Health Care Spending Research Articles

The impact of the COVID pandemic on health, healthcare utilization, and healthcare spending

This study investigates the impact of the COVID pandemic on healthcare utilization, spending, and health measures among the U.S. population during the first year of the pandemic. We utilize data from the Medical Expenditure Panel Survey and employ propensity score matching techniques to analyze the variation in healthcare outcomes due to the pandemic.Our findings indicate that the pandemic significantly reduced mental health status, the intensity of office, outpatient, and emergency room visits, and a corresponding decline in healthcare spending. On the other hand, we find improvement in health-related quality of life for most individuals, except for blacks, individuals with a high school degree or less, the uninsured, and the low-income population. The findings highlight disparities during the pandemic and the need for increased efforts to promote health equity.

Cost-Effectiveness of Adjuvanted Quadrivalent Influenza Vaccine for Adults over 65 in France

Background: In France, influenza accounts for an average of over one million consultations with GPs, 20,000 hospitalizations, and 9000 deaths per year, particularly among the over-65s. This study evaluates the cost-effectiveness of the adjuvanted quadrivalent influenza vaccine (aQIV) compared to standard (SD-QIV) and high-dose (HD-QIV) quadrivalent influenza vaccines for individuals aged 65 and older in France. Methods: The age-structured SEIR transmission model, calibrated to simulate a mean influenza season, incorporates a contact matrix to estimate intergroup contact rates. Epidemiological, economic, and utility outcomes are evaluated. Vaccine effectiveness and costs are derived from literature and national insurance data. Quality of life adjustments for influenza attack rates and hospitalizations are applied. Deterministic and probabilistic analyses are also conducted. Results: Compared to SD-QIV, aQIV demonstrates substantial reductions in healthcare utilization and mortality, avoiding 89,485 GP consultations, 2144 hospitalizations, and preventing 1611 deaths. Despite an investment of EUR 110 million, aQIV yields a net saving of EUR 14 million in healthcare spending. Compared to HD-QIV, aQIV saves 62 million euros on vaccination costs. Cost-effectiveness analysis reveals an incremental cost-effectiveness ratio of EUR 7062 per QALY. Conclusions: This study highlights the cost-effectiveness of aQIV versus SD-QIV and HD-QIV, preventing influenza cases, hospitalizations, and deaths.

P.129 Canadian neurosurgical healthcare spending trends

Background: Neurosurgical conditions impose a significant burden on the Canadian healthcare system. This study quantifies the economic impact and explores predictive models for postoperative length of stay. Methods: We analyzed data from the Canadian Institute for Health Information National Health Expenditure Trends database for 2015-2019, focusing on case volumes, healthcare costs, and lengths of stay (LOS) across age groups and conditions. Decision tree models were created to predict total LOS from patient age and average acute LOS. Results: There was a modest increase in case volumes from 6,220 ± 3,103 in 2015 to 6,492 ± 3,240 in 2018, with a slight decrease in 2019. The total estimated hospital costs ranged from 2.27 ± 0.38 million CAD in 2015 to 2.23 ± 0.44 million CAD in 2019. The highest costs were seen in the 18-59 age group, at 2.53 ± 0.43 million CAD. Decision tree models showed high accuracy for predicting LOS in cases like spinal injury (F1-score: 0.98) but were less accurate for interventions with trauma or complications (F1-scores from 0.66 to 0.97). Conclusions: The study delineates the financial demands of neurosurgery in Canada and suggests decision tree models as useful tools for predicting hospital stay, with variable accuracy depending on the case complexity.

Long-term returns to local health-care spending.

This paper investigates the effects of health-care spending on mortality rates of patients who experienced a heart attack. We relate in-hospital deaths to in-hospital spending and post-discharge deaths to post-discharge health-care spending. In our analysis, we use detailed administrative data on individual personal characteristics including comorbidities, information about the type of medical treatment and information about health-care expenses at the regional level. To account for potential selectivity in the region of health-care treatment we compare local patients with visitors and stayers with recent movers from a different region. We find that in regions with higher health-care spending mortality after heart attacks is substantially lower. From this we conclude that there are long-term returns to local health-care spending.

