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PubMed1997

Effects of weight change on plasma leptin concentrations and energy expenditure.

Circulating concentrations of leptin are closely correlated with body fat mass, and may thus constitute an afferent limb of a system regulating body fatness, with efferent limbs that affect energy expenditure and food intake. We studied 50 subjects (27 males, 23 premenopausal females; 31 never-obese, 19 obese) at usual body weight during active weight loss or weight gain and during the maintenance of body weights 10% above usual (WT + 10%) and 10% and/or 20% below usual body weight (Wt -10% and Wt -20%) to test the hypotheses that the dynamic process of weight change and the maintenance of an altered body weight are associated with significant changes in circulating concentrations of leptin and/or the relationship between fat mass and leptin, and such changes in the plasma concentration of leptin are related to changes in energy expenditure at altered body weight. Subjects were admitted to the Rockefeller University Hospital, and energy metabolism (24-h energy expenditure, resting energy expenditure, thermic effect of feeding, and nonresting energy expenditure) and circulating concentrations of leptin and insulin were examined at various weight plateaus (usual body weight, 10% above usual body weight, 10% below usual body weight, and 20% below usual body weight). Plasma leptin was also measured in some subjects during dynamic periods of weight gain or loss. Though both plasma leptin concentrations and fat mass were significantly correlated with resting energy expenditure, only the correlation of fat mass and energy expenditure remained significant in a multiple stepwise linear regression analysis. Neither absolute nor relative changes in plasma leptin between weight plateaus were significantly correlated with any of the observed changes in energy expenditure. Plasma leptin concentrations were significantly lower during weight loss than during weight maintenance at the same body composition. Plasma leptin concentrations, normalized to fat mass, were significantly lower during the maintenance of a reduced body weight in females and higher during the maintenance of an elevated body weight in males than in the same subjects at usual body weight. At all weight plateaus, plasma leptin concentrations normalized to fat mass were significantly higher in females than in males, but gender was not a significant covariate of the relationship between leptin and energy expenditure. Postabsorptive serum concentrations of insulin was a significant covariate of plasma leptin concentration in males, but not females, at Wt initial and Wt + 10%. Although plasma leptin is significantly reduced during dynamic weight loss compared with static weight maintenance at the same body weight, the lack of correlation between changes in plasma leptin and changes in energy expenditure between weight plateaus suggests that leptin is not the primary signal that mediates the changes of energy expenditure that accompany the maintenance of an altered body weight in humans.

Body Composition↗

PubMed1997

Serum leptin and energy expenditure in children.

Leptin has been hypothesized to play an important role in energy balance by affecting both energy intake and energy expenditure. The purpose of our study was to determine the relationship between fasting serum leptin concentrations and measures of energy expenditure in prepubertal children. We measured total energy expenditure (TEE; by the doubly labeled water technique), resting energy expenditure (REE; after an overnight fast), activity energy expenditure (AEE; TEE-REE), body composition (by dual energy x-ray absorptiometry), and fasting serum leptin concentration (by RIA) in 76 children. Simple correlations showed that all measures of energy expenditure (TEE, REE, and AEE) were positively related to the serum leptin concentration (r = 0.50, P < 0.001; r = 0.45, P < 0.001; and r = 0.30, P < 0.01, respectively). However, after adjusting for body composition (fat-free mass and fat mass), gender, and ethnicity, serum leptin concentrations were not related to any measure of energy expenditure (TEE, P = 0.61; REE, P = 0.97; AEE, P = 0.65). These latter findings were further confirmed using structural equation models with leptin and energy expenditure as dependent variables, and fat-free mass and fat mass as independent variables. Results from these models showed no direct effect of leptin and no indirect effect of fat mass (through leptin) on any measure of energy expenditure, when a path between fat mass and energy expenditure was present in the model. Thus, our data do not support the hypothesis that the serum leptin concentration (independent of fat mass) is related to measures of energy expenditure in children.

