Public Health Care Costs Research Articles

146 The public health care cost of physical inactivity in a regional city of Australia

146 The public health care cost of physical inactivity in a regional city of Australia

Modelling the impact of opportunistic screening on the sequelae and public healthcare costs of infection with Chlamydia trachomatis in Australian women

To describe the health outcomes and public healthcare costs of a single screening for Chlamydia trachomatis in Australian women aged 15-34 years. A decision analytic model was used to determine the epidemiological estimates of prevalence and costs of C. trachomatis infection and its diagnosis, treatment and sequelae. We estimate that in any female population in Australia, with a Chlamydia prevalence rate of 5.7% or higher, a single screening examination for Chlamydia is cost saving for the public healthcare system. We found that opportunistic screening of high-risk populations is likely to be cost saving to the public healthcare system, although there is not sufficient evidence to support periodic population screening. As our model uses conservative epidemiological and public healthcare cost estimates, the health and financial impacts of C. trachomatis used in the model may be an underestimate of the true costs of infection.

Estimating the health care savings from trans fat-free canola in Canada

Abstract Growing scientific evidence links consumption of trans fatty acids in the diet to elevated levels of cholesterol and therefore to coronary heart disease. Coronary heart disease is the single largest contributor to health care costs in Canada (both direct medical costs and indirect costs in the form of lost productivity). As with many industrialized nations, rising public health care costs are a major public policy concern in Canada. The major source of trans fats is hydrogenated vegetable oils and processed food products. New canola varieties are emerging which enable the production of canola oils that are virtually trans fat-free. This paper evaluates the potential savings in public health care costs from a trans fat-free canola oil. Using four scenarios and conservative assumptions, the paper estimates non-trivial potential health cost savings in the range of Cdn$280 million to Cdn$1.09 billion annually. A number of policy implications are discussed.

First results of the introduction of DRGs in Germany and overview of experience from other DRG countries

In spite of numerous discussions and programs aimed at reducing public health care costs in Germany, the country has seen a massive increase in health care costs at an annual average rate of 7% since 1972. When German policymakers decided to reform the health care system by passing legislative measures on 22 December 1999, one of the key elements was to oblige hospitals and health insurance providers to replace the existing retrospective and procedural reimbursement system with a new prospective and diagnostic system based on diagnosis-related groups (DRGs). German policymakers are hoping to accomplish two feats with the introduction of DRGs: firstly, to improve the profitability of the health care system, and secondly, to improve the quality of health care services because DRGs require documentation and coding, which leads to increased transparency and allows for an external comparison of rendered services (benchmarking), as well as for an analysis and assessment of how appropriate and how successful the rendered services were in each particular case. Although the intentions underlying the introduction of DRGs are unquestionable, it remains to be determined whether the introduction has negative effects as well, and to which extent these negative effects have shown up so far. Hence the purpose of our survey will be to provide an extensive and systematic overview of results from other countries, along with preliminary results from Germany. In order to judge the trade-off between the desired and negative effects in a DRG system, we will define the set of parameters that determine the incentives of health care agents in such a system before surveying the economic and medical literature in light of these parameters in Section 3 and summarizing the results in Section 4. In view of the literature analysed, we find that the introduction of DRGs hasstarted a tendency towards a reduction in costs and towards a focus on profitability. If the legislator takes the necessary actions to reduce possible negative effects like manipulation and upcoding, the introduction of G-DRGs will lead to an increase in economic effectiveness and efficiency, while bringing more transparency into the quality of medical services at the same time.

What are the realistic expectations of tocolytics?

Preterm birth, the leading cause of neonatal morbidity and mortality worldwide, is a major public health problem in terms of loss of life, long term disability (e.g. cerebral palsy, chronic lung disease), and health-care costs. The outcome of preterm infants is directly related to the gestational age at delivery. The goal of tocolytic therapy is to reduce neonatal morbidity and mortality by delaying delivery, to allow for the administration of corticosteroids and/or the safe transfer to a tertiary-care centre. However, currently available tocolytics in Canada (ritodrine, indomethacin, calcium antagonists, magnesium sulphate) have poor efficacy, have not been shown to increase the completion of a course of corticosteroids, are potentially associated with significant maternal/fetal side effects, and most importantly, have not been shown to improve neonatal outcomes. At the Canadian Tocolysis Consensus Conference, there was general agreement that recommendations should be based on good quality research evidence, particularly that of randomised clinical trials when available. It was concluded that there is little evidence to support the use of any of the currently available tocolytics; tocolytic use has not been associated with improved perinatal outcomes and often have detrimental effects on the mother. Therefore, questionable efficacy and potentially serious side effects may outweigh their use. Any new tocolytic demonstrated to improve neonatal outcome will have an immediate impact on societal and long term public health-care costs.

