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PubMed1995

Causes of Medicaid expenditure growth.

Expenditures for the Medicaid program grew at the alarming and unexpected average annual rate of nearly 20 percent from 1989 ($58 billion) to 1992 ($113 billion). These statistics raise a critical question: What caused spending to grow so dramatically? Using State-level data from 1984-92, this analysis examines the determinants of Medicaid expenditure growth. The results indicate that Medicaid enrollment, Federal Medicaid policy, and State policy are significantly related to Medicaid expenditure growth. The analysis also finds the prevalence of acquired immunodeficiency syndrome (AIDS) to be significantly related to Medicaid expenditures.

Acquired Immunodeficiency Syndrome↗
PubMed1981

National health expenditures, 1980.

The United States spent an estimated $247 billion for health care in 1980 (Figure 1), an amount equal to 9.4 percent of the Gross National Product (GNP). Highlights of the figures that underlie this estimate include the following: Health care expenditures in 1980 accelerated at a time when the economy as a whole exhibited sluggish growth. The 9.4 percent share of the GNP was a dramatic increase from the 8.9 percent share in 1979. Health care expenditures amounted to $1,067 per person in 1980 (Table 1). Of that amount, $450, or 42.2 percent, came from public funds. Expenditures for health care included $64.9 billion in premiums to private health insurance, $70.9 billion in Federal payments, and $33.3 billion in State and local government funds (Table 2). Hospital care accounted for 40.3 percent of total health care spending in 1980 (Table 3). These expenditures increased 16.2 percent between 1979 and 1980, to a level of $99.6 billion. Spending for the services of physicians increased 14.5 percent to $46.6 billion, 18.9 percent of all health care spending. All third parties combined--private health insurers, governments, philanthropists, and industry--financed 67.6 percent of the $217.9 billion spent for personal health care in 1980 (Table 4), ranging from 90.9 percent of hospital care services to 62.7 percent of physicians' services and 38.5 percent of the remainder (Table 5). Direct payments by consumers reached $70.6 billion in 1980 (Table 6). This accounted for 32.4 percent of all personal health care expenses. Outlays for health care benefits by the Medicare and Medicaid programs totaled $60.6 billion, including $35.8 billion for hospital care. The two programs combined to pay for 27.8 percent of all personal health care in the nation (Table 7).

Health Expenditures↗
PubMed1986

Changes in distribution of Medicare expenditures among aged enrollees, 1969-82.

In this article, we examined the concentration of Medicare expenditures among the aged for 1969, 1975, and 1982 to determine if expenditures have become more concentrated among a few heavy users of service over time. Despite an increase in reimbursements for the aged from $6.0 billion in 1969 to $41.8 billion in 1982, the distribution of those expenses remained remarkably stable, with a slight lessening in the concentration of reimbursements in 1982. Patterns were similar for both Part A (hospital insurance) and Part B (supplementary medical insurance) services. The concentration of expenditures was much greater among survivors than among people who died in both 1975 and 1982, with little change in the distribution of expenditures within either group.

Aged↗
PubMed1989

Hospital utilization and expenditures in a Medicaid population.

Determinants of hospital utilization and expenditures are analyzed for Medicaid enrollees in the State Medicaid household sample portion of the National Medical Care Utilization and Expenditure Survey who were continuously enrolled throughout 1980. Health status measures were the best predictors of both the probability of hospitalization and total hospitalizations. Children covered by Aid to Families with Dependent Children were the Medicaid enrollees least likely to be hospitalized. Number of hospital days, surgery, and California residence directly increased hospital expenditures. Conditions responsible for hospitalization increased hospital expenditures indirectly by increasing the number of hospital days and the probability of surgery.

Aid to Families with Dependent Children↗
PubMed1987

Family out-of-pocket expenditures for health care: United States, 1980.

Information on out-of-pocket health care expenditures for families in 1980 is presented in this report. The data discussed here were gathered through the national household sample of the National Medical Care Utilization and Expenditure Survey (NMCUES). Information for the year 1980 was collected on health problems, health care received, expenditures for care, health insurance, and related topics from approximately 6,800 families in the U.S. civilian, noninstitutionalized population. All individuals who are in institutions or in the military are excluded from this analysis as are all families with military heads of family, even if they have civilian members. For this report, a family was initially defined as: two or more persons living together who were related either by blood, marriage, adoption, or a formal foster care relationship; or as a single person living outside such relationships. Because these data were collected throughout an entire year, the important concept of "longitudinal family" was developed. This concept was necessary to deal with the fact that the composition of a family could change over time, and that families could come into existence and go out of existence over time. As the data are based on this dynamic concept of families, all measures of health care expenditures are calculated in terms of annual rates. Family data are important for understanding the health care system because decisions to seek and use health care are usually family decisions, health care is usually paid for out of family resources, and family distributions for health-related variables differ from the distributions found for individuals.

