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PubMedDate not supplied

[Private health expenditures and income distribution in Brazil].

BACKGROUND: This paper analyses the share of the family private health expenditures in the Brazilian GDP and in personal income; and the distribution of the family private health expenditures among social groups. METHODS: The research utilized the 1998 Brazilian Home Sample Survey (Pesquisa Nacional por Amostra de Domicilios) with the division of the population into four social groups according to the family income per capita; and the distribution of the family private health expenditures among health insurance, physicians, other health professionals, medical tests, drugs, orthopedic and other medical durables, vision products, dental services, hospital care, nursing home care and other health spending. RESULTS: In 1998, only 7.2% of the population with family income per capita up to 1 minimum wage had health insurance and the health expenditures of this group, that represented 52.5% of the population, was US$ 4.62 per capita. For the people with 9 and more minimum wages per capita the health insurance coverage was 83.2% and the health expenditures was US$ 114.66 per capita. CONCLUSIONS: The implementation of the Brazilian public universal health care system in 1988 denominated "Sistema Unico de Saude" was followed by an expressive expansion of private insurance coverage in the 1990's. Even if all public health expenditures had been exclusively directed to the population without any private insurance, these people's health expenditures would only reach 43% of the health expenditures of those with private insurance.

Brazil↗
PubMed1997

Maternal smoking and medical expenditures for childhood respiratory illness.

OBJECTIVES: This study sought to assess the association between environmental tobacco smoke exposure from maternal smoking and health care expenditures for respiratory conditions among US children. METHODS: Multivariate analysis of the 1987 National Medical Expenditure Survey was undertaken with a sample that included 2624 children 5 years of age and under. RESULTS: After analysis that controlled for various sociodemographic factors associated with health care usage, respiratory-related health care expenditures among children whose mothers smoke were found to be significantly higher than those expenditures for children of nonsmoking mothers. Truncated regression techniques were used to estimate that maternal smoking was associated with increased health care expenditures averaging (in 1995 dollars) $120 per year for children aged 5 years and under and $175 per year for children aged 2 years and under. Our analysis indicates that passive smoking was associated with $661 million in annual medical expenditures in 1987, representing 19% of all expenditures for childhood respiratory conditions. CONCLUSIONS: Maternal smoking is associated with significantly increased child health expenditures and contributes significantly to the overall cost of medical care.

Child, Preschool↗
PubMedDate not supplied

Impact of physical activity on medical expenditures among adults downhearted and blue.

OBJECTIVE: To examine inactivity-associated medical expenditures in adults, controlling for frequency of feeling downhearted/blue. METHODS: Using the 1987 National Medical Expenditure Survey (N=12,250), expenditures were analyzed by comparison and multivariate models. Expenditures were updated to 2003 dollars. RESULTS: Medical expenditure was 354 dollars (t=3.80, P<0.01) lower for active than inactive persons: 6.1% of the expenditure (133 dollars in 1987, 429 dollars in 2003) was inactivity associated. The total inactivity-associated expenditure was near 12 billion dollars in 1987 (38 billion dollars in 2003). CONCLUSIONS: Medical expenditure increased with frequency of feeling downhearted/blue and was higher for inactive than active people.

Adolescent↗
PubMed1992

Recent trends in Medicaid expenditures.

