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Biomedical subjects

B S Bloom

Publications and source records attributed to B S Bloom.

At least 73 records · Page 4Linked to original sources
PubMed1988

Cost of treating arthritis and NSAID-related gastrointestinal side-effects.

Non-steroidal anti-inflammatory drugs (NSAIDs) are efficacious in the treatment of arthritis. However, side-effects particularly gastrointestinal toxicity, have been well documented with their use. Thus, in assessing total direct medical costs in the treatment of arthritis, the expenses involved in treating these side-effects must be taken into account. A retrospective analysis was undertaken of all direct medical costs related to care of a group of Medicaid recipients treated for arthritis during a 2-year period. Data were obtained from the Medicaid Management Information System of Washington, D.C., USA. The actual expenditure of treating arthritis as well as the medical costs of associated NSAID-induced gastrointestinal side-effects were determined. Arthritis treatment costs per quarter were found to be $145 per patient. Approximately 25% of the population experienced NSAID-related gastrointestinal side-effects requiring further medical care. Treatment of these adverse effects costs an additional $66 per quarter per patient, thus adding 45.5% to the cost of arthritis treatment. Pharmaceutical claims comprised 42.4% of total adverse drug reaction treatment costs, while the few hospital claims accounted for 37.9% and physician charges 19.7%. It has been estimated that in 1983 direct medical costs of arthritis treatment in the USA was $8.6 billion. By extrapolating the costs in this study, it can be estimated that a further $3.9 billion was spent on treating gastrointestinal side-effects of NSAIDs, making a total of $12.5 billion.

Adult↗
PubMed1988

Cost and quality effects of outpatient cataract removal.

In March 1985, a Health Care Financing Administration regulation went into effect requiring that cataract removal without exceptional circumstances be done in outpatient settings. In this paper, we study implications of that mandate by comparing the cost and quality outcomes of cataract removal in outpatient and inpatient settings both before and after the regulation went into effect. After controlling for population and physician differences for both study periods, we found by chi square significantly fewer infections, suture adjustments, and pain requiring medication among outpatients than inpatients. Log-linear regression, however, found that the only significant predictor was inpatient or outpatient, and only for infection (p = .02), with an odds ratio of 7.55 (95% confidence interval; .92-61.60). We also found lower Medicare payments for outpatients in both study periods. For the preregulation study groups, inpatient care was 34.8% more costly than outpatient care; the cost differential dropped to 32.5% for the postregulation study groups.

Aged↗
PubMed1987

Waiting for care. Queuing and resource allocation.

Queues arise in medical care and serve as allocators in the absence of an effective market and when resources become perceptibly constrained. This is essentially the case in all countries where money is not the means for gaining access to medical services. A study estimated that the total wait in England was 96 days for nonemergency care leading to hospitalization, including primary and specialty ambulatory care, for that one quarter of patients who had been placed on a waiting list. Of the remaining hospitalized population one half were admitted immediately and another one fourth were either booked or transferred from other hospitals. The widely accepted notion that a large majority of hospitalized patients wait a long time for care in Britain is mistaken. The emphasis on primary ambulatory care means that essentially no one has to wait for general practitioner care. The wait for elective ambulatory specialty care averaged approximately 8 weeks for all patients. Although mortality is rarely an issue for those who wait, an argument can be made that convenience and quality of life are importantly affected.

Ambulatory Care↗
PubMed1986

Cost and price of comparable branded and generic pharmaceuticals.

Substituting generic for brand drugs has been increasing for two decades with the expectation that it leads to important savings. We studied 891 862 prescriptions, written for 21 pairs of branded and generic drugs, dispensed between April 1, 1984, and June 30, 1984, by 1363 selected pharmacies in 39 states. The cost per pill paid by the pharmacy was always less for the generic than the branded drug. The price per pill paid by the consumer was usually less for the generic than the brand. The wide and skewed distribution of consumer prices within and among pharmacies means that consumers cannot be guaranteed the lowest cost simply by buying generic drugs. The probability that generic would be less expensive than brand varied widely across drug pairs from .33 to .99. Continued search is no guarantee that the full distribution of prices or the lowest or nearly-lowest price will be found.

Cost Control↗
PubMed1985

The epidemiology of disease expenses. The costs of caring for children with cancer.

