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PubMed1990

Impacts of PPS on Medicare Part B expenditures and utilization for hospital episodes of care.

The universe of Medicare claims for four states from 1983 through 1986 is used to examine the impacts Medicare's prospective payment system (PPS) makes on hospital lengths of stay and on Part B expenditures for physician services associated with hospital stays. The descriptive results show that lengths of stay have fallen, while both inpatient and outpatient expenditures have risen. The regression results, on the other hand, show that PPS has reduced both lengths of stay and expenditures, and that other factors, such as increases in physician fees and patients' severity of illness, account for expenditure increases.

Diagnosis-Related Groups↗
PubMed1990

Public social welfare expenditures, fiscal years 1965-87.

The years from 1965 to 1976 were a period of great expansion in social welfare expenditures under public law. The entry of the Federal Government into the fields of health care and education was responsible for much of the growth in the first part of this period; high inflation produced increased spending in the later years. From 1977 to 1987, the rate of growth in social welfare spending slowed considerably. In fact, since 1983 the dominant characteristic of such expenditures has been their stability. Although the amount of money spent was higher in each year, little change occurred in the relative size or the apportionment of the funds. The 1987 expenditures continued this pattern. The total amount spent, $834.4 billion, represented an increase of 6.6 percent over the previous year. This amount equaled 18.8 percent of the gross national product. In constant dollar terms, the increase from 1986 to 1987 was 1.7 percent. The Federal Government provided 60-62 percent of all social welfare funding from 1980 to 1986. In 1987, this share fell slightly--to 59.9 percent. The programs for social insurance, public aid, veterans, and housing were primarily Federally funded, while education was largely a State and local responsibility. Governments at all levels spent 53.4 percent of their funds for social insurance purposes in 1987, slightly more than in 1986. However, the experience at different levels of government varied considerably. Federal spending increased 2 percent as a percent of all Federal expenditures, while State and local spending decreased about 1 percent.

Capital Expenditures↗
PubMedDate not supplied

Medicaid expenditures for maternity and newborn care in America.

An Alan Guttmacher Institute (AGI) survey of the Medicaid programs in each state and the District of Columbia found that some 542,000 low-income women have a Medicaid-subsidized delivery each year--about 15 percent of all women who give birth. The proportion ranges from three percent in Alaska to 25 percent in Michigan. The federal and state governments spend almost $1.2 billion annually for maternity care (including prenatal, postpartum and newborn care); the average expenditure per patient is $2,200. Tennessee reports the highest expenditure per patient ($3,500) and Louisiana the lowest ($1,300). Only the highest payments under Medicaid are close to charges for maternity care in the open market, a fact that results in a significant disincentive for physicians and hospitals to accept Medicaid patients. The $1.2 billion spent for Medicaid-subsidized maternity care compares with an estimated $11.5 billion spent for such care nationwide. Thus, Medicaid pays for about 10 percent of the nation's maternity care bill, although Medicaid subsidizes deliveries for 15 percent of all women who give birth. The figures for maternity care do not include Medicaid expenditures for neonatal intensive care, which, for the 17 states reporting data, average about $11,800 per infant. Although only about six percent of all newborns whose deliveries are subsidized by Medicaid require neonatal intensive care, such care is so expensive that it adds about 30 percent to all Medicaid expenditures for maternity care. Increased Medicaid payments for maternity care, including prenatal care, could have a positive impact on health outcomes for low-income mothers and their babies, and could reduce the necessity for massive and expensive medical treatment for newborns.

Child Health Services↗
PubMed1988

Expenditure and consumption of medicines in Israel 1975-85: analysis of trends and elements of growth.

Data on the annual expenditure on medicines and medical supplies have been collected and used to provide the expenditure on medicines only, by the main purchasing sectors for each of the fiscal years from 1975/76 to 1984/85 inclusive. During the decade total expenditure at constant prices increased by 145% with an average annual growth of 10.7%; on a per capita basis the growth was 107 and 8.7%, respectively. The average annual growth decreased during the later years. The real average cost of all medicines actually consumed at constant prices was derived from a pharmaceutical audit. The changes in this cost element are an indication of qualitative changes in drug therapy and in the introduction of new drugs. The analysis shows that this structural change is more significant than changes in quantity of drugs consumed per capita and changes derived from the increase in population. Comparing cross-national per capita expenditure in common units of currency, Israel had one of the lowest levels of consumption among the developed countries. Nevertheless, from 1975 to 1982 Israel had one of the highest rates of growth in per capita consumption at constant medicine prices. A discussion of environmental factors leads to the conclusion that the quality of therapeutic advantage gained by a (decreasing) number of innovative products, coupled with an increase in demand from the unprecedented growth in the number of the elderly and chronically ill, has resulted in a significant growth in consumption during the decade.

