scholarly journals Heterogeneity in Choice Inconsistencies among the Elderly: Evidence from Prescription Drug Plan Choice

2011 ◽  
Vol 101 (3) ◽  
pp. 377-381 ◽  
Author(s):  
Jason Abaluck ◽  
Jonathan Gruber
Keyword(s):  
Cost Savings ◽  
The Elderly ◽  
Potential Cost ◽  
Part D ◽  
Plan Choice ◽  
Choice Sets ◽  
Drug Expenditures ◽  
Prescription Drug Plan ◽  
Risk Protection ◽  
Out Of Pocket Costs

This paper investigates the degree to which choice inconsistencies documented in the context of Medicare Part D plan choice vary across consumers and geographic regions. Our main finding is that there is surprisingly little variation: regardless of age, gender, predicted drug expenditures or the predictability of drug demand consumers underweight out of pocket costs relative to premiums and fail to consider the individualized consequences of plan characteristics; as a result, they frequently choose plans which are dominated in the sense that an alternative plan provides better risk protection at a lower cost. We find limited evidence that the sickest individuals had more difficulty with plan choice, and we document that much of the variation in potential cost savings across states comes from variation in choice sets, not variation in consumers ability to choose.

scholarly journals Choice Inconsistencies among the Elderly: Evidence from Plan Choice in the Medicare Part D Program

2011 ◽  
Vol 101 (4) ◽  
pp. 1180-1210 ◽  
Author(s):  
Jason Abaluck ◽  
Jonathan Gruber
Keyword(s):  
Prescription Drug ◽  
No Value ◽  
Medicare Part D ◽  
The Elderly ◽  
Medicare Part ◽  
Part D ◽  
Plan Choice ◽  
Choice Sets ◽  
Prescription Drug Plan ◽  
Financial Characteristics

We evaluate the choices of elders across their insurance options under the Medicare Part D Prescription Drug plan, using a unique dataset of prescription drug claims matched to information on the characteristics of choice sets. We document that elders place much more weight on plan premiums than on expected out-of-pocket costs; value plan financial characteristics beyond any impacts on their own financial expenses or risk; and place almost no value on variance-reducing aspects of plans. Partial equilibrium welfare analysis implies that welfare would have been 27 percent higher if patients had all chosen rationally. (JEL D12, I11, J14)

scholarly journals Choice Inconsistencies among the Elderly: Evidence from Plan Choice in the Medicare Part D Program: Reply

2016 ◽  
Vol 106 (12) ◽  
pp. 3962-3987 ◽  
Author(s):  
Jason Abaluck ◽  
Jonathan Gruber
Keyword(s):  
Fixed Effects ◽  
Goodness Of Fit ◽  
The Elderly ◽  
Parametric Models ◽  
Part D ◽  
Plan Choice ◽  
Out Of Sample ◽  
Nonparametric Alternatives ◽  
Expected Utility Model

We explore the in- and out-of-sample robustness of tests for choice inconsistencies based on parameter restrictions in parametric models, focusing on tests proposed by Ketcham, Kuminoff, and Powers (2016). We argue that their nonparametric alternatives are inherently conservative with respect to detecting mistakes. We then show that our parametric model is robust to KKP’s suggested specification checks, and that comprehensive goodness of fit measures perform better with our model than the expected utility model. Finally, we explore the robustness of our 2011 results to alternative normative assumptions highlighting the role of brand fixed effects and unobservable characteristics. (JEL D12, H51, I13, I18, J14)

scholarly journals Choice Inconsistencies among the Elderly: Evidence from Plan Choice in the Medicare Part D Program: Comment

2016 ◽  
Vol 106 (12) ◽  
pp. 3932-3961 ◽  
Author(s):  
Jonathan D. Ketcham ◽  
Nicolai V. Kuminoff ◽  
Christopher A. Powers
Keyword(s):  
Utility Maximization ◽  
Medicare Part D ◽  
The Elderly ◽  
Nonparametric Tests ◽  
Medicare Part ◽  
Enrollment Decisions ◽  
Part D ◽  
Plan Choice ◽  
Out Of Sample ◽  
Validation Tests

