What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program?

2007 ◽  
Vol 65 (7) ◽  
pp. 1466-1478 ◽  
Author(s):  
Donald H. Taylor ◽  
Jan Ostermann ◽  
Courtney H. Van Houtven ◽  
James A. Tulsky ◽  
Karen Steinhauser
Keyword(s):  
Medical Expenditures ◽  
Medicare Program ◽  
The Us ◽  
Hospice Use

Medicare Program Expenditures Associated with Hospice Use

2004 ◽  
Vol 140 (4) ◽  
pp. 269 ◽  
Author(s):  
Diane E. Campbell ◽  
Joanne Lynn ◽  
Tom A. Louis ◽  
Lisa R. Shugarman
Keyword(s):  
Medicare Program ◽  
Hospice Use

scholarly journals Incremental Dental Expenditures Associated With Diabetes Among Noninstitutionalized U.S. Adults Aged ≥18 Years Old in 2016–2017

2021 ◽  
Author(s):  
Yu Chen ◽  
Ping Zhang ◽  
Elizabeth T. Luman ◽  
Susan O. Griffin ◽  
Deborah B. Rolka
Keyword(s):  
Dental Care ◽  
Private Insurance ◽  
Dental Service ◽  
Medical Expenditures ◽  
Preventive Dental Care ◽  
Surgical Services ◽  
The Us ◽  
Service Type ◽  
The Difference ◽  
Design And Methods

<b>OBJECTIVE</b> <div><p>Diabetes is associated with poor oral health, but incremental expenditures for dental care associated with diabetes in the U.S. are unknown. We aimed to quantify these incremental expenditures per person and for the nation. </p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>We analyzed data from 46,633 non-institutionalized adults aged ≥18 years old who participated in the 2016–2017 Medical Expenditures Panel Survey. We used two-part models to estimate dental expenditures per person in total, by payment source, and by dental service type, controlling for sociodemographic characteristics, health status, and geographic variables. Incremental expenditure was the difference in predicted expenditure for dental care between adults with and without diabetes. The total expenditure for the US was the expenditure per person multiplied by the estimated number of people with diabetes. Expenditures were adjusted to 2017 US dollars.</p> <p><b>RESULTS</b></p> <p>The mean adjusted annual diabetes-associated incremental dental expenditure was $77 per person and $1.9 billion for the nation. Fifty-one percent ($40) and 39% ($30) of this incremental expenditure were paid out-of-pocket and by private insurance; 69% ($53) of the incremental expenditure was for restorative/prosthetic/surgical services; and adults with diabetes had lower expenditure for preventive services than those without (incremental -$7). Incremental expenditures were higher in older adults, non-Hispanic whites, and people with higher levels of income and education. </p> <p><b>CONCLUSIONS</b></p> <p>Diabetes is associated with higher dental expenditures. These results fill a gap in the estimates of total medical expenditures associated with diabetes in the US and highlight the importance of preventive dental care among people with diabetes.</p></div>

scholarly journals Solving Medicare’s Fiscal Crisis: An Analysis of Three Policy Options

2012 ◽  
Vol 19 ◽  
pp. 23
Author(s):  
Ashley Flint
Keyword(s):  
The United States ◽  
Policy Options ◽  
The Past ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Medicare Program ◽  
Cost Growth ◽  
The Us ◽  
Congressional Action

Health care spending in the United States has increased rapidly over the past several decades. Medicare, the largest public health insurance program in the US, is a key component of these growing costs. While Medicare financing is expected to be stable over the next decade, the long-term solvency will be difficult to sustain absent congressional action. This paper analyzes three policy options for Congress to consider in addressing the problem of rapid cost growth in the Medicare program.

scholarly journals Comorbid disease drives short-term hospitalization outcomes in patients with multiple sclerosis

2020 ◽  
Vol 10 (3) ◽  
pp. 255-264 ◽  
Author(s):  
Adys Mendizabal ◽  
Dylan P. Thibault ◽  
James A. Crispo ◽  
Adina Paley ◽  
Allison W. Willis
Keyword(s):  
Multiple Sclerosis ◽  
Vascular Diseases ◽  
Patient Characteristics ◽  
Primary Study ◽  
Comorbid Disease ◽  
Collagen Vascular Diseases ◽  
Logistic Regression Models ◽  
Disease Modifying Therapy ◽  
Medicare Program ◽  
The Us