Total net Medicaid expenditures exceeded $94 billion in FY 1991, with 5 states accounting for more than 40 percent--New York, California, Massachusetts, Pennsylvania, and Texas. Nationally, inpatient and institutional long-term care payments each comprise about one-third of Medicaid spending. Medicaid expenditures have grown rapidly. From 1987 to 1991 they nearly doubled, greatly exceeding the expenditure growth for Medicare and private health insurance. This growth has been unevenly distributed. Expenditures increased by 125 percent or more in 12 States during this period, but an equal number of States had increases below 75 percent. Although expenditures grew the most slowly in institutional long-term care, this still comprises the largest payment category. Spending for inpatient services, community long-term care, insurance payments, and services not otherwise classified had the fastest rate of growth. By 1995, projected Federal expenditures for Medicaid will exceed $100 billion, approximately equal to those for Medicare in 1991. Health care inflation, State program decisions, and Federal mandates all affect the growth in Medicaid expenditures. Legislative changes have expanded coverage of pregnant women, infants, and children, and also have increased Medicaid payments of Medicare premiums and cost sharing for the elderly and disabled. Other Federal mandates raised nursing home standards and expanded EPSDT services. Legislative requirements and court challenges caused some States to increase provider payment rates. Some States developed alternative financing arrangements to accommodate the fiscal demands of higher expenditure growth. Requirements for DSH payments allowed States to use Medicaid to offset State support of public hospitals. Provider taxes and donations permitted States to increase Medicaid payments without having to raise other revenues or place an economic burden on providers. These arrangements were significantly curtailed by legislation passed in 1991.

Cost Sharing↗
PubMed1999

Hospital expenditures and utilization: the impact of HMOs.

OBJECTIVE: To determine whether hospital utilization and expenditures have declined more rapidly in metropolitan statistical areas (MSAs) with high health maintenance organization (HMO) penetration compared with MSAs with low HMO penetration. STUDY DESIGN: Levels and rates of change in hospital expenditures and hospital utilization in MSAs with varying levels of HMO penetration (1982 to 1996) were compared in a natural experiment. METHODS: MSAs were grouped into 4 categories based on HMO penetration rates in 1996. Levels and rates of change in hospital admission rates, hospital inpatient days, emergency room visits, total expenditures per capita, and expenditures per adjusted inpatient day from 1982 to 1996 were compared. A first-difference multivariate model was evaluated for 1993 to 1996. RESULTS: At the MSA level, the rates of change in hospital utilization and hospital expenditures varied only modestly with the level of HMO penetration. Changes in hospital admission rates did not vary systematically with HMO penetration rates except in the 1993 to 1996 period, when MSAs with the highest HMO penetration had the largest decline. Reductions in hospital days per capita and expenditures per day did not vary systematically by level of HMO penetration. Emergency room days declined most rapidly in the MSAs with the highest HMO penetration in the 1982 to 1993 period and were similar in the 1993 to 1996 period. Hospital expenditures per capita showed the greatest association with managed care penetration. They averaged 1.6% slower annual growth in MSAs with high versus low HMO penetration in the 1982 to 1996 period. CONCLUSIONS: This national study using data from 1982 to 1996 suggests that the effects of HMO penetration on hospital expenditures and hospital utilization at the MSA level are small (generally less than 1% per year).

Catchment Area, Health↗
PubMed2001

Specialty of principal care physician and Medicare expenditures in patients with coronary artery disease: impact of comorbidity and severity.

OBJECTIVE: To explore differences in expenditures for elderly patients with acute and chronic coronary artery disease according to the specialty of the principal care physician. STUDY DESIGN: Retrospective analysis of Medicare claims. PATIENTS AND METHODS: A total of 250,514 patients with coronary artery disease (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 410-414) were drawn from a national random sample of 1992 Medicare expenditures. Patients were classified by the physician type with the highest number of Medicare Part B outpatient claims into a cardiologist group and a generalist group. The outcome was mean total expenditures, stratifying (1) by comorbidity as measured by the modified Charlson Index and (2) by severity defined as the proportion of patients with acute myocardial infarction or unstable angina. RESULTS: Those patients in the cardiologist group had lower comorbidity and higher severity than those in the generalist group. Overall mean expenditures were significantly higher for the cardiologist group than for the generalist group ($7658 vs $6047; P < .001). These differences in mean expenditures were evident at each level of comorbidity. However, when stratified by severity of diagnosis, differences were seen predominantly in those with acute diagnoses. For those with either acute myocardial infarction or unstable angina, the mean expenditures were higher for the cardiologist group than for the combined generalist group ($15,378 vs $12,260; P < .001); however, the mean expenditures for those with only chronic conditions were similar ($4856 vs $4745; P = .53). CONCLUSION: Expenditures were higher when cardiologists were the principal care physicians treating patients with acute disease but not chronic disease.

