Rising Health Care Costs Research Articles

Evidence-based recommendations for economic evaluations in spine surgery: study protocol for a Delphi consensus

IntroductionConsidering the rising global healthcare expenses, economic evaluations are more important than ever. Even though the number of studies regarding costs and cost-effectiveness is increasing, the quality of these studies...

Equilibrium in Competitive Insurance Markets with Medical Tourism

In recent years, the rising healthcare costs in the United States have led many citizens to travel outside the country for medical care. Although such practice, commonly known as ‘medical tourism’, has become more and more popular, many insurance companies hesitate to incorporate a medical tourism option into insurance contracts. In this article, we wish to understand the theoretical rationale of that by designing an insurance contract in an environment where medical tourism is available. One crucial characteristic that influences consumers’ decision on whether to choose medical tourism is their tolerance levels associated with unexpected costs when travelling abroad for healthcare. In this article, we wish to investigate how the individuals with preference heterogeneity would self-select between the options of domestic treatment and treatment abroad offered in the contract. The results suggest that when the healthcare costs from both the treatment abroad and the domestic treatment are high and/or there is a higher chance of needing an elective treatment for the individual, insurance companies will more likely incorporate medical tourism in the contract. JEL Classification: C73, I13, D82, D86

Countering the Tragedy of the Health Care Commons by Exnovation: Bringing Unexpected Problems and Solutions into View

In the health sciences and policy, it is common to view rising health care costs as a tragedy of the commons, i.e., a situation in which the unhampered use of a resource by rational individuals leads to its depletion. By monitoring a set of outcomes, not only the costs but also patient experience and population health, simultaneously, it is claimed that the “triple aim” approach changes what is rational for health care stakeholders and, thus, can counter the rapidly rising health care costs. This approach has an important limitation: it reduces the monitored innovations to merely their outcomes; yet, how health care professionals and patients give shape to care delivery remains invisible. To get a more in-depth understanding of the consequences of adopting such an approach, in this article I use the method of exnovation instead. Exnovation foregrounds the everyday accomplishments of health care practices to enable reflection and learning. I draw on an ethnographic study into an innovation in care delivery aimed at rendering it more sustainable: Primary Care Plus. I reflected with both professionals and patients on what happened during 40 Primary Care Plus consultations. By presenting and analyzing three of these consultations, I foreground what is rendered invisible with the triple aim: improvisations, surprises and habits unfolding in practice. With exnovation, health care innovations can provide fertile soil for creating new forms of sustainable care that can help prevent the impending exhaustion of health care systems.

Examining Opportunities, Challenges and Quality of Life in International Retirement Migration.

As the world has become more interconnected due to the invention and innovation of communication and transportation technologies, more individuals than ever before have been able to travel long distances. In recent years, a growing number of physically able adults in late adulthood have chosen to move across national borders to less costly countries in order to obtain better quality of life upon reaching retirement age. In light of this under-researched but increasingly popular retirement trajectory, this research aimed to provide more insight into the opportunities and challenges that international retired migrants have encountered while retiring abroad. Through the lens of humanistic theory, this research employed a systematic review of research literature, the majority of which were peer-reviewed studies published within the last five years. The reviewed studies (n = 22) conducted spanned four out of seven continents, with heavy emphasis on Europe, the Americas, and Asia. Research results indicated that many of the international retired migrants took advantage of the opportunities of pleasant weather, lower cost of living, and various amenities offered by their host countries to enhance their quality of life by engaging in an active and meaningful lifestyle. However, language barriers, lack of social support, rising healthcare costs, increases in the cost of living, uncertain political climate, and different healthcare practices in their host countries, presented considerable challenges to many international retirees.

Challenges of prescribing antidepressants for the elderly: a scoping review

Abstract Objectives With a shift in global demographic trends favouring the older population, depression, which is increasingly common to older adults, is fast becoming a significant public health phenomenon that can result in rising healthcare costs, co-morbidities and fatalities. In particular, challenges to prescribing antidepressants to older people given their altered pharmacodynamic and pharmacokinetic profiles is of major concern to healthcare providers. We aimed to review the challenges encountered by prescribers when diagnosing and selecting older patients suited to receive an antidepressant. Methods English articles published between 2011 and 2021 were searched from the three databases which were MEDLINE, Cochrane Library and EMBASE to identify studies related to challenges in prescribing antidepressants for older people with the combination of search keywords such as depression, antidepressants, elderly and challenges, but not limited to them. Studies were excluded if the age of the participant is below 65 years old. The relevancy of the studies to be included were examined initially based on their titles and abstracts. Additional articles were searched from the reference lists of relevant articles. Key findings Out of 2500 studies, 11 articles was included in this study. The challenges were classified into three themes: challenges associated with the ageing processes, difficulty in recognising depressive symptoms and challenges in distinguishing depression from cognitive impairment. Conclusions Antidepressant prescribing in the elderly is complicated, in which there is a lack of proof for beneficial approaches. The study highlighted pertinent challenges to prescribers when older patients seek drug therapy for depression. This could have easily led to many depression cases gone undiagnosed or misdiagnosed.

