Long-haul COVID: Healthcare Utilization and Medical Expenditures 6 Months Post-diagnosis

Background Despite evidence that long-term COVID-19 symptoms may persist for up to a year, their implications for healthcare utilization and costs 6 months post-diagnosis remain unexplored. Methods Our objective is to determine for how many months post-diagnosis healthcare utilization and costs of COVID-19 patients persist above pre-diagnosis levels and explore response heterogeneity across age groups. This population-based retrospective cohort study followed COVID-19 patients’ healthcare utilization and costs from January 2019 through March 2021 using claims data provided by the COVID-19 Research Database. The patient population includes 328,777 individuals infected with COVID-19 during March-September 2020 and whose last recorded claim was not hospitalization with severe symptoms. We measure the monthly number and costs of total visits and by telemedicine, preventive, urgent care, emergency, immunization, cardiology, inpatient or surgical services and established patient or new patient visits. Results The mean (SD) total number of monthly visits and costs pre-diagnosis were .4805 (4.2035) and 130.67 (1,216.66) dollars compared with 1.1998 (8.5184) visits and 341.7576 (2,439.5581) dollars post-diagnosis. COVID-19 diagnosis associated with .7338 (95% CI, 0.7175 to 0.7500 visits; P < .001) more total healthcare visits and an additional $215.40 (95% CI, 210.76 to 220.00; P<.001) in monthly costs. Excess monthly utilization and costs for individuals under 19 years old subside after 5 months to .021 visits and $3.7, persist at substantial levels for all other groups and most pronounced among individuals 50-59 (.236 visits and $78.60) and 60-69 (.196 visits and $73.10) years old. Conclusions This study found that COVID-19 diagnosis was associated with increased healthcare utilization and costs 6 months post-diagnosis. These findings imply a prolonged burden to the US healthcare system from medical encounters of COVID-19 patients and increased spending.

Long-Term Survival and Medical Costs of Patients with Prolonged Mechanical Ventilation and Tracheostomy: A Nationwide Cohort Study

Few large-scale studies have focused on tracheostomy in patients with prolonged mechanical ventilation. This retrospective population-based study extracted data from the longitudinal National Health Insurance Research Database in Taiwan to compare long-term mortality between patients on prolonged mechanical ventilation with and without tracheostomy and their related medical expenditures. Data on newly developed respiratory failure in patients on ventilator support were extracted from 1 January 2002 to 31 December 2008. Of 10,705 patients included, 1372 underwent tracheostomy (n = 563) or translaryngeal intubation (n = 779). Overall survival of the patients with tracheostomy was followed for 5 years. Average survival was 4.98 years for the patients with tracheostomy and 5.48 years for the patients with translaryngeal intubation (not significant). Sex, age, premium-based monthly salary difference, occupation, urbanization level, chronic obstructive pulmonary disease, chronic heart failure, chronic renal disease, and cerebrovascular diseases were significantly associated with mortality for endotracheal intubation. Male sex, chronic heart failure, chronic renal disease, age ≥45 years, and low income were associated with significantly higher mortality. Although total medical expenditures were higher for the patients with tracheostomy, annual medical expenditures were not significantly different. There were no differences in long-term mortality between the two groups.

Health, wealth, and medical expenditures among the elderly in rural Tanzania: Experiences from Nzega and Igunga districts

BackgroundThe per capita health expenditure (HE) and share of gross domestic product (GDP) spending on elderly healthcare are expected to increase. In many developing countries like Tanzania, there is an increasing gap between health needs and the available resources for elderly healthcare, which leaves the elderly with poor health conditions, especially chronic diseases. These conditions lead to catastrophic HEs for the elderly. ObjectiveThis study aimed to analyse the association among health, wealth, and medical expenditure in rural residents aged 60 years and above in Tanzania. MethodsData were collected through a cross-sectional household survey to rural residents aged 60 years and above living in Nzega and Igunga districts. Standardised World Health Organization (WHO) Study on Global Ageing and Adult Health (SAGE) and European Quality of Life Five Dimension (EQ-5D) questionnaires were used. The quality of life (QoL) was estimated using EQ-5D weights. The wealth index was generated from principal component analysis (PCA). Two linear regression analyses (outpatient/inpatient) were performed to analyse the association among health, wealth, medical expenditure, and socio-demographic variables.ResultsThis study found a negative and statistically significant association between QoL and HE, whereby HE increases with the decrease of QoL. We could not find any significant relationship between HE and social gradients. In addition, age influences HE such that as age increases, the HE for both outpatient and inpatient care also increases.ConclusionThe health system in these districts allocate resources mainly according to needs, and social position is not important. We thus conclude that the system is fair. Health, not wealth, determines the use of medical expenditures.

