National Medical Expenditures Research Articles

Cost Analysis of Dropless Cataract Surgery Prophylaxis with Intracameral Antibiotics and Subconjunctival Steroids.

To determine whether dropless, injection-based cataract surgery prophylaxis with intracameral antibiotic and subconjunctival steroid may reduce healthcare system costs and patient out-of-pocket costs compared to topical medication regimens. United States national medical expenditures database. Retrospective cost analysis. Costs were analyzed for topical ophthalmics from the 2020 Medical Expenditure Panel Survey (MEPS) and for dropless medications from pharmaceutical invoices/catalogs. Main outcomes included system costs, from insurance and patient payments, and out-of-pocket costs for cataract surgery topical and dropless, injection-based prophylactic medication regimens, per eye and nationally. System costs for individual topical medications and same-class dropless, injection-based medications were compared using two-sided, one-sample t-tests. There were 583 prophylactic topical ophthalmic purchases in MEPS. Mean system costs per eye were $76.20 ± SD 39.07 for the lowest cost topical steroid (prednisolone) compared to $4.01 for the lowest cost subconjunctival steroid (triamcinolone acetonide) (p < 0.001). Per eye, the lowest cost dropless, injection-based regimen, at $15.91, results in an $87.99 (84.7%) reduction in overall healthcare costs and a $43.64 (100%) reduction in patient out-of-pocket costs relative to the lowest cost topical regimen ($103.90 ± 43.14 mean system cost and $43.64 ± 37.32 mean out-of-pocket cost per eye). Use of intracameral moxifloxacin and subconjunctival triamcinolone acetonide can reduce annual national healthcare system and out-of-pocket costs up to $450,000,000 and $225,000,000, respectively. An evidence-based cataract surgery prophylactic medication regimen of intracameral moxifloxacin and subconjunctival triamcinolone acetonide can reduce healthcare system and patient out-of-pocket costs in comparison to various topical regimens.

Economic effects of dietary salt reduction policies for cardiovascular disease prevention in Japan: a simulation study of hypothetical scenarios.

Reducing dietary salt intake is an essential population strategy for cardiovascular disease (CVD) prevention, but evidence on healthcare costs and outcomes is limited in Japan. We aimed to conduct a pilot economic evaluation under hypothetical scenarios of applying the salt reduction policies of England to Japan. We examined salt reduction policies in England: media health promotion campaigns, front-of-pack labeling, and voluntary and mandatory reformulation with best-case and worst-case policy cost scenarios. We assumed that these policies were conducted in Japan for 10 years from 2019. We used published data on epidemiology and healthcare expenditures in Japan and the costs and effects of salt reduction policies in England, and defined the benefits as a decrease in national medical expenditures on CVD. We developed a Markov cohort simulation model of the Japanese population. To estimate the annual net benefits of each policy over 10 years, we subtracted monitoring and policy costs from the benefits. We adopted a health sector perspective and a 2% discount rate. The cumulative net benefit over 10 years was largest for mandatory reformulation (best case) at 2,015.1 million USD (with costs of USD 48.3 million and benefits of USD 2063.5 million), followed by voluntary reformulation (net benefit: USD 1,895.1 million, cost: USD 48.1 million, benefit: USD 1,943.2 million), mandatory reformulation (worst case, net benefit: USD 1,447.9 million, cost: USD 1,174.5 million, benefit: USD 2,622.3 million), labeling (net benefit: USD 159.5 million, cost: USD 91.6 million, benefit: USD 251.0 million), and a media campaign (net benefit: USD 140.5 million, cost: USD 110.5 million, benefit: USD 251.0 million). There was no change in the superiority or inferiority of policies when the uncertainty of model parameters was considered. Mandatory reformulation with the best-case cost scenario might be economically preferable to the other alternatives in Japan. In future research, domestic data on costs and effects of salt reduction policies should be incorporated for model refinement.

