Medical Care Expenditures Research Articles

Budget impact analysis of chronic kidney disease mass screening test in Japan

BackgroundOur recently published cost-effectiveness study on chronic kidney disease mass screening test in Japan evaluated the use of dipstick test, serum creatinine (Cr) assay or both in specific health checkup (SHC). Mandating the use of serum Cr assay additionally, or the continuation of current policy mandating dipstick test only was found cost-effective. This study aims to examine the affordability of previously suggested reforms.MethodsBudget impact analysis was conducted assuming the economic model would be good for 15 years and applying a population projection. Costs expended by social insurers without discounting were counted as budgets.ResultsAnnual budget impacts of mass screening compared with do-nothing scenario were calculated as ¥79–¥−1,067 million for dipstick test only, ¥2,505–¥9,235 million for serum Cr assay only and ¥2,517–¥9,251 million for the use of both during a 15-year period. Annual budget impacts associated with the reforms were calculated as ¥975–¥4,129 million for mandating serum Cr assay in addition to the currently used mandatory dipstick test, and ¥963–¥4,113 million for mandating serum Cr assay only and abandoning dipstick test.ConclusionsEstimated values associated with the reform from ¥963–¥4,129 million per year over 15 years are considerable amounts of money under limited resources. The most impressive finding of this study is the decreasing additional expenditures in dipstick test only scenario. This suggests that current policy which mandates dipstick test only would contain medical care expenditure.

Competent Alternative Model for the Peasants' Medical Expenditures in China: A Case of New Rural Cooperative Medical Service System (Nrcms) in Zhejiang Province

The New Rural Cooperative Medical Service System (NRCMS) in China has been established to ensure improved medical care support for all categories of Chinese peasants to offset their burden of excessive medical care expenditures. The primary aim of this paper is to identify an appropriate alternative modelling approach for the patients’ medical expenditures. Data were collected from Jiaojiang city through cluster and multistage random sampling procedure, which was comprised of 4,630 enrolled rural people under NRCMS. The paper presented the fi rst comparison of common econometric medical expenditures modelling approaches. Major fi ndings reveal that the Generalized Linear Model (GLM) predictive accuracy appears to be better than the Finite Mixture Model (FMM) and GLM (log link) was the best performer among all approaches. It may be attributed due to the structural difference of medical expenditures between China and other developing countries compared to the developed countries. This suggests that the Chinese government may fi nd an alternative to choose GLM approach among others to minimize the peasants’ medical expenditures under NRCMS.

베이비붐세대가 65세 노인인구로 전환 시의 만성질환 환자수와 진료비 예측

Purpose: The purpose of study is to estimate the number of chronic disease patients and medical care expenditure at the time baby-boomers belong to 65 years old aging population, and compare with current 65 year-old aging population. Methods: Analysis method used an estimating formula devised by the researcher and estimated the number of chronic disease patients and medical care expenditure of each generation. Results: When comparing the estimated number of chronic diseases patients of each generation, 40.6% of the first generation, 76.4% of the second generation, 95.2% of third generation are expected to get chronic disease. When comparing each generation's total medical care expenditure, based on the estimated number of chronic diseases patients of each generation, the second generation( 1,206,251,224 thousand won) showed higher than other generation. This study compared the number of chronic disease patients and medical care expenditure between the second generation of the elderly and current elder generation. As a result, the second generation patients was higher than the fourth generation in high blood pressure, diabetes, psychological and behavioral disorder, and neurological diseases whereas the fourth generation is only high the number of patients in heart disease. As for total medical care expenditure, the second generation paid more in high blood pressure, psychological and behavioral disorder while the fourth generation in neurological disease and heart disease. Conclusion: It is desired that considering the number of chronic disease patients and medical care expenditure of baby boomers accounting for 14.6% of total population, in-depth follow-up study is carried out that inquires into what are issues with a current chronic disease management project, what business is needed in order to manage these issues, and how to fund to cover increasing medical care expenditure.

