Diabetes Mellitus

Diabetes mellitus is a chronic metabolic disorder which is at present rapidly growing to an alarming epidemic level. Various pathogenic processes are involved in the development of diabetes mellitus. This spectrums from autoimmune destruction of pancreatic beta cells with consequent deficiency of insulin to abnormalities that lead to resistance to the action of insulin. In the 21st century, the astounding rise in obesity, poor diet, and inactive lifestyles have increased the prevalence dramatically. Although several therapies are in use, Western medications are associated with adverse drug reactions and high cost of treatment. Therefore, there is currently a growing interest in herbal medicines to replace or supplement the Western medications. Extensive research is essential to enhance diagnoses, treatment, and to lessen healthcare expenditures. This chapter provides an overview of the classification, diagnosis, symptoms, complications, and economic burden of diabetes mellitus. Additionally, the authors discuss the current and upcoming therapies to treat this metabolic disorder.

Adaptation of the Care Ecosystem Intervention for Individuals with Dementia in a High-Risk, Care Management Program

The Care Ecosystem (CareEco) model is a telephone-based dementia care program providing standardized, personalized and scalable support and education for caregivers and persons living with dementia (PLWD), medication guidance, and promotion of proactive decision-making. It has demonstrated improvement in quality of life for PLWD and reduced unnecessary healthcare expenditures. We initiated a pragmatic, embedded randomized pilot trial of an adapted CareEco model for nurses who provide high-risk care management and are embedded in primary care practices within a large healthcare system. Outcomes include feasibility of collecting emergency department visits, usability and acceptability of the intervention by nurse care managers, caregiver strain, behavioral symptoms of dementia and healthcare expenditures. Challenges of implementation include engaging key care management leaders, adaptation of the CareEco training modules for nurses, identification of primary caregivers, training and reinforcing knowledge and skills of the nurses, embedding clinical assessments into care manager workflows and integration with the EMR.

Correlation of self-reported pain severity and healthcare expenditures in older United States adults

Objectives Healthcare expenditures of older United States (US) adults with different pain severity levels are important to investigate given the increasing prevalence of pain in this population. This study assessed the correlation of healthcare expenditures among older US adults with different pain severities, hypothesizing that expenditures would increase as pain severity increased. Methods This retrospective cross-sectional database study used 2018 Medical Expenditure Panel Survey (MEPS) data and included US adults aged ≥50 with self-reported pain in the past four weeks and positive healthcare costs. Adjusted linear regression models with logarithmically transformed expenditure data compared differences in: total; office-based; outpatient; emergency room; inpatient; other; and prescription medication expenditures, between those with little, moderate, quite a bit, and extreme pain. Analyses were weighted to account for the complex MEPS design and to obtain nationally representative estimates. The a priori alpha level was 0.05. Results The eligible sample of 5,123 individuals produced a weighted study population of 57,134,711 US adults aged ≥50 with pain (little = 53.1%, moderate = 21.6%, quite-a-bit = 18.5%, extreme = 6.8%). In adjusted linear regression models, compared to little pain, extreme pain had the greatest level of costs, followed by quite a bit pain and moderate pain, for total, office-based, and prescription medication costs. For instance, compared to little pain, total healthcare costs were 78% greater for those with extreme pain, 51% greater for quite a bit pain, and 37% greater for moderate pain. However, this pattern was not observed for outpatient, emergency room, inpatient, and other costs, where ≥1 comparison for each cost category was not statistically significant. Conclusions This study found total healthcare costs increased as pain severity increased, yet this was not always the case when analyzing subcategories of healthcare costs. Further research is needed to investigate why some types of healthcare costs are greater with increasing pain severity, yet others are not.

