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PubMed1996

[Relationship between medical expenditures and government-sponsored medical check-ups for the aged].

Japanese law provides for regular medical examinations for the aged. A simulation study to determine the relationship between medical expenditures of cardiovascular disease patients and government-sponsored health check-ups for the aged was conducted in a small community town in Kanagawa Prefecture. The results showed that medical expenditures decreased in accordance with an increase in health screening. However, medical expenditure for out-patients increased slightly with an increase in screening for those cardiovascular disease patients who had not received treatment prior to the government health checkup.

Adult↗
PubMed1997

Estimated expenditures for essential public health services--selected states, fiscal year 1995.

Essential public health services are activities that public health departments and other partners undertake to protect and ensure the health of the public. To characterize expenditures for those services and to distinguish within them expenditures for personal health-care services from community-based health services directed toward populations, the Public Health Service (PHS) and the Public Health Foundation surveyed senior health officials in eight states (Arizona, Iowa, Louisiana, New York, Oregon, Rhode Island, Texas and Washington [combined 1995 population: 57.8 million]). This report summarizes the results of that survey, which indicate that spending on community-based health services is a small proportion of spending on essential services and an even smaller proportion of total health-care expenditures.

Arizona↗
PubMedDate not supplied

Morbidity pattern, health care utilization and per capita health expenditure in a rural population of Tamil Nadu.

BACKGROUND: Information on the existing morbidity pattern, pattern of health care utilization and the per capita health expenditure is essential to provide need-based health care delivery to a rural population. To obtain this information we performed a study in the K.V. Kuppam Block, North Arcot Ambedkar District, Tamil Nadu. METHODS: We did a cross-sectional study, interviewing respondents from 300 households, from 3 panchayats using a multistage sampling technique. Information relating to 1440 persons was collected. The morbidity data was obtained initially for the week prior to the day of interview, followed by one week to one month and then for two months to one year. RESULTS: During 1990-91, 825 of the 1440 persons (57.3%) did not have any illness. Sex had no bearing on the number of illnesses. Of the 60 children less than 2 years of age, 42 (70%) had one or two illnesses. The period prevalence of infective and parasitic diseases was found to be 21.9% with an average of 3 episodes. Services rendered by private practitioners (registered, non-registered and indigenous) were utilized by 59% of the households and 79% of the households had used allopathic treatment at some time. The average per capita per annum health expenditure was Rs 89.9 (Rs 449 per household). This increased significantly with increase in the household size (p < 0.001) and per capita income (p < 0.01). CONCLUSION: The health-seeking behaviour of this population can be changed if efficient services are rendered through government primary health centres and subcentres. This would allow the existing voluntary agency to withdraw without much change in the per capita health expenditure.

Adolescent↗
PubMed1997

[Control of hospital expenditures].

Hospital expenditures in France (300 billion francs in 1995) comprise half of the expenditures of the Health Care Assurance system. The government directive dated 24 April 1996 created a national accreditation and evaluation agency. The effectiveness of the agency will largely depend on the ability of the experts to create a pragmatic system. The 5-year maximum delay for an accreditation request can be explained by the fact that the system is new, but will nevertheless delay hospital closure decisions and thus prolong the function of hospitals with reduced activity and thus less medical experience, leading to extra cost for the society. The directive also created regional hospitalization agencies which are to develop a regional health care policy, analyze and coordinate hospital activity and determine hospital resources. It is hoped that these agencies will be more effective than the former health care and social organization committees. The necessary decisions for hospital closures will be difficult due to the opposition of both the populations and elected officials. Finances for public facilities will continue on the basis of a global budget, an attempted macro-economic cost-containment policy which has had only limited effect. For private facilities, use of medicalization data systems could have unfavorable effects if the data is too approximative and could cause undue increase in cost over benefit if the data is too exhaustive. The directive does not appear to modify the authorization system for major equipment expenditures. There is no mention of the increasing size of hospital administration staffs. Finally, the directive does not address the fundamental question of medical behavior: a modification of medical training which would place more emphasis on clinical training and reasoning.

Financial Management, Hospital↗
PubMed1997

Medical-care expenditures attributable to cigarette smoking during pregnancy -- United States, 1995.