Acute Disease↗
PubMedDate not supplied

Child dental expenditures: 1996.

PURPOSE: Because little has been reported about child dental expenditures, federal data were used to estimate dental care expenditures for U.S. children by age, sex, ethnic/ racial background, family income, parental education and parental employment. METHODS: Parentally reported data on dental expenditures and sources of expenditures were extracted from the most recent available federal healthcare expenditures studies, the 1996 federal Medical Expenditure Panel Survey (MEPS). Using the survey's large sample and complex design, these data represent the entire U.S. child population. RESULTS: Nearly 12 billion dollars were expended for children's dental care averaging $375 per child who obtained care. Overall sources of payment were 47% out of pocket, 45% insurance and 8% "other" including primarily Medicaid. Disproportionately litde spending was made on behalf of low-income and minority children despite their higher disease experience. The proportion of spending that was paid out of pocket was high for all groups of children including those eligible for Medicaid even though Medicaid prohibits cost sharing. CONCLUSIONS: Dental care for children accounts for approximately one-quarter of U.S. dental spending and is a major component of child health care costs. Income and racial disparities in expenditures favor higher income children despite Medicaid coverage for lower income children. High levels of reported out-of-pocket costs for Medicaid eligible children suggest that Medicaid fails to meet families' needs in obtaining care. Meeting the oral health needs of poor children will require considerably greater expenditures, particularly through improved Medicaid financing and administration.

Adolescent↗
PubMed1996

[Medical expenditure for the elderly and factors related to its geographical variations within Fukuoka Prefecture].

Using national health insurance data in 1992, medical expenditure for the elderly in Fukuoka Prefecture were compared with that in all of Japan, and analyzed for relationships to several socioeconomic factors, medical supply, medical needs, and health care and welfare services using univariate and multivariate analyses to clarify factors related to geographical variations in medical expenditure within Fukuoka Prefecture. The results were as follows: 1) Compared to national average, Fukuoka Prefecture showed 43% higher per capita medical expenditure for inpatients, despite slightly lower inpatient medical expenditure per day. For outpatients, per capita medical expenditure in Fukuoka Prefecture was similar to national average. 2) Of the elderly aged 70 or over, 6.7% had hospitalizations of durations exceeding six months with over half of these being hospitalized for the entire year. Circulatory diseases, particularly stroke, were the most important cause for long-term hospitalization. 3) In both univariate and multivariate analyses of geographical variations, per capita inpatient medical expenditure was correlated positively with the number of hospital beds per 100,000 and negatively with the average number of persons per household. In the multivariate analyses, per capita inpatient medical expenditure was not correlated with all-cause death rates for the elderly aged 70 or over, an index of medical needs. This suggests that factors other than medical needs contribute greatly to the hospitalization of elderly. In both univariate and multivariate analyses, per capita outpatient medical expenditure showed a significantly positive correlation with all-cause death rates for the elderly aged 70 or over and negative with rates of participation in general health checkups.

Aged↗
PubMed1998

[Geographical distribution of medical expenditure for the aged insured by National Health Insurance in secondary medical care areas in Japan].

