Making provision for ageing populations.
Explore the source record for details and available documents.
Adult↗
SEARCH · Search PubMed
Results for “Health Expenditures”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Managed care arrangements of health networks and systems. A review of the 1999 experience.
The 1990s witnessed various health provider efforts to integrate health care delivery with financing functions. Physician and hospital-led organizations developed their own insurance products and also contracted on a capitated or shared-risk basis with health maintenance organizations (HMOs). Several studies exist on the efforts of physician-led health organizations in these areas, but few studies exist on hospital-led organizations. We examined unique data on hospital-led health networks and systems for 1999 and found that about 60% had provider-owned insurance products and 50% held capitated contracts for their affiliates. In addition, these hospital-led organizations--especially health systems--had comparable levels of capitated contracting when compared to physician-led organizations. Although interest in capitation has waned, current economic realities may reignite interest in these arrangements given their potential for containing health expenditures without increasing consumer risk. In light of this, it is now a good time for physicians and medical group managers to reflect on their experiences in the 1990s and to assess the merits and shortcomings of different intermediary organizations with which they may align.
American Hospital Association↗
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↗
Benefits, risks and costs of immunization programmes.
Prevention of disease by vaccination has been one of the major triumphs of medicine. Studies have been done on many vaccines to determine their benefits, risks, and costs. These studies have demonstrated that the benefits outweigh the risks and costs for many vaccines including polio, pertussis, measles, mumps and rubella. Thus, the use of these vaccines provides a net saving to society. Other vaccines such as those influenza and pneumococcal disease are cost-effective relative to other health expenditures. The value of benefit-risk, benefit-cost, and cost-effectiveness analyses lies not in providing the definitive basis for a decision on vaccine use or evaluation. Rather, these analytic techniques provide a structured framework which permits decision-makers to consider all relevant components of the decision in perspective to their relative contributions and subsequent effects. It forces key assumptions to be made explicit and identifies areas in which data are inadequate. The results of such analyses can assist in justifying a vaccination programme (poliomyelitis), in disseminating a programme more widely (measles), in changing health policy (smallpox), and in planning for how a vaccine might be used (hepatitis B). Cost analyses of vaccination may suggest the value of a vaccination programme, but the programme may not be widely adopted (influenza and pneumococcal vaccines). The reasons for this gap between study conclusions and application may be: disagreement with the estimates and assumptions used in the analysis; skepticism over the methodology itself; or subjective views of the vaccine or disease which remains resistant to analytical exercises.
Cost-Benefit Analysis↗
Healthy life expectancy in 191 countries, 1999.
We describe here the methods used to produce the first estimates of healthy life expectancy (DALE) for 191 countries in 1999. These were based on estimates of the incidence, prevalence, and disability distributions for 109 disease and injury causes by age group, sex, and region of the world, and an analysis of 60 representative health surveys across the world. We used Sullivan's method to compute healthy life expectancy for men and women in each WHO member country. Japan had the highest average healthy life expectancy of 74.5 years at birth in 1999. The bottom ten countries are all in sub-Saharan Africa, where the HIV-AIDS epidemic is most prevalent, resulting in DALE at birth of less than 35 years. Years of healthy life lost due to disability represent 18% of total life expectancy in the bottom countries, and decreases to around 8% in the countries with the highest healthy life expectancies. Globally, the male-female gap is lower for DALE than for total life expectancy. Healthy life expectancy increases across countries at a faster rate than total life expectancy, suggesting that reductions in mortality are accompanied by reductions in disability. Although women live longer, they spend a greater amount of time with disability. As average levels of health expenditure per capita increase, healthy life expectancy increases at a greater rate than total life expectancy.
Adolescent↗
Must diabetes be a fatal disease in Africa? Study of costs of treatment.
