Medical Care Expenditures Research Articles

Patient-Centered Medical Home Features and Health Care Expenditures of Medicare Beneficiaries with Chronic Disease Dyads

Three out of 4 Medicare beneficiaries have multiple chronic conditions, and managing the care of this growing population can be complex and costly because of care coordination challenges. This study assesses how different elements of the patient-centered medical home (PCMH) model may impact the health care expenditures of Medicare beneficiaries with the most prevalent chronic disease dyads (ie, co-occurring high cholesterol and high blood pressure, high cholesterol and heart disease, high cholesterol and diabetes, high cholesterol and arthritis, heart disease and high blood pressure). Data from the 2007-2011 Medical Expenditure Panel Survey suggest that increased access to PCMH features may differentially impact the distribution of health care expenditures across health care service categories depending on the combination of chronic conditions experienced by each beneficiary. For example, having no difficulty contacting a provider after regular hours was associated with significantly lower outpatient expenditures for beneficiaries with high cholesterol and diabetes (n = 635; P = 0.038), but it was associated with significantly higher inpatient expenditures for beneficiaries with high blood pressure and high cholesterol (n = 1599; P = 0.015), and no significant differences in expenditures in any category for beneficiaries with high blood pressure and heart disease (n = 1018; P > 0.05 for all categories). However, average total health care expenditures are largely unaffected by implementing the PCMH features considered. Understanding how the needs of Medicare beneficiaries with multiple chronic conditions can be met through the adoption of the PCMH model is important not only to be able to provide high-quality care but also to control costs. (Population Health Management 2016;19:206-211).

New evidence on factors affecting the level and growth of US health care spending

The dual problems of high and rising medical care expenditures and substantial differences in spending across geographic regions have long plagued the US health care system. We provide new evidence to explain why some states and regions of the country spend much more on medical care than others, and why health care spending for the nation as a whole has been growing rapidly over the last several decades. To do this, we estimate a health care spending panel data model using annual data on all 50 states for the period 1993–2009. Our model includes a number of socio-economic, health care provider, lifestyle and environmental variables that past studies indicate may affect the level or growth of aggregate health care spending. We exploit the time effect component of our model to obtain an upper-bound estimate of the effect of advances in medical technology. Our findings indicate that the most important factors influencing the level of spending are availability of providers, income, excessive alcohol consumption, Medicaid coverage, HMO health plans and the proportion of the population elderly and African-American. The principal drivers of growth have been the continual introduction of new medical technologies, and the growth of providers and income.

Abstract 830: Gene-specific promoter methylation is related to micronuclei frequency in urothelial cells from individuals exposed to organic solvents and paints

