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PubMed2001

Simulated weightlessness alters the nycthemeral distribution of energy expenditure in rats.

The energy metabolism adaptations to simulated weightlessness in rats by hindlimb tail suspension are unknown. 12 male rats were assigned to 7 days of isolation, 7 days of habituation to the suspension device, 10 days of simulated weightlessness, and 3 days of recovery. The 24-hour energy expenditure was measured by continuous indirect calorimetry. We calculated the 12-hour energy expenditure during the active (night) and inactive (day) periods, the minimal observed metabolic rates with the day values taken as an index of the basal metabolic rate, and the non-basal energy expenditure representing the cost of physical activity plus the diet-induced thermogenesis. Suspension did not change the mean 24-hour energy expenditure (360.8+/-15.3 J min(-1) kg(-0.67)), but reduced the night/day difference by 64 % (P<0.05) through a concomitant drop in night-energy expenditure and increase in day values. The difference between night and day minimal metabolic rates was reduced by 81 % (P<0.05), and the transient rise in day values suggests an early and moderate basal metabolic rate increase (9 %). An overall 19 % reduction in non-basal energy expenditure was observed during simulated weightlessness (P<0.05), which was mainly attributable to a reduction in the cost of physical activity. 3 days of recovery restored the night/day differences but increased the 24-hour energy expenditure by 10 % (P<0.05). In conclusion, hindlimb tail suspension in rats did not alter the 24-hour energy expenditure, but it transiently increased the basal metabolic rate, and altered both the energy expended on physical activity and the nycthemeral distribution of motor activity. These data suggest that the circadian rhythms of energy expenditure are affected during simulated weightlessness.

Animals↗
PubMed2004

Evaluation of the SenseWear Pro Armband to assess energy expenditure during exercise.

PURPOSE: To assess the accuracy of the SenseWear Pro Armband for estimating energy expenditure during exercise. METHODS: : Forty subjects (age = 23.2 +/- 3.8 yr; body mass index = 23.8 +/- 3.1 kg x m) performed four exercises (walking, cycling, stepping, arm ergometry) with each exercise lasting 20-30 min and workload increasing at 10-min intervals. Subjects wore the SenseWear Pro Armband on the right arm, and energy expenditure was estimated using proprietary equations developed by the manufacturer. Estimated energy expenditure from the SenseWear Pro Armband was compared with energy expenditure determined from indirect open-circuit calorimetry, which served as the criterion measure. RESULTS: : When a generalized proprietary algorithm was applied to the data, the SenseWear Pro Armband significantly underestimated total energy expenditure by 14.9 +/- 17.5 kcal (6.9 +/- 8.5%) during walking exercise, 32.4 +/- 18.8 kcal (28.9 +/- 13.5%) during cycle ergometry, 28.2 +/- 20.3 kcal (17.7 +/- 11.8%) during stepping exercise, and overestimated total energy expenditure by 21.7 +/- 8.7 kcal (29.3 +/- 13.8%) during arm ergometer exercise (P < or = 0.001). At the request of the investigators, exercise-specific algorithms were developed by the manufacturer and applied to the data that resulted in nonsignificant differences in total energy expenditure between indirect calorimetry and the SenseWear Pro Armband of 4.6 +/- 18.1 kcal (2.8 +/- 9.4%), 0.3 +/- 11.3 kcal (0.9 +/- 10.7%), 2.5 +/- 18.3 kcal (0.9 +/- 11.9%), and 3.2 +/- 8.1 kcal (3.8 +/- 9.9%) for the walk, cycle ergometer, step, and arm ergometer exercises, respectively. CONCLUSIONS: It appears that it is necessary to apply exercise-specific algorithms to the SenseWear Pro Armband to enhance the accuracy of estimating energy expenditure during periods of exercise. When exercise-specific algorithms are used, the SenseWear Pro Armband provides an accurate estimate of energy expenditure when compared to indirect calorimetry during exercise periods examined in this study.

Adolescent↗
PubMed1999

Decreased medical expenditures for care of HIV-seropositive patients. The impact of highly active antiretroviral therapy at a US Veterans Affairs Medical Center.

