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PubMed1986

An energy 'sources' and 'fractions' approach to the mechanical energy expenditure problem--V. The mechanical energy expenditure reduction during motion of the multi-link system.

Mechanical energy economy during motion of the multi-link system is analyzed on the basis of the theory developed in the previous publications (parts I-IV of this series, J. Biomechanics 19, 287-309). The compensation coefficients for the F- and M-sources and also the absolute compensation coefficient reflecting the mechanical energy economy due to four possible resources are introduced. These resources are the antiphase fluctuations of (I) each link's total energy fractions involving energy transformations between (1) rotational and translational fractions by F-sources, (2) kinetic and potential fractions by mg-source; (II) the links' total energies involving energy transfers between (3) links by F-sources, (4) links by M-sources. The conditions of mechanical energy economy, particularly due to M-sources, are analyzed.

Biomechanical Phenomena↗
PubMed1996

Energy expenditure in anorexia nervosa: can fat-free mass as measured by bioelectrical impedance predict energy expenditure in hospitalized patients?

Anorexia nervosa (AN) is associated with a reduced metabolically active fat-free mass (FFM) and basal metabolic rate (BMR). Excessive refeeding results in major fat deposition which is not well tolerated by patients. Prediction of BMR is, therefore, a clinical issue during refeeding, but measurement by indirect calorimetry is time-consuming and not widely available. The study aim was to determine if and when BMR could be estimated from prediction formulas based on FFM derived from bioelectrical impedance analysis (BIA) in AN patients during refeeding. Indirect calorimetry and BIA were prospectively measured bi-weekly in 9 AN patients (body mass index 13.7 +/- 0.5 kg/m2) for 10 weeks of refeeding. Initial BMR was 969 +/- 46.7 kcal/d and 27.7 +/- 1.4 kcal/kg FFM, and at week 10 increased to 1360 +/- 44.6 kcal/d and 35.8 +/- 0.8 kcal/kg FFM. While correlations improved with increasing weight, FFM and body mass index, prediction formulas are insufficient to permit prediction of BMR based on weight or FFM, even after 10 weeks of refeeding. To allow for optimal nutritional support, indirect calorimetry measurements may be useful in the early weeks of refeeding because of a large variability of basal metabolic rate between patients.

Journal Article↗
PubMed2004

Estimates and patterns of direct health care expenditures among individuals with back pain in the United States.

STUDY DESIGN: Secondary analysis of the 1998 Medical Expenditure Panel Survey. OBJECTIVE: To estimate total health care expenditures incurred by individuals with back pain in the United States, calculate the incremental expenditures attributable to back pain among these individuals, and describe health care expenditure patterns of individuals with back pain. SUMMARY OF BACKGROUND DATA: There is a lack of updated information on health care expenditures and expenditure patterns for individuals with back pain in the United States. METHODS: This study used data from the 1998 Medical Expenditure Panel Survey, a national survey on health care utilization and expenditures. Total health care expenditures and per-capita expenditures among individuals with back pain were calculated. Multivariate regression models were used to estimate the incremental expenditures attributable to back pain. The expenditure patterns were examined by stratifying individuals with back pain by sociodemographic characteristics and medical diagnosis, and calculating per-capita expenditures for each stratum. RESULTS: In 1998, total health care expenditures incurred by individuals with back pain in the United States reached 90.7 billion dollars and total incremental expenditures attributable to back pain among these persons were approximately 26.3 billion dollars. On average, individuals with back pain incurred health care expenditures about 60% higher than individuals without back pain (3,498 dollars vs. 2,178 dollars). Among back pain individuals, at least 75% of service expenditures were attributed to those with top 25% expenditure, and per-capita expenditures were generally higher for those who were older, female, white, medically insured, or suffered from disc disorders. CONCLUSIONS: Health care expenditures for back pain in the United States in 1998 were substantial. The expenditures demonstrated wide variations among individuals with different clinical, demographic, and socioeconomic characteristics.

Adolescent↗
PubMed2000

Direct expenditures related to otitis media diagnoses: extrapolations from a pediatric medicaid cohort.