Adult↗
PubMed1989

Utilization and expenditures under Medicaid for Supplemental Security Income disabled.

Recently available data on major disabling conditions of the Supplemental Security Income disabled are used to examine 1984 patterns of Medicaid expenditures in California, Georgia, Michigan, and Tennessee. Results indicate that 37-58 percent of these expenditures are for enrollees whose major disabling condition involves mental retardation or other mental disorders. This pattern occurs because a high proportion of disabled enrollees have these conditions, rather than high expenses per enrollee. Annual Medicaid expenditures per enrollee were highest for the disabled with neoplasms, blood disorders, and genitourinary conditions. Expenditures per enrollee were higher for younger enrollees and lower for those dually enrolled in Medicare.

Adolescent↗
PubMedDate not supplied

[Health expenditures in Spain at the dawn of the 3d millennium].

In 1997, per capita health expenditures reached in Spain 805 Euros as compared to 1146 Euros in the entire European Union. In terms of percent GDP, Spanish health expenditures amounted to 7.4 percent, as compared to 7.9 in the European Union. About 80% of Spanish health expenditures are public-funded. Since 1993 onwards, there is a political consensus for keeping at the same pace health expenditures increase and GDP growth. However it is not certain that such a consensus can be maintained, as trade unions are increasingly voicy for a strong growth of salaries in the public sector. There will be also pressure on the demand side, both in the short term (the Spanish people are increasingly expecting to raise their consumption of health services to the level of other European countries) and in the long run (impact of population aging).

European Union↗
PubMed2000

[Prospects for national health expenditure in Japan].

Japan's national health expenditure has been increasing by 5% annually (approximately 1.3 trillion yen) and is expected to reach 30 trillion yen in the 1999 fiscal year. This increase is mostly due to the country's rapid aging rate. However, Japan's current slow economic growth, combined with a decrease in the average number of children per family, raises the issue of how these health-expenditure increases can be afforded as the health care system continues to provide appropriate levels of essential health care services. To understand these health-expenditure trends, one must first recognize that the Japanese health care system is characterized by the country's social health insurance system, which is based on the Social Insurance Act. It is also important to consider the impact the medical fee schedule has on clinical practices. This article reviews the situation surrounding national health-care expenditures and the related issue of social health-insurance reform. In this, several topics closely connected with cancer therapies are also examined.

Forecasting↗
PubMed1999

Medical expenditures for major diseases, 1995.

This article distributes the Health Care Financing Administration's (HCFA) estimates of 1995 personal health care expenditures (PHCE) according to sex, age, and diagnosis for each type of health care service. Aggregate and per capita expenditures are reported for 18 broad categories of disease classified according to the International Classification of Diseases (ICD-9-CM). Special emphasis is given to expenditures for persons age 65 or over, the segment of the population with the highest expenditures. These results show how the relative importance of medical conditions and type of health services differs between the sexes and changes with increasing age.

Adolescent↗
PubMed2002

State expenditures on home and community based services and use of formal and informal personal assistance: a multilevel analysis.

Despite wide state variation in commitment to home and community-based services (HCBS) for functionally impaired older persons, little is known about how such variation affects older adults' strategies to compensate for their functional limitations. This study examines the association of state HCBS expenditures with use of formal and informal personal assistance among non-institutionalized older Americans aged 70 and older with functional limitations. We conducted multilevel multinomial logistic regression analysis using data from the first wave of the Assets and Health Dynamics among the Oldest Old Survey, combined with data on state HCBS expenditures. Controlling for individuals' demographic, socioeconomic, and care needs factors, persons residing in states with higher HCBS expenditures were more likely to use formal personal assistance, but not less likely to use informal assistance. Our study suggests state variation in HCBS expenditures leads to inequitable access to formal personal assistance, especially among those with high functional limitations.

Aged↗
PubMed2001

Expenditure and payment sources for treating acute respiratory infections in rural Vietnam.

