Special Needs Insurance: More Stability for a Growing Family's Budget

2021 ◽  
Vol 49 (s1) ◽  
pp. 1-31
Author(s):  
David Morel
Keyword(s):  
Special Needs ◽  
Medical Literature ◽  
Indirect Costs ◽  
Epidemiological Studies ◽  
Direct Costs ◽  
Physical Impairments ◽  
Lump Sum ◽  
Insurance Product ◽  
Single Premium ◽  
Additional Costs

Objective.— To propose an insurance product called special needs insurance. The insurance will pay parents a lump sum up to $100,000 if they have a child that is born with or develops a special needs condition such as Down syndrome, cerebral palsy or autism. Background.— Raising a child is expensive; raising a child with a special need can be hundreds of thousands of dollars more expensive. These additional costs include direct costs that are not covered by health insurance and indirect costs such as the loss of earnings when a working parent must tend to a special needs child. Method.— We analyze a gamut of birth and early childhood disabilities, both physical and cognitive, from the medico-actuarial perspective. We describe each condition using relevant medical literature and calculate prevalence rates from epidemiological studies (appendix A1-A15). After accounting for multiple births, we develop a final premium. Results.— We find that physical impairments are sufficiently well understood to guarantee a fixed payout, whereas cognitive impairments such as autism are less understood, and so for these we propose a cognitive fund that does not guarantee a fixed payout. We find that an average single premium of $4,600 allows the insurer to profitably pay out the proposed benefits. Conclusions.— Raising a special needs child can put a significant strain on the affected family's budget. We propose an insurance product that provides relief through a large lump sum payout. Although no new insurance product can be guaranteed success, our analysis of this product gives an interested insurer reasonable justification to take on this new risk.

scholarly journals Direct and indirect costs and cost-driving factors of Tuberous sclerosis complex in children, adolescents, and caregivers: a multicenter cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Janina Grau ◽  
Johann Philipp Zöllner ◽  
Susanne Schubert-Bast ◽  
Gerhard Kurlemann ◽  
Christoph Hertzberg ◽  
...  
Keyword(s):  
Tuberous Sclerosis ◽  
Direct Cost ◽  
Nursing Care ◽  
Tuberous Sclerosis Complex ◽  
Indirect Costs ◽  
Mtor Inhibitors ◽  
Direct Costs ◽  
Driving Factors ◽  
Care Level ◽  
Organ Manifestations

Abstract Background Tuberous sclerosis complex (TSC), a multisystem genetic disorder, affects many organs and systems, characterized by benign growths. This German multicenter study estimated the disease-specific costs and cost-driving factors associated with various organ manifestations in TSC patients. Methods A validated, three-month, retrospective questionnaire was administered to assess the sociodemographic and clinical characteristics, organ manifestations, direct, indirect, out-of-pocket, and nursing care-level costs, completed by caregivers of patients with TSC throughout Germany. Results The caregivers of 184 patients (mean age 9.8 ± 5.3 years, range 0.7–21.8 years) submitted questionnaires. The reported TSC disease manifestations included epilepsy (92%), skin disorders (86%), structural brain disorders (83%), heart and circulatory system disorders (67%), kidney and urinary tract disorders (53%), and psychiatric disorders (51%). Genetic variations in TSC2 were reported in 46% of patients, whereas 14% were reported in TSC1. Mean total direct health care costs were EUR 4949 [95% confidence interval (95% CI) EUR 4088–5863, median EUR 2062] per patient over three months. Medication costs represented the largest direct cost category (54% of total direct costs, mean EUR 2658), with mechanistic target of rapamycin (mTOR) inhibitors representing the largest share (47%, EUR 2309). The cost of anti-seizure drugs (ASDs) accounted for a mean of only EUR 260 (5%). Inpatient costs (21%, EUR 1027) and ancillary therapy costs (8%, EUR 407) were also important direct cost components. The mean nursing care-level costs were EUR 1163 (95% CI EUR 1027–1314, median EUR 1635) over three months. Total indirect costs totaled a mean of EUR 2813 (95% CI EUR 2221–3394, median EUR 215) for mothers and EUR 372 (95% CI EUR 193–586, median EUR 0) for fathers. Multiple regression analyses revealed polytherapy with two or more ASDs and the use of mTOR inhibitors as independent cost-driving factors of total direct costs. Disability and psychiatric disease were independent cost-driving factors for total indirect costs as well as for nursing care-level costs. Conclusions This study revealed substantial direct (including medication), nursing care-level, and indirect costs associated with TSC over three months, highlighting the spectrum of organ manifestations and their treatment needs in the German healthcare setting. Trial registration: DRKS, DRKS00016045. Registered 01 March 2019, http://www.drks.de/DRKS00016045.

