A Preoperative Grading Scale that Predicts Two-Year Health Care Costs Following Revision Lumbar Fusion Procedures: How We Can Improve the Cost of Care We Provide

2012 ◽  
Vol 12 (9) ◽  
pp. S103-S104
Author(s):  
Scott L. Parker ◽  
Saniya S. Godil ◽  
David N. Shau ◽  
Stephen K. Mendenhall ◽  
Clinton J. Devin ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Lumbar Fusion ◽  
Cost Of Care ◽  
Grading Scale ◽  
The Cost ◽  
Care Costs

Consumer Cost-Sharing as a Means to Reduce Health Care Costs

PEDIATRICS ◽  
1980 ◽  
Vol 65 (1) ◽  
pp. 168-170
Author(s):  
Stephen M. Davidson ◽  
John P. Connelly ◽  
R. Don Blim ◽  
James E. Strain ◽  
H. Doyl Taylor
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Cost Sharing ◽  
Cost Of Care ◽  
National Commission ◽  
Insurance Policies ◽  
National Medical ◽  
Use Of Services ◽  
The Cost ◽  
Care Costs

The National Commission on the Cost of Medical Care1 states in part (Recommendation 2) that "insurance policies should include provisions through which the consumer shares in the cost of care received, at the time of service, for selected benefits and for selected groups...." These cost-sharing provisions are expected to reduce national medical care expenditures by encouraging consumers to reduce their use of services in order to avoid paying additional money out of their own pockets. They will thus moderate the demand-inducing tendency of insurance, leading the rational consumer to seek only necessary services and to forego those services contributing to what is believed to be over-utilization. As the Commission states in its supporting statement:

Factors influencing 2-year health care costs in patients undergoing revision lumbar fusion procedures

2012 ◽  
Vol 16 (4) ◽  
pp. 323-328 ◽  
Author(s):  
Scott L. Parker ◽  
David N. Shau ◽  
Stephen K. Mendenhall ◽  
Matthew J. McGirt
Keyword(s):  
Health Care ◽  
Global Health ◽  
Resource Utilization ◽  
Health Care Costs ◽  
Lumbar Fusion ◽  
Perioperative Complications ◽  
Fold Increase ◽  
Cost Of Care ◽  
Site Infection ◽  
Care Costs

Object Revision lumbar fusion procedures are technically challenging and can be associated with tremendous health care resource utilization and cost. There is a paucity of data regarding specific factors that significantly contribute to increased cost of care. In light of this, the authors set out to identify independent risk factors predictive of increasing 2-year direct health care costs after revision lumbar fusion. Methods One hundred fifty patients undergoing revision instrument-assisted fusion for adjacent-segment disease (50 cases), pseudarthrosis (47 cases), or same-level stenosis (53 cases) were included in this study. Patient demographics, comorbidities, preoperative health states as assessed by patient-reported outcome questionnaires and perioperative complications were collected and analyzed. Two-year back-related medical resource utilization and direct health care costs were assessed. The independent association of all variables to increasing cost was assessed using multivariate linear regression analysis. Results There was a wide range ($24,935–$63,769) in overall 2-year direct costs for patients undergoing revision lumbar fusion (mean $32,915 ± $8344 [± SD]). Preoperative variables independently associated with 2-year direct health care costs included diagnosis of congestive heart failure, more severe leg pain (visual analog scale), greater back-related disability (Oswestry Disability Index), and worse mental health (12-Item Short Form Health Survey Mental Component Summary score). There was a 1.1- to 1.2-fold increase in cost for patients in the greatest quartiles compared with those in the lowest quartiles for these variables. Surgical site infection, return to the operating room, and spine-related hospital readmission during the 90-day global health period were postoperative variables independently associated with 2-year cost. Patients in the greatest versus lowest quartiles had a 1.7- to 1.9-fold increase in cost for these variables. Conclusions Revision lumbar fusion can be associated with considerable 2-year health care costs. These costs can also vary widely among patients, as evidenced by the 2.6-fold overall cost range in this series. Although comorbidities and preoperative severity of disease states contribute to cost of care, the primary drivers of increased cost include perioperative complications such as surgical site infection, return to the operating room, and readmission during the global health period. Measures focused on health service improvement will be most successful in reducing the cost of care for patients undergoing revision lumbar fusion.

