Personal Health Care Expenditures Research Articles

Opportunities to Increase Science of Diversity and Inclusion in Clinical Trials: Equity and a Lack of a Control.

The United States witnessed a nearly 4-fold increase in personal health care expenditures between 1980 and 2010. Despite innovations and obvious benefits to health, participants enrolled in clinical trials still do not accurately represent the racial and ethnic composition of patients nationally or globally. This lack of diversity in cohorts limits the generalizability and significance of results among all populations and has deep repercussions for patient equity. To advance diversity in clinical trials, robust evidence for the most effective strategies for recruitment of diverse participants is needed. A major limitation of previous literature on clinical trial diversity is the lack of control or comparator groups for different strategies. To date, interventions have focused primarily on (1) community-based interventions, (2) institutional practices, and (3) digital health systems. This review article outlines prior intervention strategies across these 3 categories and considers health policy and ethical incentives for substantiation before US Food and Drug Administration approval. There are no current studies that comprehensively compare these interventions against one another. The American Heart Association Strategically Focused Research Network on the Science of Diversity in Clinical Trials represents a multicenter, collaborative network between Stanford School of Medicine and Morehouse School of Medicine created to understand the barriers to diversity in clinical trials by contemporaneous head-to-head interventional strategies accessing digital, institutional, and community-based recruitment strategies to produce informed recruitment strategies targeted to improve underrepresented patient representation in clinical trials.

Food Insecurity, Healthcare Utilization, and Healthcare Expenditures: A Longitudinal Cohort Study.

Objective: This study examines the longitudinal association between household food insecurity and healthcare utilization and expenditure. Methods: A multi-wave longitudinal cohort study was conducted using the 2008-2019 and 2021 waves of the Korean Welfare Panel Study. The baseline data included participants aged ≥19years with valid responses to the food insecurity and healthcare questionnaires in the 2008 wave (n = 12,166). Healthcare outcomes encompassed outpatient visits, inpatient admissions, days hospitalized, and personal healthcare expenditure. Random effects Poisson and linear regressions were estimated. Results: Severe food insecurity was associated with a higher incidence rate of outpatient visits (IRR, 1.14; 95% CI, 1.12-1.17), days of hospitalization (IRR, 1.18; 95% CI, 1.13-1.22), and inpatient admissions (IRR, 1.40; 95% CI, 1.18-1.65). Moderate food insecurity was associated with 10.4% ( = -0.11; 95% CI, -0.14 to -0.07) or 238,276 KRW reductions in personal healthcare expenditures in the subsequent year. Conclusion: Household food insecurity was linked to increased healthcare utilization and reduced personal healthcare expenditure among Korean adults. Our findings present opportunities to identify target populations for healthcare policies and interventions.

SUDs Cost Employer Health Insurance $35 Billion Per Year

SUDs Cost Employer Health Insurance $35 Billion Per Year

Development and Implementation of a Person-Centered, Technology-Enhanced Care Model For Managing Chronic Conditions: Cohort Study.