BACKGROUND: Treatment of otitis media in children is associated with substantial expenditures because of its high frequency during childhood. Vaccines against respiratory pathogens causing otitis media are now being developed. Information about otitis media-related medical expenditures will be needed to determine the cost-effectiveness of these preventive interventions. METHODS: This study used utilization data from claims to impute otitis media-related expenditures for medical visits, pharmaceuticals, and surgical procedures for 87 057 children 13 years of age and younger who were continuously enrolled in Colorado's fee-for-service Medicaid program during 1992. International Classification of Disease, Ninth Revision diagnostic codes were used to identify visits for otitis media. An antibiotic was considered to have been prescribed to treat otitis media if it was dispensed up to 24 hours before or within 48 hours after a physician encounter showing a diagnosis of otitis media. All tympanostomies, mastoidectomies, and adenoidectomies were assumed to be related to otitis media. Expenditures were imputed from utilization using a Medicaid fee schedule. National expenditures for 1992 to treat otitis media were extrapolated from Colorado's Medicaid data. We adjusted for differences between Colorado and the United States as a whole in terms of price, number, and intensity of services; for differences in reimbursement rates by service between Medicaid and private insurance; and for differences in utilization between Medicaid enrollees and the uninsured. To provide a more current expression of medical expenditures for otitis media, we inflated the 1992 expenditure estimates to 1998 dollars using the Consumer Price Index published by the US Bureau of Labor Statistics. RESULTS: Twenty-eight percent of children experienced at least 1 episode of diagnosed otitis media. The proportion of children with a diagnosis of otitis media was highest (42%-60%) in the 7-month to 36-month age range. The proportion was also higher among white (34.5%) and Hispanic (25.3%) children than among black children (18.5%), as well as among rural (34.5%) compared with urban children (27.2%). Children 19 to 24 months of age incurred the highest total annual expenditures per child with otitis media ($239.68). Expenditures for drugs, visits, and procedures were all highest for this group. The per-patient cost to Medicaid was greater for visits than for drugs or procedures across all age groups. Total per-patient expenditures were higher for males ($174.67) than for females ($154.47) and higher for white children ($176.59) than for Hispanic ($154.12) or black children ($134.44). The differences among the ethnic groups can be attributed almost entirely to differences in expenditures for procedures and drugs. Although mean expenditures per patient varied substantially by some patient characteristics (eg, race), these differences accounted for only a small fraction of the enormous variation in costs per patient. Including children with and without otitis media, age-specific estimated expenditures per child peaked among children 1 ($132.94) and 2 years of age ($88.72). Children 3 to 6 years of age incurred expenditures only one third as great as those incurred by children 1 year of age. Total national expenditures were estimated to have been approximately $4.1 billion in 1992 dollars and $5.3 billion in 1998 dollars. Over 40% of national expenditures to treat otitis media in children younger than 14 years of age were incurred for children between 1 and 3 years of age ($453 per capita in 1992 dollars over these 2 years vs $1027 for all years of age from 2 to 13). Nationally, expenditures for visits remained the largest component of expenditures. LIMITATIONS: This study assessed expenditures from the point of view of the health care system; that is, no social costs, such as lost work time, or expenditures not normally covered by insurance, such as those for transportation, we

Adolescent↗
PubMed2005

The performance of administrative and self-reported measures for risk adjustment of Veterans Affairs expenditures.

OBJECTIVE: To evaluate the performance of different prospective risk adjustment models of outpatient, inpatient, and total expenditures of veterans who regularly use Veterans Affairs (VA) primary care. DATA SOURCES: We utilized administrative, survey and expenditure data on 14,449 VA patients enrolled in a randomized trial that gave providers regular patient health assessments. STUDY DESIGN: This cohort study compared five administrative data-based, two self-report risk adjusters, and base year expenditures in prospective models. DATA EXTRACTION METHODS: VA outpatient care and nonacute inpatient care expenditures were based on unit expenditures and utilization, while VA expenditures for acute inpatient care were calculated from a Medicare-based inpatient cost function. Risk adjusters for this sample were constructed from diagnosis, medication and self-report data collected during a clinical trial. Model performance was compared using adjusted R2 and predictive ratios. PRINCIPAL FINDINGS: In all expenditure models, administrative-based measures performed better than self-reported measures, which performed better than age and gender. The Diagnosis Cost Groups (DCG) model explained total expenditure variation (R2=7.2 percent) better than other models. Prior outpatient expenditures predicted outpatient expenditures best by far (R2=42 percent). Models with multiple measures improved overall prediction, reduced over-prediction of low expenditure quintiles, and reduced under-prediction in the highest quintile of expenditures. CONCLUSIONS: Prediction of VA total expenditures was poor because expenditure variation reflected utilization variation, but not patient severity. Base year expenditures were the best predictor of outpatient expenditures and nearly the best for total expenditures. Models that combined two or more risk adjusters predicted expenditures better than single-measure models, but are more difficult and expensive to apply.

