Differences In Medical Expenditures Research Articles

Incremental health care expenditures associated with hypertension in South Korea.

Hypertension is a significant risk factor for cardiovascular disease and the number of deaths due to hypertension increases annually. The increasing healthcare costs of hypertension are a major societal and personal issue. By estimating the medical expenses incurred by patients with hypertension, this study aimed to provide information on the additional costs of hypertension and emphasize the importance of blood pressure management. Health Panel data from 2014 to 2018 were used to calculate incremental out-of-pocket healthcare costs associated with hypertension. First, we compared the mean annual differences in medical expenditure of people with and without hypertension each year. Second, we analyzed five-year panel data from 2014 to 2018 using random Generalized Least Squares. In a cross-sectional mean difference analysis, we found that as of 2018, individuals with hypertension spent an average of 545,489 won more per year on healthcare than those without hypertension. In a five-year panel data analysis, hypertension was associated with an average of 338,799 won in medical expenses per year for the same sex, age, income groups, number of cormorbility and other lifestyle factor. Hypertension incurs incremental costs in treating the condition and its complications. This study aimed to provide information on out-of-pocket healthcare costs associated with hypertension. We highlight the importance of ongoing disease management by discussing the financial burden of chronic diseases on individuals. Managing blood pressure at a young age can reduce healthcare costs throughout an individual's lifetime.

Association of rurality, type of primary caregiver and place of death with end-of-life medical expenditures among the oldest-old population in China

BackgroundUnderstanding whether the type of primary caregiver and end-of-life (EOL) care location are associated with EOL medical expenditures is crucial to inform global debates on policies for efficient and effective EOL care. This study aims to assess trends in the type of primary caregiver and place of death stratified by rural‒urban status among the oldest-old population from 1998–2018 in China. A secondary objective is to determine the associations between rurality, the type of primary caregiver, place of death and EOL medical expenditures. MethodsA total of 20,149 deaths of people aged 80 years or older were derived from the Chinese Longitudinal Health Longevity Survey (CLHLS). Cochran-Armitage tests and Cuzick’s tests were used to test trends in the type of primary caregiver and place of death over time, respectively. Tobit models were used to estimate the marginal associations of rurality, type of primary caregiver, and place of death with EOL medical expenditures because CLHLS sets 100,000 Chinese yuan (approximately US$15,286) as the upper limit of the outcome variable. ResultsOf the 20,149 oldest-old people, the median age at death was 97 years old, 12,490 (weighted, 58.6%, hereafter) were female, and 8,235 lived in urban areas. From 1998–2018, the prevalence of informal caregivers significantly increased from 94.3% to 96.2%, and home death significantly increased from 86.0% to 89.5%. The proportion of people receiving help from informal caregivers significantly increased in urban decedents (16.5%) but decreased in rural decedents (-4.0%), while home death rates significantly increased among both urban (15.3%) and rural (1.8%) decedents. In the adjusted models, rural decedents spent less than urban decedents did (marginal difference [95% CI]: $-229 [$-378, $-80]). Those who died in hospitals spent more than those who died at home ($798 [$518, $1077]). No difference in medical expenditures by type of primary caregiver was observed.ConclusionsOver the past two decades, the increases in informal caregiver utilization and home deaths were unequal, leading to substantially higher EOL medical expenditures among urban decedents and deceased individuals who died at hospitals than among their counterparts who lived in rural areas and died at home.

Relationship between Household Income, Region and Household Healthcare Expenditure——Empirical research based on the data of China Family Tracking Survey (CFPS)

China's economy has been rapid development in recent years, the residents income is also rising, China's household per capita disposable income growth, the corresponding family health spending also presents the fast growth, while at the same time family per capita health spending continues to grow, but nearly 10 years of family health spending growth is greater than the household disposable income growth, today, After housing and food, medical expenses have become the biggest consumption expenditure of most Chinese households. The medical expenditure caused by diseases is an important factor affecting family happiness, and the aggravation of medical burden decreases family happiness. The differences between urban and rural areas and different regions not only affect the income of families, but also affect the medical expenditure of families from the aspects of medical service quality and health awareness. In addition, the implementation of medical insurance policy also alleviates the medical burden of families to a certain extent. This paper selects microscopic data of CFPS surveyed in 2016 and 2018, and conducts empirical analysis on data of tens of thousands of families with different living conditions in various regions. The results show that income is an important factor affecting family medical expenditure, and family size and health care focus will also affect family medical expenditure. Urban and rural residents and residents in different areas also show differences in medical expenditure

Are the costs of employer-sponsored health insurance passed on to workers at the individual level?