Costs and Cost Analysis↗
PubMed1977

Social welfare expenditures, fiscal year 1976.

In 1976, for the second fiscal year in a row, public expenditures for social welfare purposes expanded at an abnormally high rate. Even after adjusting the 16-percent increase in aggregate expenditures for price and population changes, the 8-percent real growth rate proves to be the highest since 1971. The $45 billion rise in social welfare expenditures to a total of $331 billion reflects the effects of both recession and inflation. Benefits for the needy and the unemployed continued to expand at the same time that higher prices triggered cost-of-living adjustments in cash benefit programs and helped swell the cost of furnishing other social welfare services. A further reflection of this growth is the rise in the proportion of the Nation's gross national product devoted to social welfare expenditures from 19.7 percent in 1975 to 20.6 percent in 1976. The latter proportion becomes 27.5 percent when private social welfare spending is included.

Financing, Government↗
PubMedDate not supplied

The cost of a preventable disease: estimated U.S. national medical expenditures for congenital syphilis, 1990.

Reported cases of congenital syphilis have increased rapidly in recent years. The purpose of this study was to estimate first-year medical care expenditures among 1990 incident cases of infants diagnosed with congenital syphilis. The authors used a synthetic estimation model to calculate expenditures for congenital syphilis as the number of treated cases multiplied by cost per case. The number of cases was derived from surveillance data adjusted for underreporting and presumptive (false-positive) treatment. Cost per case was based on expected hospital and physician charges applied to case treatment protocols appropriate to case severity. Base-case estimated first-year medical expenditure for 1990 treated cases (N = 4,400) in 1990 was +12.5 million. In sensitivity analysis, estimates ranged from +6.2 million to +47 million. Substantial reduction in congenital syphilis treatment costs could be achieved through targeted public health interventions consisting of prenatal maternal screening and contact tracing of males testing positive for syphilis. Physicians should be aggressive in presumptive treatment of newborns, since this usually prevents future disability but represents a small portion of total national expenditure for congenital syphilis. More precise data on severe cases resulting in long-term disability are needed to make reliable cost estimates.

Female↗
PubMed1994

A study of factors affecting dental expenditures in Quebec: 1962-1991.

The issue of dental manpower planning has received considerable attention in Quebec in recent years. Quebec dentists agree that there is a need for detailed information regarding the impact of economic factors on the supply of and demand for dental care in the province. This study examines the impact of economic factors on dental care expenditures in Quebec between 1962 and 1991. The functional form of the econometric model used by the authors is similar to the one used in a study of the growth of the U.S. dental sector between 1950 and 1989. The dependent variable is per capita dental expenditure, and the three independent variables are: dentist/population ratio, per capita personal disposable income; and percentage of the population with dental insurance coverage. All data come from secondary sources. The findings indicate that per capita dental expenditure has grown substantially in Quebec over the past three decades, with the rate of growth slowing dramatically during the 1980s. Dental insurance coverage, the number of dentists in the community and the disposable income of the population all have a positive impact on dental expenditure in Quebec. However, it is clear that the incomes of Quebec dentists may decrease in the future if: no restrictions are placed on the number of new dental graduates entering the profession; dental insurance programs are curtailed; or dental disease levels continue to fall.

Dentistry↗
PubMed1994

Projections of health care expenditures as a share of the GDP: actuarial and macroeconomic approaches.