An estimated 26% of women of reproductive age (i.e., 18-44 years) smoked in 1993, and approximately 19%-27% of women smoke during pregnancy. Smoking during pregnancy is causally associated with an annual estimated 32,000-61,000 low-birthweight infants and 14,000-26,000 admissions to neonatal intensive-care units. The estimated smoking-attributable direct medical-care costs for chronic conditions in 1993 were $50.0 billion; however, this estimate omitted the direct medical costs of tobacco exposure for infants and children and most of these costs for pregnant women. To derive 1995 estimates of the smoking-attributable costs for direct medical expenditures (i.e., inpatient, physician, hospital outpatient, and emergency department costs) related to pregnancy outcomes, the University of California at Berkeley and CDC analyzed data from the 1987 National Medical Expenditures Survey (NMES-2). This report summarizes the findings, which indicate substantial smoking-attributable direct medical expenditures for pregnant women and newborns.

Adult↗
PubMed1998

[International comparisons of health care resources. Expenditure shared the GNP is inadequate. Complementary real measures are necessary].

Since the health care expenditure share of the GNP (gross national product) is a measure difficult to interpret, its use can yield erroneous results in comparing health care sector development in different countries. A complementary measure of health care resources is the size and structure of the health care labour force. Information from Sweden, Denmark, the United Kingdom and the USA shows that development in expenditure share of the GNP in no way reflects development in labour resources in the respective countries. Ranking of national costs differs depending on the measures used, which is partly to be explained by differences in relative prices in terms of various investment factors--e.g., salaries of qualified personnel. The generally slow wages trend in the Swedish health care sector is a contributory factor explaining why the marked increase in the labour force during the 1970s and 1980s is incompletely reflected in the health care expenditure share of the GNP. Studies of personnel resources at the hospital level in the above-mentioned countries have shown marked national differences to exist in terms of working hours, service contracts and job descriptions, which further explains the differences manifest at an aggregate level.

Costs and Cost Analysis↗
PubMed1998

Out-of-pocket expenditures of outpatients receiving chemotherapy.

PURPOSE/OBJECTIVES: To examine the magnitude of out-of-pocket expenditures for patients undergoing chemotherapy in an outpatient clinic. DESIGN: Cross-sectional survey. SETTING: An urban outpatient chemotherapy clinic. SAMPLE: Convenience sample of 20 adult patients with cancer. METHODS: Birenbaum's Cost Interview Schedule was administered to patients as they awaited treatment in the chemotherapy clinic; demographic data were collected from patients' charts. MAIN RESEARCH VARIABLE: Out-of-pocket expenditures incurred during a one-month period of chemotherapy treatment. FINDINGS: Estimated out-of-pocket expenses, excluding lost income, ranged widely from $12-$3,130. CONCLUSIONS: Out-of-pocket expenses come from multiple sources over time and can be more costly than previously recognized. Extent of out-of-pocket expenditures may depend on treatment protocol, ease of symptom management, functional status, and nonclinical elements such as socioeconomic factors. Additional investigation can identify which patients are most vulnerable to excessive out-of-pocket expenses and who may be at risk for treatment delay or withdrawal because of difficulties in meeting expenses. IMPLICATIONS FOR NURSING PRACTICE: Recognition of the hidden costs incurred by patients with cancer as they undergo treatment enables nurses to anticipate the financial burden of illness, make necessary referrals, address quality-of-life issues because of financial distress, and avert critical delays in treatment related to overwhelming healthcare costs.

Adult↗
PubMed1997

Underestimation of daily energy expenditure with the factorial method: implications for anthropological research.

Under field conditions, total daily energy expenditure (TDEE) has generally been estimated using time allocation techniques (the factorial method). However, recent work suggests that the factorial method underestimates TDEE relative to newer, more accurate methods such as doubly labelled water (DLW) and heart-rate (HR) monitoring. This study compares estimates of TDEE obtained by the factorial and HR-monitoring methods for a sample of 61 indigenous (Evenki; 17 males, 44 females) and 32 nonindigenous ("Russian"; 10 males, 22 females) subjects from three communities in Central Siberia. Energy expenditures obtained from the two methods were significantly correlated (r = 0.495; P < 0.0001), but the factorial method significantly underestimated TDEE relative to the HR-monitoring technique (8.95 +/- 2.73 vs. 8.25 +/- 1.34 MJ/d; P < 0.005). Interpopulational analyses of data compiled from this and other studies indicate that the factorial method consistently underestimates TDEE relative to DLW and HR monitoring and that the magnitude of underestimation increases with expenditure levels. Indeed, among sedentary populations, factorial estimates of TDEE converge on those of the other methods, whereas at high activity levels the disparity is quite large. These results imply that the daily energy requirements of many subsistence-level populations have been underestimated, thus providing an overly favorable picture of energy balance. Moreover, it is likely that underrepresentation of TDEE is most problematic in rural societies of the developing world which tend to have high activity levels and great risk of malnutrition.