Did the universal zero-markup drug policy lower healthcare expenditures? Evidence from Changde, China

Background The zero-markup drug policy (also known as the universal zero-markup drug policy (UZMDP)) was implemented in stages beginning with primary healthcare facilities in 2009 and eventually encompassing city public hospitals in 2016. This policy has been a central pillar of Chinese health reforms. While the literature has examined the impacts of this policy on healthcare utilization and expenditures, a more comprehensive and detailed assessment is warranted. The purpose of this paper is to explore the impacts of the UZMDP on inpatient and outpatient visits as well as on both aggregate healthcare expenditures and its various components (including drug, diagnosis, laboratory, and medical consumables expenditures). Methods A pre-post design was applied to a dataset extracted from the Changde Municipal Human Resource and Social Security Bureau comprising discharge data on 27,246 inpatients and encounter data on 48,282 outpatients in Changde city, Hunan province, China. The pre-UZMDP period for the city public hospitals was defined as the period from October 2015 to September 2016, while the post-UZMDP period was defined as the period from October 2016 to September 2017. Difference-in-Difference negative binomial and Tobit regression models were employed to evaluate the impacts of the UZMDP on healthcare utilization and expenditures, respectively. Results Four key findings flow from our assessment of the impacts of the UZMDP: first, outpatient and inpatient visits increased by 8.89 % and 9.39 %, respectively; second, average annual inpatient and outpatient drug expenditures fell by 4,349.00 CNY and 1,262.00 CNY, respectively; third, average annual expenditures on other categories of healthcare expenditures increased by 2,500.83 CNY, 417.10 CNY, 122.98 CNY, and 143.50 CNY for aggregate inpatient, inpatient diagnosis, inpatient laboratory, and outpatient medical consumables expenditures, respectively; and fourth, men and older individuals tended to have more inpatient and outpatient visits than their counterparts. Conclusions Although the UZMDP was effective in reducing both inpatient and outpatient drug expenditures, it led to a sharp rise in other expenditure categories. Policy decision makers are advised to undertake efforts to contain the growth in total healthcare expenditures, in general, as well as to evaluate the offsetting effects of the policy on non-drug components of care.

Diabetes mellitus

Diabetes is an increasingly common, progressive metabolic disorder that results in a range of distressing symptoms, altered daily functioning, social and psychological impacts on individuals and their families, high healthcare expenditures, lost productivity, and premature mortality. Prevalence and absolute numbers of people with diabetes has grown worldwide, with no country or region spared. In this chapter, we review the data regarding diabetes burdens, describing patterns observed in low- and middle-income countries, and in high-income countries. We describe the major gaps that must be addressed, both in research and in implementation, to better detect, prevent, and treat diabetes. We describe what is known and yet unknown about vulnerable populations and describe efforts to address disparities in diabetes.

Trends in healthcare expenditures and resource utilization among a nationally representative population with opioids in the United States: a serial cross-sectional study, 2008 to 2017

Background Previous reports on healthcare costs and expenditures associated with populations prescribed an opioid primarily focused on populations who chronically use opioids or have opioid use disorder. However, studies that characterize the healthcare and expenditures costs among the wider number of people prescribed opioids in a nationally representative population are unavailable. We sought to characterize the healthcare costs and expenditures associated with a population prescribed an opioid in the U.S. from 2008 to 2017. Methods A serial cross-sectional design was used to compare the economic burden of adult household respondents who were prescribed and not prescribed an opioid using pooled data from the Medical Expenditure Panel Survey (MEPS) between 2008 and 2017. Respondents with an opioid prescription were matched to respondents without an opioid prescription using propensity score match methods with survey weights. Two-part generalized linear models were used to estimate the survey-weighted annual healthcare expenditures and resource utilization adjusting for multiple covariates. Additionally, 10-year trend comparisons between the groups were performed. Costs were adjusted to 2019 US dollars. Results There was a weighted total of 31,696,671 respondents with an opioid and 31,536,639 respondents without an opioid after propensity score matching. The sample had a mean (SD) age of 50.63 years (18.03), 58.9% females, and 81.6% Whites. Total annual economic burden among RPOs was $524 billion. Annual total expenditures per respondent with and without an opioid were $16,542 and $7067, respectively (P < 0.001). Similarly, adjusted prescription, outpatient, emergency department, and inpatient expenditures were significantly higher for respondents with an opioid compared to respondents without an opioid. Average annual increases in expenditures were significantly greater among respondents with an opioid compared to respondents without an opioid for total (+$185; 95% CI: $37–$334) and prescription (+$78; 95% CI: $28–$128) expenditures. There were no differences in the average annual trends for outpatient, emergency department, and inpatient expenditures between respondents with and without an opioid. Conclusions Respondents with an opioid prescription had higher healthcare expenditures and resource utilization compared to respondents without an opioid prescription from 2008 to 2017. Specifically, significant annual increases were observed for total and prescription expenditures. Additionally, 10-year trends in total and prescription expenditures were higher among respondents with an opioid than respondents without an opioid.

