Reshaping the Health-Care State

1994 ◽  
Vol 29 (1) ◽  
pp. 48-63 ◽  
Author(s):  
Michael Moran
Keyword(s):  
Health Care ◽  
Gross National Product ◽  
Cost Of Care ◽  
The State ◽  
National Product ◽  
Health Care Spending ◽  
Power Structures ◽  
Capitalist World ◽  
The Cost

Health Care Has Been Called ‘The World's Most successful industry’. That success is long-standing. In every nation for which we have reliable long-term evidence the proportion of Gross National Product devoted to health care is much higher than was the cast a generation ago. The state has been central to that expansion. In all advanced industrial nations it regulates health care industries; in many it pays most of the cost of care; and in some it directly employs those who do the caring. In the 1980s, however, most countries tried to slow down the growth of health care spending, or even to cut it absolutely. The ‘health care state’ is as a consequence being reshaped across the advanced capitalist world: its power structures are changing; the conditions under which it funds and delivers services are being altered; and its relations with the ‘consumers’ of care are being transformed.

Pharmacy cost in cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18358-e18358
Author(s):  
Surbhi Shah ◽  
Nathan Rubin
Keyword(s):  
Health Care ◽  
Drug Cost ◽  
Economic Burden ◽  
Cancer Care ◽  
Cost Of Care ◽  
Pharmacy Cost ◽  
Health Care Spending ◽  
Total Cost ◽  
The Cost ◽  
Active Cancer

e18358 Background: Health care spending in US is highest in the developed world and contributes to up to 1/5 of the GDP. The price escalation is steep and contribution from cancer care is soaring. The cost of medications is deemed to be the leading cause of increased health care spending. In this era of precision medicine, with more effective and better tolerated drugs, patients are using them for longer periods of time, adding to the ever mounting health care spending. Methods: We used a large claims based data set US database MarketScan to explore the economic burden of drug cost in cancer care. Between January 1, 2013 and September 30, 2015 we identified 195,290 enrollees with active cancer. We analyzed the economic burden of medications for overall cancer care by exploring the total cost of care and the pharmacy expenditure by various classes of drugs for these patients. The perspective was that of the health care system as the costs included payments by the insurer and the patient. Results: There were 195,290 active cancer patients in this analysis. Mean age was 61 years, 55% were females. Breast cancer was the most common diagnosis. Mean total cost of care and total drug cost per patient over the study period was $141,415 and $13,579, respectively. The total pharmacy expenditure across all study patients was ~2.5B. Antineoplastic drugs make up the largest portion of the total pharmacy expenditure at 39%. Cost contribution based on drug categories were anti-infective (6%), cardiovascular (6%), central nervous system (including opiates, anti-nausea medications and antidepressants) (7%), blood formulations (including anticoagulants) (8%), hormones (8%) and gastrointestinal drugs (4%) respectively. Conclusions: Based on the real world information from a large insurance claims database, this study quantifies the contribution of various drug classes to the cost of cancer care. Antineoplastic contribute to > 1/3rd of the total pharmacy spending. With increasing trend for immunotherapy and combination therapy drug costs are bound to go up even more steeply. Unless drug prices are regulated, we are looking towards an unsustainable level of growth in the health care spending in cancer care.

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

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.

scholarly journals The End of Responsible Relative Liability

1987 ◽  
Vol 54 (2) ◽  
pp. 171-175 ◽  
Author(s):  
Mark C. Weber
Keyword(s):  
Life Skills ◽  
Developmentally Disabled ◽  
Cost Of Care ◽  
The State ◽  
Recent Case ◽  
Disabled Children ◽  
Residential Placement ◽  
Handicapped Children ◽  
The Cost

Responsible relative liability laws exist to shift some of the cost of care of residentially placed handicapped children from the state to the children's parents. Because residential placement of handicapped children, particularly developmentally disabled children, would not be undertaken but for the need to teach these children life skills, the Education for the Handicapped Act would dictate that these placements be free of cost to parents. Recently, the courts have resolved the tension between the preexisting state-responsible relative laws and the Education for the Handicapped Act. Ruling in favor of the parents, they have invalidated the responsible relative charges. This article describes the conflict, its resolution in the recent case Parks v. Pavkovic, and some of the implications of that decision.

Delayed Tuberculosis Diagnosis in a Low Incidence Country and its Effect on Cost of Care

2021 ◽  
Author(s):  
James O'Connell ◽  
Niamh Reidy ◽  
Cora McNally ◽  
Debbi Stanistreet ◽  
Eoghan de Barra ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Provider ◽  
Care Provider ◽  
Delayed Diagnosis ◽  
Signs And Symptoms ◽  
Cost Of Care ◽  
Global Priority ◽  
Low Incidence ◽  
The Cost ◽  
Health Care Records

Abstract Background Tuberculosis elimination (TB) is a global priority that requires high-quality timely care to be achieved. In low TB incidence countries such as Ireland, delayed diagnosis is common. Despite cost being central to policy making, it is not known if delayed care affects care cost among TB patients in a low-incidence setting. Methods Health care records of patients with signs and symptoms of TB evaluated by a tertiary service in Ireland between July 1st 2018 and December 31st 2019 were reviewed to measure and determine predictors of patient-related delays, health care-provider related delay and the cost of TB care. Benchmarks against which the outcomes were compared were derived from the literature. Results Thirty-seven patients were diagnosed with TB and 51% (19/37) had pulmonary TB (PTB). The median patient-related delay was 60 days among those with PTB, greater than the benchmark derived from the literature (38 days). The median health care provider-related delay among patients with PTB was 16 days and, although similar to the benchmark (median 22 days, minimum 11 days, maximum 36 days) could be improved. The health care-provider related delay among patients with EPTB was 66 days, greater than the benchmark (42 days). The cost of care was €8298, and while similar to that reported in the literature (median €9,319, minimum €6,486, maximum €14,750) could be improved. Patient-related delay among those with PTB predicted care costs. Conclusion Patient-related and health care-related delays in TB diagnosis in Ireland must be reduced. Initiatives to do so should be resourced.