Cost and Value in Contemporary Heart Failure Clinical Guidance Documents

ObjectivesThis study sought to evaluate the frequency and nature of cost/value statements in contemporary heart failure (HF) clinical guidance documents (CGDs). BackgroundIn an era of rising health care costs and expanding therapeutic options, there is an increasing need for formal consideration of cost and value in the development of HF CGDs. MethodsHF CGDs published by major professional cardiovascular organizations between January 2010 and February 2021 were reviewed for the inclusion of cost/value statements. ResultsOverall, 33 documents were identified, including 5 (15%) appropriate use criteria, 7 (21%) clinical practice guidelines, and 21 (64%) expert consensus documents. Most CGDs (27 of 33; 82%) included at least 1 cost/value statement, and 20 (61%) CGDs included at least 1 cost/value-related citation. Most of these statements were found in expert consensus documents (77.7%). Three (9%) documents reported estimated costs of recommended interventions, but only 1 estimated out-of-pocket cost. Of 179 cost/value-related statements observed, 116 (64.8%) highlighted the economic impact of HF or HF-related care, 6 (3.4%) advocated for cost/value issues, 15 (8.4%) reported gaps in cost/value evidence, and 42 (23.5%) supported clinical guidance recommendations. Over time, patterns of inclusion of statements and citations of cost/value have been largely stable. ConclusionsAlthough most contemporary HF CGDs contain at least 1 cost/value statement, most CGDs focus on the high economic impact of HF and its related care; explicit inclusion of cost/value to support clinical guidance recommendations remains infrequent. These results highlight key opportunities for the integration of formalized cost/value considerations in future HF-focused CGDs.

Adherence to Choosing Wisely Campaign Guidelines at Three Health Systems

Abstract Introduction/Objective With rising healthcare costs in the United States, there has been a push for lab stewardship to improve the quality of patient care while reducing costs. To optimize the use of clinical laboratory testing, the ASCP working with other medical specialty organizations, developed the Choosing Wisely Campaign to promulgate evidence-based guidelines to optimize clinical laboratory testing. Methods/Case Report We examined adherence to three Choosing Wisely guidelines over a four-year period (2017- 2020), through queries of internal cost accounting databases to return aggregate volumes as well as variable and total costs at three large academic health systems. We measured concurrent orders for: 1) erythrocyte sedimentation rate (ESR) with C-reactive protein (CRP), 2) serum/plasma amylase with lipase, and 3) free thyroxine (FT4) and/or total triiodothyronine (TT3) with thyroid stimulating hormone (TSH) when the TSH is within the reference range (using an frequency estimate of 85% based on other studies). We also examined another guideline for concurrent orders for serum aldolase with creatine kinase (CK). We also quantified aggregate variable costs for the non-recommended test in each Choosing Wisely guideline (amylase, ESR, FT4 and/or TT3), and for serum aldolase when ordered with CK. Results (if a Case Study enter NA) Over the four-year period, there were 322,853 unnecessary tests based on these four guidelines (120,587 ESR and CRP, 30,444 amylase and lipase, 164,818 FT4 and/or TT3 with TSH, and 7,004 aldolase). Overall, unnecessary testing decreased between 2017 and 2020 for amylase with lipase, remained essentially unchanged for aldolase, and increased for the other two test guideline scenarios. The largest changes were concurrent orders for amylase and lipase at one health system (38% decrease), and orders for TT3 with a normal TSH result at another health system (324% increase). The four-year variable cost of these unnecessary tests was $1,215,309 ($303,827 mean annual cost), resulting in potential annual variable cost savings of $101,276 for each health system for the four guidelines we examined. Variable costs for unnecessary testing increased by 16.5% ($45,571) over the four-year period. Conclusion Guideline-based unnecessary testing remains as a target to improve laboratory diagnostic testing. There is potential to realize significant achievable cost savings if guidelines are implemented and maintained.

