Inpatient Expenditures Research Articles

A longitudinal study of healthcare utilisation and expenditure in people with type 2 diabetes mellitus with and without major depressive disorder.

This study investigated the healthcare service utilisation and expenditure of patients with type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD) and identified associated factors. Healthcare service utilisation and expenditure of patients with T2DM with and without MDD during 2002-2013 were examined using Taiwan's population-based National Health Insurance claims database. Healthcare service utilisation included outpatient visits and inpatient admissions, and health expenditure included outpatient, inpatient, and total medical expenditure. Moreover, non-psychiatric health service utilisation and expenditure were distinguished from total health service utilisation and medical expenditure. Average healthcare service utilisation was significantly higher in those with comorbid MDD (both total and non-psychiatric utilisation). The higher overall costs of the patients with comorbid MDD largely driven by psychiatric costs and non-psychiatric costs between the groups were not significantly different. Gender, age, income, comorbidities and complications, and diabetes complications severity index were significant factors in outpatient visits, medical expenditure, and hospitalisation in those with comorbid MDD. Type 2 diabetes patients with comorbid MDD were found to have higher costs, and that they appeared to be driven by more visits in the first 6 years and by psychiatric-related costs rather than general medical costs.

Differences in Medicare Utilization and Expenditures in the Last Six Months of Life among Patients with and without Alzheimer's Disease and Related Disorders.

Previous research has not focused on differences at the end of life among Medicare beneficiaries with, and without, a diagnosis of Alzheimer's disease and related disorders (ADRDs). The purpose of this study was to examine differences in utilization of inpatient services and Medicare expenditures (overall and by category) in the last six months of life for patients with, versus those without, a diagnosis of ADRD. The study used 2013 Medicare Research Identifiable Files (5% sample) to study utilization and expenditures for a full six months before death (n = 7895 for ADRD; n = 30,639 for non-ADRD). A generalized linear model with a gamma distribution was used to examine the association of ADRD with end-of-life service utilization and expenditures. ADRD patients were overall less expensive than their non-ADRD peers through reduced use of high-cost services, and urban patients were more likely than rural patients to use hospice and other services among both the ADRD and non-ADRD groups. After controlling for age, gender, race, dual eligibility, residence, region, chronic conditions, and type of service utilization, ADRD beneficiaries cost Medicare 11% less than non-ADRD beneficiaries (p < 0.01). Future research should examine the informal caregiving costs of caring, which is a significant part of care for an ADRD patient, as the residential setting of the beneficiary highly influences costs.

Medical Costs for Osteoporosis-Related Fractures in High-Risk Medicare Beneficiaries.

To estimate the incremental direct medical care costs associated with first fracture observable in high-risk older adults. Retrospective analysis of claims and survey data over a 3-year period from the Health and Retirement Study (HRS), a nationally representative biennial study of individuals aged 50 and older. United States. Participants were HRS respondents who consented to have their Medicare claims data linked to the HRS data, were aged 65 or older, had at least 1 risk factor for fracture observable in the data, and experienced a fracture between 1996 and 2008 (n = 689) and their propensity score-matched controls (n = 689). Total Medicare, inpatient, outpatient, emergency department, physician office visit, and prescription drug care expenditures were primary outcomes. Two-staged generalized linear models were estimated using a difference-in-differences model. Fracture cases' total Medicare expenditures increased by $13,929 (95% confidence interval (CI)=$11,920-15,938, p <.001) more than those of matched controls from the year before the index or fracture date to 1 year after the index date. Inpatient expenditures of $12,751 (95% CI=$10,790-14,7111, p < .001) more for fracture cases than comparison cases primarily drove this increase. Two and 3 years after fracture, there were no significant differences in growth in expenditures between the two groups. Results did not vary according to whether the fracture was at the hip or other site. Fractures impose a significant economic burden, especially in the first year after the fracture, in Medicare beneficiaries with at least 1 risk factor for fracture. Our sample was limited to community-dwelling individuals, and we are unable to control for fracture history before the study period. Costs may be greater for those in skilled nursing and similar facilities and for those who have had a previous fracture. J Am Geriatr Soc 66:2298-2304, 2018.

Inpatient Medicaid Usage and Expenditure Patterns After Changes in Supplemental Nutrition Assistance Program Benefit Levels.