scholarly journals POS0530 HOW DOES MULTIMORBIDITY IMPACT ON THE DIRECT AND INDIRECT COSTS IN PATIENTS WITH RHEUMATOID ARTHRITIS?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 498.3-499
Author(s):  
P. H. Hsieh ◽  
C. Geue ◽  
O. Wu ◽  
E. McIntosh
Keyword(s):  
Rheumatoid Arthritis ◽  
Early Rheumatoid Arthritis ◽  
Employment Status ◽  
Functional Disability ◽  
Hospital Admissions ◽  
Information Service ◽  
Indirect Costs ◽  
Direct Costs ◽  
Direct And Indirect Costs ◽  
The Impact

Background:Comorbidities are prevalent in patients with rheumatoid arthritis (RA) and associated with worse outcomes as well as higher economic burden. Little is known about the impact of multimorbidity on the direct and indirect costs of RA. Evidence of the incremental scale of these multimorbidity costs will usefully inform RA interventions and policies.Objectives:The aim of this study was to describe how multimorbidity impacts on the cost-of-illness, including direct and indirect costs, in patients with RA.Methods:The Scottish Early Rheumatoid Arthritis (SERA) is a registry of patients newly presenting with RA since 2011. It contains data on patient characteristics, clinical outcomes, health-related quality of life, and employment status data. These data were linked to routinely recorded hospital admissions and primary care prescribing data. Direct costs were estimated by applying relevant unit costs to healthcare resource use quantities. Indirect cost estimates were obtained from information on employment status and hospital admissions, valued by age and sex specific wages. Two-part models (probit followed by generalized linear model) were used to estimate direct and indirect costs, adjusting for age, gender, and functional disability. The Charlson Comorbidity Index (CCI) score was calculated using patient ICD-10 diagnoses from hospital records. The number of comorbidities was categorized into “RA alone”, “single comorbidity” and “multimorbidity (>1 comorbidity)”.Results:Data were available for 1,150 patients, 65.7% were female and a mean age of 57.5±14 years. The majority of patients only had RA (54.1%), followed by a single comorbidity (23.4%) and multimorbidity (22.5%). Annual total costs were significantly higher for patients with multimorbidity (£6,669 95% CI £4,871-£8,466; OR 11.3 95% CI 8.14-15.87) and for patients with a single comorbidity (£2,075 95% CI £1,559-£2,591; OR 3.52 95% CI 2.61-4.79), when compared with RA alone (£590). The excess costs were mainly driven by direct costs (£6,281 versus £1,875 versus £556). Although the difference in indirect costs between patients with multimorbidity and a single comorbidity were not statistically significant (£1,218 versus £914, p=0.11), patients with multimorbidity were associated with significantly higher costs than those with RA only (£594, p<0.01).Conclusion:The presence of comorbidity contributes significant excess to both direct and indirect costs among RA patients. In particular, patients with multimorbidity incurred substantially higher direct costs than those with a single comorbidity or RA only.Acknowledgements:The study analysed the data from the Scottish Early Rheumatoid Arthritis (SERA) study with a linkage to routinely recorded health data from Information Service Division, National Service Scotland. We would like to thank all the patients, clinical and nursing colleagues who have contributed their time and support to the study, the SERA steering committee for the approval, and Allen Tervit from the Robertson Centre for Biostatistics, University of Glasgow for the timely technical supports.Disclosure of Interests:Ping-Hsuan Hsieh: None declared, Claudia Geue: None declared, Olivia Wu Consultant of: OW has received consultancy fees from Bayer, Lupin and Takeda outside the submitted work., Emma McIntosh: None declared

