Cost Of Medical Care Services Research Articles

The Determinants of Rising Inequality in Health Insurance and Wages

Over the last 30 years in the U.S., less educated workers have experienced a sharp decline in health insurance coverage rate and stagnant wage growth. In contrast, more educated workers' health insurance coverage rate has stayed relatively stable and their wages have rapidly grown. This paper investigates the determinants of the increase in inequality in health insurance coverage and wages by estimating an overlapping generations equilibrium model of labor and health insurance markets' demand and supply. The estimated model is used to quantify the effects of changes in aggregate factors (including rising cost of medical care services, Medicaid eligibility expansion, skill-biased technological changes in the labor market, and changes in the labor force composition) on the inequality of health insurance coverage and wages. I find that the interaction between the rising cost of medical services and labor market technological change is the most important determinant of the widening gap of health insurance coverage.

The Determinants of Rising Inequality in Health Insurance and Wages: An Equilibrium Model of Workers' Compensation and Health Care Policies

Over the last 30 years in the U.S., less educated workers have experienced a sharp decline in health insurance coverage rate and stagnant wage growth. In contrast, more educated workers' health insurance coverage rate has stayed relatively stable and their wages have rapidly grown. This paper investigates the determinants of the increase in inequality in health insurance coverage and wages by estimating an overlapping generations equilibrium model of labor and health insurance markets' demand and supply. The estimated model is used to quantify the effects of changes in aggregate factors (including rising cost of medical care services, Medicaid eligibility expansion, skill-biased technological changes in the labor market, and changes in the labor force composition) on the inequality of health insurance coverage and wages. I find that the interaction between the rising cost of medical services and labor market technological change is the most important determinant of the widening gap of health insurance coverage.

The Determinants of Rising Inequality in Health Insurance and Wages: An Equilibrium Model of Workers' Compensation and Health Care Policies

I develop and structurally estimate a non-stationary overlapping generations equilibrium model of employment and workers’ health insurance and wage compensation, to investigate the determinants of rising inequality in health insurance and wages in the U.S. over the last 30 years. I nd that skill-biased technological change and the rising cost of medical care services are the two most important determinants, while the impact of Medicaid eligibility expansion is quantitatively small. I conduct counterfactual policy experiments to analyze key features of the 2010 Patient Protection and Aordable Care Act, including employer mandates and further Medicaid eligibility expansion. I nd that (i) an employer mandate reduces both wage and health insurance coverage inequality, but also lowers the employment rate of less educated individuals; and (ii) further Medicaid eligibility expansion increases employment rate of less educated individuals, reduces health insurance coverage disparity, but also causes larger wage inequality.

Health Utilization and Cost Impact of Childhood Constipation in the United States

To estimate the total health care utilization and costs for children with constipation in the United States. We analyzed data from 2 consecutive years (2003 and 2004) of the Medical Expenditure Panel Survey (MEPS), a nationally representative household survey. We identified children who either had been reported as constipated by their parents or had received a prescription for laxatives in a given year. Outcome measures were service utilization and expenditures. The MEPS database included a total of 21 778 children age 0 to 18 years, representing 158 million children nationally. An estimated 1.7 million US children (1.1%) reported constipation in the 2-year period. No differences with respect to age, sex, race, and socioeconomic status were found between the children with constipation and those without constipation. The children with constipation used more health services than children without constipation, resulting in significantly higher costs: $3430/year vs $1099/year. This amounts to an additional cost for children with constipation of $3.9 billion/year. This study demonstrates that childhood constipation has a significant impact on the use and cost of medical care services. The estimated cost per year is 3 times than that in children without constipation, which likely is an underestimate of the actual burden of childhood constipation.

Addiction Treatment History, Medical Services Utilization, and Cost

Few studies have examined the long-term patterns of health services utilization and cost for alcohol use disorders. This paper used data from baseline, 3-year, and 5-year follow-up interviews to compare utilization and cost of medical care services for problem drinkers who received chemical dependence treatment and those who did not. The analysis examined overnight hospital stays, emergency room visits, and medical office visits. The unadjusted analysis indicates that in the year immediately preceding each follow-up period, a significantly higher percentage of the chemical dependency treatment group stayed overnight at a hospital or used ER services. In terms of medical office visits, a significantly lower percentage of the treatment sample had office visits at the 5-year follow-up, but otherwise no significant differences existed. Most of the significant differences between the two groups vanished when we controlled for covariates. Researchers, policy makers, and clinicians could benefit from such information to develop alternative delivery models, formulate research initiatives, and determine areas for potential intervention and improvement.

Working together for health and human rights*

The right to a standard of living adequate for health and well‐being is being denied to vast numbers of people all over the world through increasing disparities in income and in wealth. In the name of economic development, a number of international and national policies have increased the grossly uneven distribution of income, with ever‐growing numbers of people living in poverty as well as in increasing depths of poverty. Globalization, crippling levels of external debt, and the ‘structural adjustment’ policies of international agencies have expanded the numbers and the suffering of people living in poverty and have resulted in the neglect of government‐funded social programs, of regulations protecting the environment, and of human development. Access to medical care, an essential element in the protection of health, is difficult for many, including the 44 million people in the United States who lack insurance coverage for the cost of medical care services. Working together for health and human rights also requires promotion of the right to peace. The right to life and health is threatened not only by the existence and active deployment of weapons of mass destruction, including nuclear, chemical and biological weapons and anti‐personnel landmines, but also other weapons. The twentieth century has been the bloodiest in human history, with an estimated 250 wars, more than 110 million people killed, countless people wounded and at the least 50 million refugees. Health workers must work together with people in our communities for the promotion of health and human rights, which, in Sandwell and elsewhere, are inextricably intertwined.