OBJECTIVE: To identify any changes in expenditures and in morbidity and mortality with the progression of treatment of the HIV-seropositive population from monotherapy with a nucleoside reverse transcriptase inhibitor (NRTI) [1993] through dual NRTI therapy (1995) to highly active antiretroviral therapy (HAART) [1997]. DESIGN AND SETTING: This study retrospectively compared 3 separate years of the total expenditures encountered in the management of HIV-seropositive individuals seen at a US Veterans Affairs Medical Center. INTERVENTIONS: Utilising a computerised hospital database, we identified those patients with HIV-related International Classification of Diseases, version 9 (ICD-9) codes and collected all healthcare-related expenditure data. The 3 eras selected for comparison were controlled for similar utilisation of prophylaxis against opportunistic infections, access to investigational antivirals, consistency between primary care providers and distribution of new anti-HIV therapies relative to that era. Cost data for inpatient and outpatient activities (visits and admissions) were derived from actual expenditures. Major categories were then compared, including total inpatient/outpatient expenditures and utilisation, laboratory and prescription costs, and morbidity and mortality rates. MAIN OUTCOME MEASURES AND RESULTS: The 3 periods had similar patient populations, with 86, 86 and 82% of patients in 1993, 1995 and 1997, respectively, having some degree of immunosuppression (defined as CD4+ lymphocyte counts < 500 cells/mm3). Morbidity and mortality were not changed by the addition of dual NRTI therapy. HAART therapy produced 60 and 70% declines in relative mortality when compared with the single and dual NRTI eras. Dual NRTI or HAART therapy decreased overall expenditures as compared with NRTI monotherapy. HIV-related outpatient resource utilisation other than pharmacy and laboratory costs fell by 25 and 59% in 1997 as compared with 1993 and 1995, respectively. The greatest fall in resource utilisation was for inpatient bed-days of care, where the average cost per patient fell by $US2782 between 1993 and 1997. Pharmacy and laboratory expenditures increased by $US1825 and $US231 per patient from 1993 to 1997, respectively. Overall, the impact of HAART was a decrease of $US1193 in the average total cost per patient from 1993 to 1997. CONCLUSIONS: The introduction of HAART provided a positive outcome on patient morbidity and mortality and on medical centre expenditures. The end result was a cost shift of expenditures from inpatient utilisation to outpatient pharmacy and laboratory costs. This information is important for patients and providers, who need to make clinical decisions on lifelong therapies, and for healthcare financial planners, who need to predict inpatient and outpatient healthcare utilisation during an era of limited healthcare dollars.

Anti-HIV Agents↗
PubMed2001

Functional disability and health care expenditures for older persons.

BACKGROUND: The rapidly expanding proportion of the US population 65 years and older is anticipated to have a profound effect on health care expenditures. Whether the changing health status of older Americans will modulate this effect is not well understood. This study sought to determine the relationship between functional status and government-reimbursed health care services in older persons. METHODS: Longitudinal cohort study of a representative sample of community-dwelling persons 72 years or older. Clinical data were linked with data on 2-year expenditures for Medicare-reimbursed hospital, outpatient, and home care services and Medicare- and Medicaid-reimbursed nursing home services. Per capita expenditures associated with different functional status transitions were calculated, as were excess expenditures associated with functional disability adjusted for demographic, health, and psychosocial variables. RESULTS: The 19.6% of older persons who had stable functional dependence or who declined to dependence accounted for almost half (46.3%) of total expenditures. Persons in these groups had an excess of approximately $10 000 in expenditures in 2 years compared with those who remained independent. The 9.6% of patients who were dependent at baseline accounted for more than 40.0% of home health and nursing home expenditures; the 10.0% who declined accounted for more than 20.0% of hospital, outpatient, and nursing home expenditures. CONCLUSIONS: Functional dependence places a large burden on government-funded health care services. Whereas functional decline places this burden on short- and long-term care services, stable functional dependence places the burden predominantly on long-term care services. Declining rates of functional disability and interventions to prevent disability hold promise for ameliorating this burden.

Aged↗
PubMed2004

Adult mental health needs and expenditure in Australia.

BACKGROUND: Relatively little international work has examined whether mental health resource allocation matches need. This study aimed to determine whether adult mental health resources in Australia are being distributed equitably. METHOD: Individual measures of need were extrapolated to Australian Areas, and Area-based proxies of need were considered. Particular attention was paid to the prevalence of mental health problems, since this is arguably the most objective measure of need. The extent to which these measures predicted public sector, private sector and total adult mental health expenditure at an Area level was examined. RESULTS: In the public sector, 41.6% of expenditure variation was explained by the prevalence of affective disorders, personality disorders, cognitive impairment and psychosis, as well as the Area's level of economic resources and State/Territory effects. In the private sector, 72.4% of expenditure variation was explained by service use and State/Territory effects (with an alternative model incorporating service use and State/Territory supply of private psychiatrists explaining 69.4% of expenditure variation). A relatively high proportion (58.7%) of total expenditure variation could be explained by service utilisation and State/Territory effects. CONCLUSIONS: For services to be delivered equitably, the majority of variation in expenditure would have to be accounted for by appropriate measures of need. The best model for public sector expenditure included an appropriate measure of need but had relatively poor explanatory power. The models for private sector and total expenditure had greater explanatory power, but relied on less appropriate measures of need. It is concluded that mental health services in Australia are not yet being delivered equitably.

