Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “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.

At least 145 records · Page 8Linked to original sources
PubMed2001

Expenditures for the care of HIV-infected patients in the era of highly active antiretroviral therapy.

BACKGROUND: The introduction of expensive but very effective antiviral medications has led to questions about the effects on the total use of resources for the care of patients with human immunodeficiency virus (HIV) infection. We examined expenditures for the care of HIV-infected patients since the introduction of highly active antiretroviral therapy. METHODS: We interviewed a random sample of 2864 patients who were representative of all American adults receiving care for HIV infection in early 1996, and followed them for up to 36 months. We estimated the average expenditure per patient per month on the basis of self-reported information about care received. RESULTS: The mean expenditure was $1,792 per patient per month at base line, but it declined to $1,359 for survivors in 1997, since the increases in pharmaceutical expenditures were smaller than the reductions in hospital costs. Use of highly active antiretroviral therapy was independently associated with a reduction in expenditures. After adjustments for the interview date, clinical status, and deaths, the estimated annual expenditure declined from $20,300 per patient in 1996 to $18,300 in 1998. Expenditures among subgroups of patients varied by a factor of as much as three. Pharmaceutical costs were lowest and hospital costs highest among underserved groups, including blacks, women, and patients without private insurance. CONCLUSIONS: The total cost of care for adults with HIV infection has declined since the introduction of highly active antiretroviral therapy. Expenditures have increased for medications but have declined for other services. However, there are large variations in expenditures across subgroups of patients.

Adult↗
PubMed2003

Longevity and health care expenditures: the real reasons older people spend more.

OBJECTIVES: In this study, we investigated the relative contributions of both age and time to death to health care expenditures for elderly Medicare beneficiaries. We also analyzed differences in expenditure patterns by age and time to death for various service types and payers. METHODS: We conducted graphical analysis of person-month level data on 25,994 elderly persons from the 1992-1998 Medicare Current Beneficiary Survey Cost and Use files. RESULTS: Monthly health care expenditures for elderly people increase substantially with age primarily because mortality rates increase with age and health care expenditures increase with closeness to death. Time to death is the main reason for higher inpatient care expenditures, whereas aging is the main reason for higher long-term care expenditure. DISCUSSION: Both increases in the absolute number of elderly persons and in their longevity will increase future Medicare expenditures. Yet, the expected increase in per person health care expenditures caused by greater longevity of Medicare beneficiaries will be less than expected because of the concentration of expenditures at the end of life rather than during extra years of a relatively healthy life. The latter conclusion may be altered, however, because of other underlying considerations, such as technological change.

Age Factors↗
PubMed1998

The relationship between modifiable health risks and health care expenditures. An analysis of the multi-employer HERO health risk and cost database.

This investigation estimates the impact of ten modifiable health risk behaviors and measures and their impact on health care expenditures, controlling for other measured risk and demographic factors. Retrospective two-stage multivariate analyses, including logistic and linear regression models, were used to follow up 46,026 employees from six large health care purchasers for up to 3 years after they completed an initial health risk appraisal. These participants contributed 113,963 person-years of experience. Results show that employees at high risk for poor health outcomes had significantly higher expenditures than did subjects at lower risk in seven of ten risk categories: those who reported themselves as depressed (70% higher expenditures), at high stress (46%), with high blood glucose levels (35%), at extremely high or low body weight (21%), former (20%) and current (14%) tobacco users, with high blood pressure (12%), and with sedentary lifestyle (10%). These same risk factors were found to be associated with a higher likelihood of having extremely high (outlier) expenditures. Employees with multiple risk profiles for specific disease outcomes had higher expenditures than did those without these profiles for the following diseases: heart disease (228% higher expenditures), psychosocial problems (147%), and stroke (85%). Compared with prior studies, the results provide more precise estimates of the incremental medical expenditures associated with common modifiable risk factors after we controlled for multiple risk conditions and demographic confounders. The authors conclude that common modifiable health risks are associated with short-term increases in the likelihood of incurring health expenditures and in the magnitude of those expenditures.