We determined medical costs and family out-of-pocket expenses over time for 569 children with malignant neoplasms. All medical charges (inpatient and outpatient), family out-of-pocket expenses, and wages lost were collected and annualized. The mean cost of cancer care and treatment per patient-year was $29,708, with variation by diagnosis, prognosis, and year since diagnosis. The mean annual hospital inpatient cost was $15,455; mean ambulatory care cost, $3,806; and family out-of-pocket disease-related expenses, $9,787. Family out-of-pocket expenses added about 50% to the total cost of disease-related care and consumed 38% of gross annual family income; wages lost accounted for nearly half. About 95% of all medical costs was paid by private, public, or charitable payers. Out-of-pocket medical expenses for which the family was responsible were about $1,000 each year. However, all nonmedical, disease-related expenses were borne by the family.

Cancer Care Facilities↗
PubMed1985

Where have all the students gone? An epidemiologic study of US nationals applying for certification by the Educational Commission for Foreign Medical Graduates, 1969 through 1982.

Larger and larger numbers of US nationals are studying medicine abroad and they now comprise the foremost national group of foreign medical graduates (FMGs) seeking to enter the US health care system. The Educational Commission for Foreign Medical Graduates (ECFMG) is currently conducting a comprehensive study of 205,542 graduates of foreign medical schools who, during a 14-year study period, 1969 through 1982, have sought its certification, an established prerequisite for FMGs applying for training in an accredited hospital residency program and/or licensure within the United States. This report summarizes preliminary data on the 17,642 US citizens included in the study who attended 431 different medical schools in 79 foreign countries. Particular attention is given to their performance on the combined medical knowledge-English language competence examinations requisite to the awarding of ECFMG certification.

Certification↗
PubMed1985

Cost effects of restricting cost-effective therapy.

This article examines the cost effects of a closed pharmaceutical formulary on Medicaid expenditures for peptic ulcer disease. Studies were performed before and after the imposition of a closed pharmaceutical formulary and indicated that total Medicaid costs for peptic ulcer treatment were 15.0% lower during the closed formulary than open formulary periods. The overall savings were due mainly to a sharp decline in the number of peptic ulcer patients served by Medicaid. The cost per patient-month of therapy increased by 9.4% between study periods. Pharmaceutical costs per patient-month declined by 78.9%, monthly physician payments increased by 3.1%, and monthly inpatient hospital costs increased by 23.6%. The small, short-term savings may be negated by increased expenditures in the near future when sicker patients, previously denied peptic ulcer drug treatment, may reenter the Medicaid system in need of expensive inhospital treatment.

Cimetidine↗
PubMed1984

Changing infant mortality: the need to spend more while getting less.

A steady decline of infant and maternal mortality has been recorded for as long as these statistics have been collected. Much of the improvement has been due to reductions in infectious diseases and to social, economic, and public health improvements over the years. The major portion of mortality reductions took place before there were any important effects of medical care. However, there is increasing evidence suggesting that important benefits, can still be gained from medical technology. But, with infant mortality at low levels (between 7 and 12/1,000 live births in high-income countries) the wide use of high technology to effect further reductions guarantees escalating medical care expenditures. With pressures mounting to control costs, what will society be willing to give up in order to make this care available? From where will funds come to utilize costly existing and new medical technology so that all expectant mothers and newborns needing it may have essentially unlimited access in order to reap potential benefits?

Costs and Cost Analysis↗
PubMed1983

Regionalization of surgical services.

Using data from the Studies on Surgical Services for the United States (SOSSUS), the extent of existing surgical care regionalization was examined in a defined area. Specialist surgeons comprised 55 per cent of all physicians who did operations, but performed nearly three-fourths of all operative work. About one-third of the most complex operations (CRV greater than or equal to 30), more than one-fifth of medium complexity (CRV = 20-29), and 14 per cent of low complexity (CRV less than 20) were obtained out of county of residence. Nearly one-half of all surgical patients at the university hospital were from other counties; but for those obtaining the most complex operations (CRV greater than or equal to 30), three-fourths of them were from other counties. Thus there was a substantial amount of regionalization of surgical care already existing in this area.

Catchment Area, Health↗
PubMed1980

Home and hospital cost of terminal illness.

A study was undertaken of the billed charges of the last 2 weeks of life of patients terminally ill with malignant disease. A sample was drawn of those who died at home and matched to those who died in a hospital. The cost was 10.5 times greater for the last 2 weeks of life for terminal care in a hospital than at home, due to the greater range and larger quantity of diagnostic and therapeutic services provided to hospitalized patients than to those who died at home.

Adult↗