthcare expenditure. Comparative analysis was done based on settlements and across the eight districts. Result: The study of Out of Pocket (OOP) Household Healthcare Expenditure Distribution Pattern in Kenya shows that lower income groups were found to be having highest household healthcare (OOP) expenditure while the highest income groups have the lowest out of pocket healthcare expenditure. Generally, the urban settlement with higher income has lower Household Healthcare Expenditure and vice versa. Overall, the rural settlement accounts for 58% of the total out-of-pocket household healthcare expenditure with the urban settlement accounting for the remaining 42%. Further analysis show varying percentage of household expenditure by district with the North/Eastern Province with low average household income at 332.9Kshs having the highest average Household out of pocket healthcare expenditure at 71.7%.

Lifestyle factors, direct and indirect costs for a Brazilian airline company.

OBJECTIVETo analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil.METHODSIn this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors.RESULTSOver the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs.CONCLUSIONSObesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population.

Chronic pain and health care spending: an analysis of longitudinal data from the Medical Expenditure Panel Survey.

To estimate average incremental health care expenditures associated with chronic pain by health care service category, expanding on prior research that focused on specific pain conditions instead of general pain, excluded low levels of pain, or did not incorporate pain duration. Medical Expenditure Panel Survey (MEPS) data (2008-2011; N = 26,671). Differences in annual expenditures for adults at different levels of pain that interferes with normal work, as measured by the SF-12, were estimated using recycled predictions from two-part logit-generalized linear regression models. "A little bit" of chronic pain-related interference was associated with a $2,498 increase in total adjusted expenditures over no pain interference (p < .0001) and a $1,008 increase over nonchronic pain interference (p = .0001). Moderate and severe chronic pain-related interference was associated with a $3,707 and $5,804 increase in expenditures over no pain interference and a $2,218 and $4,315 increase over nonchronic interference, respectively (p < .0001). Expenditure increases were most pronounced for inpatient and hospital outpatient expenditures compared to other types of health care expenditures. Chronic pain limitations are associated with higher health care expenditures. Results underscore the substantial cost of pain to the health care system.

Risk adjustment in aging societies.

BackgroundIn Switzerland, age is the predominant driver of solidarity transfers in risk adjustment (RA). Concerns have been voiced regarding growing imbalances in cost sharing between young and old insured due to demographic changes (larger fraction of elderly >65 years and rise in average age). Particularly young adults aged 19–25 with limited incomes have to shoulder increasing solidarity burdens. Between 1996 and 2011, monthly inter generational solidarity payments for young adults have doubled from CHF 87 to CHF 182, which corresponds to the highest absolute transfer increase of all age groups.ResultsBy constructing models for age-specific RA growth and for calculating the lifetime sum of RA transfers we investigated the causes and consequences of demographic changes on RA payments. The models suggest that the main driver for RA increases in the past was below average health care expenditure (HCE) growth in young adults, which was only half as high (average 2% per year) compared with older adults (average 4% per year). Shifts in age group distributions were only accountable for 2% of the CHF 95 rise in RA payments.Despite rising risk adjustment debts for young insured the balance of lifetime transfers remains positive as long as HCE growth rates are greater than the discount rate used in this model (3%). Moreover, the life-cycle model predicts that the lifetime rate of return on RA payments may even be further increased by demographic changes.Nevertheless, continued growth of RA contributions may overwhelm vulnerable age groups such as young adults. We therefore propose methods to limit the burden of social health insurance for specific age groups (e.g. young adults in Switzerland) by capping solidarity payments.ConclusionsTaken together, our mathematical modelling framework helps to gain a better understanding of how demographic changes interact with risk adjustment and how redistribution of funds between age groups can be controlled without inducing further selection incentives. Those methods can help to construct more equitable systems of health financing in light of population aging.Electronic supplementary materialThe online version of this article (doi:10.1186/s13561-014-0007-5) contains supplementary material, which is available to authorized users.