Because employer-sponsored health insurance (ESI) is experience rated, employers have an incentive to try to offset its cost by paying lower wages to employees who have greater medical expenditures. The existing evidence on this topic, however, illustrates only that ESI is associated with lower wages for groups of workers who are costlier to cover. In contrast, I use the variation provided by the Affordable Care Act's employer mandate to examine if differences in medical expenditures are passed on to workers at the individual level. My estimates rely on Medical Expenditure Panel Survey data in a dose response difference-in-difference framework that examines how wages change for workers with varying medical expenditures when they must soon be offered ESI. I find that each $1 difference in medical expenditures is associated with a $0.35 to $0.51 wage offset after the employer mandate's announcement wherever ESI must soon be offered to workers. Placebo analyses, focusing on workers whose employers are not affected by the mandate, provide support for a causal interpretation. I also show that my findings are not sensitive to sample selection or data reliability issues and that they cannot be explained by the effects of the Great Recession, demographic characteristics that correlate with medical expenditures, or location- or industry-specific idiosyncratic shocks.

Assessing trends in medical expenditures and measuring the impact of health-related quality of life on medical expenditures for U.S. adults with diabetes associated chronic kidney disease using 2002–2016 medical expenditure panel survey data

Abstract Background Chronic Kidney Disease (CKD) is one of the most expensive comorbidities of diabetes. The changes in medical expenditures over the years and the latest economic burden of CKD among diabetes are unknown. Objectives (1) To examine the trend and estimate the differences in medical expenditures between adults with diabetes-associated CKD and diabetes-no CKD from 2002 to 2016 using Medical Expenditure Panel Survey data (2) To study the impact of health-related quality of life (HRQOL) on medical expenditure for adults with diabetes-associated CKD. Methods This is a retrospective cross-sectional study. Descriptive statistics were used for studying the trend in medical expenditures from 2002 to 2016. HRQOL was measured using physical and mental component summary (PCS, MCS). Two-part model was utilized for estimating the incremental medical expenditure for diabetes patients by CKD status. Key findings A total of 35,112 diabetic adults were identified in the Medical Expenditure Panel Survey dataset. Among these, 3,489 individuals had CKD. The pooled mean expenditure for diabetes-associated CKD was $25,953 which was almost double of $12,170 for patients with diabetes and no CKD. Individuals with diabetes CKD had $12,109 higher adjusted direct incremental medical expenditure as compared to diabetes-no CKD. With respect to HRQOL, individuals in the highest quartile of PCS and MCS spent $18,076 and $10,307 lesser than those in the lowest quartile respectively. Conclusions Medical expenditures associated with CKD are a significant contributor to the financial burden among diabetes adults. Improvements in HRQOL also lead to lower healthcare costs in diabetes-associated CKD patients.

Trends in Medical Expenditures by Race/Ethnicity in Adults with Type 2 Diabetes 2002-2011