Differential diffusion of pharmaceutical innovations in a mixed market middle - income economy

BackgroundPolicymakers are faced with the challenge of balancing patient’s access for effective and affordable medicines to sustain the rising healthcare costs. In a mixed healthcare market such as Malaysia, coverage decisions of new medicines are different: public funded health system has a formulary listing process whereas for private sector, which is a market-based economy, depends on patient’s willingness to pay and insurance coverage. There is little overlap between public and private healthcare service delivery with access to new innovative medicines, as differentiated by sources of funding. The objectives of this study were to examine the diffusion of New Chemical Entities (NCEs) into the public and private healthcare market between 2010 and 2014, and determine the factors explaining the diffusion.MethodsWe matched medicines from the product registration database by medicine formulation to medicines in IQVIA National Pharmaceutical Audit database for each year. The price per Defined Daily Dose (DDD), market concentration and generic utilization share variables were calculated. A panel fixed effect model was performed to measure diffusion of NCEs for each year and test possible determinants of diffusion of NCEs for overall market and sector specifics.ResultsThe utilization of NCEs was larger in the private sector compared to the public sector but the speed of diffusion over time was higher in the public sector. Price per DDD was negatively associated with diffusion of NCEs, while generic utilization share was significantly regressive in the public sector. Market concentration was negatively associated with utilization of NCEs, however result tends to be mixed according to sector and Anatomical Therapeutic Chemical (ATC) category.ConclusionsUnderstanding key aspects of sectoral variation in diffusion of NCEs are crucial to reduce the differences of access to new medicines within a country and ensure resources are used on cost effective treatments.

The potential of smart home technology for improving healthcare: a scoping review and reflexive thematic analysis

ABSTRACT As aging populations grow and contribute to rising healthcare costs, policymakers and scholars recognize the need for technological solutions that reduce the costs of public service delivery. Smart homes, equipped with an array of physical and virtual networks, automated products, and intelligent system controls, present a cost-effective solution to extend the independence of older adults and persons with disabilities. We conduct a scoping review and reflexive thematic analysis of the existing literature on smart homes and healthcare. Our analysis of abstracts from 303 articles published between 2010 and 2020 finds that although the research on smart homes and health is nascent, there has been a marked growth in the last decade. The disciplines of study with the most prolific research on the health effects of smart home technology are health informatics, engineering & technology, nursing & medical, gerontechnology, computing, and wireless communications. Much of this research appears to be conducted in OECD countries. The major themes identified in the literature are supply-side topics focusing on the technological development of smart home systems and demand-side topics concentrating on primary, secondary, and tertiary users. Most of the research analyzed is a-theoretical and most empirical methodologies used involve quantitative methods.

210 Assessment of Emergency Department Health Care Providers’ Readiness for Intimate Partner Violence Screening and Correlation With Cultural Competence

Intimate partner violence (IPV) is a serious public health issue and emergency departments (ED) are often a victim’s only contact with healthcare providers (HCPs). The ED also increasingly serves as a primary source of care for racial/ethnic minorities and other historically marginalized groups because of rising healthcare costs and declining access to care. The need for culturally competent providers, resources, and messaging when addressing IPV cannot be overstated. To inform more inclusive IPV screening strategies, this study explored the intersectionality of IPV readiness and cultural competence among ED HCPs.

Ethics and Total Worker Health®: Constructs for Ethical Decision-Making and Competencies for Professional Practice.

Work has become increasingly technologically driven and fast paced, with long work hours, new/emerging hazards, and rising health care costs. Threats to worker safety, health, and well-being including non-traditional work arrangements and practices, precarious work, uncertain hazardous exposures, and work organization issues, such as heavy workloads, design of work, uneven work hours, and difficult interpersonal relationships among workers and managers are apparent. Furthermore, the relationship between personal health risk factors and workplace risks and exposures has drawn increased attention and concern. As employer economic pressures continue to build, it is anticipated that ethical dilemmas for practitioners will become increasingly complex. A review of relevant Total Worker Health® (TWH) literature, related ethical constructs and competencies, an examination of codes of ethics for occupational safety and health and health promotion/education disciplines was conducted. A case study for TWH utilizing an ethical decision-making model for the analysis of key ethical issues and solutions was completed. TWH approaches to protecting safety, promoting health, and advancing well-being are increasingly being adopted. These approaches can reveal ethical dilemmas, and ethical constructs are needed to guide decision-making. A core set of proposed ethical competencies for TWH professionals are identified as a transdisciplinary framework to support workplace ethical culture.

