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Todd H Wagner

Publications and source records attributed to Todd H Wagner.

34 records · Page 2Linked to original sources
PubMed2004

Problems paying out-of-pocket medication costs among older adults with diabetes.

OBJECTIVE: To identify problems faced by older adults with diabetes due to out-of-pocket medication costs. RESEARCH DESIGN AND METHODS: In this cross-sectional national survey of 875 adults with diabetes treated with hypoglycemic medication, respondents reported whether they had underused prescription medications due to cost pressures or had experienced other financial problems associated with medication costs such as forgoing basic necessities. Respondents also described their interactions with clinicians about medication costs. RESULTS: A total of 19% of respondents reported cutting back on medication use in the prior year due to cost, 11% reported cutting back on their diabetes medications, and 7% reported cutting back on their diabetes medications at least once per month. Moreover, 28% reported forgoing food or other essentials to pay medication costs, 14% increased their credit card debt, and 10% borrowed money from family or friends to pay for their prescriptions. Medication cost problems were especially common among respondents who were younger, had higher monthly out-of-pocket costs, and had no prescription drug coverage. In general, few respondents, including those reporting medication cost problems, reported that their health care providers had given them information or other assistance to address medication cost pressures. CONCLUSIONS: Out-of-pocket medication costs pose a significant burden to many adults with diabetes and contribute to decreased treatment adherence. Clinicians should actively identify patients with diabetes who are facing medication cost pressures and assist them by modifying their medication regimens, helping them understand the importance of each prescribed medication, providing information on sources of low-cost drugs, and linking patients with coverage programs.

Aged↗
PubMed2004

Consumers' use of the Internet for health insurance.

OBJECTIVES: We examined consumers' search for information about health insurance choices and their use of the Internet for that search and to manage health benefits. STUDY DESIGN: We surveyed a random sample of more than 4500 individuals aged 21 years and older who were members of a survey research panel during December 2001 and January 2002. METHODS: The survey included questions about searching for health insurance information in 3 health insurance markets: Medicare, individual or nongroup, and employer-sponsored group. We also asked questions about use of the Internet to manage health benefits. We tabulated means of responses to each question by market and tested for independence across demographic groups using the Pearson chi-square test. RESULTS: We identified important differences across and within markets in the extent to which people look for information about health insurance alternatives and the role of the Internet in their search. Although many individuals were unaware of whether their employer or health plan provided a website to manage health benefits, those who used the sites generally evaluated them favorably. CONCLUSIONS: Our results suggest that the Internet is an important source of health insurance information, particularly for individuals purchasing coverage individually in the nongroup and Medicare markets relative to those obtaining coverage from an employer. In the case of Medicare coverage, studies focusing on beneficiaries' use of Internet resources may underestimate the Internet's importance by neglecting caregivers who use the Internet. Many individuals may be unaware of the valuable resources available through employers or health plans.

Adult↗
PubMed2004

The relationships among age, chronic conditions, and healthcare costs.

OBJECTIVE: To learn how age and chronic illness affect costs in the Veterans Affairs healthcare system. STUDY DESIGN: Veterans Affairs patients 65 years or older were identified from administrative data. We noted their healthcare utilization, cost, and diagnosis of any of 29 common chronic conditions (CCs). We examined how those 80 years or older differed from the younger patients. RESULTS: The Department of Veterans Affairs spent dollars 8.5 billion to treat 1.6 million older patients in fiscal year 2000. Age was less important than chronic illness in explaining cost differences. The oldest patients incurred a mean of dollars 1295 greater costs than the younger patients, primarily because they were more likely to have a high-cost CC. The oldest patients incurred higher total costs than the younger patients in only 14 of 29 groups defined by CC. Long-term care accounted for most of the extra cost of the oldest patients. When this cost was excluded, the oldest patients incurred only dollars 266 more cost than the younger patients. CONCLUSIONS: Growth in the population of the oldest patients will increase the number of individuals with CCs requiring long-term care. With its limited long-term care benefit, Medicare will avoid much of this financial consequence. In contrast, the financial risk of acute and long-term care gives the Department of Veterans Affairs an incentive to develop strategies to prevent CCs associated with long-term care.