Adipose Tissue↗

PubMed2004

Energy expenditure of walking and running: comparison with prediction equations.

PURPOSE: This study established the published prediction equations for the energy expenditure of walking and running compared with the measured values. To make this comparison we first determined whether differences exist in energy expenditure for 1600 m of walking versus running, and whether energy expenditure differences occur due to being on the track or treadmill. METHODS: Energy was measured via indirect calorimetry in 24 subjects while walking (1.41 m.s(-1)) and running (2.82 m.s(-1)) 1600 m on the treadmill. A subgroup also performed the 1600-m run/walk on the track. The measured energy expenditures were compared with published prediction equations. RESULTS: Running required more energy (P < 0.01) for 1600 m than walking (treadmill: running 481 +/- 20.0 kJ, walking 340 +/- 14 kJ; track: running 480 +/- 23 kJ, walking 334 +/- 14 kJ) on both the track and treadmill. Predictions using the ACSM or Leger equations for running, and the Pandolf equation for walking, were similar to the actual energy expenditures for running and walking (total error: ACSM: -20 and 14.4 kJ, respectively; Legers walking: -10.1 kJ; Pandolf walking: -10.0 kJ). An overestimation (P < 0.01) for 1600 m was found with the McArdle's table for walking and running energy expenditure and with van der Walt's prediction for walking energy expenditure, whereas the Epstein equation underestimated running energy expenditure (P < 0.01). CONCLUSION: Running has a greater energy cost than walking on both the track and treadmill. For running, the Leger equation and ACSM prediction model appear to be the most suitable for the prediction of running energy expenditure. The ACSM and Pandolf prediction equation also closely predict walking energy expenditure, whereas the McArdle's table or the equations by Epstein and van der Walt were not as strong predictors of energy expenditure.

Adolescent↗

PubMed2001

Financial Burden and Out-of-Pocket Expenditures for Mental Health Across Different Socioeconomic Groups: Results from HealthCare for Communities.

BACKGROUND: Mental health benefits have traditionally been much less generous than benefits for physical health care, with separate deductibles, higher copayments or coinsurance, and lower limits on covered services, a trend that continues despite a recent wave of 'parity' legislation. In spite of the current policy debates on mental health insurance reforms, little is known about the burden of mental health out-of-pocket expenditures. AIMS OF THE STUDY: This study examines differences in out-of-pocket expenditures and their burden across different populations, stratified by insurance status, age, ethnicity, and socioeconomic groups. METHODS: This study uses the 1998 HealthCare for Communities household survey, the latest national survey data that are currently available, to measure the burden of out-of-pocket mental health expenditures. We use several measures of burden such as total out-of-pocket expenditures, their share of total treatment costs, and their share of family income. To address the methodological issues that arise in the calculation of the relative measures of burden (e.g. outliers, measurement error, systematic underreporting) we consider three different approaches that have been suggested in the literature and discuss their relative advantages given the type of data typically available. RESULTS: Although there is a common perception that out-of-pocket expenditures for mental health services represent a significant burden for service users, the estimates suggest that this is not the case. In fact, across the three measures of out-of-pocket expenditures as a share of income the estimates are under 10 percent for most groups. However, there is some variation in burden across groups with people who are older, uninsured, or minority spending a larger share of their income out-of-pocket. Since many insurance plans have limits on the number of visits covered and on the total amount that the insurer will pay for mental health services, the share of total mental health expenditures that are paid by individuals is another important measure of the burden faced by people with mental health service needs. We estimate that the mean out-of-pocket share of total expenditures for the group as a whole is 25 percent. In addition, we find that the burden varies across groups with older, more educated, or privately insured individuals paying a larger share of expenditures out-of-pocket. DISCUSSION: Although the overall picture regarding the burden of out-of-pocket costs relative to income is encouraging, it is also important to keep in mind that individuals make treatment decisions based on their available income. The fact that the burden of actual out-of-pocket payments is relatively low may also reflect decisions to forego potentially valuable care. Nevertheless, the results for mental health do not suggest that out-of-pocket costs are currently a major burden for most users. This situation may reflect a major change from the past given the recent shifts towards managed care, however there are no comparable data available to test this hypothesis empirically. IMPLICATIONS FOR HEALTH POLICY FORMULATION AND FURTHER RESEARCH: It may be tempting to attribute the low estimates of out-of-pocket expenditures as a share of income in this paper to recent parity legislation. However, recent research shows that parity legislation has not led to significant changes in benefit design. In fact the high ratio of out-of-pocket payments relative to total mental health care expenditures presented in this paper are consistent with a limited role of parity legislation. Another possible explanation for the observed results is the growth of managed care and the shift in treatment style towards greater use of medications, which are comprehensively covered in most private insurance plans, has reduced total treatment costs and consequently the size of out-of-pocket payments.