The ageing prisoner population: demographic shifts in Australia and implications for the economic and social costs of health care.

The Australian prisoner population has experienced a dramatic increase in the number of older inmates over the past decade, consistent with the greying of the prisoner population that is being observed worldwide. Reviews suggest the need for further evidence and practice outside of the USA. This paper aims to review and discuss the cost and social implications of the rising health-care needs of this population in Australia. A review of international research and policies is presented, as well as the results of basic economic modelling relating to the expected rise in health-care costs of the ageing prisoner population in Australia. Taking into consideration the continued rise in incarceration rates, the calculations show that the health costs of prisoners could increase by anywhere between 17% and 90% depending on whether the increase of older prisoners continues as it has in the past decade. These trends are likely to continue over the next decade and will result in higher health costs of prisons under a number of different imprisonment scenarios. Policy responses in Australia have been slow so far, with most initiatives being undertaken in the USA with promising results. The authors suggest that in the absence of a coordinated policy response, covering a range of interventions, costs will continue to increase, particularly as this population continues to age more rapidly than the general population due to an accumulation of risk factors. Well-conceived interventions would be a worthwhile investment from both financial and social perspectives. To the best of the authors' knowledge, this is the first commentary to acknowledge this rising public health issue and to both review and model its implications for the future.

Comprehensive analysis of trends in Medicare utilization and reimbursement in Physical Medicine & Rehabilitation: 2012 to 2017.

There is an absence of literature describing Medicare utilization by physiatrists, despite their key role in treating Medicare enrollees with qualifying disabilities and common neuromusculoskeletal conditions. To analyze Medicare data regarding physiatrists and their beneficiaries, services, and reimbursement, as well as trends in utilization and geographic distribution. Retrospective analysis of publicly available Centers for Medicare & Medicaid Services data for Medicare beneficiaries receiving physiatric services from 2012 to 2017. After adjustment for inflation, variables assessed for changes over time included provider and beneficiary demographics, total Medicare reimbursement, and the number of services provided, subsequently separated by drug and medical service metrics. Lorenz curves and Gini coefficients were computed to study reimbursement inequality. Choropleth maps were generated to assess geographic differences in physician density and reimbursement, both by state and ZIP code. The number of physiatrists utilizing Medicare increased from 7230 to 7895 from 2012 to 2017, whereas the average number of unique beneficiaries per clinician remained constant (307 vs. 310; p=.51). The beneficiaries' mean hierarchical conditions category (HCC) health risk score, normalized to 1.0 for the average beneficiary, increased significantly from 2012 to 2017 (1.72 vs. 1.80; p < .01). The mean Medicare reimbursement per physiatrist decreased significantly from 2012 to 2017 ($131,960 vs. $117,623; p < .001), whereas the mean number of services remained constant (3243 vs. 3077; p=.132). Botulinum toxin and baclofen injections were the two most reimbursed drug-related services. Gini coefficients ranged from 0.52 to 0.53 for 2012 to 2017, suggesting moderate reimbursement inequality, with the 75th percentile receiving on average two times the median. Both physician density and top earners were concentrated in urban and metropolitan areas. Despite rising health care costs and the increasing medical complexity of physiatrists' beneficiaries, Medicare payments have decreased over time. These trends are relevant to both providers and policymakers, particularly in light of unequal geographic distribution of physiatrists across the country.

Detection of Multidrug-Resistant Enterobacterales-From ESBLs to Carbapenemases.

Multidrug-resistant Enterobacterales (MDRE) are an emerging threat to global health, leading to rising health care costs, morbidity and mortality. Multidrug-resistance is commonly caused by different β-lactamases (e.g., ESBLs and carbapenemases), sometimes in combination with other resistance mechanisms (e.g., porin loss, efflux). The continuous spread of MDRE among patients in hospital settings and the healthy population require adjustments in healthcare management and routine diagnostics. Rapid and reliable detection of MDRE infections as well as gastrointestinal colonization is key to guide therapy and infection control measures. However, proper implementation of these strategies requires diagnostic methods with short time-to-result, high sensitivity and specificity. Therefore, research on new techniques and improvement of already established protocols is inevitable. In this review, current methods for detection of MDRE are summarized with focus on culture based and molecular techniques, which are useful for the clinical microbiology laboratory.

An IPRP survey of the regulatory requirements for the waiver of in vivo bioequivalence studies of generic medicinal products in certain dosage forms

Medicines regulatory authorities aim to address rising healthcare costs and promote access to medicines worldwide through review and approval of quality generic drug products that are interchangeable with the corresponding reference medicinal product.

