Average Total Expenditure Research Articles

Economic Analysis of Dairy Farming under Drought Prone Area in Maharashtra State of India

Background: Dairy farming is a cornerstone of the rural economy in India. Maharashtra, particularly its drought-prone districts, is critical in this sector. Despite challenges posed by erratic monsoons and limited irrigation, dairy farming remains a viable strategy for economic stability in these regions. The aim of this study was to examine the financial aspects of dairy enterprises, focusing on socio-economic characteristics, economic viability and constraints faced by farmers. Methods: The study employed a multistage stratified random sampling method. Key analytical tools included average and percentage calculations, BEP analysis and a Cobb-Douglas production function. Additionally, Garrett’s ranking technique was used to ascertain constraints in dairy farming, while the MOTAD model assessed profitability and risk. Result: The findings reveal that crossbred cow milk production is more lucrative than buffalo milk production, despite its higher average total expenditure per lactation. Break-even analysis confirmed profitability for both types of milk producers. Key determinants of milk production, such as green fodder, concentrate and labour, suggest areas for efficiency enhancements. Farmer-identified constraints include high feed costs, insufficient veterinary services and water scarcity. Utilizing the MOTAD model, the study recommends integrating dairy farming with crop cultivation to maximize returns, mitigate risks and enhance overall farm resilience in challenging environmental conditions.

Characteristics and outcomes of heart failure in Japan: A hospital-based administrative database analysis.

Epidemiological and outcome studies on patients in Japan with heart failure (HF) categorized by left ventricular ejection fraction (LVEF) are currently limited. The aim of this non-interventional database study was to provide further information on these patients. Administrative claims data and electronic medical records from hospitals participating in the Voluntary Hospitals in Japan (VHJ) organization were used. Patients hospitalized with a primary diagnosis of HF between 1 April 2017 and 30 March 2020 were categorized by baseline LVEF on echocardiogram: HF with reduced EF (HFrEF, LVEF <40%); HF with preserved EF (HFpEF, LVEF ≥50%); and HF with mildly reduced EF (HFmrEF, 40% to <50% LVEF). Patients were evaluated for baseline characteristics, pre-admission diagnosis, prescription drugs, length of hospitalization, HF treatment cost, overall cost of hospitalization, and in-hospital prescription. An exploratory analysis compared post-hospitalization mortality and re-hospitalization rates. In total, 10646 hospitalized patients from 17 VHJ hospitals were enrolled. Of these, 7212 were included in the analysis set and categorized into HFpEF (3183, 44.1%), HFmrEF (1280, 17.7%), and HFrEF (2749, 38.1%) groups based on baseline LVEF. Beta-blocker use increased during hospitalization, with a mean (95% confidence interval [CI]) of 23.3% (22.3-24.3) of patients receiving these agents before admission versus 69.4% (68.3-70.5) at discharge. Administration of diuretics, angiotensin converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs) showed a similar trend. Differences in treatments were observed between HF categories at discharge, with a higher proportion (95% CI) of ACE inhibitor use in the HFrEF group (40.6% [38.7-42.4]) versus HFmrEF (27.5% [25.1-30.0]) and HFpEF (20.6% [19.2-22.1]) groups (P<0.0001), and more ARB use in the HFmrEF and HFpEF groups (32.5% [29.9-35.1] and 31.2% [29.6-32.9], respectively) versus HFrEF (25.1% [23.5-26.8]; P<0.0001). Mean (standard deviation [SD]) length of hospitalization was 22.2 (23.3) days, and the median (interquartile range) was 17 (11-25) days. Estimated average cost of HF treatment per patient during index hospitalization was 300090 yen with HFrEF treatment costing the most. Average total healthcare expenditure during hospitalization was 1225650 yen per index hospitalization per patient, with HFrEF also the most expensive. During a mean (SD) observation period of 324 (304) days, ~21% of patients in each group required re-hospitalization for HF, and 625 patients (8.7%) died. The proportion of patients in each HF category was largely consistent with existing data. Discharge medications indicated high prescription of guideline-directed therapy. This study provides real-world data on patients with HF in Japan that can help inform future clinical decision-making.