Aged↗
PubMed1997

Transitions in health care use and expenditures among frail older adults by payor/provider type.

OBJECTIVES: To assess whether transitions in health care expenditures differed over time by payor/provider type: Medicare fee-for-service (FFS), Medicaid-Medicare, and Medicare HMO. DESIGN: Longitudinal study. SETTING: A large, nonprofit healthcare system in San Diego, California. PARTICIPANTS: A total of 450 frail older people who responded to the baseline and follow-up surveys and who survived the 18-month study period. MEASUREMENTS: Measures included three total expenditure categories for each 6-month period: low users (< $4000); medium users ($4000-$19,999); or high users ($20,000+). Seven conceptually meaningful expenditure trajectories over time were identified: (1) consistently low expenditures, (2) consistently medium expenditures, (3) consistently high expenditures, (4) decreasing expenditures, (5) increasing expenditures, (6) U-shaped expenditures, and (7) inverted U-shaped expenditures. MAIN RESULTS: Logistic regression analyses showed that HMO enrollees were about twice as likely as Medicaid-Medicare beneficiaries to have consistently low expenditures, but no differences were found between the FFS and HMO groups on this trajectory. Other expenditure patterns showed no significant differences by payor/provider group. Significant interactions among payor/provider type, low/medium/ high expenditure status, and time were observed for inpatient hospital care, skilled nursing/rehabilitation care, and home health care. CONCLUSION: This study illustrates the complexity of frail older people with respect to their health care expenditures and service use. Expanded efforts to control health care expenditures for frail older people should focus first on those who are dually-enrolled. In addition, because mean medical expenditures for high users enrolled in different payor/ provider groups were surprisingly similar, the data suggest that containing expenditures for individuals in the highest usage group ($20,000+) presents challenges for physicians practicing in an era of healthcare reform, regardless of payor/ provider setting.

Aged↗
PubMed1994

Relationships between resting and total energy expenditure in injured and septic patients.

OBJECTIVE: To quantify resting and total energy expenditure in patients who have suffered severe trauma and sepsis. DESIGN: Prospective, unblinded, observational, nonrandomized study. SETTING: Critical care unit of a Level I adult trauma center. PATIENTS: Immediate posttrauma patients or trauma patients exhibiting signs of sepsis with multiple organ dysfunction. INTERVENTIONS: An indirect calorimeter was used to measure energy expenditure at rest (resting energy expenditure) at 0700 and 1900 hrs. The energy expenditure measurement was then continued for up to 12 hrs (total energy expenditure). Clinical data were collected for computation of an illness severity score. RESULTS: Thirteen trauma and 20 septic patients were studied 240 times. All patients were mechanically ventilated. Morphine or fentanyl was infused during 99% of studies. Neuromuscular blocking agents were used in 42% of septic studies. Both the trauma and septic groups were hypermetabolic (mean trauma resting energy expenditure, 36 +/- 6 kcal/kg; mean septic resting energy expenditure, 44 +/- 8 kcal/kg; p < .05). Total energy expenditure was similar to resting energy expenditure (trauma total energy expenditure = resting energy expenditure x 1.035 +/- 0.078, septic total energy expenditure = resting energy expenditure x 1.039 +/- 0.071). Total energy expenditure and resting energy expenditure were linearly related (r2 = .89, p < .0001). CONCLUSIONS: Trauma and septic patients are hypermetabolic, even when heavily sedated or medically paralyzed. A measurement of resting energy expenditure is a close approximation of total energy expenditure in most patients.

Adult↗
PubMed2001

A national study of medical care expenditures for musculoskeletal conditions: the impact of health insurance and managed care.