Adolescent↗
PubMedDate not supplied

Antimicrobial expenditures and usage at four university hospitals. Baden-Württemberg Interuniversity Study Group.

BACKGROUND: The increasing use of antimicrobiaL drugs is resulting in enormous hospital expenditures. Careful assessment of inappropriate prescribing and a search for more cost-effective treatment strategies are urgently required. Comparisons between hospitals should help identify areas of inappropriate prescribing as well as effective drug use programs, but such analyses may be severely biased if the impact of different case-mixes is not recognized. PATIENTS AND METHODS: We studied antimicrobial usage and expenditures at four state university hospitals in southwestern Germany and assessed the significance of differences between hospital services after adjustment for patient variables. A prevalence survey was done with review of 2,254 charts of patients admitted to the surgical, medical and pediatric services to obtain information on antimicrobial drug prescription and expenditures in the week preceding the survey. RESULTS: According to pharmacy data for the year 1994, maximal differences between these hospitals in the antibiotic costs per patient-day were 1.9-fold (surgical services), 1.5-fold (medical services), and 1.6-fold (pediatric services). In a multivariate analysis, adjusted antibiotic prescription prevalence rates did not differ for medical and pediatric service patients, but did differ for surgical service patients (p = 0.03). Similarly, adjusted expenditures per patient-week differed significantly between hospitals for surgical service patients (p = 0.001), but only marginally for medical (p = 0.14) and pediatric (p = 0.05) service patients. The adjusted difference in expenditures between surgical departments was as large as 2.8-fold (95% CI 1.8 to 4.3) and was primarily related to preferential use of expensive iv antimicrobial drugs. CONCLUSION: In two hospitals, lowest expenditures in either surgery or medicine were associated with active antimicrobial drug use programs suggesting an impact of these programs on drug use and expenditures limited to these services. The identification of such large patient-mix unrelated differences in antimicrobial usage and expenditures offers opportunities for quality improvements and cost reduction.

Adolescent↗
PubMed1987

Health expenditure by area in Finland--an indicator of equity.

The responsibility of organizing and funding health services has in Finland been delegated to small local government units (to 461 communes, average pop. about 11,000), but not to counties or provinces like e.g. in other Nordic countries. PHC is organized by one or few communes and for the specialist level services they have formed 21 Central Hospital Regions (CHR). The central government pays per cent subsidies which are weighted on the basis of income of each community. In 1982 the average share of central government was 44.3% and the communes were responsible for 28.6% of the total expenditure. The national sickness insurance is subventing mainly private services. Its share was in 1982 about 11%. Direct personal costs were about 16%. There are no marked regional differences in the structure of services, e.g. the average share of inpatient care expenditure was 53% and the differences between regions small (z 6%). Total expenditure varied as indexes between regions from 82 tot 119. One reason is the high costs of some university hospitals which do not receive full compensation for services made available to other regions. The expenditure by region did not correlate at all with indicators of ageing. The same can be said of areal differences in income level. Only SMR, a crude indicator of the level of health, correlated positively with expenditure. It is concluded that the areal equity is acceptable if measured with expenditure. The general structure of services does not markedly differ between CHRs. The total health expenditure has been and will remain at the relatively low level of 6.5-7.0% of the GNP. The involvement of small communes is seen as a favourable basis of controlling the expenditure and developing an efficient service system.

Catchment Area, Health↗
PubMed2006

Incremental expenditure of treating hypertension in the United States.