Understanding racial disparities in health care expenditures for cervical cancer.

Cervical cancer demonstrates a notable efficacy in treatment, evidenced by a 92% 5-year survival rate among cases diagnosed at a localized stage. In 2020, the estimated annual national expenditure for cervical cancer care amounted to $2.3 billion in the United States. Limited real-world data are available for racial disparities in health care expenditures for cervical cancer. To evaluate racial disparities associated with annual health care expenditures among patients diagnosed with cervical cancer in the United States. A retrospective observational cohort study of annual health care expenditures in patients with cervical cancer diagnosed during 2014-2019 was performed using the Medical Expenditure Panel Survey data. In addition to the descriptive weighted analysis, an unadjusted analysis of the annual health care expenditure was conducted. An adjusted linear regression model with log transformation of the outcome variable was used to evaluate the total annual health care expenditure as well as expenditures by category across the racial groups. Overall, 826 patients with cervical cancer were identified from the Medical Expenditure Panel Survey during 2014-2019. The majority were classified as White patients (81.2%) and in the age group of 45-64 years (44.65%). On average, the total annual health care expenditure was $11,537 (95% CI = $9,887-$13,186) among the White cohort, $10,659 (95% CI = $6,704-$14,614) among the African American cohort, and $8,726 (95% CI = $6,113-$11,340) among the Hispanic cohort. After adjusting for covariates, the average total annual health care expenditure for the Hispanic cohort was 35% of the total health care expenditure of the White cohort (P < 0.001) and 46% of the African American cohort's health care expenditure (P = 0.02). Specifically, adjusted costs of office-based and outpatient visits for the Hispanic cohort were 47% (P = 0.009) and 57% (P = 0.005) lower than for the White cohort, respectively. The total annual home health care expenditure for the African American cohort was 49% lower than White patients (P = 0.03), and the Hispanic cohort's total expenditure, excluding prescription medicines, was 57% lower than African American patients (P = 0.02). This study provides valuable information regarding the health care disparities that need to be addressed among certain minority races. Reducing the disparities in health care spending across racial groups should be included as a crucial element in tackling well-established health care inequities.

Impact of a Special Operations Forces Basic Training on Body Composition and Energy Expenditure.

The Belgian Special Operations Regiment undergoes an 8-week basic training course (SOF Basic Course) following the Military Initiation Phase. The aims of the present study were to estimate energy expenditure and changes in body composition during SOF Basic Course. A multi frequency body composition analyser assessed baseline and endpoint body composition. For the purpose of estimating energy expenditure, 41 participants were fitted with triaxial accelerometers. T-tests were performed on paired and unpaired samples in order to estimate statistical significance. Effect size was estimated with Cohen's d. SOF Basic Course was completed by 88 out of 126 participants. The participants' mean (SD) age was 25.0 (4.1) years, weight was 77.6 (8.6) kg, and body fat percentage was 15.3% (3.3). Body weight of completers decreased from 78.3 (8.8) kg to 76.4 (8.0) kg (P = 0.01). Also, body fat decreased by 3.1 (1.8) kg (P = 0.01), and muscle mass increased by 1.2 (1.7) kg (P = 0.01). There was a decrease in body fat percentage from 15.3% (3.3) to 11.6% (3.4) (P = 0.01), with a Cohen's effect size of 1.86.The loss of 3.1 kg of body fat corresponds to a loss of 21,700.0 kcal (90.3 MJ) or 362.0 kcal.d-1 (1.5 MJ.d-1). The mean (SD) energy expenditure by physical activity was 1,943.0 (653.8) kcal.d-1 (14.6 [2.7] MJ.d-1). The average (SD) total energy expenditure was 4,088.0 (710.0) kcal.d-1 (36.8 [3.8] MJ.d-1). Tactical athletes must perform in hypo-energetic environment. Research in the future should investigate the impact of increased energy intake on body composition.

Parental Expenditures of Time and Money on Children in the U.S.