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 the cost of care and admission to long-term care for people with dementia in Ireland

2019 ◽  
pp. 1-9
Author(s):  
Sharon Walsh ◽  
Maria Pertl ◽  
Paddy Gillespie ◽  
Brian Lawlor ◽  
Sabina Brennan ◽  
...  
Keyword(s):  
Long Term Care ◽  
Cost Of Care ◽  
Term Care ◽  
Factors Influencing ◽  
People With Dementia ◽  
The Cost

The Economic Situation: Chapter I. The Home Economy

1967 ◽  
Vol 42 ◽  
pp. 4-19 ◽  
Keyword(s):  
Gross National Product ◽  
Economic Situation ◽  
National Product ◽  
Separate Analysis ◽  
Capital Account

This analysis and forecast for the economy is mainly concerned with the effects of devaluation and the associated measures taken. It begins, therefore, with a separate analysis of these effects. These are then superimposed on the pre-devaluation forecast for 1968. Briefly, this pre-devaluation forecast showed a rise in real gross national product of 3½ per cent between the years 1967 and 1968, and a rather higher rise than this—of nearly 4 per cent—between the fourth quarters of 1967 and 1968. It also showed a ‘basic’ deficit, on current and long-term capital account (including a ‘normal’ balancing item) of £275 million in 1967 and £250 million in 1968.

scholarly journals Measuring the cost of leaving care in Victoria

2006 ◽  
Vol 31 (3) ◽  
pp. 26-33 ◽  
Author(s):  
Catherine Forbes ◽  
Brett Inder ◽  
Sunitha Raman
Keyword(s):  
Young People ◽  
Independent Living ◽  
The State ◽  
Family Welfare ◽  
Life Outcomes ◽  
The Social ◽  
Measuring Outcomes ◽  
Poor Outcomes ◽  
The Cost

On any given night in Victoria, around 4,000 children and young people live under the care and protection of the State. For many young people, this care extends over a long period of time, sometimes until their 18th birthday. It is well documented that young people leaving State care often lack the social and economic resources to assist them in making the transition into independent living. As a consequence, the long-term life outcomes from this group are frequently very poor. A recent report from the Centre for Excellence in Child and Family Welfare in partnership with Monash University estimated that, for a typical cohort of 450 young people who leave care in Victoria each year, the direct cost to the State resulting from these poor outcomes is $332.5 million. The estimated average outcomes of the leaving care population are based on a recent survey involving sixty young people who had spent at least two years in care as teenagers. This paper provides an overview of the economic methodology used to estimate this cost, and provides discussion of the motivation for measuring outcomes in terms of costs to the State.

When the Cost Curve Bent — Pre-Recession Moderation in Health Care Spending

2012 ◽  
Vol 367 (7) ◽  
pp. 590-593 ◽  
Author(s):  
Charles Roehrig ◽  
Ani Turner ◽  
Paul Hughes-Cromwick ◽  
George Miller
Keyword(s):  
Health Care ◽  
Health Care Spending ◽  
Cost Curve ◽  
The Cost

Provider-patient communication about cost of care: Results from a national patient education program.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9578-9578 ◽  
Author(s):  
Ivy A. Ahmed ◽  
Allison Harvey ◽  
Marni Amsellem ◽  
Thomas J. Smith
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Cancer Care ◽  
Health Care Team ◽  
Cost Of Care ◽  
Care Team ◽  
Cancer Support ◽  
Support Organizations ◽  
National Patient ◽  
The Cost

9578 Background: A 2010 NIH study indicates direct cancer care expenditures will reach $158 billion in the U.S. by 2020, impacting millions of Americans. The cost of insurance for a family of 4 has increased from $6000 (2000) to over $16,000 (2011). Medical debt is a significant cause of personal bankruptcy, even if insured. The financial realities posed by costs associated with cancer care greatly complicate a cancer diagnosis. The most recent American College of Physicians Ethics Manual recommends all parties must interact honestly, openly, and fairly. (Snyder L, et al. Ann Int Med 2012, p86) This analysis explores the occurrence and value of patient-provider communication surrounding costs associated with care in a national survey of those affected by cancer. Methods: From 2011-12, 505 individuals attending Frankly Speaking About Cancer: Coping with the Cost of Care workshops completed a survey assessing experiences about the costs of cancer care. This is a Cancer Support Community national evidence-based educational program. All attendees (n=708) were eligible to complete survey. Results: Most attendees (71.3%) responded. The majority (62.4%) were people with cancer/survivors; the remainder included spouses/partners, family members, and 8.7% were health care professionals. Most (80.8%) were Caucasian, and averaged 57.2 years. Of those with cancer, 89.9% were insured at diagnosis. 59.4% reported no one on their health care team initiated a discussion about the financial aspects of their care. Included in this figure, 22.7% actively sought information from health care team, and 36.7% received no information about cost. When topic was initiated, it was by social workers (16.2%), physicians (12.3%), nurses (6.3%) or financial specialists (8.2%). When information was provided, 72.1% found it somewhat or very useful. Also, regardless of provider discussion, respondents independently sought resources for managing costs, such as other patients (44.2%), the Internet (41.5%), and patient support organizations (38.1%). Conclusions: Patients want financial information but do not receive it. These data highlight the need and value of providers initiating a dialogue about the cost of cancer care with patients.

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