Age Factors↗
PubMed2003

Use of the Internet and e-mail for health care information: results from a national survey.

CONTEXT: The Internet has attracted considerable attention as a means to improve health and health care delivery, but it is not clear how prevalent Internet use for health care really is or what impact it has on health care utilization. Available estimates of use and impact vary widely. Without accurate estimates of use and effects, it is difficult to focus policy discussions or design appropriate policy activities. OBJECTIVES: To measure the extent of Internet use for health care among a representative sample of the US population, to examine the prevalence of e-mail use for health care, and to examine the effects that Internet and e-mail use has on users' knowledge about health care matters and their use of the health care system. DESIGN, SETTING, AND PARTICIPANTS: Survey conducted in December 2001 and January 2002 among a sample drawn from a research panel of more than 60 000 US households developed and maintained by Knowledge Networks. Responses were analyzed from 4764 individuals aged 21 years or older who were self-reported Internet users. MAIN OUTCOME MEASURES: Self-reported rates in the past year of Internet and e-mail use to obtain information related to health, contact health care professionals, and obtain prescriptions; perceived effects of Internet and e-mail use on health care use. RESULTS: Approximately 40% of respondents with Internet access reported using the Internet to look for advice or information about health or health care in 2001. Six percent reported using e-mail to contact a physician or other health care professional. About one third of those using the Internet for health reported that using the Internet affected a decision about health or their health care, but very few reported impacts on measurable health care utilization; 94% said that Internet use had no effect on the number of physician visits they had and 93% said it had no effect on the number of telephone contacts. Five percent or less reported use of the Internet to obtain prescriptions or purchase pharmaceutical products. CONCLUSIONS: Although many people use the Internet for health information, use is not as common as is sometimes reported. Effects on actual health care utilization are also less substantial than some have claimed. Discussions of the role of the Internet in health care and the development of policies that might influence this role should not presume that use of the Internet for health information is universal or that the Internet strongly influences health care utilization.

Adult↗
PubMed2003

Estimated economic costs of overactive bladder in the United States.

OBJECTIVES: To estimate the economic costs of overactive bladder (OAB), including community and nursing home residents, and to compare the costs in male versus female and older versus younger populations. METHODS: The National Overactive Bladder Evaluation Program included a representative telephone survey of 5204 community-dwelling adults 18 years and older in the United States and a follow-up postal survey of all individuals with OAB identified and age and sex-matched controls. The postal survey asked respondents about bladder symptoms, self-care use, treatment use, work loss, and OAB-related health consequences. Survey data estimates were combined with year 2000 average cost data to calculate the cost of OAB in the community. Institutional costs were estimated from the costs of urinary incontinence in nursing homes, limited to only those with urge incontinence or mixed incontinence (urge and stress). RESULTS: The estimated total economic cost of OAB was 12.02 billion dollars in 2000, with 9.17 and 2.85 billion dollars incurred in the community and institutions, respectively. Community female and male OAB costs totaled 7.37 and 1.79 billion dollars, respectively. The estimated total cost was sensitive to the estimated prevalence of OAB; therefore, we calculated the average cost per community-dwelling person with OAB, which was 267 dollars per year. CONCLUSIONS: By quantifying the total economic costs of OAB, this study-the first obtained from national survey data-provides an important perspective of this condition in society. The conservative estimates of the total cost of OAB were comparable to those of osteoporosis and gynecologic and breast cancer. Although this provides information on the direct and indirect costs of OAB, quality-of-life issues must be taken into account to gain a better understanding of this condition.

Adolescent↗
PubMed2003

The effect of age on the use of health and self-care information: confronting the stereotype.

PURPOSE: Given stereotypes of older adults, there is the perception that older adults will not use health information technologies. One concern is that practitioners might shy away from providing older patients with health information, and in particular, computerized information. The study's primary objective was to evaluate whether a health information intervention had a differential effect for people of different ages. DESIGN AND METHODS: Quasi-experimental survey data from an assessment of a communitywide informational intervention were used. People were asked about their use of medical reference books, telephone advice nurses, or computers for health information in the past few months. In total, 5,909 surveys were completed. RESULTS: The data show that older adults were no less likely (and were sometimes more likely) to use health information as a result of the intervention than younger adults. For telephone advice nurses and computers, the effect of the intervention was not significantly different for the different age groups. Yet, compared with persons 18-29 years of age, those over the age of 65 had a 17-percentage point increase in using a self-care book. IMPLICATIONS: We find convincing evidence to counter the stereotype that older adults are resistant to trying new health information technologies.