OBJECTIVE: To provide estimates of all medical care expenditures on behalf of persons with musculoskeletal conditions in the United States in 1996, to estimate the increment in expenditures attributable to the musculoskeletal conditions among such persons, and to ascertain the impact of the presence or absence of health insurance and/or managed care on such expenditures. METHODS: The estimates were derived from the Medical Expenditure Panel Survey (MEPS), a national probability sample of 9,488 households, which includes responses from 21,571 persons. In the MEPS, respondents are surveyed every 6 months to report on medical care utilization and health care expenditures. Of the 21,571 persons surveyed, 4,161 reported having 1 or more musculoskeletal conditions. After weighting the data, these 4,161 individuals were inferred to represent 53.935 million persons in the nation as a whole. We tabulated all medical care expenditures of these individuals, stratified by comorbidity status, and then compared their expenditures with those among persons with chronic conditions other than musculoskeletal disease or with no chronic conditions. We then used regression techniques to estimate the increment of health care expenditures attributable to the musculoskeletal conditions. Finally, we used regression to estimate the impact of health insurance status and managed care status on the health care expenditures of the persons with musculoskeletal conditions. RESULTS: Per capita medical care expenditures in 1996 averaged $3,578 among persons with musculoskeletal conditions, for a national total of $193 billion, the equivalent of 2.5% of the Gross Domestic Product in that year. The largest components were hospital admissions (37%), physician visits (23%), and prescriptions (16%). Estimates of the per capita increment in total medical care expenditures attributable to musculoskeletal conditions ranged from a high of $723 when controlling for the other medical conditions present, to $364 when controlling for these variables and demographics. Persons with musculoskeletal conditions ages 16-64 who lacked health insurance reported total expenditures of $793, versus $3,249 among those with insurance (P < 0.0001). Among such persons with insurance, expenditures did not differ significantly between those in fee-for-service plans and those in managed care health plans. CONCLUSION: Persons with musculoskeletal conditions and health insurance experienced high total expenditures for medical care and high expenditures attributable to the musculoskeletal conditions. Insurance coverage under a managed care plan had no effect on the magnitude of these total expenditures, but lack of insurance coverage did have a significant effect among persons with musculoskeletal conditions.

Adolescent↗
PubMedDate not supplied

The association between health risks and medical expenditures in a Japanese corporation.

PURPOSE: To examine the relationship between health risks and medical care expenditures in an employer setting in Japan. DESIGN: A cross-sectional, correlational study. SETTING: A large Japanese corporation. SUBJECTS: A total of 6543 employees of a large Japanese electronics company, for whom medical expenditures, lifestyle risks and biometric data were available, were included in the analysis. Seventy-six Percent were male, and subjects were primarily white-collar workers. MEASURES: Medical expenditure data were available for fiscal year 2000, including inpatient, outpatient, and total expenditures, measured in Japanese yen. Binary expenditure indicators for those having no claims and those having high claims (90th percentile) were also created. Risk measures included biometric assessment of high blood pressure and high body mass index (BMI, body weight and height) and self-reported stress, lack of exercise, excess alcohol consumption, poor nutrition, current smoking, and recent quitting. High cholesterol and high blood glucose measures were also available for some subjects from company physicals. RESULTS: Average total expenditures were 48,017 yen (US$445). The 90th percentile of the expenditure distribution was approximately 111,750yen (US$1037). The most commonly reported risk factors were lack of exercise (52.9%), current smoking (35 %), stress (33%), and poor nutritional habits (23.6%). Least common were recently quitting smoking (2%), high blood pressure (4.1 %), and high blood glucose (9.4 %). The prevalence of overweight or obesity was 15.9%. High blood pressure and recent quitting were consistently related to high expenditures, after adjusting for the influence of other predictors. Adjusted expenditures were 76 % higher for recent quitters and 22.6% higher for employees with high blood pressure. Males and younger employees had consistently lower expenditures. Current smoking poor nutrition, and alcohol risk were also associated with lower expenditures. Those with multiple cardiovascular risk factors had adjusted medical expenditures that were 128% higher than those with no cardiovascular risks. Those who had multiple risk factors for stroke had expenditures that were 13% lower than those without stroke risk factors. CONCLUSIONS: This paper represents a first step in examining the association between health risks and medical expenditures in Japanese employees. The investigation uncovered some significant levels of risk for lack of exercise, smoking, and stress. Although results indicate some significant associations between health risks and medical expenditures, several unexpected assocations were noted that require further study. Such information provides a solid foundation for health promotion efforts in Japan and direction for subsequent investigations of health risks and medical expenditures. Future studies should address important issues of health risk measurement, data collection, and research design.