Urine Analysis has a Very Broad Prospect in the Future

Medical tests are playing an increasingly important role in the diagnosis and treatment of diseases. Urine tests, blood tests and stool tests together constitute the three major routine examination items of modern medicine and are an important part of medical tests. Urine is a body fluid normally metabolized by the human body. Compared with using blood as a test sample, using urine as a medical test sample has many advantages, such as non-invasiveness and convenient collection. This article discusses the advantages of urine test compared with blood test, the understanding and application of urine in traditional medicine, the application of urine test in social life, the current dilemma and the future urine test may play a greater role The value and advantages are discussed, aiming to increase people’s attention to urine testing by explaining the advantages of urine testing, and to discover more functions of urine testing, thereby optimizing medical testing methods and reducing the pain and fear of patients. Improve inspection efficiency, reduce national and personal medical inspection expenditures, and save medical resources.

Accountable Government Spending: A Cross-National Analysis of Child Mortality in Developing Nations.

What can national governments do to improve their capacity for well-being? While increasing public medical care expenditures can facilitate increased well-being in developing nations, cross-national research often finds that public medical care expenditures have no effect on indicators of well-being, such as child mortality. This ineffective public spending could be due to a lack of governance; however, this relationship is understudied in the cross-national literature. Using 2-way fixed and generalized least squares random effects models for a sample of 74 low- and middle-income nations from 1996 to 2012, I examine how the interaction among 5 measures of national governance and public medical care expenditures impact child mortality. The findings reveal the importance of governance in determining the effectiveness of public medical care expenditures. Both public medical care expenditures and governance improvements are essential to reduce child mortality.

Regional Differences in Specific Health Examination Utilization and Medical Care Expenditures in Japan

Background: Despite having one of the most successful health systems in the world, annual medical expenditures in Japan have been increasing year to year. We sought to clarify regional differences in medical expenditures by analyzing the relationship between the specific health examination coverage and medical care expenditure by prefecture of Japan. Methods: We used data from the National Database of Health Insurance Claims and Specific Health Checkups (NDB) Open Data Japan (2015) and Overview of 2015 National Medical Expenses to compare medical care expenditure per capita and proportions of persons receiving specific health examination between Japan nationally and individual prefectures. Results: National medical expenditures were 42.3 trillion Japanese yen (JPY) (3851 hundred million dollars), with a national per capita rate of JPY347,219 (USD3156). Per capita medical expenditure rates by prefecture ranged from JPY290,900 (USD2645) in Saitama Prefecture to JPY 444,000 (USD4036) in Kochi Prefecture. The proportion of persons receiving specific health examinations was 49.0% for Japan overall and ranged from 39.3% in Hokkaido Prefecture to 63.4% in Tokyo Prefecture. We observed a significant negative correlation between per capita medical expenditures and the proportion of persons receiving specific health examinations (R = 0.553, p < 0.001). Conclusion: We found a significant negative correlation between per capita medical expenditures and the proportion of persons receiving health examinations: prefectures with lower expenditures tended to have higher rates of medical examinations. Interventions to increase the proportion of persons receiving specific health examinations by prefecture could reduce per capita medical expenditures and reduce prefectural disparities in expenditures.

National medical expenditures by smoking status in American adults: an application of Manning’s two-stage model to nationally representative data

ObjectivesTo assess the medical expenditures of American adults by their smoking status—Current, Former or Never smokers. We update these expenditures through 2015 controlling for personal characteristics and medical history and...

Socioeconomic burden of sugar-sweetened beverages consumption in Korea.

