No Need for More Regulation: Payors and Their Role in Balancing the Cost and Safety Considerations of Off-Label Prescriptions

2011 ◽  
Vol 37 (2-3) ◽  
pp. 422-443 ◽  
Author(s):  
Amy E. Todd
Keyword(s):  
Health Care ◽  
National Health ◽  
Prescription Drugs ◽  
Health Care Expenditures ◽  
The United States ◽  
Off Label ◽  
Rate Of Growth ◽  
Increased Risk ◽  
Safety Considerations ◽  
The Cost

In 2009, health care expenditures in the United States totaled $2.5 trillion and accounted for almost eighteen percent of the national Gross Domestic Product (GDP). Rising health care costs are an increasing concern in the national health care industry and in government policy reform. When estimates show that thirty percent of health care is unnecessary, improving quality and efficiency of health care could eliminate a significant amount of excessive spending.Prescription drugs contributed to ten percent of national health expenditures in 2009, comprising about $250 billion. And while the rate of growth for overall health care spending declined as a result of the recent recession, “the number of prescription drugs dispensed rebounded to prerecession rate of growth.” Estimates show that off-label drug use comprises between twenty and sixty percent of U.S. prescriptions. This could be a troubling percentage considering that off-label use carries an increased risk of harm or ineffectiveness.

How Can the U.S. Government Control Physicians' Fees under National Health Insurance? A Lesson from the French System

1974 ◽  
Vol 4 (1) ◽  
pp. 49-57 ◽  
Author(s):  
Laurence C. Thorsen
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Prescription Drugs ◽  
The United States ◽  
Care Hospital ◽  
Government Control ◽  
The Government ◽  
The Cost

The French national health insurance program covers most of the cost of medical and dental care, hospital care, and prescription drugs. The portion of health care costs borne by the patient varied widely prior to 1960 because of the failure of the government to control physicians' and dentists' fees adequately. In 1960, using expanded regulatory powers, the French government under DeGaulle applied controls on fees by imposing penalties on physicians and dentists who refused to be bound by annual contracts between their local associations and the social security system. The result is uniform fees and less rapid increases in the cost of health care. Control of costs is achieved at the expense of traditional professional independence, but it has made the system workable and is thus instructive for the United States as we consider moving toward national health insurance.

scholarly journals Pharmacoeconomics of Cancer Therapy

1998 ◽  
Vol 5 (5) ◽  
pp. 415-424 ◽  
Author(s):  
Susan E. Beltz ◽  
Gary C. Yee
Keyword(s):  
Health Care ◽  
Treatment Decision ◽  
Health Care Expenditures ◽  
The United States ◽  
Health Care Environment ◽  
Design Data ◽  
Care Environment ◽  
Treatment Decision Making ◽  
Economic Analyses ◽  
The Cost

Background In 1990, annual costs of the diagnosis and treatment of cancer reached nearly $100 billion and currently constitutes approximately 10% of health care expenditures in the United States. As new and often more expensive therapies for cancer treatment become available, the health care decision- maker must consider the cost effectiveness of the therapy. Methods Key principles of economic analyses and the inherent differences among these analyses are reviewed. Results While pharmacoeconomic analyses are increasingly being used in treatment decision-making, several issues relating to study design, data collection, and research methods are controversial. Conclusions Pharmacoeconomics analyses are necessary in the current health care environment, but the assumptions used within the analyses warrant careful evaluation.

Continuation of Anti-TNF in Patients With Ulcerative Colitis in Remission Is Not Cost-effective Compared With Treatment Withdrawal: A Markov Model

2020 ◽  
Author(s):  
Remi Mahmoud ◽  
Chris van Lieshout ◽  
Geert W J Frederix ◽  
Bindia Jharap ◽  
Bas Oldenburg
Keyword(s):  
Ulcerative Colitis ◽  
Health Care ◽  
Cost Effectiveness ◽  
Markov Model ◽  
Cost Effective ◽  
Health Care Expenditures ◽  
Increased Risk ◽  
The Cost ◽  
Cost Effectiveness Threshold ◽  
Effectiveness Threshold