scholarly journals The physiological costs of reproduction in small mammals

2007 ◽  
Vol 363 (1490) ◽  
pp. 375-398 ◽  
Author(s):  
John R Speakman
Keyword(s):  
Life History ◽  
Small Mammals ◽  
Morphological Changes ◽  
Life History Evolution ◽  
Indirect Costs ◽  
Direct Costs ◽  
Costs Of Reproduction ◽  
Dominant Component ◽  
Trade Offs ◽  
Almost All

Life-history trade-offs between components of fitness arise because reproduction entails both gains and costs. Costs of reproduction can be divided into ecological and physiological costs. The latter have been rarely studied yet are probably a dominant component of the effect. A deeper understanding of life-history evolution will only come about once these physiological costs are better understood. Physiological costs may be direct or indirect. Direct costs include the energy and nutrient demands of the reproductive event, and the morphological changes that are necessary to facilitate achieving these demands. Indirect costs may be optional ‘compensatory costs’ whereby the animal chooses to reduce investment in some other aspect of its physiology to maximize the input of resource to reproduction. Such costs may be distinguished from consequential costs that are an inescapable consequence of the reproductive event. In small mammals, the direct costs of reproduction involve increased energy, protein and calcium demands during pregnancy, but most particularly during lactation. Organ remodelling is necessary to achieve the high demands of lactation and involves growth of the alimentary tract and associated organs such as the liver and pancreas. Compensatory indirect costs include reductions in thermogenesis, immune function and physical activity. Obligatory consequential costs include hyperthermia, bone loss, disruption of sleep patterns and oxidative stress. This is unlikely to be a complete list. Our knowledge of these physiological costs is currently at best described as rudimentary. For some, we do not even know whether they are compensatory or obligatory. For almost all of them, we have no idea of exact mechanisms or how these costs translate into fitness trade-offs.

scholarly journals Disease-Associated Costs in Children With Inflammatory Bowel Disease: A Systematic Review

2019 ◽  
Vol 26 (2) ◽  
pp. 206-215 ◽  
Author(s):  
Wael El-Matary ◽  
M Ellen Kuenzig ◽  
Harminder Singh ◽  
George Okoli ◽  
Mohammad Moghareh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Meta Analysis ◽  
Indirect Costs ◽  
Direct Costs ◽  
Variable Cost ◽  
Cost Estimates ◽  
Comorbidity Burden ◽  
Inflammatory Bowel

Abstract Background As a chronic noncurable disorder often diagnosed in childhood or adolescence, inflammatory bowel disease (IBD) confers a significant financial lifetime burden. The objective of this systematic review was to determine the disease-associated costs (both direct and indirect) associated with IBD in children and young adults. Methods We conducted a systematic review of the literature and included any study reporting direct health services–related costs or the indirect economic burden of IBD in persons aged ≤19 years (PROSPERO protocol number CRD2016036128). A technical panel of experts in pediatric gastroenterology and research methodology formulated the review questions, reviewed the search strategies and review methods, and provided input throughout the review process. Results Nine studies met criteria for inclusion, 6 of which examined direct costs, 1 of which examined both direct and indirect costs, 1 of which assessed indirect costs, and 1 of which assessed out-of-pocket (OOP) costs. Inflammatory bowel disease–associated costs were significantly higher compared with costs in non-IBD populations, with wide variations in cost estimates, which prevented us from conducting a meta-analysis. Costs in Crohn’s disease were higher than in ulcerative colitis. Overall, direct costs shifted from inpatient hospitalization as a major source of direct costs to medications, mainly driven by anti–tumor necrosis factor agents, as the leading cause of direct costs. Predictors of high costs included uncontrolled disease, corticosteroid treatment in the previous year, and comorbidity burden. Conclusions The pediatric literature examining IBD-attributable costs is limited, with widely variable cost estimates. There is a significant knowledge gap in the research surrounding indirect costs and OOP expenses.