Consumers' enrollment decisions in Medicare Part D can be explained by Abaluck and Gruber's (2011) model of utility maximization with psychological biases or by a neoclassical version of their model that precludes such biases. We evaluate these competing hypotheses by applying nonparametric tests of utility maximization and model validation tests to administrative data. We find that 79 percent of enrollment decisions from 2006 to 2010 satisfied basic axioms of consumer theory under the assumption of full information. The validation tests provide evidence against widespread psychological biases. In particular, we find that precluding psychological biases improves the structural model's out-of-sample predictions for consumer behavior. (JEL C52, D12, I13, I18, J14)

scholarly journals Utilization of Generic Cardiovascular Drugs in Medicare’s Part D Program

2021 ◽  
Author(s):  
Iris Ma ◽  
Rebecca L. Tisdale ◽  
Daniel Vail ◽  
Paul A. Heidenreich ◽  
Alexander T. Sandhu
Keyword(s):  
Generic Substitution ◽  
Cost Savings ◽  
Medicare Part D ◽  
Cardiovascular Drugs ◽  
Medicare Part ◽  
Brand Name ◽  
Potential Cost ◽  
Part D ◽  
Patient Consent ◽  
Generic Medications

Background: Generic medications cost less than brand-name medications and are similarly effective, but brand-name medications are still prescribed. We evaluated patterns in generic cardiovascular medication fills and estimated the potential cost savings with increased substitution of generic for brand-name medications. Methods: This was a cross-sectional study of cardiovascular therapies using the Medicare Part D database of prescription medications in 2017. We evaluated drug fill patterns for therapies with available brand-name and generic options. We determined the generic substitution ratio and estimated the potential savings with increased generic substitution at the national, state, and clinician level. We compared states with laws related to mandatory pharmacist generic substitution and patient consent for substitution. Results: Of ≈$22.9 billion spent on cardiovascular drugs in Medicare Part D prescription programs in 2017, ≈$11.0 billion was spent on medications with both brand-name and generic options. Although only 2.4% of medication fills were for the brand-name choice, they made up 21.2% of total spending. Accounting for estimated brand-name rebates, generic substitution for these medications would save $641 million, including $135 million in costs shouldered by patients. Furthermore, the minority of clinicians with the lowest generic utilization was responsible for a large proportion of the potential cost savings. Conclusions: There are substantial potential cost savings from substituting brand-name medications with generic medications. These savings would be primarily driven by lower use of brand-name therapies by the minority of clinicians who prescribe them at increased rates.

Abstract WP385: Delirium Significantly Contributes to Longer Hospitalization and Higher Post-Discharge Costs for Stroke Patients: An Analysis of Nationwide Data

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Aditya Kumar ◽  
Arvind Bambhroliya ◽  
Jennifer Meeks ◽  
Alicia Zha ◽  
Sunil A Sheth ◽  
...  
Keyword(s):  
Healthcare Costs ◽  
Linear Models ◽  
Cost Savings ◽  
Stroke Care ◽  
The Elderly ◽  
Index Admission ◽  
Index Hospitalization ◽  
Stroke Patients ◽  
Post Discharge ◽  
Potential Cost

Background: Healthcare costs related to delirium in the elderly and in the post-operative patient populations exceed $150 billion a year. Stroke patients are at a higher risk of developing delirium, which can significantly increase their healthcare costs. Incremental hospitalization and post-discharge costs associated with delirium have not been described in stroke patients. Methods: We analyzed Nationwide Readmission Data from 2010 - 2015 and identified adult (≥18) ischemic and hemorrhagic stroke patients. In-hospital delirium was identified using a validated algorithm. Patients who died during index hospitalization were excluded. Costs for index hospitalization and readmissions were determined using cost to charge ratios, and inflation adjusted to 2015 USD. We used generalized linear models to compare costs between delirious and non-delirious patients adjusting for demographics, comorbidities, illness severity, treatment intensity, in-hospital complications, and surgical procedures. Results: A total of 2,853,175 stroke discharges were included among whom 7.1% were documented to havein-hospital delirium on index admission. Delirious patients had a longer mean length of stay (12.01 vs 7.38 days), and higher 30-day readmission rates (16.7% vs 12.2%). At index admission, delirious patients had 9.9% higher adjusted costs of hospitalization as compared to non-delirious patients. For all admissions (including readmissions), delirious stroke patients had 12.3% higher adjusted costs of hospitalization, which translates into an additional $10,544.2 (2015) per hospitalization. (Figure) Conclusion: Our analyses highlight the potential cost savings in stroke care associated with prevention, recognition, early mitigation and effective management of delirium. Even though delirium prevalence may be underestimated in administrative data, these results indicate potential annual nationwide cost savings of more than $350 million for stroke care.