Adolescent↗
PubMed2003

The cost of operating institutional review boards (IRBs).

PURPOSE: Recent reports have claimed that institutional review boards (IRBs) are underfunded, yet little is known about the costs of operating IRBs. This study estimated the costs for operating high-volume and low-volume IRBs. METHOD: IRB costs were calculated from published summary data. Costs were standardized to reflect 2001 dollars. RESULTS: Total estimated costs for operating high-volume and low-volume IRBs were $770,674 and $76,626, respectively. The average cost per action, a measure of economic efficiency, was lower for high-volume IRBs ($277 per action) than it was for low-volume IRBs ($799 per action). CONCLUSIONS: Although high-volume IRBs are more expensive than are low-volume IRBs in absolute terms, they are more economically efficient. Policy debates should consider the potential savings from large IRBs, perhaps by encouraging small IRBs to merge, although this may result in less local review, control, and oversight.

Benchmarking↗
PubMed2003

Using average cost methods to estimate encounter-level costs for medical-surgical stays in the VA.

The U.S. Department of Veterans Affairs (VA) maintains discharge abstracts, but these do not include cost information. This article describes the methods the authors used to estimate the costs of VA medical-surgical hospitalizations in fiscal years 1998 to 2000. They estimated a cost regression with 1996 Medicare data restricted to veterans receiving VA care in an earlier year. The regression accounted for approximately 74 percent of the variance in cost-adjusted charges, and it proved to be robust to outliers and the year of input data. The beta coefficients from the cost regression were used to impute costs of VA medical-surgical hospital discharges. The estimated aggregate costs were reconciled with VA budget allocations. In addition to the direct medical costs, their cost estimates include indirect costs and physician services; both of these were allocated in proportion to direct costs. They discuss the method's limitations and application in other health care systems.

Budgets↗
PubMed2003

Average cost of VA rehabilitation, mental health, and long-term hospital stays.

This article describes the development of a database for the cost of inpatient rehabilitation, mental health, and long-term care stays in the Department of Veterans Affairs from fiscal year 1998 forward. Using "bedsection," which is analogous to a hospital ward, the authors categorize inpatient services into nine categories: rehabilitation, blind rehabilitation, spinal cord injury, psychiatry, substance abuse, intermediate medicine, domiciliary, psychosocial residential rehabilitation, and nursing home. For each of the nine categories, they estimated a national and a local (i.e., medical center) average per diem cost. The nursing home average per diem costs were adjusted for case mix using patient assessment information. Encounter-level costs were then calculated by multiplying the average per diem cost by the number of days of stay in the fiscal year. The national cost estimates are more reliable than the local cost estimates.

Blindness↗
PubMed2003

Prevalence and costs of chronic conditions in the VA health care system.

Chronic conditions are among the most common causes of death and disability in the United States. Patients with such conditions receive disproportionate amounts of health care services and therefore cost more per capita than the average patient. This study assesses the prevalence among the Department of Veterans Affairs (VA) health care users and VA expenditures (costs) of 29 common chronic conditions. The authors used regression to identify the marginal impact of these conditions on total, inpatient, outpatient, and pharmacy costs. Excluding costs of contracted medical services at non-VA facilities, total VA health care expenditures in fiscal year 1999 (FY1999) were $14.3 billion. Among the 3.4 million VA patients in FY1999, 72 percent had 1 or more of the 29 chronic conditions, and these patients accounted for 96 percent of the total costs ($13.7 billion). In addition, 35 percent (1.2 million) of VA health care users had 3 or more of the 29 chronic conditions. These individuals accounted for 73 percent of the total cost. Overall, VA health care users have more chronic diseases than the general population.

Age Factors↗
PubMed2002

Health-related consequences of overactive bladder.

