Biomedical subjects
Publications and source records attributed to M T French.
While many studies estimate medical costs and lost wages from workplace injuries, few have estimated pain and suffering costs. This study develops a wage-risk model for railroad workers and estimates the total cost of on-the-job injuries. On average, the total cost of an on-the-job injury to a railroad worker in 1980 was between $19,500 and $22,500. These estimates are substantially higher than the sum of medical costs plus lost wages.
Few studies have estimated the economic costs and benefits of substance abuse treatment services. This paper introduces a data collection instrument and method for estimating the economic cost of substance abuse treatment programs. The Drug Abuse Treatment Cost Analysis Program (DATCAP) is based on standard economic principles and the method has recently been tested in two drug abuse intervention studies. Findings from case studies at three treatment programmes are presented to demonstrate the feasibility and reliability of the instrument. The estimation methods and results can be used by treatment programmes for self-evaluation purposes and by researchers who are interested in performing cost-effectiveness or benefit-cost analyses of substance abuse services.
Although some national surveys of drug-abuse treatment have examined cost and financing issues, our study is one of the first to rigorously analyze the costs and financing of methadone treatment at the program level. Our findings are similar to those found at the national level for treatment cost but deviate significantly from the National Drug and Alcoholism Treatment Unit Survey (NDATUS) findings on funding sources. In addition to examining financing and total cost, we grouped resources into particular categories and examined variations at the client, program, regimen, and setting levels. Our specific findings show that public funding sources overwhelmingly support the programs examined; the average annual cost per client for standard methadone treatment was between $3,750 and $4,400; the marginal cost of providing enhanced treatment was between 5% and 6% of the total annual cost of standard treatment; and the average annual cost at the freestanding community-based programs was significantly different from the average annual cost at the hospital-based treatment program. Our results provide a treatment cost methodology along with a financial profile of treatment operations at three clinics that can be compared across programs and settings.
Contemporary drug abuse treatment programs exist in an extremely complex financing environment. Programs face a myriad of funding sources with different eligibility requirements and payment mechanisms that make it difficult for programs to develop a single financing strategy. To complicate the financing process, current funding sources are in a state of flux as managed care gains significance in health care reimbursement. This article will assist drug abuse treatment programs in several ways. First, it summarizes information about funding, eligibility requirements and payment mechanisms. Second, the information is geared toward drug treatment programs and less toward policymakers. Third, the article describes strategies for obtaining funding, including strategies for interacting with managed care. By using these methods for obtaining revenues, it is hoped that drug treatment programs will be able to increase their financing effectiveness.
The purpose of this article is to provide researchers, clinicians, and policymakers with a common source of published cost estimates for drug abuse consequences. Across the broad range of potential complications associated with drug abuse, some of the cost elements are specific and directly related to drug abuse per se (e.g., drug treatment costs), while other items may be related to drug abuse (e.g., typical emergency room cost). The results presented here are based on a review of completed and ongoing studies, which include published papers, monographs, conference presentations, working papers, reports, insurance company records, newsletters, and expert judgment. Whenever possible, we report an average cost estimate and the range of available estimates. Each cost element is normalized to 1994 dollars. The results are organized by type of cost and are presented in tabular format so that the findings can be easily understood and used.
Drug abuse treatment programs need to know the cost of the services they provide. Indeed, continued public and private funding is now being linked to cost and performance measures, and programs can use financial data to improve organizational efficiency. However, one of the dangers of promoting cost studies at treatment programs is that most program staff are not technically prepared to perform a cost analysis and little user-friendly information is available to offer assistance. Furthermore, not all cost methods are consistent, which can lead to noncomparable estimates that are difficult to use for policy or planning purposes. Our paper tries to fill this gap in the research literature and provide treatment programs with a much-needed technical assistance tool. Specifically, we present a structured and scientifically-based instrument for estimating the economic cost of treatment services. The Drug Abuse Treatment Cost Analysis Program (DATCAP) is described in detail along with a companion instrument to analyze treatment financing; the Drug Abuse Treatment Financing Analysis Program (DATFin). The components of both instruments are outlined and findings from a variety of actual case studies are presented. Lastly, we discuss the DATCAP User's Manual, which will enable individual programs to begin collecting the necessary data and estimating economic costs at their own clinics.
PURPOSE: The authors provide a review of the economic evaluation literature of breast cancer screening and identify important trends and gaps in the literature. OVERVIEW: Healthcare resources are limited and economic evaluation plays a critical role in resource allocation, healthcare policy, and clinical decisions. Many economic evaluations of medical practice, however, are unreliable and do not use appropriate analytic techniques. Three important trends were observed. First, two economic evaluation methods are dominant. Second, a wide range of cost estimates exists across studies. Third, a lack of standardization exists across studies with regard to basic economic evaluation principles. These findings should be considered when conducting future research, analyzing economic evaluations of breast cancer screening, and developing clinical guidelines. CLINICAL IMPLICATIONS: Concerns about cost containment in healthcare make it necessary for physicians and clinical administrators to take an active role in resource allocation decisions at the clinical level. For instance, the recent debate on the proper age to begin annual mammography screening involves both resource allocation and clinical issues. Thus, it is important for physicians and clinical administrators to be familiar with the economic evaluation literature of breast cancer screening, economic evaluation methodology, and the associated shortcomings of published estimates.
The dual purpose of this study was to: (1) determine whether problematic drug users, defined through the Drug Abuse Screening Test (DAST-10), exhibited differences in health services utilization and cost relative to a combined group of non-problematic drug users and non-drug users; and (2) assess whether the findings were similar to those for chronic drug users (CDUs) and injecting drug users (IDUs). Results showed that health services utilization and total cost were very similar for problematic drug users defined through quantity-frequency (i.e., CDU, IDU) and diagnostic (i.e., DAST-10) criteria. Findings suggest that quantity/frequency criteria for problematic drug use were reasonable approximations for diagnostic-based measures.
This paper investigates the relationship between chronic drug use and the health care system. Data from 536 African-American, Hispanic, and non-Hispanic White men and women were analyzed to determine independent risk factors for three outcome variables: 1) Need for health care treatment, 2) Utilization of health care treatment, and 3) Failure to receive needed treatment. Nine independent demographic, health, and drug-use history variables were assessed in logistic regression models. Chronic drug users were more likely in the past year to need health care treatment, were as likely to receive some health care treatment, and were more likely not to receive needed treatment than were nonusers.
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Employers are becoming increasingly concerned about the consequences and costs of substance use in their workplaces. Despite this heightened awareness, little information is available to guide them in setting up worksite-based prevention and assistance programs. Most estimates of the prevalence or consequences of substance use are derived from large national surveys of households or individual persons. The primary contribution of this research to the public health literature is the empirical results from a unique data set. In particular, this study presents results of a survey administered to more than 1,200 employees at five different worksites. Descriptive statistics for the prevalence of smoking, alcohol and illicit drug use, prescription drug misuse, and workplace consequences, such as reduced performance and absenteeism, are reported, as well as findings from a multivariate analysis of substance use prevalence and consequences. Compared with national averages, workers at these five sites tended to have substance use profiles similar to or slightly lower than estimates from large national surveys. The study's estimates may help employers identify the extent of a substance abuse problem in their worksites and specific areas to target for possible intervention.