Abstract Bladder cancer is the 9th most common cancer worldwide and patients often receive late diagnosis. Due to its high recurrence (50-80%) this malignancy is the fifth most expensive cancer in terms of total medical care expenditures. Even though epidemiologic evidence shows the etiologic link between occupational exposure to organic solvents and bladder cancer, not all exposed individuals develop such disease, making it an attractive target for prevention and risk stratification. Previously, we reported the association between multiple polymorphisms in DNA-repair and metabolism genes and an increase in chromosome instability in workers exposed to organic solvents; however, it is still unclear whether gene-specific promoter methylation contributes to chromosome breakage or loss, as an intermediate end point of disease. Here, we investigated the effect of chronic exposure to organic solvents and paints on DNA-methylation profiles and micronuclei frequency in non-smoking, car painter compared to age matched referents (non-exposed). Micronucleus frequency and methylation profiles in gene promoters of E-cadherin (CDH-1), p16INK4a, Glutathione S-transferase P (GSTP1), and Adenomatous polyposis coli (APC), were assessed in exfoliated urothelial cells from voided urine. Poisson regression analysis indicated a significant increase in micronuclei frequency in all individuals with CDH-1- (RR 16.91, 95% CI 8.2-35.76, p< 0.001) and GSTP1- (RR 2.23, 95% CI 1.58-3.12, p< 0.001) promoter methylation. In addition, exposed workers with methylated p16INK4a promoter had an increased micronuclei frequency in relation to the matched referents (RR 1.93, 95% CI 1.45-2.55, p< 0.001). In contrast, methylation in the APC promoter was associated with decreased micronuclei frequency in all individuals (RR 0.11, 95% CI 0.7-0.19, p< 0.001). Finally, overall the exposed group had a higher percentage of individuals with > 2 micronuclei/2000 cells compared to the referent group (p = 0.04). These results support the conclusion that gene-specific promoter methylation may increase micronuclei frequency in a dependent or independent interaction with occupational exposure to organic solvents. The present and other studies might be used in the primary prevention of bladder cancer to encourage preventive measures at the work place and lifestyle changes in those at highest risk of developing the disease. Citation Format: Luz S. Hoyos-Giraldo, Luisa F. Escobar-Hoyos, Diana Saavedra-Trujillo, Ingrid Reyes-Carvajal, Adriana Muñoz, Elizabeth Londoño-Velasco, Angela Tello, Silvio Carvajal, Regina Santella. Gene-specific promoter methylation is related to micronuclei frequency in urothelial cells from individuals exposed to organic solvents and paints. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 830. doi:10.1158/1538-7445.AM2015-830

Input-output analysis on the economic impact of medical care in Japan.

Objectives Since the Cabinet’s decision concerning the Basic Policies 2005, the Japanese government has implemented specific measures to suppress increases in national medical care expenditure. However, we believe that the economic significance of medical care should be quantified in terms of its economic impact on national medical care expenditure. No one has examined the economic impact of all medical institutions in Japan using data from a statement of profits and losses. We used an input–output analysis to quantitatively estimate economic impact of medical care and examined its estimation range with a probabilistic sensitivity analysis.MethodsTo estimate the economic impact and economic impact multipliers of all medical institutions in Japan, an input–output analysis model was developed using an input–output table, statement of profits and losses, margin rates, employee income rates, consumption propensity and an equilibrium output model. Probabilistic sensitivity analysis was conducted using a Monte Carlo simulation.ResultsEconomic impact of medical care in all medical institutions was ¥72,107.4 billion ($661.5 billion). This impact yielded a 2.78-fold return of medical care expenditure with a 95 % confidence interval ranging from 2.74 to 2.90.ConclusionEconomic impact of medical care in Japan was two to three times the medical care expenditure (per unit). Production inducement of medical care is comparable to other industrial sectors that are highly influential toward the economy. The contribution to medical care should be evaluated more explicitly in national medical care expenditure policies.

Analysis of Medical Care Expenditure by Japanese Prefecture using Fuzzy Robust Regression Model.

In 2012, 15.13% of the total fiscal medical care expenditure was for lifestyle-related health care costs, which was approximately 179 billion yen. Lifestyle-related diseases are not only the biggest factor in reducing healthy life expectancy but also have the most significant impact on the national medical care expenditure. In addition, lifestyle-related diseases can be prevented by moderate daily exercise, a well-balanced diet, and not smoking. Our fuzzy robust regression model is a controllable model describing a target system. Therefore, our model is used to analyze the relation between medical care expenditure and selected lifestyle factors.

Are public subsidies effective to reduce emergency care? Evidence from the PLASA study

Elderly people facing dependence are exposed to the financial risk of long lasting care expenditures. This risk is high for people facing cognitive, functional and behavioral problems. In the short-term, dependent elderly people face increased non-medical care expenditures. In the long-term, they face increased medical care expenditures, which are driven by emergency care events such as: emergency hospitalization, emergency medical visits, and emergency institutionalizations. In France, providing public financial assistance has been shown to improve dependent people's access to non-medical care services. However, the impact of public financial assistance on emergency care use has not been explored yet. Our study aims at determining whether financial assistance on non-medical care provision decreases the probability of emergency care rates using data of 1131 French patients diagnosed with Alzheimer's disease, collected between 2003 and 2007. Using instrumental variables to deal with the presence of a potential endogeneity bias, we find that beneficiaries of long-term care subsidies have a significantly lower rate of emergency care than non-beneficiaries. Failing to control for endogeneity problems would lead to misestimate the impact of long-term care subsidies on emergency care rates. Finding that home care subsidies has a protective effect for emergency care confirmed the efficacy of this public policy tool.