An economic analysis of a nurse-led telephone triage service

Telephone nurse lines help callers to select the most appropriate site and level of care for acute conditions. We examined whether compliance with nurse recommendations was associated with lower average health care expenditure, and identified the employer characteristics associated with higher than average savings. Telephone calls to a nurse-led help line made by commercial health plan members who worked for large employers were identified. The callers’ intention before calling and the nurse recommendation regarding site/level of care were recorded. Compliance was determined using medical claims during a 30-day post-call observation period and was based on adherence to nurse recommendations. A total of 132,509 calls during 2012 were identified for the study. Nurse recommendations were that 31% of the callers seek a higher level of care than mentioned at the start of the call, 25% use a lower level of care and 44% pursue their originally intended level of care. After regression-based adjustment, the average medical expenditures were compared between compliers and non-compliers. Overall, 57% of callers were compliant with nurse recommendations. The average expenditures were $328 lower among compliant callers. A logistic regression analysis identified employer characteristics positively associated with achieving higher than average savings. These were having a low employee-to-dependent ratio, a headquarters in the Western region of the US, a low prospective health risk score, and participation by the employer in a targeted communication campaign. Compliance with the triage recommendations resulted in lower average health care expenditures, and several characteristics were positively associated with achieving higher savings.

Obesity and people with disabilities: The implications for health care expenditures

This study estimates additional average health care expenditures for overweight and obesity for adults with disabilities vs. without. Descriptive and multivariate methods were used to estimate additional health expenditures by service type, age group, and payer using 2004-2007 Medical Expenditure Panel Survey data. In 2007, 37% of community-dwelling Americans with disabilities were obese vs. 27% of the total population. People with disabilities had almost three times ($2,459) the additional average obesity cost of people without disabilities ($889). Prescription drug expenditures for obese people with disabilities were three times as high and outpatient expenditures were 74% higher. People with disabilities in the 45- to 64-year age group had the highest obesity expenditures. Medicare had the highest additional average obesity expenditures among payers. Among people with prescription drug expenditures, obese people with disabilities had nine times the prevalence of diabetes as normal weight people with disabilities. Overweight people with and without disabilities had lower expenditures than normal-weight people with and without disabilities. Obesity results in substantial additional health care expenditures for people with disabilities. These additional expenditures pose a serious current and future problem, given the potential for higher obesity prevalence in the coming decade.

Details Of Motorcycle Accidents and Their Impacts on Healthcare Costs

Of overall traffic accidents in 2011 in Turkey, 7.58% (n=21,107) were motorcycle accidents. Motorcycle accidents and their impact on healthcare costs are investigated in our study. Motorcycle accidents that occurred with/without a collision between 1 July 2010 and 30 June 2011 were studied prospectively through the inspection of patients visiting the Emergency Service. The healthcare costs relevant to each person injured in a motorcycle accident were investigated via forms. Data were analyzed using frequencies, Kolmogorov-Smirnov, Mann-Whitney U, and chi-square tests on the SPSS v16.0 program. Ninety-one people involved in accidents, with a mean age of 28.47 years, were studied. The average healthcare expenditure for the 91 patients studied between reception and discharge was US$253.02 (median, US$55.90; range, US$11.52 - 7137.19). According to our study, there was no definitive correlation between the healthcare costs and the time of the accident, motorcycle type, nature of the road surface, protective equipment, weather, or daylight. According to the current study, the risk of an accident increases with young adults. Concordantly, healthcare costs increase. Thus, it is important that the legal rules with respect to the age and education necessary for receiving a license to operate a motorcycle should be redefined, and if necessary, regulated.