AbstractHow much do parents spend on children in the U.S.? While the U.S. Department of Agriculture (USDA) regularly addresses this question, it considers only money expenditures, omitting the sizeable monetary value of parental time. The 2017 and 2019 Panel Study of Income Dynamics offers a unique opportunity to provide a more complete picture. Analysis of this data reveals considerable substitutability between unpaid and paid childcare and generates estimates of average total expenditures that include a replacement cost estimate of the value of parental time. These estimates, constructed for comparability with USDA measures, reveal both higher levels of average parental expenditure and different patterns across household structure and income. These findings challenge public policies that use USDA estimates as a reference point for setting the child support obligations of non‐custodial parents and reimbursement rates for foster care. They also undermine many conventional equivalence scales and measures of income/time poverty.

Health Care Costs Following COVID-19 Hospitalization Prior to Vaccine Availability.

Postacute sequelae of coronavirus (PASC) disease of 2019 (COVID-19) include morbidity and mortality, but little is known of the impact on medical expenditures. This study measures patients' health care costs after COVID hospitalization before vaccinations. The Merative MarketScan database is used to track trends in medical expenditures for commercially insured patients hospitalized for COVID-19 (case subjects) compared with COVID-19 patients not hospitalized (control subjects) using a propensity score matching model. Medical expenditures were estimated from 30-, 60-, and 120-day clean periods after an initial COVID-19 encounter through the end of 2020. Average total medical expenditures were 96% higher for individuals hospitalized for COVID-19 starting 30 days after initial COVID-19 encounter and almost 70% higher 120 days after based on the propensity score matching. The average spending differential was $11,242 30 days after and $4959 120 days after. This effect is highest for inpatient admissions and services 60 days after at $56,862 and lowest among pharmaceuticals 120 days after at $329. The magnitude of the difference is greater for those with hypertension or diabetes where total expenditures is $14,958 30 days after, and $5962 120 days after compared with those without these chronic conditions. The results suggest both health and economic implications for COVID-19 hospitalization and supports the use of vaccinations to help mitigate these implications. PASC includes increased health care costs for hospitalized patients, particularly for those with chronic conditions. Preventing COVID-19 hospitalization has economic value in terms of reduced medical spending in addition to health benefits associated with reduced morbidity and mortality.

Food Security Analysis of Corn Farming Households In The Buffer Area of Mandalika Special Economic Zone

The existence of the Mandalika Special Economic Zone (SEZ), located in Pujut District, Central Lombok Regency, is an area adjacent to many corn cultivation areas. This condition represents strategic potential for the development of corn commodities and their derivative products. On the other hand, food security is a human right that must be fulfilled. The aim of this research is to; 1) Analyze the socio-economic conditions of corn farmers in the buffer area of Mandalika SEZ; 2) Analyze the food security of corn farmers houshold in the buffer area of Mandalika SEZ; This research was conducted using qualitative-descriptive methods. The data collection technique used interviews with respondents guided by a questionnaire with 40 respondents determined by simple random sampling. The data analysis that will be used in this research is descriptif analysis. The research results show that (1) the average total income of corn farmers is IDR. 28,960,605.28/year, this income comes from agricultural activities amounting to IDR. 23,430,722.93/year, income from non-agricultural activities of IDR. 4,164,000/year and income from other sources (Social-Assistance) of IDR. 1,365,882/year. The average total household expenditure for corn farmers is IDR. 19,506,628/year, with details of food expenditure of IDR. 11,169,548/year, and non-food expenditure of IDR. 8,337,080/year; (2) In general, respondent farmer households included the food secure category. In distribution, there are 20% of farmers who are still in the food insecure category.

Food security of lowland rice farmers to support sustainable food development in Parigi Moutong District, Indonesia

Food security is focused on increasing food availability, strengthening food distribution, accelerating food diversification and monitoring food safety. Indicators of household food security are reflected by household income, the proportion of food expenditure to total expenditure and energy adequacy figures. This study aims to (1) analyze household food security and (2) analyze the relationship between income and food security. The research data consisted of primary and secondary data, with 65 rice farming households as respondents. Sampling technique with a simple random method. The average total expenditure for household food consumption is IDR.1,387,331,-/month with a proportion of expenditure of 54% per month. The average non-food expenditure is IDR.1,192,262.-/month, with a lack of food category (> 60%). There are 47 households, with 72.30% belonging to the household group whose energy absorption is still lacking and can be interpreted as food inadequate; 18 households, with a proportion of 27.69%, are included in the household group with sufficient energy absorption. There is a correlation or relationship between income and the level of food security indicated by the value of α (0.037 <0.05).