The Morbidity Costs of Air Pollution through the Lens of Health Spending in China

This study offers one of the first causal evidence on the morbidity costs of fine particulates (PM2.5) for all age cohorts in a developing country, using individual-level healthcare spending data from the basic medical insurance program in Wuhan, China. Our instrumental variable (IV) approach uses thermal inversion to address potential endogeneity in PM2.5 concentrations and shows that PM2.5 imposes a significant impact on medical expenditures. The IV estimate suggests that a 10 μg/m3 reduction in monthly average PM2.5 leads to a 2.79% decrease in the value of health spending and a 0.70% decline in the number of transactions in pharmacies and health facilities. The effect is more salient for males, children, and older adults. Moreover, our estimates provide a lower bound of people's willingness-to-pay, which amounts to CNY 51.85 (or USD 8.38) per capita per year for a 10 μg/m3 reduction in PM2.5.

Medical expenditure for lung cancer in China: a multicenter, hospital-based retrospective survey

Background Lung cancer is the most prevalent cancer, and the leading cause of cancer-related deaths in China. The aim of this study was to estimate the direct medical expenditure incurred for lung cancer care and analyze the trend therein for the period 2002–2011 using nationally representative data in China Methods This study was based on 10-year, multicenter retrospective expenditure data collected from hospital records, covering 15,437 lung cancer patients from 13 provinces diagnosed during the period 2002–2011. All expenditure data were adjusted to 2011 to eliminate the effects of inflation using China’s annual consumer price index. Results The direct medical expenditure for lung cancer care (in 2011) was 39,015 CNY (US$6,041) per case, with an annual growth rate of 7.55% from 2002 to 2011. Drug costs were the highest proportionally in the total medical expenditure (54.27%), followed by treatment expenditure (14.32%) and surgical expenditure (8.10%). Medical expenditures for the disease varied based on region, hospital level, type, and stage. Conclusion The medical expenditure for lung cancer care is substantial in China. Drug costs and laboratory test are the main factors increasing medical costs.

Social Management in Pharmaceutical Healthcare Sector

Aims: There is an increase in demand for the social environment regulations in the pharmaceutical companies, which is a crucial strategy issue in long-term planning due to the incidence of social influence. The influence of society over resource allocation and its control over innovation is all the perceptions of today's needs. This research aims to highlight the managerial issues faced by the pharmaceutical healthcare sector of Ukraine. Our study is unique as we have analyzed the whole pharmaceutical sector of Ukraine in terms of management issues. There is no such research done yet. In addition, we have also researched the official databases and laid down the models for management practices. Methodology: The research was done to analyze the major issues in the social management of the pharmaceutical healthcare system. In addition, the related studies based on managerial issues were studied. The following databases were used to study the guidelines: World Health Organisation, Food and Drug Administration, Internationational Council for Harmonization, and European Union. Results: The results were found to be when comparing behavioural studies with non-behavioural; non-behavioural was found to be 64%, whereas behavioural was 34%. To have an in-depth knowledge of the managerial issues, we have provided an inverted tree diagram representing the significant issues in pricing and medical expenditures. These contributed 21.7% of non-behavioural studies, and in behavioural studies, it was found to be consumer or physician-level behaviour 23.4% contributing the central part of the issue. Conclusion: Here we conclude that the pharmaceutical healthcare sector plays a crucial role in the global healthcare of the general public-facing management issues; hence should be analyzed and follow the guidelines to analyze the issues within the company and set goals. Therefore, improving the management of the pharma sector will, in turn, improve public health in Ukraine.

Smog Avoidance Investment While Improving Air Quality: Health Demand or Risk Aversion? Evidence from Cities in China

Atmospheric pollution control policies have achieved remarkable progress in China since 2013, and the smog protective equipment market has experienced a great boom during the same period. From the perspectives of the health production efficiency hypothesis and the time discount rate hypothesis, this study investigates the relationship between household expenditures on air pollution avoidance and health care, and individuals’ self-assessed health based on network survey data from 17 cities in China. Using the treatment effect model to control the potential endogenous selection problems, we explain the paradox of the growing smog avoidance investment coexisting with improving air quality. First, smog avoidance investment and household medical expenditures do not have substitution effects, while the perception of pollution intensity, pollution protection knowledge, and future health preferences significantly promote smog avoidance investment and medical expenditures. Second, air pollution avoidance investment greatly increases the probability that urban residents rate their health as “good” and “very good”. The results indicate that the time preference hypothesis can explain the pollution avoidance investment behavior and health demands of Chinese urban residents well. The hidden social welfare loss caused by air pollution may still be underestimated, even though short-term avoidance costs are included in the evaluation of pollution impacts. It is necessary to optimize environmental regulations and policies to consistently improve the ecological environment.