Abstract 7: Increasing Use of Cardiovascular Devices and Rising Health Care Costs

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Peter W Groeneveld ◽  
Andrew J Epstein ◽  
Feifei Yang ◽  
Lin Yang ◽  
Daniel Polsky
Keyword(s):  
Cardiovascular Disease ◽  
Health Care ◽  
Time Series ◽  
Health Care Costs ◽  
Technology Use ◽  
Cost Of Care ◽  
Cost Increase ◽  
Total Growth ◽  
The Cost ◽  
Care Costs

Background: Drug-eluting stents (DES) and implantable cardioverter-defibrillators (ICDs) are among the most common, and most costly, interventional therapies used in patients with cardiovascular disease. Medicare coverage decisions for DES and ICDs in 2003-2005 portended a large growth in health care costs for patients with coronary artery disease (CAD) and chronic heart failure (CHF). However, the actual fiscal impact of DES and ICDs is uncertain. Methods: We examined Medicare claims from 2003-2006 and separately identified cohorts of patients between ages 65-84 in each year diagnosed with CAD and CHF. Patients were assigned to one of 306 contiguous geographic localities (i.e., Dartmouth Atlas Hospital Referral Regions [HRRs]). For each disease group in each locality in each year, we calculated the average cost of care (including Medicare payments, supplemental insurance, and patient payments) as well as the average use rate of DES (for CAD) and ICDs (for CHF). We estimated time-series HRR-fixed-effects regression models predicting average costs, with % technology use as an independent variable. We included a measure of the annual change in costs of care for non-cardiovascular disease in each HRR to control for annual cost increases unrelated to ICDs/DES. Results: Average inflation-adjusted costs for CAD patients increased from $13,558 in 2003 to $14,215 in 2006 (p<0.001), while average costs for CHF patients increased from $18,930 in 2003 to $20,235 in 2006 (p<0.001). Time-series regressions indicated that a 1% increase in DES use among the CAD population resulted in $394 in higher mean costs (p<0.001), and 1% increased ICD use in the CHF population resulted in $627 in higher mean costs (p<0.001). In aggregate, between 2003-2006 the cost increase attributable to DES in the Medicare CAD population ages 65-84 was $4.97 billion (89% of total growth), and the cost increase in the Medicare CHF population attributable to ICDs was $893 million (29% of total growth). Conclusions: Rising use of DES and ICDs between 2003-2006 was associated with significantly higher costs for patients with CAD and CHF, respectively. Increased use of these technologies explained substantial fractions of the growth in health care costs for CAD and CHF patients during these years.

scholarly journals THU0548 THE ECONOMIC BURDEN OF ANKYLOSING SPONDYLITIS IN SPAIN. RESULTS OF THE SPANISH ATLAS 2017

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 514.2-514
Author(s):  
M. Merino ◽  
O. Braçe ◽  
A. González ◽  
Á. Hidalgo-Vega ◽  
M. Garrido-Cumbrera ◽  
...  
Keyword(s):  
Health Care ◽  
Ankylosing Spondylitis ◽  
Health Care Costs ◽  
Health Care Cost ◽  
Labour Productivity ◽  
General Health Questionnaire ◽  
Indirect Costs ◽  
Productivity Losses ◽  
The Cost ◽  
Care Costs