scholarly journals Burden of Chickenpox on Families: A Study in Quebec

2001 ◽  
Vol 12 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Philippe De Wals ◽  
Manon Blackburn ◽  
Maryse Guay ◽  
Gina Bravo ◽  
Danièle Blanchette ◽  
...  
Keyword(s):  
Public Sector ◽  
Indirect Costs ◽  
Direct Costs ◽  
Postal Survey ◽  
Childhood Immunization ◽  
The Public ◽  
History Of ◽  
Absence From Work ◽  
Families With Children ◽  
Time Away

OBJECTIVE:To estimate the nonhospital costs of treating chickenpox and to ascertain the opinion of parents regarding the usefulness of vaccination. DESIGN: Retrospective postal survey.SETTING:Province of Quebec.PARTICIPANTS:Random sample of 3333 families with children aged six months to 12 years.OUTCOME MEASURES:For cases of chickenpox that occurred between September 1, 1997 and August 31, 1998, the use of health services, time away from school or work, patient care required, direct and indirect costs for the families and the health care system, and the opinion of parents regarding chickenpox and the vaccine were evaluated.RESULTS:The response rate was 64.7%, and 18.8% of households reported a history of chickenpox, a total of 693 cases. A physician was consulted in 45.8% of these cases, and medication was used in 91.7%. The frequency of hospitalizations was 0.6%. Time away from work or school caused by the disease was 4.1 days on average, with 46.5% of absences being attributed to the risk of contagion. The total average cost of a case of chickenpox was $225. Direct expenses for households accounted for 11% of the total cost, public sector direct costs 7%, indirect costs related to absence from work 38% and caregiving time 45%. A majority of parents (70%) were in favour of a systematic childhood immunization program.CONCLUSIONS:Chickenpox without complications is disruptive for families, but the direct costs for families and the public sector are relatively small.

scholarly journals Measuring the Total Cost of Ankle Fractures: A Prospective Analysis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0006
Author(s):  
Peter C. Noback ◽  
Tess Dougherty ◽  
Christina Freibott ◽  
Eric F. Swart ◽  
Melvin P. Rosenwasser ◽  
...  
Keyword(s):  
Return To Work ◽  
Indirect Cost ◽  
Direct Cost ◽  
Indirect Costs ◽  
The United States ◽  
Direct Costs ◽  
Cost Data ◽  
Ankle Fractures ◽  
Total Cost ◽  
True Value

Category: Trauma; Ankle Introduction/Purpose: Ankle fractures (AFx) are the most common foot and ankle fracture seen at hospitals in the United States, and are undoubtedly costly to patients. Quantification of the costs of fractures and their associated treatments has garnered increased attention in orthopedics in recent years through cost-effectiveness analysis. However, literature pertaining to AFx’s almost never reports on the indirect costs of AFx’s, and thus fails to accurately assess the true value of treatments. The purpose of this study was to prospectively assess the direct and indirect costs of AFx’s in operatively and nonoperatively treated patients. Secondary analysis included evaluation of the composition of indirect cost, the duration these costs are endured, and the factors that influence their magnitude. Methods: A prospective observational single-center study was performed. Adult patients presenting for initial consult for an AFx that could speak English or Spanish were enrolled. Polytrauma patients and those unable to provide complete indirect cost data were excluded. Patients completed a cost form that asked the money they had spent in the last week on transportation, household chores, and self-care due to their AFx. Patients were considered to have complete indirect cost data if they returned for follow-up visits until they reported no recurring indirect costs and had returned to work. Direct cost data was obtained directly from the hospital billing department. Amount collected was utilized. Direct costs included any costs incurred from staff treating the patient, supplies required for treatment, and the use of healthcare facilities. A descriptive analysis of the entire cohort and stratification by operative status was performed for the primary comparative analysis. Results: 60 patients were ultimately analyzed. Average age was 46.5 years. 55% were female. 10% of patients were diabetic. 17% smoked cigarettes actively. Weber A, B, and C fractures composed 12%, 72%, and 18% of fractures, respectively. Operatively treated patients (n=37) had a significantly higher total and direct cost than non-operative patients (P<0.01). Average salary of the 39 employed patients was $61,416 and return to work period was 11.2 weeks. In all patients, lost income accounted for the largest portion of total and indirect cost, averaging 38% of total cost. Longer periods of return to work were significantly associated with undergoing surgery and having less than a college-level education (P<0.05). Average number of weeks for indirect costs to amount to zero was 19.1. Conclusion: In patients treated operatively and nonoperatively, the largest cost component was an indirect cost: missed wages at 28.6% and 63.3%, respectively. While the majority of the direct costs of AFx’s are accrued in the period immediately following the injury, indirect cost components will regularly be incurred for nearly 5 months and often longer. The degree and duration to which these indirect costs accumulate are novel findings. Future research should no longer neglect reporting on an intervention’s impact on the indirect costs of AFx’s. [Table: see text]