IntroductionFood insecurity worsens health outcomes and is associated with increased health care usage and expenditures. The Supplemental Nutrition Assistance Program (SNAP) reduces but does not eliminate recipients’ food insecurity. We sought to determine whether inpatient Medicaid usage and expenditure patterns responded to an April 2009 increase in SNAP benefit levels and a subsequent November 2013 decrease.MethodsInterrupted time series models estimated responses to the 2009 and 2013 SNAP changes in the Medicaid population, compared responses between Medicaid and Medicare recipients, and compared responses between Medicaid recipients with different likelihoods of having a disability. Analyses used 2006 through 2014 Healthcare Cost and Utilization Project National (previously Nationwide) Inpatient Sample data.ResultsAfter the 2009 SNAP increase, Medicaid admission growth fell nationally from 0.80 to 0.35 percentage points per month (a difference of –0.45; 95% CI, –0.72 to –0.19), adjusting for enrollment. After the 2013 SNAP decrease, admission growth rose to 2.42 percentage points per month (a difference of 2.07; 95% CI, 0.68 to 3.46). Inflation-adjusted monthly Medicaid expenditures followed similar patterns and were associated with $26.5 billion (in 2006 dollars) in reduced expenditures over the 55 months of the SNAP increase, and $6.4 billion (in 2006 dollars) in additional expenditures over the first 14 months after the SNAP decrease. Effects were elevated for Medicaid compared with Medicare recipients and among people with a high likelihood of having a disability.ConclusionAlthough alternative causal explanations warrant consideration, changes in SNAP benefit levels were associated with changes in inpatient Medicaid usage and cost patterns.

Study on Treatment Expenditures of Urban Cancer Patients: An Evidence-Based Study From Jinan, China

Background: Cancer has become the leading cause of death in China. A recent systematic review showed that the data about economic burden of cancer in China were still very limited. Aim: This study aims to use the linked registry-claims data to analyze treatment expenditures among the patients diagnosed with lung, female breast, colorectal, and stomach cancer between 2011 and 2014 in Jinan of Shandong Province. Methods: A total of 410 urban patients were identified and selected in a tertiary hospital in Jinan of Shandong Province. We have linked the cancer registry data with health insurance claims and hospital discharge data. We were able to create the linked data of a total of 349 patients (85.1%). Inpatient, outpatient, and total treatment expenditure were computed. We also estimated the one-, two-, and three-year healthcare costs after cancer diagnosis. The local consumer price index (CPI) was used to adjust for inflation in medical expenses during the study period, and we calculated our estimates in terms of 2016 Chinese yuan (CNY). We generalized linear models to examine the factors that were associated with treatment expenditure. Results: The average total treatment expenditures of lung, female breast, colorectal, and stomach cancer were respectively 114,965, 115,344, 92,905, and 105,571 CNY. The one-, two-, and three-year total treatment expenditures of all four cancers were 78,801, 101,370, and 113,024 CNY respectively. For patients enrolled in Urban Employee Basic Insurance, 68.1%, of total expenditures were paid by the insurance. In contrast, Urban Resident Basic Insurance and New Rural Cooperative Medical Scheme only paid 46.7% and 39.1% of total expenditures of their beneficiaries. After adjusting for other control variables, health insurance type, receipt of surgery, and length of hospital stay were statistically significant associated with healthcare expenditures in male patients. For female patients, clinical stage, number of hospitalizations, and length of stay were statistically significant factors. Conclusion: The average total treatment expenditures of urban cancer patients were over two times of local disposable income per capita of urban residents in 2016. So, it makes economic sense to invest in cancer prevention and control in China, and the reimbursement gaps between different social insurance plans should be narrowed.