BackgroundCaring for individuals with chronic conditions is labor intensive, requiring ongoing appointments, treatments, and support. The growing number of individuals with chronic conditions makes this support model unsustainably burdensome on health care systems globally. Mobile health technologies are increasingly being used throughout health care to facilitate communication, track disease, and provide educational support to patients. Such technologies show promise, yet they are not being used to their full extent within US health care systems.ObjectiveThe purpose of this study was to examine the use of staff and costs of a remote monitoring care model in persons with and without a chronic condition.MethodsAt Dartmouth-Hitchcock Health, 2894 employees volunteered to monitor their health, transmit data for analysis, and communicate digitally with a care team. Volunteers received Bluetooth-connected consumer-grade devices that were paired to a mobile phone app that facilitated digital communication with nursing and health behavior change staff. Health data were collected and automatically analyzed, and behavioral support communications were generated based on those analyses. Care support staff were automatically alerted according to purpose-developed algorithms. In a subgroup of participants and matched controls, we used difference-in-difference techniques to examine changes in per capita expenditures.ResultsParticipants averaged 41 years of age; 72.70% (2104/2894) were female and 12.99% (376/2894) had at least one chronic condition. On average each month, participants submitted 23 vital sign measurements, engaged in 1.96 conversations, and received 0.25 automated messages. Persons with chronic conditions accounted for 39.74% (8587/21,607) of all staff conversations, with higher per capita conversation rates for all shifts compared to those without chronic conditions (P<.001). Additionally, persons with chronic conditions engaged nursing staff more than those without chronic conditions (1.40 and 0.19 per capita conversations, respectively, P<.001). When compared to the same period in the prior year, per capita health care expenditures for persons with chronic conditions dropped by 15% (P=.06) more than did those for matched controls.ConclusionsThe technology-based chronic condition management care model was frequently used and demonstrated potential for cost savings among participants with chronic conditions. While further studies are necessary, this model appears to be a promising solution to efficiently provide patients with personalized care, when and where they need it.

Multilevel Factors Predicting Cardiac Rehabilitation Attendance and Adherence in Underserved Patients at a Safety-Net Hospital.

This study examined multilevel factors as predictors of cardiac rehabilitation (CR) attendance and adherence among underserved patients at a safety-net hospital (SNH). Participants were recruited during hospitalization for a cardiac procedure or event. Participants responded to a questionnaire, and outcome data (including CR attendance and adherence) were extracted from medical records at baseline and 6 mo post-discharge. Data were collected from 171 participants, 92 (53.8%) of whom attended CR. On average, participants completed 24 CR sessions (66.7% adherence) and 40 (43.5%) participants fully adhered to the 36 prescribed sessions. Bivariate comparisons showed that participants who attended CR were more likely to have insurance (P = .002), perceive CR as important (P = .008), believe they needed CR (P = .005), and endorsed fewer barriers to CR (P = .005) than their nonattending counterparts. After controlling for insurance status, a regression analysis to predict attendance revealed only 1 predictor; perceived lack of time (P = .04). Bivariate analyses showed that only 1 clinical factor, treatment during hospitalization, was significantly related to adherence (P = .03). Patients with medical management alone (no revascularization) showed less adherence than their counterparts with revascularization. Although access to insurance is a significant predictor of attendance, psychological barriers that are amenable to being addressed by CR staff are also important. Findings suggest that perceived lack of time is important in SNH patient decision making to attend CR. This psychological barrier is a subject on which CR staff can intervene to educate patients about the life expectancy increases and decreased personal health care expenditures because of attendance.

US state health expenditure convergence: A revisited analysis

This paper studies the evolution of US state health expenditure for a sample that covers 1966–2014. Our results provide evidence against the existence of a single pattern of behavior of personal health care expenditure across the US states. Rather, we can observe the existence of two statistically different convergence clubs. We cannot find evidence of convergence when we disaggregate health expenditure into its three main payers: Medicare, Medicaid and private health insurance expenditure, whilst we again find evidence of convergence clubs. However, the estimated clubs for Medicaid and private health insurance expenditure are statistically different that estimated for total health expenditure. Consequently, our results offer strong evidence of heterogeneity in the evolution of US health expenditure. The analysis of the forces that drive club creation shows that economic situation and some supply-side factors are important. We can also appreciate that some healthcare outcome variables are only related to private insurance health expenditure. The other health expenditures, thus, show a certain lack of efficiency which may be due to practices that have little benefit for patient health.