Adolescent↗
PubMed1990

Effect of chemotherapy on resting energy expenditure in patients with non-Hodgkin's lymphoma. Results of a sequential study.

This study compared the resting energy expenditure (REE) modifications observed during successive intensive identical chemotherapy courses in non-Hodgkin's lymphoma patients to assess indirectly the metabolic changes induced by the cytotoxic effect of drugs on the tumor. With this therapeutic regimen, reduction of tumor mass is mostly achieved during the first course of chemotherapy. The study included 10 non-Hodgkin's lymphoma adult patients receiving three intensive 5-day courses of Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), cyclophosphamide, vindesine, and bleomycin. Resting energy expenditure was evaluated by indirect calorimetry during each course, first within the first 2 days before chemotherapy and then on days 2, 3 and 5. Initial REE (day 0) on entry into the study (21.8 +/- 1.2 kcal/kg.d-1) represented 99 +/- 6.7% of theoretical REE. Resting energy expenditure on day 0 was lower during course 2 and 3 (19.1 +/- 0.7 and 18.4 +/- 1.8 kcal/kg/d) than during course 1 (21.8 +/- 1.2 kcal/kg/d). The REE profile was different among the 3 courses: course 1 induced a significant REE decrease on days 3 and 5 (P less than 0.01); during course 2, REE remained stable and was lower than during course 1; during course 3, REE increased on days 2, 3, and 5 (P less than 0.05). Energy balance was positive during the three courses and nutritional status remained stable. The REE decrease observed during course 1 may be regarded as the metabolic effect of chemotherapy on the tumor metabolism.

Adult↗
PubMed1993

Energy expenditure in dogs with lymphoma fed two specialized diets.

BACKGROUND: Cancer-caused cachexia has been reported to be caused in part by an increase in energy expenditure, and diets with nutrient profiles containing 30-50% nonprotein calories as fat instead of carbohydrate may exacerbate this state of inefficient energy utilization. METHODS: Indirect calorimetry was performed on 22 dogs with high-grade lymphoblastic lymphoma that were randomized into a blind study and fed isocaloric amounts of a high-fat diet (Diet A) or a high-carbohydrate diet (Diet B) before and after remission was attained with up to five doses of doxorubicin chemotherapy (30 mg/m2 intravenously). Indirect calorimetry was also performed on 30 normal dogs for comparison. RESULTS: During the initial evaluation period, the resting energy expenditure (REE/kg0.75, P < 0.05) and respiratory quotient (RQ, P < 0.05) were significantly lower than in the controls. Six weeks after the start of the study, the REE/kg0.75 and oxygen consumption (VO2/kg0.75) were significantly (P < 0.05) lower in both groups of dogs with lymphoma compared with the controls. The RQ determined 6 weeks after the start of the study for the dogs fed Diet A was significantly (P < 0.05) lower compared with that in the controls evaluated at the same time. When the two groups of dogs with lymphoma were compared with each other, there was no significant difference in any of the outcomes. The REE/kg0.75 and VO2/kg0.75 values were significantly lower (P < 0.05) in the group fed Diet A after the third evaluation period compared with the second evaluation. The REE/kg0.75 and VO2/kg0.75 values were significantly lower (P < 0.05) in the group given Diet B at the fourth evaluation period compared with the fifth. CONCLUSIONS: These data suggest that energy expenditure of dogs with lymphoma decreases transiently in response to chemotherapy and remission, but these values are less than those determined in normal dogs and not altered significantly by diet.

Animals↗
PubMed1988

Effect of posture and locomotion on energy expenditure.

Energy expenditure for human adults and infants and for dogs was measured in resting (supine or lateral) posture, in bipedal posture and locomotion, and in quadrupedal posture and locomotion. Variations in respiratory and heart rate and in body temperature were utilized in this comparative study. Oxygen consumption was also measured in human adults. In human adults, bipedal posture and locomotion were shown to be much less energy-consuming than corresponding quadrupedal posture and locomotion. The opposite was observed in adult dogs, where bipedalism was shown to be much more energy-consuming than quadrupedalism. In addition, this study demonstrated, for human adults in their natural erect posture, an energy expenditure barely higher than in supine or lateral resting posture, while the dogs in their natural quadrupedal stance, the energy expenditure is much higher than in their resting posture. With respect to energy, therefore, humans are more adapted to bipedalism than dogs to quadrupedalism. Human children, at the transitional stage between quadrupedalism and bipedalism, have high and almost equal requirements for all postures and locomotions. This demonstrates, in term of energy, their incomplete adaptation to erect behavior.

