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PubMed1994

The success and repeal of the Medicare Catastrophic Coverage Act: a paradoxical lesson for health care reform.

Congress intended the Medicare Catastrophic Coverage Act (MCCA) of 1988 to reduce the risk for illness-related catastrophic financial losses in the elderly. The act was short-lived, facing repeal just one year after passage. Many elderly persons were convinced that the costs of the program outweighed the benefits. However nursing home payment provisions of the MCCA may have affected out-of-pocket expenses paid by the elderly for long-term care more than consumers realized at the time of repeal. A transmittal memorandum, issued by the Health Care Financing Administration independent of Congressional action, enhanced consumers' ability to qualify for Medicare nursing home benefits. We investigated the effects of the Medicare policy change on nursing home payer mix and out-of-pocket expenses in 489 Pennsylvania nursing homes. We found that substantial shifts in payer mix from self-pay to Medicare payment sources occurred, reducing out-of-pocket expenses. Unfortunately the debate over the MCCA's repeal did not include discussion of the improved nursing home benefit structure. These findings, and the fate of the MCCA legislation, reinforce the importance of comprehensive information and clear communication in promoting health care reform.

Aged↗

PubMed1991

Personal costs incurred by women attending a mammographic screening programme.

A survey of the personal costs (travel and time) incurred by 150 randomly selected women attending a mammographic screening programme indicated that 74% travelled by car and 78 (52%) were accompanied by another person. Of the 78 accompanying persons 16 also had a breast x-ray. Fifteen women in the survey and 10 of the unscreened accompanying persons had taken leave from work to attend the programme, and this leave was unpaid for five women and two unscreened accompanying persons. The mean travel costs, out-of-pocket expenses, and opportunity costs per attendance were $6.45, $8.14, and $13.75, respectively. The personal costs involved in attending a screening programme appear to be substantial and may deter women from attending.

Aged↗

PubMed1977

Age differences in health care spending, fiscal year 1976.

Of the $120.4 billion spent by the Nation for personal health care in fiscal year 1976, 29% was spent for those aged 65 or older, 15% for those under age 19, and the remaining 56% for those aged 19-64. The average health bill reached $1,521 for the aged, $547 for the intermediate age group, and $249 for the young. Public funds financed 68% of the health expenses of the aged with Medicare and Medicaid together accounting for 59%. Private sources paid 74% of the health expenses of the young and 70% of the expenses of those aged 19-64. Third-party payments met 65% of the health expenditures of all those under age 65.

Adolescent↗

PubMed1979

Age differences in health care spending, fiscal year 1977.

This report of health care spending in fiscal year 1977 reveals that of the $142.6 billion spent by the Nation for personal health care in fiscal year 1977, 29 percent was spent for those aged 65 or older, 59 percent for those aged 19-64, and 13 percent for those below age 19. The average health bill reached $1,745 for the aged, $661 for the intermediate age group, and $253 for the young. Public funds financed 67 percent of the health expenses of the aged, with Medicare and Medicaid together accounting for 61 percent. More than two-thirds of the health expenses of the young and 71 percent of the expenses of those aged 19-64 were paid by private sources. Third-party payments met 68 percent of the health expenditures of all those under age 65.

Adult↗

PubMed2002

Willingness to pay for health risk reduction in the context of altruism.

This paper presents results on the valuation of health risks in the presence of altruism. The contingent valuation method is utilised in a split sample experiment for estimating the private and public values in reducing the risk of flu. Data modelling for the dichotomous choice method follows a Bayesian approach, which accounts for zero responses and is adequate for the comparison of small sample results. The results of the experiment suggest that altruism is a positive component in the value of reducing the probability of flu, which depends positively on the number of days involved, the health status and the personal income of the subject. The marginal value of risk is found to be a decreasing function of the reduction in the probability of becoming ill.

Altruism↗

PubMed2001

Changes in finances, insurance, employment, and lifestyle among persons diagnosed with hairy cell leukemia.