Small area estimation of household expenditure on insurance programs for minimizing the impact of natural disasters in West Java, Indonesia

West Java is one of Indonesia’s Provinces with a high disaster risk index. The Province has experienced earthquakes, volcanic eruptions, tidal waves, droughts, landslides, floods and tsunamis. In the event of a disaster, the government’s budget allocation is used for handling losses due to disasters. Seeing these conditions, it is necessary to carry out disaster risk management efforts to reduce losses by using natural disaster insurance by households. Publication of household insurance expenditures is essential to see the community’s ability to pay insurance for handling losses due to disasters. This study aims to estimate the average household expenditure on insurance and the average total household expenditure by district/city in the West Java Province. The analytical method used is the Small Area Estimation using the Fay-Herriot model with logarithmic transformation. The data source is the National Socio-Economic Survey (SUSENAS) for March 2019. The results show the proportion of insurance expenditure to total household expenditure (ability to pay) was relatively low, ranging from 0.93%–2%. This result is still far from the ability to pay insurance in developing countries, which is 5%. This finding can be used to see the power of households to pay for insurance (ability to pay). The government can take policies related to this to minimize losses due to natural disasters in the West Java Province.

Sorghum Contribution to Increased Income and Welfare of Dryland Farmer Households in Wonogiri, Indonesia

Sorghum is uniquely adapted to dryland and used by the Indonesian government to optimize the utilization of dryland and increase farmers’ incomes. The objective of this study was to analyze the contribution of sorghum to increasing income and the level of welfare of dryland farmer households in Wonogiri, Central Java, Indonesia. The study was conducted from October to December 2022 using a survey method through direct interviews with purposively selected sorghum-growing farmers. A set of questions included household income and expenditure. The average total income and expenditure indicators, poverty line figures, RMW, and ERFHI were used to measure the welfare level of farmer households. The study found that the income derived from sorghum contributes 22.87% to total household income and tends to increase household income by 29.65%. According to the average total income earned, farming households were in a prosperous condition. This can be seen from the total income, which is higher than the total expenditure, the average per capita income higher than the poverty line, the average total income higher than RMW, and the value of ERFHI at 1.25. Income derived from sorghum has increased by 21.43–56.00% from less prosperous households to prosperous ones. The results of this study are expected to contribute to the existing literature on sorghum development and farmers’ income and to be a reference for policy makers in formulating poverty alleviation programs and improving the welfare of farmer households, as well as expanding sorghum development by optimizing the utilization of agroecological, economic and social resources.

Analysis of the proportion of food expenditures for rice farming households in Lampuyang Village, Teluk Sampit District, Kotawaringin Timur Regency

The purpose of this study was to determine the proportion of food expenditure to the total expenditure of rice farming households. Knowing the quantity and quality of household food consumption of rice farmers. Knowing rice farmer household food security. In this research, 41 rice farming households were taken as samples. The method used in this research is descriptive method. The method of taking the research location was carried out by purposive sampling, namely in the village of Lampu which is in the Teluk Sampit District, East Kotawaringin Regency. Types and sources of data used consist of primary data and secondary data. Data collection techniques were carried out by interviews, observation, and recording. Data analysis method is descriptive with average and percentage analysis. Based on the results of the study, the average total expenditure of rice farming households was IDR 2,752,117.40. It is known that spending on food is around IDR 1,647,079.45 (59.85%) and spending on non-food is around IDR 1,105,037.95 (40.15%). The average energy adequacy level of rice farming households is in the sufficient category of 51.8%, while the average protein adequacy level of rice farming households is 90.2% which is in the sufficient category. Conditions Food security in rice farming households is mostly food vulnerable, namely 36.6%, followed by food shortages of 29.3%, food insecurity of 19.5%, while food secure households are only 14.6%. So that it can be said that the food security of farmer households is still relatively poor.