LifeWorks@TURCK

LifeWorks@TURCK

Medical care expenditures associated with chronic kidney disease in adults with diabetes: United States 2011

ObjectiveApproximately 1 in 3 adults with diabetes have CKD. However, there are no recent national estimates of the association of CKD with medical care expenditures in individuals with diabetes. Our aim is to assess the association of CKD with total medical expenditures in US adults with diabetes using a national sample and novel cost estimation methodology. Research design and methodsData on 2,053 adults with diabetes in the 2011 Medical Expenditure Panel Survey (MEPS) was analyzed. Individuals with CKD were identified based on self-report. Adjusted mean health services expenditures per person in 2011 were estimated using a two-part model after adjusting for demographic and clinical covariates. ResultsOf the 2,053 individuals with diabetes, approximately 9.7% had self-reported CKD. Unadjusted mean expenditures for individuals with CKD were $20,726 relative to $9,689.49 for no CKD. Adjusted mean expenditures from the 2-part model for individuals with CKD were $8473 higher relative to individuals without CKD. Additional significant covariates were Hispanic/other race, uninsured, urban dwellers, CVD, stroke, high cholesterol, arthritis, and asthma. The estimated unadjusted total expenditures for individuals with CKD were estimated to be in excess of $43 billion in 2011. ConclusionsWe showed that CKD is a significant contributor to the financial burden among individuals with diabetes, and that minorities and the uninsured with CKD may experience barriers in access to care. Our study also provides a baseline national estimate of CKD cost in Diabetes by which future studies can be used for comparison.

The costs and benefits of reducing racial-ethnic disparities in mental health care.

Previous studies have found that timely mental health treatment can result in savings in both mental health and general medical care expenditures. This study examined whether reducing racial-ethnic disparities in mental health care offsets costs of care. Data were from a subsample of 6,206 individuals with probable mental illness from the 2004-2010 Medical Expenditure Panel Survey (MEPS). First, disparities in mental health treatment were analyzed. Second, two-year panel data were used to determine the offset of year 1 mental health outpatient and pharmacy treatment on year 2 mental and general medical expenditures. Third, savings were estimated by combining results from steps 1 and 2. Compared with whites, blacks and Latinos with year 1 outpatient mental health care spent less on inpatient and emergency general medical care in year 2. Latinos receiving mental health care in year 1 spent less than others on inpatient general medical care in year 2. Latinos taking psychotropic drugs in year 1 showed reductions in inpatient general medical care. Reducing racial-ethnic disparities in mental health care and in psychotropic drug use led to savings in acute medical care expenditures. Savings in acute care expenditures resulting from eliminating disparities in racial-ethnic mental health care access were greater than costs in some but not all areas of acute mental health and general medical care. For blacks and Latinos, the potential savings from eliminating disparities in inpatient general medical expenditures are substantial (as much as $1 billion nationwide), suggesting that financial and equity considerations can be aligned when planning disparity reduction programs.

Who Are the Big Medical Care Spenders?

The top 5 percent of medical care consumers account for 50 percent of medical care expenditures, which is 9 percent of annual U.S. GDP. We offer new theoretical and empirical evidence that not just poor health, but the path to poor health, can better predict big spenders. Modeling the full distribution of expenses using the Health and Retirement Survey, we find that a 10 percent decline in health increases the probability of participation in the top 5 percent by 22 percent. Focusing on health dynamics gives policy makers new avenues to address high medical care costs.