Background:Ankylosing Spondylitis (AS) is a disease associated with a high number of comorbidities, chronic pain, functional disability, and resource consumption.Objectives:This study aimed to estimate the burden of disease for patients diagnosed with AS in Spain.Methods:Data from 578 unselected patients with AS were collected in 2016 for the Spanish Atlas of Axial Spondyloarthritis via an online survey. The estimated costs were: Direct Health Care Costs (borne by the National Health System, NHS) and Direct Non-Health Care Costs (borne by patients) were estimated with the bottom-up method, multiplying the resource consumption by the unit price of each resource. Indirect Costs (labour productivity losses) were estimated using the human capital method. Costs were compared between levels of disease activity using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score (<4 or low inflammation versus ≥4 or high inflammation) and risk of mental distress using the 12-item General Health Questionnaire (GHQ-12) score (<3 or low risk versus ≥3 or high risk).Results:The average annual cost per patient with AS in 2015 amounted to €11,462.3 (± 13,745.5) per patient. Direct Health Care Cost meant an annual average of €6,999.8 (± 9,216.8) per patient, to which an annual average of €611.3 (± 1,276.5) per patient associated with Direct Non-Health Care Cost borne by patients must be added. Pharmacological treatment accounted for the largest percentage of the costs borne by the NHS (64.6%), while for patients most of the cost was attributed to rehabilitative therapies and/or physical activity (91%). The average annual Indirect Costs derived from labour productivity losses were €3,851.2 (± 8,484.0) per patient, mainly associated to absenteeism. All categories showed statistically significant differences (p<0.05) between BASDAI groups (<4 vs ≥4) except for the Direct Non-Healthcare Cost, showing a progressive rise in cost from low to high inflammation. Regarding the 12-item General Health Questionnaire (GHQ-12), all categories showed statistically significant differences between GHQ-12 (<3 vs ≥3), with higher costs associated with higher risk of poor mental health (Table 1).Table 1.Average annual costs per patient according to BASDAI and GHQ-12 groups (in Euros, 2015)NDirect Health CostsDirect Non-Health CostsIndirect CostsTotal CostBASDAI<4917,592.0*557.32,426.5*10,575.8*≥43769,706.9*768.05,104.8*15,579.7*Psychological distress (GHQ-12)<31468,146.8*493.6*3,927.2*12,567.6*≥32609,772.9*807.2*4,512.3*15,092.5*Total5786,999.8611.33,851.211,462.3* p <0.05Conclusion:Direct Health Care Costs, and those attributed to pharmacological treatment in particular, accounted for the largest component of the cost associated with AS. However, a significant proportion of the overall costs can be further attributed to labour productivity losses.Acknowledgments:Funded by Novartis Farmacéutica S.A.Disclosure of Interests:María Merino: None declared, Olta Braçe: None declared, Almudena González: None declared, Álvaro Hidalgo-Vega: None declared, Marco Garrido-Cumbrera: None declared, Jordi Gratacos-Masmitja Grant/research support from: a grant from Pfizzer to study implementation of multidisciplinary units to manage PSA in SPAIN, Consultant of: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly, Speakers bureau: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly

What's Cheaper Than Pediatric Care?

PEDIATRICS ◽  
1976 ◽  
Vol 58 (5) ◽  
pp. 772-772
Author(s):  
Richard M. Narkewicz
Keyword(s):  
Health Care ◽  
Child Care ◽  
Health Care Costs ◽  
Pediatric Care ◽  
Continuing Care ◽  
Well Child Care ◽  
Fee Structure ◽  
The Cost ◽  
Care Costs

In these days of rising health care costs, the finger has been pointed at physicians as the cause of these increases. Because of these charges each physician should look critically at his own fee structure and try to compare it with other commodities in today's budgets. I have done just that. In totaling the cost of complete well-child care for a child and continuing care through the age of 20 years, I was surprised to find that in the present fee structure it costs a family $464.25.

Factors Influencing Two-Year Health Care Costs in Patients Undergoing Revision Lumbar Fusion Procedures: A Guide to Where Should We Target Our Cost and Quality Improvement Initiatives

2012 ◽  
Vol 12 (9) ◽  
pp. S9-S10
Author(s):  
Scott L. Parker ◽  
Saniya S. Godil ◽  
David N. Shau ◽  
Stephen K. Mendenhall ◽  
Clinton J. Devin ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Care Costs ◽  
Lumbar Fusion ◽  
Factors Influencing ◽  
Care Costs

Cost analysis of a randomized trial of early palliative care (PC) in patients with metastatic non-small cell lung cancer (NSCLC).

