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At least 1,261 records · Page 70Linked to original sources
PubMed1999

Predictors of Medicare costs in elderly beneficiaries with breast, colorectal, lung, or prostate cancer.

BACKGROUND: Determining the apportionment of costs of cancer care and identifying factors that predict costs are important for planning ethical resource allocation for cancer care, especially in markets where managed care has grown. DESIGN: This study linked tumor registry data with Medicare administrative claims to determine the costs of care for breast, colorectal, lung and prostate cancers during the initial year subsequent to diagnosis, and to develop models to identify factors predicting costs. SUBJECTS: Patients with a diagnosis of breast (n = 1,952), colorectal (n = 2,563), lung (n = 3,331) or prostate cancer (n = 3,179) diagnosed from 1985 through 1988. RESULTS: The average costs during the initial treatment period were $12,141 (s.d. = $10,434) for breast cancer, $24,910 (s.d. = $14,870) for colorectal cancer, $21,351 (s.d. = $14,813) for lung cancer, and $14,361 (s.d. = $11,216) for prostate cancer. Using least squares regression analysis, factors significantly associated with cost included comorbidity, hospital length of stay, type of therapy, and ZIP level income for all four cancer sites. Access to health care resources was variably associated with costs of care. Total R2 ranged from 38% (prostate) to 49% (breast). The prediction error for the regression models ranged from < 1% to 4%, by cancer site. CONCLUSIONS: Linking administrative claims with state tumor registry data can accurately predict costs of cancer care during the first year subsequent to diagnosis for cancer patients. Regression models using both data sources may be useful to health plans and providers and in determining appropriate prospective reimbursement for cancer, particularly with increasing HMO penetration and decreased ability to capture complete and accurate utilization and cost data on this population.

Aged↗
PubMed2002

The effect of Medicare supplemental insurance on Medicare expenditures.

This study estimated the effect of Medicare supplemental insurance plans on Medicare expenditures, controlling for unobserved selection. For employer-sponsored policies, there was significant unobserved favorable selection into plans with and without prescription drug coverage. For individual plans, there was unobserved adverse selection into plans with drug benefits and unobserved favorable selection into plans without. Individual supplemental plans without prescription drugs increased Medicare expenditures by $914 annually, while those with drugs increased Medicare expenditures by $491. Employer policies also significantly increased Medicare expenditures ($207 without drug coverage and $447 with drug coverage), but the increase was less than that associated with individual policies.

Aged↗
PubMed2002

Spillover effects of Medicare fee reductions: evidence from ophthalmology.

Relatively little research has examined physicians' supply responses to Medicare fee cuts especially whether fee reductions for specific procedures have "spillover" effects that cause physicians to increase the supply of other services they provide. In this study we investigate whether ophthalmologist changed their provision of non-cataract services to Medicare patients over the time period 1992-1994, when the Medicare Fee Schedule (MFS) resulted in a 17.4% reduction in the average fee paid for a cataract extraction. Following the McGuire-Pauly model of physician behavior (McGuire and Pauly, 1991), we estimated a supply function for non-cataract procedures that included three price variables (own-price, a Medicare cross-price and a private cross-price) and an income effect. The Medicare cross-price and income variables capture spillover effects. Consistent with the model's predictions, we found that the Medicare cross-price is significant and negative, implying that a 10% reduction in the fee for a cataract extraction will cause ophthalmologists to supply about 5% more non-cataract services. Second, the income variable is highly significant, but its impact on the supply of non-cataract services is trivial. The suggests that physicians behave more like profit maximizing firms than target income seekers. We also found that the own-price and the private cross-price variables are highly significant and have the expected positive and negative effects on the volume of non-cataract services respectively. Our results demonstrate the importance of evaluating volume responses to fee changes for the array of services the physician performs, not just the procedure whose fee has been reduced. Focusing only on the procedure whose fee has been cut will yield an incomplete picture of how fee reductions for specific procedures affect physician supply decisions.

Adult↗
PubMed2002

Waiting time as a competitive device: an example from general medical practice.