Journal Article↗

PubMed1994

Extremes in body mass index: probability of healthcare expenditures.

BACKGROUND: This study was conducted as a first initiative to investigate the relationship between body mass index [BMI, weight(kg)/height(m)2] and healthcare expenditures by third party providers for lifestyle-related diseases and disorders. METHOD: Data were analyzed for 383 individuals who were continuously employed and covered by the same comprehensive health insurance plan during a 2-year baseline period followed by a 5-year observation period. A multiple logistic regression analysis that adjusted for covariates was used to ascertain whether BMI and baseline expenditure status separately or in combination influenced the probability of healthcare expenditures during the observation period. RESULTS: After controlling for age, gender, and smoking status, probability of healthcare expenditures for lifestyle-related medical problems was significantly (P < 0.04) greater during the observation period for adults with high as well as low BMIs plus baseline expenditures and lowest for subjects whose BMIs were in the midrange regardless of their baseline expenditures. Odds of expenditures increased significantly (P = 0.0079) with age of nonsmokers, but was approximately constant and high for smokers at all ages. The absence of any significant interaction of either smoking status or age with BMI indicated that the relationship between BMI and the log odds of expenditures was consistent across age and smoking categories. CONCLUSIONS: The analyses support the conclusion that the highest probability of expenditures occurs with the combination of baseline insurance expenditures and BMI extremes and the lowest probability occurs when BMIs are near 26 or 27 (approximately 19% above the ideal of 22). The findings also provide further justification for focusing on extremes in body weight as health priorities.

Adult↗

PubMed2004

[Do we spend too much on medications? Pharmaceutical expenditures, an absolutely essential item in European countries].

OBJECTIVE: To find out if the performance of the pharmaceutical expenditure between the most developed European countries come close more to a luxury good or a necessary good. To compare the pharmaceutical Spanish expenditure with the one of those countries. DESIGN: Cross-sectional study. SETTING: International. Europe. PARTICIPANTS: European countries members of the Organisation for Economic Co-operation and Development (OECD) and the European Union. METHODS: The data come from the OECD reports and other papers with the same source of information. The majority of the data refer to year 2000. The relationship between pharmaceutical expenditure and other variables as expenditure on health, on research and development (R&D), and socio-demographic variables are analysed with correlation and multiple linear regression. RESULTS: In both groups of countries, the Gross Domestic Product per capita (GDPPC) is positively and significantly correlated with the expenditure per capita on health (public and total) and on R&D, but not with pharmaceutical expenditure per capita (PhEPC). The pharmaceutical expenditure as part of total expenditure on health (PhE/TE) or as percentage of GDP (PhE/GDP), is negatively and significantly correlated with income (GDPPC). The regression model accepts as explicative variables of PhE/GDP: the income (negatively), the employment in health (negatively) and the PhEPC (positively). The PhEPC in Spain is situated in the average of the most developed European countries, and expressed as PhE/TE or as PhE/GDP is situated in the group of the countries with greater pharmaceutical expenditure, the majority of them with a lower GDPPC to the Spanish one. CONCLUSIONS: The performance of the pharmaceutical expenditure between the countries studied come close to a necessary good than to a luxury good. The PhEPC in Spain is situated in the average of these countries and, expressed as PhE/GDP or as PhE/TE, would be according to the Spanish income.