BACKGROUND: While being cured of cancer generally leads to a life expectancy similar to that of the general population, the extent to which other aspects of life are affected is unknown. To address these concerns, patients with hairy cell leukemia, a cancer with a very high cure rate, were queried about employment, insurance, finances, and lifestyle during and following their treatment. METHODS: Study participants (n = 31) ranging in age from 24 to 73 years at the time of diagnosis (median, 49 years) were surveyed regarding changes in health and life insurance, employment, out-of-pocket medical costs, exercise, diet, and use of mental and alternative health services that occurred during or following hairy cell leukemia treatment. RESULTS: Following a diagnosis of hairy cell leukemia, 61.3% of the respondents paid for some aspect of medical care in spite of having health insurance coverage at the time of diagnosis. Four respondents (12.9%) could not obtain health insurance following treatment, and the occupational choices of several individuals or their spouses were based in large part on a desire to obtain or maintain comprehensive health insurance. Of the 13 individuals who attempted to purchase life insurance, 10 had difficulty obtaining a policy or were denied coverage. Lifestyle changes were noted by 40% to 60% of respondents, and included reports of more frequent exercise, adoption of a healthier diet, and having a greater appreciation for life, loved ones, and physical health. CONCLUSIONS: While hairy cell leukemia is a highly curable malignancy, cancer survivors' lives and lifestyles are altered substantially after receiving treatment for the illness.

Adult↗

PubMed1990

Measurement of the personal cost of illness due to some major water-related diseases in an Indian rural population.

A field study, aimed at measuring the personal cost of illness from five major water-related diseases was undertaken in a rural area of Uttar Pradesh (India) in 1981-82. The diseases included in the study were--enteric fever, acute diarrhoeal diseases, infective hepatitis, conjunctivitis and scabies. The measurement of the cost of illness included information on losses in productivity and treatment costs. The annual costs of illnesses per 100 people in 1981 were Rs 7353 (US $525) for enteric fever, Rs 5333 (US $381) for acute diarrhoeal diseases, Rs 7364 (US $526) for conjunctivitis, Rs 1839 (US $131) for scabies and Rs 211 (US $15) for infective hepatitis. In 1982, costs for above diseases were Rs 8622 (US $616), Rs 5191 (US $371), Rs 3289 (US $235), Rs 7402 (US $529) and Rs 323 (US $23) respectively. The aggregate annual costs of illnesses due to the above five diseases per person ranged between Rs 221 (US $16) and Rs 248 (US $18) in the two years.

Adolescent↗

PubMed1999

Prescription drug coverage and spending for Medicare beneficiaries.

Outpatient prescription drug coverage is not a Medicare covered benefit. Debate continues in Congress and elsewhere on modernizing the Medicare benefit package, including proposals that would help the Nation's seniors pay for prescription drugs. Very little is known about which persons within the Medicare population have drug coverage from other sources. Using 1995 data from the Medicare Current Beneficiary Survey (MCBS), the authors present information on who has coverage by various sociodemographic categories. The data indicate higher-than-average levels of coverage for minority persons, beneficiaries eligible for Medicare because of disability, and those with higher incomes.

Adolescent↗

PubMed2005

Beginning the transition to adulthood: the experiences of six families with youths with cerebral palsy.

This qualitative study focused on the experiences of six 20- to 23-year-old persons with cerebral palsy and their parents during the transition to adulthood and explored perceived changes in their relationship. Using semi-structured interviews, three interrelated themes emerged: (a) perceptions of readiness for increased autonomy, (b) opportunities for the young adults to make independent decisions and learn from life experiences, and (c) shifting parental roles. The youths' autonomy related to parental perceptions of their readiness and push for autonomy, the parent's personal beliefs and readiness to support the changing relationship, and the parents' needs for separation from the child. In some families of youths requiring ongoing support for personal care, finances were a barrier to altering relationships with their child.

Adult↗

PubMed2006

Making decisions for incapable adults. 2: Advanced decisions refusing care.

