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.

scholarly journals Catastrophic health care expenditure due to septic shock and dengue shock in Vietnam

2019 ◽  
Vol 113 (10) ◽  
pp. 649-651 ◽  
Author(s):  
Angela McBride ◽  
B Thuy Duong ◽  
V Vinh Chau Nguyen ◽  
C Louise Thwaites ◽  
Hugo C Turner ◽  
...  
Keyword(s):  
Health Care ◽  
Septic Shock ◽  
Critical Care ◽  
Health Care Expenditure ◽  
Health Care Expenditures ◽  
Cost Of Treatment ◽  
Catastrophic Payments ◽  
The Cost ◽  
Median Hospital ◽  
Catastrophic Health Care Expenditure

Abstract Background The cost of treatment for infectious shock in intensive care in Vietnam is unknown. Methods We prospectively investigated hospital bills for adults treated for septic and dengue shock in Vietnam and calculated the proportion who faced catastrophic health care expenditures. Results The median hospital bills were US$617 for septic shock (n=100) and US$57 for dengue shock (n=88). Catastrophic payments were incurred by 47% (47/100) and 13% (11/88) of patients with septic shock and dengue shock, respectively, and 56% (25/45) and 84% (5/6) fatal cases of septic shock and dengue shock respectively. Conclusions Further advocacy is required to moderate insurance co-payments for costly critical care interventions.

scholarly journals THU0548 THE ECONOMIC BURDEN OF ANKYLOSING SPONDYLITIS IN SPAIN. RESULTS OF THE SPANISH ATLAS 2017

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 514.2-514
Author(s):  
M. Merino ◽  
O. Braçe ◽  
A. González ◽  
Á. Hidalgo-Vega ◽  
M. Garrido-Cumbrera ◽  
...  
Keyword(s):  
Health Care ◽  
Ankylosing Spondylitis ◽  
Health Care Costs ◽  
Health Care Cost ◽  
Labour Productivity ◽  
General Health Questionnaire ◽  
Indirect Costs ◽  
Productivity Losses ◽  
The Cost ◽  
Care Costs

Background:Ankylosing Spondylitis (AS) is a disease associated with a high number of comorbidities, chronic pain, functional disability, and resource consumption.Objectives:This study aimed to estimate the burden of disease for patients diagnosed with AS in Spain.Methods:Data from 578 unselected patients with AS were collected in 2016 for the Spanish Atlas of Axial Spondyloarthritis via an online survey. The estimated costs were: Direct Health Care Costs (borne by the National Health System, NHS) and Direct Non-Health Care Costs (borne by patients) were estimated with the bottom-up method, multiplying the resource consumption by the unit price of each resource. Indirect Costs (labour productivity losses) were estimated using the human capital method. Costs were compared between levels of disease activity using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score (<4 or low inflammation versus ≥4 or high inflammation) and risk of mental distress using the 12-item General Health Questionnaire (GHQ-12) score (<3 or low risk versus ≥3 or high risk).Results:The average annual cost per patient with AS in 2015 amounted to €11,462.3 (± 13,745.5) per patient. Direct Health Care Cost meant an annual average of €6,999.8 (± 9,216.8) per patient, to which an annual average of €611.3 (± 1,276.5) per patient associated with Direct Non-Health Care Cost borne by patients must be added. Pharmacological treatment accounted for the largest percentage of the costs borne by the NHS (64.6%), while for patients most of the cost was attributed to rehabilitative therapies and/or physical activity (91%). The average annual Indirect Costs derived from labour productivity losses were €3,851.2 (± 8,484.0) per patient, mainly associated to absenteeism. All categories showed statistically significant differences (p<0.05) between BASDAI groups (<4 vs ≥4) except for the Direct Non-Healthcare Cost, showing a progressive rise in cost from low to high inflammation. Regarding the 12-item General Health Questionnaire (GHQ-12), all categories showed statistically significant differences between GHQ-12 (<3 vs ≥3), with higher costs associated with higher risk of poor mental health (Table 1).Table 1.Average annual costs per patient according to BASDAI and GHQ-12 groups (in Euros, 2015)NDirect Health CostsDirect Non-Health CostsIndirect CostsTotal CostBASDAI<4917,592.0*557.32,426.5*10,575.8*≥43769,706.9*768.05,104.8*15,579.7*Psychological distress (GHQ-12)<31468,146.8*493.6*3,927.2*12,567.6*≥32609,772.9*807.2*4,512.3*15,092.5*Total5786,999.8611.33,851.211,462.3* p <0.05Conclusion:Direct Health Care Costs, and those attributed to pharmacological treatment in particular, accounted for the largest component of the cost associated with AS. However, a significant proportion of the overall costs can be further attributed to labour productivity losses.Acknowledgments:Funded by Novartis Farmacéutica S.A.Disclosure of Interests:María Merino: None declared, Olta Braçe: None declared, Almudena González: None declared, Álvaro Hidalgo-Vega: None declared, Marco Garrido-Cumbrera: None declared, Jordi Gratacos-Masmitja Grant/research support from: a grant from Pfizzer to study implementation of multidisciplinary units to manage PSA in SPAIN, Consultant of: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly, Speakers bureau: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly

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 relationships between obesity-increasing risk factors for public health, environmental impacts, and health expenditures worldwide

2018 ◽  
Vol 29 (1) ◽  
pp. 131-147 ◽  
Author(s):  
Eduardo Botti Abbade
Keyword(s):  
Public Health ◽  
Health Care ◽  
Environmental Impact ◽  
Environmental Impacts ◽  
Health Care Cost ◽  
Health Care Systems ◽  
Health Expenditures ◽  
Health Care Expenditures ◽  
Public Health Care ◽  
Content Type

Purpose The purpose of this paper is to investigate the associations between obesogenic severity, the public health situation, environmental impacts, and health care expenditures in populations worldwide. Design/methodology/approach This ecological study is based on official data available for approximately 140 countries worldwide. This study defines four main variables: obesogenic severity, environmental impact, public health implications (PHI), and health expenditures, all measured through specific indicators. Data were obtained mainly from the WHO, World Bank, and IDF. The indicators were reduced to the main variables through factorial reduction and multiple regression analyses were used to test the main hypotheses. Findings Obesogenic severity strongly and positively affects environmental impacts (β=0.6578; p<0.001), PHI-1 (cardiovascular risk factor) (β=0.3137; p<0.001) and PHI-2 (blood glucose and diabetes diagnoses) (β=0.3170; p<0.001). Additionally, environmental impacts strongly and positively affect PHI-1 (β=0.4978; p<0.001) but not PHI-2. Thus, results suggest that environmental impact, PHI-1, and PHI-2 strongly affect health expenditures (β=0.3154; p<0.001, β=0.5745; p<0.001, and β=−0.4843; p<0.001, respectively), with PHI-2 negatively affecting the health expenditures. Practical implications This study presents evidence that can aid in decision making regarding public and private efforts to better align budgets and resources as well as predict the needs and expenditures of public health care systems. Originality/value This investigation finds that the main variables addressed are strongly associated at the worldwide level. Thus, these analytical procedures can be used to predict public health and health care cost scenarios at the global level.

The Evolution and Importance of Public Credit

2011 ◽  
Author(s):  
David Stasavage
Keyword(s):  
Interest Rates ◽  
Early Modern Europe ◽  
Access To Credit ◽  
Public Credit ◽  
The Difference ◽  
City States ◽  
The Cost ◽  
Territorial States ◽  
New Evidence

This chapter examines why access to credit was important for European states and provides extensive new evidence on the evolution of public credit across five centuries, from 1250 to 1750. The ability to borrow was critical in medieval and early modern Europe because it allowed states to participate in wars, either defensive or offensive. In order to better understand this fact, the chapter analyzes the movement that took place from compulsory to paid service for soldiers, along with opportunities to finance wars through current taxation. It also explains when states first borrowed long-term and measures the cost of borrowing, focusing on interest rates based on nominal rates at issue when these are available, and based on the fiscal proxy when they are not. The chapter highlights the difference between city-states and territorial states, with the former enjoying an apparent financial advantage that allowed them to begin borrowing earlier and to obtain access to lower-cost finance.

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.

scholarly journals The Effect of Initiation of Anti-TNF Therapy on the Subsequent Direct Health Care Costs of Inflammatory Bowel Disease

2019 ◽  
Vol 25 (10) ◽  
pp. 1718-1728 ◽  
Author(s):  
Laura E Targownik ◽  
Eric I Benchimol ◽  
Julia Witt ◽  
Charles N Bernstein ◽  
Harminder Singh ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Expenditures ◽  
Population Based ◽  
World Population ◽  
Median Cost ◽  
Future Health ◽  
Before And After ◽  
Future Health Care ◽  
The Cost ◽  
The Impact