OBJECTIVE: Overactive bladder (OAB) is a condition of urgency, with or without urge incontinence, usually with frequency and nocturia. This study assesses whether people with OAB are at greater risk for urinary tract infections (UTIs), falls and injuries, and increased number of visits to the doctor compared to age- and gender-matched controls. The study also estimates costs associated with these health-related consequences. PATIENTS & METHODS: A US representative telephone survey under the National Overactive Bladder Evaluation (NOBLE) Program was conducted with 5204 English-speaking adults older than 18 years. The survey asked respondents about bladder symptoms. Based on the telephone survey, 865 symptom-identified OAB cases and 903 age- and gender-matched controls were sent a postal questionnaire. A total of 397 cases and 522 controls returned the questionnaires. Nonrespondent cases and controls did not differ with regard to age, gender, educational status, diabetes, congestive heart failure, and self-rated health status. Regression analyses were conducted to assess the effect of OAB on health-related consequences, controlling for age, gender, race, education, marital status, number of previous births, self-reported health status, diabetes, and congestive heart failure. RESULTS: People with OAB reported 0.84 (20%) more visits to the physician (P < .05) and 0.21 (138%) more UTIs in the last year than people without OAB (P < .001). Overactive bladder cases also had over twice the odds of being injured in a fall than people without OAB (odds ratio = 2.26; 95% confidence interval 1.46, 3.51). Consistent with having more falls, OAB cases had an increased risk of bone fracture (P < .1). This effect, however, was not statistically significant (at alpha level 0.05) due to the limited sample size. The estimated cost of UTIs associated with OAB was approximately $1.37 billion US dollars in year 2000. The cost of falls without bone fracture due to OAB was $55 million. Falls with bone fracture accounted for approximately $386 million; however, further research with a larger sample is needed to accurately estimate these costs. CONCLUSION: People with OAB self-report significantly more UTIs and a greater risk of being injured in a fall. Given the large prevalence of UTIs and concerns of overprescribing antibiotics, these results are important for health plans and policy makers. In addition, people with OAB visit their physicians more often than people without OAB. These consequences entail significant economic costs, of which a large percentage will be incurred by health plans. To the extent that OAB causes these consequences, there may be significant savings from effectively treating OAB.

Accidental Falls↗
PubMedDate not supplied

Computerized health information and the demand for medical care.

OBJECTIVE: Consumer health information, once the domain of books and booklets, has become increasingly digitized and available on the Internet. This study assessed the effect of using computerized health information on consumers' demand for medical care. METHODS: The dependent variable was self-reported number of visits to the doctor in the past year. The key independent variable was the use of computerized health information, which was treated as endogenous. We tested the effect of using computerized health information on physician visits using ordinary least squares, instrumental variables, fixed effects, and fixed-effects instrumental variables models. The instrumental variables included exposure to the Healthwise Communities Project, a community-wide health information intervention; computer ownership; and Internet access. Random households in three cities were mailed questionnaires before and after the Healthwise Communities Project. In total, 5909 surveys were collected for a response rate of 54%. RESULTS: In both the bivariate and the multivariate analyses, the use of computerized health information was not associated with self-reported entry into care or number of visits. The instrumental variables models also found no differences, with the exception that the probability of entering care was significantly greater with the two-stage conditional logit model (P <.05). CONCLUSIONS: Although providing people with health information is intuitively appealing, we found little evidence of an association between using a computer for health information and self-reported medical visits in the past year. This study used overall self-reported utilizations as the dependent variable, and more research is needed to determine whether health information affects the health production function in other important ways, such as the location of care, the timing of getting care, or the intensity of treatment.

Adolescent↗
PubMedDate not supplied

Spending for specialized mental health treatment in The VA: 1995-2001.

The mid-1990s saw dramatic changes in mental health care in the Department of Veterans Affairs (VA), the largest provider of such care in the United States. Spending for specialized inpatient mental health care fell 21 percent from 1995 to 2001, while spending for specialized outpatient care rose 63 percent. The shift from inpatient to outpatient care was accompanied by rapid increases in outpatient medication costs. Overall, the VA reduced the average cost (per VA user) of specialized mental health care by 22 percent while it increased the number of users of these services by 35 percent.

Ambulatory Care↗