A Labor-Management Approach to Health Care Cost Savings: The Peoria Experience

1998 ◽  
Vol 27 (1) ◽  
pp. 23-37
Author(s):  
Patrick A. Parsons ◽  
Jerry Belcher ◽  
Tom Jackson
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Health Care Cost ◽  
Quality Of Work Life ◽  
Care Plan ◽  
Management Approach ◽  
Labor Management ◽  
Positive Effects ◽  
The City ◽  
Care Costs

Health care costs and the nature of the benefits package are an issue that plagues most jurisdictions. Written in a cooperative effort to reflect the perspectives of the labor and management co-chairs, Peoria's story is an example of the cooperation that has developed in that city. In addition to describing a remarkable city-wide effort to reduce health care costs and maintain an attractive benefit package, the article shows how success on a topic of importance to the parties and the community can sow the seeds of a broader cooperative relationship that improves services, quality of work life and the nature of the labor-management relationship. By agreement, the city and labor unions took the health care plan off the bargaining table, and instead, gave it to a city-wide joint committee, which solved the crisis and manages this difficult issue. Among other advances that mark a change from the past, the positive effects from the dramatic success in health care has contributed to a first-ever, five-year negotiated settlement between the city and the firefighters. Read about how Peoria accomplished this change by bold risk taking and by carefully nurturing the effort.

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

User Fees for Health Care: Why a Bad Idea Keeps Coming Back (Or, What's Health Got to Do With It?)

1995 ◽  
Vol 14 (2) ◽  
pp. 360-390 ◽  
Author(s):  
Robert G. Evans ◽  
Morris L. Barer ◽  
Greg L. Stoddart
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Health Care Costs ◽  
Health Care Providers ◽  
Final Analysis ◽  
User Fees ◽  
Care Providers ◽  
Positive Effects ◽  
The Face ◽  
Care Costs

ABSTRACTCalls for user fees in Canadian health care go back as far as the debate leading up to the establishment of Canada's national hospital insurance program in the late 1950s. Although the rationales have shifted around somewhat, some of the more consistent claims have been that user fees are necessary as a source of additional revenue for a badly underfunded system, that they are necessary to control runaway health care costs, and that they will deter unnecessary use (read abuse) of the system. But the real reasons that user fees have been such hardy survivors of the health policy wars, bear little relation to the claims commonly made for them. Their introduction in the financing of hospital or medical care in Canada would be to the benefit of a number of groups, and not just those one usually thinks of. We show that those who are healthy, and wealthy, would join health care providers (and possibly insurers) as net beneficiaries of a reintroduction of user fees for hospital and medical care in Canada. The flip side of this is that those who are indigent and ill will bear the brunt of the redistribution (for that is really what user fees are all about), and seniors feature prominently in those latter groups. Claims of other positive effects of user fees, such as reducing total health care costs, or improving appropriateness or accessibility, simply do not stand up in the face of the available evidence. In the final analysis, therefore, whether one is for or against user fees reduces to whether one is for or against the resulting income redistribution.

Health care costs of physical inactivity in Canadian adults

2012 ◽  
Vol 37 (4) ◽  
pp. 803-806 ◽  
Author(s):  
Ian Janssen
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Physical Inactivity ◽  
Health Care Cost ◽  
Care Costs

The purpose of this study was to provide a contemporary estimate of the health care cost of physical inactivity in Canadian adults. The health care cost was estimated using a prevalence-based approach. The estimated direct, indirect, and total health care costs of physical inactivity in Canada in 2009 were $2.4 billion, $4.3 billion, and $6.8 billion, respectively. These values represented 3.8%, 3.6%, and 3.7% of the overall health care costs.

The Distribution of Health Care Costs and Their Statistical Analysis for Economic Evaluation

1998 ◽  
Vol 3 (4) ◽  
pp. 233-245 ◽  
Author(s):  
Andrew Briggs ◽  
Alastair Gray
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Health Care Cost ◽  
Cost Data ◽  
Parametric Methods ◽  
Patient Level Data ◽  
Patient Level ◽  
Level Data ◽  
Care Costs ◽  
Non Parametric