Drug Costs↗

PubMed1994

The effect of inflation on expenditures by mental health organization between 1969 and 1990.

At first glance, the rise in current dollar expenditures for all mental health organizations from $3.3 billion in 1969 to $28.4 billion in 1990 seems enormous. However, if the annual expenditures are adjusted for inflation and expressed in constant dollars, the rise in expenditures is only from $3.3 billion in 1969 to $5.6 billion in 1990. Thus, most of the increase in expenditures by mental health organizations over the past two decades is due to inflation, with less than 10 percent due to increases in real purchasing power. Since both the number of private psychiatric hospitals and the expenditures they incurred increased dramatically between 1969 and 1990, these hospitals showed gains in absolute dollar amounts and in dollar amounts per capita, even if the expenditures are expressed in constant dollars. To a lesser extent, the same was true of RTCs. Although both VA medical centers and State mental hospitals showed increases in expenditures as measured in current dollars, if expenditures are expressed in constant dollars, these organizations showed net decreases. Their inpatient populations also decreased during this period. However, if expenditures per inpatient under care are examined, the reverse is true. The per patient expenditures for State mental hospitals increased between 1969 and 1990, even if the results are stated in constant dollars.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

Expenditures and sources of funds for mental health organizations: United States and each state, 1988.

Expenditures. Expenditures by the 8 types of mental health organizations covered in this report totaled $23.1 billion in 1988 in the United States and territories. Three States (California, New York, and Pennsylvania) accounted for 30 percent of this total. Nationally, State and county mental hospitals (hereafter called State mental hospitals) accounted for the largest proportion of all expenditures (30 percent, down from 34 percent in 1986). Private psychiatric hospitals and multiservice mental health organizations had the next largest expenditures, each accounting for 20 percent of the total, followed by the separate psychiatric services of non-Federal general hospitals at 16 percent. Department of Veterans Affairs (VA) mental health services, residential treatment centers (RTCs) for emotionally disturbed children, freestanding psychiatric outpatient clinics, and freestanding psychiatric partial care organizations accounted for 6 percent, 6 percent, 3 percent, and less than one-half percent of total expenditures, respectively. State mental hospitals represented the largest expenditures of any single type of mental health organization in 23 States; expenditures of private psychiatric hospitals were largest in 12 States; and expenditures of multiservice mental health organizations were the largest in 10 States. The $23.1 billion total for 1988 represented a 25 percent increase over the 1986 figure but, when adjusted for inflation, the estimated increase (expressed in constant dollars) was only 10 percent overall and 8 percent on a per capita basis. Constant dollar expenditures of most types of mental health organizations increased between 1986 and 1988, with the largest increase occurring among private psychiatric hospitals (54 percent). In contrast, constant dollar expenditures decreased for State mental hospitals and VA mental health services. Sources of Funds In 1988, the funds received by mental health organizations totaled $23.4 billion. Of this total, $8.8 billion (38 percent) was provided directly by State governments, predominantly by State mental health agencies. Direct Federal funds, plus Medicare and Medicaid (including the State and local share of Medicaid), provided $6.5 billion (28 percent) of total funding. Fees from clients (including private insurance) provided $5.2 billion (22 percent); direct local government funds provided 7 percent; and all other sources, 5 percent. State governments provided 77 percent of the funds received by State mental hospitals and were also the largest single source of funds for multiservice mental health organizations (51 percent) and freestanding psychiatric partial care organizations (44 percent). VA mental health services were funded by the Federal government, while 62 percent of funding for private psychiatric hospitals came from client fees (including private insurance).(ABSTRACT TRUNCATED AT 400 WORDS)

Community Mental Health Services↗

PubMed2005

Impact of morbid obesity on medical expenditures in adults.