In the second article focussing on the provisions of the new Mental Capacity Act 2005, Richard Griffith considers the impact on district nurse practice of advanced decisions refusing health care, that will allow a person to refuse even life-sustaining treatment in incapacity, and lasting powers of attorney, that will allow a person to appoint one or more people to make decisions concerning their personal welfare and property and affairs. For the first time in England and Wales a person will be able to appoint another to make consent-to-treatment decisions on their behalf that will be binding on district nurses and other health professionals.

Adult↗

PubMed2004

Through gendered lens:explaining Chinese caregivers' task performance and care reward.

The Chinese cultural norm of xiao, or filial piety, has long been held responsible for the practice of familial caregiving for older parents. Yet few explore the gendered nature of such a cultural practice in the current changing economic dynamics. Using data collected in 1997-1999 from 110 Chinese caregivers who were caring for physically dependent elder parents, this researcher explores the influence of changing economic conditions and Chinese cultural values in caregiver task performance and reward. Findings suggest that Chinese caregiving is highly gendered: Women are more likely to be unemployed and provide more personal care than men; sons are not more likely than daughters to provide financial assistance for parents. Chinese cultural values are playing an important role sanctioning caregiver task performance. Caregivers who believed in patrilocal norms provided more financial assistance; caregivers who reported higher social pressure provided more personal care. While the caregivers' report of social pressure is positively related to the caregivers' performance in personal care tasks, it is negatively related to caregiver reward. The author further explores the gendered implications for the changing economy and culture in China.

Adult↗

PubMedDate not supplied

Medical school tuition and young physicians' indebtedness.

Medical school tuition and medical student debt have increased dramatically during the past two decades, but loans are available on favorable terms, which makes it possible for students without personal or family means to get a medical education. As an investment, medical education is an excellent choice; its net present value is more than a million dollars. Cost is nevertheless a strong deterrent to potential applicants, especially minority applicants. If tuition and indebtedness continue to increase while physician incomes do not, there may come a time when only the wealthy can finance a medical education, and medical schools may have increasing difficulty recruiting qualified students.

Costs and Cost Analysis↗

PubMedDate not supplied

Betwixt and between: targeting coverage reforms to those approaching Medicare.

Recent Medicare buy-in proposals agree on setting eligibility at age sixty-two but disagree on linking eligibility to loss of employer insurance or ability to pay. We examine arguments for targeting incremental coverage for older Americans in these ways. While access to retiree health insurance is declining, we question whether targeting loss of employer insurance can address many older Americans' insurance problems. Furthermore, focusing on persons ages sixty-two to sixty-four misses a large group of persons in poor health with limited resources. Efforts to improve coverage for older Americans should consider trade-offs between defining eligibility by age versus ability to pay.

Age Factors↗

PubMed2006

Development of a Money Mismanagement Measure and cross-validation due to suspected range restriction.

A measure of the tendency to mismanage money was developed in an evaluation of a representative payee program for individuals with serious mental illnesses. A conceptual model was composed to guide item development, and items were tested, revised, added, and rejected in three waves of data collection. Rasch analyses were used to examine measurement properties. The resulting Money Mismanagement Measure (M3) consisted of 28 items with a Rasch person reliability at .72. Restriction of range was likely responsible for the low Rasch reliability. Validity analyses supported the construct validity of the M3. Subsequently, a cross-validation study was conducted on an untreated sample not as susceptible to range restriction. The M3 produced a Rasch person reliability = .85 with good validity. The M3 fills a gap that can facilitate research in the understudied area of money mismanagement.

Cross-Sectional Studies↗

PubMed2004

Valuing health care using willingness to pay: a comparison of the payment card and dichotomous choice methods.