Adolescent↗
PubMed2002

Medical expenditures during the last year of life: findings from the 1992-1996 Medicare current beneficiary survey.

OBJECTIVE: To compare medical expenditures for the elderly (65 years old) over the last year of life with those for nonterminal years. DATA SOURCE: From the 1992-1996 Medicare Current Beneficiary Survey (MCBS) data from about ten thousand elderly persons each year. STUDY DESIGN: Medical expenditures for the last year of life and nonterminal years by source of payment and type of care were estimated using robust covariance linear model approaches applied to MCBS data. DATA COLLECTION: The MCBS is a panel survey of a complex weighted multilevel random sample of Medicare beneficiaries. A structured questionnaire is administered at four-month intervals to collect all medical costs by payer and service. Medicare costs are validated by claims records. PRINCIPAL FINDINGS: From 1992 to 1996, mean annual medical expenditures (1996 dollars) for persons aged 65 and older were $37,581 during the last year of life versus $7,365 for nonterminal years. Mean total last-year-of-life expenditures did not differ greatly by age at death. However, non-Medicare last-year-of-life expenditures were higher and Medicare last-year-of-life expenditures were lower for those dying at older ages. Last-year-of-life expenses constituted 22 percent of all medical, 26 percent of Medicare, 18 percent of all non-Medicare expenditures, and 25 percent of Medicaid expenditures. CONCLUSIONS: While health services delivered near the end of life will continue to consume large portions of medical dollars, the portion paid by non-Medicare sources will likely rise as the population ages. Policies promoting improved allocation of resources for end-of-life care may not affect non-Medicare expenditures, which disproportionately support chronic and custodial care.

Aged↗
PubMed2002

A national study of medical care expenditures for respiratory conditions.

This study was undertaken to estimate the magnitude of medical care expenditures among persons with respiratory conditions in the USA in 1996, and the increment in expenditures attributable to these conditions. The study data were derived from the 1996 Medical Expenditure Panel Survey, a national sample of 21,571 persons. Of the 21,571, 1,027 reported one or more respiratory condition. After weighting, the individuals may represent about 12.1 million persons in the USA. All medical care expenditures of these individuals were tabulated, stratified by comorbidity status, and then compared to those among persons with nonrespiratory conditions or with no conditions. Regression techniques were then used to estimate the increment of healthcare expenditures attributable to the respiratory conditions. From a national total of $45.3 billion, medical care expenditures averaged $3,753 among persons with respiratory conditions. Hospital stays comprised the largest component (45%). The per capita increment in total expenditures attributable to respiratory conditions ranged from $1,003-2,588, from a national total ranging from $12.1-31.3 billion. The total medical care expenditure of persons with respiratory conditions was estimated to be $45.3 billion, of which $12.1-31.3 billion represents an increment in expenditures associated with the conditions themselves.

Case-Control Studies↗
PubMed2007

The relationship between age and healthcare expenditure among persons with diabetes mellitus.

Few studies have examined how a person's age is related to healthcare expenditure among individuals with chronic conditions. The authors reviewed and examined the association between age and healthcare expenditure among persons with diabetes. Crude healthcare expenditure increases with age. Excluding expenditure associated with long-term and home healthcare, medical costs per person peaks at approximately 80 years of age. For males, persons aged 19-34 years had the lowest per-person medical costs, but, for females, those aged 0-18 years had the lowest per-person medical cost. Healthcare expenditure associated with long-term care and home care increased exponentially beyond 65 years of age. There were considerable differences between sexes in terms of the association of age with healthcare expenditure. Age is not a cause for increased healthcare costs; it is the ageing process and the increased likelihood of morbidity and mortality that comes with increasing age that lead to an increase in costs. The three dominant factors that mediate the positive relationship between age and healthcare expenditure are i) the high medical cost associated with death and the increasing likelihood of death with age; ii) increasing long-term and home care with age, particularly among the very elderly; and iii) the rising number and severity of diabetes-related complications with age. A person's age has no effect or a minimal positive effect on a person's demand for healthcare and total healthcare spending, after adjusting other covariates among persons with diabetes. The aging of populations should have a small impact on future healthcare expenditure. Including non-traditional factors in the cost model, such as proximity to death and prevalence of future diabetes-related complications, would improve the prediction of future healthcare expenditure for persons with diabetes.