ObjectiveReadmission is used as a quality indicator and is the primary target outcome for disease-modifying therapy (DMT) for multiple sclerosis (MS). However, data on readmissions for patients with MS are limited.MethodsUsing the US Nationwide Readmissions Database, we performed a retrospective cohort study of adults hospitalized for MS in 2014. Primary study outcomes were within 30- and 90-day readmissions. Descriptive analyses compared patient, clinical, and hospital variables readmission status. Multivariable logistic regression models estimated the associations between these variables and readmission.ResultsOf 16,629 individuals meeting the study criteria, most were women (73.7%), aged 35–54 years (48.0%), and Medicare program participants (36.8%). In total, 49.7% of inpatients with MS had 1–2 comorbid medical conditions and 23.7% had 3 or more. Having 3 or more comorbidity conditions associated with increased adjusted odds of the 30-day readmission (adjusted odds ratio [AOR] 1.92, 1.34–2.74). Anemia (AOR 1.62, 1.22–2.14), rheumatoid arthritis/collagen vascular diseases (AOR 2.20, 1.45–3.33), congestive heart failure (AOR 2.43, 1.39–4.24), chronic pulmonary disease (AOR 1.35, 1.02–1.78), diabetes with complications (AOR 2.27, 1.45–3.56), hypertension (AOR 1.25, 1.03–1.53), obesity (AOR 1.35, 1.05–1.73), and renal failure (AOR 1.68, 1.06–2.67) were associated with the 30-day readmission. Medicare insurance and nonroutine discharge were also associated with readmission, whereas patient characteristics (sex, age, and socioeconomic status) were not. The most frequent (26.7%) reason for readmission was multiple sclerosis. Ninety-day analyses produced similar findings.ConclusionsComorbid diseases were associated with the readmission for persons with multiple sclerosis. Evaluations of the real-world effectiveness for DMTs in reducing hospitalizations in patients with MS may need to consider comorbid disease burden and management.

scholarly journals Long-haul COVID: Healthcare Utilization and Medical Expenditures 6 Months Post-diagnosis

2021 ◽  
Author(s):  
Owen Fleming
Keyword(s):  
Healthcare Utilization ◽  
Age Groups ◽  
Population Based ◽  
Medical Expenditures ◽  
Urgent Care ◽  
Research Database ◽  
Surgical Services ◽  
The Us ◽  
The Mean

Abstract Background Despite evidence that long-term COVID-19 symptoms may persist for up to a year, their implications for healthcare utilization and costs 6 months post-diagnosis remain unexplored. Methods Our objective is to determine for how many months post-diagnosis healthcare utilization and costs of COVID-19 patients persist above pre-diagnosis levels and explore response heterogeneity across age groups. This population-based retrospective cohort study followed COVID-19 patients’ healthcare utilization and costs from January 2019 through March 2021 using claims data provided by the COVID-19 Research Database. The patient population includes 328,777 individuals infected with COVID-19 during March-September 2020 and whose last recorded claim was not hospitalization with severe symptoms. We measure the monthly number and costs of total visits and by telemedicine, preventive, urgent care, emergency, immunization, cardiology, inpatient or surgical services and established patient or new patient visits. Results The mean (SD) total number of monthly visits and costs pre-diagnosis were .4805 (4.2035) and 130.67 (1,216.66) dollars compared with 1.1998 (8.5184) visits and 341.7576 (2,439.5581) dollars post-diagnosis. COVID-19 diagnosis associated with .7338 (95% CI, 0.7175 to 0.7500 visits; P < .001) more total healthcare visits and an additional $215.40 (95% CI, 210.76 to 220.00; P<.001) in monthly costs. Excess monthly utilization and costs for individuals under 19 years old subside after 5 months to .021 visits and $3.7, persist at substantial levels for all other groups and most pronounced among individuals 50-59 (.236 visits and $78.60) and 60-69 (.196 visits and $73.10) years old. Conclusions This study found that COVID-19 diagnosis was associated with increased healthcare utilization and costs 6 months post-diagnosis. These findings imply a prolonged burden to the US healthcare system from medical encounters of COVID-19 patients and increased spending.

The Hybridized Nature of America’s Health Care System

2011 ◽  
Vol 1 (3) ◽  
pp. 53-63 ◽  
Author(s):  
Monica Gaughan
Keyword(s):  
Theoretical Perspective ◽  
The Elderly ◽  
The United States ◽  
Policy Reforms ◽  
Public System ◽  
Us Congress ◽  
The Past ◽  
Medicare Program ◽  
The Us

The theoretical perspective of Bozeman’s publicness work is used to frame a two-part case study of the health insurance system in the United States. It begins with a historical overview of the incremental changes to the system over the past 70 years, illustrating how competing economic and political authorities have combined to create a uniquely expensive and poorly performing system. The empirical lens then focuses on one component of the US system, the Medicare program for the elderly and disabled. It shows how a fully public system has become increasingly privatized through a series of policy reforms starting in the 1990s. This analysis is timely in light of the recent Affordable Care Act of 2010 and the continuing efforts of the US Congress to limit the growth of entitlements such as Medicare.

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