Total Health Care Expenditures Research Articles

Contemporary Incremental Healthcare Costs for Allergic Rhinitis in the United States.

Describe contemporary changes in healthcare expenditure and utilization associated with allergic rhinitis (AR) over the past decade. Cross-sectional analysis. Patients reporting a diagnosis of AR were extracted from the 2018 Medical Expenditure Panel Survey and linked to the consolidated expenditures file. AR patients were then compared to non-AR patients to demonstrate differences in healthcare utilization for office visits, emergency facility visits, and prescriptions. In addition, differences in total healthcare costs, office-based costs, and prescription costs were calculated, using demographic- and comorbidity-adjusted multivariate models. Results were compared to those obtained in 2007. In 2018, an estimated 1.94 ± 0.2 million adult patients reported AR (0.8% of the US population receiving medical care), a 90% decrease from the 17.8 ± 0.7 million patients seen in a formal healthcare setting for AR in 2007 (7.9%). AR patients still formally seen in 2018 had an average of 4.4 ± 1.3 more office visits (P= .001) and 9.7 ± 2.2 more prescription fills (P< .001) than non-AR patients. In contrast to the 2007 findings, there was no difference in total health care expenditure per person with AR per year. When comparing total healthcare expenditure between 2018 and 2007, there was a net decrease of $1,176 per person with AR per year (P< .01). Patients reporting AR in a formal healthcare encounter fell significantly over the past decade, and per-person expenditure associated with an AR diagnosis also decreased significantly. The transition of nasal corticosteroids to over-the-counter was potentially a key driver behind these changes. 3 Laryngoscope, 132:1510-1514, 2022.

Hospice Saves Costs for Families: Evidence from 16 Years of Medicare Survey Data

Research ObjectiveUse of hospice is an indicator of high quality end‐of‐life care. As of 2019, more than half of all deaths in the US occurred under the care of hospice. Economic evaluations of hospice have primarily focused on cost savings to the Medicare program or managed care programs without consideration of costs to families. Families of people near end of life are vulnerable to adverse financial experiences, which may compound their physical, mental and emotional burden through bereavement. Our objective was to estimate the impact of hospice use on family out‐of‐pocket (OOP) and total healthcare expenditures.Study DesignWe conducted a pooled, cross‐sectional analysis of healthcare spending in the last 6 months of life using data from the nationally representative Medicare Current Beneficiary Survey (MCBS), 2002–2018. We measured total healthcare expenditures across all payers (Medicare, Medicaid, private insurance, HMO, family OOP, other) and by expenditure type (inpatient care, outpatient care, skilled nursing, home health, hospice, and prescription drugs). We used propensity‐score based Inverse Probability Treatment Weighting to match participants who used hospice and those who did not, stratifying the exposure group by duration of hospice use.Population StudiedMCBS participants who died between 2002 and 2018.Principal FindingsOf 8568 decedents, average total healthcare expenditures in the last six months of life were $42,343 (SD $44,427) and family OOP expenditures were $4827 (SD $9550). OOP spending for families was driven by nursing home care, averaging $538 in the last month of life, followed by spending for medical provider visits ($229 in the last month of life). Total healthcare expenditures were lower for those who used hospice compared to matched non‐hospice controls for the following hospice care durations: 7 days prior to death ($1417 lower expenditures for hospice users, P &lt; 0.001); 2 weeks prior to death ($5221 lower, P &lt; 0.001); 1 month prior to death ($6426, P &lt; 0.001); and 3 months prior to death ($3351, P &lt; 0.010). Family OOP expenditures were lower for those who used hospice 2 weeks prior to death ($275, P &lt; 0.001), 1 month prior to death ($402, P &lt; 0.001), and 3 months prior to death ($464, P = 0.072) compared with matched controls who did not use hospice. Families enrolled with hospice spent significantly less OOP on medical provider visits and inpatient care than families who did not enroll with hospice.ConclusionsHospice enrollment was associated with lower costs for families in the month prior to death, as well as savings for payers. The magnitude of OOP savings of hospice enrollment to families are meaningful to many Americans, particularly those with lower socioeconomic status. Savings in healthcare expenditures in total and for families were driven by inpatient care and medical provider visits.Implications for Policy or PracticeAs healthcare continues to shift from institutions to the community settings and use of home‐based care such as hospice increases, it is important to assess cost shifting to families. Our findings that hospice does not shift economic burden from Medicare to families underscores the need to promote timely access to hospice care as even those with short hospice durations experienced cost savings.Primary Funding SourceNational Institutes of Health.