PURPOSES: To determine what factors affect medical expenditure for the aged insured by the National Health Insurance among secondary medical care areas. METHOD: The original data of municipalities were combined and converted into the data of secondary medical areas. The original data included medical expenditure of the aged in 1994, medical supply factors per 100,000 population (numbers of doctors, numbers of general beds in hospitals, numbers of clinics, etc.) and socio-economic factors (income, proportion of employees for three sectors of industries, population density, average size of family, etc.). Medical expenditures for inpatients and outpatients were used separately as independent variables. The medical supply and socio-economic factors have been used as dependent variables. Multiple regression models were applied to clarify the differences in the contributing factors between inpatient and outpatient. RESULTS: 1. The maximum inpatient and outpatient medical expenditures for the aged are respectively 4 times and 2.6 times more expensive than minimum expenditures among secondary medical care areas. 2. The numbers of beds, income per capita, numbers of doctor, average size of family, proportion of employees for third level industry and income accounted for 57.4% of variance in inpatient medical expenditure of the aged. 3. The proportion of employees for first level industry, the numbers of beds and average members of family accounted for 21.4% of variance in outpatient medical expenditure of the aged. 4. Medical expenditure for inpatients related with medical supply and socioeconomic factors differently from that of outpatients.

Aged↗
PubMed1991

Protein status and metabolic expenditure determine the response to intravenous nutrition--a new classification of surgical malnutrition.

To determine whether nutritional and metabolic factors affect the response to intravenous nutrition (IVN) 146 surgical patients were classified according to their protein and metabolic status using direct measurements of body protein and metabolic expenditure. The patients were grouped into four categories: category I, moderate to severe protein depletion without raised metabolic expenditure; category II, moderate to severe protein depletion with raised metabolic expenditure; category III, mild protein depletion without raised metabolic expenditure; and category IV, mild protein depletion with raised metabolic expenditure. After 2 weeks of IVN patients in category I gained a mean(s.e.m.) of 0.43(0.06) kg of body protein (P less than 0.001) and had significant rises in both plasma transferrin and prealbumin (P less than 0.05); patients in category II gained 0.30(0.11) kg of protein (P less than 0.005) and also had significant rises in transferrin and prealbumin (P less than 0.05). Patients in category III lost 0.24(0.11) kg protein (P less than 0.05) and had no changes in either transferrin or prealbumin and patients in category IV lost 0.51(0.13) kg of body protein (P less than 0.001) and although there was a significant rise in plasma prealbumin there was no significant change in plasma transferrin. When postoperative patients were examined separately, they did not differ significantly from preoperative patients except in category I, where their protein gain was only 0.19(0.10) kg, an amount not significantly different from that gained by patients in category II. In each of the four categories described, the changes in total body protein occurring with 2 weeks of IVN were determined by the relative effects of two competing processes; protein depletion and raised metabolic expenditure. With moderate to severe protein depletion (approximately 30 per cent depletion of body protein stores) there was a marked tendency to gain protein with IVN. When the patient had a raised metabolic expenditure or was postoperative this tendency of depleted patients to gain protein was still present but it was less. With only mild protein depletion (approximately 10 per cent depletion) increases in metabolic expenditure made it difficult, if not impossible, to prevent continuing protein loss in spite of aggressive nutritional support. The patient categories we have described determine the response to IVN and form the basis of a new clinical classification of surgical malnutrition.

Blood Proteins↗
PubMed1996

Increased energy expenditure in growing adolescents with Crohn's disease.