Adolescent↗
PubMed2002

Research on energy expenditure in individuals with eating disorders: a review.

OBJECTIVE: This study reviews the published research on energy expenditure in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). METHOD: Individual studies are reviewed and their results summarized. RESULTS: The most consistent finding is evidence of reduction in resting energy expenditure (REE) in patients with AN, which increases with increased energy intake and body weight. Data regarding BN are inconsistent. Three available studies in subjects with BED have not found evidence of changes in energy expenditure corrected for lean body mass compared with obese non-binge eaters. DISCUSSION: The ability to reliably and cost-effectively measure REE may aid in the refeeding of patients with AN where REE is reduced. Changes in BN and BED subjects have yet to be identified consistently.

Anorexia Nervosa↗
PubMed2002

Research on energy expenditure in individuals with eating disorders: a review.

OBJECTIVE: This study reviews the published research on energy expenditure in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). METHOD: Individual studies are reviewed and their results summarized. RESULTS: The most consistent finding is a reduction in resting energy expenditure (REE) in patients with AN, which increases with increased energy intake and body weight. Data regarding BN are inconsistent. Three available studies in subjects with BED have not found evidence of changes in energy expenditure corrected for lean body mass compared with obese non-binge eaters. DISCUSSION: The ability to measure REE reliably and cost-effectively may aid in the refeeding of patients with AN in whom REE is reduced. Changes in individuals with BN and BED have yet to be consistently identified.

Energy Metabolism↗
PubMed2005

Estimating the price elasticity of expenditure for prescription drugs in the presence of non-linear price schedules: an illustration from Quebec, Canada.

The price elasticity of demand for prescription drugs is a crucial parameter of interest in designing pharmaceutical benefit plans. Estimating the elasticity using micro-data, however, is challenging because insurance coverage that includes deductibles, co-insurance provisions and maximum expenditure limits create a non-linear price schedule, making price endogenous (a function of drug consumption). In this paper we exploit an exogenous change in cost-sharing within the Quebec (Canada) public Pharmacare program to estimate the price elasticity of expenditure for drugs using IV methods. This approach corrects for the endogeneity of price and incorporates the concept of a 'rational' consumer who factors into consumption decisions the price they expect to face at the margin given their expected needs. The IV method is adapted from an approach developed in the public finance literature used to estimate income responses to changes in tax schedules. The instrument is based on the price an individual would face under the new cost-sharing policy if their consumption remained at the pre-policy level. Our preferred specification leads to expenditure elasticities that are in the low range of previous estimates (between -0.12 and -0.16). Naïve OLS estimates are between 1 and 4 times these magnitudes.

Aged↗
PubMed2001

Dietary intake and resting energy expenditure in relation to weight loss in unselected cancer patients.

Weight loss and anorexia are frequent findings in advanced cancer. The progressive wasting could be attributed to changes in dietary intake and/or energy expenditure mediated by metabolic alterations. In this study, we analyzed dietary intake in generalized malignant disease of solid tumor type in relation to resting energy expenditure (REE) and reported weight loss. In a group of 297 unselected cancer patients from a university hospital outpatient clinic, dietary intake of energy and macronutrients from a 4-day food record, REE by indirect calorimetry, height, weight and weight loss were recorded. Protein intake was validated against 24 hr urine nitrogen in a subgroup (n = 53), and no indication of systematic misreporting was found. Mean daily dietary intake was below maintenance requirements, 26 +/- 10 kcal/kg. Weight loss of more than 10% was present in 43% of patients and elevated REE (>110% of predicted) in 48%. Dietary intake did not differ between normo- and hypermetabolic patients, nor was tumour type or gender related to energy and protein intake. Weight loss could not be accounted for by diminished dietary intake since energy intake in absolute amounts was not different and intake per kilogram body weight was higher in weight-losing patients compared to weight-stable patients. Dietary macronutrient composition did not differ from the general population. Dietary intake of energy and protein was decreased, but dietary macronutrient composition did not appear to be changed. Weight loss and hypermetabolism were frequent and not compensated for by an increase in spontaneous food intake. Our results indicate that an expected up-regulation of dietary intake in response to elevated energy expenditure is frequently lost in cancer patients. This may be the explanation behind cancer cachexia rather than a primary decrease in appetite.

Adult↗
PubMed1994

Determinants of free-living energy expenditure in normal weight and obese women measured by doubly labeled water.