Dialysis and Total Health Care Costs in the United States and Worldwide: The Financial Impact of a Single-Payer Dominant System in the US.

Significance Statement In the United States, dialysis provision is an example of a robust, single-payer dominant system with cost containment. When compared with the cost of dialysis in other countries, Medicare dialysis costs in the United States as a function of overall health care expenditures are approximately $60,000 per patient less than expected, likely due to substantial cost containment imposed by Medicare as the dominant payer.

Informal Caregiving: Implications for Healthcare Expenditures

Introduction: Informal caregivers are family, friends, and neighbors who provide assistance to people in need of care without pay. Caregivers play a critical role in patients’ care. Care provided by informal caregivers is often seen as a lower cost substitute to formal care and their contributions are assumed to take strain off the care system. Caregivers, however, report significant consequences such as a decline in their health and a higher use of healthcare services due to their caregiving responsibilities. While many studies have explored these outcomes using self-reported measures, use of administrative databases to substantiate such claims is rare. The objective of this study was to examine the impact of caregiving on healthcare utilization amongst informal caregivers.Methods: The outcome was total healthcare expenditures for publicly funded healthcare services in Ontario, Canada. The population consists of Ontarians who a) participated in the 2008/09 Canadian Community Health Survey – Health Aging Supplement Survey (CCHS-HAS) and b) provided consent to link their survey results to health administrative databases. The exposure was measured as self-reported role as a primary caregiver that started within 5 years of the date that the survey was completed; the comparison group was those who did not self-identify as caregivers in CCHS-HAS. Total healthcare costs of caregivers and non-caregivers were compared pre versus post reported caregiving start date using a difference-in-differences design. Both one and two-year periods of healthcare utilization were examined. The study period was 2002 to 2011. Generalized Linear Models is used to model the total healthcare costs. Sensitivity analyses were conducted to test the robustness of the results.Results: The sample consists of 1265 caregivers and 3010 non-caregivers. The average age was 62.6 and 67.7 for caregivers and non-caregivers, respectively. Nearly 60% of caregivers and 54% of the non-caregivers were female. After adjusting for confounders, it was found that while caregivers’ costs associated with use of publicly funded services increased over time, caregiving had a negative impact on total costs in comparison to non-caregivers. Caregivers used the healthcare services less than non-caregivers. In the first year after caregiving this difference was 3% but not statistically significant. This, however, changed with time; the difference increased by 8% to 11% and became statistically significant. Discussion: Despite overwhelming self-reported evidence of caregivers’ declining health and increased use of health services due to caregiving, we found that use of healthcare services increased by a lesser amount amongst caregivers than for non-caregivers. If caregivers’ health has not similarly improved relative to non-caregivers, this suggests that caregivers may not have time to ensure their own medical needs are addressed.Conclusions: Our findings suggest the need for careful consideration of caregivers and their needs when designing and implementing healthcare interventions such as integrated care models.Lessons learned: By providing an estimation of healthcare expenditure implications of caregiving, we offer an alternative method to be considered in economic evaluations of the healthcare system, evaluation studies, health economics, and caregiving studies. Limitations: The main limitation is that caregiver status and timing is based on survey self-report which could incorrectly classify the exposure and bias estimates of cost. Lack of specific data on caregiving characteristics (e.g. hours of care provided) could have introduced bias in our results.Future research: More research in different jurisdictions and on different caregiver populations are required to substantiate our findings.

Nonelderly Adult Cancer Survivors in High Deductible Health Plan: Healthcare Expenditure, Utilization and Access.