From a theoretical model we predict that only physicians with quality characteristics perceived as inferior by patients are willing to embark on waiting time reductions. Because of variation in these quality characteristics among physicians, market equilibrium is likely to show a range of waiting times for physician services. This hypothesis is supported by results from a study of Norwegian general practitioners. Since the waiting time offered by a physician influences the number of patient-initiated consultations, a policy implication of our study is that the distinction between patient-initiated and physician-initiated consultations may be less clear-cut than often assumed in the literature.

Appointments and Schedules↗
PubMed2002

The effect of competition on reserve capacity: The case of California hospitals in the late 1990s.

This paper empirically investigates how competitive forces have affected bed capacity in the California hospital services industry using a data set for the late 1990s. The empirical results offer several conclusions about the effect of different types of competition on bed capacity during a period characterized by heightened price consciousness. In contrast to earlier periods, hospitals are found to continuously react to increased inter-hospital competition by reducing the supply of beds relative to patient demand. Similar to earlier periods, the empirical results suggest that increased physician/supplier competition leads to a reduction in bed capacity. Finally and in contrast to earlier studies, findings indicate that increased payer competition, as measured by the percentage of managed care patients in the market area, causes less bed capacity up to a point.

California↗
PubMed2000

Effect of antidepressant choice on the incidence and economic intensity of hospitalization among depressed individuals.

This study identified differences in hospital utilization for mental health problems among depressed patients initially treated with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs). A retrospective sample of 2,557 patients was obtained from a private insurance claims database. Quasi-experimental, two-stage multivariate regression modeling was used to estimate the likelihood of hospitalization and subsequent inpatient expenditures. Only 2% of the sample were hospitalized, and the average expenditures per admitted patient was about $8,000. Patients initially prescribed sertraline had the same likelihood of hospitalization for a mental health problem as patients prescribed TCAs. Patients initially prescribed fluoxetine were half as likely to be hospitalized as patients initially prescribed TCAs. Once hospitalized, no differential effects of a specific antidepressant on inpatient expenditures were found.

Adolescent↗
PubMed2003

Relevance of outlier cases in case mix systems and evaluation of trimming methods.

OBJECTIVES: To determine the most appropriate outlier trimming method when the main source of information for case mix classification is length of stay (LOS) because cost information is unavailable. METHODS: Discharges (35,262) from two public hospitals were analysed. LOS and cost outliers were calculated using different trimming methods. The agreement between cost and LOS trimming was analysed. RESULTS: The trimming method using the geometric mean with two standard deviations (GM2) showed the highest level of agreement between cost and LOS and revealed the greatest proportion of extreme costs. Nearly 5% of cases were outliers, containing 16% of total LOS. This was the best approximation to 18% of extreme cost because when GM2 was applied to LOS, 88% of outlier cost was revealed. CONCLUSIONS: The methods were analysed because they are the most frequently used but the same methodology could be employed to compare other outlier determination methods. Outliers should be calculated because they ought to be valued differently from inlier cases.

Diagnosis-Related Groups↗
PubMed2002

Efficient use of health care resources: the interaction between improved health and reduced health related income loss.

Cost effectiveness is a criterion that is often recommended for prioritizing between different types of health care. A modified use of this criterion can be justified as the outcome of a choice that is made "behind a veil of ignorance." Reduced health will in many cases also gives an income loss that is shared between the patient and society ar large. In the special case where the marginal utilities of health status (measured by QALYs) and income are independent of the health state, an efficient allocation of health resources is characterized by net marginal costs per QALY being equalized across different types of health care. Net marginal costs are equal to gross marginal costs minus the reduction in health related income losses due to treatment. In the general case where marginal utilities depend on the health state this rule must be modified.

Budgets↗
PubMed2002

Employer offers, private coverage, and the tax subsidy for health insurance: 1987 and 1996.

