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PubMed2004

Do out-of-pocket health expenditures rise with age among older Americans?

PURPOSE: Relationships are examined between age and out-of-pocket costs for different health goods and services among the older population. DESIGN AND METHODS: Age patterns in health service use and out-of-pocket costs are examined by use of the 1990 Elderly Health Supplement to the Panel Study of Income Dynamics (N = 1,031, age 66+). Multivariate regression is used to examine how age effects are mediated by health, insurance, and socioeconomic variables. RESULTS: Although long-term care expenditures increased with age, out-of-pocket costs for most other services did not. Total out-of-pocket costs increased with age only when nursing home costs were included. Increases with age in hospital and prescription costs were explained by declining health. Patterns of service use suggested reduced access to discretionary care among the oldest old. IMPLICATIONS: Although expenditures did not increase with age for most services, the high personal cost for nursing home care among the oldest old underlines the need for increased efforts to support them in the community. Greater spending by those in poor health highlights the importance of preventing age-related health conditions and their complications. Improved access to discretionary care among the oldest old may help to reduce the need for care in higher cost settings. The high prevalence of out-of-pocket prescription spending across the age range provides impetus for current efforts to reduce these costs.

Age Factors↗
PubMed1999

Association of managed care market share and health expenditures for fee-for-service Medicare patients.

CONTEXT: Managed care has the potential to transform fundamentally the structure and functioning of the entire health care system, including the care provided to patients who are not enrolled in managed care plans. OBJECTIVE: To determine whether increasing health maintenance organization (HMO) market share is associated with decreased expenditures for the care of patients covered by Medicare's traditional fee-for-service plan, a group cared for well outside the boundaries of managed care. DESIGN AND SETTING: Data from the Health Care Financing Administration were used to compare expenditures for the care of Medicare fee-for-service beneficiaries for 802 market areas, representing the entire United States, for 1990 to 1994. These data were matched with data on system-wide (Medicare and non-Medicare) HMO market share in these areas. PATIENTS: All fee-for-service Medicare beneficiaries (1990-1994) except for those with end-stage renal disease. MAIN OUTCOME MEASURE: Average fee-for-service expenditure per fee-for-service Medicare beneficiary by market area. RESULTS: In a regression model, increases in system-wide HMO market share were associated with declines in both Part A and Part B fee-for-service expenditures per Medicare beneficiary (P<.001). Increases from 10% market share to 20% market share were associated with 2.0% decreases in Part A fee-for-service expenditures and 1.5% decreases in Part B fee-for-service expenditures. CONCLUSIONS: Managed care can have widespread effects on the health care system. Health care for individuals who are not covered by managed care organizations can be influenced by the presence of managed care. Lower expenditures in areas with high HMO market shares may indicate that traditional Medicare beneficiaries in areas with high market shares received fewer or less intensive services than traditional Medicare beneficiaries in other areas.

Fee-for-Service Plans↗
PubMed1998

Are cuts to health expenditure in Victoria compromising quality of care?

Separate state-wide surveys of women who had recently given birth in Victoria were conducted in 1989 and 1993. The first survey was conducted in conjunction with the Victorian Ministerial Review of Birthing Services. The second survey occurred three years after the release of the Review's final report and three months after the introduction of casemix funding. It coincided with a period of substantial cutbacks to expenditure on Victorian public hospitals. In both studies, surveys were mailed to women 6 to 9 months after the birth. Response rates were 71.4% (n = 790) in 1989 and 62.5% (n = 1336) in 1993. Between the two surveys, the proportion of women giving critical feedback about caregivers, more than doubled. The survey findings suggest that standards of care are being compromised in the current economic and policy environment.

Delivery Rooms↗
PubMed2002

Living with rheumatoid arthritis: expenditures, health status, and social impact on patients.

OBJECTIVE: To determine costs related to living with rheumatoid arthritis (RA), and to identify the association between health status-as measured by the Health Status Questionnaire short form-36 (SF-36) and the disease specific index Health Assessment Questionnaire (HAQ)-and the social impact of RA. METHODS: A prospective cohort study was carried out on 81 patients with RA who completed four consecutive three month cost diaries. The SF-36, HAQ, and social impact at baseline and one year follow up were also assessed. RESULTS: Women reported worse SF-36 physical function and HAQ scores than men and received more assistance from family and friends. Women spent more on non-prescription medication and devices to assist them than men. Older patients had higher expenditure on visits to health professionals, whereas younger patients spent more on prescription medication and tests. Pension status and membership of private health insurance schemes were important determinants in these differences in expenditure. CONCLUSION: Costs increased with duration of disease, those with private health insurance had greater out of pocket costs (excluding membership fees), and those with pension support had fewer costs. Women were more affected by RA than men in health status, social impact, and out of pocket costs.

Adult↗
PubMed1985

The impact of the laboratory's multiparametric analyser on the medical technology and health expenditure in Japan.

The use of an automatic analyzer for blood chemistry has become widespread since the latter half of the 1970s. This medical equipment conserved while improving accuracy. This technology has had a greater impact upon the structure of medical practice, management of medical institutions and medical economics, than previous diagnostic tests such as the X-ray, electrocardiograph and manual laboratory tests. This report analyzes the nationwide use of blood chemistry automatic analyzer, based on statistics from the Ministry of Health and Welfare. First, attempts are made to evaluate the significance of the provision of the multiple-channel auto-analyzer. Second, we review the impact of this technology on medical care and its background in three phases: medical institutions, clinical Laboratory Test Centers and national medical expenditure and the response of the government. These phenomena are common to the fruits of the technological revolution centered on ME (Medical Engineering or Medical Electronics), such as CT, ultrasonograph, hemodialyser. The rational utilization of this equipment will require the cooperative efforts of both economists and medical technologists.

Blood Chemical Analysis↗