Current Health Care Expenditure Research Articles

Socio-economic determinants of public healthcare

The main socio-economic mission of the healthcare system is to participate in the formation of workforce, strengthen the labor potential of society, and promote economic growth. The national health serves as an important economic resource. The COVID-19 pandemic has proven that losses due to illness and absence of employees from the workplace have negative economic consequences. The bibliometric study conducted via the VOSViewer bibliometric analysis of Scopus publications in 2014-2024 for the query “socio-economic determinants of public healthcare” allowed to structure the scientific work within 8 clusters. The latter showed leading researchers from the USA, the UK, India, Australia, Canada, Germany, Italy and Spain. In 2020-2023, due to the pandemic, publication activity in this area increased significantly. The article conducts a regression analysis of the impact of socio-economic determinants on the level of public healthcare. The public healthcare index is the population life expectancy. Among socio-economic determinants, there are nine components as factor attributes: current healthcare expenditures per capita; income shares of the richest and poorest – 10% and 20%; mortality rates up to 5 years and from suicide; number of people using at least basic sanitation and safe drinking water services, etc. The data for Ukraine from the World Bank statistical base for 2002-2019 were used as an information fundament. The multiple regression generation by the method of stepwise exclusion of variables was implemented using the MS Excel software. The article formulates a list of recommendations for increasing life expectancy. It includes measures to ensure the sanitary and epidemiological well-being of the population, development of healthcare infrastructure. The research also ensures availability of medical services to the population. The study educates and informs the population about the hygiene importance, proper use of sanitation and the consequences of inadequate sanitary conditions for health. Relevance of affordable sanitation improvement programmes for the poor is discussed.

Economic impact of inflammatory bowel disease in Catalonia: a population-based analysis.

Inflammatory bowel disease (IBD) has a major economic impact on healthcare costs. The aim of this study was to evaluate the current healthcare expenditure associated with IBD in a population-wide study in Catalonia. Retrospective observational study. All patients with IBD included in the Catalan Health Surveillance System (CHSS) were considered eligible. The CHSS compiles data on more than 7 million individuals in 2020 (34,823 with IBD). Data on the use of healthcare resources and its economic impact were extracted applying the International Classification of Diseases, 10th revision, Clinical Modification codes (ICD-10-CM codes). Health expenditure, comorbidities, and hospitalization were calculated according to the standard costs of each service provided by the Department of Health of the Catalan government. The data on the IBD population were compared with non-IBD population adjusted for age, sex, and income level. IBD costs were recorded separately for Crohn's disease (CD) and ulcerative colitis (UC). Prevalence of comorbidities was higher in patients with IBD than in those without. The risk of hospitalization was twice as high in the IBD population. The overall healthcare expenditure on IBD patients amounted to 164M€. The pharmacy cost represents the 60%. The average annual per capita expenditure on IBD patients was more than 3.4-fold higher (IBD 4200€, non-IBD 1200€). Average costs of UC were 3400€ and 5700€ for CD. The risk of comorbidities was twice as high in patients with IBD and their use of healthcare resources was also higher than that of their non-IBD counterparts. Per capita healthcare expenditure was approximately 3.4 times higher in the population with IBD. The study was not previously registered.

Impact of coronavirus disease (COVID-19) on food security: bibliometric analysis and empirical evidence

Impact of coronavirus disease on sustainable growth and food security is dramatically negative. Despite significant number of publications focused on food security and coronavirus disease issues, a deeper analysis of food security damages activated by COVID-19 is necessary. This determines the main task of this research. Theoretical block of the study involves bibliometric analysis of relevant Scopus publications using VOSviewer. Empirical block of the study involves: 1) formation of Food Security Index for 15 European countries based on a combination of Principal Component Analysis, ranking, Fishburn formula and additive convolution; 2) panel data regression modelling aimed at clarifying impact of macroeconomic indicators and healthcare expenditures on food security during 2000–2021 (model 1), 2000–2019 (model 2) and 2020–2021 (model 3). Model 1 demonstrates that 1% increase in current health care expenditures leads to 0.003 units increase in Food Security Index; impact of the dummy variable characterizing COVID-19 pandemic is also positive. Model 2 demonstrates similar results. Model 3 confirms only positive and statistically significant impact of trade and agricultural land on Food Security Index. The results can be useful to government officials for adjusting political measures in food governance, political decision-making and good governance, recovery of sustainable growth in post-pandemic period.