Background: To compare healthcare expenditure, utilization and access between nonelderly adult cancer survivors enrolled in a high deductible health plan with a health savings account (“HDHP+HSA”), HDHP without HSA (“HDHP alone”) and low deductible health plan (“LDHP”). Methods: 1735 cancer survivors, aged 18–64 years, with continuous private coverage identified from the 2012–2017 Medical Expenditure Panel Survey: HDHP alone (n = 353), HDHP+HSA (n = 242) and LDHP (n = 1140). Healthcare expenditures, utilization and inability/delay obtaining medical care were analyzed using generalized linear regressions with inverse propensity score weighting and doubly robust estimation. Results: HDHP alone group (23,255 USD) had significantly higher total healthcare expenditure compared to HDHP+HSA (15,580 USD, p = 0.012) and LDHP (16,261 USD, p = 0.016). HDHP alone (6089 USD; p = 0.002) and HDHP+HSA (5743 USD; p = 0.012) groups had significantly higher out-of-pocket (OOP) expenditure compared to LDHP (4853 USD). HDHP alone (17,128 USD, p = 0.010) and LDHP (12,645 USD, p = 0.045) had significantly higher private insurer payments compared to HDHP+HSA (9216 USD). No differences were found in utilization or inability/delay obtaining medical care across groups. Conclusions: Non-elderly adult cancer survivors with continuous coverage and comparable sociodemographic characteristics enrolled in HDHP with HSA displayed the lowest healthcare costs compared to HDHP without HSA and LDHP. HDHP+HSA had a significantly higher OOP expenditure than LDHP. No significant differences were observed in utilization or access among groups.

Older Adults Engage With Personalized Digital Coaching Programs at Rates That Exceed Those of Younger Adults.

Background: The US population is aging and has an expanding set of healthcare needs for the prevention and management of chronic conditions. Older adults contribute disproportionately to US healthcare costs, accounting for 34% of total healthcare expenditures in 2014 but only 15% of the population. Fully automated, digital health programs offer a scalable and cost-effective option to help manage chronic conditions. However, the literature on technology use suggests that older adults face barriers to the use of digital technologies that could limit their engagement with digital health programs. The objective of this study was to characterize the engagement of adults 65 years and older with a fully automated digital health platform called Lark Health and compare their engagement to that of adults aged 35–64 years.Methods: We analyzed data from 2,169 Lark platform users across four different coaching programs (diabetes prevention, diabetes care, hypertension care, and prevention) over a 12-month period. We characterized user engagement as participation in digital coaching conversations, meals logged, and device measurements. We compared engagement metrics between older and younger adults using nonparametric bivariate analyses.Main Results: Aggregate engagement across all users during the 12-month period included 1,623,178 coaching conversations, 588,436 meals logged, and 203,693 device measurements. We found that older adults were significantly more engaged with the digital platform than younger adults, evidenced by older adults participating in a larger median number of coaching conversations (514 vs. 428) and logging more meals (174 vs. 89) and device measurements (39 vs. 28) all p ≤ 0.01.Conclusions: Older adult users of a commercially available, fully digital health platform exhibited greater engagement than younger adults. These findings suggest that despite potential barriers, older adults readily adopted digital health technologies. Fully digital health programs may present a widely scalable and cost-effective alternative to traditional telehealth models that still require costly touchpoints with human care providers.

Healthcare utilization at retirement in China.

Previous studies, mostly analyzing data from high-income economies, present mixed evidence on the relationship between retirement and healthcare utilization. This study leverages administrative data for over 80,000 urban Chinese workers to explore the effect of retirement on outpatient and inpatient care utilization using a fuzzy regression discontinuity design. The analyses of medical claims from a large city in China complement and extend the current literature by providing evidence of potential mechanisms underlying increased short-run utilization. In this relatively well-insured population, annual total healthcare expenditures significantly increase primarily because of more intensive use of outpatient care at retirement, especially at the right tail of the distribution of outpatient visits. This increase in outpatient care appears to stem from a decline in the patient cost-sharing rate and the reduced opportunity cost of time upon retirement, interacting with supplier-induced demand, not from any sudden impact on health. We do not find evidence of change in inpatient care at retirement. The results hold for both females and males, and are robust to a number of sensitivity analyses.