BACKGROUND/OBJECTIVESExcessive sugar consumption may increase the risk for development of several diseases. Although average dietary sugar intake of Koreans is within the recommended level, an increasing trend has been found in all age groups. This study aimed to evaluate the population attributable fractions (PAF) to dietary sugar for disease and death in Korea, and to estimate the socioeconomic effects of a reduction in dietary sugar.MATERIALS/METHODSThe prevalence of sugar-sweetened beverages (SSB) overconsumption (≥ 20 g of sugar from beverages) was analyzed using the Korean National Health and Nutrition Examination Survey 2015. Disease-specific relative risks of excessive SSB consumption were obtained through reviewing previous studies. Using the prevalence of SSB overconsumption and each relative risk, PAFs for morbidity and mortality were calculated. Socioeconomic costs of diseases and death attributable to SSB overconsumption were estimated by using representative data on national medical expenditures, health insurance statistics, employment information, and previous reports.RESULTSDisease-specific PAF to SSB consumption ranged from 3.11% for stroke to 9.05% for obesity and dental caries, respectively. Costs from disease caused by SSB overconsumption was estimated at 594 billion won in 2015. About 39 billion won was estimated to be from SSB consumption-related deaths, and a total of 633 billion won was predicted to have been saved through preventing SSB overconsumption.CONCLUSIONSSugars overconsumption causes considerable public burdens, although the cost estimates do not include any informal expenditure. Information on these socioeconomic effects helps both health professionals and policy makers to create and to implement programs for reducing sugar consumption.

Medical Expenditures and Earnings Losses Among US Adults With Arthritis in 2013.

We estimated the economic impact of arthritis using 2013 US Medical Expenditure Panel Survey (MEPS) data. We calculated arthritis-attributable and all-cause medical expenditures for adults age ≥18 years and arthritis-attributable earnings losses among those ages 18-64 years who had ever worked. We calculated arthritis-attributable costs using multistage regression-based methods, and conducted sensitivity analyses to estimate costs for 2 other arthritis definitions in MEPS. In 2013, estimated total national arthritis-attributable medical expenditures were $139.8 billion (range $135.9-$157.5 billion). Across expenditure categories, ambulatory care expenditures accounted for nearly half of arthritis-attributable expenditures. All-cause expenditures among adults with arthritis represented 50% of the $1.2 trillion national medical expenditures among all US adults in MEPS. Estimated total national arthritis-attributable earning losses were $163.7 billion (range $163.7-$170.0 billion). The percentage with arthritis who worked in the past year was 7.2 percentage points lower than those without arthritis (76.8% [95% confidence interval (95% CI)] 75.0-78.6 and 84.0% [95% CI 82.5-85.5], respectively, adjusted for sociodemographics and chronic conditions). Total arthritis-attributable medical expenditures and earnings losses were $303.5 billion (range $303.5-$326.9 billion). Total national arthritis-attributable medical care expenditures and earnings losses among adults with arthritis were $303.5 billion in 2013. High arthritis-attributable medical expenditures might be reduced by greater efforts to reduce pain and improve function. The high earnings losses were largely attributable to the substantially lower prevalence of working among those with arthritis compared to those without, signaling the need for interventions that keep people with arthritis in the workforce.

The Impact of Obesity on Medical Care Costs and Labor Market Outcomes in the US

The prevalence of obesity has risen dramatically in most countries of the world, and the economic consequences of obesity are not well understood. We analyzed data from the Medical Expenditure Panel Survey (MEPS) for 2001-2015 and estimated the percentage of healthcare costs that were associated with adult obesity, both for the US as a whole and for the most populous states. We also reviewed the literature on the impact of obesity on economic outcomes such as medical care costs, employment, and wages. The percent of US national medical expenditures devoted to treating obesity-related illness in adults rose from 6.13% in 2001 to 7.91% in 2015, an increase of 29%. Substantial differences existed across states; in 2015, some states (AZ, CA, FL, NY) devoted 5%-6% of medical expenditures to obesity, whereas others (NC, OH, WI) spent >12% of all healthcare dollars on obesity. A review of previous literature that exploited natural experiments to estimate causal effects found that obesity raises medical care costs and lowers wages and the probability of employment. A substantial and rising percentage of healthcare costs are associated with obesity. This is true for the US, for individual states, for each category of expenditure, and for each type of payer. Previous literature generally found that obesity worsens economic outcomes, such as medical care costs, wages, and employment, and imposes negative external costs that may justify government intervention.

