Correlates of Worry About Health Care Costs Among Older Adults

Although older adults in the United States incur more health care expenses than younger adults, little research has been done on their worry about health care costs. Using data from the 2013 National Health Interview Survey ( n = 7,253 for those 65+ years), we examined factors associated with older adults’ health care cost worries, defined as at least a moderate level of worry, about ability to pay for normal health care and/or for health care due to a serious illness or accident. Bivariate analyses were used to compare worriers and nonworriers. Binary logistic regression analysis was used to examine the association of income, health status, health care service use, and insurance type with worry status. Older age and having Medicaid and Veterans Affairs (VA)/military health benefits were associated with lower odds of worry, while low income, chronic pain, functional limitations, psychological distress, and emergency department visits were associated with higher odds. Practice and policy implications for the findings are discussed.

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A Qualitative Exploration of Racial and Ethnic Differences in Cost of Care Conversations Among Older Adults

10.21203/rs.3.rs-55371/v1 ◽

2020 ◽

Author(s):

Kyaien Oquinn Conner ◽

Jaqueline Wiltshire ◽

Edlin Colato Garcia ◽

Barbara Langland-Orban ◽

Erica Anderson ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Focus Group ◽

Health Care Costs ◽

Financial Burden ◽

Wait Time ◽

The United States ◽

Cost Of Care ◽

Care Costs ◽

Racial Ethnic

Abstract Background: The rapidly growing racially diverse, aging population in the United States is presenting unique challenges for our social, economic, and healthcare systems. Rising health care costs, increased patient cost-sharing, and limited financial resources make this generation of older Americans susceptible to large medical bills or debt which disproportionally impacts older racial/ethnic minorities. Cost-of-care (CoC) conversations between patients and doctors is one recommended approach to containing health care costs and alleviating patients’ financial burden of care.Methods: The current study used focus group methodology to qualitatively explore the contextual factors that influence CoC conversations in a diverse sample of older adults (N=27). Results: Three focus groups were held with White (n=10), African American (n= 9) and Hispanic/Latino (n=8) participants. Thematic analysis yielded four broad themes. Results suggest that CoC conversations are not occurring with physicians, although conversations are occurring with dentists and pharmacists. Contributors to CoC conversations included positive provider affect, rapport/relationship building, and communication. Barriers included: new age physicians, lack of physician training, wait time, lack of focus on the patient, language, provider preferences, fear of physicians, and religion; however, there was little similarity across racial/ethnic groups.Conclusions: The results of this qualitative study suggest that cost-of-care conversations are not occurring between providers and their patients. Several barriers, contributors, and solutions to cost-of-care conversations were identified by focus group participants, which have important implications for the field, and are addressed in this manuscript.

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Health care resource utilization and cost burden of hemophilia B in the United States

Blood Advances ◽

10.1182/bloodadvances.2020003424 ◽

2021 ◽

Vol 5 (7) ◽

pp. 1954-1962

Author(s):

Tyler W. Buckner ◽

Iryna Bocharova ◽

Kaitlin Hagan ◽

Arielle G. Bensimon ◽

Hongbo Yang ◽

...

Keyword(s):

Health Care ◽

Health Care Costs ◽

The United States ◽

Health Care Resource ◽

Emergency Department Visits ◽

Factor Ix ◽

Hemophilia B ◽

Annual Total ◽

Clinical Profiles ◽

Care Costs

Abstract Hemophilia B is a rare congenital blood disorder characterized by factor IX deficiency. Clinical profiles of hemophilia B range from mild to severe forms of the disease. The objective of this study was to characterize the economic burden associated with differing clinical profiles of hemophilia B from a US health system perspective. Using the IBM MarketScan database (June 2011-February 2019), a claims-based algorithm was developed to identify 4 distinct profiles (mild, moderate, moderate-severe, and severe) in adult males with hemophilia B based on the frequency of hemorrhage events and factor IX replacement claims. Mean annual health care resource use (HRU) and costs were statistically compared between patients with hemophilia B (N = 454) and 1:1 demographic-matched controls (N = 454), both overall and with stratification by clinical profile. Compared with matched controls, patients with hemophilia B had a significantly higher comorbidity burden (Charlson Comorbidity Index, mean ± standard deviation [SD]: 0.9 ± 1.7 vs 0.3 ± 0.9, P < .001). Across all clinical profiles, patients with hemophilia B had significantly higher HRU vs matched controls (mean ± SD: 0.3 ± 0.6 vs 0.1 ± 0.3 inpatient admissions; 0.6 ± 1.2 vs 0.2 ± 0.6 emergency department visits; 17.7 ± 22.9 vs 8.0 ± 11.0 outpatient visits; all P < .001). Annual total health care costs per patient among patients with hemophilia B were more than 25-fold higher vs matched controls (mean ± SD: $201 635 ± $411 530 vs $7879 ± $29 040, respectively, P < .001). Annual total health care costs per patient increased with increasing severity (mean ± SD: mild, $80 811 ± $284 313; moderate, $137 455 ± $222 021; moderate-severe, $251 619 ± $576 886; severe, $632 088 ± $501 270). The findings of this study highlight the substantial burden of illness associated with hemophilia B.

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Direct Health Care Costs Associated with Asthma in British Columbia

Canadian Respiratory Journal ◽

10.1155/2010/361071 ◽

2010 ◽

Vol 17 (2) ◽

pp. 74-80 ◽

Cited By ~ 69

Author(s):

Mohsen Sadatsafavi ◽

Larry Lynd ◽

Carlo Marra ◽

Bruce Carleton ◽

Wan C Tan ◽

...

