Impact analysis of expanding anti-TNF therapy for Crohn’s disease

Aim: To estimate the impact of universal anti-TNF therapy in patients with moderate-to-severe Crohn’s disease. Materials & methods: Developed a population-level Markov model to estimate the impact on health outcomes and medical expenditures of expanding anti-TNF therapy use versus current treatment practices. Results: Reductions in deaths (2600), hip fractures (980), major adverse cardiac events (2700) and patient out-of-pocket medical spending (2%) over 5 years. Total societal costs would be US$22,100 higher per patient per year, primarily due to the high cost of anti-TNF therapy. Conclusion: Expanding anti-TNF therapy use among US adult patients with moderate-to-severe Crohn’s disease would reduce morbidity and mortality, decrease disease-related medical costs and increase treatment costs compared with current practice. Despite the higher costs, this approach could substantially benefit patients.

Comparison of Catastrophic Out-of-Pocket Medical Expenditures in the US and South Korea

To date, relatively few studies have examined catastrophic out-of-pocket medical spending in the United States, especially in comparison to other high-income countries. We compared catastrophic out-of-pocket medical spending among adults age 65 and older in the United States versus South Korea, a high-income country with national health insurance that is often overlooked in cross-country comparisons. We defined catastrophic medical spending as health care expenditure for the past two years that exceeds 50% of one’s annual household income. Using data from the 2016 Health and Retirement Study (HRS) and Korean Longitudinal Study of Aging (KLoSA), we performed a logistic regression to examine the factors affecting catastrophic out-of-pocket medical spending for older adults in both countries. We also performed a Blinder-Oaxaca decomposition to compare the contribution of demographics factors versus health system-level factors to catastrophic out-of-pocket medical spending. The proportion of respondents with catastrophic out-of-pocket medical expenditure was higher in the US; the proportion was 5.8% and 3.0% in the US and South Korea, respectively. Both in the US and South Korea, respondents who were in the lower-income quartiles, who had experienced a stroke or had diabetes, and who rated their health as poor had higher odds of catastrophic out-of-pocket medical expenditure. The Blinder-Oaxaca non-linear decomposition showed that the significant difference in the rate of catastrophic out-of-pocket medical spending between the two countries was attributable to unobservable system-level factors, not observed differences in the sociodemographic characteristics between the two countries.

Illness and Wage Loss: Longitudinal Evidence from India (and Implications for the Universal Health Coverage Agenda)

Background: A key aim of Universal Health Coverage (UHC) is to protect individuals and households against the financial risk of illness. Large-scale health insurance expansions are therefore a central focus of the UHC agenda. Importantly, however, health insurance does not protect against a key dimension of financial risk associated with illness: forgone wage income (due to short-term disability). In this paper, we quantify the economic burden of illness in India attributable--separately--to wage loss and to medical care spending, as well as differences in them across the socio-economic distribution. Methods: We use data from two Indian longitudinal household surveys: (i) the Village Dynamics in South Asia (VDSA) survey (1,350 households surveyed every month for 60 months between 2010 and 2015) and (ii) the Indian Human Development Survey (IHDS) (more than 40,000 households surveyed in 2005 and again in 2011). The VDSA allows us to study the economic dynamics of illness using high-frequency observations, and the IHDS allows us to confirm our findings in a nationally-representative sample. Both contain individual- and household-level information about illness, wage income, and medical spending over time. We use longitudinal variation in illness to estimate regression models of economic burden separately for wage loss and medical care spending across the socio-economic distribution. Our regression models include a series of fixed effects that control for differences in time-invariant household (or individual) characteristics and time-varying factors common across households. Findings: 1,184 households (88%) in the VDSA sample reported an episode of illness over 60 months, and 15770 households (40%) in the IHDS reported an illness in the preceding year. In the VDSA sample, on average, a day of illness was associated with a reduction in monthly per capita wage income of Rs 77 [95% CI -99 to -57] and an increase in monthly per capita medical spending of Rs 126 [95% CI 110-142]. Variation across the socio-economic distribution was substantial. Among the poorest households, wage loss due to illness is roughly 15% of total household spending--nearly three times greater than medical spending. Alternatively, among the most affluent households, wage loss is less than 5% of total household spending--and only one-third of medical spending. Put differently, wage loss accounts for more than 80% of the total economic burden of illness among the poorest households, but only about 20% of the economic burden of illness among the most affluent. Estimates from the IHDS sample show that this socio-economic gradient is present in the Indian population generally. Interpretation: Wage loss accounts for a substantial share of the total economic burden of illness in India--and disproportionately so among the poorest households. If Universal Health Coverage truly aims to protect households against the financial risk of illness--particularly poor households, the inclusion of wage loss insurance or another illness-related income replacement benefit is needed.