Cost‐Effectiveness of Cardiac Resynchronization Therapy in the MADIT‐CRT Trial

The Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT) trial demonstrated that cardiac resynchronization therapy (CRT) when added to the implantable cardiac defibrillator (ICD) reduces risk of heart failure or death in minimally symptomatic patients with reduced cardiac ejection fraction and wide QRS complex. To evaluate 4-year cost-effectiveness of CRT-ICD compared to ICD alone using MADIT-CRT data. Patients enrolled in the trial were randomized to implantation of either ICD or CRT-ICD in a 2:3 ratio, with up to 4-year follow-up period. Cost-effectiveness analyses were conducted, and sensitivity analyses by age, gender, and left bundle branch block (LBBB) conduction pattern were performed. A total of 1,271 patients with ICD or CRT-ICD (US centers only) who reported healthcare utilization and health-related quality of life data. We used the EQ-5D (US weights) to assess patient HRQOL and translated utilization data to costs using national Medicare reimbursement rates. Average 4-year healthcare expenditures in CRT-ICD patients were higher than costs of ICD patients ($62,600 vs 57,050, P = 0.015), mainly due to the device and implant-related costs. The incremental cost-effectiveness ratio of CRT-ICD compared to ICD was $58,330/quality-adjusted life years (QALY) saved. The cost effectiveness improved with longer time horizon and for the LBBB subgroup ($7,320/QALY), with no cost-effectiveness benefit being evident in the non-LBBB group. In minimally symptomatic patients with low ejection fraction and LBBB, CRT-ICD is cost effective within 4-year horizon when compared to ICD-only.

Length of Stay and Cost for Surgical Site Infection after Abdominal and Cardiac Surgery in Japanese Hospitals: Multi-Center Surveillance

This study evaluated the influence of surgical site infections (SSIs) after abdominal or cardiac surgery on the post-operative duration of hospitalization and cost. A retrospective 1:1 matched case-control study of length of stay and healthcare expenditures for patients who were discharged from nine hospitals, between April 1, 2006 and March 31, 2008, after undergoing abdominal or cardiac surgery and who did and did not have a SSI. Information was obtained from 246 pairs of patients who had undergone abdominal surgery and 27 pairs of patients who had undergone cardiac surgery. Overall, the mean post-operative hospitalization was 20.7 days longer and the mean post-operative healthcare expenditure was $8,791 higher in the SSI group than for the SSI-free group. Among the patients who had undergone abdominal surgery, development of SSI extended the average hospitalization by 17.6 days and increased the average healthcare expenditure by $6,624. Among the patients who had undergone cardiac surgery, SSI extended the post-operative hospitalization by an average of 48.9 days and increased the post-operative healthcare expenditure by an average of $28,534. Under the current healthcare system in Japan, the development of SSI after abdominal surgery necessitates extension of hospitalization two-fold and increases the post-operative healthcare expenditure 2.5-fold. Development of SSI after cardiac surgery necessitates extension of hospitalization fourfold and increases the healthcare expenditure six-fold.

Estimation of benefit of prevention of occupational cancer for comparative risk assessment: methods and examples

ObjectivesTo quantify the life years gained and financial savings by preventing a case of occupational cancer.MethodsThe authors retrieved data from the Taiwan Cancer Registry and linked them with the National...

Spreading the word about seasonal influenza

A group of small children in the low-income west African country of Sierra Leone stand in a line. Each is holding a poster with the slogan: 'Prevent the new fresh cold'. This is a simple way of spreading a message about influenza. Messages can be communicated to the public in many forms, be it through the mass media, social networks or simple methods such as the one above, but that is not the issue. The question is which model works best for which country and why. When you consider that, according to the World Health Organization (WHO), seasonal influenza is responsible for three to five million cases of severe illness and between 250 000 and 500 000 deaths each year, effective communication campaigns are of paramount importance. So, the key question health workers need to ask is how those working in the field can get these messages across. Take, for example, Sierra Leone, one of the world's lowest-income countries, with an average health-care expenditure of only US$ 41 per person per year, was the subject of a WHO study in the autumn of 2009 that looked at the best way to get health messages across during the A(H1N1) influenza pandemic earlier that year. [ILLUSTRATION OMITTED] The project which took the form of an awareness campaign, says Nahoko Shindo, a medical officer at WHO, posed several problems, most notably the need to ensure that the message reached its intended target: the local community. Sierra Leone, we took two groups, she explains. One group from George Brook a semi-urban setting around the capital, Freetown, and the other from Blama, a village in the east of the country. They have very different cultures and perceptions about the disease. There were other challenges. You can't really talk about the importance of hand-washing in areas where there is no safe water, so you really have to focus on respiratory hygiene, says Shindo. Respiratory hygiene includes putting your hand over your mouth when you sneeze or cough and not spitting near other people. In the tropical climate of many countries in Africa, where only two seasons exist--'dry' and 'rainy', the virus circulates all year round. For many people in Sierra Leone, traditional healers are just as important as modern medicine. Most people cannot read or write so the influenza control campaign was run along simple lines. Town criers were used to spread the message about the 'new fresh cold' and local singers would perform songs about the virus in the local language in marketplaces or other areas where people gather. Certain sections of society were targeted. For example, pregnant women were informed of the dangers of pandemic influenza by midwives who could, according to Shindo, efficiently pass on the information to the targeted population. To evaluate the campaign's success, the team working on the project developed two questionnaires. The first assessed the community's knowledge of influenza and randomly-selected members of the community responded. The second looked at community leaders' commitment to raise awareness after the end of the project. Community leaders involved in project implementation were interviewed. In each case, evaluators took down the verbal responses to the questions posed and translated them into English. The results of the WHO study showed that, broadly speaking, grassroots channels of communication involving community leaders were more effective than static methods, such as posters and mass media to get across messages about influenza. Different countries communicate the need to combat seasonal influenza in different ways. Last year Brazil undertook its 13th seasonal influenza vaccination campaign, during which approximately 32.75 million doses of vaccine were administered. The campaign included a Day of National Mobilization on 30 April, and the health ministry extended the provision of these vaccines to pregnant women, children aged six months to two years and health-care workers; it had only been provided to indigenous people and health-care workers in previous years. …