Complementary and Conventional Medicine Use Among Youth With Recurrent Headaches

To identify prevalence and patterns of complementary and alternative medicine (CAM) use among youth with recurrent headaches (HA) and evaluate associations with co-occurring health problems and limitations as well as with the use and expenditures for conventional medical care. Variables were constructed for youth aged 10 to 17 by using linked data from the 2007 National Health Interview Survey and the 2008 Medical Expenditures Panel Survey. Bivariate, logistic, and 2-part regression analyses were used. Of the 10.6% of youth experiencing HA, 29.6% used CAM, rising to 41% for the many HA sufferers who also experienced difficulties with emotions, concentration, behavior, school attendance, or daily activities. Biologically based products (16.2%) and mind-body therapies (13.3%) were most commonly used, especially by the 86.4% of youth with HA experiencing at least 1 other chronic condition. Compared with non-CAM users, youth with HA who used CAM also had higher expenditures for and use of most types of conventional care. CAM use is most common among youth with HA experiencing multiple chronic conditions and difficulties in daily functioning. Associations among CAM use, multiple chronic conditions, and higher use of conventional care highlight the need for medical providers to routinely ask about CAM use to meet the complex health needs of their patients and facilitate the optimal integration of care. Research is needed to identify models for coordinating complementary and conventional care within a medical home and to understand the health benefits or risks associated with CAM use in conjunction with conventional treatments for patients with HA.

Building Wave Response Rates in a Longitudinal Survey

In national health care surveys, significant amounts of resources are allocated to obtaining the participation of households that constitute the last 5–10% of the overall survey response rate. This study examines the implications of a reduction in targeted first-round response rates in the Medical Expenditure Panel Survey (MEPS), a national health care survey designed to produce estimates of health care utilization, expenditures, and insurance coverage. The potential impact of this modification on annual and overall longitudinal survey response rates, survey estimates, and costs is determined and compared with an alternative approach that subsamples these difficult to field cases. Study findings revealed nonuniform results when evaluating the capacity of these alternative design strategies to achieve precision targets while simultaneously satisfying data collection budget constraints for a variety of medical care expenditure estimates. Based on these results, it was determined that additional experimentation was necessary prior to implementing design modifications.

Geographic variation in commercial medical-care expenditures: A framework for decomposing price and utilization

This study introduces a new framework for measuring and analyzing medical-care expenditures. The framework focuses on expenditures at the disease level that are decomposed between price and utilization. We find that both price and utilization differences are important contributors to expenditure differences across commercial markets. Further examination shows that for some diseases utilization drives variation while for others price is more important. Finally, when disease-specific measures are aggregated across diseases, much of the important disease-specific variation is masked, leading to much smaller measures of aggregate variation.

Economic Burden of Men's Health Disparities in the United States

Very little is known about the economic consequences of men’s health disparities. Using data from the 2006 through 2009 Medical Expenditure Panel Survey and the National Vital Statistics Reports, we estimated the potential cost savings of eliminating health disparities for racial/ethnic minority men. The total direct medical care expenditures for African American men were $447.6 billion of which $24.2 billion was excess medical care expenditures. With regard to indirect costs to the economy, African American and Hispanic men incurred $317.6 and $115.0 billion respectively. These findings indicate that we cannot afford to overlook the disparities that exist, particularly among African American and Hispanic men. Failure to do so is both socially and morally wrong and carries huge economic consequences.

Comparing Methods for Imputing Employer Health Insurance Contributions in the Current Population Survey

The degree to which firms contribute to the payment of workers’ health insurance premiums is an important consideration in the measurement of income and for understanding the potential impact of the 2010 Affordable Care Act on employment-based health insurance participation. Currently the U.S. Census Bureau imputes employer contributions in the Annual Social and Economic Supplement of the Current Population Survey based on data from the 1977 National Medical Care Expenditure Survey. The goal of this paper is to assess the extent to which this imputation methodology produces estimates reflective of the current distribution of employer contributions. The paper uses recent contributions data from the Medical Expenditure Panel Survey-Insurance Component to estimate a new model to inform the imputation procedure and to compare the resulting distribution of contributions. These new estimates are compared with those produced under current production methods across employee and employer characteristics.