CONTEXT: Morbid obesity (body mass index (BMI) > or =40 kg/m2) is associated with substantially increased morbidity and mortality from chronic health conditions and with poorer health-related quality of life; however, less is known about the impact of morbid obesity on healthcare expenditures. OBJECTIVE: To examine the impact of morbid obesity on healthcare expenditures using a nationally representative sample of US adults. DESIGN, SETTING, AND PARTICIPANTS: We performed a cross-sectional analysis of 16 262 adults from the 2000 Medical Expenditure Panel Survey, a nationally representative survey of the noninstitutionalized civilian population of the United States. Per capita healthcare expenditures were calculated for National Institutes of Health BMI categories, based on self-reported height and weight, using a two-part, multivariable model adjusted for age, gender, race, income, education level, type of health insurance, marital status, and smoking status. MAIN OUTCOME MEASURES: Odds of incurring any healthcare expenditure and per capita healthcare expenditures associated with morbid obesity in 2000. RESULTS: When compared with normal-weight adults, the odds of incurring any healthcare expenditure in 2000 were two-fold greater among adults with morbid obesity. Per capita healthcare expenditures for morbidly obese adults were 81% (95% confidence interval (CI): 48-121%) greater than normal-weight adults, 65% (95% CI: 37-110%) greater than overweight adults, and 47% (95% CI: 11-96%) greater than adults with class I obesity. Excess costs among morbidly obese adults resulted from greater expenditures for office-based visits, outpatient hospital care, in-patient care, and prescription drugs. Aggregate US healthcare expenditures associated with excess body weight among morbidly obese US adults exceeded $11 billion in 2000. CONCLUSIONS: The economic burden of morbid obesity among US adults is substantial. Further research is needed to identify interventions to reduce the incidence and prevalence of morbid obesity and improve the health and economic outcomes of morbidly obese adults.

Adult↗

PubMed2003

Comorbidity and the concentration of healthcare expenditures in older patients with heart failure.

OBJECTIVES: To examine comorbidity and concentration of healthcare expenditures in older patients with heart failure (HF) in the Medicare program. DESIGN: Retrospective analysis of older fee-for-service HF patients, using the 1996 Medicare Current Beneficiary Survey and linked Medicare claims. SETTING: Variety of clinical settings. PARTICIPANTS: One thousand two hundred sixty-six older HF patients from a nationally representative survey. MEASUREMENTS: Medicare expenditure per person and by types of healthcare services, prevalence of comorbid conditions, and multivariate regression on the association between comorbidities and healthcare expenditure. RESULTS: Medicare spent an average of 16,514 dollars on medical reimbursement for each HF patient in 1996. Eighty-one percent of patients had one or more comorbid diseases according to a 17-disease grouping index. The top 20% of HF patients accounted for 63% of total expenditure. Comorbidity was associated with significantly higher Medicare expenditure. HF patients with more-expensive comorbidities included those with peripheral vascular disease (24% of patients, mean total expenditure 26,954 dollars), myocardial infarction (16% of patients, mean total expenditure 29,867 dollars), renal disease (8% of patients, mean total expenditure 33,014 dollars), and hemiplegia or paraplegia (5% of patients, mean total expenditure 33,234 dollars). Diseases and disorders other than heart failure constituted a significant fraction of the causes of inpatient admissions. Comorbid conditions were more likely to be associated with expensive inpatient care, and patients with these diseases were more likely to spend more overall and more on other types of Medicare services including home health aid, skilled nursing facility, and hospice care. CONCLUSION: Disease management should consider comorbid conditions for improving care and reducing expenditures in older patients with HF.

Activities of Daily Living↗

PubMed2004

Differences in Medicare expenditures during the last 3 years of life.