Long-term costs and cost-effectiveness of adjunctive corticosteroids for patients with septic shock in New Zealand

ObjectiveThe aim of the study was to determine whether adjunctive hydrocortisone reduced healthcare expenditure and was cost-effective compared with placebo in New Zealand patients in the Adjunctive Glucocorticoid Therapy in Patients with Septic Shock (ADRENAL) trial. DesignThis is a health economic analysis using data linkage to New Zealand Ministry of Health databases to determine resource use, costs, and cost-effectiveness for a 24-month period. SettingThe study was conducted in New Zealand. Participants and interventionPatients with septic shock were randomised to receive a 7-day continuous infusion of 200 mg of hydrocortisone or placebo in the ADRENAL trial. Main outcome measuresHealthcare expenditure was associated with all hospital admissions, emergency department presentations, outpatient visits, and pharmacy expenditure. Effectiveness outcomes included mortality at 6 months and 24 months and quality of life at 6 months. Cost-effectiveness outcomes were assessed with reference to quality-adjusted life years gained at 6 months and life years gained at 24 months. ResultsOf 3800 patients in the ADRENAL trial, 419 (11.0%) were eligible, and 405 (96.7% of those eligible) were included. The mean total costs per patient over 24 months were $143,627 ± 100,890 and $143,772 ± 97,117 for the hydrocortisone and placebo groups, respectively (p = 0.99). Intensive care unit costs for the index admission were $50,492 and $62,288 per patient for the hydrocortisone and placebo groups, respectively (p = 0.09). The mean number of quality-adjusted life years gained at 6 months and mean number of life years gained at 24 months was not significantly different by treatment group, and the probability of hydrocortisone being cost-effective was 55% at 24 months. ConclusionsIn New Zealand, adjunctive hydrocortisone did not reduce total healthcare expenditure or improve outcomes compared with placebo in patients with septic shock.

Financial and social impacts of drug price changes: Evidence from 2017 healthcare reform in Liaoning Province, China.

Healthcare reform was launched in China in 2017 to reduce the financial burden on both patients and the government by terminating the 15% markup on drug prices at public hospitals. To evaluate this reform's impacts, we conduct a quantitative study based on the operational data from one of the top 10 hospitals in Liaoning, China. Specifically, we utilize log-linear and logistic regression models to examine the policy's impacts on patients' total healthcare expenditures and the hospital's adjustments of its offering list that consists of western medicine (WM), traditional Chinese medicine (TCM) and non-medicine (NM). We find that the reform effectively alters the patients' spending structure and the hospital's profit model: (1) it decreases patients' average per-visit expenditure on WM and TCM while increases their average NM expenditure; (2) it differently affects patients from various socioeconomic groups and leaves space to target on groups that may demand extra financial and healthcare assistance; (3) it slows down the hospital's revenue increase and incentivizes the hospital to shift the WM revenue from margin-driven to volume-driven and to weigh more on NM revenue and (4) it encourages the hospital to keep WMs with steady price and drop WMs whose price keeps rising.

Gesundheitsausgaben und die Rolle des Alters: Eine detaillierte Analyse der Kosten von Überlebenden und Verstorbenen

Germany faces various socio-political challenges due to its ongoing ageing population. Significant increases in social security contributions are widely expected. The impact of ageing on healthcare expenditure is acontroversial issue. Experts agree that costs for end-of-life care account for asignificant part of total healthcare expenditures. For ameaningful forecast, detailed information on healthcare costs differentiated by survivors and decedents is necessary. Extensive data are hardly available for Germany. The aim of the analysis was therefore to describe healthcare costs in the statutory health insurance. The basis for the calculation is billing data from the statutory health insurance "AOK Niedersachsen" (Lower Saxony). Persons who survived or died in 2017 were included in the analysis. Average costs were standardised. The data of 2.46 million survivors and 34,307 decedents were analysed. The average annual healthcare costs were 2756 € for survivors and 21,830 € for decedents in the last year of life. The average healthcare costs for survivors increase with age whereas costs for decedents are highest in younger age groups and decline with increasing age. Adetailed analysis of end-of-life costs shows an exponential increase of costs in the last three years of life with the highest costs in the quarter before death (10,577 €). The analysis gives adetailed overview on the structure of healthcare expenditure in the statutory health insurance and can serve as abasis for future forecasts regarding healthcare expenditure.