The Fiscal Space for Health in Vietnam: Challenges from Population Aging

Vietnam's population is aging, leading to a higher proportion of elderly individuals. Despite significant health financing reforms, But changes in epidemiology, demographics, and growing demand for health care will continue to put pressure on health spending. This paper examines the fiscal space for health in Vietnam amidst population aging by analyzing data from 2009 to 2020. Findings reveal that healthcare resources have not kept pace with the escalating demands due to the aging of Vietnam's population faster than forecast. Total health expenditure as a percentage of GDP shows this clear increase. Private healthcare spending, particularly out-of-pocket expenses, is on the rise. Spending from the health insurance fund also increases every year,, placing future burdens on young workers. In addition, the State budget allocations for healthcare have also grown, but economic growth will compensate for this shortfall.

Influence of social vulnerability index on Medicare beneficiaries' expenditures upon discharge.

Medicare beneficiaries' healthcare spending varies across geographical regions, influenced by availability of medical resources and institutional efficiency. We aimed to evaluate whether social vulnerability influences healthcare costs among Medicare beneficiaries. Multivariable regression analyses were conducted to determine whether the social vulnerability index (SVI), released by the Centers for Disease Control and Prevention (CDC), was associated with average submitted covered charges, total payment amounts, or total covered days upon hospital discharge among Medicare beneficiaries. We used information from discharged Medicare beneficiaries from hospitals participating in the Inpatient Prospective Payment System. Covariate adjustment included demographic information consisting of age groups, race/ethnicity, and Hierarchical Condition Category risk score. The regressions were performed with weights proportioned to the number of discharges. Average submitted covered charges significantly correlated with SVI (β = 0.50, p < 0.001) in the unadjusted model and remained significant in the covariates-adjusted model (β = 0.25, p = 0.039). The SVI was not significantly associated with the total payment amounts (β = -0.07, p = 0.238) or the total covered days (β = 0.00, p = 0.953) in the adjusted model. Regional variations in Medicare beneficiaries' healthcare spending exist and are influenced by levels of social vulnerability. Further research is warranted to fully comprehend the impact of social determinants on healthcare costs.

The Lifetime Health and Economic Burden of Smokeless Tobacco use in Bangladesh, India, and Pakistan: Results From ASTRAMOD.

Under the current policy landscapes, the lifetime health and economic burden of smokeless tobacco (ST) products, consumed by over 297 million ST users in South Asia, is unknown. The aim of this study was to estimate the lifetime health effects and costs attributable to current and future ST use in Bangladesh, India, and Pakistan where the majority of ST users live. We developed a Markov-based state-transition model (ASTRAMOD) to predict the lifetime costs of treatment of four diseases (oral, pharyngeal, esophageal cancers, and stroke) and disability-adjusted life years (DALYs), attributable to the current and future use of ST under existing ST policy scenario. Country-specific Global Adult Tobacco Surveys, life tables, and meta-analyses of South Asian and South East Asian studies were used to populate the model. A probabilistic sensitivity analysis evaluated the uncertainty in model predictions. If there were no change in the current ST policies, the lifetime ST-attributable treatment costs would be over US$19 billion in India, over US$1.5 billion in Bangladesh, and over US$3 billion in Pakistan. For all countries, the attributable costs are higher for younger cohorts with costs declining with increasing age for those over 50. The model predicted that a typical 15-year-old male adoloscent would gain 0.07-0.18 life years, avert 0.07-0.19 DALYs, and generate a cost-savings of US$7-21 on healthcare spending if ST policies were changed to eliminate ST use. Policy interventions aimed at decreasing the uptake of ST and increasing quitting success have the potential to substantially decrease the economic and health burden of ST. This study provides the most comprehensive estimates of the lifetime health and economic burden of ST by 5-year age and sex cohorts. This is also the first study that highlights the scale of health and economic burden of ST in Bangladesh, India, and Pakistan if there were no changes in the current ST policies. Policymakers and practitioners can use the reported data to justify their decisions to improve current ST policies and practices in their country. Researchers can use the ASTRAMOD methodology to estimate the impact of future ST policy changes.