Integrated Tubulars Supply Model Provides Cost Savings to Drilling Projects

2020 ◽  
Author(s):  
M. Hamzah
Keyword(s):  
Supply Chain ◽  
Cost Savings ◽  
Asia Pacific ◽  
Potential Cost ◽  
Alternative Scheme ◽  
Safety Stocks ◽  
Storage Location ◽  
Supply Planning ◽  
Drilling Site ◽  
Drilling Project

Classical Oil Country Tubular Goods (OCTG) procurement approach has been practiced in the indus-try with the typical process of setting a quantity level of tubulars ahead of the drilling project, includ-ing contingencies, and delivery to a storage location close to the drilling site. The total cost of owner-ship for a drilling campaign can be reduced in the range of 10-30% related to tubulars across the en-tire supply chain. In recent decades, the strategy of OCTG supply has seen an improvement resulting in significant cost savings by employing the integrated tubular supply chain management. Such method integrates the demand and supply planning of OCTG of several wells in a drilling project and synergize the infor-mation between the pipes manufacturer and drilling operators to optimize the deliveries, minimizing inventory levels and safety stocks. While the capital cost of carrying the inventory of OCTG can be reduced by avoiding the procurement of substantial volume upfront for the entire project, several hidden costs by carrying this inventory can also be minimized. These include storage costs, maintenance costs, and costs associated to stock obsolescence. Digital technologies also simplify the tasks related to the traceability of the tubulars since the release of the pipes from the manufacturing facility to the rig floor. Health, Safety, and Environmental (HSE) risks associated to pipe movements on the rig can be minimized. Pipe-by-pipe traceability provides pipes’ history and their properties on demand. Digitalization of the process has proven to simplify back end administrative tasks. The paper reviews the OCTG supply methods and lays out tangible improvement factors by employ-ing an alternative scheme as discussed in the paper. It also provides an insight on potential cost savings based on the observed and calculated experiences from several operations in the Asia Pacific region.

Improved Oxygen Dissolution Control for Oxygen Activated Sludge

1988 ◽  
Vol 20 (4-5) ◽  
pp. 101-108 ◽  
Author(s):  
R. C. Clifft ◽  
M. T. Garrett
Keyword(s):  
Activated Sludge ◽  
Control Method ◽  
Control Strategies ◽  
Cost Savings ◽  
Utilization Efficiency ◽  
Oxygen Production ◽  
Oxygen Utilization ◽  
Potential Cost ◽  
Oxygen Dissolution ◽  
The City

Now that oxygen production facilities can be controlled to match the requirements of the dissolution system, improved oxygen dissolution control can result in significant cost savings for oxygen activated sludge plants. This paper examines the potential cost savings of the vacuum exhaust control (VEC) strategy for the City of Houston, Texas 69th Street Treatment Complex. The VEC strategy involves operating a closed-tank reactor slightly below atmospheric pressure and using an exhaust apparatus to remove gas from the last stage of the reactor. Computer simulations for one carbonaceous reactor at the 69th Street Complex are presented for the VEC and conventional control strategies. At 80% of design loading the VEC strategy was found to provide an oxygen utilization efficiency of 94.9% as compared to 77.0% for the conventional control method. At design capacity the oxygen utilization efficiency for VEC and conventional control was found to be 92.3% and 79.5%, respectively. Based on the expected turn-down capability of Houston's oxygen production faciilities, the simulations indicate that the VEC strategy will more than double the possible cost savings of the conventional control method.