Spatiotemporal analysis of the effect of global development indicators on child mortality

BackgroundChild mortality continue to be a major public health issue in most developing countries; albeit there has been a decline in global under-five deaths. The differences in child mortality can best be explained by socioeconomic and environmental inequalities among countries. In this study, we explore the effect of country-level development indicators on under-five mortality rates. Specifically, we examine potential spatio-temporal heterogeneity in the association between major world development indicators on under-five mortality, as well as, visualize the global differential time trend of under-five mortality rates.MethodsThe data from 195 countries were curated from the World Bank’s World Development Indicators (WDI) spanning from 2000 to 2017 and national estimates for under-five mortality from the UN Inter-agency Group for Child Mortality Estimation (UN IGME).We built parametric and non-parametric Bayesian space-time interaction models to examine the effect of development indicators on under-five mortality rates. We also used employed Bayesian spatio-temporal varying coefficient models to assess the spatial and temporal variations in the effect of development indicators on under-five mortality rates.ResultsIn both parametric and non-parametric models, the results show indicators of good socioeconomic development were associated with a reduction in under-five mortality rates while poor indicators were associated with an increase in under-five mortality rates. For instance, the parametric model shows that gross domestic product (GDP) (β = − 1.26, [CI − 1.51; − 1.01]), current healthcare expenditure (β = − 0.40, [CI − 0.55; − 0.26]) and access to basic sanitation (β = − 0.03, [CI − 0.05; − 0.01]) were associated with a reduction under-five mortality. An increase in the proportion practising open defecation (β = 0.14, [CI 0.08; 0.20]) an increase under-five mortality rate. The result of the spatial components spatial variation in the effect of the development indicators on under-five mortality rates. The spatial patterns of the effect also change over time for some indicators, such as PM2.5.ConclusionThe findings show that the burden of under-five mortality rates was considerably higher among sub-Saharan African countries and some southern Asian countries. The findings also reveal the trend in reduction in the sub-Saharan African region has been slower than the global trend.

Patterns of better breast cancer care in countries with higher human development index and healthcare expenditure: Insights from GLOBOCAN 2020.

The huge burden of breast cancer (BC) necessitates the profound and accurate knowledge of the most recent cancer epidemiology and quality of care provided. We aimed to evaluate BC epidemiology and quality of care and examine the effects of socioeconomic development and healthcare expenditure on disparities in BC care. The results from the GLOBOCAN 2020 study were utilized to extract data on female BC, including incidence and mortality numbers, crude rates, and age-standardized rates [age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs)]. The mortality-to-incidence ratio (MIR) was calculated for different locations and socioeconomic stratifications to examine disparities in BC care, with higher values reflecting poor quality of care and vice versa. In both descriptive and analytic approaches, the human development index (HDI) and the proportion of current healthcare expenditure (CHE) to gross domestic product (CHE/GDP%) were used to evaluate the values of MIR. Globally, 2,261,419 (95% uncertainty interval (UI): 2,244,260-2,278,710) new cases of female BC were diagnosed in 2020, with a crude rate of 58.5/100,000 population, and caused 684,996 (675,493-694,633) deaths, with a crude rate of 17.7. The WHO region with the highest BC ASIR (69.7) was Europe, and the WHO region with the highest ASMR (19.1) was Africa. The very high HDI category had the highest BC ASIR (75.6), and low HDI areas had the highest ASMR (20.1). The overall calculated value of female BC MIR in 2020 was 0.30, with Africa having the highest value (0.48) and the low HDI category (0.53). A strong statistically significant inverse correlation was observed between the MIR and HDI values for countries/territories (Pearson's coefficient = -0.850, p-value < 0.001). A significant moderate inverse correlation was observed between the MIR and CHE/GDP values (Pearson's coefficient = -0.431, p-value < 0.001). This study highlighted that MIR of BC was higher in less developed areas and less wealthy countries. MIR as an indicator of the quality of care showed that locations with higher healthcare expenditure had better BC care. More focused interventions in developing regions and in those with limited resources are needed to alleviate the burden of BC and resolve disparities in BC care.