Impact of the removal of patient co-payments for antiretroviral therapy (ART) on out-of-pocket expenditure, adherence and virological failure among Australian adults living with HIV

Background: In 2015, New South Wales (Australia) removed patient co-payments for ART of HIV. We hypothesized the policy change would reduce overall out-of-pocket (OOP) healthcare expenditure, improve ART adherence, and better maintain HIV suppression. Methods: Using data from a national, 2-year prospective study of adults with HIV on ART (n=364) (2013-2017), we compared OOP healthcare expenditure, ART adherence, and virological failure (VF) in participants subject to the co-payment policy change with participants from other jurisdictions who never paid, and who always paid, co-payments. We used fixed effects regression models to compare outcomes, and incidence rates for VF. Results: Although ART co-payments declined, there was no significant change in total OOP healthcare expenditure in participants ceasing co-payments compared to those who continued (adjusted coefficient 0.09, 95% CI -0.31 to 0.48). Co-payment removal did not significantly reduce suboptimal ART adherence (from 17.5% to 16.3%) or VF (from 5.0 to 3.7 episodes per-100-person-years). Participants in the lowest income group but not receiving concessional government benefits incurred a non-significant increase in total OOP healthcare expenses; while concessional participants experienced a significant increase in non-ART HIV healthcare costs after the policy changed. Conclusion: In this population, ART co-payments represented a small proportion of OOP healthcare expenditure. Its removal did not materially impact ART adherence or VF, although the study was not powered to detect these.

Differences in Healthcare Expenditures, Visits, and Prescriptions by Race for Common Benign Urologic Conditions

ObjectiveTo identify differences in healthcare expenditures and utilization by race in patients treated for common benign urologic conditions. Materials and MethodsA retrospective secondary data analysis was conducted of patients with common benign urologic conditions using 2016-2018 Medical Expenditure Panel Survey data. Benign conditions included urolithiasis, cystitis, erectile dysfunction (ED), pelvic organ prolapse (POP), urinary incontinence (UI), and benign prostatic hyperplasia (BPH). Generalized linear models were used to evaluate the relationship between total healthcare expenditures and utilization and race for each condition. Adjusted analyses accounted for age, sex, number of chronic conditions, poverty status, self-reported health status, marital status, highest degree of educational attainment, and insurance status. ResultsThe weighted analysis sample consisted of 27,110,416 patients, of whom 80.9% were Non-Hispanic white, 6.9% Non-Hispanic black, and 12.2% other minority races. After adjustment, total healthcare expenditures were significantly lower for Non-Hispanic blacks (incidence rate ratio [IRR] = 0.19, 95% confidence interval [CI]: 0.06-0.61) and other minority races (IRR = 0.30, 95% CI: 0.10-0.88) compared to Non-Hispanic whites treated for ED. Similarly, compared to Non-Hispanic whites, healthcare expenditures were significantly lower for Non-Hispanic blacks treated for UI (IRR = 0.56, 95% CI: 0.35-0.90). ConclusionHealthcare expenditures are significantly lower for Non-Hispanic black patients treated for ED and UI in the US Future research is needed to determine if these differences represent an inequality in the delivery of urologic care for patients with these conditions.

