Alternative definitions of disability: relationship to health-care expenditures.
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Persons with Disabilities↗
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Results for “Health Expenditures”
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Controlling health care expenditures.
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Cost Control↗
Measuring financial protection in health in the United States.
One rationale for health insurance coverage is to provide financial protection against catastrophic health expenditures. This article defines a lack of financial protection as household spending on health care when: (1) out-of-pocket (OOP) health expenditures exceed 10% of family income; (2) out-of-pocket expenditures exceed an absolute level of 2000 US dollars per family member on an annual basis; and (3) combined out-of-pocket and prepaid health expenditures exceed 40% of family income. The article explores how the likelihood of households in the United States surpassing these thresholds varies by income level, extent of insurance coverage, and the number of chronic conditions. The results show clearly that there is a lack of financial protection for health services for a wide segment of the US population-particularly so for poor families and those with multiple chronic conditions. The results are placed in an international context. Similar studies in other countries would allow for more in-depth comparisons of financial protection than are currently possible.
Catastrophic Illness↗
Health care expenditure and hospital management.
The article briefly describes the health financing system of Japan and then proceeds to analyse expenditure. The focus, however, of the paper is to express concern at the poor level of management in the hospital systems in Japan. The author urges hospital directors to engage in a much more pro-active management approach.
Cost Control↗
Value of health care expenditures.
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Cost-Benefit Analysis↗
Israel's expenditure on health services.
In 1986, the State of Israel utilized 7.6% of its gross national product (GNP) for health care. At first glance this seems to be a reasonable level of expenditure when compared with the percentage of GNP devoted to health care in eight selected industrialized non-communist nations. However, Israel devoted fewer dollars per citizen on health care than any of the eight other nations. We investigate the role of three factors that contributed to this relatively low expenditure level: a) health personnel and bed supply levels, b) operations and procedure rates, and c) relative wage costs of health personnel. If Israel had the same level of per capita GNP as the USA, its annual health service per capita expenditure would increase from $472 to $1,328. If, in addition, its health personnel received the same wage differentials (in relation to the average wage levels) as those received by health personnel in the USA, it is estimated that Israel would spend around $1,842 annually per capita on health care (representing 10.7% of its GNP). This figure is only $98 less than what the USA spends, and creates a vastly different impression concerning the efficiency of the health system than does the original unadjusted expenditure of only $472 per head, which is $1,468 less than that spent by the USA. The Israeli health system can be said to be characterized by adequate manpower inputs, high bed occupancy rates, low surgery rates relative to the USA (not necessarily a negative phenomenon), and low relative wage inputs. The relatively limited available output indicators lead us to believe that productivity per person employed in the health services could be raised. The low absolute levels of health expenditures in Israel are mainly due to a combination of a low GNP per head and relatively low wage differentials between health service staff and other income earners.
Bed Occupancy↗
Cost/benefit of high technology in diagnostic radiology.
High technology is frequently blamed as a main cause for the last decade's disproportionate rise in health expenditure. Total costs for all large diagnostic and therapeutic appliances are typically less than 1% of annual expenditure on health care. CT, DSA, MRI, interventional radiology, ESWL, US, mammography, computers in radiology and PACS may save 10-80% of total cost for diagnosis and treatment of disease. Expenditure on high technology is in general vastly overestimated. Because of its medical utility, a slower deployment cannot be desirable.
Cost-Benefit Analysis↗
Pharmacy-and diagnosis-based risk adjustment for children with Medicaid.
BACKGROUND: Risk adjustment is useful for adjusting health care payments based on patients' health status. OBJECTIVE: This work seeks to examine how well pharmacy- and diagnosis-based risk adjusters predict child health expenditures in Medicaid populations. RESEARCH DESIGN: We used 1994-1995 Medicaid claims files for all children ages 0-18 years who were not covered by managed care in 3 states: Georgia, New Jersey, and Wisconsin. We examined separately 6 risk adjustment methods, 2 pharmacy-based and 4 diagnosis-based. We compared predictive accuracy of the methods for the whole sample and stratified by state and Medicaid enrollment category. FINDINGS: Models with risk adjustment (either diagnosis- or pharmacy-based) had better predictive accuracy than demographic models. The pharmacy and diagnosis-based models had similar predictive accuracy. Risk adjuster performance differed by Medicaid enrollment category and state. Risk-adjusted models generally underpredict expenditures in populations with worse health status (eg, those in the Supplemental Security Income program [SSI]). The pharmacy-based models performed well for children in SSI relative to children in foster care. CONCLUSIONS: Both pharmacy- and diagnosis-based risk adjustment improved the prediction of health expenditures compared models without risk adjustment. No single risk adjuster performed best in all situations, suggesting that optimal choices of risk adjusters may differ by purpose and context.
Adolescent↗
Health care expenditure and GDP: are they broken stationary?