P826 Economic impact of inflamatory bowel disease in Catalonia. A population-based analysis

Abstract Background Background: Inflammatory Bowel Disease (IBD) has an important economic impact in healthcare costs and resources utilization. Population data on this topic are scarce. The aim of this study was to evaluate the current healthcare expenditures of IBD in a population-wide study Catalonia. Methods Methods: All patients with IBD included in the Catalan Health Surveillance System (CHSS) were included. CHSS includes data on more than 7 million individuals in 2020, 34,823 of them being diagnosed of IBD. Data on prevalence, incidence, comorbidities, stratification of risk, use of healthcare resources and economic impact were extracted from the CHSS according to ICD-10-CM codes. Health expenditure was calculated according to the standard costs of each service provided by the Department of Health (Generalitat de Catalunya). The utilization of healthcare services and associated expenditure of IBD were compared with a control group of patients not identified as IBD adjusted by age, sex, and income level (hereinafter referred to as “non-IBD”). IBD costs were separately provided for Crohn’s Disease (CD) and Ulcerative Colitis (UC). Results Results: The prevalence and incidence of IBD in 2020 was 405.6 and 27.2 per 100,000 inhabitants, respectively. Total number of IBD patients in 2020 was 37,381. Prevalence of comorbidities (neoplasia, arthritis, chronic obstructive pulmonary disease, asthma, cardiac disease, ictus and mental disease) was higher in IBD patients’ when compared to non-IBD population. The risk of hospitalization in IBD was twice those of the non-IBD individuals. The global healthcare expenditures of patient with IBD was 164M€. The average annual expenditure for an IBD patient was 4M€ versus 1M€ for non-IBD population; being more than 3.4-fold higher. Cost in UC was 3,360€ and 5,699€ for CD patient. Conclusion Conclusion: Patients with IBD presented a higher risk of comorbidities (1.5-2 fold) and healthcare resources utilization. Healthcare expenditure per patient were approximately 3.4 times higher than the non-IBD population.

Efficiency of Healthcare Expenditure in the Pre-Pandemic and Pandemic Periods

Via bibliometric analysis, the research identifies the contextual vectors of the healthcare financial provision effectiveness. Moreover, we broaden the empirical substantiation of panel data regression modelling for 34 European countries. In particular, we define performance of public (budgetary) and private financing to reduce the mortality rate and raise life expectancy in pre-pandemic and pandemic periods. The systematization of existing literature sources and approaches to solving the problem is implemented by means of bibliometric and monographic analysis. Consequently, there are 6 contextual clusters of scientific research on determining the healthcare financial provision effectiveness in the modern science. Within the analysed works, researchers mainly study general prerequisites of the healthcare financial provision effectiveness. The optimal cost formation of medical services for diagnosing and treating diseases is reproduced as well. The issue urgency consists in analysing the efficient patterns of spending various funds to decrease the mortality rate and increase life expectancy in the pre-pandemic and pandemic periods. Subsequently, we detect some general parameters of healthcare resistance to counter shocks similar to the COVID-19 pandemic. In this paper, we show statistical analysis of mortality indexes (total and COVID-19). Among 34 European countries, the highest and lowest efficiency levels were identified within these parameters. The study empirical block constructs 8 regression models on panel data. They differ in dependent (mortality rate or life expectancy) or independent variables (block 1: current and capital healthcare expenditures in GDP; block 2: current healthcare expenditures), and modelling period (pre-pandemic – 2000-2019, pandemic– 2020-2022 or the current period). The modelling results represent financial drivers and change inhibitors of the mortality rate and life expectancy during the pandemic and pre-pandemic periods. Therefore, we established the most effective groups of healthcare expenditures, which is based on the country epidemiological situation. The obtained results can be useful for scientists, representatives of state and local authorities.

Determining the temporal patterns of the impact of financial determinants and public health factors on the local community resilience in the context of overcoming the consequences of the COVID-19 pandemic