Age Factors↗
PubMed1980

Projections of national health expenditures, 1980, 1985, and 1990.

This paper presents projections of national health expenditures by type of expenditure and sources of funds for 1980, 1985, and 1990. A major purpose of these projections is to provide a baseline for health care expenditures in the absence of national health insurance and cost containment. Rapid growth in health expenditures is projected to continue to 1990. National health expenditures increased 350 percent between 1965 and 1978, reaching $192 billion in 1978. They are projected to reach $245 billion in 1980, $440 billion in 1985 and $760 billion in 1990, under current legislation. As a proportion of the Gross National Product (GNP), health expenditures rose from 6.2 percent to 9.1 percent between 1965 and 1978. They are projected to continue to rise, reaching 10.5 percent by 1985 and 11.5 percent by 1990. Sources of payments for these expenditures are also shifting. From 1965 to 1978, the percentage of total health expenditures that was government financed increased 16 percentage points, from 25 to 41 percent. The Federal share of public funds during the same period grew rapidly, from 53 percent in 1965 to 69 percent in 1978. In 1985, approximately 42 percent of total health spending is projected to be financed from public funds, of which 72 percent will be paid by the Federal government. Public funds are expected to account for 43 percent of total national health expenditures by 1990.

Financing, Government↗
PubMed1981

National health expenditures: short-term outlook and long-term projections.

This paper presents projections of national health expenditures by type of expenditure and source of funds for 1981, 1985, and 1990. Rapid growth in national health expenditures is projected to continue through 1990. National health expenditures increased 400 percent between 1965 and 1979, reaching $212 billion in 1979. As a proportion of the Gross National Product (GNP), health expenditures rose from 6.1 percent to 9.0 percent between 1965 and 1979. They are expected to continue to rise, reaching 10.8 percent by 1990. This study projects that, under current legislation, national health expenditures will research $279 billion in 1981, $462 billion in 1985, and $821 billion in 1990. Sources of payments for these expenditures are shifting. From 1965 to 1979, the percentage of total health expenditures financed by public funds increased 17 percentage points--from 26 to 43 percent. The Federal share of public funds during this same period grew rapidly, from 51 percent in 1965 to 67 percent in 1979. This study projects that in 1985 approximately 45 percent of total health spending will be financed from public funds, of which 68 percent will be paid for by the Federal government. Public funds will account for 46 percent of total national health expenditure by 1990.

Financing, Government↗
PubMed2005

[Catastrophic health expenditures in Mexico: magnitude, distribution and determinants].

OBJECTIVE: To describe the magnitude, distribution, and determinants of catastrophic health expenditures in Mexico. MATERIAL AND METHODS: The information source was the National Performance Assessment Survey and the methodology, the one developed by the World Health Organization for assessing fair financing. Households with catastrophic expenditures were defined as those with health expenditures over 30% of their ability to pay. Multivariate analysis by logistic and linear regression were used to identify the determinants of catastrophic expenditures. RESULTS: A total of 3.8% of the households incurred in catastrophic health expenditures. There were huge differences by state. The uninsured, poor, and rural households showed a higher impoverishment risk. Sixty percent of the catastrophic expenditures were attributable to outpatient care and medication. A 10% increase of insured households could result in a 9.6% decrease in catastrophic expenditures. Disability, adults 60 years of age and older, and pregnancy increased the probability of catastrophic expenditures. CONCLUSIONS: The insurance of older adults, pregnant women, and persons with disabilities could reduce catastrophic health expenditures in Mexico.