Health Care Expenditure Among People With Disabilities

Workplace health-promotion programs have the potential to reduce health care expenditures, especially among people with disabilities. Utilizing nationally representative survey data, the authors provide estimates for health care expenditures related to secondary conditions, obesity, and health behaviors among working-age people with disabilities. Furthermore, by computing the expenditures attributable to secondary conditions, obesity, and health behaviors, the authors emphasize the importance of disability-inclusive workplace health-promotion programs for employees with disabilities. Overall, the authors observed that the annual average health care expenditure among employed people with disabilities was US$4,524 (95% confidence interval [CI] = US$4,248–US$4,800) compared with US$1,325 (95% CI = US$1,299–US$1,351) for employed people without disabilities. Furthermore, obesity accounted for 27% to 41% of excess expenditures for people with various disability classifications compared with their nonobese peers with disabilities. Secondary conditions accounted for about 20% to 25% of higher health care expenditures among working people with various disability classifications, compared with their peers with disabilities who do not have secondary conditions. In addition, lack of exercise and alcohol consumption accounted for one fourth to over one third of excess health care expenditures among employed people with disabilities. The authors discuss implications of these findings for rehabilitation counselors and public health practitioners.

An empirical investigation of the efficiency effects of integrated care models in Switzerland

This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency. The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006-2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model. Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5%, respectively, of the variation in total health care expenditure can be attributed to the effects of selection. Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy-makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care.

Burden of illness of hypertension among women using menopausal hormone therapy: a US perspective

Objective:To estimate the burden of illness (BOI) of hypertension in a cohort of women receiving menopausal hormone therapy (HT).Methods:Patients with at least one prescription for menopausal HT were selected from the PharMetrics database during the period July 1, 2003, to June 30, 2005. Hormone therapy patients were divided into those with and without hypertension. The nonhypertensive cohort was propensity score–matched to the hypertensive cohort, controlling for patient demographics, overall comorbidities, and type of HT use. The BOI of hypertension in the menopausal HT cohort was defined as the difference in average annual total healthcare expenditures per person between the cohorts.Results:The prevalence of menopausal HT use was 9.75% among potentially eligible patients in this commercially insured sample. Hypertension was the most common comorbidity in the menopausal HT cohort, with a prevalence of 34%. Hormone therapy patients with hypertension (n = 106,729) had significantly higher average annual healthcare expenditures compared to matched HT patients without hypertension ($8908 vs. $5960 per person per year; difference of $2948; p < 0.001).Conclusions:Hypertension is the most common comorbidity among menopausal HT users in the United States. The annual BOI of hypertension is both substantial and significant when compared to matched patients without hypertension, averaging $2948 per patient per year.