OBJECTIVE: To estimate the costs of diagnosis and treatment of diabetes in Tanzania. DESIGN: Costs estimated from the reported and recorded experience of patients with newly presenting diabetes in 1989-90 and of diabetic patients first seen in 1981-2. SETTING: Muhimbili Medical Centre, Dar es Salaam. SUBJECTS: 464 patients (315 men and 149 women). 262 patients diagnosed during 1 September 1989-31 August 1990 (group 1) and 202 during 1 June 1981-31 August 1982 (group 2). RESULTS: The average annual direct cost of diabetes care in 1989-90 was $287 for a patient requiring insulin and $103 for a patient not requiring insulin. Purchase of insulin accounted for 68.2% ($156) of the average annual outpatient costs for patients requiring insulin. For patients not requiring insulin the cost of oral hypoglycaemic drugs and treatment of chronic complications and infections accounted for 42.5% ($29.3) and 48.8% ($33.7) of costs respectively. Cost of outpatient care of diabetic patients for the whole of Tanzania was estimated at $2.7m, *75,128 (32.2%) of which was for insulin. Doctors' and nurses' costs accounted for 0.2% of total costs of outpatient care. The annual direct inpatient care costs were estimated at $1.25m. Around 0.2% of the Tanzanian population aged 15 years and over used the equivalent of 8% of the total government health expenditure, which was $47,4088,382. CONCLUSION: Diabetes places a severe strain on the limited resources of developing countries. If African patients with diabetes have to pay for their treatment most will be unable to do so and will die.
Adolescent↗
Approaches to pharmacy benefit management and the impact of consumer cost sharing.
BACKGROUND: Numerous mechanisms have been introduced to deliver prescription drug benefits while controlling pharmaceutical costs. An understanding of the most prominent mechanisms of benefit management is an important step in determining the most effective approach to take in future years. OBJECTIVES: The aims of this review were to illustrate the mechanisms by which managed care has attempted to efficiently and equitably deliver pharmacy benefits and to discuss the impact of such programs, including consumer cost sharing. METHODS: A review of the literature was conducted using the PreMedline and MEDLINE databases from the years 1966 to 2002, reference lists from relevant articles, and online sources, including news releases, conference materials, and pharmacy benefit management reports. RESULTS: Numerous pharmacy benefit management tools and their impact on utilization, expenditures, and health outcomes are reviewed, including disease state management; utilization management (ie, quantity limitations and prior authorization); drug utilization review; formulary management (ie, open and closed); delivery systems (ie, retail and mail order); and mechanisms for implementing consumer cost sharing (ie, generic incentives, multitiered copayments, and co-insurance). Although there is some evidence to suggest that certain benefit management tools have been successful in reducing health plan expenditures, a more thorough investigation of their potential unintended consequences is needed. CONCLUSIONS: Implementing adequate levels of consumer cost sharing is necessary if employers and health plans are to continue offering prescription drug benefits. It is important to remember, however, that quality health care cannot be forfeited for the sake of short-term cost savings.
Community Participation↗
The cost effectiveness of pharmacological smoking cessation therapies in developing countries: a case study in the Seychelles.
OBJECTIVE: To examine the incremental cost effectiveness of the five first line pharmacological smoking cessation therapies in the Seychelles and other developing countries. DESIGN: A Markov chain cohort simulation. SUBJECTS: Two simulated cohorts of smokers: (1) a reference cohort given physician counselling only; (2) a treatment cohort given counselling plus cessation therapy. INTERVENTION: Addition of each of the five pharmacological cessation therapies to physician provided smoking cessation counselling. MAIN OUTCOME MEASURES: Cost per life-year saved (LYS) associated with the five pharmacotherapies. Effectiveness expressed as odds ratios for quitting associated with pharmacotherapies. Costs based on the additional physician time required and retail prices of the medications. RESULTS: Based on prices for currently available generic medications on the global market, the incremental cost per LYS for a 45 year old in the Seychelles was 599 US dollars for gum and 227 dollars for bupropion. Assuming US treatment prices as a conservative estimate, the incremental cost per LYS was significantly higher, though still favourable in comparison to other common medical interventions: 3712 dollars for nicotine gum, 1982 dollars for nicotine patch, 4597 dollars for nicotine spray, 4291 dollars for nicotine inhaler, and 1324 dollars for bupropion. Cost per LYS increased significantly upon application of higher discount rates, which may be used to reflect relatively high opportunity costs for health expenditures in developing countries with highly constrained resources and high overall mortality. CONCLUSION: Pharmacological cessation therapy can be highly cost effective as compared to other common medical interventions in low mortality, middle income countries, particularly if medications can be procured at low prices.