Abstract Background Anti–tumor necrosis factor (anti-TNF) drugs are highly effective in the treatment of moderate-to-severe Crohn’s disease (CD) and ulcerative colitis (UC), but they are very costly. Due to their effectiveness, they could potentially reduce future health care spending on other medical therapies, hospitalization, and surgery. The impact of downstream costs has not previously been quantified in a real-world population-based setting. Methods We used the University of Manitoba IBD Database to identify all persons in a Canadian province with CD or UC who received anti-TNF therapy between 2004 and 2016. All inpatient, outpatient, and drug costs were enumerated both in the year before anti-TNF initiation and for up to 5 years after anti-TNF initiation. Costs before and after anti-TNF initiation were compared, and multivariate linear regression analyses were performed to look for predictors of higher costs after anti-TNF initiation. Results A total of 928 people with IBD (676 CD, 252 UC) were included for analyses. The median cost of health care in the year before anti-TNF therapy was $4698 for CD vs $6364 for UC. The median cost rose to $39,749 and $49,327, respectively, in the year after anti-TNF initiation, and to $210,956 and $245,260 in the 5 years after initiation for continuous anti-TNF users. Inpatient and outpatient costs decreased in the year after anti-TNF initiation by 12% and 7%, respectively, when excluding the cost of anti-TNFs. Conclusions Direct health care expenditures markedly increase after anti-TNF initiation and continue to stay elevated over pre-initiation costs for up to 5 years, with only small reductions in the direct costs of non-drug-related health care.

Can Information on Cost Improve Clinicians' Behavior?: Lessons from Health Care Trials and Management

1997 ◽  
Vol 13 (4) ◽  
pp. 553-561 ◽  
Author(s):  
Peter F. Lowet ◽  
John M. Eisenberg
Keyword(s):  
Health Care ◽  
Price Competition ◽  
Educational Interventions ◽  
Cost Information ◽  
Improved Outcomes ◽  
Practice Variations ◽  
The Cost ◽  
The Impact

AbstractFacing intense price competition and societal pressures, health care provider organizations have focused increasingly on the cost-effectiveness of medical services. In instances when there is insufficient evidence that a more expensive treatment course generates improved outcomes, the lower cost option is often encouraged. Yet, with resource utilization still determined principally by individual physicians, large practice variations often persist. This paper reviews the literature and explores the impact of sharing cost information on physicians' practice patterns utilizing management theory concepts. More research should be conducted to determine long-term benefits of educational interventions, physicians' fundamental views on the relationship between cost and quality and its effect on their responsiveness to cost information, and the role of leadership in changing clinical behavior.

Cost/benefit of synbiotics in acute infectious gastroenteritis: spend to save

2012 ◽  
Vol 3 (3) ◽  
pp. 189-194 ◽  
Author(s):  
Y. Vandenplas ◽  
S. De Hert
Keyword(s):  
Health Care ◽  
Placebo Group ◽  
Concomitant Medication ◽  
Health Care Cost ◽  
Cost Benefit ◽  
Food Supplement ◽  
Food Supplementation ◽  
Ambulatory Treatment ◽  
Infectious Gastroenteritis ◽  
The Cost

The cost/benefit ratio of probiotics in the ambulatory treatment of acute infectious gastro-enteritis with or without a synbiotic food supplement (containing fructo-oligosaccharides and probiotic strains of Streptoccoccus thermophilus, Lactobacillus rhamnosus, Lactobacillus acidophilus, Bifidobacterium lactis and Bifidobacterium infantis) has been studied. 111 children (median age 37 and 43 months for the synbiotic and placebo group, respectively) with acute infectious gastroenteritis were included in a randomised, prospective placebo-controlled trial performed in primary health care. All children were treated with an oral rehydration solution and with the synbiotic food supplement (n=57) or placebo (n=54). Physicians were allowed to prescribe additional medication according to what they considered as ‘necessary’. Cost of add-on medication and total healthcare cost were calculated. Median duration of diarrhoea was 1 day shorter (95% confidence interval -0.6 to -1.9 days) in the symbiotic than in the placebo group (P<0.005). Significantly more concomitant medication (antibiotics, antipyretics, antiemetics) was prescribed in the placebo group (39 prescriptions in 28 patients) compared to the synbiotic group (12 prescriptions in 7 patients) (P<0.001). The difference was most striking for antiemetics: 28 vs. 5 prescriptions. The cost of add-on medication in the placebo group was evaluated at € 4.04/patient (median 4.97 (interquartile (IQ) 25-75: 0-4.97)) vs. € 1.13 /patient in the synbiotic arm (P<0.001). If the cost of the synbiotic is considered, median cost raised to € 7.15/patient (IQ 25-75: 7.15-7.15) (P<0.001). The extra consultations needed to prescribe the concomitant medication resulted in a higher health care cost in the placebo group (€ 14.41 vs. € 10.74/patient, P<0.001). Synbiotic food supplementation resulted in a 24 h earlier normalisation of stool consistency. Although use of the synbiotic supplementation increased cost, add-on medication and extra consultations were reduced, resulting in a reduction of health care cost of 25%.

Sign in / Sign up

Export Citation Format

Share Document