Rational Addiction and Tobacco Consumption: Theory and Empirical Evidence

Since the end of the eighties the Becker and Murphy model of rational addiction has been the dominant approach to estimate addiction effects. A rational addictive consumer, a smoker for instance, is supposed to maximize over the life cycle a stable utility function and to be fully aware of the future consequences of her addiction and chooses to be an addicted because she evaluates the benefits of addiction to be greater than its full costs. It follows that public policy should not interfere with such fully rational behaviour. On the other hand, the additional public health care costs smokers impose on non smokers could be internalised using price mechanisms, as the long run price elasticity of demand is supposed to be significantly higher than the short run one. This work tries to assess, through a review of the literature, whether the idea of rational addiction is robust, with a focus on smoking behaviour.

Why is less money spent on health care for the elderly than for the rest of the population? Health care rationing in German hospitals

The consequences of population ageing for the public health care system and health care costs may be less severe than is commonly assumed. Hospital discharge data from Germany's largest health insurer (AOK) show that the cost of caring for patients during their last year of life makes up a large part of total health expenditures. And this last year of life is less costly if patients die at an advanced age. As a multivariate analysis reveals, oldest old patients as a rule receive less costly treatment than younger patients for the same illness. Moreover, this pattern is more pronounced for elderly women than for elderly men. These findings suggest that health care is informally rationed according to the age and sex of the patient. The data also indicate that there may be more age-related rationing going on in Germany than in the United States. Future research should investigate the national, institutional, and individual factors behind health care rationing. In this paper, I discuss the physician's professional decision as one plausible determinant.

Current oral agents for type 2 diabetes

PREVIEWIncreasingly, type 2 diabetes takes a toll on public health and healthcare costs in the United States. Although the remedy for this growing problem is very complex, two critical components of its control are prevention and effective therapy. Progress in diabetes prevention is likely to take decades. But fortunately, growth in our understanding of what occurs in this chronic disease has led to advances in the pharmacologic options aimed at decreasing hyperglycemia, the main clinically measurable metabolic consequence of diabetes. In this article, Drs Ahmann and Riddle provide an overview of the oral agents now available for the treatment of diabetes and discuss the clinical factors that help determine when to use which medication and what outcome to expect.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a severe, often disabling disorder with prevalence as high as 422 cases per 100,000 in the United States. Aside from the adverse effects to patients' quality of life, sequela of the disorder include a negative impact on the economy as well as a burden on public health care costs. Some avenues of current research into the possible genesis of the syndrome are neurally mediated hypotension, viral pathogen, immunological disorders, lymphocyte enzyme system abnormalities, or a purely psychological root. This paper is a review of the literatures as to a neuroendocrinologic cause, namely dysfunction of the hypothalamic-pituitary-adrenal axis.

Role of the pharmaceutical industry in health care cost containment

The pharmaceutical industry in the United States is comprised of 50 major companies whose total sales for 1983 were approximately $17 billion, slightly more than 10% of the total revenues of the hospital industry in the same year. Prescription drugs have long been considered a highly cost-effective treatment. Past history, consumer price indexes, a decline in share of health care spending and recent Pharmaceutical Manufacturers Association studies all indicate that drugs represent an economical form of treatment that can reduce overall health care costs. It is clear that the pharmaceutical industry can play a prominent role in containing costs within the health care delivery system. Research-directed companies can effect economies by developing innovative therapies that replace less effective, older or more costly ones. The federal government has recently provided powerful incentives to foster expansion of the industry, in addition to enacting legislation to contain public health care costs. During 1985, the research-directed industry will invest close to $4 billion in both basic research and specific product development projects. The largest portion of these funds continues to be devoted to developing superior cardiovascular drugs. The industry is also searching for better ways to define, document and present the cost-effectiveness of its products.

Private and public health-care costs.

Private and public health-care costs.

Private and Public Health-Care Costs

Private and Public Health-Care Costs