ObjectiveThe objective of the study was to examine racial/ethnic differences in medical expenditures (prescription, office-based, in-patient, out-patient, emergency room, total) over time, overall and by type of expenditure, in a nationally representative sample of adults with diabetes. MethodsA weighted sample of 17,820,243 adults aged ≥18 with diabetes from the Medical Expenditure Panel Survey (MEPS) dataset from 2002 to 2011 were analyzed for this study. Multiple comparison testing and general linear model (GLM) were used to test for differences in expenditures by race. Total unadjusted expenditures by racial/ethnic category stratified by different insurance categories (privately insured, publicly insured, uninsured and overall) were also estimated. ResultsNon-Hispanic Whites (NHW) had more than $4000 higher expenditures than Hispanics and Other races (p < 0.0001). Prescription costs were about $410 less for Non-Hispanic Blacks (NHB) (p < 0.0001), and more than $600 less for Hispanics (p < 0.0001) and Others (p < 0.0001) compared to NHW. ConclusionMinority groups with type 2 diabetes were found to have significantly less total expenditures, with the exception of total expenditures for NHB compared to NHW. These findings indicate minorities with type 2 diabetes may be receiving less care than NHW, which has implications for the known disparities in health outcomes and complications in individuals with diabetes.

PUK19 ASSESSING TREND IN MEDICAL EXPENDITURE AND MEASURING THE IMPACT OF HEALTH-RELATED QUALITY OF LIFE (HRQOL) ON MEDICAL EXPENDITURE FOR U.S. ADULTS WITH DIABETES ASSOCIATED CHRONIC KIDNEY DISEASE (CKD)USING 2002-2016 MEDICAL EXPENDITURE PANEL SURVEY (MEPS) DATA

In the United States, 9.4% of the population is currently living with diabetes and over 247,000 are suffering from diabetes caused kidney failure. Chronic Kidney Disease (CKD) is one of the most expensive comorbidities of diabetes. The changes in medical expenditures over the years and the latest economic burden of CKD among diabetes patients is unknown. We aim to 1) examine the trend and estimate the differences in medical expenditures between adults with diabetes associated CKD and diabetes-no CKD from 2002 to 2016 using Medical Expenditure Panel Survey data, and 2) study the impact of health-related quality of life (HRQoL) on medical expenditure for adults with diabetes associated CKD.

Differences in Medical Expenditures for Men and Women with Diabetes in the Medical Expenditure Panel Survey, 2008-2016.

Background: Evidence suggests that women have increased health care costs; however, little is known about expenditures for women with diabetes compared with men with diabetes. The objective of this study was to calculate expenditures for men and women and to identify factors associated with increased costs in women.Materials and Methods: Adults with diabetes (n = 2,078) from the 2011 Medical Expenditure Panel Survey (MEPS) were identified. A generalized linear model with gamma distribution and log link was used to estimate incremental expenditure in women compared with men and to identify reasons for this difference. Sequential models were analyzed by entering variables in blocks (demographics, medical comorbidities, mental comorbidity and disability, and functional limitation). IRB approval was waived for this secondary data analysis.Results: Unadjusted mean total expenditures were $12,485 for women with diabetes compared with $10,828 for men (p = 0.04). In the model with demographic variables and medical comorbidities, expenditures for women increased to $1,720 (p = 0.03) (95% confidence interval [CI] 164–3,266) compared with men. With a comorbid mental health disorder, expenditures for women decreased slightly, but they remained significantly higher than for men at $1,668 (p = 0.04) (95% CI 104–3,222). In the final analysis with all variables, incremental expenditures increased by $1,314 for women compared with men and were no longer statistically significantly higher than for men (p = 0.10; 95% CI −257 to 2,933).Conclusions: Our findings show that women with diabetes have increased expenditures for health care compared with men with diabetes. Increased functional limitation and disability in women account for incremental increases in costs, which suggest a need for more efforts to manage disability burden in women with diabetes.

Regional Differences in Specific Health Examination Utilization and Medical Care Expenditures in Japan

