Rising Health Costs Research Articles

The state of interventions to address substance-related disorders in South African workplaces: implications for research, policy, and practice

Substance abuse in South Africa is highly prevalent and continues to be a major cause of mortality and a risk factor for both communicable and non-communicable diseases. The employer costs associated with substance abuse remain high owing to rising health costs, accidents, absenteeism, and workers’ compensation claims placing the organisation and its employees at risk for harm. This article describes the status of current policy, prevention, and treatment interventions to address substance abuse in the South African workplace. Key issues highlighted are the need for research into the extent and impact of substance abuse in the South African workforce, the promotion of substance abuse policies that are comprehensive in nature, and the need to upscale prevention and treatment initiatives through a move away from a traditional labour approach to addressing substance-related disorders in the workplace to the adoption of a more public health approach. Cost-effectiveness of substance abuse interventions is explored alongside the importance of ensuring that employers, practitioners, and other role players engage with the evidence of what works using international standards as the basis.

Does current evidence support the use of intraoperative cell salvage in reducing the need for blood transfusion in caesarean section?

An important cause of maternal morbidity and direct maternal death is obstetric haemorrhage at caesarean section. Concerns regarding allogeneic blood safety, limited blood supplies and rising health costs have collectively generated enthusiasm for the utility of methods intended to reduce the use of allogeneic blood transfusion in cases of haemorrhage at caesarean section. This can be achieved by intraoperative cell salvage (IOCS). The aim of this review is to summarize and examine the evidence for the efficacy of IOCS during caesarean section, in women at risk of haemorrhage, in reducing the need for allogeneic blood transfusion. The majority of the evidence currently available is from case reports and case series. Although this evidence appears to support the use of IOCS in obstetrics, strong clinical evidence or economic effectiveness from clinical trials are essential to support the routine practice of IOCS in obstetrics. Current evidence is limited to reported case series and two small controlled studies. Overall, IOCS may reduce the need for allogeneic blood transfusions during caesarean section. Future large randomized trials are required to assess effectiveness, cost effectiveness and safety. The results of the current ongoing SALVO (A randomised controlled trial of intra-operative cell salvage during caesarean section in women at risk of haemorrhage) trial will shed light on these aspects.

Family Medicine in Saudi Arabia-Next Steps

The increased prevalence of communicable, non-comunicable diseases, the global expanding of the elderly population, significant mental health issues,rising health costs,overutilization and medicalization of illnesses necessitate the need for a reliable community-based health care team. Efforts towards efficient, well organized family medicine speciality programs will produce needed, commited, and skilled primary care or family physicians that qualify them to provide continuous, comprehensive and accountable evidence-based health care for patients of all age groups. The Saudi Aramco Medical Services Organization (SAMSO), the first JCIA accredited hospital in the Middle East has taken significant strides to address the challenges facing the family medicine discipline.We aim through the following review to emphasize the role of family physicians, highlight some challenges globally and in Saudi Araba and provide list ofgeneral recommendations that would support the model.

Assessing the state of health research in the Eastern Mediterranean Region

Member states across the Eastern Mediterranean region face unprecedented health challenges, buffeted by demographic change, a dual disease burden, rising health costs, and the effects of ongoing conflict and population movements - exacerbated in the near-term by instability arising from recent political upheaval in the Middle East. However, health actors in the region are not well positioned to respond to these challenges because of a dearth of good quality health research. This review presents an assessment of the current state of health research systems across the Eastern Mediterranean based on publicly available literature and data sources. The review finds that - while there have been important improvements in productivity in the Region since the early 1990s - overall research performance is poor with critical deficits in system stewardship, research training and human resource development, and basic data surveillance. Translation of research into policy and practice is hampered by weak institutional and financial incentives, and concerns over the political sensitivity of findings. These problems are attributable primarily to chronic under-investment - both financial and political - in Research and Development systems. This review identifies key areas for a regional strategy and how to address challenges, including increased funding, research capacity-building, reform of governance arrangements and sustained political investment in research support. A central finding is that the poverty of publicly available data on research systems makes meaningful cross-comparisons of performance within the EMR difficult. We therefore conclude by calling for work to improve understanding of health research systems across the region as a matter of urgency.

Journal of Diabetes NEWS

<i>Journal of Diabetes</i> NEWS

Impacts of rising health care costs on families with employment-based private insurance: a national analysis with state fixed effects.