scholarly journals Role of endoscopy in gastroesophageal reflux disease

2015 ◽  
Vol 6 (03) ◽  
pp. 89-95
Author(s):  
Tarun Rai ◽  
Prashanth Vennalaganti ◽  
Prateek Sharma
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Indirect Costs ◽  
The United States ◽  
Epidemiological Studies ◽  
Western World ◽  
Western Countries ◽  
American Society

AbstractGastroesophageal reflux disease is a condition due to reflux of stomach content in the esophagus causing trouble symptoms or complications or both. GERD is a clinical diagnosis and typically presents with a heartburn and/or regurgitation and a positive response to antacid secretory medications. GERD is the leading outpatient diagnosis among all gastrointestinal disorders in the United States. Approximately 40% of population report occasional symptoms of GERD whereas 10-20% of patients will have symptoms at least once in a week. Recent guidelines from gastrointestinal societies such as American College of Gastroenterology, American Society for Gastrointestinal Endoscopy and American College of Physicians have laid out specific indications regarding role of esophagogastroduodenoscopy in GERD. Despite these recommendations, studies have revealed that one-fifth to two-fifth EGDs may not be clinically indicated, especially where open access endoscopy referral system is used. Traditionally, GERD has been thought to be a disease of the western world. Prevalence rates had been estimated to be lower in Asia when compared to that of the Western Countries. Few recent epidemiological studies in India showed the prevalence of reflux disease in India to be between 8-24%, which is comparable to the western world. The use of EGDs becomes more critical for developing countries such as India where prevalence of GERD and BE is comparable to the western countries but have limited resources. In addition to direct cost for an EGD, it burdens economy with indirect costs such as time off from the work, transportation and any procedural complications. Risk stratifying patients with GERD may therefore prevent unnecessary procedures, harms and costs. The aim of this paper is to review the existing evidence on the role of endoscopy in GERD.

MODEL BIAYA TIDAK LANGSUNG PROYEK STRUKTUR GEDUNG BETON BERTULANG

1970 ◽  
Author(s):  
I Ketut Nudja S ◽  
I N. Sutarja ◽  
Mayun Nadiasa
Keyword(s):  
Reinforced Concrete ◽  
Indirect Cost ◽  
Cost Model ◽  
Linear Regression Analysis ◽  
Indirect Costs ◽  
Direct Costs ◽  
Accounting System ◽  
Building Structures ◽  
Reinforced Concrete Building ◽  
Concrete Building