Utilización de servicios sanitarios por parte de las poblaciones inmigrante y nativa en la Comunidad Autónoma de la Región de Murcia

Objective To analyze the patterns of utilisation for three types of public health services (outpatient specialist visits, emergency visits and hospitalisations) in the Comunidad Autónoma de la Región de Murcia. We examine the differences between the average rates of utilization of these services among natives and non-Spanish immigrants, and whether these differences are due to differences in demographic structure, or to different behaviour between these groups. Methods We use econometric models for utilisation to exploit administrative records on health care utilisation and the well established Oaxaca decomposition method. This splits average rates of utilisation and/or average health expenditure into two components: the first one stands for the part of the difference that can be attributed to differential patterns of behaviour among the two groups; the second one represents the part of the difference in average expenditure that can be attributed to the fact that average demographic characteristics among both groups differ. Results The rates of use of outpatient specialist visits, emergencies and hospital nights by the native population are greater than the corresponding rates for the immigrant population. For individuals aged between 20 to 40 years old, the utilisation rates of African and Latin-American females are higher than those for native females. The average health expenditure of native males is greater than that of immigrants. The difference is mainly due to different demographic features among the native and immigrant populations, except for the «rest of Europe» group, whose individuals show a different behaviour. In fact, among the 20 to 40 age group, the average health expenditure of native females equals that of Latin-American women, which is in turn below that of African females. Conclusions In this paper we show that the remarkable differences in the age-gender balance among different (in terms of nationality) groups of insured residents in Murcia has a considerable effect on consumption of health services and therefore on the average health care expenditure attributable to these groups.

Urban-Rural Differences in the Effect of a Medicare Health Promotion and Disease Self-Management Program on Physical Function and Health Care Expenditures

To evaluate the impact of a multicomponent health promotion and disease self-management intervention on physical function and health care expenditures among Medicare beneficiaries. To determine if these outcomes vary by urban or rural residence. We analyzed data from a 22-month randomized controlled trial of a health promotion/disease self-management program that included 766 elderly Medicare beneficiaries from western New York, West Virginia, and Ohio. Physical function was measured by changes in self-reported dependencies in activities of daily living over the study period. Total health care expenditures were measured by aggregating expenditures from major sources (acute, postacute, and long-term care). We used ordinary least squares models to examine the effects of the intervention on both physical function and cost outcomes during the 22-month period. The results indicated that the intervention reduced physical functional decline by 54% (p = .03) in the study sample. Stratified analyses showed that the intervention effect was much stronger in the rural sample. Mean total health care expenditures were 11% ($3,100, p = .30) lower in the intervention group. The effects of the intervention on average health care expenditures were similar among urban and rural participants. The intervention offered a promising strategy for reducing decline in physical function and potentially lowering total health care expenditures for high-risk Medicare beneficiaries, especially for those in rural areas. Future studies need to investigate whether the findings can be replicated in other types of rural areas through a refined intervention and better targeting of the study population.

Prevalence of Chronic Illness in Pregnancy, Access to Care, and Health Care Costs: Implications for Interconception Care

Access to health care after pregnancy is especially important for pregnant women with chronic illness. The purpose of our study was to describe the prevalence of chronic illness in pregnant women and factors affecting the receipt of ongoing care. We conducted a cross-sectional analysis of 6,294 women between 19 and 45 years of age from the Medical Expenditure Panel Survey (MEPS). Chronic illness was defined using aggregate clinical classification codes in the MEPS. Women were divided into 4 groups: pregnant and currently not pregnant, with and without chronic illness. We analyzed group differences in demographic variables, socioeconomic status, and access to health care. We also estimated inpatient, outpatient, emergency room, and pharmacy expenditures for the 4 study groups. All analyses accounted for the complex survey design of MEPS. Overall, 27% of pregnant women and 39% of nonpregnant women reported a chronic illness. There were no differences in race/ethnicity, poverty, or health insurance status between pregnant women with and without chronic illness. Women with chronic illness were more likely to have a usual source of care. Among pregnant women, the presence of a chronic condition did increase out-of-pocket expenditures, but did not increase total average health care expenditures, even after adjusting for other characteristics. Pregnant women with chronic illness were similar to pregnant women without chronic illness in terms of access to care and total health care costs. Further research is needed to determine whether these similarities persist after delivery, given the relatively high prevalence of women with chronic illness who are of childbearing age.