Undernutrition is considered to have a central role in the pathogenesis of growth retardation in Crohn's disease. This may occur as a consequence of inadequate food intake, increased energy expenditure, or both. Ten growing adolescents with inactive Crohn's disease were assessed with respect to anthropometric parameters and resting energy expenditure, measured by indirect calorimetry during remission, repeated in relapse (N = 5), and compared to that predicted from the Harris-Benedict formula. Mean energy intake was assessed with seven-day diaries in five patients and compared to recommended intake for age, sex, weight, and physical activity. Ten healthy, growing, age- and sex-matched adolescents served as controls. Nine patients with inactive Crohn's disease, who had ceased growing, were matched for disease site and duration and acted as disease controls. Patients and disease controls had lower body mass index (19.2 +/- 0.6; 20.9 +/- 0.7) than healthy controls (23.7 +/- 0.6; P < 0.001). Percent body fat was lower in patients (13.2 +/- 1.9%) compared to healthy controls (20.5 +/- 2.4%; P < 0.05) but not to disease controls (17.0 +/- 2.6%). Patients had higher resting energy expenditure per kilogram of fat-free mass than disease or healthy controls (36.9 +/- 5.1; 32.9 +/- 2.6; 30.9 +/- 2.1 kcal; P < 0.02). Measured resting energy expenditure in patients, but not in disease or healthy controls, was higher than the predicted (measured: predicted 1.15, 1.03, 0.9, respectively; P < 0.03). Energy intake in patients was 97% of recommended intake but the measured ratio of energy intake/resting energy expenditure was lower than the predicted ratio (1.49 vs 1.71; P < 0.05). During subsequent relapse in five patients resting energy expenditure was unchanged. In growing adolescents with inactive Crohn's disease, there is increased energy expenditure that is not accompanied by an increase in energy intake. Relapse of disease does not appear to increase resting energy expenditure further but may "divert" energy from growth to disease activity. This suggests that nutritional therapy should be directed towards increasing caloric intake to maximize growth potential.

Adolescent↗
PubMed2006

Absence of circadian and photoperiodic conservation of energy expenditure in three rodent species.

According to a traditional homeostatic view, living beings spend metabolic energy at a constant rate, just like a light bulb spends electrical energy, so that energy expenditure can be expressed in units of watts. However, research conducted during the last half-century has evinced pronounced circadian variation in physiological processes, not only demonstrating circadian rhythmicity in energy expenditure but also raising the hypothesis that energy expenditure may be regulated on a daily (circadian) basis rather than on a constant-rate (homeostatic) basis. In the present study, the hypothesis of circadian (and photoperiodic) conservation of energy expenditure was tested in three rodent species: domestic mice, Nile grass rats, and Syrian hamsters. Two correlates of energy expenditure (running-wheel activity and food intake) and a classic index (oxygen consumption) were used. Changes in energy expenditure were studied in animals maintained under light-dark cycles (LDs) with periods shorter or longer than 24 h as well as in animals maintained under 24-h LDs with short and long photophases. In none of the conditions in any of the species was evidence found in support of the hypothesis of circadian (or photoperiodic) conservation of energy expenditure. Energy expenditure was generally conserved on a homeostatic basis.

Animals↗
PubMed1998

Re-interpreting anaerobic metabolism: an argument for the application of both anaerobic glycolysis and excess post-exercise oxygen comsumption (EPOC) as independent sources of energy expenditure.

Due to current technical difficulties and changing cellular conditions, the measurement of anaerobic and recovery energy expenditure remains elusive. During rest and low-intensity steady-state exercise, indirect calorimetric measurements successfully represent energy expenditure. The same steady-state O2 uptake methods are often used to describe the O2 deficit and excess post-oxygen consumption (EPOC): 1 l O2 = 5 kcal = 20.9 kJ. However, an O2 deficit plus exercise O2 uptake measurement ignores energy expenditure during recovery, and an exercise O2 uptake plus EPOC measurement misrepresents anaerobic energy expenditure. An alternative solution has not yet been proposed. Anaerobic glycolysis and mitochondrial respiration are construed here as a symbiotic union of metabolic pathways, each contributing independently to energy expenditure and heat production. Care must be taken when using O2 uptake alone to quantify energy expenditure because various high-intensity exercise models reveal that O2 uptake can lag behind estimated energy demands or exceed them. The independent bioenergetics behind anaerobic glycolysis and mitochondrial respiration can acknowledge these discrepancies. Anaerobic glycolysis is an additive component to an exercise O2 uptake measurement. Moreover, it is the assumptions behind steady-state O2 uptake that do not permit proper interpretation of energy expenditure during EPOC; 1 l O2 not = 20.9 kJ. Using both the O2 deficit and a modified EPOC for interpretation, rather than one or the other, leads to a better method of quantifying energy expenditure for higher intensity exercise and recovery.