Given the rapid growth of health care costs, some experts were concerned with erosion of employment-based private insurance (EBPI). This empirical analysis aims to quantify the concern. Using the National Health Account, we generated a cost index to represent state-level annual cost growth. We merged it with the 1996-2003 Medical Expenditure Panel Survey. The unit of analysis is the family. We conducted both bivariate and multivariate logistic analyses. The bivariate analysis found a significant inverse association between the cost index and the proportion of families receiving an offer of EBPI. The multivariate analysis showed that the cost index was significantly negatively associated with the likelihood of receiving an EBPI offer for the entire sample and for families in the first, second, and third quartiles of income distribution. The cost index was also significantly negatively associated with the proportion of families with EBPI for the entire year for each family member (EBPI-EYEM). The multivariate analysis confirmed significance of the relationship for the entire sample, and for families in the second and third quartiles of income distribution. Among the families with EBPI-EYEM, there was a positive relationship between the cost index and this group's likelihood of having out-of-pocket expenditures exceeding 10 percent of family income. The multivariate analysis confirmed significance of the relationship for the entire group and for families in the second and third quartiles of income distribution. Rising health costs reduce EBPI availability and enrollment, and the financial protection provided by it, especially for middle-class families.

Health Insurance Costs and Young Firms

A common argument in the US health policy debate is that rising health insurance costs, coupled with the tying of insurance to employers, inhibits the survival and growth of entrepreneurial firms. Economic theory suggests that these costs may indeed adversely affect small businesses: the firms may be unable to pass on to employees the full cost of benefits due to downward nominal wage rigidities or labor market competition with large firms. I use the Kauffman Firm Survey of businesses beginning formal operations in 2004 to measure the effects of rising health costs on firm survival, employment growth, and propensity to offer insurance in each subsequent year. I exploit variation in insurance premia over time and across states, instrumenting for endogenous premium growth using insurance market regulation and tort reform. Estimates suggest that firms facing higher growth in health costs are more likely to offer insurance, possibly due to the higher value of insurance when potential loss rises. I find no significant effect of rising health costs on firm survival or employment growth and can rule out large negative effects.

Unintentional injuries among older adults in northern Sweden – a one‐year population‐based study

To study the epidemiology of unintentional injuries in a population of 21,000 Swedish older adults (65+) and to compare the injury incidence with similar data collected two decades earlier. This is a retrospective epidemiologic cross-sectional study based on a 1-year data set of all the 1753 registered injury events from a well-defined population. The injury rate per 1000 individuals was three times higher in the 85+ age group than in the 65-74 age group. The rate was also higher in women than in men aged 75 and older. Fractures, especially on lower and upper extremities, were the most common injuries. Falls in residential care facilities caused the most serious injuries. In transport areas, pedestrian falls and bicyclist crashes were much more common than car crashes. Of the 1753 people injured, 42% were treated as inpatients for a total of 11,569 days; 86% of these days were caused by injury events in the home (57%) or in residential care facilities (29%). Our 65+ age group occupied 69% of all hospital bed-days for trauma in all ages (0-102 years). Over the last two decades, the injury and fracture rate per 1000 individuals has increased by 40-50%, especially in the older age groups. During this time, the nursing strategy for older adults has changed in Sweden. As a result, more people live in their homes nowadays. This increase is distressing especially when we consider the current knowledge of preventive measures. The high number and proportion (>2/3) of inpatient trauma days for these age groups are a heavy burden for the medical sector. These facts call for more effective preventive measures, especially in the home and in residential care facilities, to minimize the negative health effects and the rising health costs.

Poor Nutrition Amidst Plenty

Hunger and food insecurity is on the rise in Maine as are increases in obesity, heart disease, and diabetes, all linked to food choices. Old and young, immigrant and native, rural and urban—Mainers are experiencing a food emergency made graver by the economic recession and rising health costs. Dora Anne Mills writes about “poor nutrition amidst plenty,” its causes, consequences, and the programs and policies that address it

Hunger in Maine

Hunger and food insecurity is on the rise in Maine. Mainers are experiencing a food emergency made graver by the economic recession and rising health costs. The authors of this article discuss hunger in Maine, focusing on private efforts to alleviate it.

The Swiss social insurance system: Social security and grass-roots democracy

The foundations of Switzerland's social insurance system can be traced to 1890 when a public referendum voted the inclusion of an article into the Federal Constitution that gave the executive the task of creating a sickness and accident insurance scheme. Currently, as in other European countries, the Swiss social insurance system is facing challenges as a result of rising health costs and demographic shifts, which are placing a growing burden on both public finances and private households. To reach policy decisions to address these challenges, the Swiss system is distinguishable from those of its European neighbours because of a continuing tradition of political decision-making based on grass-roots democracy: through referenda, the Swiss people remain directly responsible for the development of the national social insurance system. Importantly, not only might this unique feature of Swiss democracy lead the Swiss people more readily to accept and identify with their social insurance system but it may offer a sound democratic base upon which to build a consensual approach to address the policy challenges that lie ahead.