Adult↗
PubMed2006

Domestic health expenditure in Hong Kong: 1989/90 to 2001/02.

OBJECTIVE: To estimate the total domestic health expenditure in Hong Kong between fiscal years 1989/90 and 2001/02, with breakdown by financing source, provider, and function over time. METHODS: The standard health accounting methods as per the Organisation for Economic Co-operation and Development System of Health Accounts guidelines of 2000 were adopted. RESULTS: Total domestic health expenditure was $68,620 million in the fiscal year 2001/02. In real terms, expenditure grew at an average rate of 7% while gross domestic product increased by 4% during the same period. This indicates a growing share of health spending relative to gross domestic product, from 3.8% in 1989/90 to 5.5% in 2001/02. This upward trend was largely driven by increased public spending that rose 208% in real terms over the period, compared with 76% for private spending. Out-of-pocket payments by households accounted for about 70% of private spending while employers and insurance accounted for 28%. Private insurance plays an increasingly important role in financing private spending whereas household expenditure has shown a corresponding decrease during the period. Expenditure incurred at providers of ambulatory services and hospitals accounted for more than 70% of total health expenditure during the observed period. Hospitals' share of total spending increased by 18%, reaching 45% of total expenditure in 2001/02, whilst the share of providers of ambulatory services reduced to 30% in 2001/02. The two largest functional components of total health expenditure were ambulatory care (35-41%) and in-patient curative care (20-27%). Public spending generally financed in-patient curative care and ambulatory services; private spending was concentrated on ambulatory services and medical goods outside the patient care setting. CONCLUSION: These data provide important information for the public, policymakers, and researchers to assess the performance of the health care system longitudinally, and to evaluate health expenditure-related policies.

Ambulatory Care↗
PubMed1990

[International comparisons of institutional medical care expenditures--an analysis using the OECD health data bank].

Expenditures for institutional medical care of eleven OECD countries including Japan were studied using the OECD health data bank. Objectives of this study were to clarify the factors associated with increases in institutional medical care expenditures, and to compare these expenditures between Japan and other OECD countries. The main findings were as follows; 1) Expenditures for institutional medical care per person for the entire population were positively correlated with expenditures per day per in-patient, but not significantly correlated with hospital bed-days per person. 2) Hospital bed-days were strongly correlated with the numbers of beds per 1000 population. 3) There was a negative correlation between expenditures per day per in-patient and average length of stay. 4) Increases in expenditure for institutional medical care per person in 1970s were mainly due to increases in expenditures per day per in-patient. 5) Expenditure per day per in-patient in Japan was the lowest except for Austria and the number of hospital admissions as percentage of the total population was the lowest among the eleven countries surveyed.

Databases, Factual↗
PubMed1995

[Distribution of medical expenditures for the elderly].

The distribution in medical service use by the elderly was examined by using data from medical fee claim records of the Medical System for the Elderly for one year. The following are among the main findings: More than 50 percent of the patients consumed less than 300,000 yen per year, and those patients whose annual medical expenditures were between 600,000 yen to 4,000,000 yen consumed 54 percent of the total expenditures of the elderly. The top 10 percent of patients consumed 50 percent of medical expenditures, and top 1 percent consumed 10 percent. Lorenz curves of medical expenditures for different regions were relatively similar despite the large differences in medical expenditures per patient. Medical expenditures per patient did not appear to be related to the concentration in distribution of expenditures, although the former was strongly related to the proportion of long-term hospitalized patients. After various measures to control the increase rate of medical expenditures in 1980's, public attention has shifted slowly to the quality of services provided and cost-effectiveness of medical services. The concentration in distribution of medical expenditures was considered to be a meaningful approach to investigate the effectiveness of medical services.

Aged↗
PubMedDate not supplied

State estimates of Medicaid expenditures attributable to cigarette smoking, fiscal year 1993.