Anaerobiosis↗
PubMed1988

Weight loss leads to a marked decrease in nonresting energy expenditure in ambulatory human subjects.

The extent to which the resting and nonresting components of 24-hour energy expenditure decrease after weight reduction has not been prospectively assessed in ambulatory, weight-stable, reduced-obese humans. Accordingly, 24-hour energy expenditure was estimated as the weight-stabilizing (+/- 50 g/d) daily caloric intake of a defined liquid diet in a cross-sectional study of ten reduced-obese subjects after a 23.2% +/- 9.4% weight loss and 18 obese subjects at baseline weight. A regression analysis demonstrated an 18% decrease in the mean daily energy requirement of the reduced-obese subjects compared with that of subjects of the same relative body weight who had never dieted. Strong linear relationships were noted between estimated 24-hour energy expenditure and fat-free mass (FFM), and between resting metabolic rate (RMR) and FFM in the subjects at baseline weight. In six reduced-obese men, the 24-hour energy expenditure was only 75.7% +/- 5.6% of the value predicted by regression analysis for the decreased FFM. In these six subjects the RMR was 97.4% +/- 7.5% of that predicted for the decreased FFM, suggesting that essentially all the energy savings relative to FFM in the reduced-obese state occurred in nonresting energy expenditure. In a subsequent group of seven subjects studied longitudinally before and after a 21.5% +/- 2.3% weight loss, the decrease in nonresting energy expenditure accounted for 582 +/- 276 kcal/d or 71% of the decrease in estimated 24-hour energy expenditure. These data suggest a decrease in the nonresting energy expenditure of ambulatory reduced-obese individuals, which is greater than previously appreciated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Resting energy expenditure and metabolic changes after lung volume reduction surgery for emphysema.

BACKGROUND: Oxygen consumption volume (VO2) and resting energy expenditure are increased in emphysema because of impaired respiratory function and mechanics, with greater oxygen cost of breathing and altered metabolism. We hypothesized that lung volume reduction surgery may improve energy expenditure and metabolism. METHODS: In this 1-year prospective study, 30 patients with moderate-to-severe emphysema underwent bilateral lung volume reduction surgery; 28 similar patients, who refused operation, followed a standard respiratory rehabilitation program. Oxygen consumption volume and resting energy expenditure, both corrected for fat-free mass, VO2 proportion of respiratory muscles (%VO2Resp), respiratory quotient, and energy substrate oxidation were determined by using a calorimetric chamber with indirect methods. RESULTS: Only after surgery significant improvements resulted in 1-second forced expiratory volume (+20.4%, p = 0.009), residual volume (-24.8%, p = 0.001), diffusion-lung carbon-monoxide (+18.4%, p = 0.008), body mass index (+5.5%, p = 0.01), resting energy expenditure (-8.2%, p = 0.006), and %VO2Resp (-44.1%, p = 0.0008) with increase in respiratory quotient (0.79 versus 0.84, p = 0.03) and conversion from prevalent lipid (44.6% versus 34.3%, p = 0.0007) to prevalent carbohydrate (25.2% versus 42.2%, p = 0.0006) metabolism. Thirteen operated on patients discontinued oral steroids, showing the most significant improvements. The remaining 17 experienced significant changes compared with the rehabilitation group despite oral steroids (resting energy expenditure -7.0% versus +4.1%, and %VO2Resp -34.0% versus +0.7%, p = 0.001). Decrease of resting energy expenditure and %VO2Resp correlated with reduction of residual volume (p = 0.02 and p = 0.001) and increment of body mass index (p = 0.03 and p = 0.004). CONCLUSIONS: Lung volume reduction surgery significantly decreased %VO2Resp and resting energy expenditure over respiratory rehabilitation and despite oral steroid therapy. Substrate oxidation changed from prevalent lipid to prevalent carbohydrate. Correlations with residual volume and nutritional status suggest that restoration of respiratory mechanics reduces energy expenditure and approximates metabolism to normal.

