Prevalence and Costs of Chronic Conditions in the VA Health Care System

Chronic conditions are among the most common causes of death and disability in the United States. Patients with such conditions receive disproportionate amounts of health care services and therefore cost more per capita than the average patient. This study assesses the prevalence among the Department of Veterans Affairs (VA) health care users and VA expenditures (costs) of 29 common chronic conditions. The authors used regression to identify the marginal impact of these conditions on total, inpatient, outpatient, and pharmacy costs. Excluding costs of contracted medical services at non-VA facilities, total VA health care expenditures in fiscal year 1999 (FY1999) were $14.3 billion. Among the 3.4 million VA patients in FY1999, 72 percent had 1 or more of the 29 chronic conditions, and these patients accounted for 96 percent of the total costs ($13.7 billion). In addition, 35 percent (1.2 million) of VA health care users had 3 or more of the 29 chronic conditions. These individuals accounted for 73 percent of the total cost. Overall, VA health care users have more chronic diseases than the general population.

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PACE: An Interdisciplinary Community-Based Practice Opportunity for Pharmacists

The Senior Care Pharmacist ◽

10.4140/tcp.n.2019.439 ◽

2019 ◽

Vol 34 (7) ◽

pp. 439-443

Author(s):

Jamie McCarrell

Keyword(s):

Health Care ◽

Health Care Services ◽

Patient Advocacy ◽

Health Care Expenditures ◽

The Elderly ◽

The United States ◽

Community Based ◽

Care Services ◽

Care For The Elderly ◽

Ample Opportunity

PACE programs (Programs of All-inclusive Care for the Elderly) across the United States provide a valuable service to older adults with a significant nursing need by allowing them to remain safely living in the community for as long as possible through the provision of extensive, community-based health care services to its participants. Clinical pharmacists have previously been underutilized in PACE, but ample opportunity exists to provide meaningful pharmacy services within PACE programs. Pharmacists working in PACE programs can expect to significantly impact clinical outcomes, health care expenditures, and patient advocacy.

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Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115623 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5623

Author(s):

Jamie M. Smith ◽

Haiqun Lin ◽

Charlotte Thomas-Hawkins ◽

Jennifer Tsui ◽

Olga F. Jarrín

Keyword(s):

Health Care ◽

Home Health Care ◽

Race And Ethnicity ◽

Health Care Services ◽

Propensity Scores ◽

The United States ◽

Home Health ◽

Medicare Beneficiaries ◽

Timely Initiation ◽

Care Services

Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization admission during 2015. Of these patients, 26.6% were discharged to home health care. To evaluate the association between timing of home health care initiation and 30-day rehospitalizations, multivariate logistic regression models including patient demographics, clinical and geographic variables, and neighborhood socioeconomic variables were used. Inverse probability-weighted propensity scores were incorporated into the analysis to account for potential confounding between the timing of home health care initiation and the outcome in the cohort. Compared to the patients who received home health care within the recommended first two days, the patients who received delayed services (3–7 days after discharge) had higher odds of rehospitalization (OR, 1.28; 95% CI, 1.25–1.32). Among the patients who received late services (8–14 days after discharge), the odds of rehospitalization were four times greater than among the patients receiving services within two days (OR, 4.12; 95% CI, 3.97–4.28). Timely initiation of home health care following diabetes-related hospitalizations is one strategy to improve outcomes.

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Revising the ERDs for the 21st Century

Ethics & Medics ◽

10.5840/em202146815 ◽

2021 ◽

Vol 46 (8) ◽

pp. 1-2

Author(s):

John F. Brehany ◽

Keyword(s):

United States ◽

Health Care ◽

21St Century ◽

Health Care Services ◽

Care Delivery ◽

The United States ◽

Care Services ◽

Moral Tradition ◽

Modern Health Care ◽

Catholic Health Care

Since their inception in 1948, The Ethical and Religious Directives for Catholic Health Care Services (ERDs) have guided Catholic health care ministries in the United States, aiding in the application of Catholic moral tradition to modern health care delivery. The ERDs have undergone two major revisions in that time, with about twenty years separating each revision. The first came in 1971 and the second came twenty-six years ago, in 1995. As such, a third major revision is due and will likely be undertaken soon.

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Rural Michigan Farmers’ Health Concerns and Experiences: A Focus Group Study

Journal of Primary Care & Community Health ◽

10.1177/21501327211053519 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110535

Author(s):

Nathan Wright ◽

Marylee Scherdt ◽

Michelle L. Aebersold ◽

Marjorie C. McCullagh ◽

Barbara R. Medvec ◽

...

Keyword(s):

Health Care ◽

Focus Groups ◽

Health Care System ◽

Health Care Services ◽

Well Being ◽

The United States ◽

Full Time ◽

Rural Residents ◽

Care Services ◽

Care System

Objectives: Rural residents comprise approximately 15% of the United States population. They face challenges in accessing and using a health care system that is not structured to meet their unique needs. It is important to understand rural residents’ perceptions of health and experiences interacting with the health care system to identify gaps in care. Methods: Our team conducted focus groups with members of the Michigan Farm Bureau during their 2019 Annual Meeting. Topics explored included resources to manage health, barriers to virtual health care services, and desired changes to localized healthcare delivery. Surveys were used to capture demographic and internet access information. Conclusion: Analysis included data from 2 focus groups (n = 14). Participants represented a wide age range and a variety of Michigan counties. The majority were full-time farm owners with most—93% (n = 13)—reporting they had access to the internet in their homes and 86% (n = 12) reporting that their cellphones had internet capabilities. Participants identified challenges and opportunities in 4 categories: formal health care; health and well-being supports; health insurance experiences; and virtual health care. Conclusion: The findings from this study provide a useful framework for developing interventions to address the specific needs of rural farming residents. Despite the expressed challenges in access and use of health care services and resources, participants remained hopeful that innovative approaches, such as virtual health platforms, can address existing gaps in care. The study findings should inform the design and evaluation of interventions to address rural health disparities.