Background: Despite having one of the most successful health systems in the world, annual medical expenditures in Japan have been increasing year to year. We sought to clarify regional differences in medical expenditures by analyzing the relationship between the specific health examination coverage and medical care expenditure by prefecture of Japan. Methods: We used data from the National Database of Health Insurance Claims and Specific Health Checkups (NDB) Open Data Japan (2015) and Overview of 2015 National Medical Expenses to compare medical care expenditure per capita and proportions of persons receiving specific health examination between Japan nationally and individual prefectures. Results: National medical expenditures were 42.3 trillion Japanese yen (JPY) (3851 hundred million dollars), with a national per capita rate of JPY347,219 (USD3156). Per capita medical expenditure rates by prefecture ranged from JPY290,900 (USD2645) in Saitama Prefecture to JPY 444,000 (USD4036) in Kochi Prefecture. The proportion of persons receiving specific health examinations was 49.0% for Japan overall and ranged from 39.3% in Hokkaido Prefecture to 63.4% in Tokyo Prefecture. We observed a significant negative correlation between per capita medical expenditures and the proportion of persons receiving specific health examinations (R = 0.553, p < 0.001). Conclusion: We found a significant negative correlation between per capita medical expenditures and the proportion of persons receiving health examinations: prefectures with lower expenditures tended to have higher rates of medical examinations. Interventions to increase the proportion of persons receiving specific health examinations by prefecture could reduce per capita medical expenditures and reduce prefectural disparities in expenditures.

Exploration of Medical Trajectories of Stroke Patients Based on Group-Based Trajectory Modeling.

A high mortality rate is an issue with acute cerebrovascular disease (ACVD), as it often leads to a high medical expenditure, and in particular to high costs of treatment for emergency medical conditions and critical care. In this study, we used group-based trajectory modeling (GBTM) to study the characteristics of various groups of patients hospitalized with ACVD. In this research, the patient data were derived from the 1 million sampled cases in the National Health Insurance Research Database (NHIRD) in Taiwan. Cases who had been admitted to hospitals fewer than four times or more than eight times were excluded. Characteristics of the ACVD patients were collected, including age, mortality rate, medical expenditure, and length of hospital stay for each admission. We then performed GBTM to examine hospitalization patterns in patients who had been hospitalized more than four times and fewer than or equal to eight times. The patients were divided into three groups according to medical expenditure: high, medium, and low groups, split at the 33rd and 66th percentiles. After exclusion of unqualified patients, a total of 27,264 cases (male/female = 15,972/11,392) were included. Analysis of the characteristics of the ACVD patients showed that there were significant differences between the two gender groups in terms of age, mortality rate, medical expenditure, and total length of hospital stay. In addition, the data were compared between two admissions, which included interval, outpatient department (OPD) visit after discharge, OPD visit after hospital discharge, and OPD cost. Finally, the differences in medical expenditure between genders and between patients with different types of stroke—ischemic stroke, spontaneous intracerebral hemorrhage (sICH), and subarachnoid hemorrhage (SAH)—were examined using GBTM. Overall, this study employed GBTM to examine the trends in medical expenditure for different groups of stroke patients at different admissions, and some important results were obtained. Our results demonstrated that the time interval between subsequent hospitalizations decreased in the ACVD patients, and there were significant differences between genders and between patients with different types of stroke. It is often difficult to decide when the time has been reached at which further treatment will not improve the condition of ACVD patients, and the findings of our study may be used as a reference for assessing outcomes and quality of care for stroke patients. Because of the characteristics of NHIRD, this study had some limitations; for example, the number of cases for some diseases was not sufficient for effective statistical analysis.

1632-P: Trends in Obesity and Medical Expenditure among Women with Diabetes, 2008-2016: Differences by Race/Ethnicity