Socioeconomic differences in healthcare expenditure and utilization in The Netherlands

BackgroundWorldwide, socioeconomic differences in health and use of healthcare resources have been reported, even in countries providing universal healthcare coverage. However, it is unclear how large these socioeconomic differences are for different types of care and to what extent health status plays a role. Therefore, our aim was to examine to what extent healthcare expenditure and utilization differ according to educational level and income, and whether these differences can be explained by health inequalities.MethodsData from 18,936 participants aged 25–79 years of the Dutch Health Interview Survey were linked at the individual level to nationwide claims data that included healthcare expenditure covered in 2017. For healthcare utilization, participants reported use of different types of healthcare in the past 12 months. The association of education/income with healthcare expenditure/utilization was studied separately for different types of healthcare such as GP and hospital care. Subsequently, analyses were adjusted for general health, physical limitations, and mental health.ResultsFor most types of healthcare, participants with lower educational and income levels had higher healthcare expenditure and used more healthcare compared to participants with the highest educational and income levels. Total healthcare expenditure was approximately between 50 and 150 % higher (depending on age group) among people in the lowest educational and income levels. These differences generally disappeared or decreased after including health covariates in the analyses. After adjustment for health, socioeconomic differences in total healthcare expenditure were reduced by 74–91 %.ConclusionsIn this study among Dutch adults, lower socioeconomic status was associated with increased healthcare expenditure and utilization. These socioeconomic differences largely disappeared after taking into account health status, which implies that, within the universal Dutch healthcare system, resources are being spent where they are most needed. Improving health among lower socioeconomic groups may contribute to decreasing health inequalities and healthcare spending.

Trajectories of end-of-life medical and long-term care expenditures for older adults in Japan: retrospective longitudinal study using a large-scale linked database of medical and long-term care claims

BackgroundAn accurate understanding of the current state of end-of-life care is important for healthcare planning. The objectives of this study were to examine the trajectories of end-of-life medical and long-term care expenditures and associated factors.MethodsThis was a retrospective longitudinal study using a large-scale linked database of medical and long-term care claims—National Health Insurance, Advanced Elderly Medical Insurance, and long-term care insurance—covering Prefecture A in Japan. Patients aged ≥70 years who died between April 1, 2016, and March 31, 2017, were included (N = 16,084 patients; mean age = 85.1 ± 7.5 years; 7804 men (48.5%) and 8280 women (51.5%)). The outcome measures were medical expenditures (inpatient, outpatient, and prescription), long-term care expenditures, and total healthcare expenditures (the sum of medical and long-term care expenditures) during the 60 months before the date of death. We calculated each patient’s monthly medical and long-term care expenditures for 60 months before the date of death and applied group-based trajectory modeling to identify distinct trajectories. Factors associated with spending trajectories were examined via multinomial logistic regression analyses. Explanatory variables included age, sex, diseases, and the medical services used.ResultsWe identified six distinct spending trajectories for the total healthcare expenditures: high persistent (45.6%), medium-to-high persistent (26.1%), early rise then high persistent (9.8%), late rise (6.4%), low persistent then very late rise (i.e., when spending starts increasing later than “late rise”; 6.4%), and progressive increase (5.7%). Factors associated with the high-persistent trajectory were chronic illnesses, various organ failures, neurodegenerative diseases, fractures, and tube feeding. The trajectory pattern of medical expenditures was similar to that of total healthcare expenditures; however, a different pattern was seen for long-term care expenditures.ConclusionsRegarding combined medical and long-term care spending of the last 5 years, most patients belonged to a pattern in which the healthcare expenditures remained high, and a combination of multiple factors contributed to these patterns. This finding can offer healthcare providers a longer-term perspective on end-of-life care.

Patterns of African Healthcare Funding: Investment Implications for Public-Private Partnerships