Only 2 Stars For This Tour Of 6 Nations’ Health Reforms

Only 2 Stars For This Tour Of 6 Nations’ Health Reforms

Review of methods for objective surgical skill evaluation

Rising health and financial costs associated with iatrogenic errors have drawn increasing attention to the dexterity of surgeons. With the advent of new technologies, such as robotic surgical systems and medical simulators, researchers now have the tools to analyze surgical motion with the goal of differentiating the level of technical skill in surgeons. The review for this paper is obtained from a Google Scholar and PubMed search of the key words "objective surgical skill evaluation." Only studies that included motion analysis were used. In this paper, we provide a clinical motivation for the importance of surgical skill evaluation. We review the current methods of tracking surgical motion and the available data-collection systems. We also survey current methods of surgical skill evaluation and show that most approaches fall into one of three methods: (1) structured human grading; (2) descriptive statistics; or (3) statistical language models of surgical motion. We discuss the need for an encompassing approach to model human skill through statistical models to allow for objective skill evaluation.

Development of a method for assessing operating room management based on diagnosis procedure combination E- and F-file data

Due to rising health costs, hospitals are making efforts to assess and improve management efficiency. However, at present, Japanese hospitals rely on individual assessment methods. Due to the lack of a common method of assessment - based on standardized data available from all hospitals - meaningful comparisons cannot be conducted. The objectives of this study were to develop a method of assessing OR management based on standardized administrative data, and to apply this method in assessing and comparing OR efficiencies in a multi-institutional setting.

Analyse des séjours hospitaliers: apport des données infirmières

Background: In Switzerland the aim of health insurance (LAMal) is to control rising health costs. One method is to institute a prospective payment system (DRGs) for all Swiss hospitals in 2012, according to which hospital funding will be based only on medical and administrative data. Question: What is the contribution of nursing to the analysis of hospital stays? Method: On the basis of all patient hospital stays in the CHUV (Lausanne) during 2005 and 2006, we have compared a medico-administrative data model and a nursing data model. We used a logistic regression on the probability of patient exit. Results: The capacity of discrimination of the model is appreciably improved since the surface under curve O.C.R. passes from 0.712 with the casemix data and the rang of day to 0.785 if it’s adds data on heaviness of care (pseudo R 2 respectively 0.096 and 0.152). Discussion: This approach provides evidence on the feasibility of using standards of care pathway allowing managers to analyse the organisation of patient care and securing a better estimate of hospital funding.

Congress Passes Mental Health Parity Bill

nation, you’ve seen it contributing to the slower rate of increase in health care costs,” Zirkelbach said. Helen Darling, president of the National Business Group on Health, said her member companies are also looking at disease and care management as a way to curtail rising health costs. The Washington, DC–based nonprofit association is made up of large employers that are seeking solutions to their health care issues. “There’s been a sea change in the way employers are thinking about their role,” Darling said. “About 3 years ago, we began saying that we actually had to change the health profile of our employees and their dependents, because if they’re not healthy, they cannot be productive. We’re going to continue this for several more years to see if it makes a difference.” TREATING PATIENTS The economic climate for health insurance is also putting pressures on hospitals and physicians. Carolyn Steinberg, vice president for trends analysis with the American Hospital Association, said her institutions are facing between 20% and 25% in uncompensated care from insured patients who cannot pay their part of the bill. Beyond such financial concerns, hospitals also often serve as the “bad guys” when treating insured patients who may be under cost pressures to choose plans with low premiums but high copayments. “Patients don’t really understand that they are making choices when they enroll in health plans and don’t realize they may face co-pays or that they need to use certain preferred providers,” Steinberg said. “Hospitals have to deliver the bad news of what the plans are not delivering.” Himmelstein said that for physicians, the current health insurance climate makes it more difficult to treat patients. “Before,whenIprescribedamedicine orrecommendedatest, theconversation wasabout ‘DoIneedthis?’”Himmelstein said.“Nowmuchoftheconversationcenters on, ‘Is my insurance going to pay for this? If they pay only a part, can I afford it?’ I’mspendinga lotof timewith the insurance hassles.” Still, Himmelstein recognizes the real burdens are on patients. “Fifteen years after the Clinton Administration’s health reform effort, health care costs are a significantly higher part of the US gross domestic product and finding affordable coverage is much more difficult,” Himmelstein said. “Fifteen years ago, the issue was about covering the uninsured; today, the crisis is for those with insurance.”

Workplace wellness programs in Canada: An exploration of key issues

Faced with the reality of rising health costs, Canadian employers are thinking beyond traditional notions of responsibility for employee health and have begun to embrace Workplace Wellness Programs (WWPs). This article investigates the critical issues of WWPs in the Canadian context from the perspective of key stakeholders. Using a combination of literature and key informant interviews, seven key themes are presented along with recommendations for wider implementation of WWPs in Canada.