Background: Obesity results in significant morbidity, preventable mortality, and increased medical expenditures among women with diabetes. The aim of this study was to examine racial/ethnic differences in obesity trends and medical expenditures among a nationally representative sample of women with diabetes. Methods: Nine years of data (2008-2016) from the Medical Expenditure Panel Survey (MEPS) Full Year Consolidated File were used for the analyses. Cochran-Armitage tests were used to determine statistical significance of trends in obesity and mean expenditure for women with diabetes. Two-part statistical modeling with a combination of binomial and positive distributions was used to evaluate differences in medical expenditure. Data were clustered to 3 time points: 2008-2010, 2011-2013, 2014-2016. BMI levels were classified as underweight (&amp;lt;18.5), normal (≥18.5 - 24.9, overweight (≥25.0 - 29.9), and obese (≥30.0 - 134.7). Analyses were weighted for the U.S. population. Results: Cochran-Armitage tests showed trends in obesity from 2008 to 2016 differed significantly between Hispanic and Non-Hispanic white (NHW) women with diabetes (p=0.01). Among obese women, trends in mean medical expenditures differed significantly between Hispanic (p&amp;lt;0.001), non-Hispanic black (NHB) (p&amp;lt;0.001), and other (p&amp;lt;0.001) women with diabetes compared to NHW women with diabetes. Two-part modeling showed obese Hispanic (-0.66 (-0.87, -0.42)) and NHB (-0.33 (-059, -0.01)) women with diabetes were significantly less likely to spend on healthcare compared to NHW women with diabetes; however, among those with expenditure, Hispanic women spent 30% less ($4520.81) and NHB women spent 17% less ($2555.72) compared to NHW women with diabetes. Conclusions: These findings suggest further understanding of the factors associated with differences in trends for obesity between Hispanic and NHW women with diabetes and medical expenditures among obese minority and NHW women with diabetes. Disclosure J.S. Williams: None. S. Nagavally: None. L.E. Egede: Consultant; Self; Novo Nordisk Inc. Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Funding National Institutes of Health

The Impact of a Heart Failure Management Program in a Medicare Advantage Population.

Heart failure (HF) is currently among the most prevalent and costly chronic diseases among older adults, who are at increased risk because of other chronic conditions and the aging process. HF has a significant impact on the health care system, patient outcomes, and the unsustainable rising costs of care. The primary objectives were to: (1) determine cost savings differences in medical expenditures between engaged and non-engaged members referred to a HF management program; (2) examine differences in length of stay and time to first post-engagement acute inpatient admission; and (3) examine the impact of using a remote weight monitoring scale on medical expenditures and inpatient admissions. Generalized linear modeling was used to compare key outcomes among individuals who engaged in the program and a propensity-matched cohort of those who were eligible but did not engage. Key outcomes included post-engagement acute inpatient medical service utilization, all-cause per-member-per-month medical expenses, and acute inpatient length of stay. When paired with regular use of a remote weight monitoring scale, engagement in this HF management program appears to be associated with decreased risk for acute inpatient admission and lower all-cause medical expenditures. Participation in a clinically based HF management program may improve health-related and financial outcomes among older individuals. However, further development and evaluation of disease management programs could help to improve their effectiveness and thus patient outcomes.

The impact of arthritis and joint pain on individual healthcare expenditures: findings from the Medical Expenditure Panel Survey (MEPS), 2011

BackgroundJoint pain, including back pain, and arthritis are common conditions in the United States, affecting more than 100 million individuals and costing upwards of $200 billion each year. Although activity limitations associated with these disorders impose a substantial economic burden, this relationship has not been explored in a large U.S. cohort.MethodsIn this study, we used the Medical Expenditures Panel Survey to investigate whether functional limitations explain the difference in medical expenditures between patients with arthritis and joint pain and those without. We used sequential explanatory linear models to investigate this relationship and accounted for various covariates.ResultsUnadjusted mean expenditures were $10,587 for those with joint pain or arthritis, compared with $3813 for those without. In a fully adjusted model accounting also for functional limitations, those with joint pain or arthritis paid $1638 more than those without, a statistically significant difference.ConclusionsThe growing economic and public health burden of arthritis and joint pain, as well as the corresponding complications of functional, activity, and sensory limitations, calls for an interdisciplinary approach and heightened awareness among providers to identify strategies that meet the needs of high-risk patients in order to prevent and delay disease progression.

Association between periodontitis and medical expenditure in older adults: A 33-month follow-up study.