Cost-Analysis of Treatment of Childhood Acute Lymphoblastic Leukemia Based on UKALL Protocol

Background: Health systems have adopted financing to enhance access to care for patients with cancer. The cost of acute lymphoblastic leukemia (ALL) treatment is a blurred image for hospitals and third party payers. The cost of each component of the care should be analyzed to differentiate justifiable cost and to act on wasteful practices. Objectives: Therefore, this is a study on the direct and indirect costs of ALL based on the United Kingdom protocol (UKALL), in pediatric ALL management in Iran. Methods: A retrospective study design was used to study children with ALL managed with UKALL protocol in specialized pediatric hospitals from 2010 - 2015. The data was collected from patients' medical records. Results: Total direct medical cost per patient was 8282 USD. Most of costs were from inpatient beds (3338 +/- 1110 USD) and drug expenditures (2157 +/- 1035 USD). The direct non-medical cost incurred by study participants was 1286.4 USD, the total indirect cost of productivity loss was 769.9. Conclusions: The cost of ALL management imposed huge treat on financial capability of peoples caring for children. The treats will affect the whole society and the health system of the country unless strategies are designed to contain the costs. The policy makers from the top level of the country to the service providers should be hand and glove to devise a suitable national ALL management protocol which will avert the observed alarms.

Why is the inpatient cost of dying increasing in India?

IntroductionThere is an evidence of increasing inpatient expenditure for decedents. Estimates used to assess the economic burden of out-of-pocket (OOP) healthcare expenditure provide an underestimation for inpatient decedent cases. The aims of this paper are to study the trend and pattern of inpatient decedent expenditure and decipher the reasons behind the increasing cost in India.MethodsUsing three rounds of national level National Sample Survey (NSS) data on morbidity & healthcare conducted during 1995–2015 in India, total and component-wise cost of dying was estimated by the socio-demographic characteristics and types of diseases. Generalised linear model was employed to find the changing effect of inpatient decedents on inpatient expenditure on three-time points.ResultsMore than half among inpatient decedents were elderly. Mean inpatient expenditure for neoplasm, circulatory system-related diseases and external causes of mortality and morbidity increased substantially during these two decades. Mean decedent inpatient expenditure become double, diagnostic and bed charges increased by 243%, 323% respectively during 2004–05 to 2014–15. During 2014–15 average decedents aged 15–59 years spent ₹53599 in last twelve month of their life. Controlling all other potential factors, the inpatient expenditure among decedents increased substantially between 1995–96 and 2014–15.DiscussionOut-of-pocket inpatient health expenditure widened between survivor and decedents in between 1995–2014. Increase in the proportion of elderly, proportion of non-communicable and lifestyle-related diseases, expenses on drugs, diagnostics, bed charges largely private sector expenses were the leading reasons for increasing inpatient decedent expenditure. Age-based risk adjustment and modification of end-of-life care are strongly required, future social insurance based on the health-based value of out-of-pocket expenditure rather than their pure consumption value need to be designed to tackle the burden.

Inpatient Expenditures Attributable to Hospital-Onset Clostridium difficile Infection: A Nationwide Case-Control Study in Japan.

Hospital-onset Clostridium difficile infections (CDIs) have a considerable clinical and economic impact on patients and payers. Quantifying the economic impact of CDIs can guide treatment strategies. However, previous studies have generally focused on acute care hospitals, and few have included cost estimates from non-acute care hospitals such as long-term care facilities. This study aimed to quantify the hospital-onset CDI-attributable inpatient expenditures and length-of-stay durations in all healthcare institutions that provide inpatient care (including acute and non-acute care) in Japan. Using national-level insurance claims data, we analyzed patients who had been hospitalized between April 2010 and December 2016. CDI cases were identified and matched with non-CDI controls using hospitalization year, treating hospital, age, sex, surgical procedure, comorbidities, and main diagnoses. Through multivariable regression analyses, we estimated the CDI-attributable inpatient expenditures (2016 US dollars) and length-of-stay durations (days) while adjusting for variations in factors such as patient characteristics, comorbidities, surgery, prescribed antibiotic, geographic region, and hospitalization year. We also analyzed the CDI-attributable inpatient expenditures and length-of-stay durations according to hospital type (acute care and rehabilitation/long-term care). The analysis was conducted using 3768 matched pairs. Overall, CDI-attributable inpatient expenditures and length-of-stay durations were US$3213 and 11.96days, respectively. Rehabilitation/long-term care hospitals had substantially higher inpatient expenditures and longer hospitalizations than acute care hospitals. This study quantified the hospital-onset CDI-attributable inpatient expenditures and hospitalizations in both acute and non-acute care hospitals. The inclusion of non-acute care hospitals provides a more accurate representation of the economic burden of CDIs.

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.