OBJECTIVE: To develop estimates of state Medicaid expenditures attributable to smoking for fiscal year 1993. METHODS: The smoking-attributable fractions (SAFs) of state Medicaid expenditures were estimated using a national model that describes the relationship between smoking and medical expenditures, controlling for a variety of sociodemographic, economic, and behavioral factors. RESULTS: In fiscal year 1993, the SAF for all states (all types of expenditures) was 14.4%, with a range from 8.6% in Washington DC to 19.2% in Nevada. On average, SAFs ranged from a low of 7.9% for home health services expenditures to 21.7% for hospital expenditures. An estimated total of $12.9 billion of fiscal year 1993 Medicaid expenditures was attributable to smoking. The relative error of this estimate was 40.3%. CONCLUSIONS: Cigarette smoking accounts for a substantial portion of annual state Medicaid expenditures, with considerable variation among states. The range in expenditures among the states is due to differences in smoking prevalence, health status, other socioeconomic variables used in the model, and the level and scope of the Medicaid program.

Adult↗
PubMed1990

Ablation of abnormal energy expenditure by curative tumor resection.

Resting energy expenditure is abnormal in most patients with cancer and may contribute to cancer cachexia. These metabolic abnormalities may be a direct measure of tumor metabolism, or represent alterations in the size or activity of the body cell mass, or both. To unravel this pathogenesis, we prospectively studied 68 preoperative patients with cancer about to undergo curative resection by measuring resting energy expenditure before and after tumor resection. The preoperative measured resting energy expenditure was compared with expected resting energy expenditure based on Harris-Benedict resting energy expenditure predictions: 10 patients were hypometabolic (less than 90% Harris-Benedict); 35 were normometabolic (90% to 110% Harris-Benedict); and 23 were hypermetabolic (greater than 110% Harris-Benedict). Using each patient as his or her own control, resting energy expenditure normalized or remained normal following curative resection. In contrast, after palliative resection, resting energy expenditure remained hypermetabolic or significantly increased toward hypermetabolism. Tumor induces an abnormal metabolic rate, since tumor removal results in prompt normalization of resting energy expenditure. The abnormal energy expenditure of patients with cancer cannot be solely attributed to abnormal host body composition.

Analysis of Variance↗
PubMed1995

Abnormalities of energy expenditure and the development of obesity.

The role of energy expenditure in the development of obesity remains unclear. This issue is examined using data from prospective studies of energy expenditure and obesity, the effects of overfeeding and diet composition on energy expenditure, and studies of the relationship between energy expenditure for physical activity and body composition. The combined results from these investigations strongly support the view that low energy expenditure can facilitate rapid weight gain in susceptible individuals. It is speculated that, in susceptible individuals, low energy expenditure for resting energy expenditure as well as physical activity are part of a range of mechanisms available for providing surplus energy for rapid weight gain. In addition, both cross-sectional and intervention studies indicate that there is an equilibration between the level of energy expenditure for physical activity and body fat content. While genetic and other factors clearly play an important role in this relationship, it appears that a modest reduction in body fat content can be achieved by increasing energy expenditure for physical activity in physical exercise programs.

Adolescent↗
PubMed2006

Physical activities in adolescent girls: variability in energy expenditure.

BACKGROUND: Understanding interindividual variability of energy expended in common activities is important for determining precise estimates of energy expenditure in surveillance studies and clinical trials. The purpose of this study was to describe the variability in energy expenditure for selected physical activities among adolescent girls. METHODS: Seventy-four adolescent girls (aged 13 to 14 years) participated in this cross-sectional investigation. Data were collected in 2001 and analyzed in 2004. Energy expenditure was measured by indirect calorimetry for ten activities and during a submaximal cycle ergometer test, which was used to estimate cardiorespiratory fitness. Variability in energy expended for the various activities was expressed by standard deviation, coefficient of variation, and range for three different energy expenditure variables: relative VO2 (milliliters per kilogram per minute), absolute VO2 (liters per minute(-1)), and calculated metabolic rate (kilojoules per minute). RESULTS: Depending on the expression of energy expenditure, coefficients of variation ranged from a low of 13.2% for climbing stairs to a high of 38.4% for playing a computer game. Some lower-intensity activities were associated with greater variability in energy expenditure. Bicycling showed consistently higher coefficients of variation across expressions of energy expenditure (29.1%, 37.7%, and 33.5% for relative VO2, absolute VO2, and calculated metabolic rate, respectively). CONCLUSIONS: Energy expenditure for common activities is highly variable in adolescent girls. The coefficient of variation was higher in some activities of lower intensity, regardless of energy expenditure expression. This variance may influence the evaluation of physical activity interventions, particularly with regard to issues such as a prescribed dose of activity and the statistical power to detect change.