Medical Expenditures Associated With Hypertension in the U.S., 2000–2013

IntroductionTrends of prevalence, treatment, and control of hypertension have been documented in the U.S., but changes in medical expenditures associated with hypertension over time have not been evaluated. This study analyzed these expenditures during 2000–2013 among U.S. adults.MethodsData from the Medical Expenditure Panel Survey were analyzed in 2016. The study population was non-institutionalized men and non-pregnant women aged ≥18 years. Hypertension was defined as ever been diagnosed with hypertension or currently taking antihypertensive medications. Medical expenditures included all payments to medical care providers. Expenditures associated with hypertension were estimated by two-part regression models and adjusted into 2015 U.S. dollars. Controlling variables included sociodemographic characteristics, marital status, insurance, region, smoking status, weight status, health status, and comorbidities. Trends were analyzed using joinpoint method.ResultsTotal per-person annual expenditures associated with hypertension in 2000–2001 ($1,399) were not significantly different from those in 2012–2013 ($1,494) (average annual percent change [AAPC]= −0.6%, p=0.794), but annual national spending increased significantly from $58.7 billion to $109.1 billion (AAPC=8.3%, p=0.015), mainly because of the increase in the number of people treated for hypertension. Per-person outpatient payments were 22.7% higher in 2012–2013 than in 2000–2001 ($416 vs $322, p<0.05; AAPC=0.8%, p-trend 0.826). Payments for prescription medications took up a larger proportion of the medical expenditures associated with hypertension, compared to payments for outpatient or other services (33%–46%).ConclusionsDuring 2000–2013, annual national medical expenditures associated with hypertension increased significantly. Preventing hypertension could alleviate hypertension-associated economic burden.

Longevity and health care: a cost-benefit type analysis of life expectancy and medical expenditure.

The relationship between the amount of national medical expenditures and increases in longevity in Japan is explored. The author notes that although Japanese life expectancy is now among the highest in the world a result of this trend has been an increase in the survival of those who are more or less permanently sick or invalid. The need to concentrate future resources on increasing the quality of life for those who survive is stressed. (summary in JPN) (ANNOTATION)

The impact of asthma on the cost effectiveness of surgery for chronic rhinosinusitis with nasal polyps.

The objective of this work was to evaluate the impact of asthma on the cost-effectiveness profile of endoscopic sinus surgery (ESS) compared to medical therapy for patients with chronic rhinosinusitis with nasal polyps (CRSwNP). The study design consisted of a cohort-style Markov decision-tree cost utility analysis with a 35-year time horizon. Matched cohorts of CRSwNP patients with (n = 95) and without (n = 95) asthma who underwent ESS were compared with cohorts of patients from the national Medical Expenditures Survey Panel (MEPS) database who underwent medical management for chronic rhinosinusitis (CRS). Baseline, 1-year, and 2-year health utility values were calculated from responses to the EuroQol-5 Dimension (EQ-5D) instrument in both cohorts. The primary outcome measure was the incremental cost effectiveness ratio (ICER) for each cohort. The reference cases for CRSwNP patients with and without asthma yielded ICERs for ESS vs medical therapy alone of $12,066 per quality-adjusted life year (QALY) and $7,369 per QALY, respectively. At a willingness-to-pay threshold of $50,000/QALY, the ICER scatter plots demonstrated 86% and 99% certainty that the ESS strategy was the most cost-effective option for CRSwNP patients with and without asthma, respectively. ESS was not significantly more cost effective for CRSwNP patients without asthma (p = 0.494). ESS remains cost effective compared to medical therapy for patients both with and without asthma. While the comorbidity of asthma results in an inferior ICER result, it does not result in a statistically significant negative impact on the overall cost effectiveness of ESS.