In this paper, we analyse the stationarity of the real per capita health care expenditure (HCE) and real per capita GDP for a sample of OECD countries, allowing for the presence of multiple structural breaks. One novelty of the paper is that it permits the presence of structural breaks that affect both the level and the slope of the time series. After the cross-section dependence is accounted for, we have found that these variables can be characterised as stationary processes evolving around a broken trend.
Developing Countries↗
The role of the EBMT activity survey in the management of hematopoietic stem cell transplantation. European Group for Blood Marrow Treansplantation.
Disease or treatment oriented registries form an integral part of modern medicine. They complement industry driven, corporate group sponsored and institutional research and are, together with prospective randomised trials cornerstones of modern evidence based medicine. Focus has been on rapid collection, analysis and dissemination of information on rare procedures with stress on patient outcome. In complex expensive procedures, such as hematopoietic stem cell transplants (HSCT), novel structures are required to catch outcome at team or national level. The annual activity survey of the European Group for Blood and Marrow Transplants EBMT forms such an instrument. Since 1990, EBMT has been collecting, on an annual basis, numbers of HSCT from the preceding year according to indication, donor type and stem cell source. The survey covers all European countries. In 1990, 143 teams reported 4,234 HSCT; in the year 2000, 619 teams reported 19,136 HSCT (33% allogeneic, 67% autologous). This information, which covers over 90% of all HSCT performed in Europe and is based on 132,963 HSCT (33% allogeneic, 67% autologous), gives a clear overview of current status and ongoing trends. It shows the general increase in HSCT from 1990 to 2000 with few exceptions, such as autologous HSCT for breast cancer and allogeneic HSCT for chronic myeloid leukemia. It illustrates the shift in technology from bone marrow as stem cell source in 1990 (100%) to peripheral blood in 2000 (96% of autologous, 53% of allogeneic HSCT). Supplemented by population data and economic factors (Gross national Product, Health Care Expenditures, Health Care systems) of the individual countries it allows comparison of transplant rates (Number of transplants per 10 million inhabitants), team densities (Number of transplant teams per 10 million inhabitants) and trends between countries. It permits quantification of the impact of economics and health care systems and provides a basis for quality control and allows assessment of the main factors influencing team decisions: evidence, disease prevalence, economics and expectations. As such, it is an essential tool for patient counselling and health care planning.
Data Collection↗
The "unexpected" growth of the private health sector in Greece.
The article analyses the situation which exists in the private health sector in Greece, it presents data on the growth of the private sector and discusses the reasons for this phenomenon in relation to privatisation trends in other European countries. The growth of private health care in Greece in the last 10 years is evident despite governmental attempts to minimise its role through the development of the National Health System in 1983 and the legislative restrictions on the private sector. Private health expenditure has increased, reaching 3.9% of the country's GNP (43% of the total expenditure in health) in 2000. The number of private hospitals and hospital beds has decreased (hospitals decreased from 468 in 1990 to 218 in 2000 and private beds decreased from 25,075 in 1980 to 15,806 in 2000) mainly because of the reduction in the number of small private hospitals. On the other hand, private doctors and private diagnostic centres have significantly increased. This situation is believed to be attributed mainly to the provision of inadequate and low quality public health services which have caused widespread dissatisfaction among the general public, and factors associated to improved standards of living, as well as the rapid growth of private insurance.
Delivery of Health Care↗
Problems of the health-impaired elderly: a foundation's experience in geriatrics.
Elderly people, particularly those over age 75, are subject to problems of access to needed health services, of the appropriateness of these services in relation to their needs, and of increasing infirmity, disability and dependency, with loss of their natural support systems. The proportion of health expenditures deployed to deal with the institutionalization and long-term requirements of elderly people is increasing in a national climate characterized by tightening constraints on public expenditures for health care under Medicare and Medicaid. The Robert Wood Johnson Foundation has accepted objectives and roles to find better ways to use what we already know to improve elderly people's access to health care, to improve their functional effectiveness, and to make their health care more affordable. The results of some of the programs it has supported represent innovative approaches and demonstrate ways in which we may accomplish these objectives.
Aged↗
Diabetes in Canadian Women.
HEALTH ISSUE: Diabetes mellitus (DM) is a chronic health condition affecting 4.8% of Canadian adults >/= 20 years of age. The prevalence increases with age. According to the National Diabetes Surveillance System (NDSS) (1998-1999), approximately 12% of Canadians aged 60-74 years are affected. One-third of cases may remain undiagnosed. The projected increase in DM prevalence largely results from rising rates of obesity and inactivity. KEY FINDINGS: DM in Canada appears to be more common among men than women. However, among Aboriginal Canadians, two-thirds of affected individuals are women. Although obesity is more prevalent among men than women (35% vs. 27%), the DM risk associated with obesity is greater for women. Socio-economic status is inversely related to DM prevalence but the income-related disparities are greater among women. Polycystic ovarian syndrome affects 5-7% of reproductive-aged women and doubles their risk for DM. Women with gestational diabetes frequently develop DM over the next 10 years. DATA GAPS AND RECOMMENDATIONS: Studies of at risk ethnic/racial groups and women with gestational diabetes are needed. Age and culturally sensitive programs need to be developed and evaluated. Studies of low-income diabetic women are required before determining potential interventions. Lifestyle programs in schools and workplaces are needed to promote well-being and combat obesity/inactivity, together with lobbying of the food industry for needed changes. High depression rates among diabetic women influence self-care ability and health care expenditures. Health professionals need further training in the use of effective counseling skills that will assist people with DM to make and maintain difficult behavioural changes.