In the article it is developed a methodological toolkit for determining the temporal patterns of the influence of financial determinants and public health factors on the local community resilience in the context of overcoming the consequences of the COVID-19 pandemic, based on the use of panel data regression modeling (testing for the presence of a lag of up to 3 years). The practical approbation of the approach was carried out on the basis of a sample from 21 European countries for the period 2000-2021. The following indicators were chosen as local community resilience parameters (outcome indicators): level of tax revenue decentralization; the level of income decentralization (ratio of own incomes of local budgets to central government incomes); the level of expenditure decentralization (the ratio of own expenditures of local budgets to central government expenditures). The financial and infrastructural factors of public health, the impact of which on performance indicators was studied, are the following: the number of beds (per 1,000 people); capital expenditures for health care (% of GDP); current health care expenditures (% of GDP); domestic government health care expenditures (% of current health care expenditures); domestic private health care expenditures (% of current health care expenditures); out-of-pocket health care expenditures (% of current health care expenditures). Based on the results of the approbation of the developed approach, immediate drivers and inhibitors of ensuring local community resilience, as well as drivers and inhibitors of delayed action, were identified. The obtained results allow us to note that in the context of strengthening the financial resilience of local community, it is necessary to increase the number of hospital beds, as well as the volume of current expenditures on health care, and to ensure this growth mainly by the expenditures from private financial resources and out-of-pocket expenditures.

Association between Economic Growth, Mortality, and Healthcare Spending in 31 High-Income Countries.

This study aims to investigate the association between gross domestic product (GDP), mortality rate (MR) and current healthcare expenditure (CHE) in 31 high-income countries. We used panel data from 2000 to 2017 collected from WHO and OECD databases. The association between CHE, GDP and MR was investigated through a random-effects model. To control for reverse causality, we adopted a test of Granger causality. The model shows that the MR has a statistically significant and negative effect on CHE and that an increase in GDP is associated with an increase of CHE (p < 0.001). The Granger causality analysis shows that all the variables exhibit a bidirectional causality. We found a two-way relationship between GDP and CHE. Our analysis highlights the economic multiplier effect of CHE. In the debate on the optimal allocation of resources, this evidence should be taken into due consideration.

Expenditure on Heart Failure in the United States: The Medical Expenditure Panel Survey 2009-2018

BackgroundWith rising United States health care expenditure, estimating current spending for patients with heart failure (HF) informs the value of preventative health interventions. ObjectivesThe purpose of this study was to estimate current health care expenditure growth for patients with HF in the United States. MethodsThe authors pooled MEPS (Medical Expenditure Panel Survey) data from 2009-2018 to calculate total HF-related expenditure across clinical settings in the United States. A 2-part model adjusted for demographics, comorbidities, and year was used to estimate annual mean and incremental expenditures associated with HF. ResultsIn the United States, an average of $28,950 (2018 inflation-adjusted dollars) is spent per year for health care–related expenditure for individuals with HF compared with $5,727 for individuals without HF. After adjusting for demographics and comorbidities, a diagnosis of HF was associated with $3,594 in annual incremental expenditure compared with those without HF. HF-related expenditure increased from $26,864 annual per person in 2009-2010 to $32,955 in 2017-2018, representing a 23% rise over 10 years. In comparison, expenditure on myocardial infarction, type 2 diabetes mellitus, and cancer grew by 16%, 28%, and 16%, respectively. Most of the cost was related to hospitalization: $12,569 per year. Outpatient office-based care and prescription medications saw the greatest growth in cost over the period, 41% and 24%, respectively. Estimated incremental national expenditure for HF per year was $22.3 billion; total annual expenditure for adults with HF was $179.5 billion. ConclusionsHF is a costly condition for which expenditure is growing faster than that of other chronic conditions.

Influence of Health Expenditure on COVID-19 Contraction: Theoretical and Empirical Analysis