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Too Much Medicine: Behavioral Science Insights on Overutilization, Overdiagnosis, and Overtreatment in Health Care

Policy Insights from the Behavioral and Brain Sciences ◽

10.1177/2372732218786042 ◽

2018 ◽

Vol 5 (2) ◽

pp. 155-162 ◽

Cited By ~ 6

Author(s):

Victoria A. Shaffer ◽

Laura D. Scherer

Keyword(s):

Health Care ◽

Health Care Services ◽

Behavioral Science ◽

The United States ◽

Science Literature ◽

Psychological Mechanisms ◽

Care Services ◽

Medical Tests ◽

Diagnostic Labels ◽

Cost Of Health Care

Overutilization—defined as the use of health care services for which the benefits do not outweigh the harms—has been identified as one of the leading contributors to the rising cost of health care in the United States. Although informational interventions designed to address overutilization have had a significant, but modest, impact on the rate of overutilization, they have not been sufficient to solve the problem. Also, various psychological mechanisms contribute to the desire for more medical tests and treatments. To effectively address overutilization, we need to better understand the psychological underpinnings of overuse in medicine. The article reviews recent findings from the behavioral science literature—including reliance on anecdotal evidence, test-related affect, the use of diagnostic labels, and medical maximizing tendencies—that lend insight into why patients sometimes seek, demand, or expect medical tests and treatments that are considered by experts to be low value.

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… And Health Care for All: Immigrants in the Shadow of the Promise of Universal Health Care

American Journal of Law & Medicine ◽

10.1177/009885880903500105 ◽

2009 ◽

Vol 35 (1) ◽

pp. 185-204 ◽

Cited By ~ 1

Author(s):

Adrianne Ortega

Keyword(s):

United States ◽

Health Care ◽

Health Care Services ◽

Insurance Coverage ◽

The United States ◽

Care Plan ◽

Universal Health Care ◽

Care Services ◽

Eligibility Requirements ◽

Universal Health

President Obama’s ambitious universal health care plan aims to provide affordable and accessible health care for all. The plan to cover the estimated 46.5 million uninsured, however, ignores the over thirty million non-citizens living in the United States. If the United States passes universal health care coverage, Congress should repeal the prohibitions of the Welfare Reform Act, extend Medicaid coverage to non-citizens, and allow non-citizens to purchase employer-based insurance coverage.President Obama’s plan follows the lead of state universal health care legislation by retaining private, employer-sponsored insurance coverage and expanding the eligibility requirements of the Medicaid program. This strategy will not aid uninsured immigrants or overburdened states and hospitals, though, because current law excludes most non-citizens from nonemergency health care services.

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The future of Indian Health Services for native Americans in the United States: an analysis of policy options and recommendations

Health Economics Policy and Law ◽

10.1017/s1744133116000141 ◽

2016 ◽

Vol 11 (4) ◽

pp. 397-414

Author(s):

Tiffany Henley ◽

Maureen Boshier

Keyword(s):

United States ◽

Health Care ◽

Native Americans ◽

American Indians ◽

Health Care Services ◽

The United States ◽

Policy Options ◽

Care Services ◽

Policy Window ◽

The Impact

AbstractThe passage of the Affordable Care Act in the United States has opened a policy window for the establishment of an independent Medicaid agency for the Navajo Nation. This article explores several policy options to improve health care services for Native Americans. Although there is a lack of scholarly research on the impact of healthcare reform and the effectiveness of current health care programs for American Indians, policymakers should utilize evidence-based research to inform policy decisions.

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Understanding and applying a resource-based relative value system to your neurosurgical practice

Neurosurgical FOCUS ◽

10.3171/foc.2002.12.4.4 ◽

2002 ◽

Vol 12 (4) ◽

pp. 1-5 ◽

Cited By ~ 8

Author(s):

Gregory J. Przybylski

Keyword(s):

Health Care ◽

Health Care Services ◽

Historical Review ◽

Health Care Expenditures ◽

Third Party ◽

Physician Reimbursement ◽

Care Services ◽

Relative Value ◽

Fee Schedule

The payment policy for United States physicians was formerly based on determination of customary and prevailing charges from their fee schedules. Rapidly growing health care expenditures in the 1980s led to a fundamental change in payment reimbursement in which the new system was based on the resource costs to the physician for providing health care services. This reform highlights the significant regulatory morass that has come to burden the health care industry. One of the most critical changes in physician reimbursement was caused by the Congressional mandate that led to the development of a resource-based relative value scale (RBRVS) for the creation of the Medicare physician fee schedule. Most physicians, however, have limited familiarity with the RBRVS system, which now serves as the basis for Medicare-related physician reimbursement as well as many third-party payers. A historical review of the development of the RBRVS will serve as the basis for applying the methodology to improve the effectiveness of the neurosurgeon's practice.

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