Savings in Medical Expenditures Associated with Reductions in Body Mass Index Among US Adults with Obesity, by Diabetes Status.

BackgroundThe prevalence of obesity has more than doubled in the USA in the past 30 years. Obesity is a significant risk factor for diabetes, cardiovascular disease, and other clinically significant co-morbidities. This paper estimates the medical care cost savings that can be achieved from a given amount of weight loss by people with different starting values of body mass index (BMI), for those with and without diabetes. This information is an important input into analyses of the cost effectiveness of obesity treatments and prevention programs.MethodsTwo-part models of instrumental variables were estimated using data from the Medical Expenditure Panel Survey (MEPS) for 2000–2010. Models were estimated for all adults as well as separately for those with and without diabetes. We calculated the causal impact of changes in BMI on medical care expenditures, cost savings for specific changes in BMI (5, 10, 15, and 20 %) from starting BMI levels ranging from 30 to 45 kg/m2, as well as the total excess medical care expenditures caused by obesity.ResultsIn the USA, adult obesity raised annual medical care costs by $US3,508 per obese individual, for a nationwide total of $US315.8 billion (year 2010 values). However, the relationship of medical care costs over BMI is J-shaped; costs rise exponentially in the range of class 2 and 3 obesity (BMI ≥35). The heavier the obese individual, the greater the reduction in medical care costs associated with a given percent reduction in BMI. Medical care expenditures are higher, and rise more with BMI, among individuals with diabetes than among those without diabetes.ConclusionsThe savings from a given percent reduction in BMI are greater the heavier the obese individual, and are greater for those with diabetes than for those without diabetes. The results provide health insurers, employers, government agencies, and health economists with accurate estimates of the change in medical care expenditures resulting from weight loss, which is important information for calculating the cost effectiveness of interventions to prevent and treat obesity.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-014-0230-2) contains supplementary material, which is available to authorized users.

Medical care expenditure in suicides from non-illness-related causes.

Objectives:Several epidemiological studies on medical care utilization prior to suicide have considered the motivation of suicide, but focused on the influence of physical illnesses. Medical care expenditure in suicide completers with non-illness-related causes has not been investigated.Methods:Suicides motivated by non-illness-related factors were identified using the investigator’s note from the National Police Agency, which was then linked to the Health Insurance Review and Assessment data. We investigated the medical care expenditures of cases one year prior to committing suicide and conducted a case-control study using conditional logistic regression analysis after adjusting for age, gender, area of residence, and socioeconomic status.Results:Among the 4515 suicides motivated by non-illness-related causes, medical care expenditures increased in only the last 3 months prior to suicide in the adolescent group. In the younger group, the proportion of total medical expenditure for external injuries was higher than that in the older groups. Conditional logistic regression analysis showed significant associations with being a suicide completer and having a rural residence, low socioeconomic status, and high medical care expenditure. After stratification into the four age groups, a significant positive association with medical care expenditures and being a suicide completer was found in the adolescent and young adult groups, but no significant results were found in the elderly groups for both men and women.Conclusions:Younger adults who committed suicide motivated by non-illness-related causes had a higher proportion of external injuries and more medical care expenditures than their controls did. This reinforces the notion that suicide prevention strategies for young people with suicidal risk factors are needed.

Patterns and Predictors of Hospital Readmission in Taiwan.