Recognition and Analysis of the Drivers and Key Factors Affecting Exposure Households with Catastrophic and Impoverishing Health Expenditure in Iran with the Futures Study Approach Protocol (Preprint)

BACKGROUND Health expenditure is a vital issue for policymakers not as it were due to the health outcome significance, but moreover since of the gradual total health expenditure rises that has ended up a major concern. To survey the financial related burden due to out-of-pocket payments, two commonly elite approaches have been utilized: catastrophic and impoverishing health expenditures. Catastrophic healthcare expenditures and impoverishment both can prevent individuals from accessing effective healthcare services. In Iran, the high out-of-pocket and increase in the share of the population experiencing catastrophic healthcare expenditures and poor financial protection of households against catastrophic healthcare expenditures are among the major public health concerns. To identify the drivers, key factors, and the trends of catastrophic and impoverishing healthcare expenditures among Iranian households, this study will be conducted by futures studies approach. OBJECTIVE - To identify the key drivers affecting the future of catastrophic and impoverishing healthcare expenditure in Iran. - To assess the trend in the incidence and intensity of CHE in Iran. - To categorize the key drivers - To prioritize main promoter factors in terms of importance, effectiveness and lack of uncertainty. METHODS This study will conduct in four steps. The drivers of the future of Exposure Households with Catastrophic and Impoverishing Health Expenditure will be listed by analyzing the results of a scoping review and then semi-structured interviews with health financial experts. Afterward, key drivers will be categorized using Porter's five forces (social, technical, economic, environmental, and political) for the macro environment and prioritized using the Fuzzy Analytical Hierarchy Process (FAHP) formulated in excel software. Further, cross-impact analysis of promoter factors and analytic hierarchy process will be used to determine main promoter factors in terms of importance, effectiveness, and lack of uncertainty. RESULTS We anticipate that the results of this protocol study will provide a comprehensive overview of the evidence on the determinants of unfairness and payments that expose the Iranian households to catastrophic and impoverishing health care expenditures and identify research gaps. CONCLUSIONS In our study, we will examine the rates of catastrophic health expenditure and impoverishment from medical expenses and its drivers in Iran. This will provide insight into the level of financial protection that a healthcare financing system provides for its citizens. It reflects the financial burden shouldered by families and the financial barriers that reduce their access to health care.

Patterns of Healthcare Expenditures among Older United States Adults with Pain and Different Perceived Health Status

The objective of this study was to assess the pattern of healthcare expenditures among United States (U.S.) adults aged ≥ 50 years with pain and annual total positive healthcare expenditures with different levels of perceived health. The study used the 2018 Medical Expenditure Panel Survey data. Unadjusted and adjusted linear regression models were used to compare logarithmically transformed total healthcare expenditures between those with excellent, very good, good, and fair/poor health. The a priori alpha value was 0.05. The study included 5123 U.S. adults aged ≥50 with self-reported pain (excellent = 8.9%, very good = 28.3%, good = 36.2%, fair/poor = 26.6%). In adjusted analyses, compared to fair/poor health, those with excellent health had the greatest adjusted reduction in expenditures (55% lower), followed by very good health (36.5% lower) and good health (24.9% lower). In conclusion, total positive healthcare expenditures were comparatively lower among those with better perceived health status for older (≥ 50 years) U.S. adults with pain that interfered with normal work in the past four weeks.