BACKGROUND: This study determined incremental direct expenditures of treating hypertension in the United States population. METHODS: Analysis of the 2001 Medical Expenditure Panel Survey (MEPS), a national probability sample survey of the civilian noninstitutionalized U.S. population, was conducted. Hypertensive patients were identified as those with a medical diagnosis for hypertension based on International Classification of Diseases (ICD)-9 codes; patients who were consumers of hypertension-related medical care services including inpatient and outpatient visits, emergency room visits, home health visits, office-based medical provider visits, and other medical expenses; patients who self-reported being diagnosed with hypertension by their physicians; and patients who were prescribed antihypertensive medication. Incremental expenditure of treating hypertension was estimated through least-squares regression adjusting for age, sex, ethnicity, education, and comorbidities using the D'Hoore et al version of the Charlson comorbidity index. Sample data were projected to the U.S. population and 95% confidence limits for estimates were calculated using the Taylor expansion method. RESULTS: Sample estimates projected to the population indicated that approximately 17.4% of individuals >or=18 years of age in the ambulatory population have hypertension. Total incremental annual direct expenditures for hypertension patients were estimated to be more than 54.0 billion US dollars in 2001 after adjusting for demographics and comorbidities. Mean incremental annual direct expenditures for an individual with hypertension was 1,131 US dollars . Prescription medicines, inpatient visits, and outpatient visits constituted >90% of overall incremental expenditures. CONCLUSIONS: With incremental direct medical expenditures estimated at nearly 55.0 billion US dollars, hypertension expenditures represent a significant amount of health care resource use.

Adolescent↗
PubMedDate not supplied

Physical partner violence and medicaid utilization and expenditures.

OBJECTIVES: Little research has addressed differences in health care expenditures among women who are currently experiencing intimate partner violence (IPV) compared with those who are not. The purpose of this work is to provide estimates of direct medical expenditure for physician, drug, and hospital utilization among Medicaid-eligible women who screened as currently experiencing IPV compared with those who are not currently experiencing IPV. METHODS: In this family practice-based cross-sectional study, women were screened for current IPV using a 15-item Index of Spouse Abuse-Physical (ISA-P) between 1997 and 1998. Consents were obtained from study subjects to review Medicaid expenditure and utilization data for the same time period. RESULTS: Mean physician, hospital, and total expenditures were higher for those women with higher IPV scores compared with those who scored as not currently experiencing IPV, after adjusting for confounders. Higher IPV scores were associated with a three-fold increased risk of having a total expenditure over $5,000 (95% confidence interval [CI] 1.3, 8.4). The mean total expenditure difference between the high IPV and no IPV groups was $1,064 (95% CI $623, $1506). The adjusted risk ratio for high IPV score and the log of total Medicaid expenditures was 2.3 (95% CI 1.2, 4.4). CONCLUSIONS: Women screened as experiencing higher IPV scores had higher Medicaid expenditures compared with women not currently experiencing IPV. Early IPV assessment partnered with effective clinic or community-based interventions may help to identify IPV earlier and reduce the health impact and cost of IPV.

Adolescent↗
PubMed1997

Health expenditures in Latin America and the Caribbean.

This paper presents the results of a study commissioned by the Latin American and Caribbean Technical Department of the World Bank to document and analyze health expenditures in Latin America and the Caribbean. In 1990, the countries of this region spent US$ 69 billion on health, with an average per capita health expenditure of US$ 162. On average, the countries spent 6.2% of their GDP on health, with the expenditures divided about equally between the public and private sectors. In both the public and private sectors, per capita health expenditures were positively and significantly correlated with per capita income. However, this relationship holds only for the public sector, when health expenditures are measured as a proportion of GDP. While several poorer countries were dependent on external assistance, with increasing income, the countries relied more on public expenditures to finance health care. Based on the limited time series data, it is evident that there was a considerable variation among countries regarding the proportion spent on capital investments, primary health care, and drugs, but not on salaries. Looking ahead, with increasing economic development, the proportion of GDP spent on health, along with public health expenditure as a proportion of total health expenditure, is likely to increase rapidly, while aid dependency is likely to decline.

Caribbean Region↗
PubMed2003

Using self-reported data to predict expenditures for the health care of older people.

OBJECTIVES: To create and test a method for using self-reported data to predict future expenditures for the health care of older people. DESIGN: A two-stage regression model of the relationship between self-reported data and Medicare expenditures during the following year was constructed from a randomly selected (derivation) half of a cohort of fee-for-service Medicare beneficiaries. For the other (validation) half of the cohort, two sets of predictions of 12-month Medicare expenditures were generated, one using the new two-stage model and the other using the principal inpatient diagnostic cost group (PIP-DCG) method now used to risk-adjust capitation payments to Medicare + Choice health plans. Both sets of predictions were compared with Medicare's actual 12-month expenditures for the validation cohort. SETTING: Ramsey County, Minnesota. PARTICIPANTS: Community-dwelling Medicare beneficiaries aged 70 and older (N = 13,682) who responded to a mailed survey. MEASUREMENTS: Predicted-to-observed ratio (PTOR) of Medicare expenditures. RESULTS: For the validation cohort, Medicare's actual 12-month expenditures totaled $26.5 million. The two-stage model predicted Medicare expenditures of $26.4 million (PTOR = 1.00); the PIP-DCG method predicted $31.2 million (PTOR = 1.18). Within subpopulations of healthy and ill beneficiaries, the two-stage model's predictions remained considerably more accurate than the PIP-DCG predictions. CONCLUSION: Self-reported data may predict future Medicare expenditures more accurately than administrative data about beneficiaries' demographic characteristics, and previous hospitalizations.