Balancing Innovation and Affordability in Anti-Obesity Medications: The Role of Alternative Weight Maintenance Program

Abstract Despite remarkable clinical advances in highly effective anti-obesity medications, their high price and potential budget impact pose a major challenge in balancing equitable access and affordability. While most attention has been focused on the amount of weight loss achieved, less consideration has been paid to interventions to sustain weight loss after an individual stops losing weight. Using a policy simulation model, we quantified the impact of a weight maintenance program following the weight loss plateau from the initial full-dose GLP-1s or incretin mimetic use on long-term health care savings and the loss of some health benefits (e.g., maintenance of weight loss, improvements in cardiometabolic risk factors, and reductions in diabetes and cardiovascular events). Our model suggested that compared to continuous long-term full-dose GLP-1s or incretin mimetic drugs, the alternative weight maintenance program would generate slightly fewer clinical benefits while generating substantial savings in lifetime health care spending. Using less expensive and potentially less effective alternative weight maintenance programs may provide additional headroom to expand access to anti-obesity medications during the active weight-loss phase without increasing total health care spending.

Healthcare use and out-of-pocket costs for rural family caregivers and care recipients in a randomized controlled trial.

Rural family caregivers (FCGs) in the United States often experience high economic costs. This randomized controlled trial compared a transitional palliative care intervention (TPC) to support FCGs of seriously ill care recipients (CRs) to an attention control condition. We evaluated the TPC's effect on healthcare use and out-of-pocket spending for both FCGs and CRs. TPC FCGs received teaching, guidance, and counseling via video calls for 8 weeks following CR discharge from the hospital. After discharge, a research assistant called all FCGs once a month for up to 6 months or CR death to collect self-reported healthcare utilization (e.g., outpatient, emergency department, and hospital), out-of-pocket healthcare spending (e.g., deductibles and coinsurance), and health-related travel costs (e.g., transportation, lodging, food) for FCGs and CRs. Incidence rate ratios (IRRs) were estimated using negative binomial regressions. The study included 282 FCG-CR dyads across three U.S. states. Follow-up over the 6-month period was shortened by high CR mortality rates across both arms (29%), but was similar across arms. TPC reduced nights in the hospital for CR (IRR = 0.75; 95% confidence interval [CI] = 0.56-0. 99). Total out-of-pocket spending was not significantly different for TPC versus control. Across both groups, mean out-of-pocket spending for dyads was $1401.85, with healthcare payments contributing $1048.58 and transportation expenses contributing $136.79. TPC dyads reported lower lodging costs (IRR = 0.71; 95% CI = 0.56-0.89). This study contributes to evidence that palliative care interventions reduce the number of nights in the hospital for seriously ill patients. Yet, overall rural FCGs and seriously ill CRs experience substantial out-of-pocket economic costs in the 6 months following hospitalization. Transitional care intervention design should consider impacts on patient and caregiver spending. gov # is NCT03339271.

A case of SIADH following uncomplicated mild traumatic brain injury: Did cognitive bias delay treatment?

Key Clinical MessageTo optimize clinical care, it is imperative for providers to recognize their own inherent cognitive biases and the impact that has on their clinical decision making, thereby minimizing complications such as prolonged hospitalization, unnecessary healthcare spending, and impaired patient satisfaction and functional outcomes.

Which health conditions report the most spending on medical imaging? Evidence for Colombia

Medical imaging is essential for the proper diagnosis and treatment of many diseases. The literature has found that medical imaging generally accounts for a significant percentage of total healthcare spending. We analyzed a national database between 2013 and 2021, with more than 19 million patients on average, to review which health conditions account for the highest spending on medical imaging in the Colombian health system. We segmented the analysis by type of medical imaging, life cycles, health condition and sex. Our findings indicate that cardiac and mental illnesses account for the highest per capita spending on medical imaging, especially for the elderly. As a proportion of total expenditure, hypertension and tuberculosis are added, with special emphasis on the infancy-childhood life cycle.