When Income Declines and Morbidity Rises: An Inquiry into Consumption Smoothing in the Transition to Retirement in China

China still relies on out-of-pocket (OOP) medical spending, having a high prevalence of catastrophic payments with large poverty impacts for individuals. Taking age-associated morbidity into account, people of an advanced age encounter health-related income shocks more often than younger cohorts. Exploiting the Harmonized China Health and Retirement Longitudinal Study (CHARLS), I use a fixed effects regression model to investigate whether pensions and health insurance allow for consumption smoothing in the presence of health shocks. I provide suggestive evidence that pensions slightly decrease non-food consumption when health shocks occur. Moreover, health insurance does not seem to completely substitute costly smoothing mechanisms. I record an ongoing trend of increasing OOP spending on hospitalization, with health insurance reducing these by 19 percent. Financial transfers from family members remain an important unofficial insurance channel for households to cope with health shocks.

Systematic Review of the Effect of a Zero-Markup Policy for Essential Drugs on Healthcare Costs and Utilization in China, 2015–2021

Objective: This systematic review aimed to discuss the effects of a zero-markup policy for essential drugs (ZPED) on healthcare costs and utilization in China in the years 2015–2021.Methods: We searched the PubMed, Embase, Scopus, and CINAHL databases for all associated studies carried out from January 1, 2015, to May 31, 2021, without any limitations regarding the language the studies were written in. To prevent selection bias, gray documents were tackled by other means. The methodological approaches were assessed by applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Newcastle-Ottawa Scale (NOS) collaboration tool.Results: Forty studies were selected at first and then 15 studies that met the inclusion criterion. Most of the studies showed a considerable decrease in total medical spending and drug spending in both outpatient and inpatient services. After the implementation of ZPED, studies showed that the medical services increased and total hospital income sustained, despite a decrease in drug revenue. Minimal or no government subsidy is required from a financial perspective.Conclusions: Although, the government could implement ZEPD with lower medical cost and drug cost to patients, and sustained income for health facilities, we have limited understanding of whether the increase in medical services was induced by the provider or was a response to unmet needs in the population. Further, studies using rigorous and advanced methods to study health policy, patient behaviors, provider behaviors, and government decisions are warranted.

Can Sound Health Insurance Increase the Internal Circulation in the Economy of China?

In 2020, President Xi Jinping put forward a constructing cycle that has been given priority in this study. This particular cycle, when considered within the inner loop and outer loop, promotes the guiding ideology of the new development pattern of the binary economy that exists in recent times. Therefore, to gauge the extent of the promotion of domestic production and consumption, from the perspectives of medical expenses, this study refers to the bootstrap rolling window causality method, which considers the evidence-based medical spending on the consumption Granger causality. The results show that the Granger causality exists between medical expenditure and consumption expenditure at different time interval endpoints. In contrast, however, the variable of consumption does not produce Granger causality between medical expenditure and consumption. In this regard, a series of measures, such as increasing medical insurance expenditure, improvement of the medical insurance system, reduction of the housing price rise, and increasing government investment have been proposed to promote the development of the domestic circular economy.

A Cross-Sectional Analysis of Oral Health Spending Over the Lifespan in Commercial and Medicaid Insured Populations

Background: Life course theory creates a better framework to understand how oral health needs and challenges align with specific phases of the lifespan, care models, social programs, and changes in policy. Methods): Data are from the 2018 IBM Watson Multi-State Medicaid Marketscan Database (31 million claims) and the 2018 IBM Watson Dental Commercial and Medicare Supplemental Claims Database (45 million claims). Analysis compares per enrollee spending fee-for-service dental claims and medical spending on dental care from ages 0 to 89. Results: Dental utilization and spending are lower during the first 4 years of life and in young adulthood than in other periods of life. Stark differences in the timing, impact, and severity of caries, periodontal disease, and oral cancer are seen between those enrolled in Medicaid and commercial dental plans. Early childhood caries and oral cancer occur more frequently and at younger ages in Medicaid populations. Conclusions: This unique lifespan analysis of the U.S. multi-payer dental care system demonstrates the complexities of the current dental service environment and a lack of equitable access to oral healthcare. Practical Implications: Health policies should be focused on optimizing care delivery to provide effective preventive care at specific stages of the lifespan.

Change in country-level COVID-19 case fatality rate is associated with improved testing; no apparent role of medical care or disease-specific knowledge

Observed case fatality rate (CFR) of COVID-19 has decreased since the beginning of the pandemic. Reasons for this decline include improved knowledge of COVID-19 pathogenesis, leading to improved medical care of confirmed cases. However, ascertainment also plays a role: as more low-risk individuals are tested and more mild cases identified, observed CFR will decline. Previously I showed that geography-level CFR was cross-sectionally negatively associated with test density; here I test for similar trends within geography over six months, and check plausibility of various posited causes. Although CFR varied between geographies, its association with testing did not: in 141 geographies, CFR dropped by an average of 18% for each doubling of test density. Change in CFR within a given geography was not associated either with that geography’s medical spending or with whether the bulk of cases occurred early or late in the pandemic. This shows that medical interventions, including those specific to COVID-19, have only a minimal effect on total CFR. Two major conclusions follow. First, interventions to reduce CFR should be evaluated by comparing groups that received the intervention to those who did not: decline in CFR after an intervention is not evidence of effectiveness. Second, improving clinical care of confirmed COVID-19 cases has only a minimal effect on death rates. To minimize the total death toll of COVID-19, policymakers should prioritize reducing infections.