STUDY QUESTION. Can the steady increases in health care expenditures as a share of GDP projected by widely cited actuarial models be rationalized by a macroeconomic model with sensible parameters and specification? DATA SOURCES. National Income and Product Accounts, and Social Security and Health Care Financing Administration are the data sources used in parameters estimates. STUDY DESIGN. Health care expenditures as a share of gross domestic product (GDP) are projected using two methodological approaches--actuarial and macroeconomic--and under various assumptions. The general equilibrium macroeconomic approach has the advantage of allowing an investigation of the causes of growth in the health care sector and its consequences for the overall economy. DATA COLLECTION METHODS. Simulations are used. PRINCIPAL FINDINGS. Both models unanimously project a continued increase in the ratio of health care expenditures to GDP. Under the most conservative assumptions, that is, robust economic growth, improved demographic trends, or a significant moderation in the rate of health care price inflation, the health care sector will consume more than a quarter of national output by 2065. Under other (perhaps more realistic) assumptions, including a continuation of current trends, both approaches predict that health care expenditures will comprise between a third and a half of national output. In the macroeconomic model, the increasing use of capital goods in the health care sector explains the observed rise in relative prices. Moreover, this "capital deepening" implies that a relatively modest fraction of the labor force is employed in health care and that the rest of the economy is increasingly starved for capital, resulting in a declining standard of living.

Actuarial Analysis↗
PubMed1993

Managing the health care system under a global expenditure limit: a workshop summary.

There is ongoing debate as to whether global budgets, or expenditure limits, are compatible with a strategy for managed competition. The Robert Wood Johnson Foundation sponsored an invitational conference for public and private policymakers to discuss the issue. The meeting's purpose was to explore how global expenditure limits might work and what their implications would be for costs, access, and quality of health care. This article summarizes the ideas presented at the conference, looking in particular at global expenditure limit models in Germany and Canada. Overall, the papers and presentations at this meeting demonstrated that global expenditure limits have the potential to provide the necessary fiscal discipline to manage the health care system and provide a greater degree of certainty and accountability for payers, providers, and patients. However, it is also clear that without a common set of principles about the role health care should play in our society and an agreed upon framework of governance for the system, it will be difficult for the United States to resolve the detailed and complex implementation and administration issues of a reformed health care system.

Budgets↗
PubMed1994

Children in foster care in the state of Washington. Health care utilization and expenditures.

OBJECTIVE: To determine and compare health care utilization and expenditures of children in foster care with those of other children and to identify and describe high-cost children in foster care. DESIGN: Analysis of the Medicaid program claims data in the state of Washington. POPULATION: A total of 1631 children in foster care and 5316 children in the Aid to Families With Dependent Children (AFDC) program in 1990. The children were ages 0 through 7 years and eligible for Medicaid continuously during the study year. MAIN OUTCOME MEASURES: Health care utilization and expenditures classified by types of health service and health care provider; proportion of children with 1990 expenditures exceeding $10,000 and most prominent diagnoses associated with their health care utilization. RESULTS: Mental health services were used by 25% of children in foster care compared with 3% of AFDC children (P < .001), and supportive services of visiting nurses and physical therapists were used by 13% of children in foster care and 1% of AFDC children (P < .001). Twice as many children in foster care than AFDC children used medical equipment or specialist services or were hospitalized (P < .001). Mean health care expenditures in 1990 were $3075 for children in foster care and $543 for AFDC children (P < .001). High-cost children included 8% of children in foster care and 0.4% of AFDC children. Among the high-cost children in foster care (n = 106), 59% had mental disorders and 31% had congenital conditions. CONCLUSIONS: Results suggest a higher prevalence and greater complexity of illnesses, particularly mental disorders, among children in foster care. Despite the high utilization and cost of mental health services, previous research suggests there may be underutilization of these services compared with need. Appropriate allocation of resources is essential if foster care agencies are to adequately meet the diverse and compelling needs of children in foster care.

Child↗
PubMed1998

Financing structure dynamics and other determinants of Medicaid pharmaceutical expenditures, 1993-1996.

Medicaid budgets, growing two to three times faster than total state budgets, constitute the fastest growing component of state budgets. Due to their high expenditure growths, pharmaceutical benefits, a cost-effective provision of the indigent health program, gradually began restructuring in the early 1980s. More recent policy shifts (beginning in the early 1990s) toward managed Medicaid (federal HCFA Waivers 1115 and 1915b) are placing renewed emphasis on minimizing program expenditures, expanding access, and reducing cost-ineffective interventions. Therefore, this article investigates the roles that changes in the Medicaid finance configurations, cost-control policies, and program design attributes play as determinants of indigent drug expenditures of states. (Medicaid Compilation Data for 1993 and 1996, obtained from the National Pharmaceutical Council, were used in multiple regression analysis.) Cost containment policy recommendations for managing the drug program expenditures are discussed.