The Economic Burden of Dementia in India

This paper provides the first estimate of the economic cost borne by Indian individuals living with dementia and their families based on nationally and state-wise representative data from the Longitudinal Aging Study in India (LASI). We found that the annual household cost attributable to dementia was $571. This is a significant figure, equivalent to 20 percent of annual healthcare spending by the Indian government. Our results identify important differences in cost components relative to high-income countries, emphasizing the need for culturally tailored interventions to support people living with the condition and their families in the Indian context.

A more complete measure of vertical integration between physicians and hospitals.

To develop an accurate and reproducible measure of vertical integration between physicians and hospitals (defined as hospital or health system employment of physicians), which can be used to assess the impact of integration on healthcare quality and spending. We use multiple data sources including from the Internal Revenue Service, the Centers for Medicare and Medicaid Services, and others to determine the Tax Identification Numbers (TINs) that hospitals and physicians use to bill Medicare for services, and link physician billing TINs to hospital-related TINs. We developed a new measure of vertical integration, based on the TINs that hospitals and physicians use to bill Medicare, using a broad set of sources for hospital-related TINs. We considered physicians as hospital-employed if they bill Medicare primarily or exclusively using hospital-related TINs. We assessed integration status for all physicians who billed Medicare from 1999 to 2019. We compared this measure with others used in the existing literature. We conducted a simulation study which highlights the importance of accurately identifying integrated physicians when study the effects of integration. We extracted physician and hospital-related TINs from multiple sources, emphasizing specificity (a small proportion of nonintegrated physicians identified as integrated). We identified 12,269 hospital-related TINs, used for billing by 546,775 physicians. We estimate that the percentage of integrated physicians rose from 19% in 1999 to 43% in 2019. Our approach identifies many additional physician practices as integrated; a simpler TIN measure, comparable with prior work, identifies only 30% (3877) of the TINs we identify. A service location measure, used in prior work, has both many false positives and false negatives. We developed a new measure of hospital-physician integration. This measure is reproducible and identifies many additional physician practices as integrated.

Exploring the role of spending on malaria incidence in Uganda using the auto-regressive distributed lag approach.

Malaria has remained a persistent global health problem. Despite multiple government and donor initiatives to eradicate malaria and its detrimental effects on Uganda's health outcomes, the incidence of malaria is worrying as it appears higher than the average of 219 cases per 1000 for sub-Saharan Africa for the period 2017-2018. This study investigated the effect of public and private healthcare spending on the incidence of malaria in Uganda. Employing time series data spanning over 20years from the first quarter of 2000 to the last quarter of 2019, the study builds a model based on the Grossman framework for analysing demand for health. The estimation technique used was the ARDL approach that takes into account reverse causality and incidental relationships. Prior to the adoption of the technique, a bounds test was performed to determine whether the variables contained in the model have a long-term relationship. Several diagnostic tests for serial correlation, functional normality, and heteroskedastic specification error were carried out to verify the ARDL model's goodness of fit. Additionally, the cumulative sum of recursive (CUSUM) and cumulative sum of squares of recursive residuals (CUSUMSQ) were used to test model stability. The results indicate that in the long run, an increase in public spending of one percent significantly reduces malaria incidence by 0.196 at the 10 percent level of significance. On the other hand, there is no significant evidence of private health expenditure's effect on malaria incidence. However, in the short run, public spending reduces malaria incidence by a smaller magnitude of 0.158 percent relative to the long-run. Still, private expenditure is found to exhibit no significant effect. Additional findings point to the importance of GDP per capita and urban population growth in reducing malaria incidence, whereas female unemployment, income inequality, as well as female-headed household. In the short run, however, the female-headed households and urban population growth are found to significantly reduce malaria incidence while an improvement in regulatory quality decreases malaria incidence by 0.129 percent. There is need for further government interventions to reduce malaria incidence in the country via budget allocation, as well as the strengthening of programmes to raise household income to support private health spending, in addition to the development of strategies to promote well-planned and organized urban centres.

Projecting a long‐term healthcare expenditure in the United States: Do climate change, globalization, and technological innovation play a major role?