Abstract 045: Incremental Medical Expenditures Attributable to Hypertension in China’s Middle-aged and Elderly Population

Background: Hypertension is a prevalent and costly health condition in China. We sought to estimate the inpatient and outpatient expenditures attributable to hypertension among China’s middle-aged and elderly population. Methods: Data for this study was from the China Health and Retirement Longitudinal Survey (CHARLS) 2011 and 2013, a comprehensive and nationally representative survey of Chinese residents aged 45 and older. We selected our study sample among respondents who had complete information on biomarker blood pressure measures and had not developed hypertension in 2011. Hypertension in 2013 was identified in the following steps: (a) He/she had an average systolic blood pressure of ≥ 140 mmHg, and/or an average diastolic blood pressure of ≥ 90 mmHg and/or (b) He/she was currently taking anti-hypertensive medications. The outcome measures were total inpatient expenditures in the past year and outpatient expenditures in the last month. We used a difference-in-difference approach, by classifying those with hypertension as treatment group, and those without hypertension as control group. A propensity score weighting approach was applied to balance out the population characteristics between the treatment and control groups. Linear regression was used to examine the incremental medical expenditures attributable to hypertension. Results: The final sample contained 7827 observations. For those who developed hypertension between 2011 and 2013, their inpatient expenditure increased faster and on average, the hypertension-attributable inpatient expenditures were¥129.5 ($20.9) per person in a year. When we restricted the sample to those with only positive inpatient expenditures, the incremental expenditure reached ¥1526.2 ($246.2) a year. On average, the hypertension-attributable outpatient expenditures were ¥31.0 ($5) per person each month. When we only considered the sample with positive outpatient expenditures, the incremental outpatient expenditures reached ¥276.1 ($44.5) in a month. Conclusions: Having hypertension was associated with substantially higher medical expenditures for both inpatient and outpatient care services. Given that the prevalence of hypertension among adults aged 45 and older was 33% (180 million) in China), the estimated national medical expenditures attributable to hypertension would be as high as ¥90.3 billion ($14.6 billion) per year.

Hyperlipidemia and Medical Expenditures by Cardiovascular Disease Status in US Adults.

Hyperlipidemia is a major risk factor for cardiovascular disease (CVD), affecting 73.5 million American adults. Information about health care expenditures associated with hyperlipidemia by CVD status is needed to evaluate the economic benefit of primary and secondary prevention programs for CVD. The study sample includes 48,050 men and nonpregnant women ≥18 from 2010 to 2012 Medical Expenditure Panel Survey. A 2-part econometric model was used to estimate annual hyperlipidemia-associated medical expenditures by CVD status. The estimation results from the 2-part model were used to calculate per-capita and national medical expenditures associated with hyperlipidemia. We adjusted the medical expenditures into 2012 dollars. Among those with CVD, per person hyperlipidemia-associated expenditures were $1105 [95% confidence interval (CI), $877-$1661] per year, leading to an annual national expenditure of $15.47 billion (95% CI, $5.23-$27.75 billion). Among people without CVD, per person hyperlipidemia-associated expenditures were $856 (95% CI, $596-$1211) per year, resulting in an annual national expenditure of $23.11 billion (95% CI, $16.09-$32.71 billion). Hyperlipidemia-associated expenditures were attributable mostly to the costs of prescription medication (59%-90%). Among people without CVD, medication expenditures associated with hyperlipidemia were $13.72 billion (95% CI, $10.55-$15.74 billion), higher in men than in women. Hyperlipidemia significantly increased medical expenditures and the increase was higher in people with CVD than without. The information on estimated expenditures could be used to evaluate and develop effective programs for CVD prevention.

Low-protein diet for the prevention of renal failure.

