Impact of new technologies on health-care costs and on the nation's "health"

1990 ◽  
Vol 36 (8) ◽  
pp. 1612-1616 ◽  
Author(s):  
T A Massaro
Keyword(s):  
Health Care ◽  
New Technologies ◽  
Well Being ◽  
Cost Of Care ◽  
American Health Care System ◽  
The Public ◽  
American Health Care ◽  
The Cost ◽  
The Impact ◽  
Care Costs

Abstract By virtually all criteria, the American health-care system has the largest and most widely distributed technology base of any in the world. The impact of this emphasis on technology on the cost of care, the rate of health-care inflation, and the well-being of the population is reviewed from the perspective of the patient, the provider, and the public health analyst.

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:

Abstract MP76: Assessing the Impact of the "Health Bucks" Program on Cardiovascular Disease in New York City: A Modeling Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Heesun Eom ◽  
Stella S Yi ◽  
Daniel Bu ◽  
Rienna Russo ◽  
Brandon Bellows ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Health Care ◽  
New York ◽  
New York City ◽  
Health Care Costs ◽  
York City ◽  
Fruits And Vegetables ◽  
The Cost ◽  
The Impact ◽  
Care Costs

Background: Low fruit and vegetable (FV) consumption is considered one of the leading causes of deteriorating health outcomes, and has been linked to obesity, diabetes, and cardiovascular disease. Yet, few adults in New York City (NYC) consume the daily recommended amounts. In order to address the need for fresh and affordable fruits and vegetables, the NYC Department of Health and Mental Hygiene has implemented the “Health Bucks” program, which provides low-income population with coupons that can be used to purchase fruits and vegetetabls. Previous studies have shown the impact of the Health Bucks program on fruit and vegetable consumption; however, it is unclear how the program would influence cardiovascular health and the associated health care costs in the long term. Objective: To estimate the health and economic impact of the Health Bucks program using a validated microsimulation model of cardiovascular disease (CVD) in NYC. Methods: We used the Simulations for Health Improvement and Equity (SHINE) CVD Model to estimate the impact of the Health Bucks program on lifetime CVD events and direct medical costs (2019 USD). We considered different program strengths by assuming the program can reduce the cost of fruits and vegetables by 20%, 30%, and 40%. Population characteristics were estimated based on data from the 2013-2014 NYC Health and Nutrition Examination Survey. CVD risk factor trajectories and risk of incident CVD events were derived from six pooled longitudinal US cohorts. Policy effects were derived from the literature. We run 1,000 simulations to account for uncertainties in the parameter. We discounted costs by 3% and reported health care costs in 2019 dollars. Results: A Health Bucks program that can reduce the cost of fruits and vegetables by 20%, 30%, and 40% would prevent 2,690 (95% CI: -14,793, 20,173), 27,386 (95% CI: 9,967, 44,805), and 50,014 (95% CI: 15,227, 50,014) coronary heart disease events, respectively, over the simulated lifetimes of the NYC population. The program would also prevent 47,469 (95% CI: 35,008, 59,931), 59,127 (95% CI: 46,676, 71,579), and 85,359 (95% CI: 72,902, 97,815) stroke events based on the price reduction level. The program would result in savings in health care costs, ranged from $937 million to $1.8 billion based on the price reduction level over the lifetime or from $19 million to $37 million annually. Conclusions: We projected that the Health Bucks program could prevent a significant number of CVD events among adults in NYC and yield substantial health care cost savings. Public health practitioners and policymakers may consider adopting this program in other locations.

scholarly journals What Is the Cost of Disease Progression Among Patients with Indolent or Aggressive Non-Hodgkin Lymphoma (NHL)?

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5957-5957
Author(s):  
Nicole Engel-Nitz ◽  
Stacey Dacosta Byfield ◽  
Timothy Bancroft ◽  
Anderson J. Amy ◽  
Carolina Reyes ◽  
...  
Keyword(s):  
Health Care ◽  
Index Date ◽  
Progressive Disease ◽  
Hospice Care ◽  
Diagnosis Codes ◽  
Equity Ownership ◽  
The Cost ◽  
The Impact ◽  
Care Costs