The Coronavirus Global Pandemic Now Poses Additional Peril To The Already Burdened Healthcare Systems With Inadequate Funding In Africa. This Paper Attempts To Present The Funding Patterns For Healthcare In Nigeria, Congo, Tanzania, Egypt, And South Africa. It Also Explored Investor Opportunities For Lowering OOPs And Increasing Investor Profits. Data Were Drawn From The WHO, The World Bank, And World Charts Databases. Government Health Expenditure Was Far Below What Individuals And Families Pay From Out-Of-Pocket Payments (OOPs) For Healthcare Services Except In South Africa, Where OOP Accounts For Only 8%. Contrary To Popular Notion, Donation Funds Or Foreign Aid For Healthcare Accounts For A Lower Percentage Of Total Healthcare Expenditure In The Countries Under Consideration. Households Mostly Bore The Healthcare Expenditure Burden (Nigeria’s OOPs Of 77%, Congo- 48%, And Egypt- 60%). Averagely, Nigeria And Congo Only Spent About 3% Of Their National Budget On Healthcare. In Comparison, Tanzania And Egypt Spent An Average Of 4% And 5% (South Africa-8%) Between 2010 And 2017, Reflecting Low-Risk Protection For Households. Specific Aspects For Investments Through Public-Private Partnerships (PPP) Reviewed In This Paper Should Include Designing Innovative Financing Models Focusing On Risk Pooling Mechanisms To Help Bridge The Funding Gap, Local Production, And Manufacture Of Pharmaceuticals And Healthcare Equipment At This Time, Instead Of Importation. Investors Can, Therefore, Take Advantage Of The Various Initiatives Outlined In This Paper To Achieve Better Health Outcomes In Africa.

Long-Term Healthcare Expenditures Following Combat-Related Traumatic Brain Injury.

Traumatic brain injury (TBI) is one of the most common injuries resulting from U.S. Military engagements since 2001. Long-term consequences in terms of healthcare utilization are unknown. We sought to evaluate healthcare expenditures among U.S. military service members with TBI, as compared to a matched cohort of uninjured individuals. We identified service members who were treated for an isolated combat-related TBI between 2007 and 2011. Controls consisted of hospitalized active duty service members, without any history of combat-related injury, matched by age, biologic sex, year of hospitalization, and duration of follow-up. Median total healthcare expenditures over the entire surveillance period represented our primary outcome. Expenditures in the first year (365 days) following injury (hospitalization for controls) and for subsequent years (366th day to last healthcare encounter) were considered secondarily. Negative binomial regression was used to identify the adjusted influence of TBI. The TBI cohort consisted of 634 individuals, and there were 1,268 controls. Healthcare expenditures among those with moderate/severe TBI (median $154,335; interquartile range [IQR] $88,088-$360,977) were significantly higher as compared to individuals with mild TBI (median $113,951; IQR $66,663-$210,014) and controls (median $43,077; IQR $24,403-$83,590; P < .001). Most expenditures were incurred during the first year following injury. This investigation represents the first continuous observation of healthcare utilization among individuals with combat-related TBI. Our findings speak to continued consumption of health care well beyond the immediate postinjury period, resulting in total expenditures approximately six to seven times higher than those of service members hospitalized for noncombat-related reasons.

Temporal trends and variation in out-of-pocket expenditures and patient cost sharing: evidence from a Chinese national survey 2011\u20132015

ObjectivesThis study aims to examine: (1) temporal trends in the percentage of cost-sharing and amount of out-of-pocket expenditure (OOPE) from 2011 to 2015; (2) factors associated with cost-sharing and OOPE; and (3) the relationships between province-level economic development and cost-sharing and OOPE in China.SettingA total of 10,316 adults aged ≥45 years from China followed-up from 2011 to 2015 were included in the analysis. We measured two main outcome variables: (1) patient cost sharing, measured by the percentage of OOPE as total healthcare expenditure, and (2) absolute amount of OOPE.ResultsBased on self-reported data, we did not find substantial differences in the percentage of cost sharing, but a significant increase in the absolute amount of OOPE among the middle-aged and older Chinese between 2011 and 2015. The percentage of cost-sharing was considerably higher for outpatient than inpatient care, and the majority paid more than 80% of the total cost for prescription drugs. Provinces with higher GDP per capita tend to have lower cost-sharing and a higher OOPE than their counterparts, but the relationship for OOPE became insignificant after adjusting for individual factors.ConclusionReducing out-of-pocket expenditure and patient cost sharing is required to improve financial protection from illness, especially for those with those with chronic conditions and reside in less developed regions in China. Ongoing monitoring of financial protection using data from various sources is warranted.

Health Costs of Older Opioid Users with Pain and Comorbid Hypercholesterolemia or Hypertension in the United States.