Ability To Pay Dan Willingness To Pay Iuran BPJS Kesehatan Pada Pedagang Pasar Bulu Semarang Di Era Pandemi

Market traders were included in the informal workers with the second largest proportion of 3.31 million people. The purpose of this study was to calculate the ability to pay and willingness to pay fur market traders for BPJS Health contributions during the pandemic. This type of research was descriptive through quantitative methods, there are 96 respondents to the fur market traders who were registered in the PBPU segment. Subjects were determined using Systematic Random Sampling. The results showed that most of the respondents' household income per month was classified as medium which was in the interval ? IDR 2.067.295,00 to ? IDR 5.168.237,00. The average total expenditure of household respondents was IDR 3.668.339,00. The biggest type of expenditure was non-food expenditure with an average total expenditure of IDR 1.756.523.00. The real amount of Ability To Pay (ATP) for Fur Market traders had an average value of IDR 84.792,00 per person per month. Most of the respondents (88.5%) were able to pay BPJS Health contributions. There were 11 respondents unable to pay BPJS Health contributions. Calculation of the estimated average Willingness To Pay (WTP) obtained was IDR 26.411.00. The researcher's suggestion is for BPJS Health to collaborate with the UPTD Semarang City market in the BPJS Health socialization program in order to increase the knowledge and awareness of traders about the importance of health insurance.

Evaluation of the association between health insurance status and healthcare utilization and expenditures among adult cancer survivors in the United States.

Health care expenditures for cancer care has increased significantly over the past decade and is further projected to rise. This study examined the associations between health insurance status and total direct health care expenditures and health care utilization among cancer survivors living in the United States. A cross-sectional study of cancer survivors aged ≥18 years, identified from the Medical Expenditures Panel Survey (MEPS) during 2017 using International Classification of Diseases, Tenth Revision codes specific for cancer. Health insurance was categorized into Private, Medicare, Medicaid, and uninsured. Multivariable ordinary least squares regression was used to examine the association between log expenditures and health insurance. Negative binomial regression with log link was used to obtain adjusted incident rate ratios (AIRR) for health care utilization. Survey weights were used to produce nationally representative estimates of the US population. A total of 1140 (weighted=13.9 million) cancer survivors were identified. Compared to the adjusted mean annual health care expenditures for the private group ($14,265; 95% confidence interval (CI): $12,645 to $16,092), the adjusted mean annual health care expenditures for the Medicare group were higher ($15,112; 95%CI: $13,361 to $17,092). As compared to the private group, the average annual expenditures for uninsured cancer survivors ($2315; 95%CI:1038 to $3501) was significantly lower and so was their health care utilization. Adjusted rates of ER visits for Medicaid were twice (AIRR:2.04; SE:0.28; p=0.001) as compared to privately insured. A difference in the average total direct expenditures between uninsured and privately insured patients was found. Uninsured had the lowest health care utilization while Medicaid reported significantly higher number of ER visits. Despite differences in program structures, health care expenditures across insurance types were similar. Lower utilization of health care services among uninsured suggests cost maybe a barrier to accessing care.

The economic burden of biologic disease-modifying antirheumatic drugs in rheumatoid arthritis patients in the United States

Background Previous U.S. economic burden estimates for rheumatoid arthritis (RA) varied from $85.6 to 148.1 billion annually. However, these estimates do not reflect comparative amounts spent on RA treatment options in addition to other medical expenditures. Therefore, this study’s goal was to comparatively analyze the overall economic burden of U.S. patients treated for RA using conventional disease-modifying antirheumatic drugs (DMARDs) versus TNF alpha biologic DMARDs. Research Design and Methods This retrospective observational study analyzed Medical Expenditure Panel Survey Household Component data from 2016 to 2018. Healthcare utilization, total medical expenditures, and out-of-pocket expenditures were compared between RA medication groups. Results Three hundred twenty-five adult RA patients experiencing 603 RA-related events, including at least one medical visit, between 2016 and 2018 were identified. Rheumatic arthritis-attributable medical expenditures among patients prescribed DMARDs were $11.4 billion. Average total medical expenditures were significantly higher for the TNF alpha biologic group $26,216.67 (95% CI: $19,502.84–$32,930.5) versus $5,388.52 (95% CI: $2,768.25–$8,008.79) for the conventional DMARD group (p<0.001). Conclusions RA patients receiving TNF alpha biologics experienced significantly higher total medical and out-of-pocket expenditures; however, they have experienced fewer or no occurrences of high-cost drivers of healthcare utilization compared to patients receiving conventional DMARDs.