The cost of the project itself , in line with the accounting system which consists of direct costs and indirect costs . Contractor in determining competitive bidding strategy, should propose a cost which include estimate real cost plus mark up . Based on observations at PT. Sarana Bangun Ragam Cipta, a contractor company , found that the company does not  follow the rules mentioned above, Besides that the book keeping system for the project cost has not implemented a financial accounting system properly , so that the  proportion of direct costs and indirect costs of each project is un know. It required a study to be conducted to  determine the proportion of direct costs to indirect costs and indirect cost model. Quantitative research was conducted on the 12 (twelve ) project of  reinforced concrete building structures using two (2 ) independent variables , namely the direct costs ( X1 ) and duration ( X2 ) and 1 ( one ) dependent variable , ie indirect costs (? ) . Descriptive analysis to determine the proportion of indirect costs to direct costs . Analysis of data using multiple linear regression analysis to determine the indirect cost model of reinforced concrete building structures projects. From analysis found the average proportion of indirect costs to direct cost was 8.50 % , meanwhile  indirect cost model is ? = - 1.462E7 + 0.056 ( X1 ) + 558,775.937 ( X2 ) , where : ? = Indirect costs ( Rp . ) , X1 = direct costs (Rp .) , X2 = Duration ( days ) . The proportion of indirect costs can be used to calculate indirect costs = 0.085 x direct costs and the above model can also be used to predict the value of ? with accuracy 90% or at ? (±) 0.10, if the values ??of X1 and X2 is know on popolation where the data is taken

Economic evaluation of adjuvant chemotherapy in Stage III (SIII) colon cancer: Capecitabine versus 5FU/LV

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6046-6046 ◽  
Author(s):  
K. Virik ◽  
C. Skedgel ◽  
T. Younis
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Drug Cost ◽  
Indirect Costs ◽  
Cost Effective ◽  
Recurrence Risk ◽  
Direct Costs ◽  
Cost Difference ◽  
Free Survival ◽  
Risk Of Cancer

6046 Background: Adjuvant chemotherapy for SIII colon cancer is an accepted standard of care. Oral Capecitabine (C) has been shown to be at least equivalent and possibly superior to 5FU/LV (F) with a superior relapse free survival (RFS). This new option is associated with a higher drug cost. An economic analysis was undertaken to compare these two alternatives. Methods: A cost minimisation analysis was performed in Canadian $ ($) using C and F given as per the X-ACT (X) trial. The direct costs including chemotherapy drug acquisition, supportive medications, laboratory investigation and health resources utilisation were examined based in Nova Scotia. Indirect costs included travel and opportunity cost based on the average provincial wage and participation rates. Complete drug delivery was assumed. A direct payer perspective was used. A cost-effectiveness (CE) model was also constructed to estimate the required lower risk of cancer recurrence for C to be cost effective compared to F at a commonly used CE threshold. The Markov model developed used a hypothetical cohort of 1,000 patients with SIII colon cancer and projected costs and outcomes over 5 years (discounted 3% and in $2,005). All recurrences were modeled to death. Recurrence rates, median survival with recurrent disease, costs and utility scores were derived from the literature. Estimates of background mortality without recurrence were obtained from Canadian Life Tables. Sensitivity analysis (SA) was performed using a range of recurrence risk hazard ratios (HR) including that reported in the X trial. Results: Compared to F, C is associated with higher direct costs, principally reflecting the higher drug cost (difference: $5,589/patient) but less resources utilisation cost (difference: - $1,804/patient). The total indirect costs favour C (difference: - $2,464/patient). For C to be potentially CE compared to 5FU/LV, a ≥ 9% lower relative recurrence risk (HR = 0.91) with C would be required. At the reported RFS HR 0.86, the CE of C relative to F is $15,844 per disease free survival years gained and $22,097 per quality adjusted life years gained. Conclusions: C has more direct costs but has indirect cost savings. It has the potential to be cost effective as seen in the SA and is a CE alternative to F at the HR for RFS reported in the X trial. No significant financial relationships to disclose.

Impact of bovine respiratory disease (BRD) from the perspective of the Canadian beef producer

2009 ◽  
Vol 10 (2) ◽  
pp. 109-110 ◽  
Author(s):  
Kee Jim
Keyword(s):  
Respiratory Disease ◽  
Bovine Respiratory Disease ◽  
Indirect Costs ◽  
Direct Costs ◽  
Production Costs ◽  
Direct And Indirect Costs ◽  
Carcass Disposal ◽  
The Cost

AbstractThe costs of bovine respiratory disease (BRD) to the beef producer can be estimated by identifying and summing the direct and indirect costs associated with the disease. The major direct costs are attributable to the cost of the feeder, production costs and carcass disposal. The indirect costs are mainly associated with infrastructure and labour.

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