PHP118 Patterns and Predictors of HosPital readmission in taiwan Cheng J.S.1, Ku H.P.1, Chang C.J.2 1Chang Gung University, Tao-Yuan, Taiwan, 2Chang Gung University, Kwei Shan, Tao Yuan, Taiwan Objectives: Hospital readmissions have been an important issue, as they reflect suboptimal quality of medical care and incur high health care expenditures. However, limited information is available on the patterns of hospital readmission in the entire population to support a thorough planning to prevent hospital readmissions. Therefore, this study aimed to examine the patterns and economic burden of hospital readmission in Taiwan, and identify predictors of hospital readmissions. MethOds: This study used the National Health Insurance Research Database of enrollees randomly selected from those enrolled in the National Health Insurance program in 2005. Individuals who were admitted to acute hospitals in 2005 were selected and their readmission patterns one-year after discharge were examined. Cox proportional hazards regression model was adopted to identify predictors of hospital readmission. Results: The 30-day, 6-month and one-year readmission rates were 11%, 25%, and 34%, respectively. During the one-year follow-up, 52% of total health care expenditures were due to hospital readmissions. Of those who were readmitted to hospitals, 56% were readmitted once and took up 29% of the cost of rehospitalization. However, those readmitted for more than three times (5%) accounted for 30% of the cost. The major disease category of the highest 30-day and one-year readmission rates was neoplasms. The disease of the highest 30-day and one-year readmission rates were cancer of bronchus and lung (36%) and cancer of liver and intrahepatic bile duct (74%), respectively, and the most frequent reason for readmission was the disease itself. Age, gender, place of residence, previous hospitalization history, comorbidities, and length of stay of the index hospitalization were risk factors of hospital readmissions. cOnclusiOns: This study identified diseases of higher short-term and long-term readmission rates, causes of shortterm and long-term hospital readmissions, and predictors of hospital readmission. The information is of importance for planning interventions to reduce hospital readmission rate.

Educational Attainment and Life Expectancy

National objectives for health concentrate on improving life expectancy and enhancing health-related quality of life. Although U.S. life expectancy has seen significant extensions over the last century, the rate of increase has been falling behind other wealthy countries, and these trends have been worsening over the last 30 years. In addition, the United States spends considerably more on health care in comparison with major trading competitors. Most policy approaches for enhancing health focus on increasing expenditures for medical care. Yet, medical care explains only about 10% of the variance in health outcomes, whereas behavioral and social factors outside of health care explain nearly 50%. Evidence suggests that educational attainment may be one of the strongest correlates of life expectancy. As a baseline, cancer screening and optimizing established risk factors for premature death typically extend life expectancy by less than 1 year. In contrast, remediating the health disparity associated with low educational attainment might enhance life expectancy by up to a decade. Amassing persuasive evidence on the health benefits of interventions to improve educational attainment will be challenging. To address this issue, a robust program of systematic research is needed.

Relationship of serious psychological distress to quality of life in adults with diabetes.

To examine the association between serious psychological distress (SPD) and the Physical and Mental Health components of Quality of Life (QOL) while controlling for depression in a national sample of adults with diabetes. SPD was assessed in 1,659 adults with diabetes who participated in the 2007 Medical Care Expenditure Survey (MEPS). SPD was measured by the 6-item Kessler scale. Depression was assessed with the PHQ-2 screen. Quality of life was measured with the physical (PCS) and mental (MCS) components of the SF-12. We used multiple linear regression to assess the relationship between SPD and quality of life while controlling for relevant covariates and depression screen results to assess the independent effect of SPD on QOL above and beyond the effect of depression. Among US adults with diabetes, 9% had SPD and 15.4% screened positive for depression. Among those with SPD, 85.8% had depression and among those with depression, 50.5% had SPD. In the adjusted model for socio-demographic factors and comorbidities, SPD was significantly associated with lower PCS scores (-5.51 95% CI -7.55; -3.45) and MCS scores (-18.99 95% CI -20.81; -17.18). In the adjusted model that also controlled for depression, SPD was still significantly associated with lower PCS scores (-3.03 95% CI -5.63; -0.43) and MCS scores (-9.46 95% CI -11.67; -7.24). Among U. S. adults, SPD is associated with significantly diminished QOL above and beyond the effects of depression. Targeted interventions to mitigate the adverse effects of SPD are needed, independent of programs to address depression.