Recent Trends in Taiwanese Medical Spending

AbstractSince the creation of National Health Insurance (NHI) in 1995, Taiwan's medical spending has been increasing rapidly, as has been the case in most countries worldwide. This paper follows international standards in documenting recent trends in Taiwan's medical spending by category, relying on official statistics, Surveys of Family Income and Expenditure (SFIE) data and administrative reimbursement panel data from the NHI Universal Database (NHIUD). Two findings are noteworthy. First, we find a rapidly widening gap since 1996 between rich and poor in terms of out‐of‐pocket payments and those by private health insurance; meanwhile, the gap between them in terms of NHI expenditure has remained roughly constant. This trend can be attributed mainly to a positive income gradient in personal health care expenditure among elderly individuals (aged 65 or older). Second, end‐of‐life hospital spending is large in both magnitude and proportion. Average end‐of‐life hospital spending is more than 30 times average hospital spending by the total population, and it accounts for 15.9 per cent of total hospital care expenditure (or 5.0 per cent of overall medical spending), even though the population near death accounts for only 0.51 per cent of the overall population. Two‐thirds of end‐of‐life hospital spending is on the elderly, who also constitute two‐thirds of the population near death. For both the elderly and working‐age adults, the share of end‐of‐life hospital spending strikingly aligns with the share of deaths.

Recent Trends in Taiwanese Medical Spending

Since the creation of National Health Insurance (NHI) in 1995, Taiwan’s medical spending has been increasing rapidly, as has been the case in most countries worldwide. This paper follows international standards in documenting recent trends in Taiwan’s medical spending by category, relying on official statistics, Surveys of Family Income and Expenditure (SFIE) data, and administrative reimbursement panel data from the NHI Universal Database (NHIUD). Two findings are noteworthy. First, we find a rapidly widening gap since 1996 between rich and poor in terms of out-of-pocket payments and those by private health insurance; meanwhile, the gap between them in terms of NHI expenditure has remained roughly constant. This trend can be attributed mainly to a positive income gradient in personal health care expenditure among elderly individuals (aged 65 or older). Second, end-of-life hospital spending is enormous in both magnitude and proportion. Average end-of-life hospital spending is more than 30 times average hospital spending by the total population. It accounts for 15.9 percent of total hospital care expenditure (or 5.0 percent of overall medical spending), even though the population near death accounts for only 0.51 percent of the overall population. Two-thirds of end-of-life hospital spending is on the elderly, who also constitute two-thirds of the population near death. For both the elderly and working-age adults, the share of end-of-life hospital spending strikingly aligns with the share of deaths.

The Economic Impact of Smoking and of Reducing Smoking Prevalence: Review of Evidence.

The Economic Impact of Smoking and of Reducing Smoking Prevalence: Review of Evidence.

Party Politics, Governors, and Healthcare Expenditures: A Regression Discontinuity Design Approach

This study examines the impact of the gubernatorial partisanship on the growth of health care expenditures for the panel data set of 50 U.S. states over the 1991 to 2009 period. Using the parametric regression discontinuity design, I find no partisan effect on the growth of state’s per capita real total personal health care expenditures. However, an analysis of the growth rates of the components of the health care expenditures suggests that there is a causal effect of party affiliation of the governors on “prescription drugs component. These findings are robust to the inclusion of additional covariates in the parametric approach as well to the use of non-parametric regression discontinuity approach.