Cost-minimization analysis of drugs used in the treatment of Asthma and COPD diseases in India

2020 ◽  
Vol 15 ◽  
Author(s):  
Billu Payal ◽  
Anoop Kumar ◽  
Harsh Saxena
Keyword(s):  
Generic Drugs ◽  
Cost Minimization ◽  
Cost Savings ◽  
Chronic Obstructive ◽  
Pulmonary Medicine ◽  
Potential Cost ◽  
Maximum Cost ◽  
Cost Minimization Analysis ◽  
Cost Variation ◽  
The Cost

Background: Asthma and Chronic Obstructive Pulmonary Diseases (COPD) are well known respiratory diseases affecting millions of peoples in India. In the market, various branded generics, as well as generic drugs, are available for their treatment and how much cost will be saved by utilizing generic medicine is still unclear among physicians. Thus, the main aim of the current investigation was to perform cost-minimization analysis of generic versus branded generic (high and low expensive) drugs and branded generic (high expensive) versus branded generic (least expensive) used in the Department of Pulmonary Medicine of Era Medical University, Lucknow for the treatment of asthma and COPD. Methodology: The current index of medical stores (CIMS) was referred for the cost of branded drugs whereas the cost of generic drugs was taken from Jan Aushadi scheme of India 2016. The percentage of cost variation particularly to Asthma and COPD regimens on substituting available generic drugs was calculated using standard formula and costs were presented in Indian Rupees (as of 2019). Results: The maximum cost variation was found between the respules budesonide high expensive branded generic versus least expensive branded generic drugs and generic versus high expensive branded generic. In combination, the maximum cost variation was observed in the montelukast and levocetirizine combination. Conclusion: In conclusion, this study inferred that substituting generic antiasthmatics and COPD drugs can bring potential cost savings in patients.

Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience

2021 ◽  
pp. 193229682110025
Author(s):  
Urooj Najmi ◽  
Waqas Zia Haque ◽  
Umair Ansari ◽  
Eyerusalem Yemane ◽  
Lee Ann Alexander ◽  
...  
Keyword(s):  
Insulin Aspart ◽  
Community Hospital ◽  
Task Force ◽  
Hospital Setting ◽  
Cost Savings ◽  
Self Management ◽  
Self Administration ◽  
Potential Cost ◽  
Hospital Leadership ◽  
Insulin Pens

Background: Insulin pen injectors (“pens”) are intended to facilitate a patient’s self-administration of insulin and can be used in hospitalized patients as a learning opportunity. Unnecessary or duplicate dispensation of insulin pens is associated with increased healthcare costs. Methods: Inpatient dispensation of insulin pens in a 240-bed community hospital between July 2018 and July 2019 was analyzed. We calculated the percentage of insulin pens unnecessarily dispensed for patients who had the same type of insulin pen assigned. The estimated cost of insulin pen waste was calculated. A pharmacist-led task force group implemented hospital-wide awareness and collaborated with hospital leadership to define goals and interventions. Results: 9516 insulin pens were dispensed to 3121 patients. Of the pens dispensed, 6451 (68%) were insulin aspart and 3065 (32%) were glargine. Among patients on insulin aspart, an average of 2.2 aspart pens was dispensed per patient, but only an estimated 1.2 pens/patient were deemed necessary. Similarly, for inpatients prescribed glargine, an average of 2.1 pens/patient was dispensed, but only 1.3 pens/patient were necessary. A number of gaps were identified and interventions were undertaken to reduce insulin pen waste, which resulted in a significant decrease in both aspart (p = 0.0002) and glargine (p = 0.0005) pens/patient over time. Reductions in pen waste resulted in an estimated cost savings of $66 261 per year. Conclusions: In a community hospital setting, identification of causes leading to unnecessary insulin dispensation and implementation of hospital-wide staff education led to change in insulin pen dispensation practice. These changes translated into considerable cost savings and facilitated diabetes self-management education.

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