Objective: Where patient level data are available on health care costs, it is natural to use statistical analysis to describe the differences in cost between alternative treatments. Health care costs are, however, commonly considered to be skewed, which could present problems for standard statistical tests. This review examines how authors report the distributional form of health care cost data and how they have analysed their results. Method: A review of cost-effectiveness studies that collected patient-level data on health care costs. To supplement the review, five datasets on health care costs are examined. Consideration is given to the use of parametric methods on the transformed scale and to non-parametric methods of analysing skewed cost data. Results: Since economic analysis requires estimation in monetary units, the usefulness of transformation-based methods is limited by the inability to retransform cost differences to the original scale. Non-parametric rank sum methods were also found to be of limited use for economic analysis, partly due to the focus on hypothesis testing rather than estimation. Overall, the non-parametric approach of bootstrapping was found to offer a useful test of the appropriateness of parametric assumptions and an alternative method of estimation where those assumptions were found not to hold. Conclusions: Guidelines for the analysis of skewed health care cost data are offered.

Direct Health Care Cost and Work Incapacity Related to Complex Regional Pain Syndrome in Switzerland: A Retrospective Analysis from 2008 to 2015

Pain Medicine ◽  
2019 ◽  
Vol 20 (8) ◽  
pp. 1559-1569 ◽  
Author(s):  
Stefan Markus Scholz-Odermatt ◽  
François Luthi ◽  
Maria Monika Wertli ◽  
Florian Brunner
Keyword(s):  
Health Care ◽  
Complex Regional Pain Syndrome ◽  
Health Care Costs ◽  
Health Care Cost ◽  
Rare Condition ◽  
Pain Syndrome ◽  
Treatment Costs ◽  
Insurance Costs ◽  
Increased Risk ◽  
Care Costs

Abstract Objective First, to determine the number of accident-related complex regional pain syndrome (CRPS) cases from 2008 to 2015 and to identify factors associated with an increased risk for developing CRPS. Second, to analyze the duration of work incapacity and direct health care costs over follow-up periods of two and five years, respectively. Design Retrospective data analysis. Setting Database from the Statistical Service for the Swiss National Accident Insurances covering all accidents insured under the compulsory Swiss Accident Insurance Law. Subjects Subjects were registered after an accident between 2008 and 2015. Methods Cases were retrospectively retrieved from the Statistical Service for the Swiss National Accident Insurances. Cases were identified using the appropriate International Classification of Diseases, 10th Revision, codes. Results CRPS accounted for 0.15% of all accident cases. Age, female gender (odds ratio [OR] = 1.53, 95% confidence interval [CI] = 1.47–1.60), and fracture of the forearm (OR = 38, 95% CI = 35–42) were related to an increased risk of developing CRPS. Over five years, one CRPS case accumulated average insurance costs of $86,900 USD and treatment costs of $23,300 USD. Insurance costs were 19 times and treatment costs 13 times the average costs of accidents without CPRS. Within the first two years after the accident, the number of days lost at work was 20 times higher in patients with CRPS (330 ± 7 days) than in patients without CRPS (16.1 ± 0.1 days). Two-thirds of all CRPS cases developed long-term work incapacity of more than 90 days. Conclusion CRPS is a relatively rare condition but is associated with high direct health care costs and work incapacity.

scholarly journals Increasing Prevalence and Direct Health Care Cost of Inflammatory Bowel Disease Among Adults: A Population-Based Study From a Western Canadian Province

2021 ◽  
Author(s):  
Jessica Amankwah Osei ◽  
Juan Nicolás Peña-Sánchez ◽  
Sharyle A Fowler ◽  
Nazeem Muhajarine ◽  
Gilaad G Kaplan ◽  
...  
Keyword(s):  
Health Care ◽  
Inflammatory Bowel Disease ◽  
Health Care Costs ◽  
Bowel Disease ◽  
Health Care Cost ◽  
Population Based ◽  
Annual Increase ◽  
Average Annual Increase ◽  
Inflammatory Bowel ◽  
Care Costs