Healing Body and Mind: A Critical Issue for Health Care Reform

Back to table of contents Previous article Next article Book ReviewFull AccessHealing Body and Mind: A Critical Issue for Health Care ReformLeslie R. Pyenson M.D.Leslie R. Pyenson M.D.Search for more papers by this authorPublished Online:1 Apr 2008https://doi.org/10.1176/ps.2008.59.4.451AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Almost any American can recite an example of how the U.S. health care system has caused personal stress and frustration. The urgent need for health care reform is debated regularly in the press, on television, in blogs, and in movie documentaries. Roger Kathol and Suzanne Gatteau offer a solution to an important aspect of the problem through an examination of "a fragmented health system, in which treatment of the mind (mental health) is severed from the body (physical health), resulting in mindless health care." Following the recommendations of an Institute of Medicine committee report ( 1 ), Kathol and Gatteau outline a program to integrate the treatment of physical and behavioral problems, which addresses concerns of patients, health care providers, and health plans. The authors' evidence-based accounts of patients with familiar health complaints illuminate the problem: segregating treatment of behavioral issues from medical issues results in persistent health problems, increased costs, and a decline in employee productivity. The authors note that patients with frequent somatic complaints make excessive doctor and emergency room visits, resulting in two million unnecessary hospital admissions per year, and adding an estimated annual cost of $10 to $20 billion ( 2 ). Additionally, the cost to businesses in the United States because of alcohol- and drug-related disorders totals more than $100 billion a year. Despite high expenditures on services, in terms of quality of health care, treatment for alcohol dependence ranks last ( 3 ). Rapidly rising health costs precipitated the development of a managed care system to replace traditional fee-for-service insurance. The managed care system was designed not only to deny coverage to patients who use services excessively but also to eliminate unnecessary procedures and tests. Unfortunately, this new system shifted decision-making power from clinicians to health plan administrators. Medicine became a business focused on quarterly profits and a favorable short-term expense-to-income ratio, rather than on the long-term strategic goal of improving overall health. The emphasis on treating physical illness took precedence over treating behavioral problems, which were historically perceived as unrelated to physical illness, overdiagnosed, and unprofitable.The authors describe the flaws in those perceptions. They outline a new paradigm based on employer commitment, coordinated communication among health care providers, and consolidated administration of medical and behavioral health plan coverage, which would include equitable reimbursement for behavioral health personnel based on coding procedures used in physical medicine. They point out that adopting their paradigm would decrease utilization of services, lower health costs, increase employee productivity, and improve overall health.Dr. Kathol is an adjunct professor of internal medicine and psychiatry at the University of Minnesota and president of Cartesian Solutions, an integrated health care consulting company. He is a past president of the American Academy of Clinical Psychiatry, the Academy of Psychosomatic Medicine, and the Association of Medicine and Psychiatry. His coauthor, Suzanne Gatteau, is a freelance writer.Kathol's experience and Gatteau's writing skills have resulted in a book that offers a logical, rational solution to a complex health care problem. Health professionals, health plan administrators, consumers, and legislators seeking a solution to problems resulting from fragmented health care will find this book informative and practical. Its publication is especially timely in a presidential election year.Dr. Pyenson recently retired as chief of medical and psychological analysis at the Central Intelligence Agency and is currently a clinical consultant with SpecTal, LLC, Reston, Virginia.

How Much ‘Skin In The Game’ Do Medicare Beneficiaries Have? The Increasing Financial Burden Of Health Care Spending, 1997–2003

Rising health costs and an aging population present critical policy challenges. This paper examines the financial burden of out-of-pocket health spending among Medicare beneficiaries between 1997 and 2003. Over this period, median out-of-pocket spending as a share of income increased from 11.9 percent to 15.5 percent. In 2003, the 25 percent of beneficiaries with the largest burden spent at least 29.9 percent of their income on health care, while 39.9 percent spent more than a fifth of their income on health care. Results suggest that sustained increases in out-of-pocket spending could make health care less affordable for all but the highest-income beneficiaries.

Why Is the Australian Government Interested in Complementary Medicine? A Case Study of Economic Rationalism

To address rising health costs, the Australian government has relied on several strategies: (1) covert rationing that entails limiting public health funds for particular patients or services; (2) the allocation of patients awaiting surgery to a priority level; (3) increased copayments for physician visits necessitated by practices such as physicians refusing to bulk bill; and (4) the establishment of an independent auditor for the private health insurance industry. However, the health economics literature rarely mentions that the growing support in various ways of the Australian government for complementary medicine may constitute another strategy for curtailing rising health costs. The government's main support for complementary medicine has come in the form of training programs in chiropractic, osteopathy, Chinese medicine, and naturopathy in public tertiary institutions and partnerships between private complementary colleges and public universities. Compared with biomedical education with its need for hospitals and sophisticated technology, complementary training programs are inexpensive. Furthermore, complementary services are generally not covered by Medicare but must be paid for either out of pocket or by a private health plan.