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PubMedDate not supplied

Marital status and health care expenditures among the elderly in a managed care organization.

The purpose of this study was to determine the relationship of marital status in and health care expenditures among the elderly in a managed care organization. The study population consisted of 277 functionally impaired elderly people who were 75 years and older enrolled in a managed care organization. In separate analyses, the relationship between marital status and total expenditure per enrollee, the number of outpatient visits, hospital admissions, and emergency department (ED) visits during the two-year study period was examined. The results indicate that married individuals had significantly higher health care expenditures than the unmarried. However, there were no significant differences in number of hospital admissions, number of outpatient visits, and number of ED visits. It would behoove health care administrators and policy makers to take into consideration marital status when planning, designing, and implementing health care policies for the elderly.

Aged↗
PubMed2006

The impact of state laws limiting malpractice damage awards on health care expenditures.

Twenty-eight states have laws that limit payments in malpractice cases, and several studies indicate that these laws reduce the frequency and severity of malpractice claims and lower premiums. Moreover, proponents believe that such laws reduce health care expenditures by reducing the practice of defensive medicine. However, there is a dearth of empirical evidence about the impact of these laws on the cost of health care. We used multivariate models and relatively recent data to estimate the impact of state tort reform laws that directly limit malpractice damage payments on health care expenditures. Estimates from these models suggest that laws limiting malpractice payments lower state health care expenditures by between 3% and 4%.

Compensation and Redress↗
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↗
PubMed1989

Does a small minority of elderly account for a majority of health care expenditures? A sixteen-year perspective.

Canadian and American analysts commonly find that a small proportion of the elderly is responsible for a large share of health care expenditures. Data on a representative cohort in Manitoba indicate that the longer the time frame studied, the less health care usage concentrates in a single small group of elderly people. Over the sixteen-year period treated, the average older person's risks of using hospital and nursing home services is nevertheless notably higher than reported to date; yet, one-half of the elderly make relatively minimal demands on the health care system. The results reinforce calls for targeting the needs of intensive consumers of health care services and highlight the variability of cumulative usage patterns among older Manitobans.

Aged↗
PubMedDate not supplied

Applying DALY to assessing national health insurance performance: the relationship between the national health insurance expenditures and the burden of disease measures in Iran.

The Iranian government has considered using DALYs as an indicator to prioritize health service expenditures to reduce the burden of disease for the public. A cross-sectional study was designed to compare several measures of the burden of disease with the actual amounts of national health insurance (NHI) expenditures, in one province of Iran (Semnan) for a period of 2 months (September 2000 and February 2001). Furthermore, on the basis of the research findings, a questionnaire was designed and distributed to stakeholders at local and national levels to explore their ideas about the gap between the expenditures of the diseases group and their burden. A semi-structured interview was conducted to elicit participants' views on the research findings. The results of this study have revealed that, currently, there is no strong relation between the NHI expenditures and DALY (r = 0.41, p = 0.09), but that there are stronger relationships between the amounts of NHI reimbursements with YLL (r = 0.52, p < 0.05), mortality (r = 0.67, p < 0.01) and hospital days (r = 0.90, p < 0.01). Comparing each group of disorders' DALY with the resources allocated to them (cost per DALY) it was shown that diabetes mellitus, musculoskeletal diseases, maternal conditions, sense organ disorders received considerably generous funding; and, perinatal conditions, congenital abnormalities, nutritional deficiencies were relatively under-funded. The qualitative research results showed that the majority of respondents agreed that the differences presently existing between disorders' burden and NHI expenditures cannot be justified; and, further, that reducing the overall burden of disease must be one of the most important objectives for the NHI.

Attitude to Health↗
PubMed2002

Unit root properties of OECD health care expenditure and GDP data.

This note reconsiders the unit root properties of health care expenditure (HCE) and gross domestic product (GDP) for OECD countries. The time-series properties of this data set has been much discussed in the literature with contrasting results from the application of a range of test procedures. We use a recently developed test to examine the relationship between the two variables. The results in this paper confirm earlier findings that when the data are considered as a panel, there is strong evidence of unit roots in both GDP and HCE data.

Cross-Cultural Comparison↗
PubMed1991

How should resources be reallocated between physicians and nurses in Africa and Latin America?

This paper examines ways in which health resources could be reallocated between physicians, nurses and other medical inputs in Africa and Latin America, according to their cost-effectiveness. An underlying question concerns whether countries in Africa and Latin America with decreasing health budgets in the 1980s should reduce the number of highly trained and more expensive workers, i.e. physicians, and redirect resources to less trained and less expensive workers, i.e. nurses. This paper designs a methodology for quantifying the cost-effectiveness of physicians, nurses and government health expenditure in relation to improvements in the population's health status. Direct estimation of the professionals' effectiveness is unsuitable in this 45-country study. Instead, for measuring the unobserved effectiveness of health providers and health expenditures, infant mortality rate has been chosen as the indicator. Infant mortality is an accepted indicator of the health status in a given population. From another viewpoint, neonatal health is dependent on contact with health care services; this means that inappropriate care may increase the likelihood of infant mortality. Therefore, at the same time infant mortality is an indicator of the effectiveness of services. We used a general linear model as a way of estimating the relationship between infant mortality, health manpower and health expenditures. Forty-five countries were examined over three years and 135 observations were included in the final sample. Three scenarios were estimated: (1) African and Latin American countries, or low and middle-income countries, (2) only middle-income and (3) only low-income countries.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa↗
PubMed2002

National health insurance expenditure for adult beneficiaries in Taiwan in their last year of life.

BACKGROUND AND PURPOSE: The cost of health care in the last year of life is a major issue of health services research. The purposes of this study were to examine health care use and expenditure under National Health Insurance (NHI) by Taiwanese adults in the last year of life, and to compare their results with those of randomly selected survivors. METHODS: A total of 9,369 adult decedent NHI beneficiaries were selected from NHI enrollee files and the Death Certificate data file for 1999. To compare expenses with those of patients without fatal illness, 10,000 randomly sampled adult beneficiaries of NHI who were alive on December 31, 1999, were selected as a survival group. NHI reimbursement and utilization information for these decedents and survivors were obtained by linking these samples to NHI claims files. RESULTS: The total NHI expenditure in the last year of life for the 9,369 decedents was US$71.6 million. About 54.5% of all medical expenses in the last year of life were incurred in the last 3 months of life. Nephritis and cancer were the most expensive causes of death, with per capita expenses of US$15,220 and US$10,828, respectively. The average expenses for survivors increased with age, while that for decedents increased with age from the 20- to 44-year age group to the 45- to 64-year age group, then decreased for decedents aged 65 and over. The age-dependent pattern of decreasing expenses with increasing age was found in cancer deaths for all age groups and in elderly decedent groups for most causes of death. CONCLUSIONS: This study demonstrated the relatively large amount of health care resources used by Taiwanese NHI participants in their last year of life and suggests the importance of greater awareness of the implications of allocation of medical care resources for terminally ill patients by policymakers and health care providers.

Adult↗
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↗
PubMedDate not supplied

Ways to think about money.

Healthy People 2010, the nation's objectives for achieving a higher level of health, includes Goal 23-16: Increase the proportion of federal, tribal, state, and local public health agencies that gather accurate data on public health expenditures, categorized by essential public health service. Taking time to understand the complexities of accounting for public health expenditures, as well as the reasons for doing so, is an essential precursor to taking the needed steps to include economic information in public health policy making and public health systems research.

Accounting↗