Keyword(s):

Health Care ◽

British Columbia ◽

Asthma Control ◽

Health Care Costs ◽

Economic Burden ◽

Emergency Department Visits ◽

Common Disease ◽

Physician Visits ◽

Hospitalization Costs ◽

Care Costs

BACKGROUND: A better understanding of health care costs associated with asthma would enable the estimation of the economic burden of this increasingly common disease.OBJECTIVE: To determine the direct medical costs of asthma-related health care in British Columbia (BC).METHODS: Administrative health care data from the BC Linked Health Database and PharmaNet database from 1996 to 2000 were analyzed for BC residents five to 55 years of age, including the billing information for physician visits, drug dispensations and hospital discharge records. A unit cost was assigned to physician/emergency department visits, and government reimbursement fees for prescribed medications were applied. The case mix method was used to calculate hospitalization costs. All costs were reported in inflation-adjusted 2006 Canadian dollars.RESULTS: Asthma resulted in $41,858,610 in annual health care-related costs during the study period ($331 per patient-year). The major cost component was medications, which accounted for 63.9% of total costs, followed by physician visits (18.3%) and hospitalization (17.8%). When broader definitions of asthma-related hospitalizations and physician visits were used, total costs increased to $56,114,574 annually ($444 per patient-year). There was a statistically significant decrease in the annual per patient cost of hospitalizations (P<0.01) over the study period. Asthma was poorly controlled in 63.5% of patients, with this group being responsible for 94% of asthma-related resource use.CONCLUSION: The economic burden of asthma is significant in BC, with the majority of the cost attributed to poor asthma control. Policy makers should investigate the reason for lack of proper asthma control and adjust their policies accordingly to improve asthma management.

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Analgesic Usage for Low Back Pain: Impact on Health Care Costs and Service Use

Spine ◽

10.1097/01.brs.0000160843.77091.07 ◽

2005 ◽

Vol 30 (9) ◽

pp. 1075-1081 ◽

Cited By ~ 79

Author(s):

Molly T. Vogt ◽

C Kent Kwoh ◽

Doris K. Cope ◽

Thaddeus A. Osial ◽

Michael Culyba ◽

...

Keyword(s):

Health Care ◽

Low Back Pain ◽

Back Pain ◽

Health Care Costs ◽

Service Use ◽

Low Back ◽

Care Costs

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International differences in health care costs in Europe and the United States: Do these affect the cost-effectiveness of diagnostic strategies for pulmonary embolism?

European Radiology ◽

10.1007/s003300050951 ◽

1999 ◽

Vol 9 (9) ◽

pp. 1926-1931 ◽

Cited By ~ 21

Author(s):

A. R. van Erkel ◽

W. B. van den Hout ◽

P. M. T. Pattynama

Keyword(s):

United States ◽

Health Care ◽

Pulmonary Embolism ◽

Cost Effectiveness ◽

Health Care Costs ◽

The United States ◽

International Differences ◽

Diagnostic Strategies ◽

The Cost ◽

Care Costs

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The Effect of Noninvasive Telemonitoring for Chronic Heart Failure on Health Care Utilization: Systematic Review (Preprint)

10.2196/preprints.26744 ◽

2020 ◽

Author(s):

Stefan L Auener ◽

Toine E P Remers ◽

Simone A van Dulmen ◽

Gert P Westert ◽

Rudolf B Kool ◽

...

Keyword(s):

Heart Failure ◽

Health Care ◽

Chronic Heart Failure ◽

Health Care Utilization ◽

Health Care Costs ◽

Emergency Department Visits ◽

Care Utilization ◽

Controlled Trials ◽

Randomized Controlled ◽

Care Costs

BACKGROUND Chronic heart failure accounts for approximately 1%-2% of health care expenditures in most developed countries. These costs are primarily driven by hospitalizations and comorbidities. Telemonitoring has been proposed to reduce the number of hospitalizations and decrease the cost of treatment for patients with heart failure. However, the effects of telemonitoring on health care utilization remain unclear. OBJECTIVE This systematic review aims to study the effect of telemonitoring programs on health care utilization and costs in patients with chronic heart failure. We assess the effect of telemonitoring on hospitalizations, emergency department visits, length of stay, hospital days, nonemergency department visits, and health care costs. METHODS We searched PubMed, Embase, and Web of Science for randomized controlled trials and nonrandomized studies on noninvasive telemonitoring and health care utilization. We included studies published between January 2010 and August 2020. For each study, we extracted the reported data on the effect of telemonitoring on health care utilization. We used <i>P</i><.05 and CIs not including 1.00 to determine whether the effect was statistically significant. RESULTS We included 16 randomized controlled trials and 13 nonrandomized studies. Inclusion criteria, population characteristics, and outcome measures differed among the included studies. Most studies showed no effect of telemonitoring on health care utilization. The number of hospitalizations was significantly reduced in 38% (9/24) of studies, whereas emergency department visits were reduced in 13% (1/8) of studies. An increase in nonemergency department visits (6/9, 67% of studies) was reported. Health care costs showed ambiguous results, with 3 studies reporting an increase in health care costs, 3 studies reporting a reduction, and 4 studies reporting no significant differences. Health care cost reductions were realized through a reduction in hospitalizations, whereas increases were caused by the high costs of the telemonitoring program or increased health care utilization. CONCLUSIONS Most telemonitoring programs do not show clear effects on health care utilization measures, except for an increase in nonemergency outpatient department visits. This may be an unwarranted side effect rather than a prerequisite for effective telemonitoring. The consequences of telemonitoring on nonemergency outpatient visits should receive more attention from regulators, payers, and providers. This review further demonstrates the high clinical and methodological heterogeneity of telemonitoring programs. This should be taken into account in future meta-analyses aimed at identifying the effective components of telemonitoring programs.

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