The prevalence of chronic kidney disease (CKD) is estimated to be 8–16% worldwide, and it is increasing. CKD is a risk factor for heart attack and stroke, and it can progress to kidney failure requiring dialysis or transplantation. Recently, diabetic nephropathy has become the most common cause of CKD. In Japan, the cumulative probability of requiring hemodialysis by the age 80 years is 1/50 in males and 1/100 in females. The number of patients under hemodialysis in Japan exceeded 320,000 in 2014, among which 38,000 were newcomers and 27,000 died.The annual medical costs of hemodialysis are 1.25 trillion yen in Japan, representing 4% of the total national medical expenditures in 2014. A low-protein diet (less than 0.5 g/kg b.wt.) is a very effective intervention. Low-protein rice (1/10 to 1/25 of the normal protein contents) is helpful to control the consumption of proteins, decreasing at the same time the intake of potassium and phosphate.Protein restriction is indicated as soon as the eGFR becomes lower than 60 ml/min/1.73 m2 body surface, in order, to slow disease progression. The newly developed low-protein Indica rice is expected to help many CKD patients in China and Southeast Asia.

Decreased rate of hip fracture and consequent reduction in estimated medical costs in Japan

The frequency of hip fractures associated with aging of the population is declining in many countries. Even in Japan, where this frequency has been increasing continually, a shift to decreasing frequency has been noted in recent reports. The objective of this study was to investigate the effects of this decrease and to estimate the number of hip fracture patients and the resulting reduction in national medical care expenditures. The differences in the number of patients were estimated by multiplying the population for each sex and each age group by the fracture rates before the decrease (2007) and after the decrease (2012). Total reduced cost was calculated by multiplying the treatment cost required for hip fracture and the annual medical cost of nursing care. The estimated number of hip fracture patients decreased by approximately 4000 in the elderly female population, and the resulting reduction in medical costs was approximately US$280 million. The number of patients with hip fractures has decreased in elderly Japanese women; as a result, the medical costs for treatment and nursing care might decrease.

Cost utility analysis of endoscopic sinus surgery for chronic rhinosinusitis.

The purpose of this work was to evaluate the cost-effectiveness of endoscopic sinus surgery (ESS) compared to medical therapy for patients with chronic rhinosinusitis (CRS). The study design consisted of a microsimulation Markov decision-tree economic model with a 31-year time horizon. A cohort of 489 patients who underwent ESS for CRS were matched 1 to 1 with a cohort of 489 patients from the national Medical Expenditures Panel Survey database who underwent medical management for CRS. Utility scores were calculated from responses to the EuroQol 5-Dimension instrument in both cohorts. Decision-tree analysis and a subsequent 10-state Markov model utilized published event probabilities as well as primary data from a large multisurgeon prospective outcomes study to calculate long-term costs and utility. The primary outcome measure was incremental cost per quality-adjusted life year (QALY). Multiple sensitivity analyses were performed. The incremental cost-effectiveness ratio (ICER) for ESS vs medical therapy alone was $13,851.26 per QALY. The cost effectiveness acceptability curve demonstrated 85.84% and 98.69% certainty that the ESS strategy was the most cost-effective option at willingness-to-pay thresholds of $25,000 and $50,000 per QALY, respectively. This study shows ESS to be a cost-effective intervention compared to medical therapy alone for the management of patients with CRS.

A Comparison of Management Conditions in Japan's Dental Clinics and Medical Clinics

In recent years, national medical expenditures have continued to increase in Japan, and have now reached 39 trillion yen. In contrast, dental clinic expenditures have been slow to grow over the past few years, totaling 2.7132 trillion yen. At the same time, the number of dentists continues to increase, with a total of 102,551 dentists in 2012, surpassing the 100,544 physicians at medical clinics. Objective: Given this, we compared management conditions at dental clinics and medical clinics over time to determine whether management conditions of dental clinics are really as harsh as often claimed. Methods: we used the relevant data provided in the Central Social Insurance Medical Council's Survey on Economic Conditions in Health Care for statistics, which depicts management conditions at clinics, and analyzed the causes. Results: Annual fluctuations in the revenue/expense gap (revenue less expense) show that the gap for dentists far undercut that for physicians at medical clinics. The main reason for this decline in revenue is that the number of dental patients declined more that the unit price rose compared to the medical clinic. Conclusion: We determined that management conditions are harsh for dental clinics. DOI: 10.14693/jdi.v22i2.507

Comment on “How does the Price Regulation Policy Impact on Patient–Nurse Ratios and the Length of Hospital Stays in Japanese Hospitals?”