Cost of hemodialysis after coverage by national health insurance in Japan: a sharing experience with Indonesian health reform system

About 50 years ago, Japan established a health insurance system covering the entire population, and started a period of rapid economic growth, similar to what is happening now in Indonesia. Although improvements in health conditions definitely contributed to the development of modern Japan, the costs of medical care became a serious burden on the economy. In this short report, we review the concept of medical care expenditure in Japan, focusing especially on end-stage renal disease, to provide suggestions to medical reform in Indonesia.

Medical Care Burden of Children with Autism Spectrum Disorders

This paper aims to examine health care utilization and expenditure in the provision of medical care to understand the medical care burden of children with autism spectrum disorders based on recent literature reviews. This article reviews the recent literature in Medline, PubMed, and Google by using key terms that are relevant to autism spectrum disorder (ASD) and health care (medical care) utilization, medical care costs, and expenditures. I also hand-searched the reference lists of all of the included articles and recent narrative and systematic reviews related to medical care utilization and the costs of ASD to identify potentially relevant articles. The literature on medical care utilization and expenditures related to ASD highlights the fact that the disorder imposes high medical care burdens on families and on society. It is necessary to initiate appropriate, comprehensive, and accessible medical care services for individuals with ASD, particularly for those with comorbid conditions. Future studies should examine the impact of such improvements in the management of children with ASD on medical care utilization and costs.

Impact of the 2011 Great East Japan Earthquake on community health: ecological time series on transient increase in indirect mortality and recovery of health and long-term-care system

BackgroundThe objectives were to clarify the trend in the cause-specific mortality rate and changes in health and long-term-care use after the Great East Japan Earthquake in 2011.MethodsWe obtained the following...

Effect of Microloans on the Livelihood of Beneficiaries: A Descriptive Study in Ethiopia

Microcredit has been found to be a critical instrument in order to improve the livelihood of the poor. It is prominently used to improve the livelihood of the household borrowers where it is believed to be under exploited in research. Hence, it is indispensable to examine its real effectiveness and to have sufficient information on the economic and social impact indicators (human capital). For the purpose of assessing the impact of DECSI microcredit on the livelihood of borrower households, a sample of 278 respondents (that is, 123 clients who had at least 3 years of attachment to the organization and 155 eligible non-participants representing the characteristics of the existing sample borrowers) was considered for the present study. Data were collected by using a semi-structured questionnaire that was prepared and distributed for both clients and eligible non-clients and the oral interviews were conducted while the questionnaires were filled out by the respondents. The results of the study revealed that microloan participation had a positive significant average effect on households' average monthly income, consumption expenditure, savings, and housing improvements. However, the number of employment opportunities generated for the household members showed not much of a difference. Whereas, the average effect on children's education and medical care expenditure was positive due to the respondents' participation in the microcredit program.

한방외래의료 이용의 사회경제적 결정요인 연구: 의료패널자료를 이용한 고정효과모형과 합동 Ordinary Least Square 모형의 비교

Background: Korea is considered to have an integrative health system where both western medicine and Korean (traditional) medicine are officially recognized and provided. Although Korean medicine has been covered by National Health Insurance over 20 years, equity in the utilization of Korean medical care has rarely been examined. Methods: We examined medical care utilization and expenditure of outpatient Korean medicine using panel fixed effects model to remove selection bias. Then we compared it with pooled ordinary least square (OLS) model. This study used Korea Health Panel data, which provides accurate information on out-of-pocket health care payment, including non-covered medical services. Results: Principal findings indicate that the frequency of the utilization of Korean medicine is related with unobservable individual choices different from western medicine, so the panel fixed effect model is appropriate. But pooled OLS model is better fitted for the expenditure of Korean medicine, after controlling for western medical care expenditure. After adjusting for the selection bias, socioeconomic status (income, education) was significantly associated with the expenditure of Korean medicine, but not with the frequency of the utilization of Korean medicine. Conclusion: This study shows that expenditure of Korean medicine utilization is inequitable across socioeconomic groups, which implies that health insurance coverage of Korean medicine is not sufficient.