Rising Annual Costs of Dizziness Presentations to U.S. Emergency Departments

Dizziness and vertigo account for roughly 4% of chief symptoms in the emergency department (ED). Little is known about the aggregate costs of ED evaluations for these patients. The authors sought to estimate the annual national costs associated with ED visits for dizziness. This cost study of adult U.S. ED visits presenting with dizziness or vertigo combined public-use ED visit data (1995 to 2009) from the National Hospital Ambulatory Medical Care Survey (NHAMCS) and cost data (2003 to 2008) from the Medical Expenditure Panel Survey (MEPS). We calculated total visits, test utilization, and ED diagnoses from NHAMCS. Diagnosis groups were defined using the Healthcare Cost and Utilization Project's Clinical Classifications Software (HCUP-CCS). Total visits and the proportion undergoing neuroimaging for future years were extrapolated using an autoregressive forecasting model. The average ED visit cost-per-diagnosis-group from MEPS were calculated, adjusting to 2011 dollars using the Hospital Personal Health Care Expenditures price index. An overall weighted mean across the diagnostic groups was used to estimate total national costs. Year 2011 data are reported in 2011 dollars. The estimated number of 2011 US ED visits for dizziness or vertigo was 3.9 million (95% confidence interval [CI] = 3.6 to 4.2 million). The proportion undergoing diagnostic imaging by computed tomography (CT), magnetic resonance imaging (MRI), or both in 2011 was estimated to be 39.9% (39.4% CT, 2.3% MRI). The mean per-ED-dizziness-visit cost was $1,004 in 2011 dollars. The total extrapolated 2011 national costs were $3.9 billion. HCUP-CCS key diagnostic groups for those presenting with dizziness and vertigo included the following (fraction of dizziness visits, cost-per-ED-visit, attributable annual national costs): otologic/vestibular (25.7%; $768; $757 million), cardiovascular (16.5%, $1,489; $941 million), and cerebrovascular (3.1%; $1059; $127 million). Neuroimaging was estimated to account for about 12% of the total costs for dizziness visits in 2011 (CT scans $360 million, MRI scans $110 million). Total U.S. national costs for patients presenting with dizziness to the ED are substantial and are estimated to now exceed $4 billion per year (about 4% of total ED costs). Rising costs over time appear to reflect the rising prevalence of ED visits for dizziness and increased rates of imaging use. Future economic studies should focus on the specific breakdown of total costs, emphasizing areas of high cost and use that might be safely reduced.

Health Care Expenditure for Ulcerative Colitis Adult Patients for the Years 2007 to 2009: A Nationwide Estimate using Medical Expenditure Panel Survey

Purpose: Ulcerative colitis is a chronic disease characterized by periods of increased disease activity that may require outpatient visits, inpatient hospitalizations and expensive medications. To quantify the direct medical expenditure associated with ulcerative colitis (UC) in United States using the Medical Expenditure Panel Survey (MEPS). Methods: MEPS is a nationally representative longitudinal survey conducted by Agency for Healthcare Research and Quality and National Center for Health Statistics. The Household component of MEPS (MEPS-HC) collects detailed information at the person and household level on health care utilization, expenditures, health insurance and health status for U.S civilian noninstitutionalized population. Patients with ulcerative colitis were identified in MEPS using ICD-9-CM code: 556.X. Nationally representative estimates of health care expenditure for UC patients were obtained from weighted MEPS data. In addition, the expenditure of UC patients for years 2007 to 2009 was combined to improve statistical precision of estimates. All expenditure estimates prior to 2009 were inflation adjusted using the Personal Health Care Expenditure Price Index (PHCE) and results were expressed in 2009 dollars. Results: The mean age of UC patients was 46.2 years (95% CI 42.87 to 49.59) and 48.3% were male; 88.3% were white and 6.7% were black. Of all UC patients, 8.3% were smokers. For the years 2007 to 2009, the average annual expenditure per UC patient was $8,801.32 (95%CI: $7718.29 to $9884.36). The highest proportion of cost for UC patients (32.5%) was related to pharmacy expenditure: $2,859.27 (95%CI: $2692.28 to $3026.25). The total outpatient expenditure excluding prescription costs comprised 42.3% of total expenditure as compared to only 8.5% of inpatient expenditure. Conclusion: The MEPS-HC data for the years 2007-2009 indicate that the largest proportion of health-care expenditure for UC patients is related to prescriptions and is 4 times higher than attributed to inpatient expenditure.

O perfil das internações do SUS para fratura osteoporótica de fêmur em idosos no Brasil: uma descrição do triênio 2006-2008

Osteoporosis is a multifactorial syndrome of the skeletal system, and hip fracture is the most serious consequence for the elderly, due to the high mortality and cost. This article describes osteoporotic hip fractures in Brazilian elderly in 2006-2008. Secondary data were obtained from the Authorization Forms for Hospital Admissions (AIH) and allowed the creation of indicators for hip fracture in elders. The proportion of elderly patients hospitalized for hip fractures in the Unified National Health System was 1%. The percentages of hospital admissions and deaths were higher in females, and increased with age. Hip fractures accounted for approximately 2% of health care expenditures for persons 60 years or older. Length of hospital stay ranged from one to seven days, 50.1% occurred in charity hospitals, and 42.7% occurred outside the county of residence. The findings emphasize the need for greater attention to osteoporosis and show the relevance of costs in hospital admissions for elderly with osteoporotic hip fractures. Understanding such hospitalizations can contribute to the formulation of health policies to address this issue.