Public-private partnership in health care of India: A review of governance and stewardship issues

Indian health care is characterized by a mixed health system and different kinds of delivery structure. Mixed health systems can be defined as involving ‘centrally planned government health services that operate side-by-side with private markets for similar or complementary products and services’.1 Public health care delivery system includes teaching hospitals, secondary level hospitals (at district and subdivisional level), first-level referral hospitals (community health centres/rural hospitals), dispensaries, primary health centres, sub-centres and health posts. The private sector, both for-profit and not for profit, however, is the dominant sector and services range from 2-bed facilities to 1000+ bed hospitals.2The private provisioning of health care has grown from a mere 5 to 10 percent during India’s independence era to 82 percent of outpatient visit, 52 percent of inpatient expenditure, and 40 percent of births in institution.3 A report of the task force on Medical Education for the National Rural Health Mission in India determined that the private sector provides 58 percent of hospital buildings, 29 percent hospital beds, and 81 percent of the doctors in India.

Improving the performance of social health insurance system through increasing outpatient expenditure reimbursement ratio: a quasi-experimental evaluation study from rural China

BackgroundChina has set up a universal coverage social health insurance system since the 2009 healthcare reform. Due to the inadequate funds, the social health insurance system reimbursed the inpatient expenditures with much higher ratio than outpatient expenditure. The gap in reimbursement ratios resulted in a rapid rising hospitalization rate but poor health outcomes among the Chinese population. A redistribution of social health insurance funds has become one of the main challenges for the performance of Social Health Insurance.MethodsTwo comparable counties, Dangyang County and Zhijiang County, in Hubei Province of China, were sampled as the intervention group and the control group, respectively. The Social Health Insurance Management Department of the intervention group budgeted 600 yuan per capita per year to the patients with 3rd stage hypertension to cover their outpatient expenditures. The outpatient spending in the control group were paid out-of-pocket. The inpatient expenditures reimbursement policies in both groups were not changed. Besides, the Social Health Insurance Management Department of the intervention group budgeted 100 yuan per patient per year to township physicians and hospitals to provide health management services for the patients. While, the health management services in the control group were still provided by health workers. A Propensity Score Matching model and Difference-in-differences model were used to estimate the net effects of the intervention in dimensions of medical services utilization, medical expenditures, SHI reimbursement, and health outcomes.ResultsOne thousand, six hundred and seventy three pairs of patients were taken as valid subjects to conduct Difference-in-differences estimation after the Propensity Score Matching. The net intervention effect is to increase outpatient frequency by 3.3 (81.0%) times (P < 0.05), to decrease hospitalization frequency by 0.075 (− 60.0%) times (P < 0.05), and to increase the per capita total medical service utilization frequency by 3.225 (76.8%) times (P < 0.05). The per capita total medical expenditure decreased 394.2 (− 27.7%) yuan. The SHI reimbursed 90.3 yuan more per capita for the outpatient spending, but the per capita inpatient expenditure reimbursement and per capita total medical expenditure reimbursement decreased significantly by 282.6 (− 44.0%) yuan and 192.3 (− 28.5%) yuan, respectively (P < 0.05). The intervention reduced the per capita inpatient out-of-pocket expenditure and the per capita total out-of-pocket expenditure by 192.8 (− 36.7%) yuan and 201.9 (− 29.9%) yuan, respectively (P < 0.05). The intervention significantly decreased the diastolic blood pressure of the intervention group by 2.9 mmHg (P < 0.05) but had no significant impact on the systolic blood pressure (− 7.9 mmHg, P > 0.05).ConclusionFor China and countries attempting to establish a universal coverage SHI with inadequate funds, inpatient services were expensive but might not produce good health outcomes. Outpatient care for patients with chronic diseases should be fundamental, and outpatient expenditures should be reimbursed with a higher ratio.