Aged↗
PubMed1999

Factors contributing to trends in prescription drug expenditures.

Between 1970 and 1995, national prescription drug expenditures and Medicaid drug expenditures increased proportionately less than did total health care expenditures and total Medicaid expenditures, respectively, although they increased to a greater extent than did expenditures in other sectors of the economy. General inflation, which cannot be controlled by health care policy, has been the major factor contributing to the growth in national prescription drug expenditures. Other contributors were population growth, increases in per capita prescription use, increases in per-prescription intensity (ie, real drug expenditures), and the fact that prescription drug prices exceeded general inflation. Medicaid drug expenditures have increased mainly because of growth in the number of drug recipients, increases in prescription drug prices, and economy-wide inflation.

Data Collection↗
PubMed2003

Comparison of peptic-ulcer drug use and expenditures before and after the implementation of a government policy to separate prescribing and dispensing practices in South Korea.

BACKGROUND: The South Korean government instituted a new policy, the separation of prescribing and dispensing (SPD) of medications, on July 1, 2000, to provide greater differentiation between the roles of physicians and pharmacists than had historically existed in South Korea. It was hoped that this policy would promote the rational use of medications and reduce medication expenditures, which accounted for approximately 30% of the total health care expenditures before the implementation of SPD. OBJECTIVE: The purpose of this study was to assess the effects of SPD on drug market share and expenditures for branded and generic medications by comparing the use of and expenditures for peptic-ulcer medications before and after the implementation of SPD. METHODS: Data on expenditures and quantity of use in January and December 2000 (in terms of defined daily dose [DDD]) of peptic-ulcer medications were obtained from the Korean National Health Insurance claims database. These data were derived using a 3-stage probability sample of prescription data from medical clinics in South Korea. RESULTS: The number of prescription drug claims for peptic-ulcer drugs increased by 13.9% after the introduction of SPD. Medication expenditures increased by 98.4% for peptic-ulcer medications. The use of more expensive drugs and branded products, even when generic products were available, accounted for most of this increase. In particular, the use of branded ranitidine 150 mg (measured by DDD) increased from 6.3% of the market share before SPD to 27.6% of the market share after the implementation of SPD. CONCLUSIONS: The implementation of SPD increased both prescription drug claims and expenditures for peptic-ulcer medications. A principal factor contributing to the increase in expenditures was the use of branded medications.

Anti-Ulcer Agents↗
PubMedDate not supplied

Short-run associations between medical care expenditures and adherence to clinical practice guideline-based measures for diabetes.

OBJECTIVES: To estimate relationships between medical care expenditures in 1996 and adherence to seven guideline-based measures for diabetes. METHODS AND DATA: Nonlinear exponential regression analyses were used to estimate relationships between medical care expenditures in 1996 and adherence to guideline-based measures that year, adjusting for differences in patients' demographics, location, plan type, and severity of illness. Adherence to criteria regarding physician visits, eye exams, blood sugar tests, urinalysis, triglyceride tests, total cholesterol tests, and HDL cholesterol tests was studied for 18,403 patients in 35 health plans. RESULTS: Average total medical expenditures would be $713 higher if all patients were treated according to the guideline-based measures in 1996, compared to what expenditures would be if no patients were treated that way. Average diabetes-related expenditures would be about $322 higher. Two important exceptions to this pattern were for adherence to the suggested frequency of hemoglobin A1c blood sugar tests and ophthalmology visits for dilated eye exams. Having the recommended number of these tests was associated with significantly lower total expenditures. CONCLUSIONS: In general, adherence to clinical practice guideline-based measures was more costly than deviating from those criteria, in the short-run. Perhaps expenditures should be higher for many patients who are not treated according to guidelines. Randomized studies with more years of follow-up should be conducted to assess whether short-term investments in guideline adherence pay off with lower medical expenditures and greater levels of health in the long term.

Databases, Factual↗