This paper compares willingness to pay (WTP) estimates generated from the dichotomous choice (DC) and payment card (PC) approaches. In a split-sample WTP experiment concerned with allocating scarce health care resources across three health care interventions, the DC approach is shown consistently to generate larger welfare estimates than the PC. Observed difference between PC and DC experiments cannot be explained by the inclusion of non-demanders or methods of statistical analysis but may be partly explained by "yea-saying". No evidence of range bias or mid-point bias was found with PC responses. Data were also collected on respondents' ordinal rankings of the three interventions and person-trade-offs (PTOs). Neither of these approaches converged with WTP. Future work must address the decision heuristics individuals employ when responding to valuation experiments.

Air Ambulances↗

PubMedDate not supplied

The affordability of a nutritious diet for households on welfare in Toronto.

OBJECTIVES: This study assesses the affordability of a nutritious diet for households in Toronto that are supported by welfare. METHODS: For three hypothetical households, welfare incomes were compared to the monthly costs for food, shelter, and other essential expenditures in Toronto. RESULTS: If households lived in market rental accommodation, average monthly incomes were insufficient to cover expenses for the single-person household and two-parent family, and barely adequate for the single-parent family considered in this study. However, the single-parent family's actual income fell below expenses for six months of the year. For households with children, the relative inadequacy of welfare increased as children grew older. Living in rent-geared-to-income housing afforded substantial financial advantage, but the welfare income of single-person households was still insufficient to meet basic needs. INTERPRETATION: These findings indicate discrepancies between welfare incomes and costs of basic needs, which may explain the vulnerability of welfare recipients to food insecurity.

Budgets↗

PubMedDate not supplied

[The prepayment scheme in Rwanda (I): analysis of a pilot experiment].

Rwanda has made the setting up of a prepayment scheme a priority in its health sector reform in order to make health services more financially accessible to the population. A pilot study was carried out in three districts. The yearly family subscription charge was fixed at 7.9 US dollars, which covers care delivered at Health Centre level as well as some services at the hospital. The beneficiaries and providers mention difficulties in order to mobilise the subscription charges all at a time, the insufficiency of the offer of services at the hospital and the absence of involvement of the political authorities in the process. The Ministry of Health did initiate the experiment but the choice of the privileged pilot districts prevents results from being extrapolated to the country taken as a whole with a view to a possible extension at a later stage. Given the relatively short time in which it has taken place, the population could neither understand the contingency and solidarity issues implied nor have the opportunity to feel personally involved in the system. As a conclusion, the study advocates the continuation of the experiment with a reinforcement of the coordination which should take the weak points identified into account.

Delivery of Health Care↗

PubMed2006

The economic burden of prescription drug use among elderly patients in Ponce, Puerto Rico.

OBJECTIVE: To examine the economic impact of prescription drug use on the personal income of elderly individuals in Ponce, Puerto Rico. METHODS: One-hundred elderly individuals who attend five care centers were interviewed using a four-page structured questionnaire. The interview collected information about the source and amount of income of participants, the type of insurance coverage for prescription drugs, the amount of expenditures for prescription drugs that are paid out-of-pocket and the barriers they face to use or obtain prescription drugs. RESULTS: Participants were mostly female (69%) and the average age was 77 years. The average monthly income reported was 476 dollars, 79% of which was derived from Social Security. The average monthly expenditure was 364.00 dollars of which 117.00 dollars (32%) was spent on health related expenditures: 70.00 dollars (19%) on prescription drugs, 31.00 dollars (8%) on health insurance premiums, 10.00 dollars (3%) on medical expenditures not related to prescription drugs, and 6.00 dollars (2%) on over-the-counter drugs. The great majority reported having health insurance but one-third pay out-of-pocket for their prescription drugs. Nearly two-thirds expressed they have experienced problems to obtain or use medications in the past six months. Thirty-eight percent reported that the problem was that the cost of medications was too high. CONCLUSION: In spite of insurance coverage, the cost of prescription drugs places a substantial economic burden on elderly individuals. On average, prescription drug expenditures comprise nearly 20% of the personal expenditures of respondents, second only to groceries. This accounts for 15% of their personal income. The economic burden of prescription drugs on the elderly may affect access to needed drugs and may adversely impact health outcomes.

Age Factors↗