Reducing costs at the end of life through provider incentives for hospice care: A retrospective cohort study

Background: Costs of medical care have been found to be highest at the end of life. Aim: To evaluate the effect of provider reimbursement for hospice care on end-of-life costs. Design: The policy expanded access to hospice care for end-stage renal disease patients, a policy previously limited to cancer patients only. This study employed a difference-in-differences analysis using a generalized linear model. The main outcome is inpatient expenditures in the last 30 days of life. Setting/participants: A cohort of 151,509 patients with chronic kidney disease or cancer, aged 65 years or older, who died between 2005 and 2012 in the National Health Insurance Research Database, which contains all enrollment and inpatient claims data for Taiwan. Results: Even as end-of-life costs for cancer are declining over time, expanding hospice care benefits to end-stage renal disease patients is associated with an additional reduction of 7.3% in end-of-life costs per decedent, holding constant patient and provider characteristics. On average, end-of-life costs are also high for end-stage renal disease (1.88 times higher than those for cancer). The cost savings were larger among older patients—among those who died at 80 years of age or higher, the cost reduction was 9.8%. Conclusion: By expanding hospice care benefits through a provider reimbursement policy, significant costs at the end of life were saved.

Disparities in out-of-pocket inpatient expenditures in rural Shaanxi Province, western China from 2011 to 2014: a time series analysis.

To investigate the long-term trend of disparity of monthly average out-of-pocket inpatient expenditures (OOP) between areas with different developing levels since the new healthcare reform. Time series regression was used to assess the trend of disparities of OOP and monthly average inpatient expenditures (AIE) between areas with different developing levels in rural Shaanxi Province, western China. The data of OOP and AIE in primary health institutions, secondary hospitals, tertiary hospitals and also all levels of the hospital were analysed separately covering the period 2011 through to 2014. The disparity of AIE at all levels of hospitals was increasing (coefficient=0.003, P=0.029), and only the disparity of AIE in secondary hospitals was statistical significant (coefficient=0.003, P=0.012) when separately considering different levels of the hospital. The disparity of OOP in all levels of the hospital was increasing (coefficient=0.007, P=0.001), and the OOP in primary hospitals contributed most of the disparity (coefficient=0.019, P=0.000), followed by OOP in secondary (coefficient=0.008, P=0.003) and tertiary hospitals (coefficient=0.004, P=0.091). A statistically significant absolute increase in the trend of disparities of OOP and AIE at all levels of hospital was detected after the new healthcare reform in Shaanxi Province, western China. The increase rate of disparity of OOP was bigger than that of AIE. A modified health insurance plan should be proposed to guarantee equity in the future.

PHS15 - The Impact of Patient-Centered Medical Home on Hypertension-Associated Health Care Utilization and Cost

We examined the effect of patient centered medical home (PCMH) on health service expenditures and utilization in a national probability sample of US civilian noninstitutionalized adult population who were diagnosed with hypertension. The 2010-2015 Medical Expenditure Panel Survey data were analyzed. Our study population was limited to noninstitutionalized US adults ≥18 years of age diagnosed with hypertension. We investigated the impact of PCMH on the direct hypertension-related total, inpatient, prescription medications, outpatient, emergency room, office based, and other medical expenditures by employing Log transformed multiple linear regression models and the propensity score method. Of the 18,630 adults identified with hypertension, 19.2% (n = 3,583) had received PCMH care during 2010 to 2015. After matching, No PCMH group showed greater mean in all hypertension-related health service expenditures and utilization. After adjusting for confounders, PCMH group showed significant lower total, office-based, outpatient, number of office-based visits and outpatient visits compared with control group. A significant relationship between experiencing PCMH care and a lower total health care expenditure were found among patient with hypertension. To reduce the overall cost of care for those patients, policy makers should implement new intervention strategies that are effective in facilitating the access to PCMH.

Oregon Medicaid Expenditures After the 2014 Affordable Care Act Medicaid Expansion: Over-time Differences Among New, Returning, and Continuously Insured Enrollees.