Abstract Background and Aims Anti-tumour necrosis factor alpha [anti-TNF] treatment accounts for 31% of health care expenditures associated with ulcerative colitis [UC]. Withdrawal of anti-TNF in patients with UC in remission may decrease side effects and infections, while promoting cost containment. Approximately 36% of patients relapse within 12–24 months of anti-TNF withdrawal, but reintroduction of treatment is successful in 80% of patients. We aimed to evaluate the cost-effectiveness of continuation versus withdrawal of anti-TNF in patients with UC in remission. Methods We developed a Markov model comparing cost-effectiveness of anti-TNF continuation versus withdrawal, from a health care provider perspective. Transition probabilities were calculated from literature, or estimated by an expert panel of 11 gastroenterologists. Deterministic and probabilistic sensitivity analyses were performed to account for assumptions and uncertainty. The cost-effectiveness threshold was set at an incremental cost-effectiveness ratio of €80,000 per quality-adjusted life-year [QALY]. Results At 5 years, anti-TNF withdrawal was less costly [-€10,781 per patient], but also slightly less effective [-0.04 QALY per patient] than continued treatment. Continuation of anti-TNF compared with withdrawal costs €300,390/QALY, exceeding the cost-effectiveness threshold. Continued therapy would become cost-effective if the relapse rate following anti-TNF withdrawal was ≥43% higher, or if adalimumab or infliximab [biosimilar] prices fell below €87/40 mg and €66/100 mg, respectively. Conclusions Continuation of anti-TNF in UC patients in remission is not cost-effective compared with withdrawal. A stop-and-reintroduction strategy is cost-saving but is slightly less effective than continued therapy. This strategy could be improved by identifying patients at increased risk of relapse.

Selling Cost Containment

1993 ◽  
Vol 19 (1-2) ◽  
pp. 95-119
Author(s):  
Timothy Stoltzfus Jost ◽  
Sandra J. Tanenbaum
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Reform ◽  
Cost Containment ◽  
Health Care Expenditures ◽  
The United States ◽  
Single Payer

Health care expenditures in the United States have continued to grow despite efforts to control them. This Article discusses the need for health care reform, outlines the model that reform should follow, and considers why the United States has not progressed toward a workable solution. It introduces a single-payer approach to cost containment and explains how such an approach could be “sold” in the United States. Finally, the Article examines various ways to mobilize support for such health care reform.

Preoperative Predictors and Costs of 30-Day Readmission Following Inpatient Pediatric Tonsillectomy in the United States

2021 ◽  
pp. 019459982098070
Author(s):  
Habib Khoury ◽  
Shaghauyegh S. Azar ◽  
Hannah Boutros ◽  
Nina L. Shapiro
Keyword(s):  
Health Care ◽  
Financial Burden ◽  
Preoperative Assessment ◽  
Health Care Expenditures ◽  
The United States ◽  
Postoperative Hemorrhage ◽  
International Classification Of Disease ◽  
Neurologic Disorders ◽  
Common Causes ◽  
National Trends

Objectives To understand national trends in 30-day postoperative readmission following inpatient pediatric tonsillectomy and adenoidectomy. Study Design Retrospective cohort study. Setting Nationwide Readmissions Database. Methods We used the Nationwide Readmissions Database to identify and analyze 30-day readmissions following inpatient tonsillectomy from 2010 to 2015. Using the International Classification of Disease codes, we identified 66,652 patients and analyzed the incidence, causes, risk factors, and costs of 30-day readmission. Results Of 66,652 patients who underwent inpatient tonsillectomy, 2660 (4.0%) experienced a readmission. Readmitted patients were more commonly aged <2 years (23.4 vs 10.6%, P = .01) and had a greater burden of comorbidities, including preoperative anemia (3.9 vs 1.3%, P < .001), coagulopathy (3.5 vs 1.4%, P < .001), and neurologic disorders (19.1 vs 6.6%, P < .001). Readmitted patients experienced higher rates of postoperative complications (17.4 vs 9.0%, P < .001) and had a longer length of stay (4.5 vs 2.2 days, P < .001). Index cost of hospitalization was higher among readmitted patients ($14,129 vs $7307, P < .001), and each readmission cost an additional $7576. Postoperative hemorrhage (21.3%) and dehydration (17.7%) were the 2 most common causes for readmission. Independent predictors of readmission included age <3 years, multiple comorbidities, and postoperative neurologic complications. The incidences of tonsillectomies and readmissions declined during the study period, most notably between 2010 and 2012. Conclusion Readmission after inpatient tonsillectomy and adenoidectomy places a substantial financial burden on the health care system. Targeted strategies to improve preoperative assessment and optimize postoperative care may prevent readmission, reduce unnecessary health care expenditures, and improve patient outcomes.