Energy Balance And Body Composition In Elite Alpine Skiers During Training At Altitude And Across The Competitive Season

Alpine skiing is characterized by phases of demanding on-snow glacier training and competitions in extreme environments, where maintaining body composition (BC) is crucial for performance and may play a role in injury prevention. However, sport-specific literature on energy balance (EB) and strategies to avoid unfavorable changes in BC are still lacking. PURPOSE: To analyze EB and BC during a training camp at altitude and over the course of a competitive season. METHODS: In a prospective observational study, active male (n = 9, 27 ± 2.9 yrs) and female (n = 10, 25 ± 3.0 yrs) international skiers, competing in either speed (SPEED; n = 10) or technical (TEC; n = 9) disciplines, completed a 7 to 15-day training camp at altitude (base: 1800 m, glacier: 3500 m). BC (displacement plethysmography and bioelectrical impedance) was assessed at baseline, directly before and after the camp and at the end of the season. At altitude, food intake was assessed directly and indirectly, urine samples were collected for estimation of energy expenditure (doubly labelled water isotope method). RESULTS: During the training camp, an overall increase in body mass (BM, p = 0.011) and fat mass (FM, p < 0.001) was observed, whereas FFM remained unchanged. Increases in FM were prominent in men (p < 0.001) and SPEED (p = 0.002), but not in women or TEC. An average total daily energy expenditure (TEE) of 4088 ± 895 kcal/d and an energy intake (EI) of 4375 ± 1223 kcal resulted in an overall positive EB. EE in SPEED was significantly higher than in TEC (p = 0.03), with the highest EE observed in male speed athletes (~5900 kcal). Moreover, EB differed (p = 0.01) between men (760 ± 890 kcal/d) and women (-138 ± 490 kcal/d). Over the course of a season, FFM (p = 0.007) and skeletal muscle mass (SMM, p = 0.05) decreased significantly. Whereas women tended lose more SMM than men (p = 0.09), reductions in BM tended to be greater in male when compared to female athletes (p = 0.07). CONCLUSION: The findings indicate that alpine skiers are able to meet the high energy demands during a short-term training camp, but not over the course of a competitive season. Therefore, BC should be monitored during key training and competition phases to identify athletes at risk and -if necessary- nutritional support should be provided to avoid being in a negative EB.

Determinants of The Expenditure of Tourist Demand in Coastal Destinations

The aim of this work is to analyze the determinants of tourist expenditure in Monte Hermoso, a destination located in the southwest of the province of Buenos Aires, Argentina. Tourist surveys were administered during the austral summer (January-February) and considered as primary information. Socioeconomic and trip-related variables were selected to explain the determinants of the average total expenditure of tourists in this destination. The Ordinary Least Squares (OLS) method was applied. From the results obtained, it was determined that the level of income, origin, group size, and type of accommodation are the regressors that best demonstrate the spending behavior of the destination's domestic demand. Therefore, it is possible to identify the most attractive demand segments that contribute to improving competitiveness and increasing the rate of return of the destination.

The Economic Burden of Hospital Costs on Families With Type 1 Diabetes Mellitus Children: The Role of Medical Insurance in Shandong Province, China.