Aged↗
PubMed1981

Prognosis, survival, and the expenditure of hospital resources for patients in an intensive-care unit.

To define more precisely the factors determining the allocation of resources to critically ill patients, we asked physicians to estimate at the time of admission the short-term prognosis of patients who accounted for 1831 admissions to a medical intensive-care and coronary-care unit. We then examined the relations between this prognosis, the actual outcome, and the resource expenditure during a single hospitalization. We found that the care of nonsurvivors involved a significantly higher mean expenditure than did the care of survivors (P less than 0.01). Among nonsurvivors, expenditure positively correlated with the probability of survival estimated at the time of admission (P less than 0.001). Among survivors, expenditure negatively correlated with the probability of survival (P less than 0.001). Among both nonsurvivors and survivors, total expenditure and expenditure per day were greatest for patients whose outcome were most unexpected. We conclude that prognostic uncertainty is important in determining resource expenditures for the critically ill. This factor warrants greater consideration in future studies of expenditure for the care of catastrophically ill patients.

Boston↗
PubMed2004

Identifying workers at risk for high health care expenditures: a short questionnaire.

The objective of this study was to create and measure the predictive accuracy of a brief questionnaire for screening new workers to identify those at increased risk for generating high health care insurance expenditures during the following year. Such an instrument could help health plans and providers intervene to mitigate the health risks of identified high-risk workers. We mailed a 53-item questionnaire to members of a "derivation cohort" (adult food processing workers, n = 15496) and obtained records of the eligible respondents' health insurance expenditures during the following year. Using multiple linear regression, we identified eight of the questions that predicted future expenditures most accurately, and created a formula to predict total expenditures from answers to these questions. To validate the formula's predictive accuracy, we used the eight-item questionnaire to survey two "validation cohorts" (transportation workers, n = 7445; and their dependents, n = 5562), inserted responses into the scoring formula, classified respondents into high-risk (top 10%) or low-risk (lower 90%) groupings, and then compared health insurance expenditures generated by the high- and low-risk groups during the following year. In the derivation cohort, age, sex, regular use of medications, frequent visits to physicians, and having arthritis, diabetes, cancer, or high cholesterol predicted future health care expenditures. In the worker and dependent validation cohorts, the respondents classified by the formula as high-risk generated insurance expenditures during the following year that were 2.4 and 1.8 times greater than those generated by the members of the low-risk groups (p < 0.001). An eight-item questionnaire and its scoring formula can identify high-risk groups of workers that will generate high health care expenditures during the following year. Healthcare organizations could use this questionnaire to help target new workers for care management and disease management interventions.

Adult↗
PubMed2005

Projecting future drug expenditures--2005.

PURPOSE: Drug expenditure trends in 2003 and 2004 and projected drug expenditures for 2005 are discussed. SUMMARY: Various factors are likely to affect drug costs, including drug prices, drugs in development, and generic drugs. In 2003 there was a continued moderation of the increase in drug expenditures. Drug expenditures increased by 11.4% from 2002 to 2003. Through the first nine months of 2004, expenditures increased by only 8.7% compared with 2003. This moderation can be attributed to many factors, particularly patent expirations, prescription-to-nonprescription conversions and a continued slowdown in new drug approvals. Higher cost sharing for consumers and continued weaknesses in several sectors of the U.S. economy affecting employment levels and insurance coverage also contributed to this smaller increase in drug utilization. It is expected that 2005 drug expenditure growth will out-pace the growth in overall health care expenditures and growth in the economy. CONCLUSION: In 2005, there should be a 10-12% increase in drug expenditures in outpatient settings, a 12-15% increase in clinics, and a 6-9% increase in hospitals.

Drug Costs↗
PubMed1995

Case mix controlled service use and expenditures in the social/health maintenance organization demonstration.