Body Mass Index and Medical Care Expenditures in Korea: An eight-year follow-up Study

Body Mass Index and Medical Care Expenditures in Korea: An eight-year follow-up Study

Cost information of chemotherapy for cervical and endometrial cancer in Japan.

Treatment cost is one of the biggest concerns for cancer patients. Providing information to cancer patients about treatment cost and available financial support contributes to high-quality care. The aim of this study was to determine chemotherapy costs and other medical care expenditures for patients with cervical and endometrial cancer. Data from the Diagnosis Procedure Combination system, which is the Japanese version of the Diagnosis-related Group system, were used to identify 179 patients with cervical cancer and 244 patients with endometrial cancer who received chemotherapy from 2008-2010 at a specialized cancer hospital. The costs of chemotherapy per bolus, various protocols, and other medical care expenditures were investigated. The cost per bolus of chemotherapeutic agents varied from ¥13,804-258,906 ($US 173-3236). The total medical cost for each course, including supportive care and treatment for chemotoxic symptoms, ranged ¥22,230-590,140 ($US 278-7377). Fourteen protocols were used in this population. Multiple regression analysis revealed that the factors related to the total medical care cost for cervical cancer were cost of chemotherapeutic agents, laboratory tests, oral medications, number of complications, and age. For endometrial cancer, cost of chemotherapeutic agents, laboratory tests, and oral medications were the factors related to the total medical care costs. The cost of various chemotherapy protocols and the total medical care was determined using the Diagnosis Procedure Combination system. Nurses should give the information about treatment cost and discuss the cost with patients to facilitate high-quality care.

The association between functional disability and acute care utilization among the elderly in Taiwan

Disability is associated with increased long-term care use among the elderly, but its association with utilization of acute care is not well understood. The aim of this study is to investigate the association between functional disability and acute medical care utilization among the elderly. This nationwide, population-based cohort study was based on data from the 2005 National Health Interview Survey (NHIS), linking to the 2004–2007 National Health Insurance (NHI) claims data. A total of 1521 elderly subjects aged 65 years or above were observed from the year 2004 to 2006; this sample was considered to be a national representative sample. The utilization of acute medical care (including outpatient services, emergency services, and inpatient services) and medical expenditure were measured. Functional disability was measured by determining limitations on activities of daily living (ADLs), instrumental activities of daily living (IADLs), and mobility. After adjusting for age, comorbidity, and sociodemographic characteristics, functional disability that affected IADLs or mobility was a significant factor contributing to the increased use of care. A clear proportional relationship existed between disability and utilization, and this pattern persisted across different types of acute care services. Disability affecting IADLs or mobility, rather than ADLs, was a more sensitive predictor of acute medical care utilization. Compared to elderly persons with no limitations, the medical expenditure of those with moderate-to-severe limitations was 2–3 times higher for outpatient, emergency, and inpatient services. In conclusion, functional disability among the elderly is a significant factor contributing to the increased use of acute care services.

Influence of Socio-Demographic Characteristics on Eye Care Expenditure: Data from the Medical Expenditure Panel Survey 2007

ABSTRACTObjective: To evaluate the association between sociodemographic factors and eye care expenditure and to assess the burden of ocular expenditure compared to total health care expenditure.Methods: A retrospective analysis of ocular expenditure in participants of the 2007 Medical Expenditure Panel Survey. Data from 20,620 unique participants aged ≥18 years were evaluated for eye care expenditure by demographic characteristics.Results: A total of 22% of the studied population had eye care expenditures in 2007. Demographic factors significantly associated with higher probability of having eye care expenditures included older age (65+ years 35%, 45–64 years 23%, <45 years 17%), female sex (female 26%, male 19%), higher educational attainment (greater than high school education 25%, less than high school education 17%), having insurance (private 24%, uninsured 13%), and visual impairment (mild 31%, none 22%). Older age, female sex, higher educational attainment, having insurance, and presence of visual impairment were also significantly associated with higher mean eye care expenditure. In those with eye care expenditure, the mean ratio between eye care and total medical expenditure was 24%, with uninsured patients spending 42% of their medical care expenditure on eye care.Conclusions: Demographic factors are associated with both the probability of having ocular expenditure and the amount of expenditure. Of all factors examined, insurance status has the most potential for modification. Policy makers should consider these numbers when devising the terms by which eye care coverage will be provided under the Patient Protection and Affordable Care Act.