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.

A comprehensive assessment of the cost of multiple sclerosis in the United States

1998 ◽  
Vol 4 (5) ◽  
pp. 419-425 ◽  
Author(s):  
Kathryn Whetten-Goldstein ◽  
Frank A Sloan ◽  
Larry B Goldstein ◽  
Elizabeth D Kulas
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Health Insurance ◽  
Informal Care ◽  
Annual Cost ◽  
Lifetime Cost ◽  
The United States ◽  
Personal Health ◽  
Secondary Sources ◽  
The Cost

Comprehensive data on the costs of multiple sclerosis is sparse. We conducted a survey of 606 persons with MS who were members of the National Multiple Sclerosis Society to obtain data on their cost of personal health services, other services, equipment, and earnings. Compensation of such cost in the form of health insurance, income support, and other subsidies was measured. Survey data and data from several secondary sources was used to measure costs incurred by comparable persons without MS. Based on the 1994 data, the annual cost of MS was estimated at over $34 000 per person, translating into a conservative estimate of national annual cost of $6.8 billion, and a total lifetime cost per case of $2.2 million. Major components of cost were earnings loss and informal care. Virtually all persons with MS had health insurance, mostly Medicare/Medicaid. Health insurance covered 51 per cent of costs for services, excluding informal care. On average, compensation for earnings loss was 27 per cent. MS is very costly to the individual, health care system, and society. Much of the cost (57 per cent) is in the form of burdens other than personal health care, including earnings loss, equipment and alternations, and formal and informal care. These costs often are not calculated.

Health Care Cost Containment in Large American Cities

1989 ◽  
Vol 18 (1) ◽  
pp. 87-100 ◽  
Author(s):  
Perry Moore
Keyword(s):  
Health Care ◽  
Cost Containment ◽  
Local Governments ◽  
Health Care Cost ◽  
The United States ◽  
Public Agencies ◽  
The Public ◽  
Survey Results ◽  
The Cost ◽  
American Cities

This research provides information about the health care cost containment efforts of local governments and agencies across the United States, particularly in large American cities. Survey results indicate that while the public sector lags behind the private sector, public agencies are beginning to match the cost containment efforts of private employers. While initiation of these efforts represents considerable recent progress, their tangible benefits are not yet apparent.

The Arguments against a National Health Program: Science or Ideology?

1988 ◽  
Vol 18 (2) ◽  
pp. 179-189 ◽  
Author(s):  
Vicente Navarro
Keyword(s):  
United States ◽  
National Health ◽  
Health Program ◽  
Health Expenditures ◽  
The United States ◽  
Federal Deficit ◽  
Rate Of Growth ◽  
Empirical Information ◽  
Universal Health ◽  
Program Science

This article provides empirical information that questions some of the major arguments put forward against the establishment of a comprehensive and universal health program in the United States. The positions that (1) “Americans do not want a further expansion of government roles in their lives,” (2) “a National Health Program would further increase the rate of growth of health expenditures,” (3) “the federal deficit is too large and needs to be reduced before establishing a National Health Program,” and (4) “people do not want to pay higher taxes,” are shown to be ideological rather than scientific. The author presents evidence that questions each of these assumptions.

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