Abstract Objectives Our study aimed to calculate the prevalence and estimate the direct health care costs of inflammatory bowel disease (IBD), and test if trends in the prevalence and direct health care costs of IBD increased over two decades in the province of Saskatchewan, Canada. Methods We conducted a retrospective population-based cohort study using administrative health data of Saskatchewan between 1999/2000 and 2016/2017 fiscal years. A validated case definition was used to identify prevalent IBD cases. Direct health care costs were estimated in 2013/2014 Canadian dollars. Generalized linear models with generalized estimating equations tested the trend. Annual prevalence rates and direct health care costs were estimated along with their 95% confidence intervals (95%CI). Results In 2016/2017, 6468 IBD cases were observed in our cohort; Crohn’s disease: 3663 (56.6%), ulcerative colitis: 2805 (43.4%). The prevalence of IBD increased from 341/100,000 (95%CI 340 to 341) in 1999/2000 to 664/100,000 (95%CI 663 to 665) population in 2016/2017, resulting in a 3.3% (95%CI 2.4 to 4.3) average annual increase. The estimated average health care cost for each IBD patient increased from $1879 (95%CI 1686 to 2093) in 1999/2000 to $7185 (95%CI 6733 to 7668) in 2016/2017, corresponding to an average annual increase of 9.5% (95%CI 8.9 to 10.1). Conclusions Our results provide relevant information and analysis on the burden of IBD in Saskatchewan. The evidence of the constant increasing prevalence and health care cost trends of IBD needs to be recognized by health care decision-makers to promote cost-effective health care policies at provincial and national levels and respond to the needs of patients living with IBD.

scholarly journals Managing health care in Australia: Steps on the health care roundabout?

2003 ◽  
Vol 9 (3) ◽  
pp. 105 ◽  
Author(s):  
Peter Harvey
Keyword(s):  
Health Care ◽  
Chronic Illness ◽  
Population Health ◽  
Health Care Costs ◽  
Health Care Cost ◽  
Illness Management ◽  
Health Care Market ◽  
Coordinated Care ◽  
Management Skills ◽  
Care Costs

This paper explores some of the lessons of the coordinated care trials in Australia in the context of managed care in America and asks how do we best manage our finite health care dollars for the most equitable and effective outcomes for whole populations? The COAG trial in Australia tested a more structured process for managing the care of patients with chronic illness and postulated that currently fragmented health system funding could be pooled around individual patient need, and managed for improved economic outcomes and patient wellbeing. There is little doubt, following this initiative and much work in other countries, that as health care costs rise, for a range of reasons, improvements are needed in the management of our resources if we are to control rising health care costs. We also know that chronic illness, much of which is preventable and avoidable, is the major component in the rising health care cost equation and a factor likely to consume around 75% of our health dollars in the future. Much chronic illness can be prevented through social and population health strategies and we know that even if chronic illness can?t be prevented, it can be managed better through community-based chronic illness management programs. These programs rely on information, education, patient lifestyle and behaviour change, and on patients developing improved self-management skills. But, what is the best way to manage population health in Australia and ensure equity and fairness in the health care market as we evolve new approaches, especially to the management of chronic illness?

Malnutrition-Related Health Care Cost in Japan: An Analysis of Health Insurance Claims Data

2019 ◽  
Vol 31 (7) ◽  
pp. 594-602
Author(s):  
Sumito Ogawa ◽  
Tatsuya Hosoi ◽  
Masahiro Akishita ◽  
Ataru Igarashi
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Costs ◽  
Health Care Cost ◽  
International Classification Of Diseases ◽  
Health Insurance Data ◽  
Classification Of Diseases ◽  
Insurance Claims Data ◽  
Health Insurance Claims Data ◽  
Care Costs

The objective of our study is to evaluate the prevalence and health care cost of malnutrition in Japan. Using the health insurance data, we defined 2 types of malnutrition, strictly diagnosed malnutrition (SDM) and disease-associated malnutrition (DAM) by International Classification of Diseases 10th Revision. We also analyzed the health care costs by body mass index (BMI) data from medical checkups. The nationwide prevalence of SDM was estimated 0.8%, and that of SDM plus DAM was 2.9%. The total annual health care cost for SDM patients in Japan was $14.5 billion, representing 4.3% of the national health expenditures in 2014; the excess cost for patients with SDM was estimated to be $9.7 billion. The health care costs became high among the patients with either low BMI or high BMI. Because of the rapidly aging population, actions are urgently needed to avoid increasing the current high health care costs of malnutrition.

scholarly journals P771 Increasing prevalence and direct health care cost of inflammatory bowel disease: A population-based evidence from a western Canadian province