This paper highlights important effects of the health sector reform in rural Vietnam, such as the expenditure for treatment, payment sources among patients and provision of private services. Using a cross-sectional design with a structured questionnaire, the occurrence of illnesses and utilization of health care for 4,769 members in randomly selected households were investigated, with a focus on acute respiratory infections (ARI). Three hundred and seventy people were reported to have suffered from an ARI in the four weeks prior to interview. In 96% of the cases some action had been taken, most often self-medication. The average expenditure for the first treatment was high, 25,000 Dong (US$ 1.7), which is appropriately equal to one third of the monthly per capita in the district. The majority of the expenditure was for drug purchasing in the private or public services. Expenditure for treatment of acute respiratory infections was highest in the hospitals, lower in commune health stations and private clinics, and lowest in the case of self-medication. There was no consultation fee at the commune health stations and private clinics. About half of the patients had borrowed money or sold agricultural products to pay for treatment. Only 2% of the patients benefited from health insurance. High burden of ARI, high cost of treatment and poor coverage of health insurance may create severe economic problems in poor families. Our findings indicate a need to develop pre-payment schemes and the appropriate allocation of resources in order to establish an efficient and equitable health care system.

Acute Disease↗
PubMedDate not supplied

Healthcare expenditure in patients treated with venlafaxine or selective serotonin reuptake inhibitors for depression and anxiety.

We compared healthcare expenditure over a six-month period following initiation of therapy with either venlafaxine (immediate and extended-release) or a selective serotonin reuptake inhibitor (SSRI) in depressed patients with or without anxiety. Patients beginning treatment for a new depressive episode were identified retrospectively using the administrative data of the MEDSTAT MarketScan database for the period 1994-1999. Before beginning therapy, patients prescribed venlafaxine had more non-mental illnesses (0.85 vs 0.76; p<0.01) and hospitalisations for mental illness (0.53 vs 0.29; p<0.05) than patients prescribed SSRIs. In the six months after initiating treatment, venlafaxine was associated with lower hospitalisation expenditure for non-mental illness ($177 vs $526; p<0.01) than SSRIs, although total healthcare expenditure was not significantly different. Venlafaxine was associated with a 50% decrease in the odds of hospitalisation for non-mental illness compared with SSRIs, with significantly lower inpatient expenditure.

Adolescent↗
PubMed2001

Reconciling medical expenditure estimates from the MEPS and the NHA, 1996.

This article compares 1996 estimates of national medical care expenditures from the Medical Expenditure Panel Survey (MEPS) and the National Health Accounts (NHA). The MEPS estimate for total expenditures in 1996 was $548 billion; whereas, the NHA estimate for personal health care (PHC) in 1996 was $912 billion. Much of this apparent difference, however, arises from differences in scope between MEPS and NHA--rather than from differences in estimates for comparably-defined expenditures. We adjusted the NHA for differences in included populations and types of services covered, finding a much smaller difference between MEPS and a comparably-defined NHA.

Family Characteristics↗
PubMed1992

An analysis of early intervention expenditures in Massachusetts.

Early intervention expenditure data from Massachusetts were linked to service data on a 157-member sample of Massachusetts early intervention service recipients. The findings revealed an enormous variability in the total expenditure per child estimate. Regression analyses identified specific child, family, and program characteristics that were significant predictors of the hours of service received. These results were then used to estimate expected hours of service and per child expenditures for eight subgroups. Variations in total expenditures by subgroup reflected differences in the distribution of service hours by service type. The implications of these findings for the implementation of Part H of P.L. 99-457 were discussed.

Child, Preschool↗
PubMed2003

Trends in cardiovascular drug utilization and drug expenditures in Canada between 1996 and 2001.

BACKGROUND: There is increasing interest in studying trends in drug utilization because drug costs are the fastest growing sector of the health care system. OBJECTIVES: To focus on the trends in the utilization of and expenditures for cardiovascular drugs in Canada by drug class and by province over a six-year period. METHODS: Data from the IMS Health Canada CompuScript Audit database were used for this study from the period of February 1996 to January 2002. Patterns of drug utilization and expenditures in Canada were described for cardiovascular drug classes, individual agents within classes and by provincial analyses. RESULTS: Substantial increases in both the utilization of and the expenditures for cardiovascular medications have occurred in Canada over the last six years. Newer medication classes such as angiotensin converting enzyme inhibitors and statins now comprise the majority of cardiovascular drugs prescribed, along with continued high use of diuretics. Increases in some drug classes, such as angiotensin converting enzyme inhibitors, statins and beta-blockers, appear to be based on trial evidence or guidelines. However, marketing may play a larger role in the increases in use of angiotensin receptor blockers and specific drugs, such as amlodipine besylate and atorvastatin, because their increased utilization cannot be explained by major clinical trial evidence and/or practice guidelines. CONCLUSIONS: Changes in patterns of cardiovascular drug utilization and expenditures in Canada may be associated with clinical trial evidence, clinical practice guidelines, policy changes and/or marketing initiatives.