Adult↗
The National Population Program: how cost-effective is it?
Explore the source record for details and available documents.
Achievement↗
Interaction among fertility, income investment in human capital, female labor force participation, and industrialization in Korea.
Explore the source record for details and available documents.
Asia↗
The Danish health care system: evolution--not revolution--in a decentralized system.
The Danish health care system has undergone gradual changes, but not radical reforms, from 1970 until 2004. Theoretically, the development can be viewed from the perspective of fiscal federalism, decentralization, and incentives embodied in reimbursement systems. Furthermore, path dependence and incrementalism have characterized the system. The Danish health care system is decentralized politically, financially, and operationally. The counties are responsible for health care, and finance it out of county income and property taxes along with block grants from the state. Hospitals are publicly owned while general practitioners are private entrepreneurs working on contract with the counties. Hospital services and GP and specialist services are free, while there are co-payments for drugs, adult dental care, physiotherapy and the like. Co-payments make up close to 19% of total health expenditures. The system has been characterized by expenditure control, reasonable positive development in productivity, and a high degree of patient and citizen satisfaction despite waiting lists. Free choice of hospital was introduced more than 10 years ago. It has recently been expanded so that after waiting 2 months for treatments like elective surgery at public hospitals, citizens can choose either private hospitals or go abroad with full payment from public funds. The thinking behind decentralization gradually has been eroded for a number of reasons. This has led to a reform that will be effective as of January 2007. The number of counties will be reduced, but the new regions retain responsibility for health care. A national earmarked health tax will be introduced so that the regions will receive revenues from state block grants and municipal co-payment, for instance an amount per hospitalization.
Denmark↗
Cost implications of different surgical management strategies for primary hyperparathyroidism.
BACKGROUND: Controversy exists about optimal management of patients with primary hyperparathyroidism. To date, no studies have explored the cost implications of variation in practice. METHODS: Results from a national survey of endocrine surgeons were combined with results from a survey of endocrinologists and financial data from Medicare. Patterns of use of resources were identified, annual costs for the surgical management of primary hyperparathyroidism in the United States were calculated, and the financial impact of variation in practice was estimated. RESULTS: Survey respondents (n = 109) were experienced endocrine surgeons, performing an average of 33 parathyroidectomies annually. Seventy-five percent of patients undergo localization before initial exploration for primary hyperparathyroidism. In order of preference, these studies were sestamibi (43%), ultrasonography (28%), and sestamibi with single-photon emission computed tomography (26%). Although there is variation in preoperative and postoperative practice, in-hospital costs have the greatest influence on total cost. An estimated $282 million is spent annually in the United States on operations for primary hyperparathyroidism. National health expenditures could range by more than $70 million, depending on whether management strategies involving low or high use of resources are employed. CONCLUSIONS: Substantial variation among endocrine surgeons in the management of primary hyperparathyroidism has important cost implications. Implementation of evidence-based guidelines to optimize clinical and economic performance should be considered.
Female↗
Cost of an outbreak of hepatitis A in Puglia, Italy.
In total, 5889 cases of hepatitis A virus infection were reported during an outbreak in Puglia, a region of Southern Italy, in 1996. The primary cause of the outbreak was consumption of contaminated food (raw shellfish, vegetables, etc.), with a contributory risk factor of person-to-person transmission. A detailed questionnaire was completed by 250 randomly selected patients to obtain information sufficient to calculate the direct and indirect costs of the outbreak for the individual patient, the National Health Service (NHS) and society as a whole. A conversion rate of $US1 = 1530 Italian lire (L) has been used throughout the study since this was the average exchange rate in 1996. For the individual patient with hepatitis A virus infection, the mean cost was L1.013 million ($US662), which was equivalent to 6.6% of the mean annual income of the employed patients. The total cost of the outbreak to the NHS was L23.98 billion ($US15.67 million), which was equivalent to 0.4% of the total public health expenditure in the region in 1996. The total cost of the outbreak to society (individual patient, NHS and third parties combined) was L37.406 billion ($US24.45 million), corresponding to 0.04% of the gross domestic product of the entire region in 1996, with a mean cost per patient of L6.35 million ($US4150) from a societal perspective. The majority of patients (86.3%) were 11 to 30 years of age, reflecting the increasing susceptibility of younger patients to hepatitis A virus infection in recent decades. These economic and demographic data provide important information for the evaluation of preventive strategies including public education, sanitation and immunisation, so as to optimise the use of local health resources.