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 4-4 ◽  
Author(s):  
Joseph A. Greer ◽  
Angela Tramontano ◽  
Pamela M McMahon ◽  
Areej El-Jawahri ◽  
Ravi Bharat Parikh ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Trial ◽  
Health Care Costs ◽  
Standard Care ◽  
Secondary Analysis ◽  
Cost Of Care ◽  
Average Total Cost ◽  
Total Cost ◽  
Metastatic Nsclc ◽  
Care Costs

4 Background: Several randomized, controlled trials have shown that early, integrated palliative and oncology care improves quality of life, mood, and symptom burden in patients with advanced cancers. However, the degree to which early involvement of specialty PC in the ambulatory care setting impacts the cost of care remains unknown. We investigated the health care costs for patients with metastatic NSCLC enrolled in a clinical trial of early PC. Methods: For this secondary analysis, we examined data from a randomized trial of 151 patients with newly-diagnosed metastatic NSCLC from 06/2006 to 07/2009. Patients received either early PC integrated with standard care or standard care (SC) alone. We abstracted costs for emergency and inpatient care, outpatient visits, intravenous chemotherapy, and physician services from the hospital’s accounting system. Oral chemotherapy costs were estimated based on actual drug charges for patients. To estimate hospice costs, we used Medicare reimbursement rates. For each participant, we calculated the average total cost of care per day for the entire study period as well as the total cost of care for the final 30 days prior to death. Costs differences between groups were examined with the Wilcoxon Rank-Sum Test. Results: We analyzed health care costs of the 138 patients who died by 07/15/2013 (early PC N=68; SC N=70). The mean number of days on study was longer for patients assigned to early PC (M=397, SD=360) versus SC (M=299, SD=266). Over the study period, early PC was associated with a lower average total cost per day of $117 (SD=$436) compared to SC (p=.09). In the final 30 days of life, patients in the early PC group incurred higher total costs for hospice care (Mean difference=$1,053, SD=$3,162, p=.11), while expenses for chemotherapy were less (Mean difference=$757, SD=$2,143, p=.06). No cost differences between groups met the threshold for statistical significance. Conclusions: Although this secondary analysis was inconclusive due to the lack of statistical power to examine differences in cost outcomes, the delivery of early PC for patients with metastatic NSCLC does not appear to increase health care expenses over the course of disease or at the end of life. Clinical trial information: NCT01038271.

PROBLEMS OF ASSESSING THE HEALTH CARE COSTS EFFECTIVENESS

2017 ◽  
Vol 11 (6) ◽  
pp. 137-151 ◽  
Author(s):  
Людмила Горшкова ◽  
Lyudmila Gorshkova
Keyword(s):  
Health Care ◽  
Life Expectancy ◽  
Health Care Costs ◽  
Public Expenditure ◽  
Health Care Expenditure ◽  
Important Indicator ◽  
Life Expectancy At Birth ◽  
Logarithmic Curve ◽  
The Cost ◽  
Care Costs

Assessing the effectiveness of health care expenditure is a major economic task. The most important indicator to assess the effectiveness of health care costs is the expected life expectancy (ELE). Infant mortality is also closely related to DLE. The article substantiates the logarithmic model of the dependence of ELE from health care expenditure (per person for a particular year). Each country is represented by a point on the coordinate plane with an ordinate equal to the ELE in this country and an abscissa equal to the health care expenditure in it. The modeling logarithmic curve is taken as the theoret-ical threshold of the cost-effectiveness: the higher the curve is the point repre-senting the country, the more effective the health care costs in this country, and the lower the threshold curve, the costs are more unprofitable. It is shown that the dependence of ELE from GDP (or GRP by regions of Russia) is not so obvious: although there is a tendency to such a dependence, but with a large number of drop-out values. Despite the achievement of the highest average expected life expectancy in Russia in the country's history, it is significantly lower than in developed countries. The main causes of low expected life expectancy at birth are unsatisfactory health indicators, and as a result, high incidence and disability. Traumatism on the roads and suicides are one of the significant reasons for the low expected life expectancy in Russia and are significantly higher than similar indicators in other countries. The article shows the close correlation between the cost of health care per person and expected life expectancy. However, in the Russian Federation, the share of public expenditure in the structure of aggregate health expenditure is decreasing. Social insurance funds are more than half of the health care public expenditure. The author reveals considerable regional differences in health spending per person and average expected life expectancy. The article highlights the insufficient level of health care costs in Russia as a whole and in regions.

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