Abstract Background: The natural histories of aggressive and indolent NHL vary in terms of the timing and pattern of disease progression. However, little is known about the impact of progression of disease (PD) on costs, and in particular how this differs between aggressive and indolent subtypes of NHL. This study examined patterns of care and outcomes for patients with aggressive and indolent NHL, and the impact of PD on health care costs. Methods: To identify cases of NHL, this retrospective studyused medical and pharmacy claims from a large national US health plan to identify commercially insured and Medicare Advantage (MA) patients age ≥18 years from 1/2007 - 8/2014 with ≥2 medical claims for NHL based on ICD-9-CM diagnosis codes. Patients were divided into cohorts of aggressive (AGG) NHL and indolent (IND) and based on diagnosis codes. Patients were required to have ≥1 claim for systemic anti-cancer therapy, with the index date being defined as the first observed claim for such therapy. Continuous enrollment in the health plan for 6 months prior to (baseline period), and ≥6 months after, the index date (variable follow-up period) was required; patients with <6 months of follow-up due to death were included. An algorithm to identify line of therapy (LOT) periods was implemented. PD was defined as: start of a second LOT, receipt of hospice care (based on procedure or revenue codes) or death (based on Social Security Administration death data). Health care costs were calculated over 6-month periods of follow-up (6, 12, 18, 24 months), with costs calculated for pharmacy, inpatient hospital, ambulatory, and other sites of service. Results: A total of 1,197 AGG and 2,454 IND patients met study criteria. Progression was experienced by 40.6% of AGG and 49.4% of IND patients respectively during the entire study period; 6-month progression was 18.9% (AGG) and 18.5% (IND). Compared to patients without PD during the study period, patients who progressed had higher average costs over each time period: in the first 6-months, costs were $138,957 PD vs. $108,607 for non-PD among AGG, and $114,644 PD vs. $80,873 for non-PD among IND (Figure, Table). Similarly, total costs for PD were higher than non-PD over 12, 18, and 24 months (Figure). Costs by site of service were higher for PD patients compared to non-PD patients among both the AGG and IND groups, particularly for inpatients costs; the table shows costs by site of service for the first 6 months, and results were similar over 12, 18, and 24 months. A higher proportion of AGG patients died compared with IND patients. Approximately one third of patients who died used hospice services among AGG and IND, and of these, 90.1% of AGG and 91.3% of IND used 3 or more days of hospice care. Conclusion: Among both aggressive and indolent NHL populations, costs were higher for patients with progressive versus without progressive disease, and increased over longer follow-up time. Patients with aggressive NHL had higher costs compared with patients with indolent NHL for both progressive and non-progressive disease. This study is the first to quantify systematically the cost of progression in NHL, both indolent and aggressive, and can inform efforts to improve value-based care, taking into account costs not just of therapy, but of subsequent progression. Disclosures Engel-Nitz: Optum: Employment, Other: UnitedHealth Group stock. Dacosta Byfield:UnitedHealth Group: Equity Ownership; Optum: Employment. Bancroft:Optum: Employment, Other: UnitedHealth Group stock. Amy:Optum: Employment, Other: UnitedHealth Group stock. Reyes:Genentech: Employment; Roche: Equity Ownership.

PROPOSALS FOR CHILD HEALTH CARE

PEDIATRICS ◽  
1969 ◽  
Vol 44 (3) ◽  
pp. 312-314
Author(s):  
Alfred Yankauer
Keyword(s):  
Health Care ◽  
Child Health ◽  
Good Health ◽  
The Other ◽  
Child Health Care ◽  
American Health Care System ◽  
The Public ◽  
Population Analyses ◽  
American Academy Of Pediatrics ◽  
American Health Care

In contrast to the prevailing tenor of less than a decade ago, few voices can be heard today reassuring the public or the professional that the American "health care system" is itself in good health. Having dealt with the aged through Medicare, the national spotlight now focuses on children who form the other major segment of our "poverty population." Analyses and complaints, proposals and programs flow forth at an accelerating pace. Two types of programs are discussed in the current issues of Pediatrics-one as a proposal presented to the American Academy of Pediatrics last fall, and the other as a report of work in progress.

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 Parents and offspring in an evolutionary game: the effect of supply on demand when costs of care vary

2011 ◽  
Vol 279 (1726) ◽  
pp. 109-115 ◽  
Author(s):  
Uri Grodzinski ◽  
Rufus A. Johnstone
Keyword(s):  
Evolutionary Game ◽  
Cost Of Care ◽  
Quantitative Relation ◽  
Costs And Benefits ◽  
Parental Responsiveness ◽  
Opposite Case ◽  
On Demand ◽  
The Cost ◽  
The Impact ◽  
Care Costs

Current models of parent–offspring communication do not explicitly predict the effect of parental food supply on offspring demand (ESD). However, existing theory is frequently interpreted as predicting a negative ESD, such that offspring beg less when parental supply is high. While empirical evidence largely supports this interpretation, several studies have identified the opposite case, with well-fed offspring begging more than those in poorer condition. Here, we show that signalling theory can give rise to either a negative or a positive ESD depending on the precise form of costs and benefits. Introducing variation among parents in the cost of care, we show that the ESD may change sign depending upon the quantitative relation between two effects: (i) decreased supply leads to increased begging because of an increase in marginal fitness benefit of additional resources to offspring, (ii) decreased supply leads to reduced begging because it is associated with a decrease in parental responsiveness, rendering begging less effective. To illustrate the interplay between these two effects, we show that Godfray's seminal model of begging yields a negative ESD when care is generally cheap, because the impact of supply on the marginal benefits of additional resources then outweighs the associated changes in parental responsiveness to begging. By contrast, the same model predicts a positive ESD when care is generally costly, because the impact of care costs on parental responsiveness then outweighs the change in marginal benefits.