PHS104 - Effect Of Insurance Coverage On Health-Care Expenditures Among Patients With Arthritis

To compare the effect of insurance coverage on health-care related expenditures among patients with arthritis in the United States. A cross-sectional analysis was conducted. Subjects were derived from the National Medical Expenditures Panel Survey (MEPS) for those whom reported having any type of arthritis in 2009. A series of weighted univariate statistics were applied to examine patient’s demographic characteristics (gender, race, age, etc.) and insurance coverage (private, public, and uninsured). We further employed a generalized linear regression model to compare the health-care expenditures (inpatient, emergency room, outpatient, prescription drug) among different insurance status. All analyses utilized SAS PROC SURVEYs’ application to adjust for the complex sampling design employed by MEPS database. There were an estimated 55.99 million arthritis patients from 2009 MEPS, in which 8.5 million (15.1%) had rheumatoid arthritis; 21.2 million (37.7%) had osteoarthritis; and 26.5 million (47.2%) had unspecified arthritis. It is estimated that the majority of the arthritis patients 34.9 million (62.35%) were covered by private insurance, 16.5 million (29.5%) were covered by public plans and about 4.5 million (8%) were uninsured. The total medical expenditure for patients with arthritis in 2009 was $522.6 billion. Total prescription expenditures among arthritis patients were $122.1 billion. Per capita medical care expenditures among private, public and uninsured arthritis patients averaged $8,751, $12,093 and $3,730 respectively (P<0.0001). Also, there is a significant difference (P<0.0001) in the prescription expenditures among private, public and uninsured arthritis patients. Average prescription expenditure is $1982.6, $2991.6 and $748 respectively. ConclusionsOur findings indicate that uninsured arthritis patients had significant lower costs in total health-care expenditure than insured patients. Consistently with other studies, the uninsured have more unmet health needs than insured Americans. Such undertreated and/or underutilized situation may place uninsured people at risk of a serious disability complication.

Effects of Health Guidance on Outpatient and Pharmacy Expenditures: A Disease- and Drug-Specific 3-Year Observational Study Using Propensity-Score Matching

BackgroundEvidence is lacking on whether health guidance for metabolic syndrome reduces health care expenditures. The author used propensity-score matching to evaluate the effects of health guidance on health care expenditure.MethodsMen who did and did not receive health guidance from a health insurance society (approximately 60 000 covered lives) were matched (n = 397 respectively) using propensity scores. Health insurance claims were compared using cumulative health care expenditures for metabolic syndrome-related outpatient medical care and drug costs for the period from the initial consultation to 3 years later.ResultsNo difference was observed between intervention and control groups in cumulative outpatient charges or drug costs related to metabolic syndrome. However, regression analysis using the Tobit model showed that health guidance resulted in a small, nonsignificant reduction in health care expenditure.ConclusionsHealth guidance for metabolic syndrome did not reduce outpatient charges or drug costs related to metabolic syndrome during the 3-year period after the intervention. Findings from Tobit regression suggest that health guidance might eventually result in savings, but this hypothesis remains untested.

Workplace Health: Engaging Business Leaders to Combat Obesity

This article explores how employers can be part of the solution to obesity by offering workplace wellness programs and facilitating opportunities for physical activity, access to healthier foods and beverages, and incentives for disease management and prevention to help prevent weight gain among their employees.