AbstractRecognizing the paramount importance of health, the United Nations Development Program has outlined sustainable development goals, emphasizing Goal 3, which focuses on ensuring and promoting healthy lives and well‐being for all. Consequently, this study delves into the determinants of healthcare expenditure (HCE), specifically focusing on financial development (FDV), tourism (TOR), technological innovations (TINs), economic growth (EG), and climate change in the United States. The investigation utilizes data spanning from the first quarter of 2000Q1 to the fourth quarter of 2020Q4. To achieve this objective, we employed innovative quantile‐based methodologies, including wavelet quantile regression and quantile‐on‐quantile Granger causality. These approaches facilitated a comprehensive exploration of the dynamic interactions between HCE and its influencing factors across various quantiles and periods. The wavelet quantile regression and quantile‐on‐quantile regression analysis findings consistently indicate a positive impact of CO2, TOR, EG, globalization, FDV, foreign direct investment, and TIN on HCE in the United States. Furthermore, the results obtained from the quantile‐on‐quantile Granger causality demonstrate that CO2 emissions, TOR, EG, globalization, FDV, foreign direct investment, and TIN significantly predict HCE across all quantiles. These insights have informed the formulation and implementation of various policies addressing the complex interplay between healthcare spending and its driving factors.

Does the introduction of an infliximab biosimilar always result in savings for hospitals? A descriptive study using real-world data

BackgroundBiosimilars are biologic drugs that have the potential to increase the efficiency of healthcare spending and curb drug-related cost increases. However, their introduction into hospital formularies through initiatives such as non-medical switching must be carefully orchestrated so as not to cause treatment discontinuation or result in increased health resource utilization, such as additional visits or laboratory tests, among others. This retrospective cohort study aims to assess the impact of the introduction of CT-P13 on the healthcare expenditures of patients who were treated with originator infliximab or CT-P13.MethodsGastroenterology, immunoallergology and rheumatology patients treated between September 2017 and December 2020 at a university hospital in Western Switzerland were included and divided into seven cohorts, based on their treatment pathway (i.e., use and discontinuation of CT-P13 and/or originator infliximab). Costs in Swiss francs were obtained from the hospital's cost accounting department and length of stay was extracted from inpatient records. Comparisons of costs and length of stay between cohorts were calculated by bootstrapping.ResultsSixty immunoallergology, 84 rheumatology and 114 gastroenterology patients were included. Inpatient and outpatient costs averaged (sd) CHF 1,611 (1,020) per hospital day and CHF 4,991 (6,931) per infusion, respectively. The mean (sd) length of stay was 20 (28) days. Although immunoallergology and rheumatology patients had higher average costs than gastroenterology patients, differences in costs and length of stay were not formally explained by treatment pathway. Differences in health resource utilization were marginal.ConclusionsThe introduction of CT-P13 and the disruption of patient treatment management were not associated with differences in average outpatient and inpatient costs and length of stay, in contrast to the results reported in the rest of the literature. Future research should focus on the cost-effectiveness of non-medical switching policies and the potential benefits for patients.

Healthcare Spending vs Mortality in CNS Cancer: Has Anything Changed?

Abstract Background The financial implications of central nervous system (CNS) cancers are substantial, not only for the healthcare service and payers, but also for the patients who bear the brunt of direct, indirect, and intangible costs. This study sought to investigate the impact of healthcare spending on CNS cancer survival using recent US data. Methods This study used public data from the Disease Expenditure Project 2016 and the Global Burden of Disease Study 2019. The primary outcome was the annual healthcare spending trend from 1996 and 2016 on CNS tumors adjusted for disease prevalence, alongside morbidity and mortality. Secondary outcomes included drivers of change in healthcare expenditures for CNS cancers. Subgroup analysis was performed stratified by age group, expenditure type, and care type provided. Results There was a significant increase in total healthcare spending on CNS cancers from $2.72 billion (95% CI, $2.47B to $2.97B) in 1996 to $6.85 billion (95% CI, $5.98B to $7.57B) in 2016. Despite the spending increase, mortality rate per 100,000 people did not change significantly, with 5.30 ± 0.47 in 1996 and 7.02 ± 0.47 in 2016, with an average of 5.78 ± 0.47 deaths per 100,000 over the period. The subgroups with the highest expenditure included patients aged 45 to 64, those with private insurance, and those receiving inpatient care. Conclusions This study highlights a significant rise in healthcare costs for CNS cancers without corresponding improvements in mortality rate, indicating a mismatch of healthcare spending, contemporary advances, and patient outcome as it relates to mortality.