Activities of Daily Living↗
PubMed2006

Locomotion is the major determinant of sibutramine-induced increase in energy expenditure.

The anti-obesity effect of the serotonin and noradrenaline reuptake inhibitor sibutramine has been attributed to a dual mechanism involving a reduction of food intake and an increase in energy expenditure. This dual action increases the possibilities for induction of a negative energy balance, the principal goal of an anti-obesity treatment. To elucidate the mechanism behind sibutramine-induced increase in energy expenditure, we applied indirect calorimetry combined with monitoring locomotor activity and body temperature. We confirm that sibutramine has both anorectic and thermogenic effects. In addition, we show here that sibutramine also causes a dose-dependent increase in locomotor activity (LMA) of rats, occurring in parallel with increase in energy expenditure. The dose of sibutramine necessary to induce an effect on locomotion and energy expenditure was only marginally higher than the dose sufficient to induce a significant reduction of food intake. The relation between LMA and energy expenditure was similar to that found with d-amphetamine, which causes both hyper-locomotion and increased energy expenditure, but was different from 2,4-dinitrophenol which causes increase in energy expenditure but not in locomotion. The effect of sibutramine (20 mg/kg) on energy expenditure was not inhibited by the non-selective 5-HT receptor antagonist, metergoline (1 mg/kg), or a high dose (20 mg/kg) of the non-selective beta-blocker propranolol, but was blocked by D1 dopamine receptor inhibitor SCH 23390 (0.3 mg/kg). Therefore, we conclude that the effect of sibutramine on energy expenditure in rats is predominantly due to a dopamine-dependent increase in locomotor activity.

2,4-Dinitrophenol↗
PubMed2002

Statistical comparison of consumer drug expenditures and discretionary purchases to assess drug affordability.

BACKGROUND: Affordability may be defined as the absence of economic barriers to a good or service. There are 2 frequently observed measures of affordability: a consumer's ability to pay and his or her physical access to a good or service. Thus, most programs designed to subsidize consumers' health care costs, especially state programs that address prescription drug expenditures for people aged > or =65 years, base eligibility on measures of income as a proxy for a consumer's ability to pay. These measures do not explicitly include a consumer's willingness to pay for medications. For example, it is possible that some Medicare beneficiaries may be resistant to paying for medication because other major health care expenditures are typically covered by insurance. This resistance could be exacerbated by the keen awareness among the general population of the rising costs of medications. Because medications are considered a necessity, expenditure levels are usually compared with expenditures for other necessities, such as housing and medical services. OBJECTIVE: In an attempt to assess consumers' potential willingness to pay for medications, this article draws on data from the US Bureau of Labor Statistics' Consumer Expenditure Surveys to compare pharmaceutical expenditures with out-of-pocket expenditures for discretionary purchases, such as dining outside the home. RESULTS: Personal out-of-pocket expenditures for medications have ranged from 0.8% to 1.0% of consumer unit income since 1985. These expenditures are relatively small compared with those for necessities, such as housing (33%) and food (13.5%). They are also less than the share of income dedicated to many nonessentials. CONCLUSION: Assessing inability versus unwillingness to pay for medication remains a problem for both researchers and health care policy makers attempting to determine the affordability of medications.

Aged↗