The Effect of Telehealth on Hospital Services Use: Systematic Review and Meta-analysis.

BackgroundTelehealth interventions, that is, health care provided over a distance using information and communication technology, are suggested as a solution to rising health care costs by reducing hospital service use. However, the extent to which this is possible is unclear.ObjectiveThe aim of this study is to evaluate the effect of telehealth on the use of hospital services, that is, (duration of) hospitalizations, and to compare the effects between telehealth types and health conditions.MethodsWe searched PubMed, Scopus, and the Cochrane Library from inception until April 2019. Peer-reviewed randomized controlled trials (RCTs) reporting the effect of telehealth interventions on hospital service use compared with usual care were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation guidelines.ResultsWe included 127 RCTs in the meta-analysis. Of these RCTs, 82.7% (105/127) had a low risk of bias or some concerns overall. High-quality evidence shows that telehealth reduces the risk of all-cause or condition-related hospitalization by 18 (95% CI 0-30) and 37 (95% CI 20-60) per 1000 patients, respectively. We found high-quality evidence that telehealth leads to reductions in the mean all-cause and condition-related hospitalizations, with 50 and 110 fewer hospitalizations per 1000 patients, respectively. Overall, the all-cause hospital days decreased by 1.07 (95% CI −1.76 to −0.39) days per patient. For hospitalized patients, the mean hospital stay for condition-related hospitalizations decreased by 0.89 (95% CI −1.42 to −0.36) days. The effects were similar between telehealth types and health conditions. A trend was observed for studies with longer follow-up periods yielding larger effects.ConclusionsSmall to moderate reductions in hospital service use can be achieved using telehealth. It should be noted that, despite the large number of included studies, uncertainties around the magnitude of effects remain, and not all effects are statistically significant.

Dialysis and Total Health Care Costs in the United States and Worldwide: The Financial Impact of a Single-Payer Dominant System in the US.

Significance Statement In the United States, dialysis provision is an example of a robust, single-payer dominant system with cost containment. When compared with the cost of dialysis in other countries, Medicare dialysis costs in the United States as a function of overall health care expenditures are approximately $60,000 per patient less than expected, likely due to substantial cost containment imposed by Medicare as the dominant payer.

P77. Optimizing the spine surgery instrument trays to immediately increase efficiency and lower costs in the operating room

<h3>BACKGROUND CONTEXT</h3> Spine surgery is increasingly scrutinized in a climate of rising health care costs given its cost per procedure compared to other specialties. Fortunately, there are many sources of inefficiency that can be addressed without compromising patient care. Surgical trays are often poorly configured and have considerable economic implications as they comprise a large portion of perioperative budgets. Instruments are typically added on an ad-hoc basis, based on surgeon request, which can result in excessively large and inefficient trays. A solution must take into account the conflicting issues of clinical need, costs, ease of batching, prevention of adverse clinical events, and minimization of wear-and-tear on instruments. Clinician review and cost-analysis of surgical trays are two methods historically used to address this challenge, although they have shortcomings. We conducted an interventional quality improvement study to determine if a customized mathematical inventory optimization model would result in greater reduction of instruments than a clinician review. <h3>METHODS</h3> This was a single-site quality improvement study conducted at a large academic hospital which performs over 750 laminectomy procedures annually. Two trays are required: 1) Laminectomy Tray (LT) and 2) Basic Neurosurgery Tray (BNT). As such, the focus of our study was to optimize these two trays. A trained observer was present in the operating room (OR) during 25 randomly selected laminectomy procedures. Processes in the MDRD and OR were observed to comprehensively quantify associated costs. The results of the observations were applied to a mathematical model to determine ideal tray configuration. In addition, a clinician review (CR) of the trays was performed for comparison. <h3>RESULTS</h3> The mathematical model produced an ideal tray size of 29 for the LT, representing a reduction of 41% from the original size of 49. For the BNT, the mathematical model produced an ideal tray size of 23 instruments, a reduction of 50% instruments from the original size of 46. Combined, this represented $20,934 in annual savings. In contrast, CR alone suggested an ideal tray size of 35 (29% reduction) for the LT and 37 (19%) for the BNT instruments, and $11,197 in annual savings. <h3>CONCLUSIONS</h3> Superior reduction of surgical trays used for laminectomy was achieved using a mathematical model when compared to CR alone. The mathematical model yielded an additional 10% instrument reduction and $9,737 in savings compared to clinician review alone. Our model comprehensively optimizes the surgical trays by incorporating several cost drivers important to major processes involved in surgical tray assembly, processing and OR utilization. This model may be generalizable to all specialties and hospitals to determine optimal tray configuration. The financial implications are broad; at our institution, application of the mathematical model to all surgical trays would result in projected costs savings of $312,476 annually. Surgeons and managers looking to manage costs should consider this evidence-based approach. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Cancer care affordability: what is our role?