OBJECTIVE: To examine age, gender, race, and area income differences in Medicare expenditures in the 3 years before death. DESIGN: Cross-sectional study. PARTICIPANTS: A random sample of aged Medicare beneficiaries who died 1996 to 1999, N = 241,047. MEASURES: We estimate differences in mean Medicare expenditures by year before death and by age, gender, race, and area income, adjusting for comorbidities and Medicaid enrollment. RESULTS: Expenditures for blacks are lower in the second and third years before death and are not significantly different from whites in the last year of life (LYOL) (y3 = 70%, P <.0001; y2 = 82%, P <.0001; LYOL = 119%, P =.098). Differences in expenditures between decedents with area incomes over $35,000 compared to under $20,000 attenuate by the LYOL (y3 = 116%, P <.0001; y2 = 107%, P <.0001; LYOL = 96%, P <.0001). Expenditure patterns for women versus men vary by age. Among the younger cohorts (68 to 74 and 75 to 79), expenditures are higher for women in all 3 years before death. This difference attenuates among older cohorts; in the oldest cohort (90+), expenditures for men exceed those for women by 11% in the LYOL (P <.0001). Older beneficiaries have higher expenditures in the second and third years before death but lower expenditures in the LYOL. On average, the youngest cohort expended $8,017 more in the LYOL relative to the oldest cohort, whereas in the third year before death, the oldest cohort's expenditures were $5,270 more than those for the youngest cohort (P <.0001). CONCLUSIONS: Age-associated differences in aggregate Medicare payments for end-of-life care are more substantial than other differences. The fact that other differences attenuate in the LYOL may reflect having overcome barriers to health care, or reflect an effective ceiling on the opportunities to provide services for persons with overwhelming illness.

Black or African American↗

PubMed1997

Mental health expenditures for services for people with severe mental illnesses.

OBJECTIVE: To provide comprehensive information on expenditures for mental health and substance abuse services for a large number of people with severe mental illnesses, this study examined use of major types of clinical-medical mental health and psychiatric rehabilitation services over a one-year period. METHODS: Data were obtained for 1,890 clients in ten public county-based nonmetropolitan mental health systems in Wisconsin. Expenditures were for services provided with public funding, including local sources of funding, Medicaid, and Medicare. Data about services and expenditures were obtained from county records and unduplicated Medicaid claims for 12 months in 1989 and 1990. RESULTS: Expenditures per client averaged $10,995 for one year ($13,992 in 1994 dollars), with a maximum of $95,093. Expenditures for community-based outpatient services, including residential care and vocational services, represented 53.5 percent of all expenditures; residential care accounted for 12.4 percent and vocational services for 5.7 percent. Overall, 46.5 percent was spent for institutional care, with inpatient hospital care accounting for 12.6 percent. Approximately 40.6 percent of total expenditures were for services not typically covered under managed care plans. CONCLUSIONS: Expenditures for community-based care accounted for more than half of total expenditures. Expenditure patterns revealed the important role of social and rehabilitation services, a role that must be continued in managed care arrangements if they are to provide adequate services for people with severe mental illnesses.

Adult↗

PubMed2002

[The relationship between undergoing a basic health checkup based on the Health and Medical Services Law for the Aged and medical expenditure covered under the National Health Insurance in Japan].

OBJECTIVES: This study examined the relationship between undergoing the basic health checkup based on the Health and Medical Services Law for the Aged among urban residents and medical expenditure covered under the National Health Insurance in Japan. METHODS: The subjects were all residents of a city with a population of three hundred and fifty thousand, covered by National Health Insurance and over forty years of age. Medical expenditure was compared by age and sex between examinees who had undergone the basic health checkup for the past three years running and non-examinees who had had no checkup. In addition, from the results of a questionnaire survey of randomly sampled citizens, we compared the living habits of the above two groups, the examinees and non-examinees. RESULTS: For outpatients, the medical expenditure per case, the medical expenditure per capita for seniors, and the medical expenditure per day were lower, and the number of examination days per case and the examination rate (the number of receipts per capita) were higher in the examinee group than in the non-examinee group. For inpatients, the medical expenditure per case, the medical expenditure per capita, the medical expenditure per day for seniors, the number of examination days per case, and the examination rate were lower in the examinee group compared to the non-examinee group. The increase in medical expenditure with age was less in the examinee group than in the non-examinee group. In men, the examinees had significantly better living habits (especially exercise and meals) than the non-examinees. No differences in living habits were found in women. CONCLUSIONS: Medical expenditure was lower among examinees than non-examinees. In men, regular examinees had better living habits than non-examinees.