Along with rapid aging, medical expenditure for older adults has been increasing in Japan. Research has shown that periodontitis is a useful predictor for excess medical expenditure; however, limited information is available on the elderly population after adequately considering confounding factors. The aim of the present study was to evaluate the association between periodontitis and long-term medical expenditure in elderly Japanese. Baseline health and periodontal examinations were carried out in June 2008. Japanese adults (n = 245) aged 80 years were classified into quartiles based on periodontal inflamed surface area (PISA), which quantifies the degree of periodontal inflammation. Medical care use and costs were monitored by assessment of the National Health Insurance claim files from the baseline survey through the end of February 2011. Multivariable analysis of the differences in medical expenditure among PISA quartiles was carried out using linear regression with robust standard errors. The participants in the fourth (with the largest PISA) and third quartiles had significantly higher inpatient medical expenditure compared with those of the first quartile (P < 0.01 and = 0.04, respectively). Participants in the fourth quartile had significantly higher total medical expenditure (P < 0.01) compared with the first quartile. A trend was observed of higher inpatient and total medical expenditure with increasing PISA. A significant association was found between periodontitis and future increase in medical expenditure, suggesting that periodontitis might be a modifiable factor for the reduction of excess medical expenditure among elderly Japanese. Geriatr Gerontol Int 2016; 16: 856-864.

Case Management for Medical Aid Beneficiaries in Korea: Findings from Case-control Study

This study was to evaluate effects of case management provided for 7 months for medical aid in Korea. This study was a retrospective comparative study using secondary data analysis. Data from two pre-existing survey were reanalyzed. The data were collected through door to-door interviews using the structured questionnaire. For the medical service use, claims data from the Korea National Health Insurance Corporation was used. Subjects were 73 in the intervention group and 118 in the control group. There was no significant change in the intervention group in self-care ability (p = .296), medication adherence (p = .194) or quality of life (p = .903) compared to those of the control group. For hospital visiting days, it appeared to decrease in the intervention group (p = .038) but with no significant difference from that of the control group (p = .157). Neither were there significant differences in medical expenditures (p = .605). Although the effect of case management in this study appeared extremely limited, the short intervention period and characteristics of the medical aid beneficiaries and the limit of controlling only the demand side were discussed as factors to be considered. Nurses have been carrying out professional roles in case management in Korea. However more efforts are needed to develop case management as an area for nursing specialization.

Medical expenditures among immigrant and nonimmigrant groups in the United States: findings from the Medical Expenditures Panel Survey (2000-2008).

The objective of the study was to examine time trends and differences in medical expenditures between noncitizens, foreign-born, and US-born citizens. We used multi-year Medical Expenditures Panel Survey (2000-2008) data on noninstitutionalized adults in the United States (N=190,965). Source specific and total medical expenditures were analyzed using regression models, bootstrap prediction techniques, and linear and nonlinear decomposition methods to evaluate the relationship between immigration status and expenditures, controlling for confounding effects. We found that the average health expenditures between 2000 and 2008 for noncitizens immigrants ($1836) were substantially lower compared with both foreign-born ($3737) and US-born citizens ($4478). Differences were maintained after controlling for confounding effects. Decomposition techniques showed that the main determinants of these differences were the availability of a usual source of health care, insurance, and ethnicity/race. Lower health care expenditures among immigrants result from disparate access to health care. The dissipation of demographic advantages among immigrants could prospectively produce higher pressures on the US health care system as immigrants age and levels of chronic conditions rise. Barring a shift in policy, the brunt of the effects could be borne by an already overextended public health care system.

Racial disparities in medical expenditures within body weight categories.

Despite federal guidelines calling for the reduction of obesity and elimination of health disparities, black-white differences in obesity prevalence and in medical expenditures and utilization of health care services persist. To examine black-white differences in medical expenditures and utilization of health care services (office-based visits, hospital outpatient visits, ER visits, inpatient stays and prescription medication) within body weight categories. This study used data from the 2006 Medical Expenditures Panel Survey (MEPS) and included 15,164 non-Hispanic white and non-Hispanic black adults. We used a standard two-part econometric model to examine black-white differences in how expenditures (total annual medical expenditures and expenditures for each type of service) vary within body weight categories. Blacks in each weight category were less likely to use any medical care than their white counterparts, even after controlling for socio-demographic characteristics, perceived health status, health conditions and health beliefs. Among those who received medical care, there is no significant difference in the total amount spent on care between blacks and whites. Compared to whites, blacks in each body weight category were significantly less likely to use office-based visits, hospital outpatient visits, and medications. Among those who used medications, blacks had significantly lower expenditures than whites. Blacks in obese class II/III were significantly less likely to have any medical expenditures on inpatient care than their white counterparts. Black-white racial differences in total medical expenditures were observed in each body weight category and were significantly different in the obese I class, overweight, and healthy weight categories. Obese blacks also spent a smaller amount than obese whites--the insignificance might be due to the smaller sample size. These differences cannot be fully explained by socio-demographics, health conditions, or health beliefs. Black-white differences in medical expenditures may be largely due to relatively inexpensive types of care (office-based visits, outpatient care, medication) rather than more costly ones (inpatient care, ER).