Adult↗
PubMed2005

The impact of population ageing on future Danish drug expenditure.

Population ageing is likely to place an increasing burden on future health care budgets. Several studies, however, have demonstrated that the impact of ageing on future hospital expenditures will be overestimated when not accounting for proximity to death. This is because the greater health care expenditures among the elderly are not only due to age per se but due to the high "costs of dying". Similar studies for pharmaceutical expenditures are scarce. The aim of this study was first to estimate the impact of the ageing Danish population on future total expenditures (public outlays as well as private co-payment) on out-of-hospital prescription drugs, holding everything but demographic changes constant. Second, it was to describe the association between age and drug expenditure among survivors compared to that of decedents, and to evaluate the extent to which drug expenditure is increasing with proximity to death in the last 2 years of life. Taking expenditure during the last year of life and the changes in mortality rates into account, future expenditure of prescription drugs was projected by multiplying the estimated mean annual drug expenditure according to age, gender and survival status by the predicted future number of Danes in each stratum, and subsequently, summing up across all strata. A generalized method was developed to account for expenditure several years prior to death. The projection was based on current drug utilisation from a representative prescription database covering the county of Funen, Denmark, and the most recent Danish population forecast for the period 2003-2030. The total population was projected to increase by 0.8% during the period 2003-2030, while the increase was 58% for people aged 75 years and over. The total drug expenditure was projected to increase by 16.9% during the same period when accounting for proximity to death, while it was 17.9% when this was not done. The projected growth in drug expenditure was not merely due to the drug consumption of the elderly. Moreover, the drug expenditure of elderly decedents was only increasing slightly with proximity to death. We conclude that the ageing of the population per se is likely to increase future expenditure on prescription drugs. This predicted increase, however, is small compared to recently observed increases in drug expenditures. The results of the study indicate that Danish policies aimed at limiting the increase in public drug expenditure should focus on rational pharmacotherapy and on the promotion of prescription of cost-effective pharmaceuticals-rather than targeting the drug use of the elderly or reducing the reimbursement generally.

Adolescent↗
PubMedDate not supplied

State estimates of total medical expenditures attributable to cigarette smoking, 1993.

OBJECTIVE: To estimate state-by-state totals of medical expenditures attributable to cigarette smoking for calendar year 1993. METHODS: The smoking-attributable fractions (SAFs) of total state medical expenditures, by type of expenditure, were estimated using a national model that describes the relationship between smoking and medical expenditures, controlling for a variety of sociodemographic, economic, and behavioral factors. Employing data from the Behavioral Risk Factor Surveillance System, the authors used the national model to estimate SAFs for the 50 states and the District of Columbia, then applied these SAFs to published state medical expenditures, by type of expenditures, to estimate total 1993 state medical expenditures attributable to smoking. National estimates are the sums of state estimates. RESULTS: In 1993, the estimated proportion of total medical expenditures attributable to smoking for the U.S. as a whole was 11.8%, with a range across states from 6.6% to 14.1%. By type of expenditure, SAFs ranged from a low of 8.0% for home health expenditures to a high of 15.9% for nursing home expenditures for the nation as a whole. Total U.S. medical expenditures attributable to smoking amounted to an estimated $72.7 billion in 1993 (95% interval estimate $48.0-$97.4 billion). Estimates of total smoking-attributable state medical expenditures (SAEs) ranged from $79.6 million to $8.72 billion. CONCLUSIONS: Cigarette smoking accounted for a substantial portion of state and national medical expenditures in 1993, with considerable variation among states. The range across states was due to differences in smoking prevalence, health status, other socioeconomic variables used in the model, and the magnitude and patterns of state medical expenditures.

Adult↗
PubMed2005

The impact of China's retail drug price control policy on hospital expenditures: a case study in two Shandong hospitals.