There is interest in assessing health care utilization and expenditures among new Medicaid enrollees after the 2014 Medicaid expansion. Recent studies have not differentiated between newly enrolled individuals and those returning after coverage gaps. To assess health care expenditures among Medicaid enrollees in the 24 months after Oregon's 2014 Medicaid expansions and examine whether expenditure patterns were different among the newly, returning, and continuously insured (CI). Retrospective cohort study using inverse-propensity weights to adjust for differences between groups. Oregon adult Medicaid beneficiaries insured continuously from 2014 to 2015 who were either newly, returning, or CI. Monthly expenditures for inpatient care, prescription drugs, total outpatient care, and subdivisions of outpatient care: emergency department, dental, mental and behavioral health, primary care, and specialist care. After initial increases, newly and returning insured (RI) outpatient expenditures dropped below CI. Expenditures for emergency department and dental services among the RI remained higher than among the newly insured. Newly insured mental and behavioral health, primary care, and specialist expenditures plateaued higher than RI. Prescription drug expenditures increased over time for all groups, with CI highest and RI lowest. All groups had similar inpatient expenditures over 24 months post-Medicaid expansion. Our findings reveal that outpatient expenditures for new nonpregnant, non-dual-eligible Oregon Medicaid recipients stabilized over time after meeting pent-up demand, and prior insurance history affected the mix of services that individuals received. Policy evaluations should consider expenditures over at least 24 months and should account for enrollees' prior insurance histories.

Inpatient care expenditure of the elderly with chronic diseases who use public health insurance: Disparity in their last year of life

The Thai elderly are eligible for the Civil Servant Medical Benefit Scheme (CS) or Universal Coverage Scheme (UCS) depending on their pre-retirement or their children work status. This study aimed to investigate the disparity in inpatient care expenditures in the last year of life among Thai elderly individuals who used the two public health insurance schemes. Using death registration and inpatient administrative data from 2007 to 2011, our subpopulation group included the elderly with four chronic disease groups: diabetes mellitus, hypertension and cardiovascular disease, heart disease, and cancer. Among 1,242,150 elderly decedents, about 40% of them had at least one of the four chronic disease conditions and were hospitalized in their last year of life. The results showed that the means of inpatient care expenditures in the last year of life paid by CS and UCS per decedent were 99,672 Thai Baht and 52,472 Thai Baht, respectively. On average, UCS used higher healthcare resources by diagnosis-related group relative weight measure per decedent compared with CS. In all cases, the rates of payment for inpatient treatment per diagnosis-related group adjusted relative weight were higher for CS than UCS. This study found that the disparities in inpatient care expenditures in the last year of life stemmed mainly from the difference in payment rates. To mitigate this disparity, unified payment rates for various types of treatment that reflect costs of hospital care across insurance schemes were recommended.

The direct cost of epilepsy in children: Evidence from the Medical Expenditure Panel Survey, 2003–2014

IntroductionEpilepsy is frequent in children and often requires complex healthcare interventions. There is a paucity of recent and detailed healthcare expenditures among children with epilepsy in the United States (US). MethodsData on children (aged ≤17years) from the Medical Expenditure Panel Survey-Household Component (MEPS-HC) from 2003 to 2014 were analyzed. Unadjusted overall and specific cost components were compared between children with epilepsy and those without epilepsy. We used a two-part model with gamma distribution and log link for the estimation of independent incremental cost incurred by epilepsy in children. Unadjusted and adjusted mean expenditures and aggregate burden of epilepsy were estimated. ResultsOut of 54,393,387 (weighted) US children, 457,873 (0.84%) had epilepsy. Children with epilepsy had nearly six times higher healthcare expenditure than those without epilepsy ($2024 [95% confidence interval (CI): 1917–2130] vs. $12,577 [95% CI: 7922–17,231]). Unadjusted inpatient expenditure for epilepsy ($4418 [95% CI: 1550–7285) was ten times higher than that for children without epilepsy, representing more than one-third of unadjusted total direct cost. The adjusted difference in medical expenditure between children with and those without epilepsy was $8317 (95% CI: 3701–13,363). The annual unadjusted aggregate cost of epilepsy in children was approximately $5.8 billion. The annual adjusted difference in cost of epilepsy between children with and those without epilepsy was $3.8 billion. ConclusionUnadjusted and adjusted medical expenditure among children with epilepsy is high. The high expenditure is essentially driven not only by inpatient expenditure but also by home healthcare, outpatient, and medication healthcare expenditures.