Healthcare expenditures and patient satisfaction: cost and quality from the consumer's perspective in the US

ABSTRACTBackground: Both cost and quality of healthcare are major concerns in the United States. Using patient satisfaction as a quality indicator, we seek to identify the relationship between healthcare cost and quality from the perspective of the community-dwelling population in the United States.Methods: We examined a nationally representative sample of 13 980 adults (age ≥ 18 years) in the 2003 Medical Expenditure Panel Survey (MEPS). Given the idiosyncrasies of the cost data distribution, a recently developed extended estimating equation (EEE) model was employed to identify the relationship between patient satisfaction and healthcare expenditure, after controlling for individual demographic covariates, co-morbidity profile, and functional and activity limitations. A series of sensitivity analyses were conducted, in addition, to verify the identified relationship. All statistics were adjusted using the proper sampling weight from the MEPS data.Results: Average annual healthcare expenditures for 2003 ranged between $3923 and $6073 when grouped by patient satisfaction ratings with a mean value $4779 for all individuals who rated perceived satisfaction of their healthcare. We found that there is no statistically signif­icant relationship between patient satisfaction and total healthcare expenditure ( p = 0.60) and a non-monotonic relationship is not identified either. All sensitivity analyses results revealed a lack of relationship between patient satisfaction and healthcare expenditures.Limitations: Patient satisfaction might not reflect the quality of healthcare from an objective clinical standpoint. The identified cost–satisfaction relationship may not be extrapolated to other quality indicators. Due to the cross-sectional study design, no causal relationship could be inferred between patient satisfaction and healthcare expenditure.Conclusions: Our study adds to the literature on health­care cost and quality by suggesting that the improvement of patient satisfaction may not require additional health­care spending.

Direct Cost Burden Among Insured US Employees With Migraine

To provide a current estimate of the national direct health-care cost burden of illness associated with migraine among a US insured population. Individuals with migraine use health-care resources more than those without migraine, incurring substantial costs to US employers. The Thomson Medstat's Commercial Claims and Encounters 2004 database was utilized for this study. Only paid claims were analyzed. The migraine cohort had a primary migraine diagnosis and/or a migraine-specific abortive drug prescription during 2004. A matched control cohort with no evidence of migraine was generated using propensity score techniques. Demographic characteristics and overall comorbidities were similar between cohorts. A second-stage regression controlled for any remaining significant intergroup differences. The burden of illness of migraine was defined as the difference in average total health-care expenditures per person between cohorts. The national burden of illness was defined as the average expenditure for migraine of national population estimates of privately insured individuals, and was estimated by projecting the migraine prevalence rate and average expenditure using Medical Expenditure Panel Survey population estimates. Patients with migraine (n=215,209) had significantly higher average health-care expenditures compared with matched controls ($7007 vs $4436 per person per year; difference of $2571; P<.001). Migraine-associated national expenditure estimates: outpatient care, $5.21 billion; prescriptions, $4.61 billion; inpatient care, $0.73 billion; and emergency department care, $0.52 billion. The direct costs associated with patients with migraine were found to be $2571 per person per year higher than in matched nonmigraine controls. The projected national burden of migraine of $11.07 billion is substantially higher than previous estimates.

Private Health Insurance in Germany: Consequences of a Dual System

A variety of financial and non-financial incentives has resulted in a considerable degree of adverse selection against social health insurance in Germany. Enrollees in private health insurance are healthier, have higher incomes and have fewer dependents than enrollees in social health insurance. Adverse selection decreases average premium income and at the same time increases average healthcare expenditures in social health insurance. As a consequence, financial sustainability of the public system declines. Moreover, financial incentives for healthcare providers have led to preferential treatment for privately insured patients in outpatient care. The dual health insurance system in Germany is therefore inequitable as well as inefficient, and cannot be considered a role model for post-Chaoulli Canada.