The effect of frailty on post-operative outcomes and health care expenditures in patients treated with partial nephrectomy

Health care expenditures in the United States have continued to grow despite efforts to control them. This Article discusses the need for health care reform, outlines the model that reform should follow, and considers why the United States has not progressed toward a workable solution. It introduces a single-payer approach to cost containment and explains how such an approach could be “sold” in the United States. Finally, the Article examines various ways to mobilize support for such health care reform.

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Dutch Public health Foresight study 2018/20

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1290 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

H Hilderink

Keyword(s):

Public Health ◽

Health Care ◽

Health Care Expenditures ◽

Living Environment ◽

Societal Challenges ◽

Challenges And Opportunities ◽

Future Challenges ◽

National Prevention ◽

Business As Usual ◽

Insight Into

Abstract The four-year Public Health Foresight Study (VTV) provides insight into the most important societal challenges for public health and health care in the Netherlands. The seventh edition of the Dutch Public Health Foresight study was published in 2018, with an update in 2020. In this update a business-as-usual or Trend Scenario was developed using 2018 as a base year. In the trend scenario demographic and epidemiological projections have been used to depict the future trends regarding ageing, health, disease, health behaviors, health expenditures and health inequalities. Next, these trends are used to identify the most important future challenges and opportunities for public health. In the 2020 update, special attentions is given to climate change and the local living environment and their impacts and interaction with public health outcomes. Trends in lifestyle-related lifestyle show both positive (smoking prevalence) and negative (overweight prevalence) future developments. Dementia will be the leading cause of mortality and disease burden in 2040 by far. Health care expenditures will double by 2040, with cancers showing the most rapid growth of all disease groups. The insights of this study are directly used as input for the National Health Policy Memorandum and for the National Prevention Accord.

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Preoperative Predictors and Costs of 30-Day Readmission Following Inpatient Pediatric Tonsillectomy in the United States

Otolaryngology ◽

10.1177/0194599820980709 ◽

2021 ◽

pp. 019459982098070

Author(s):

Habib Khoury ◽

Shaghauyegh S. Azar ◽

Hannah Boutros ◽

Nina L. Shapiro

Keyword(s):

Health Care ◽

Financial Burden ◽

Preoperative Assessment ◽

Health Care Expenditures ◽

The United States ◽

Postoperative Hemorrhage ◽

International Classification Of Disease ◽

Neurologic Disorders ◽

Common Causes ◽

National Trends

Objectives To understand national trends in 30-day postoperative readmission following inpatient pediatric tonsillectomy and adenoidectomy. Study Design Retrospective cohort study. Setting Nationwide Readmissions Database. Methods We used the Nationwide Readmissions Database to identify and analyze 30-day readmissions following inpatient tonsillectomy from 2010 to 2015. Using the International Classification of Disease codes, we identified 66,652 patients and analyzed the incidence, causes, risk factors, and costs of 30-day readmission. Results Of 66,652 patients who underwent inpatient tonsillectomy, 2660 (4.0%) experienced a readmission. Readmitted patients were more commonly aged <2 years (23.4 vs 10.6%, P = .01) and had a greater burden of comorbidities, including preoperative anemia (3.9 vs 1.3%, P < .001), coagulopathy (3.5 vs 1.4%, P < .001), and neurologic disorders (19.1 vs 6.6%, P < .001). Readmitted patients experienced higher rates of postoperative complications (17.4 vs 9.0%, P < .001) and had a longer length of stay (4.5 vs 2.2 days, P < .001). Index cost of hospitalization was higher among readmitted patients ($14,129 vs $7307, P < .001), and each readmission cost an additional $7576. Postoperative hemorrhage (21.3%) and dehydration (17.7%) were the 2 most common causes for readmission. Independent predictors of readmission included age <3 years, multiple comorbidities, and postoperative neurologic complications. The incidences of tonsillectomies and readmissions declined during the study period, most notably between 2010 and 2012. Conclusion Readmission after inpatient tonsillectomy and adenoidectomy places a substantial financial burden on the health care system. Targeted strategies to improve preoperative assessment and optimize postoperative care may prevent readmission, reduce unnecessary health care expenditures, and improve patient outcomes.

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Why Do Some Firms Spend So Much on Medical Care? Accounting for Variation

Forum for Health Economics & Policy ◽

10.2202/1558-9544.1015 ◽

2000 ◽

Vol 3 (1) ◽

Author(s):

Matthew Eichner ◽

Mark McClellan ◽

David A. Wise

Keyword(s):

Health Care ◽

Health Care Cost ◽

Health Care Expenditures ◽

Cost Of Treatment ◽

Consistent Method ◽

The Difference ◽

The Cost ◽

Cost Differences ◽

Average Expenditure

We are engaged in a long-term project to analyze the determinants of health care cost differences across firms. An important first step is to summarize the nature of expenditure differences across plans. The goal of this article is to develop methods for identifying and quantifying those factors that account for the wide differences in health care expenditures observed across plans.We consider eight plans that vary in average expenditure for individuals filing claims, from a low of $1,645 to a high of $2,484. We present a statistically consistent method for decomposing the cost differences across plans into component parts based on demographic characteristics of plan participants, the mix of diagnoses for which participants are treated, and the cost of treatment for particular diagnoses. The goal is to quantify the contribution of each of these components to the difference between average cost and the cost in a given firm. The demographic mix of plan enrollees accounts for wide differnces in cost ($649). Perhaps the most noticeable feature of the results is that, after adjusting for demographic mix, the difference in expenditures accounted for by the treatment costs given diagnosis ($807) is almost as wide as the unadjusted range in expenditures ($838). Differences in cost due to the different illnesses that are treated, after adjusting for demographic mix, also accounts for large differences in cost ($626). These components of cost do not move together; for example, demographic mix may decrease expenditure under a particular plan while the diagnosis mix may increase costs.Our hope is that understanding the reasons for cost differences across plans will direct more focused attention to controlling costs. Indeed, this work is intended as an important first step toward that goal.

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