Budgets↗
PubMed1998

[Relationship of utilization rate of health examination under the Elderly Act to medical expenditure and days of medical care for the elderly].

The aim of this study was to investigate the relationship of utilization rate of health examination to medical expenditure and days of medical care per insured person under the Elderly Act. The factors related with the utilization rate of health examination were also analyzed by multiple regression analysis. The material used in this analysis was the 1993 national health insurance data for all of the 3,252 municipalities of Japan. The main results were as follows: 1. The average medical expenditure and days of medical care among the municipalities declined in the increasing order of the three categories of utilization rate of health examination; municipalities with utilization rate of less than 30% being the highest, and those with 50% or more being the lowest. 2. The average medical expenditure and days of medical care among the municipalities with community health centers were smaller than those without. 3. Multiple regression analysis showed that utilization rate had a positive relationship to percentage of elderly, presence of community health center, public financial power index, and number of public health nurses per resident. It had a negative relationship to the population and the number of clinical beds per resident. The number of public health nurses per resident was the most significant factor related with the utilization rate (standardized partial regression coefficient = 0.32). These results suggest that increasing the utilization rate of health examination and the number of community health centers could serve to lower medical expenditure and days of medical care through the promotion of the health services provided by municipalities.

Community Health Services↗
PubMed2005

Frequency, predictors, and expenditures for pediatric insurance claims for complementary and alternative medical professionals in Washington State.

BACKGROUND: This study describes the frequency, predictors, and expenditures for the use of complementary and alternative medicine (CAM) in an insured pediatric population. METHODS: Washington state requires CAM-licensed medical professional coverage in private health insurance. We performed a cross-sectional analysis of services provided to children in 2002 by conventional professionals, chiropractors, naturopathic physicians, acupuncturists, and massage therapists. Both chi(2) tests and logistic regression analysis were used to identify statistically significant differences in use and explanatory factors. RESULTS: Of 187 323 children covered by 2 large insurance companies, 156 689 (83.6%) had any claims during the year. For those with claims, 6.2% of children used an alternative professional during the year, accounting for 1.3% of total expenditures and 3.6% of expenditures for all outpatient professionals. We found that CAM use was significantly less likely for males (odds ratio, 0.91; 95% confidence interval, 0.87-0.95) and more likely for children with cancer, children with low back pain, and children with adult family members who use CAM. Visits to chiropractors or massage therapists nearly always yielded diagnoses of musculoskeletal conditions. In contrast, diagnoses from naturopathic physicians and acupuncturists more closely resembled those of conventional professionals. CONCLUSIONS: Insured pediatric patients used CAM professional services, but this use was a small part of total insurance expenditures. We found that CAM use was more common among some children, depending on their sex, age, medical conditions, and whether they had an adult family member who used CAM. Although use of chiropractic and massage was almost always for musculoskeletal complaints, acupuncture and naturopathic medicine filled a broader role.

Adolescent↗
PubMed1987

Resting energy expenditure of host and tumor is similar in rats with methylcholanthrene-induced sarcoma.

In the present study we assessed the resting energy expenditure of 30 free-feeding control and methylcholanthrene-induced sarcoma-bearing rats prior to and following surgical removal of the tumor. Tumor-bearing rats demonstrated carcass wasting and massive tumor growth. The resting energy expenditure data in our model suggest that neither the presence and growth of a tumor nor its removal significantly change resting energy expenditure beyond the normal range for non-tumor-bearing rats. We suggest that in the partition of energy costs between host and tumor, both carry a similar input, proportional to their relative weight, into the total combined resting energy expenditure of host and tumor.

Animals↗
PubMed2004

Effects of a low-glycemic load diet on resting energy expenditure and heart disease risk factors during weight loss.