Medical Expenditures Associated With Diabetes Among Privately Insured U.S. Youth in 2007

OBJECTIVETo estimate, among privately insured youth in the U.S., medical expenditures associated with diabetes and the difference in medical expenditures between individuals with insulin-treated diabetes mellitus (ITDM) and with non-ITDM (NITDM).RESEARCH DESIGN AND METHODSUsing the 2007 MarketScan commercial claims and encounter database, we analyzed data for 49,356 youth (aged ≤19 years) who were continuously enrolled in fee-for-service health plans. Youth with diabetes (cases) were identified from inpatient, outpatient, and pharmaceutical drug claims. Each case was matched with five controls (without diabetes) by age (±2 years), sex, census region, and urban versus rural residence. We used regression models to estimate medical expenditures in total and by component (inpatient, outpatient, and medication).RESULTSThe predicted mean annual total per-person medical expenditures were $9,061 for youth with diabetes and $1,468 for those without, an excess of $7,593 for those with diabetes; of which, 43% was for prescription drugs. The predicted mean annual total expenditures were $9,333 for ITDM youth and $5,683 for NITDM youth, respectively, an excess of $3,650 for those with ITDM diabetes, of which 59% was for prescription drugs.CONCLUSIONSThe excess medical expenditures associated with diabetes, ITDM in particular, among youth are substantial. Our estimates of excess expenditures can be used to assess the economic burden of diabetes overall and by diabetes treatment mode. Our estimated excess expenditure for NITDM may be used for evaluating the economic efficiency of interventions aimed at preventing type 2 diabetes in U.S. youth.

건강보험환자와 의료급여환자 간 의원 외래 의료이용 차이와 공급자 진료행태

The purpose of this study was to examine the role of provider practice patterns in the difference in health expenditure between the two types of patients: Health Insurance and Medical Aid type 1. The study used the outpatient claim data for all Medicaid and health insurance patients of hypertension who received medical services from 8,454 primary care physicians during the first half of 2006. The data were stratified by patient's gender and age for the two groups of patients who received care from the same physician. The dependent variables were the differences in medical expenditure per case, patient days per case and medical expenditure per patient day between Medicaid patients and health insurance patients. Empirical results showed that physician characteristics, such as physicians under age 50, greater proportion of pediatric Medicaid patients, lower proportion of new Medicaid patients and the greater number of comorbidity of Medicaid patients are associated with the greater difference between the two types of patients (i.e., greater expenditure of Medicaid patients relative to health insurance patients). This study shows that factors associated with provider practice patterns need to be taken into account in Medicaid policy.

Racial Differences in Health Insurance Coverage and Medical Expenditures in the United States

This article uses a unique data set from 1957 to examine the racial gap in health insurance coverage and the extent to which that gap influenced racial differences in health care spending. Results indicate that black households in 1957 were statistically significantly less likely to purchase health insurance than white households, even after controlling for differences in income, years of schooling, age, family size, marital status, and other personal and job-related characteristics. Findings in the article also provide weak support for the hypothesis that a racial gap in health insurance coverage contributed to racial differences in health care spending between blacks and whites; even after controlling for differences in income, education, and other characteristics, racial differences in medical expenditures were smaller for insured than for uninsured families, although the result is not statistically significant.