The Affordable Care Act and Income-Based Disparities in Healthcare Coverage and Spending Among Non-Elderly Adults with Cancer

Abstract The Affordable Care Act (ACA) significantly reduced uninsured individuals and improved financial protection; however, escalating cancer treatment has led to substantial out-of-pocket expenses, causing severe financial and mental health distress for individuals with cancer. Mixed evidence on the ACA's ongoing impact highlights the necessity of assessing health spending changes across income groups for informed policy interventions. In our nationally representative survey evaluating the early-and-long-term effects of the ACA on non-elderly adult cancer patients, we categorized individuals-based income subgroups defined by the ACA for eligibility. We found that ACA implementation increased insurance coverage, particularly evident post-2 years. Early post-ACA, there were declines in out-of-pocket spending for the lowest and low-income groups by 26.52% and 38.31% respectively, persisting long-term only for the lowest-income group. High-income groups experienced continuously increased out-of-pocket and premium spending by 25.39% and 34.28% respectively, with a notable 122% increase in the risk of high-burden spending. This study provides robust evidence of income-based disparities in financial burden for cancer care, emphasizing the need for healthcare policies promoting equitable care and addressing spending disparities across income brackets.

Real-world treatment patterns and medical costs of prostate cancer patients in Switzerland – A claims data analysis

BackgroundProstate cancer (PC) is the most prevalent cancer in men in Switzerland. However, evidence on the real-world health care use of PC patients is scarce. The aim of this study is to describe health care utilization, treatment patterns, and medical costs in PC patients over a period of five years (2014–2018). MethodWe used routinely collected longitudinal individual-level claims data from a major provider of mandatory health insurance in Switzerland. Due to the lack of diagnostic coding in the claims data, we identified treated PC patients based on the treatments received. We described health care utilization and treatment pathways for patients with localized and metastatic PC. Costs were calculated from a health care system perspective. ResultsA total of 5591 PC patients met the inclusion criteria. Between 2014 and 2018, 1741 patients had outpatient radiotherapy for localized or metastatic PC and 1579 patients underwent radical prostatectomy. 3502 patients had an androgen deprivation therapy (ADT). 9.5% of these patients had a combination therapy with docetaxel, and 11.0% had a combination with abiraterone acetate. Docetaxel was the most commonly used chemotherapy (first-line; n = 413, 78.4% of all patients in chemotherapy). Total medical costs of PC in Switzerland were estimated at CHF 347 m (95% CI 323–372) in 2018. ConclusionMost PC patients in this study were identified based on the use of ADT. Medical costs of PC in Switzerland amounted to 0.45% of total health care spending in 2018. Treatment of metastatic PC accounted for about two thirds of spending.

Examining the dynamic impact of carbon emissions, renewable energy and economic growth on healthcare expenditure in Asian countries

This study aims to examine the impact of renewable energy, carbon emissions, and economic growth on healthcare spending in 36 Asian countries during 2000–2019. Fully Modified Ordinary Least Square (FMOLS) and Dynamic Ordinary Least Square (DOLS) models have been applied to the panel data for 36 Asian countries. The study's findings show that CO2 emissions in Asia increased due to public and private health spending, with the commercial health sector having a larger negative influence on CO2 emissions than the public sector. According to FMOLS and DOLS findings, carbon emissions and GDP are positively related to health spending, indicating that high economic growth through energy-intensive production processes leads to increased carbon emissions, but on the contrary, renewable energy consumption has decreased healthcare expenditure. This study advocates new policies to reduce carbon emissions and hospitalisation without jeopardising national economic growth. In order to achieve sustainable health services and an environmentally friendly future in Asia, health administrators must raise state and private healthcare spending while implementing an effective cost-service and energy-efficient management plan.