Labels, Lawyers, & Logic

2015 ◽  
Vol 21 (2) ◽  
Author(s):  
Peter J. Pitts
Keyword(s):  
Health Care ◽  
Monetary Incentives ◽  
Quality Health Care ◽  
American Health Care System ◽  
The Public ◽  
American Health Care ◽  
Achievable Goal ◽  
Quality Health ◽  
Corporate Liability ◽  
Excessive Risk

America deserves access to high-quality health care without avoidable medical errors and complications. This achievable goal begins with harnessing and using the power of information. And that begins with clear, accurate, and usable labeling.The American health care system is undermined, underserved, and undervalued when labeling is written more for corporate liability protection than as a valuable tool for health care providers.Today, labeling includes excessive risk information and exaggerated warnings. And this has set into motion a dangerous dynamic: labeling that does not accurately communicate to either the health care professional or the patient the conditions in which any given product can be used safely and effectively. This is nothing less than a grave menace to the public health. America is suffering from a legal system that is dangerous to its health. Why has this happened? There is, unfortunately, a simple answer - fear of liability. Manufacturers have significant monetary incentives to add dense and confusing legalese because, under current law in most states, they can be found liable for failing to provide "adequate" warnings about therapeutic products. Money, not medicine, is driving this dangerous practice. When it comes to labeling written for lawyers rather than doctors, more is less.

scholarly journals COVERAGE OF ISSUES THE IMPACT OF STRESS ON HEALTH AND COUNTERMEASURES IN A PUBLIC HEALTH CURRICULUM

2021 ◽  
Vol 1 (15) ◽  
pp. 38-47
Author(s):  
T.S. Gruzieva ◽  
N.V. Hrechyshkina ◽  
H.V. Inshakova ◽  
S.V. Vlasenko
Keyword(s):  
Public Health ◽  
Health Care ◽  
Action Plan ◽  
Well Being ◽  
Public Health Workforce ◽  
Educational Standards ◽  
Health Curriculum ◽  
The Public ◽  
The Impact ◽  
Health And Well Being

Aim: substantiation of educational content on the impact of stress on health and countermeasures in a public health curriculum. Materials and methods: bibliographic, information and analytical methods and content analysis were used in the work. The study was carried out as part of the research work of the Bogomolets National Medical University on the topic «Medical and social substantiation of the optimization of the healthcare organization in the context of the public healthcare system development» (state registration number 0120U100807). Sources of information included scientific literature on the research topic, strategic and policy documents of WHO and WHO / Europe, including the WHO-ASPHER Competency Framework for the Public Health Workforce in the European Region, the Health 2020: the European policy for health and well-being, the European Action Plan for Strengthening Public Health Capacities and Services, educational standards for the preparation of Masters in Medicine and Public Health, an exemplary curriculum of the discipline «social medicine, public health» for the preparation of Masters of Medicine. Results. A study of scientific sources of literature has shown the growing influence of psychological factors, including stress, on the formation of population health and the need for countermeasures, which requires, among other things, the training of health care professionals able to determine the impact of stresses on public health, assess their prevalence, justify countermeasures. Justification of educational content on these issues was carried out on the basis of an analysis of the provisions of educational standards for the training of masters of health, an exemplary curriculum "social medicine, public health" for training masters of medicine, WHO documents, including the WHO-ASPHER Competency Framework for the Public Health Workforce in the European Region, the Health 2020: the European policy for health and well-being, the European Action Plan for Strengthening Public Health Capacities and Services etc. Learning content includes a statement of the purpose of the lesson on the topic «Stresses and Conflicts, mechanisms of protecting people from stress actions», its rationale, a list of basic concepts, educational target tasks, pre-classroom training issues, basic theoretical questions, typical examples of solving specific situational tasks, a list of recommended literature. The theoretical part of the lesson includes versatile questions of the prevalence of stressful situations in society, their causes, types and signs of stress, the impact of stressful situations on the health of the population, types of conflicts, their consequences, causes of conflicts, phases of their deployment and methods of settlement, measures to protect people from stress, psychoprophylaxis, strategies and measures to counter the negative impact of stress on public health. Conclusions. Training of Masters of Health Care in countering the negative effects of stressful situations on health will contribute to improving the preventive component in health care, reducing the global burden of disease caused by stressful situations, maintaining and strengthening the health of the population.

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