Total free-living energy expenditure (TEE) was measured in 9 normal weight controls and 5 obese women using the doubly labeled water (DLW) method. Resting energy expenditure (REE) and the thermic effect of food (TEF) were measured by indirect calorimetry and the energy cost of physical activity (PA) calculated by deduction, in order to quantify the components and identify determinants of free-living TEE. Although REE was quantitatively the major component of TEE in both groups, PA best explained the variability, contributing 76% to the variance in free-living TEE. The obese women had elevated values for TEE (12397 +/- 2565 vs. 8339 +/- 1787 kJ/d, mean +/- SD; p < 0.005), compared with the control women. PA (5071 +/- 2385 vs. 2552 +/- 1452; p < 0.05) and REE (6393 +/- 678 vs. 5084 +/- 259; p < 0.0005) were also raised in the obese, whereas TEF was not significantly different between the groups, accounting for 7.6% of energy expenditure for the obese and 8% for the control subjects. Body weight was the single best determinant of mean daily free-living TEE across both groups. We conclude that PA and body weight are the main determinants of free-living TEE.

Adult↗
PubMed1994

Energy intake and physical activity in Pima Indians: comparison with energy expenditure measured by doubly-labeled water.

To test the validity of survey techniques for measuring diet and activity patterns of Pima Indians, sequential 24-hour recalls, a food frequency questionnaire (FFQ), and an activity questionnaire were compared to free-living energy expenditure. Total energy expenditure (TEE) measured by doubly labeled water was 13.27 +/- 2.95 MJ/d for the 12 males (mean +/- SD: 35 +/- 14 yr; 97 +/- 35 kg; 32 +/- 9% body fat) and 11.67 +/- 1.85 MJ/d for the 9 females (31 +/- 13 yr; 106 +/- 32 kg; 49 +/- 6% body fat). Energy intake assessed by 24-hour recall was 13.59 +/- 7.81 MJ/d for men and 9.29 +/- 2.77 MJ/d for women, compared to 12.84 + 2.85 and 9.40 + 2.61 MJ/d for men and women, respectively, by FFQ. Both dietary methods indicated significant underreporting by women when compared to TEE. Energy intake assessed by FFQ was significantly correlated with TEE (r=0.48, p=0.03). This was true with 24-hour recall energy intake only when data from two extremely large alcohol consumers were eliminated (r=0.64, p=0.03, N=19). Although a low level of activity was apparent, the activity questionnaire produced significant correlations with measurements of energy expenditure and therefore represents an important tool for examining the relationship between physical activity and diseases.

Adult↗
PubMed1999

Components of total energy expenditure in healthy young women are not affected after 14 days of feeding with medium-versus long-chain triglycerides.

OBJECTIVE: To examine the effect of consumption of medium-chain triglycerides (MCT) vs. long-chain triglycerides (LCT) on total energy expenditure (TEE) and its components in young women during the second week of a 2-week feeding period. RESEARCH METHODS AND PROCEDURES: Twelve healthy lean women (age: 22.7+/-0.7 years, body mass index [BMI]: 21.5+/-0.8 kg/m2) were fed weight maintenance diets containing 15% of energy as protein, 45% as carbohydrate, and 40% as fat, 80% of which was treatment fat, for 2 weeks in a randomized cross-over design separated by a 2-week washout period. Dietary fat was composed of triglycerides containing either 26% medium-chain fatty acids (MCFA) and 74% long-chain fatty acids (LCFA), or 2% MCFA and 98% LCFA. Free-living TEE was measured from day 7 to 14 on each dietary treatment using doubly labeled water (DLW). Basal metabolic rate (BMR) and thermic effect of food (TEF) were measured on days 7 and 14 using respiratory gas exchange analysis (RGE) for 30 minutes and 330 minutes, respectively. Activity-induced energy expenditure (AIEE) was derived as the difference between TEE and the sum of BMR and TEF. RESULTS: The average TEE while consuming the MCT diet (2246+/-98 kcal/day) did not differ from that of the LCT diet (2186+/-138 kcal/day. BMR was significantly higher on the MCT diet on day 7 (1219+/-38 kcal/day vs. 1179+/-42 kcal/day), but not on day 14; there was no effect of diet on TEF. There were no differences in BMR, TEF, or AIEE between diets when expressed as percentages of TEE. On average, BMR, TEF, and AIEE represented 54.6%, 8.2%, and 37.2%, respectively, of TEE. DISCUSSION: Results suggest that between day 7 and day 14 feeding of MCT vs. LCT at these levels, TEE is not affected and that increases seen in energy expenditure following MCT feeding may be of short duration. Thus, compensatory mechanisms may exist which blunt the effect of MCT on energy components over the longer term.

Adult↗