CONTEXT: Weight loss elicits physiological adaptations relating to energy intake and expenditure that antagonize ongoing weight loss. OBJECTIVE: To test whether dietary composition affects the physiological adaptations to weight loss, as assessed by resting energy expenditure. DESIGN, STUDY, AND PARTICIPANTS: A randomized parallel-design study of 39 overweight or obese young adults aged 18 to 40 years who received an energy-restricted diet, either low-glycemic load or low-fat. Participants were studied in the General Clinical Research Centers of the Brigham and Women's Hospital and the Children's Hospital, Boston, Mass, before and after 10% weight loss. The study was conducted from January 4, 2001, to May 6, 2003. MAIN OUTCOME MEASURES: Resting energy expenditure measured in the fasting state by indirect calorimetry, body composition by dual-energy x-ray absorptiometry, cardiovascular disease risk factors, and self-reported hunger. RESULTS: Resting energy expenditure decreased less with the low-glycemic load diet than with the low-fat diet, expressed in absolute terms (mean [SE], 96 [24] vs 176 [27] kcal/d; P = .04) or as a proportion (5.9% [1.5%] vs 10.6% [1.7%]; P = .05). Participants receiving the low-glycemic load diet reported less hunger than those receiving the low-fat diet (P = .04). Insulin resistance (P = .01), serum triglycerides (P = .01), C-reactive protein (P = .03), and blood pressure (P = .07 for both systolic and diastolic) improved more with the low-glycemic load diet. Changes in body composition (fat and lean mass) in both groups were very similar (P = .85 and P = .45, respectively). CONCLUSIONS: Changes in dietary composition within prevailing norms can affect physiological adaptations that defend body weight. Reduction in glycemic load may aid in the prevention or treatment of obesity, cardiovascular disease, and diabetes mellitus.

Adult↗
PubMedDate not supplied

Measuring human energy expenditure: what have we learned from the flex-heart rate method?

The measurement of daily energy expenditure is an important aspect of research on human health and nutrition. Over the last 30 years, G.B. Spurr has been a leader in developing and implementing methods for more effectively assessing energy expenditure and physical activity in traditional and modernizing populations. One of his most notable contributions has been the development of the "Flex Heart Rate" (flex-HR) method. Since its inception in the late 1980s, the flex-HR method has become a standard tool for measuring daily energy expenditure in free-living human populations. This article reviews the initial development and validation of the flex-HR technique, and examines recent refinements of the method and its application to research in biomedicine and human population biology. The review and analyses highlight how the flex-HR technique has improved on earlier methods of assessing energy expenditure and greatly advanced our understanding of variability in human energy requirements.

Anthropometry↗
PubMed2006

Energy intake, energy expenditure, and reproductive costs of female wild golden lion tamarins (Leontopithecus rosalia).

Callitrichid females are often described as energetically constrained. We examined the energy budgets of 10 female wild golden lion tamarins (GLTs, Leontopithecus rosalia) in an effort to understand how energy intake and expenditure might influence physical condition and therefore reproductive performance. We used focal animal sampling to record behavioral data and conducted energy analyses of foods consumed by GLTs to estimate intake and expenditure. We used two-tailed Wilcoxon signed-rank tests to compare intake in the reproductive vs. nonreproductive period and expenditure in the reproductive vs. nonreproductive period. Energy intake decreased during the reproductive period compared to the nonreproductive period. While total expenditure did not vary significantly across the two periods, females spent more time and therefore expended significantly more energy engaged in energetically inexpensive behaviors (i.e., sleeping or being stationary) during the reproductive period compared to the nonreproductive period. We suggest that reproductive female GLTs may adopt a reproductive strategy that includes high intake prior to pregnancy and lactation, and energy conservation during pregnancy and lactation.

Animals↗
PubMed1984

The time and energy expenditure of indigenous women horticulturalists in the northwest Amazon.

The energy cost of subsistence activities and the daily time and energy budgets of Tatuyo women were assessed as part of a village energy flow study. The Tatuyo are swidden horticulturalists relying on bitter manioc (Manihot esculenta) as a staple crop. Except for the actual felling of new gardens, women are responsible for most of the horticultural work and food preparation. Time budgets were assessed using 24-hour activity diaries. Rates of energy expenditure in typical activities were measured by indirect calorimetry using a Max-Planck respirometer. Daily energy expenditure was calculated using these rates in conjunction with the activity diaries. Rates of energy expenditure in standard activities were moderate and broadly comparable to published values for other populations living in tropical environments. The mean daily energy expenditure was 2,133 kcal (8.9 MJ). This value is similar to that reported for other subsistence horticulturalists and close to the FAO recommendation for energy intake for moderately active individuals.

Adolescent↗