Antidepressant treatment and health services utilization among HIV-infected medicaid patients diagnosed with depression.

To characterize the prevalence and predictors of diagnosed depression among persons with HIV on Medicaid and antidepressant treatment among those diagnosed, and to compare utilization and costs between depressed HIV-infected individuals treated with and without antidepressant medications. Merged Medicaid and surveillance data were used to compare health services utilized by depressed individuals who were or were not treated with antidepressant medications, controlling for other characteristics. The study population comprised Medicaid recipients in New Jersey who were diagnosed with HIV or AIDS by March 1996 and received Medicaid services between 1991 and 1996. Logistic regression and ordinary least squares regressions were employed. Women were more likely and African Americans were less likely to be diagnosed with depression. Women and drug users in treatment were more likely to receive antidepressant treatment. Depressed patients treated with antidepressants were more likely to receive antiretroviral treatment than those not treated with antidepressants. Monthly total expenditures were significantly lower for individuals diagnosed with depression and receiving antidepressant therapy than for those not treated with antidepressants. After controlling for socioeconomic and clinical characteristics, treatment with antidepressant medications was associated with a 24% reduction in monthly total health care costs. Depressed HIV-infected patients treated with antidepressants were more likely than untreated subjects to receive appropriate care for their HIV disease. Antidepressant therapy for treatment of depression is associated with a significantly lower monthly cost of medical care services.

The economic burden of asthma in US children: Estimates from the National Medical Expenditure Survey

Background: Asthma is the leading chronic illness of childhood, is responsible for substantial pediatric morbidity, and has a significant impact on use of health resources. Objective: Our purpose was to assess the per capita impact of pediatric asthma on medical care utilization and total expenditures. Methods: A population-based national probability survey, the National Medical Expenditure Survey, was conducted in 1987 to determine the use and cost of health care services in the United States. We analyzed the responses for all children aged 1 to 17 years with (n = 667) and without (n = 6911) asthma. Children with asthma were identified with use of a population-based screening question. Frequency and cost of medications, ambulatory visits, emergency department care, and hospitalizations for all reasons, including asthma, were assessed. Results: The period prevalence of childhood asthma in 1987 was 8.8% and the treated prevalence (any asthma medications) was 4.0%. Forty-one percent of families with asthmatic children were classified as having no primary insurance. Children with asthma used substantially more services in all categories of care: 3.1 times as many prescriptions, 1.9 times as many ambulatory provider visits, 2.2 times as many emergency department visits, and 3.5 times as many hospitalizations. Only 10.7% of children with asthma were defined as chronic users of medications. Children with asthma incurred an average of $1129 (SD $5310) per child per year in total health care expenditures compared with $468 (SD $2960) for children without asthma, a 2.8-fold difference. Conclusion: Asthma has considerable impact on the use and costs of medical care services among US children. Data from the 1987 National Medical Expenditure Survey provide a useful baseline against which more recent, postguideline data should be compared. (J Allergy Clin Immunol 1999;104:957-63.)

Predictors of a medical-offset effect among patients receiving antidepressant therapy.

Characteristics of patients receiving antidepressant therapy were examined to identify factors that may be associated with a medical-offset effect. In a retrospective study, the authors analyzed claims data from a large health insurer in New England. The study subjects included 1,661 persons initiating treatment for depression with selective serotonin reuptake inhibitors or tricyclic antidepressants between July 1991 and June 1993. Patients with anxiety disorders, coronary heart disease, cancer, and chronic fatigue syndrome and those remaining on their initial regimens of antidepressant therapy for at least 6 months were more likely to experience significant reductions in the costs of medical care services. The number of visits to mental health providers had no effect on the costs of medical services. Specific comorbid conditions and sustained use of antidepressant drugs may be associated with a medical-offset effect for patients receiving treatment for depression.

The economic returns from investments in physical and mental health: a case study of migrant farmworkers in rural New York.

Spiraling costs of medical care services and limited federal and state resources necessitate discriminating and cost-effective strategies for financing health care to indigent populations. Thus, while the selection among intervention strategies is aided by information on both the cost and benefits of program alternatives, data on the latter aspect is more difficult to obtain. Human capital research provides a mechanism for assessing one of the multifarious aspects of the benefits of medical services. Research suggests that labor market earnings opportunities are affected by health status. The present study explores this relationship for migrant farmworkers in a vegetable production county (Orange County) in upstate New York. Multivariate analysis indicated that mental well-being was an important predictor of earnings for migrant farmworkers. Directions for public health policy intervention strategies are also discussed.

Relation of psychopathology in general medical inpatients to use and cost of services

The authors investigated the relation between psychopathology in medically ill inpatients and use and cost of medical care services. Of 455 medical inpatients, the Medical Inpatient Screening Test identified 27.9% as very depressed, 27.5% as very anxious, 20.2% as having cognitive dysfunction, and 8.6% as having high pain levels. Overall, the test identified 51% of the patients as having high levels of psychopathology or pain. These subjects had a 40% longer median length of hospital stay and 35% greater mean hospital costs than those with low levels of psychopathology or pain. Patients with greater psychopathology also had higher hospital charges, more procedures during hospitalization, and more discharge diagnoses but did not differ from the other patients in sex, race, age, diagnosis-related group (DRG) major diagnostic category, or DRG weight.