Revealing age-specific past and future unrelated costs of pneumococcal infections by flexible generalized estimating equations

We aimed to study the excess health-care expenditures for persons with a known positive isolate of Streptococcus pneumoniae. The data set was compiled by linking the database of the largest Belgian Sickness Fund with data obtained from laboratories reporting pneumococcal isolates. We analyzed the age-specific per-patient cumulative costs over time, using generalized estimating equations (GEEs). The mean structure was described by fractional polynomials. The quasi-likelihood under the independence model criterion was used to compare different correlation structures. We show for all age groups that the health-care costs incurred by diagnosed pneumococcal patients are significantly larger than those incurred by undiagnosed matched persons. This is not only the case at the time of diagnosis but also long before and after the time of diagnosis. These findings can be informative for the current debate on unrelated costs in health economic evaluation, and GEEs could be used to estimate these costs for other diseases. Finally, these results can be used to inform policy on the expected budget impact of preventing pneumococcal infections.

Pharmaceuticals: Access, Cost, Pricing, and Directions for the Future

Prescription drug expenditures make up less than 10 percent of total personal health care expenditures in the United States, but over the last decade the amount that Americans spend on prescription drugs has grown much faster than any other component of personal health care. For example, between 1999 and 2000, hospital care costs rose about 5 percent, physicians and clinical services 6 percent, while prescription drug expenditures climbed more than 17 percent. In dollar amounts, prescription drug expenditures doubled, from $61 billion to $122 billion, between 1995 and 2000. Is this an unwarranted expense that needs to be controlled, or does it represent increased value, as pharmaceuticals substitute for older, most costly treatments? What is the prevalence of health insurance coverage for prescription drugs, and how does this affect specific populations who have limited or no drug benefits? What are the components of drug prices? And what do we need to consider when we design health care policy? Stephen Soumerai and Patricia Danzon look at several aspects of pharmaceutical drug usage and pricing in the United States, illustrating their observations with their published research findings. They then briefly review recent legislative proposals to broaden public insurance coverage for prescription drugs and make their own policy recommendations.

Do fluctuations in health expenditure affect economic growth

The temporal interdependence between health expenditure and economic growth has been the focus in a num- ber of recent empirical studies. While some insights have been gained from these studies, the focus has been on national economies, either in developed or developing countries. This paper explores this relationship at the U.S. state-level. The paper contributes to the literature by investigating possible dynamic relations between health care expenditure and eco- nomic growth, measured by gross state product, in the southeast United States. By employing time series approach, the empirical results confirm the presence of a weak, but positive relationship. After detecting unit roots in the data, co- integration in general, was not detected, as a long-run relationship seemed to exist only for Georgia. The results of the VAR analysis are correspondingly limited. However the shapes of the impulse functions do confirm the proper positive relationship between positive personal health care expenditure changes and economic growth.

Perceived unmet need for hospitalization service among elderly Chinese people in Zhejiang province