Intensive economic development leads to the inevitable consequences of anthropogenic impact on the environment. Air pollution, soil degradation, water pollution and lack of clean drinking water lead to deteriorating human health and increasing the burden on the health care system. Globalization and integration have also become important drivers of the rapid spread of the COVID-19 pandemic. All this leads to the need to transform the health care system and the model of its financing, and adapt it to these challenges. The aim of this work is to identify theoretical (based on bibliometric analysis) and empirical (based on panel data regression modelling) patterns of the impact of health care expenditure on the effectiveness of the COVID-19 combating. The theoretical part of the work involves the implementation of bibliometric analysis based on 262 Scopus publications, in the title, keywords or annotations of which both concepts such as «health expenditure» and «COVID-19» are mentioned. The practical implementation of this task is carried out using VOSviewer v.1.6.17. According to the results of the bibliometric analysis, contextual, geographical and temporal patterns of publishing activity of scientists on certain issues were revealed. The empirical part of the work involves a statistical analysis to identify the relationship between morbidity and mortality due to COVID-19 and the volatility of the share of current health expenditure in GDP and its structure. The task of this stage is to determine the benchmarking model of financial support of the health care system, which demonstrates the greatest resistance to COVID-19. The analysis was conducted on the basis of data for 13 countries in Europe and Asia (Azerbaijan, Belarus, Armenia, Georgia, Estonia, Latvia, Lithuania, Moldova, Poland, Romania, Slovakia, Hungary and Ukraine). According to statistical analysis, the most resistant to COVID-19 is the health care system of Estonia, which is characterized by the volume of health care expenditure at 4-6% of GDP. At the same time, in the structure of the current health care expenditure, 25% is private expenditure and 75% is government expenditure, and external financing is almost non-existent. However, similar proportions of public and private expenditure in other countries do not ensure similar resistance to coronavirus, so this ratio is not a benchmark. A more in-depth analysis using panel regression modelling in Stata 12/SE revealed the positive impact of public, private and external health expenditures on reducing mortality, as well as the positive impact of increasing current health expenditures on life expectancy. The obtained theoretical and practical results can be useful for scientists and government officials in the context of optimizing the financial support of the health care system, taking into account its effectiveness in resisting national and global threats (COVID-19).

Association between economic growth, mortality and healthcare spending in 31 high-income countries

Abstract Background During the last decades, countries' healthcare spending has grown continuously, becoming a major expenditure item and threatening the overall sustainability of healthcare systems. Plenty of literature shows conflicting evidence about the relationship between economic variations and measurable health outcomes. This study aims to investigate the association between GDP, population mortality and healthcare spending in OECD high-income countries. Methods We conducted a cross-sectional study using panel data across 31 high-income countries from 2000 to 2017. Socioeconomic data for every year and each country were extracted from WHO and OECD Database. The association between current healthcare expenditure (CHE), GDP and mortality rate (MR) was investigated through a random-effects model. To control for possible reverse causality, we adopted a test of Granger causality for heterogeneous panel data models. Results The results of the random-effects model show that the MR has no statistically significant effect on CHE. We found no statistically significant association between countries' MR and GDP when the latter is the dependent variable. Our results show that an increase in GDP is associated with a significant increase of CHE (b = 0.066, p &amp;lt; 0.001) and CHE is significantly associated with an increase in GDP (b = 3.188, p &amp;lt; 0.001). The Granger causality analysis shows a unidirectional association between MR and CHE, with MR influencing CHE, albeit with a small statistical significance (p = 0.045). Between GDP and CHE, the causality is bidirectional, while between GDP and MR we found no causality. Conclusions In this study, we found a strong two-way relationship between GDP and CHE, both in the causality analysis and in the random-effect panel model. Our analysis highlights the economic multiplier effect of CHE. In the debate on the optimal allocation of resources often resulting from economic crises, this evidence should be taken into due consideration. Key messages Policymakers worldwide need to recognize the economic impact of healthcare spending when allocating financial resources. Spending on health leads to economic growth. In light of the current health-economy dichotomy, it is important to produce robust scientific evidence supporting healthcare spending.

Optimizing a Surgical Practice from Start to Finish

Relative to other nations, health care in the United States is costly, poorly coordinated, and underperforms across a spectrum of qualitative metrics [1]. Current health care expenditures (2019) represent a $3.8 trillion dollar cost to the US economy, an increase of 4.7% over the previous year [2]. Of these expenditures, surgical and hospital-based procedures and care comprise the largest proportion. Despite 80 million surgical procedures being performed annually, and at enormous cost, our delivery system is plagued by systemic inefficiency, fragmentation, and wide practice-to-practice variations in quality, cost, and perioperative care plans [3].

Impacts from Economic Development and Environmental Factors on Life Expectancy: A Comparative Study Based on Data from Both Developed and Developing Countries from 2004 to 2016.