Journal Article↗
Data needs for health policy in an aging population (including a survey of data available in the United States of America).
The development of a coordinated, systematic and responsive data base is essential for governments to make informed decisions for policy development and planning, to assess the impact of these decisions, and to operate their programmes effectively. One of the most significant challenges is the development of data systems capable of satisfying the multiple needs for data, and providing the data required for evaluating the impact of health programmes, while keeping the respondent burden reasonable. The United States of America is fortunate in having well-developed systems of data collection by national surveys for demographic, social and economic characteristics of the population, morbidity and mortality, health expenditures, and use of health and long-term care services. Current survey and administrative record data sets are described. Policy issues in health care for aging populations require the use of multiple data sets which may require modification of or addition to existing surveys and administrative records. Recommendations are made for an extension of the data bases already in existence and on the expansion of analytical capacity to address health policy issues for the elderly.
Aging↗
Health care expenditures: international comparisons, 1970-80.
This article is based on the findings of a study developed to compare health care costs in the United States during 1970-80 with those of six other industrially advanced countries--Canada, France, the Federal Republic of Germany, the Netherlands, Sweden, and the United Kingdom. Although health care expenditures in the United States have traditionally been relatively high, as a share of gross national product, they were exceeded in 1980 in West Germany and Sweden and equaled by the Netherlands. All the countries experienced increases in health care spending that outpaced inflation in other sectors of the economy. For the decade as a whole, the United States encountered a slower rate of growth than most of the other countries, both in terms of actual expenditures and when adjusted for inflation as measured by the Consumer Price Index. As the decade progressed, however, most of the other countries succeeded in slowing their rate of increase to a greater degree than did the United States. The data also suggest that wage inflation was less of a factor in raising the cost of health care in the United States than was the case in most of the other countries.
Cross-Cultural Comparison↗
Determinants of expenditure variation in health care and care of the elderly among Finnish municipalities.
In Finland, municipal health care expenditure varies from FIM 3 800 per capita to FIM 7 800 per capita. The objective of this study was to estimate the impact of different economic, structural and demographic factors on the per capita costs of health services and care of the elderly. Using regression analysis we attempted to explain observed differences in expenditure by determining separately the effects of allocative and productive inefficiency and the effects of factors influencing the demand for services. We found income level of local population, generosity of central government matching grant, allocative efficiency (the mix of care between institutional and non-institutional care), productive efficiency of service providers, and factors associated with the need of services (age structure, morbidity) to be the most important determinants of health care expenditure. Our results reveal that municipalities have the means at their disposal (by shifting resources to outpatient care and increasing productivity) to significantly reduce expenditure on health services and care of the elderly.
Aged↗
Primary care physicians and specialists as personal physicians. Health care expenditures and mortality experience.
BACKGROUND: The advent of managed care has resulted in considerable debate regarding the relative effects of specialist and primary care on patient outcomes and costs. Studies on these subjects have been limited to a disease-focused orientation rather than a patient-focused orientation inherent in primary care management. We examined whether persons using a primary care physician have lower expenditures and mortality than those using a specialist as their personal physician. METHODS: Using data on a nationally representative sample of 13,270 adult respondents tot he 1987 National Medical Expenditure Survey reporting as their personal physician either a primary care physician (general practitioner, family physician, internist, or obstetrician-gynecologist) or a specialist, we examined total annual health care expenditures and 5-year mortality experience. RESULTS: Respondents with a primary care physician, rather than a specialist, as a personal physician were more likely to be women, white, live in rural areas, report fewer medical diagnoses and higher health perceptions and have lower annual healthcare expenditures (mean: $2029 vs $3100) and lower mortality (hazard ratio = 0.76, 95% confidence interval [CI], 0.64-0.90). After adjustment for demographics, health insurance status, reported diagnoses, health perceptions, and smoking status, respondents reporting using a primary care physician compared with those using a specialist had 33% lower annual adjusted health care expenditures and lower adjusted mortality (hazard ratio = 0.81; 95% CI, 0.66-0.98). CONCLUSIONS: These findings provide evidence for the cost-effective role of primary care physicians in the health care system. More research is needed on how to optimally integrate primary and specialty care.
Economics, Medical↗
International comparisons of health care expenditures and satisfaction.
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Attitude to Health↗