Antiviral Agents↗
Policy implications of the diffusion and control of medical technology.
Medical technology has become a controversial national policy issue, largely because of rapidly rising national health expenditures and their relation to medical technology. These costs are increasingly viewed in relation to benefits or effectiveness. Attempts to control medical technology, to consider benefits in relation to costs, have largely been regulatory, and have failed to ameliorate cost rises. This failure has stimulated consideration of the reimbursement system as a controlling device. The Medicare program already has developed a rather formal process for making reimbursement decisions based on technology assessments. However, fundamental reform of the reimbursement system seems necessary to counter perverse incentives built into payment. Recent proposals to shift to prospective payment is an example of such a change. However, the basically private nature of the health care system and the limited leverage of the Medicare program limits the power of the federal government to make change.
Communication↗
Does testing for prostate-specific antigen contribute to declining prostate cancer mortality? Estimating the broader economic influences on aggregate prostate cancer mortality rates.
Key variables associated with prostate cancer mortality were examined using Canadian province level time-series data over the period 1979-1999 in a multiple regression framework. The key variables driving the prostate cancer mortality rate are per capita income, per capita number of family physicians, rate of prostate cancer incidence, real per capita total health spending, and a time trend. As well, provincial dummy variables show that regional differences exist with higher rates of mortality in eastern Canada. Econometric results show a positive and significant relationship between incidence and mortality, suggesting that the increased amount of prostate-specific antigen (PSA) testing may not have been responsible for mortality declines. However, there is also a downward trend in mortality from prostate cancer when all other factors are controlled for that can be attributed partly to the onset of PSA testing given that the benefits should emerge over time. A 1% increase in incidence is associated with a 0.2% increase in mortality. A 1% increase in real per capita income is associated with a 0.5% increase in mortality when real per capita income is below Canadian dollars 20,054. A 1% increase in the per capita number of family physicians reduces the mortality rate by 0.5%. A 1% increase in real per capita total health expenditures is associated with a 0.7% decline in the mortality rate. Finally, by 1999 there were 4.74 fewer deaths per 100,000 population due to the effect of time after controlling for all other factors--a decrease of approx. 15%.
Aged↗
Multi-sectoral approach to DOTS--the only hope.
This article reviews both the global and Kenyan tuberculosis (TB) situations and gives a manager's perspective of the management of a national TB control program with limited resources. It demonstrates how complex it can be to manage a control program with a 500% increase in case load and a 60% decline in real per capita health expenditure during the last 20 y. The picture is complicated even further by a high prevalence of TB among the country's nomadic population inhabiting the arid and semi-arid parts of the country. Acceptable treatment results are achieved through a combination of appropriate strategies. However, the future picture is grim unless more personnel are used to implement the DOTS strategy.
AIDS-Related Opportunistic Infections↗
Why managed care has failed to contain health costs.
Much evidence points to the fact that managed care plans (health maintenance organizations and preferred provider insurance) reduce costs and offer value for money. Yet they apparently have not helped to slow national health expenditures. One explanation is that the practices of purchasers (including government and employers), the tax laws, and other market imperfections have reduced the demand for real cost containment, depriving managed care plans of an adequate incentive to cut cost and price. These market conditions can and should be corrected; the managed competition proposal being discussed at the national level is a comprehensive plan for doing so.
Competitive Medical Plans↗
Statutory coherence and policy implementation: the case of family planning.
Explore the source record for details and available documents.
Americas↗