A register-based case-control study of health care utilization and costs in binge-eating disorder

ObjectiveCapturing trends in healthcare utilization may help to improve efficiencies in the detection and diagnosis of illness, to plan service delivery, and to forecast future health expenditures. For binge-eating disorder (BED), issues include lengthy delays in detection and diagnosis, missed opportunities for recognition and treatment, and morbidity. The study objective was to compare healthcare utilization and expenditure in people with and without BED. MethodsA case-control design and nationwide registers were used. All individuals diagnosed with BED at eating disorder clinics in Sweden between 2005 and 2009 were included (N = 319, 97% female, M age = 22 years). Ten controls (N = 3190) were matched to each case on age-, sex-, and location of birth. Inpatient, hospital-based outpatient, and prescription medication utilization and expenditure were analyzed up to eight years before and four years after the index date (i.e., date of diagnosis of the BED case). ResultsCases had significantly higher inpatient, hospital-based outpatient, and prescription medication utilization and expenditure compared with controls many years prior to and after diagnosis of BED. Utilization and expenditure for controls was relatively stable over time, but for cases followed an inverted U-shape and peaked at the index year. Care for somatic conditions normalized after the index year, but care for psychiatric conditions remained significantly higher. ConclusionIndividuals with BED had substantially higher healthcare utilization and costs in the years prior to and after diagnosis of BED. Since previous research shows a delay in diagnosis, findings indicate clear opportunities for earlier detection and clinical management. Training of providers in detection, diagnosis, and management may help curtail morbidity. A reduction in healthcare utilization was observed after BED diagnosis. This suggests that earlier diagnosis and treatment could improve long-term health outcomes and reduce the economic burden associated with BED.

How Much Inpatient Cost Can be Saved by Integrated Service? An Empirical Study from China

Background: Cost is a great concern for integrated care. China has been trying to build a hierarchical medical system to integrate services between different medical institutions, so that mild patients can be referred to primary institutions and cost can be cut. Our aim is to explore how much inpatient cost could be saved by the hierarchical medical system. Methods: This study was carried out in Xi County, China, based on the rural inpatient database in 2015. We firstly screen out the inpatient record in county hospitals which could have been in township hospitals based on self-evaluation capability and practical capability of township hospitals and then calculate the difference in cost between township and county hospitals which could have been saved. Self-evaluation capability referred to all the disease that township hospitals thought they could handle by inpatient service and practical capability referred to all the disease that township hospitals actually handled by inpatient service. Results: Under the self-evaluation capacity, 14.90% of the inpatient records in county hospitals could have been in township hospitals and 11.84 million￥ (5.20% of the total inpatient expenditure within county) could have been saved. Under the practical capability, 6.95% of the inpatient records in county hospitals could have been in township hospitals and 7.15 million￥ (3.14% of the total inpatient expenditure within county) could have been saved. Discussion: Cost reduction by service integration was limited by the capability of township hospitals. Conclusion: Cost reduction by the hierarchical medical system was small. Lessons learned: Capability improvement of primary medical institutions is a key task for service integration and effectiveness raise. Limitations: We did not compare the inpatient quality and take the patient's willingness into account. Suggestions for future research: Comparison of quality and patient willingness need to be considered in further studies.

Nationwide Healthcare Expenditures among Hypertensive Individuals with Stroke: 2003-2014

Of all the various clinical entities, hypertension is arguably most strongly linked to the occurrence of stroke. However, the impact of stroke on health-care expenditures in patients with hypertension has not been previously evaluated. We analyzed data from the Medical Expenditure Panel Survey Household Component, 2003-2014 data. Adults aged 18 years or greater were included in this analysis. We used a 2-part model (adjusting for demographic, comorbidity, and time) to estimate the incremental health-care expenditures incurred by stroke among individuals with hypertension. On average, $4057 more dollars (adjusted incremental health-care expenditure) was spent on individuals with hypertension plus stroke versus no history of stroke. Overall unadjusted mean medical expenditure in those with a comorbid diagnosis of stroke was twice as high as in those without a diagnosis of stroke ($16,668 versus 8374; P < .001). Inpatient expenditures (37.4%), outpatient expenditures, and prescription expenditures (nearly 23% each) accounted for almost 80% of the total mean unadjusted direct expenditures. Annual average unadjusted aggregate costs among individuals with hypertension and stroke were $98.3 billion, while annual adjusted aggregate incremental costs were higher by $24 billion among patients with stroke versus those without stroke. Among individuals with hypertension in the United States, those who have experienced a stroke incur tens of billions of dollars in higher health-care expenditures compared with those without known stroke. Greater emphasis on stroke prevention strategies and cost control initiatives (wherever appropriate) are warranted.