Economists have long been interested in the effect of tax-based subsidies on private health insurance coverage. We examine this relationship using pooled data from the 1987 National Medical Expenditure Survey and the 1996 Medical Expenditure Panel Survey. Our main tax price elasticity estimates for employer offers and for private coverage are near the mid-point of the existing literature. However, these estimates may mask substantial differences in tax-price responsiveness across subsets of workers. Our more disaggregated analysis reveals tax price responsiveness to be significantly above average for low-income workers, workers with low health risks, and workers in small firms--precisely those groups whose continued participation in employment-related risk pooling is of greatest policy concern. In addition, we present family-level elasticities that allow for joint decision-making in two-worker families.

Adult↗
PubMed1997

Surgical suite utilization and capacity planning: a minimal cost analysis model.

In this paper, we are concerned with cost reduction, operating suite utilization, and capacity planning in surgical services. We studied 58,251 computerized surgical records from a teaching hospital to determine a model for measuring operating suite utilization, analyzing the quality of surgical schedules, and allocating surgical suite budgets (capacity planning). The classical definition of operating suite (OR) utilization, encountered in the literature is the ratio of the total OR time used to the total OR time allocated or budgeted. To create a better measure of utilization, we measured underutilization and overutilization providing a more complete description of the overall use of resources. Because the costs of under and overutilization of operating suites are high, they are attractive potential targets for cost minimization and the magnitude of the potential savings are such that attempts to measure and eliminate this inefficiency could be financially rewarding.

Algorithms↗
PubMed2003

Using auctions for contracting with hospitals when quality matters.

This paper analyzes the problem of contracting with hospitals with hidden information when the number of patients wanting treatment depends on the quality of health care services offered. The optimal policy is characterized in the case of a single hospital. It is demonstrated that the regulator can reduce the information rent by decreasing the quality. When the regulator is assumed to be able to organize an auction for awarding the right to provide the service, we characterize the optimal auction and the first score tendering procedure implementing it. The regulator can reimburse a unit price per treated patient and let the hospital choose the level of quality. It is proved that the expected quality of health care services is greater and the expected payment is lower than in the monopoly case.

Competitive Bidding↗
PubMed2003

Hospital competition, GP fundholders and waiting times in the UK internal market: the case of elective surgery.

In this paper I model the demand for and supply of elective surgery using a modified Hotelling framework in which time, money, and distance are determinants of the demand for hospital care. Hospitals compete with each other in terms of the waiting time and consequently treat a certain number of patients. The basic model of hospital competition is then extended to incorporate the general practitioner (GP) fundholding scheme whereby the GPs are allocated a budget with which to buy care for their patients. Waiting time increases when production of care becomes more expensive, when the benefit obtained from treatment increases, when the unit cost of distance decreases, and when the importance given to time as a performance indicator decreases. The higher the money price the lower the waiting time. Finally, the money price paid by the GP fundholders is greater than that paid by the Health Authorities and greater than the hospitals marginal cost of production. As a consequence, fundholding patients pay a zero time price while non-fundholding patients experiment a positive waiting time.

Economic Competition↗
PubMed2003

Comparing the financial risk of bed-day and DRG based pricing types using parametric and simulation methods.

The extent of random financial risk involved in the Finnish bed-day and Diagnosis Related Groups (DRG) based hospital pricing systems were estimated and compared using parametric and simulation methods. DRG based payment schemes were found to provide significantly better protection against financial risk for municipalities, but municipality's size was the main determinant of financial risk. Small municipalities should use longer contracts between hospitals or form bigger purchaser-organisations for risk pooling. In addition, the current risk management system proved to be ineffective in decreasing the random variation in total costs.

Benchmarking↗
PubMed2003

Payment policy and inefficient benefits in the Medicare+Choice program.

We investigated whether constraints on premium rebates by health plans in the Medicare+Choice program result in inefficient benefits. Since relationships between revenue and benefits could be confounded by unobserved variation in the cost of coverage, we took advantage of natural experiment that occurred following passage of the Benefits Improvement and Protection Act of 2000. Our findings indicate that benefits in zero premium plans were more sensitive to changes in payment rates than were benefits in plans that charged nonzero premiums. These results strongly suggest that current Medicare policy induces plans to offer benefits that are not valued by enrollees at or above their cost.