Both economic development level and environmental factors have significant impacts on life expectancy at birth (LE). This paper takes LE as the research object and selects nine economic and environmental indicators with various impacts on LE. Based on a dataset of economic and environmental indicators of 20 countries from 2004 to 2016, our research uses the Pearson Correlation Coefficient to evaluate the correlation coefficients between the indicators, and we use multiple regression models to measure the impact of each indicator on LE. Based on the results from models and calculations, this study conducts a comparative analysis of the influencing mechanisms of different indicators on LE in both developed and developing countries, with conclusions as follow: (1) GDP per capita and the percentage of forest area to land area have a positive impact on LE in developed countries; however, they have a negative impact on LE in developing countries. Total public expenditure on education as a percentage of GDP and fertilizer consumption have a negative impact on LE in developed countries; however, they have a positive impact on LE in developing countries. Gini coefficient and average annual exposure to PM2.5 have no significant effect on LE in developed countries; however, they have a negative impact on LE in developing countries. Current healthcare expenditures per capita have a negative impact on LE in developed countries, and there is no significant impact on LE in developing countries. (2) The urbanization rate has a significant positive impact on LE in both developed countries and developing countries. Carbon dioxide emissions have a negative impact on LE in both developed and developing countries. (3) In developed countries, GDP per capita has the greatest positive impact on LE, while fertilizer consumption has the greatest negative impact on LE. In developing countries, the urbanization rate has the greatest positive impact on LE, while the Gini coefficient has the greatest negative impact on LE. To improve and prolong LE, it is suggested that countries should prioritize increasing GDP per capita and urbanization level. At the same time, countries should also work on reducing the Gini coefficient and formulating appropriate healthcare and education policies. On the other hand, countries should balance between economic development and environmental protection, putting the emphasis more on environmental protection, reducing environmental pollution, and improving the environment’s ability of self-purification.

Intellectual capital-based performance improvement: a study in healthcare sector

BackgroundKnowledge resources are in most productive sectors distinctive in terms of competitiveness. Still, in the health sector, they can have an impact on the health of the population, help make the organisations more efficient and can help improve decision-making processes. The purpose of this paper is to investigate the Intellectual Capital impact on healthcare organization’ performance in the Italian healthcare system.MethodsThe theoretical framework linked to intellectual Capital in the health sector and the performance evaluation related to efficiency supports the analysis carried out in two stages to determine the right placement of resources and the exogenous variables that influence performance level. The evaluation of the impact of the ICs on performance is determined through the Data envelopment analysis. The incidence of the exogenous variables has been established through linear regression.ResultsEmpirical results in Italy show some IC components influence organization ‘performance (Essential Levels of Assistance) and could be used for defining the policy of allocation of resources in healthcare sector. The efficiency of 16 regions considered in 2016 based on Slack-Based-Model constant returns-to-scale (SBM-CRS) and Slack-Based-Model variable returns-to-scale (SBM-VRS) identifies a different ability to balance IC and performance. Current healthcare expenditure and the number of residents is correlated with the identified efficiency and performance levels.ConclusionsThis paper embeds an innovative link between healthcare performance, in term of efficiency and IC which aligns resource management with future strategy. The study provides a new decision-making approach.

Association of Country-Specific Socioeconomic Factors With Survival of Patients Who Experience Severe Classic Acute Graft-vs.-Host Disease After Allogeneic Hematopoietic Cell Transplantation. An Analysis From the Transplant Complications Working Party of the EBMT.

Acute graft-vs.-host disease (aGvHD) is one of the most frequent causes of transplant-related mortality (TRM) after allogeneic hematopoietic cell transplantation (alloHCT). Its treatment is complex and costly. The aim of this study was to retrospectively analyze the impact of country-specific socioeconomic factors on outcome of patients who experience severe aGvHD. Adults with hematological malignancies receiving alloHCT from either HLA-matched siblings (n = 1,328) or unrelated donors (n = 2,824) developing grade 3 or 4 aGvHD were included. In univariate analysis, the probability of TRM at 2 years was increased for countries with lower current Health Care Expenditure (HCE, p = 0.04), lower HCE as % of Gross Domestic Product per capita (p = 0.003) and lower values of the Human Development Index (p = 0.02). In a multivariate model, the risk of TRM was most strongly predicted by current HCE (HR = 0.76, p = 0.006). HCE >median was also associated with reduced risk of the overall mortality (HR 0.73, p = 0.0006) and reduced risk of treatment failure (either relapse or TRM; HR 0.77, p = 0.004). We conclude that country-specific socioeconomic factors, in particular current HCE, are strongly associated with survival of patients who experience severe aGvHD.