BACKGROUND: The social health maintenance organization (S/HMO) demonstration was implemented, in part, to determine if the presumed integration of acute and chronic care in these plans could produce sufficient savings to allow plans to offer expanded and chronic care benefits without increased cost to the Medicare program. METHODS: S/HMO members and a sample of fee-for-service (FFS) recipients were tracked over three years to assess their utilization experience. Analyses controlled for case mix, using Grade of Membership procedures. RESULTS: In 1987, the last year of risk sharing, S/HMOs reported higher total expenditures than FFS in each health status class. For the "healthy," differences were largest for physician care. In other classes, differences in nonskilled nursing or home care use were noted. In 1988, the first year of full risk, Seniors Plus had equivalent or lower expenditures relative to FFS for all classes. Elderplan had lower expenditures in four of six classes and provided more service to the "frail" and the "acutely ill." SHP had higher expenditures in all classes because of higher hospital and nursing home expenditures. Medicare Plus II had higher expenditures in all classes, for physician, nonskilled nursing home, and home care expenditures. CONCLUSIONS: Overall plan losses and higher expenditures among a number of case mix groups suggest a need for refinement of S/HMO operations--especially in case management relationships to medical care and in the selection of "high risk" cases.

Diagnosis-Related Groups↗
PubMed1985

Health expenditures and elderly adults.

The purpose of the study was to examine how health expenditures vary among elderly households and how expenditure patterns across other commodity groups are influenced by various factors, including higher medical expenditures. Household expenditure data for five different age groups of elderly households included in the 1972-1973 Consumer Expenditure Survey were used in the analysis. Multiple regression procedures were used to estimate a complete set of budget share equations with and without health expenditures as an independent variable. Results indicate readjustments in expenditure patterns resulting from higher direct medical payments are likely to lead to significant reductions in food, housing, transportation, and taxes under current policy. This could have important long-run implications for elderly adults as well as for the entire economy. The research also indicated the importance of controlling for age differences when studying expenditure patterns of elderly adults.

Age Factors↗
PubMed2006

Household food insecurity and food expenditure in Bolivia, Burkina Faso, And the Philippines.

This study examined the association between food insecurity, determined by a modified version of the U.S. Household Food Security Survey Module (US HFSSM), and total daily per capita (DPC) consumption (measured as household expenditures) in Bolivia, Burkina Faso, and the Philippines. Household food insecurity was determined by an adapted 9-item US HFSSM version. A short version of the World Bank's Living Standards Measurement Study (LSMS) consumption module measured household expenditures. Focus groups were used to adapt the survey instrument to each local context. The sample (n approximately 330 per country) includes residents of urban and rural areas. A 12-month food expenditure aggregate was generated as part of the total household expenditures calculation. DPC food expenditure, which represented over 60% of the total household consumption, as well as expenditures on specific food groups correlated with food insecurity both as a continuous Food Insecurity Score (FinSS) and a tricategorical food insecurity status variable. ANOVA and regression analysis were executed adjusting for social and demographic covariates. Food-secure households have significantly higher (P < 0.05) total DPC food expenditures as well as expenditures on animal source foods, vegetables, and fats and oils than moderately and severely food-insecure households. The results offer evidence that the US HFSSM is able to discriminate between households at different levels of food insecurity status in diverse developing world settings.

Adult↗
PubMed2004

Out-of-pocket healthcare expenditures of older Americans with depression.

The objective of this study was to estimate mean annual out-of-pocket (OOP) healthcare expenditures of Americans aged 65 and older with self-reported depression and compare these expenditures with the OOP expenditures of older Americans with hypertension, heart disease, diabetes mellitus, and arthritis. Data from the 1999 Medical Expenditure Panel Survey, which employs a nationally representative stratified random sample of households in the United States, were used to estimate mean OOP expenditures for health care during 1999. The data were limited to observations on individuals aged 65 and older living in households in the United States included in the 1999 Medical Expenditure Panel Survey sample (N=2,730). Mean OOP expenditures for older Americans with depression were $1,835 in 1999. Most of the spending ($1,090) was for prescription drugs in this population. For patients with depression, only 8% of total OOP spending was for depression-specific services and treatments. Mean OOP spending was greater for persons with depression than it was for older Americans with hypertension ($1,181) and arthritis ($1,190), whereas OOP spending for depression was similar to spending of older Americans with heart disease ($1,412) and diabetes mellitus ($1,527). Older Americans with depression have high OOP expenditures, with most of this spending for health services and drugs to treat general medical conditions.

Age Factors↗