Adult↗

PubMed1998

High-expenditure children with Supplemental Security Income.

OBJECTIVE: To examine the clinical characteristics and health service use of children with high Medicaid expenditures. METHODOLOGY: We examined 1992 Medicaid claims and eligibility files from four states (California, Georgia, Michigan, Tennessee) for children with at least $10000 billed to Medicaid who obtained Medicaid through the Supplemental Security Income (SSI) Program and a comparison group (matched by age group and gender) of children receiving Medicaid for other reasons. We compared mean expenditures, examined expenses by category, and examined diagnoses associated with at least $10000 in expenses. RESULTS: In 1992, Medicaid paid on average approximately $1000 for children with non-SSI Medicaid enrollment. Expenditures for children with SSI were 2.9 to 9.4 times higher, but once the approximately 10% of children with high expenditures were excluded, SSI average expenditures were only 1.5 to 2.7 times higher than the non-SSI average. Children with high expenditures are likely to use hospitals and long-term care, and these services account for more than half of the average expenditures. Children with high expenditures and SSI are more likely to have chronic medical conditions than are their peers enrolled in Medicaid but not through SSI. CONCLUSIONS: A small proportion of children, even on SSI, account for very large proportions of Medicaid expenditures. Most children with SSI, despite having relatively severe mental health, physical, or developmental disabilities, have relatively modest Medicaid expenditures.

Child↗

PubMed1992

[Factors affecting the increase in hospitalized medical care expenditure in Japan: analysis of national data in all 47 prefectures].

To clarify factors affecting the increase in annual expenditure for hospitalized medical care in Japan, the effects of the following four variables in all 47 prefectures were analyzed: (1) the hospitalized medical care expenditure per day per inpatient, (2) the number of admissions per population base, (3) average length of stay of patients in hospital per year and (4) the number of hospital beds per population base. The annual expenditure for hospitalized medical care per population base was correlated most significantly with the number of hospital beds per population base. The annual expenditure was also significantly correlated positively with the number of admissions per population base and average length of stay of patients in hospital per year, and inversely with the hospitalized medical care expenditure per day per inpatient. Hospitalized medical care expenditure per day per inpatient was inversely correlated with average length of stay of patients in hospital and the number of hospital bed per population base. Results from stepwise multiple regression analysis indicated that the number of hospital bed per population base and the hospitalized medical care expenditure per day per inpatient are the only two variables which have significant effects on the annual expenditure for hospitalized medical care per population base. The annual rate of increase for annual expenditure for hospitalized medical care per population base from 1980 to 1986 was 6.1%. Similarly, the rate of increase in the hospitalized medical care expenditure per day per inpatient was 3.5%; that of the number of admissions per population base was 3.1%.(ABSTRACT TRUNCATED AT 250 WORDS)

Health Care Costs↗

PubMed2005

[Fair health financing and catastrophic health expenditures: potential impact of the coverage extension of the popular health insurance in Mexico].