Decomposing Medical-Care Expenditure Growth

Medical-care expenditures have been rising rapidly, accounting for almost one-fifth of GDP in 2009. In this study, we assess the sources of the rising medical-care expenditures in the commercial sector. We employ a novel framework for decomposing expenditure growth into four components at the disease level: service price growth, service utilization growth, treated disease prevalence growth, and demographic shift. The decomposition shows that growth in prices and treated prevalence are the primary drivers of medical-care expenditure growth over the 2003 to 2007 period. There was no growth in service utilization at the aggregate level over this period. Price and utilization growth were especially large for the treatment of malignant neoplasms. For many conditions, treated prevalence has shifted towards preventive treatment and away from treatment for late-stage illnesses.

Medical Care Price Indexes for Patients with Employer‐Provided Insurance: Nationally Representative Estimates from MarketScan Data

Commonly observed shifts in the utilization of medical care services to treat diseases may pose problems for official price indexes at the Bureau of Labor Statistics (BLS) that do not account for service shifts. We examine how these shifts may lead to different price estimates than those observed in official price statistics at the BLS. We use a convenience sample of enrollees with employer-provided insurance from the MarketScan database for the years 2003 to 2007. Population weights that consider the age, sex, and geographic distribution of enrollees are assigned to construct representative estimates. We compare two types of price indexes: (1) a Service Price Index (SPI) that is similar to the BLS index, which holds services fixed and measures the prices of the underlying treatments; (2) a Medical Care Expenditure Index (MCE) that measures the cost of treating diseases and allows for utilization shifts. Over the entire period of study the CAGR of the SPI grows 0.7 percentage points faster than the preferred MCE index. Our findings suggest that the health component of inflation may be overstated by 0.7 percentage points per year, and real GDP growth may be understated by a similar amount. However, more work may be necessary to precisely replicate the indexes of the BLS to obtain a more accurate measure of these price differences.

Economic and health consequences in women subject to intimate partner abuse

BackgroundIntimate partner abuse (IPA) has inter-generational effects, cause emotional and physical harm; in addition, affect the women's financial lives. Latin American studies have estimated that at least 30% of GDP...

Medical Care and Payment for Diabetes in China: Enormous Threat and Great Opportunity

BackgroundThe Diabetes Impact Study followed up a large national population-based screening study to estimate the use of and expenditures for medical care caused by diabetes in China and to ascertain the use and cost of essential basic medicines and care.MethodsIn 2009–10, the study team interviewed 1482 adults with diabetes and 1553 adults with glucose tolerance in the normal range from population-based random samples at 12 sites in China. The response rate was 67%.FindingsAfter adjusting for age, sex, and urban/rural location, people with diabetes received 1.93 times more days of inpatient treatment, 2.40 times more outpatient visits, and 3.35 times more medications than people with normal glucose tolerance (all p<0.05). Adjusted expenditures for medical care were 3.38 times higher among people with diabetes than among people with normal glucose tolerance (p<0.01, unadjusted 3.97). Persons who were diagnosed with ≥10 years prior to the survey paid 3.75 times as much for medical care as those with ≤5 years of diagnosed diabetes. Among persons with diabetes, 45.2% took medication to control blood sugar, 21.1% took an antihypertensive medicine, 22.4% took daily aspirin, and 1.8% took a statin. Over the three months before the interview, 46.1% of persons with diabetes recalled seeing a doctor, 48.9% recalled a blood pressure measurement, and 54.5% recalled a blood sugar test. Over the year preceding the interview, 32.1% recalled a retinal screening and 17.9% recalled a foot examination.ConclusionsIn China, health care use and costs were dramatically higher for people with diabetes than for people with normal glucose tolerance and, in relative terms, much higher than in industrialized countries. Low-cost generic medicines that would reduce diabetes expenditures were not fully used.

Both Symptom and Disease: Relating Medical Malpractice to Health-Care Costs

Tort reformers blame the high cost of American health care on defensive responses to rampant medical malpractice litigation. Defenders of the tort system counter that holding health care providers liable for negligence improves safety and ensures compensation for injury. The relationship between medical malpractice and health care expenditures is more complex than either of these positions reflects. The existing medical malpractice system increases medical spending mainly because it has evolved in tandem with other inflationary features of the health care system and may make those features even more difficult to change. In other words, medical malpractice is both a symptom of a costly health care system and a costly disease in its own right.