In this study, we determined the prevalence of unmet need for hospitalization service and the characteristics of the elderly with this unmet need in Zhejiang province, China. Data were collected from a random sample of 4046 Chinese aged 60 years and older in Zhejiang province. Based on the Andersen-Newman service utilization framework, multivariable logistic regression analysis was used to determine independent effects of these variables on the likelihood of having an unmet need for hospitalization service. Overall, the prevalence of unmet need was 16.2% for hospitalization service. Among predisposing factors, only educational level was statistically significant. Individuals with higher education were less likely to report unmet needs. Among enabling factors, residential area, social support, personal yearly income and personal healthcare expenditure were strongly associated with the presence of unmet need. Those with less enabling resources (e.g. residing in rural areas) were more likely to report unmet need [Odds ratio (OR) = 1.5-6.5]. All the need factors, except for physical function, were strongly associated with the presence of unmet need. Seniors in poorer health (e.g. in fair or poor health) were more likely to report unmet need than their counterparts in better health (OR = 1.5-2.8). In spite of relatively high insurance coverage rates, unmet need for hospitalization service remains high among the elderly people of Zhejiang province in China. Application of comprehensive intervention strategies such as conducting health education, creating social support, promoting community participation and promoting inter-sectional cooperation may be more effective in reducing unmet need for hospitalization service.

Stock returns and the short-run predictability of health expenditure: Some empirical evidence

The rising cost of health care, compounded with an aging population, has been the subject of constant discussion in the popular media. Accurate forecasts of health care expenditure are therefore important for both policy makers and industrial practitioners. Extending a branch of the macroeconomics literature that examines the role of asset prices as useful predictors of major macro variables (such as consumption, output growth and inflation), this study investigates whether the current equity market captures useful information on the growth of future health care expenditure. We focus on short-run (one-year) predictability. The preliminary evidence based on US data shows that industry-specific stock returns have some predictive power for personal health care expenditure and its major components (hospital care, durable medical equipment and prescription drugs). Nevertheless, the significance of the improvement in forecasting accuracy depends on the estimation scheme and whether parameter inconstancy is accounted for.

Diabetic retinopathy : facts and resources

AbstractDiabetic retinopathy (DR) is the most frequent ocular complication in patients with diabetes and the main cause of blindness in the working age population in industrialized and developing countries. The most important risk factors that contribute to the pathogenesis of DR are chronic hyperglycaemia, hyperlipidemia and hypertension. Epidemiologic data show that each year 12 percent of new cases of legal blindness are attributed to diabetic retinopathy (DR) and that its prevalence increases with both increased duration of diabetes and the age of patients. Of insulin‐dependent patients with diabetes for 30 or more years, 12% are blind. Diabetic macular edema (DME) is a frequent manifestation of DR and the leading cause of legal blindness in patients with type 2 diabetes. Over a 10‐year period, non clinically significant DME and clinically significant DME will respectively develop in 14% and 10% of known diabetic patients. Approximately half of patients with DME will loose two or more lines of visual acuity within 2 years. Overall social costs (expenditures and lost productivity) caused by DR are about $174 billion in the USA. Approximately 20% of health care expenditures for persons with DM (50% with DM as a co‐morbidity), 10% of expenditures for complications of DM and 15% of expenditures for health care for DM are ophthalmic. Therefore, DR accounts for significant economic costs that can be reduced with early diagnosis, achieved with screening methods. Screening of DR allows for timely treatment, vision preservation and consequent saving costs. Implementation of screening systems in different environments worldwide is the first necessary step in order to prevent blindness caused by diabetes mellitus.

Effect of the California Tobacco Control Program on Personal Health Care Expenditures

BackgroundLarge state tobacco control programs have been shown to reduce smoking and would be expected to affect health care costs. We investigate the effect of California's large-scale tobacco control program on aggregate personal health care expenditures in the state.Methods and FindingsCointegrating regressions were used to predict (1) the difference in per capita cigarette consumption between California and 38 control states as a function of the difference in cumulative expenditures of the California and control state tobacco control programs, and (2) the relationship between the difference in cigarette consumption and the difference in per capita personal health expenditures between the control states and California between 1980 and 2004. Between 1989 (when it started) and 2004, the California program was associated with $86 billion (2004 US dollars) (95% confidence interval [CI] $28 billion to $151 billion) lower health care expenditures than would have been expected without the program. This reduction grew over time, reaching 7.3% (95% CI 2.7%–12.1%) of total health care expenditures in 2004.ConclusionsA strong tobacco control program is not only associated with reduced smoking, but also with reductions in health care expenditures.