OBJECTIVE: To assess the impact on fair health financing and household catastrophic health expenditures of the implementation of the Popular Health Insurance (Seguro Popular de Salud). MATERIAL AND METHODS: Data analyzed in this study come from the National Income and Expenditure Household Survey (Encuesta Nacional de Ingresos y Gastos de los Hogares, ENIGH), 2000, and the National Health Insurance and Expenditure Survey, (Encuesta Nacional de Aseguramiento y Gasto en Salud, ENAGS), 2001. Estimations are based on projections of extension of the Popular Health Insurance under different conditions of coverage and out-of-pocket expenditure reductions in the uninsured population. The mathematic simulation model assumes applying the new Popular Health Insurance financial structure to the 2000 expenditure values reported by ENIGH, given the probability of affiliation by households. RESULTS: The model of determinants of affiliation to the Popular Health Insurance yielded three significant variables: being in income quintiles I and II, being a female head of household, and that a household member had a medical visit in the past year. Simulation results show that important impacts on the performance of the Mexican Health System will occur in terms of fair financing and catastrophic expenditures, even before achieving the universal coverage goal in 2010. A reduction of 40% in out-of-pocket expenditures and a Popular Health Insurance coverage of 100% will decrease catastrophic health expenditures from 3.4% to 1.6%. CONCLUSIONS: Our results show that the reduction of out-of-pocket expenditures generated by the new financing and health provision Popular Health Insurance model, will improve the financial fairness index and the financial contribution to the health system, and will decrease the percentage of households with catastrophic expenditures, even before reaching universal coverage. A greater impact may be expected due to coverage extension initiating in the poorest communities that have a very restricted and progressive financial contribution.

Adolescent↗

PubMedDate not supplied

[The federal health expenditure on the uninsured population: Mexico 1980-1995].

In the last fifteen years Mexico suffered several economic crisis which have negatively affected public expenditure in social welfare and, as a consequence, public expenditure in health. This paper discusses the relationship between the adjustment policies adopted to confront these crisis and public expenditure in health care for the non-insured population, as well as the regional distribution of this expenditure. In part one, the evolution of general public expenditure, public expenditure in social welfare, and public expenditure in health between 1980 and 1995 is described. In part two, the distribution of public health expenditure for the non-insured population among the five regions in which the country was divided by the National Health Survey II is discussed. The main conclusion of this paper is that, between 1980 and 1995, the public expenditure gaps that have existed for a long time in Mexico among regions remained unchanged. These gaps basically affect the southern states of the country, are not related to health needs, and may deepen in view of the new relative cuts in public expenditure in social welfare announced by the new administration.

Financing, Government↗

PubMed2001

Using forecasting models to estimate the effects of changes in the composition of claims for selective serotonin reuptake inhibitors on expenditures.

BACKGROUND: The use of selective serotonin reuptake inhibitors (SSRIs) as antidepressant therapy has increased considerably since the introduction of fluoxetine in 1989. By 1999, 3 of the 4 available SSRIs were among the top 10 most frequently used drugs in the United States. In addition, SSRIs were one of the major contributors to the growth in psychotropic medication expenditures during the past 5 years. OBJECTIVE: The purpose of this article was to examine the utilization patterns of the 4 most commonly used SSRIs and their contribution to rising antidepressant medication expenditures among claimants in a publicly funded drug program. Using the results of forecasting models, we explored possible ways to control these growing expenditures. METHODS: Cross-sectional antidepressant claims and expenditure data from the Ontario Drug Benefits program for 1992 to 1998 were examined. Five scenarios were modeled in which future SSRI expenditures and claims were predicted using exponential smoothing models. RESULTS: If the historical patterns of use continued, a 20% increase in the 1998 level of expenditures was expected to occur by the year 2000. Predicted expenditures are sensitive to the composition of the SSRI claims. Exclusive use of 1 of the 4 major SSRIs (fluvoxamine, fluoxetine, paroxetine, and sertraline) could decrease projected expenditures by 30% or increase them by 11%. An "equal shares" approach, in which each of the 4 SSRIs are used in equal proportions in the population, may reduce expenditures by approximately 8%. CONCLUSIONS: The current trends in the utilization data suggest that sertraline and paroxetine are being used as first-line treatments. The results of the forecasting models suggest that growing expenditures could be curbed if these 2 antidepressants were not used in that manner. Short of limiting the drugs available on benefit formularies, there may be a way to control costs through the use of a prescribing algorithm. Although our results support the use of fluoxetine for first-line SSRI treatment as a cost-control measure, we do not definitively recommend its adoption. These findings contribute to the discussion about using fixed versus flexible formularies as a potential cost-control mechanism.

Adult↗