Canada↗
PubMed2004

Medical expenditures attributable to injuries--United States, 2000.

In the United States, injuries (i.e., unintentional and intentional) are the leading cause of death among persons aged <35 years and the fourth leading cause of death among persons of all ages. Injuries create a substantial burden on society in terms of medical resources used for treating and rehabilitating injured persons, productivity losses caused by morbidity and premature mortality, and pain and suffering of injured persons and their caregivers. To estimate annual injury-attributable medical expenditures in the United States, CDC analyzed data on injury prevalence and costs from the 2000 Medical Expenditure Panel Survey (MEPS) and the National Health Accounts (NHA). This report summarizes the results of that analysis, which indicated that injury-attributable medical expenditures cost as much as 117 billion dollars in 2000, approximately 10% of total U.S. medical expenditures. This finding underscores the need for innovative and effective interventions to prevent injuries.

Adolescent↗
PubMed2004

Are the additional health expenditures generated by insurance bad for society?

Conventional economic theory has concluded that the additional health expenditures generated by insurance coverage are bad for society and lead to inefficiently high health care expenditures. To reduce costs, economists have promoted solutions--cost sharing insurance policy and managed care--designed to reduce this additional care. This article discusses a new theory of insurance that suggests that much of these additional health expenditures are actually efficient and good for society. As a result, insurance coverage is much better for society than economists have thought. Also, the policy prescriptions are different. The new theory suggests that cost sharing should be applied sparingly, that policy should focus on reducing high prices in order to reduce health expenditures, and that the uninsured should be insured under some type of national insurance program.

Cost Sharing↗
PubMed2005

Does the use of SSRIs reduce medical care utilization and expenditures?

BACKGROUND: Although selective serotonin reuptake inhibitors (SSRIs) are more expensive than tricyclic antidepressants (TCAs), SSRIs may reduce overall health costs compared with TCAs through improved compliance and reduced need for other medical care services. Economic evaluation studies using clinical trial or claims data have not accurately estimated the actual costs associated with antidepressants because they did not appropriately address two issues: the heterogeneity of SSRI and TCA users and the use of antidepressants for non-indicated symptoms. AIMS OF THE STUDY: This study estimates the relative substitution effect of SSRIs on the overall utilization of outpatient and inpatient care and other prescription drugs compared to TCAs. This study identifies and controls for heterogeneities in diagnosis among SSRI and TCA users and looks for variations in substitution effects across utilization. METHODS: To estimate the direct effect of SSRIs compared with TCAs on the utilization of other medical care resources in a naturalistic setting, this study uses the Medical Expenditure Panel Survey, national panel survey data, from 1996 to 1998. The main model of analysis is a two-part regression: the first part is a probit model of any use and the second part is a log linear model of expenditures among users. Baseline physical health status, depression severity, and socioeconomic factors that could affect antidepressant choice and medical care utilization are controlled for. RESULTS: A considerable fraction of antidepressant use, especially among TCA users, is for reasons other than depression. After controlling for the heterogeneity in SSRI and TCA users, this study does not find consistent evidence of the substitution of SSRIs for other medical care. Although SSRIs, compared with TCAs, reduce overall outpatient visits and other prescription drugs, they increase the utilization of these services for depression. Antidepressant choice does not influence the utilization or expenditure level for inpatient services which composed the largest part of medical expenditure in this study sample. Results are robust when the analysis is restricted to the SSRI or TCA users with a depression diagnosis. DISCUSSION: The potential cost-incremental effect of SSRIs over TCAs for the treatment of depression can be compromised by the reduced utilization for symptoms other than depression among SSRI users. This study uses national survey data and takes into account the heterogeneity of SSRI and TCA users so the results can be generalized to real clinical practice. IMPLICATIONS FOR HEALTH CARE PROVISION: The costs associated with antidepressants are not only for the treatment of depression symptoms. Antidepressants are commonly prescribed for conditions for which the clinical and economic benefits are not established. This practice may lead to significant unnecessary healthcare expenses. IMPLICATIONS FOR HEALTH POLICIES: Antidepressant prescriptions for non-indicated conditions should be considered in setting policies designed to control costs associated with antidepressants and in developing clinical guidelines for antidepressant prescription. IMPLICATIONS FOR FUTURE RESEARCH: Future research on the economic evaluation of antidepressants should consider the use of antidepressants for health conditions other than depression. The economic incentives for and clinical benefits of the prescription of antidepressants for non-indicated conditions could be explored in future research.

Adult↗