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S611-S612
Author(s):  
J A Osei ◽  
J N Peña-Sánchez ◽  
S A Fowler ◽  
N Muhajarine ◽  
G Kaplan ◽  
...  
Keyword(s):  
Health Care ◽  
Inflammatory Bowel Disease ◽  
Health Care Costs ◽  
Bowel Disease ◽  
Health Care Cost ◽  
Population Based ◽  
Canadian Province ◽  
Annual Increase ◽  
Inflammatory Bowel ◽  
Care Costs

Abstract Background More than 0.3% of the populations in Europe, North America, and Oceania live with inflammatory bowel disease (IBD). Canada has increasing prevalence trends of IBD with 1% of Canadians estimated to have IBD by 2030. Evidence about IBD prevalence and health care costs over time can contribute to health resources allocation and health care planning. Our study aimed to 1) estimate the prevalence and direct health care costs of IBD in the province of Saskatchewan (SK), Canada, and 2) test if trends in the prevalence and direct health care costs of IBD increased over two decades. Methods We conducted a retrospective population-based cohort study using administrative health data of SK between 1999/00 and 2016/17 fiscal years. A validated case definition was used to identify prevalent IBD cases. The costing method adopted by the Canadian Institute for Health Information was used to estimate direct health care costs in 2013/14 Canadian dollars among IBD cases. Generalised linear models (GLMs) with generalised estimating equations were used to test the trends. Negative binomial and gamma distributions were used to, respectively, model prevalence and health care cost trends. Sex and age group were covariates in all models; the Charlson comorbidity index was also included in the cost model. Annual prevalence rates and direct health care cost estimates with their 95% confidence intervals (95%CI) were reported. Results In 2016, there were 6468 (Crohn’s disease: 3663 [56.63%], ulcerative colitis: 2805 [43.37%]) IBD cases ascertained in SK. The number of prevalent cases increased over the analysis period by 56%. The total direct health care costs increased from $7.8 million in 1999 to $50.8 million in 2016. The average annual IBD prevalence increased from 341/100,000 (95%CI 340–341) in 1999 to 664/100,000 (95%CI 663–665) in 2016, a 3.3% (95%CI 2.4–4.3) average annual increase. The total average annual direct health care costs of IBD increased from $1.8 (95%CI $1.6–2.0) thousand per patient in 1999 to $7.1 (95%CI $6.7–7.5) thousand per patient in 2016, an average annual increase of 9.2% (95% CI 8.5–9.8), Figure 1. Conclusion In the Canadian province of SK, prevalence and direct health care costs, respectively, tripled and quadrupled over two decades. Our results provide relevant information and analysis on the burden of IBD in SK. These findings are in agreement with previous studies from other provinces. The evidence of constant increasing prevalence and health care cost trends of IBD needs to be recognised by health care decision-makers to promote cost-effective health care policies at provincial and national levels and respond to the needs of patients living with IBD.

scholarly journals Predicting Health Care Costs Using Evidence Regression

Proceedings ◽  
2019 ◽  
Vol 31 (1) ◽  
pp. 74 ◽  
Author(s):  
Belisario Panay ◽  
Nelson Baloian ◽  
José Pino ◽  
Sergio Peñafiel ◽  
Horacio Sanson ◽  
...  
Keyword(s):  
Neural Network ◽  
Health Care ◽  
Artificial Neural Network ◽  
Regression Model ◽  
Health Care Costs ◽  
Health Care Cost ◽  
Gradient Boosting ◽  
Boosting Method ◽  
Artificial Neural ◽  
Care Costs

People’s health care cost prediction is nowadays a valuable tool to improve accountability in health care. In this work, we study if an interpretable method can reach the performance of black-box methods for the problem of predicting health care costs. We present an interpretable regression method based on the Dempster-Shafer theory, using the Evidence Regression model and a discount function based on the contribution of each dimension. Optimal parameters are learned using gradient descent. The k-nearest neighbors’ algorithm was also used to speed up computations. With the transparency of the evidence regression model, it is possible to create a set of rules based on a patient’s vicinity. When making a prediction, the model gives a set of rules for such a result. We used Japanese health records from Tsuyama Chuo Hospital to test our method, which includes medical checkups, exam results, and billing information from 2016 to 2017. We compared our model to an Artificial Neural Network and Gradient Boosting method. Our results showed that our transparent model outperforms the Artificial Neural Network and Gradient Boosting with an R 2 of 0 . 44 .

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