<h3>Objectives:</h3> With rapidly rising health care costs, affordability is a major concern of cancer treatment and survivorship. We sought to determine the role oncologists believe they should play in decreasing costs and improving cancer care affordability. <h3>Methods:</h3> A survey was developed to assess oncologists' attitudes toward affordability and assess whether a range of provider-based solutions to reduce financial toxicity for patients would be practical or acceptable to practicing clinicians. Attending physicians practicing clinical cancer care at an urban, academic, tertiary referral center, were emailed a voluntarily, anonymous survey. Surveys were administered via REDCap between February and March 2020. Four reminder emails were sent to encourage participation. <h3>Results:</h3> Of 851 eligible physicians, 346 completed the survey (41% response rate); 342 answered all questions (99% completion rate). A total of 118 (34%) were medical oncologists, 52 (15%) were surgical oncologists, 46 (13%) were radiation oncologists, 7 (2%) were neuro-oncologists, and 123 (36%) were other specialty oncologists. One hundred twelve (32%) were within 5 years of their terminal year of training, 165 (48%) were 6-25 years out, and 69 (20%) were more than 25 years out. One hundred eighty-eight (54%) were male. Of all participants, 308 (89%) indicated they believed that at least 20% of patients on active treatment have significant financial issues related to paying for their cancer treatment; 57 participants (16%) indicated they thought that at least 60% of patients may have this concern; 286 (83%) felt there was at least some way of either preventing or mitigating patient financial toxicity; 285 (82%) indicated they thought they should play an active role in minimizing financial toxicity; and 270 (78%) indicated they thought they should be aware of a patient's risk for financial toxicity prior to making treatment recommendations. Two hundred thirty-nine participants (70%) believed they could modify test or treatment plans to reduce costs for patients at high risk for financial burden if they knew, and 232 (67%) said they would modify their plans; this included 55 (24%) who would modify treatment dosing/frequency, 152 (66%) would change testing/imaging frequency, and 154 (67%) who would change follow-up interval. A total of 223 (65%) felt that national guidelines should incorporate patient affordability concerns when being developed. Only 76 (22%) had received any training on costs, affordability, or value-based care, and only 18 (5%) had received any training on cost conversations. <h3>Conclusions:</h3> Academic oncologists overwhelmingly believe they should play an active role in addressing affordability issues for patients, and the majority believe it is possible to reduce financial toxicity through various means. Provider-facing interventions to improve patient affordability may include proactively identifying patients at high risk for financial burden in order to create tailored plans to reduce their risk of high costs and resultant financial toxicity.

Predicting Health Spending in Turkey Using the GPR, SVR, and DT Models

Rising healthcare costs for countries and the long-term maintainability of this situation are at the center of the political agenda. The steady increase in health spending puts pressure on government budgets, healthcare, and personal patient financing. Policymakers would like to plan reforms to reduce these costs to adapt to problems that may arise. This has led planners to decision support systems and forecasting models. In this paper, three machine learnings algoritms, namely Support Vector Regression (SVR), Decision Tree Regression (DT), and Gaussian Process Regression (GPR) are employed to design a forecasting model for Health Spendings (HS) of Turkey considering various determinants. Gross domestic product per capita, urban population rate, unemployment rate, population ages 65 and above, the life expectancy, the physicians’ rate, and the total number of hospital beds are used as inputs. The data set consists of 30 years between 1990- 2019, which splits as training and test sets. Developed models were compared considering performance metrics, and the most accurate model was identified. The coefficient of determinations (R2 ) for SVR, GPR, and DT models are 0.9929, 0.9989, and 0.9611 in the training phase, 0.9536, 0.8944, and 0.1166 in the testing stage, respectively. Therefore, the SVR model has accurate prediction results with the highest R2 and the least root mean square error values in the testing phase. The study showed that the proposed SVR model reduced RMSE value by 32.02% and 39.66% compared to the GPR and DT models, respectively. Consequently, the Health Spendings of Turkey can be predicted by employing SVR with high accuracy.&nbsp;