It has been said that the fee-for-service (FFS) system in Japan's public health insurance system is a major contributor to Japan's relatively low national medical expenditures. Basically, this system allows the central government to almost fully control the prices of medical services through the reimbursement system of public health insurance, which covers most of the medical usage in Japan. This price control has been used for not only suppressing total medical expenditures, but also for balancing the allocations of medical resources by making higher rewards for services in short supply. Noguchi (2015), however, reveals the limitations of this approach by showing the “overreaction” of patient–nurse ratio (PNR) to changes in the FFS criteria. I have four major comments on Noguchi's (2015) paper. First, I would have liked to have seen a more detailed description about the reasons why the government wanted to lower PNR at the particular times it did. In particular, since the abstract and conclusion read as if the main policy implication of Noguchi (2015) is that the changes in the FFS caused an undesired outcome (an increase in beds for acute care), Noguchi should explain why the government, which wanted to reallocate health-care resources toward subacute and long-term care, also aimed to lower the PNR at the same time. As mentioned in Noguchi's paper, the changes in FFS intended to lower PNR and shorten the length of hospital stays (LHS), and the empirical results suggest that both PNR and LHS actually decreased in response to the changes. That is, the revision achieved its primary objectives. If the final goal of this fee revision is to expedite the treatment of acute diseases through the provision of more intensive human resources, I feel it is off the point to accuse hospitals of inducing more resources toward acute care. A second and related comment relates to the overall goals of the series of FFS revisions in Japan. In the concluding section, Noguchi argues that “[a] series of revisions of FSS aim to clarify and differentiate the roles and functions of medical facilities with various characteristics” (p. 318), and this argument seems to be the basis for the rather negative tone of Noguchi's overall evaluation of the FFS revision in 2000 and 2006. However, non-experts (like me) cannot see how the government actually planned to achieve such a differentiation by the FFS revisions. Were there any revisions other than the ones examined in this paper to focus on the differentiation, or were the policymakers just saying that the roles and functions of medical facilities should be differentiated? If the latter is the case, I think the problem is more on the self-inconsistency of the policy rather than the overreaction of the hospitals. Third, to me it was not very clear why the effect of the revisions on LHS is larger for small hospitals, whereas the effect on PNR is small and statistically insignificant for them. It is not surprising that small hospitals cannot recruit as many nurses as they want, and thus they cannot lower PNR as much as larger hospitals. Then, however, the effect on LHS should be smaller for them if the FFS revision affects LHS through a lower PNR. Even if the FFS revision has a direct effect on LHS through the price change, unless it differentiates hospitals by its size, it is not clear why small hospitals respond more. Fourth, it would be very informative if Noguchi provided further evidence on the heterogeneous effects across different types of hospitals other than those related to hospital size. For example, hospitals in underpopulated area may have difficulties in recruiting nurses because they are less attractive workplace for nurses and are more financially stressed than other types of hospitals. If so, the effects on PNR should be smaller for such hospitals. Also, the ownership of hospitals may affect hospital compliance. I believe such information should be available from the data used in this study, so it could be a good extension for future research.

Prediction of Hypertension Complications Risk Using Classification Techniques

Chronic diseases including hypertension and its complications are major sources causing the national medical expenditures to increase. We aim to predict the risk of hypertension complications for hypertension patients, using the sample national healthcare database established by Korean National Health Insurance Corporation. We apply classification techniques, such as logistic regression, linear discriminant analysis, and classification and regression tree to predict the hypertension complication onset event for each patient. The performance of these three methods is compared in terms of accuracy, sensitivity and specificity. The result shows that these methods seem to perform similarly although the logistic regression performs marginally better than the others.