In China, 44.4% of total health expenditures in 2001 were for pharmaceuticals. Containment of pharmaceutical expenditures is a top priority for policy intervention. Control of drug retail prices was adopted by the Chinese government for this purpose. This study aims to examine the impact of this policy on the containment of hospital drug expenditures, and to analyze contributing factors. This is a retrospective pre/post-reform case study in two public hospitals. Financial records were reviewed to analyze changes in drug expenditures for all patients. A tracer condition, cerebral infarction, was selected for in-depth examination of changes in prices, utilization, expenditures and rationality of drugs. In the two hospitals, a total of 104 and 109 cerebral infarction cases, hospitalized respectively before and after the reform, were selected. Prescribed daily dose (PDD) was used for measuring drug utilization, and the contribution of price and utilization to changes in drug expenditures were decomposed. Rationality of drug use post-reform was reviewed based on published literature. Drug expenditures for all patients still increased rapidly in the two hospitals after implementation of the pricing policy. In the provincial hospital, drug expenditures per patient for cerebral infarction cases declined, but not significantly. This was mainly attributable to reduced utilization. In the municipal hospital, drug expenditure per patient increased by 50.1% after the reform, mainly due to greater drug utilization. Three to five fold higher drug expenditure per inpatient day in the provincial hospital was due to use of more expensive drugs. Of the top 15 drugs for treating cerebral infarction cases after the reform, 19.5% and 46.5% of the expenditures, in the provincial and municipal hospitals, respectively, were spent on drugs with prices set by the government. A large proportion of expenditures for the top 15 drugs, at least 65% and 41% in the provincial and municipal hospitals, respectively, was spent on allopathic drugs without an adequate evidence base of safety and efficacy supporting use for cerebral infarction. Control of retail prices, implemented in isolation, was not effective in containing hospital drug expenditures in these two Chinese hospitals. Utilization, more than price, determined drug expenditures. Improvement of rational use of drugs and correcting the present incentive structure for hospitals and drug prescribers may be important additional strategies for achieving containment of drug expenditures.

China↗
PubMed2003

Persistence in health expenditures in the short run: prevalence and consequences.

BACKGROUND: Knowing whether persons in the top percentiles of the health expenditure distribution exhibit persistently high expenditure is fundamental to developing health plan payment policies, containing costs, and understanding the consequences of costly illnesses. OBJECTIVES: To determine the extent of high expenditure persistence over a 2-year period. To identify the correlates and consequences of expenditure persistence. SUBJECTS: A national sample of the population from a longitudinal panel of the Medical Expenditure Panel Survey (MEPS). METHODS: Changes in a person's position in the expenditure distribution were examined. chi2 tests were used to identify differences in characteristics between high and low spenders. Logistic regression was used to predict the likelihood of expenditure persistence. Changes in income, employment, out-of-pocket expenditure burden, and health insurance were compared for high and low spenders. RESULTS: Of the top 5% of spenders in 1996, 30% retain this position in 1997 and 45% are in the top decile of 1997 spenders. High expenditures begin to regress to the mean over the study period. Cancer, mental disorders, diabetes, and infectious diseases and being in the top decile of 1996 spenders increase the probability of expenditure persistence (P < 0.05 for all). This probability also has a strong random component. An increased proportion of persons in the top expenditure decile for both years had out-of-pocket health spending greater than 20% of income in 1997 (P < 0.10). Persons with persistently high expenditures were less likely than low spenders to lose employment-based coverage (5.4% vs. 8.8%, P < 0.05) but no changes in income or employment status were detected. CONCLUSIONS: A sizable minority of persons exhibits persistently high expenditures, creating incentives for favorable risk selection. Few consequences of short-run expenditures persistence are observed.

Adult↗
PubMed1998

Influence of body temperature, with or without sedation, on energy expenditure in severe head-injured patients.

OBJECTIVE: To quantify the effect of body temperature and sepsis on energy expenditure in head-injured patients. DESIGN: Prospective, nonrandomized, observational study. SETTING: Neurosurgical intensive care unit. PATIENTS: Severe head-injured patients. INTERVENTIONS: Use of an indirect calorimeter to measure energy expenditure. MEASUREMENTS AND MAIN RESULTS: Mean arterial pressure (MAP), heart rate (HR), body temperature, and mean hourly energy expenditure were recorded. Twenty-four patients had 1,919 hourly measures of the above parameters. The measurement periods were divided into four groups, according to the anesthetic agents used for sedation: fentanyl and midazolam (group FM); fentanyl, midazolam, and curarization (group C); thiopental (group T); and no sedation (group NS). The energy expenditure/basal energy expenditure ratio (EE/BEE) was significantly lower in group T (1.20 +/- 0.15) than in group FM (1.32 +/- 0.24) or group C (1.32 +/- 0.20) and was significantly higher in group NS (1.60 +/- 0.33). There was a significant correlation between body temperature and EE/BEE (p < .0001, r2 = .27) only in sedated patients. Using the equation of the regression line to correct energy expenditure for differences in body temperatures between groups, the difference in energy expenditure between groups with sedation disappeared. This finding suggested that the low energy expenditure under thiopental was due only to hypothermia. Sepsis significantly increased energy expenditure independently of fever. There was a weak but statistically significant correlation between energy expenditure and HR (p<.01, r2 = .13) but not between energy expenditure and MAP. CONCLUSIONS: Sedation had a major effect on energy expenditure. In sedated patients, body temperature was the main determinant of energy expenditure; the anesthetic agent used had little influence on the level of energy expenditure. Sepsis increased energy expenditure independently of fever, probably through hormonal changes.