Costs and Cost Analysis↗
PubMed2003

Appraising the economic efficiency of cancer treatment: an exploratory analysis of lung cancer.

This paper tests whether the measured cost-effectiveness of treating different subgroups of an incident population of lung cancer patients differs significantly and, by implication, whether the provision of care to these patients is tolerably efficient in economic terms. Data from administrative records and Registry follow-up on 544 non-small cell lung cancer patients diagnosed at a single NCI-designated Comprehensive Cancer Center are used to conduct the empirical analysis. The main results show statistically significant differences in cumulative costs and patient outcomes across subgroups differing by disease stage and treatment modality. These findings imply that the delivery of lung cancer care is inefficient. Substantive and methodological implications are discussed.

Aged↗
PubMedDate not supplied

Natural capital in ecology and economics: an overview.

The Brundtland Commission report, Our Common Future, defined sustainable development as development that meets the needs of the present without compromising the ability of future generations to meet their own needs. Although the idea of sustainable development has been widely accepted, it has proved difficult to identify and implement policies and practices that promote sustainable economic growth. Some economists, environmental scientists and policy analysts believe that they can transform the consensus about sustainability into manageable practices. They propose to accomplish this feat with a set of new ideas about the relationships between the economy and the environment offered under the banner of 'natural capital'. An ideal account of natural capital would be one or more standard measures or models that would allow the direct comparison of environmental goods, like forests, fresh water and clean air, with economic goods, like money, capital and productivity. By bringing economic science and environmental science to an objective common ground, a natural capital model has the potential to provide a concrete means of comparing the economic and ecological costs and benefits of particular policies and programmes. This paper offers a survey and analysis of several new contributions to the formation of the natural capital concept from economists, ecologists, policy analysts, biometricians, foresters and a philosopher. The paper concludes that existing microeconomic theory may be 'ungreenable', if it is not reformulated. While macroeconomic approaches to natural capital have beenmore successful, they share the limitation that ecosystems and species are valued solely in monetary terms. These problems are taken to suggest that the development of a successful natural capital model may require economic theory to be recast to include non-monetary social preferences and values.

Conservation of Natural Resources↗
PubMed2003

Setting prices for new vaccines (in advance).

New vaccines have high social value, but the incentives to firms to develop new vaccines appear to be weak. This paper recommends setting a procurement price for a new vaccine prior to the vaccine's development, with the price based on the anticipated benefits from developing the vaccine. The price paid to vaccine suppliers is not equal to the price charged to either consumers supplied by public or private sources, so a high price does not choke off demand. A supply price leading to efficient levels of investment can be figured in advance based on cost-effectiveness analyses. Calculations indicate that efficient vaccine prices are considerably above prices currently paid for new vaccines.

Drug Costs↗
PubMed2004

Determinants of health expenditure growth of the OECD countries: jackknife resampling plan estimates.

Due to the lack of internal consistency across unit root and cointegration test methods for short time-series data, past research findings conflict on whether the OECD health expenditure data are stationary. Stationarity reasonably guarantees that the estimated OLS relationship is nonspurious. This paper departs from past investigations that applied asymptotic statistical tests of unit root to insufficient time-series lengths. Instead, data were calibrated in annual growth rates, in 5-year (1968-72, ..., 1993-97) partitions, for maximum likelihood estimation using flexible Box-Cox transformations model and bias-reducing jackknife resampling plan for data expansion. The drivers of OECD health care spending growth are economic and institutional. Findings from the growth convergence theory affirm that health care expenditure growth accords with conditional beta convergence. Statistical significance and optimal functional form models are not unique across the growth period models. Our findings exemplify the benefits of jackknife resampling plan for short data series, and caution researchers against imposing faulty functional forms and applying asymptotic statistical methods to short time-series regressions. Policy implications are discussed.

Analysis of Variance↗