ObjectiveThis study estimates the economic burden imposed on families by comparing the hospitalization costs of T1DM children with and without medical insurance in Shandong province.MethodsOur data comprised 1,348 T1DM inpatient records of patients aged 18 years or younger from the hospitalization information system of 297 general hospitals in 6 urban districts of Shandong Province. Descriptive statistics are presented and regression analyses were conducted to explore the factors associated with hospitalization costs.ResultsChildren with medical insurance had on average total hospitalization expenditures of RMB5,833.48 (US$824.02) and a hospitalization stay of 7.49 days, compared with the children without medical insurance who had lower hospitalization expenditures of RMB4,021.45 (US$568.06) and an average stay of 6.05 days. Out-of-pocket expenses for insured children were RMB3,036.22 (US$428.89), which is significantly lower than that of the uninsured children (P < 0.01). Out-of-pocket (OOP) expenditures accounted for 6% of the annual household income of insured middle-income families, but rose to a significant 25% of the annual income for low-income families. These OOP expenditures imposed a heavy economic burden on families, with some families experiencing long-term financial distress. Both insured and uninsured families, especially low-income families, could be tipped into poverty by hospitalization costs.ConclusionHospitalization costs imposed a significant economic burden on families with children with T1DM, especially low-income insured and uninsured families. The significantly higher hospitalization expenses of insured T1DM children, such as longer hospitalization stays, more expensive treatments and more drugs, may reflect both excess treatment demands by parents and over-servicing by hospitals; lower OOP expenses for uninsured children may reflect uninsured children from low-income families forgoing appropriate medical treatment. Hospital insurance reform is recommended.

The economic burden of dementia in low- and middle-income countries (LMICs): a systematic review

IntroductionMore than two-thirds of people with dementia live in low- and middle-income countries (LMICs), resulting in a significant economic burden in these settings. In this systematic review, we consolidate the...

Comparison of health-care utilization and expenditures for minimally invasive vs. open colectomy for benign disease

BackgroundAdoption of minimally invasive approaches continues to increase, and there is a need to reassess outcomes and cost. We aimed to compare open versus minimally invasive colectomy short- and long-term health-care utilization and payer/patient expenditures for benign disease.MethodsThis is a retrospective analysis of IBM® MarketScan® Database patients who underwent left or right colectomy for benign disease between 2013 and 2018. Outcomes included total health-care expenditures, resource utilization, and direct workdays lost up to 365 days following colectomy. The open surgical approach (OS) was compared to minimally invasive colectomy (MIS) with subgroup analysis of laparoscopic (LS) and robotic (RS) approaches using inverse probability of treatment weighting.ResultsOf 10,439 patients, 2531 (24.3%) had open, 6826 (65.4%) had laparoscopic, and 1082 (10.3%) had robotic colectomy. MIS patients had shorter length of stay (LOS; mean difference, − 1.71, p < 0.001) and lower average total expenditures (mean difference, − $2378, p < 0.001) compared with open patients during the index hospitalization. At 1 year, MIS patients had lower readmission rates, and fewer mean emergency and outpatient department visits than open patients, translating into additional savings of $5759 and 2.22 fewer days missed from work for health-care visits over the 365-day post-discharge period. Within MIS, RS patients had shorter LOS (mean difference, − 0.60, p < 0.001) and lower conversion-to-open rates (odds ratio, 0.31 p < 0.001) during the index hospitalization, and lower hospital outpatient visits (mean difference, − 0.31, p = 0.001) at 365 days than LS.ConclusionMIS colectomy is associated with lower mean health-care expenditures and less resource utilization compared to the open approach for benign disease at index operation and 365-days post-discharge. Health-care expenditures for LS and RS are similar but shorter mean LOS and lower conversion-to-open surgery rates were observed at index operation for the RS approach.

A medical home for children in foster care reduces expenditures

ABSTRACT Children in foster care are at risk from fragmented care, delayed access, medical complexity, and increased mental health needs. We studied health care expenditures for children in foster care managed by a Patient-Centered Medical Home foster care specialty clinic (Fresh Start). We used Alabama Medicaid claims data from 2016 to 2018 to compare the costs incurred by 75 pediatric patients managed by Fresh Start with 75 matched children in foster care. Compared to their matched controls, the average total expenditures of Fresh Start children were lower by $536 (p = .02, 95% CI [−1008, −63]), primary care expenditures were lower by $171 (p = .09, 95% CI [−371, 28]), and pharmacy expenditures were lower by $63 (p = .02, IQR = 598). Reduced expenditures identified among children managed by the Fresh Start PCMH may represent more access to care coordination, behavioral health services, and trauma-informed care, with more pronounced effects on primary care and pharmacy costs.