This retrospective cross-sectional database study used 2018 Medical Expenditure Panel Survey data to quantify and assess differences in healthcare expenditures between opioid users and non-users among a non-institutionalized sample of older (≥50 years) United States adults with pain in the past four weeks and a diagnosis of comorbid hypercholesterolemia (pain–hypercholesterolemia group) or hypertension (pain–hypertension group). Hierarchical multivariable linear regression models were constructed by using logarithmically transformed positive cost data and adjusting for relevant factors to assess cost differences between groups. Percent difference between opioid users and non-users was calculated by using semi-logarithmic equations. Healthcare costs included inpatient, outpatient, office-based, emergency room, prescription medication, other, and total costs. In adjusted analyses, compared to non-users, opioid users in the pain–hypercholesterolemia and pain–hypertension groups respectively had 66% and 60% greater inpatient expenditure, 46% and 55% greater outpatient expenditure, 67% and 72% greater office-based expenditure, 50% and 60% greater prescription medication expenditure, 24% and 22% greater other healthcare expenditure, and 85% and 93% greater total healthcare expenditure. In conclusion, adjusted total healthcare expenditures were 85–93% greater among opioid users versus non-users in older United States adults with pain and comorbid hypercholesterolemia or hypertension. Future research is needed to identify opioid use predictors among these populations and reduce expenditures.

Special Need Pooled Trust Disbursements and the Well-being of Nursing Facility Residents Receiving Medicaid Benefits

ABSTRACT Medicaid is the largest health insurer in America, comprising one-sixth of the nation’s total healthcare expenditures. Of this, 40% covers long-term care services for older adults and adults with disabilities. Yet, Medicaid does not provide access to all goods and services needed. Pooled special needs trusts (pooled trusts) are a program through which older individuals, requiring long-term care, may set aside assets and remain Medicaid eligible. Pooled trust funds purchase items such as medical devices, telecommunications and funeral services. This article explores the relationship between Medicaid, pooled trusts and their role in nursing home residents’ well-being. To understand this relationship, a descriptive study sorts the disbursements from a pooled trust into the 5 Gallup-Healthways Index well-being domains. The analysis shows that pooled trust funds purchased goods and services related to well-being. Thus, pooled trusts offer a means for states to expand the support they provide individuals in nursing facilities beyond the medical services covered by Medicaid to include goods and services associated with well-being.

PSS6 Identification of Healthcare Expenditures Associated with Frequent Exercise Status Among United States Older Adults with Self-Reported PAIN

Frequent exercise is often recommended for older adults with pain, however the association between frequent exercise and healthcare expenditures in this population is unknown. This study sought to identify if differences exist in the healthcare expenditures of older United States (US) adults with pain who reported frequent exercise versus those who did not. This cross-sectional study included a nationally-representative sample of US adults from the 2018 Medical Expenditure Panel Survey who were aged ≥50 years, alive during the calendar year, with self-reported pain in the past four weeks, and positive total healthcare expenditures. The independent variable was frequent exercise status, defined as doing ≥30 minutes of moderate-vigorous intensity physical activity ≥5 times per week. Adjusted linear regression models assessed differences in total annual healthcare expenditures between individuals who reported frequent exercise and those who did not. Secondary analyses assessed differences between the groups for: emergency room; inpatient; office-based; outpatient; other; and prescription medication expenditures. Cost data were logarithmically transformed for analysis. Analyses accounted for the complex survey design. The a priori alpha level was 0.05. An estimated 23,940,144 of 56,979,267 older US adults with pain reported frequent exercise. Frequent exercise status was associated with all personal characteristics except ethnicity, census region, and smoking status (p>0.05). In adjusted analyses, individuals who reported frequent exercise had 15% lower annual prescription medication expenditures compared to those who did not report frequent exercise (β=-0.16, p=0.007). There were no statistical differences between frequent exercise status for the other categories of healthcare expenditures (p>0.05). Adjusted annual prescription medication expenditures were 15% lower among older US adults with pain who reported frequent exercise versus those who did not, while there was no difference between frequent exercise status for all other healthcare expenditures. Future research should investigate clinical and humanistic outcomes between frequent exercise status in this population.