The Impact of Private Insurance Access on Nonurgent Inflammatory Bowel Disease-Related Emergency Department Use

Abstract Background Inflammatory bowel disease (IBD)-related Emergency Department (ED) visits are a costly component to current healthcare expenditures. Patients who are discharged directly from the ED for nonurgent issues (aka “treat and release” ED visits) present an opportunity for quality improvement. Purpose To determine the impact of private insurance on IBD-related treat and release ED visits. The secondary outcome was cost per IBD-related ED visit. Methodology A retrospective cohort study was performed on the 2006 Nationwide Emergency Department Sample (NEDS). Comparisons were made between patients with access to private insurance vs those without. Multivariable survey-weighted logistic and linear regression models with clustering by hospital were created for the primary and secondary outcomes, respectively. Results In total, 19,324 patient encounters were included in the stratified analytic sample. Of these, 9272 (47.98%) patients reported private insurance as their primary payment method. An additional 10,052 (52.02%) patients reported an alternative payment form. The private insurance group was statistically younger, less likely to reside in an urban setting and had more representation within the highest income quartile. The OR of a treat and release ED visit was 1.47 (95% confidence interval 1.34–1.62) for no private insurance compared to private insurance. On average, the cost per ED visit of patients without private insurance was $214.80 ± 48.48, P &amp;lt; 0.001 less than those with private insurance. Conclusions Lack of private insurance is an important predictor of IBD-related treat and release ED visits.

Impact of overweight or obesity trajectory on health expenditure in Korea.

This study aimed to identify the effect of the overweight or obesity (OWOB) trajectory on current health care expenditure in South Korea. Ten years of publicly released data (2002-12) were obtained in 2016 from a retrospective cohort of National Health Insurance System claims. This study included 51,844 adults (aged 30-59 years in 2002) and 21,196 elderly adults (aged ≥ 60 years in 2002). Compared with adults who maintained normal weight (NW), higher yearly total health expenditures were estimated for adults who lost weight over the 10-year period: by 11.5% (95% confidence interval (CI): 0.18-22.96%) when changing from NW to underweight (UW) and 6.2% (95% CI: 0.47-12.01%) from OWOB to UW/NW. Elderly adults had higher health expenditures when they lost weight by 14.0% (95% CI: 0.37-27.70%) from NW to UW and 6.8% (95% CI: 0.13-13.51%) from OWOB to UW/NW compared with when they maintained NW. These findings indicate the importance of early intervention to control OWOB, particularly because people in late adulthood have greater health care needs for reasons other than OWOB.

Measuring healthcare expenditure: different methods, different results.

Accurate information on healthcare expenditure is essential; however, a number of issues arise when healthcare expenditure is being measured. Traditionally healthcare expenditure data in Ireland have been limited, especially data that facilitate comparable analysis through time and across particular programmes or services. Recently however, a major development in Irish healthcare expenditure estimates was the publication of Irish healthcare current expenditure estimates for 2013 according to the international standard of the OECD System of Health Accounts (SHA). The aim of the analysis presented in this paper is to examine how alternative methodologies for measuring healthcare can influence the estimate(s) of healthcare expenditure. The methods and results (in terms of healthcare expenditure) of the Central Statistics Office (CSO) application of SHA methodology will be compared and contrasted with an alternative methodology for measuring healthcare expenditure developed by Wren et al. [1]. The two approaches to measuring healthcare expenditure in Ireland reached a very similar figure for total current healthcare expenditure in 2013. However, there were considerable disparities in the components of expenditure. There is no one absolute definition or estimate of healthcare expenditure, and different methodological approaches to estimating expenditure will likely yield different results. Therefore, care is required when assessing healthcare expenditure to ensure that there is a clear understanding about what is and is not included in the estimate.

Incentives in Rheumatology: the Potential Contribution of Physician Responses to Financial Incentives, Public Reporting, and Treatment Guidelines to Health Care Sustainability.

Concerns about the sustainability of current health care expenditure are focusing attention on the cost, quality and value of health care provision. Financial incentives, for example pay-for-performance (P4P), seek to reward quality and value in health care provision. There has long been an expectation that P4P schemes are coming to rheumatology. We review the available evidence about the use of incentives in this setting and provide two emerging examples of P4P schemes which may shape the future of service provision in rheumatology. Currently, there is limited and equivocal evidence in rheumatology about the impact of incentive schemes. However, reporting variation in the quality and provision of rheumatology services has highlighted examples of inefficiencies in the delivery of care. If financial incentives can improve the delivery of timely and appropriate care for rheumatology patients, then they may have an important role to play in the sustainability of health care provision.