Adolescent↗
PubMedDate not supplied

[Out-of- pocket expenditures during hospitalization of young leukemia patients with state medical insurance in two Mexican hospitals].

OBJECTIVE: To estimate out-of-pocket expenditures for health care during the first hospitalization of children treated for leukemia in two hospitals of the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social-IMSS-). MATERIAL AND METHODS: A cross-sectional study was conducted in Mexico City and Leon, Guanajato, Mexico in 1997. The study population consisted of the parents of 51 children under 15 years of age diagnosed with leukemia, who were hospitalized for the first time in two IMSS hospitals. A questionnaire was applied to participants to obtain direct and indirect expenditures during that period. Consumer price indexes (1997-2002) were used to estimate expenditure prices for 2002. Average expenditures and catastrophic expenditures were estimated. Factors associated with expenditures were analyzed using a linear regression model in which the dependent variable was the total household expenditures during hospitalization. RESULTS: The average household cost per hospitalization was 7,318 pesos, 86% of which corresponded to medical care and 14% to indirect costs. Catastrophic expenditures occurred in 14% of households. In 47% of household expenditures exceeded 100% of the total household income during the hospitalization period. Expenditures during hospitalization were associated with place of residence, income level, and type of medical insurance. CONCLUSIONS: Being an IMSS policyholder decreased out-of-pocket expenditures, but not complementary expenditures, which may still be unaffordable for a large segment of the population. For more than a half of the households studied, continuity of care was compromised, as expenditures during the first hospitalization entailed using up savings, going into debt, and/or selling household property.

Child↗
PubMed2004

Mental health care system and mental health expenditures in the Czech Republic.

BACKGROUND: Although the mental health care is a substantial component of the health system in the Czech Republic, there is a lack of information and research on mental health expenditures. Determining the level and profile of mental health expenditures is the first step in achieving awareness of the cost of mental illness to society. AIMS OF THE STUDY: To describe the mental health care financing and delivery system in the Czech Republic and to estimate the mental health expenditures in 2001. The paper examines expenditures with regard to structure by type of service, relative share of total health expenditures, and relative share of the gross domestic product. It also makes international comparisons of mental health expenditures between the Czech Republic and other countries. METHODS: The data discussed in this study come from the Institute of Health Information and Statistics of the Czech Republic and from the General Health Insurance Fund of the Czech Republic. Mental health expenditures are defined as expenditures on services for patients with primary or first-listed diagnoses from Chapter V, Mental and Behavioural Disorders (F00-F99), of the Tenth Revision of International Classification of Diseases (ICD-10). Different methods of allocation are used for various types of services. In addition, expenditures of sickness insurance related to mental illness are also estimated. RESULTS: Mental illness is diagnosed and treated in about 4% of the population. The share of mental illness on the total morbidity in the population is approximately 2%. The share of mental health expenditures on both the total health expenditures (3.54%) and the gross domestic product (0.26%) is low when compared to levels in other developed countries. Psychiatric hospitals consume 35.6% of mental health expenditures; prescribed drugs and medical aid consume 33.2%; specialized outpatient services consume 17.4%; and shares of other services are relatively low. IMPLICATIONS FOR HEALTH CARE POLICY FORMULATION: First, if the amount of expenditures allocated to mental health can be interpreted as an indicator of the government's commitment to mental health, then, in comparison to other developed countries, mental health has a low priority in the Czech Republic. Second, the improved availability of data on morbidity and regular analyses of these data are needed and should yield fast and valuable results.

Czech Republic↗