Journal of health & medical economics最新文献

Socioeconomic Status and Relative Incidence of Hysterectomy and Endometrial Ablation in Young Australian Women 澳大利亚年轻妇女子宫切除术和子宫内膜切除术的社会经济地位和相对发生率

Journal of health & medical economics Pub Date : 2019-01-01 DOI: 10.36648/2471-9927.5.1.43

L. Rawlings, P. O’Shaughnessy, Agnes Wilson, S. Robson

{"title":"Socioeconomic Status and Relative Incidence of Hysterectomy and Endometrial Ablation in Young Australian Women","authors":"L. Rawlings, P. O’Shaughnessy, Agnes Wilson, S. Robson","doi":"10.36648/2471-9927.5.1.43","DOIUrl":"https://doi.org/10.36648/2471-9927.5.1.43","url":null,"abstract":"Decisions regarding surgery are complex and economic influences affect choices made both by patients and their doctors. There is evidence that surgeons’ decisions to offer operations are affected by financial incentives, yet we could find no studies addressing whether, once a decision to operate is made and a choice of procedures is available, operations offering greater financial reward are favoured. The choice between endometrial ablation or hysterectomy in heavy menstrual bleeding offers an opportunity to study decision-making. We obtained on all private hospital claims made in Australia for either endometrial ablation or hysterectomy for women aged 30 to 50 years for the five-year period 2012 to 2016 inclusive, according to socioeconomic status. The overall incidence rates and the ratio between hysterectomy and ablation, and the association between socio-economic factors, were examined using linear regression. We found that the surgery with the greatest economic impact on the patient (hysterectomy) was more commonly performed than ablation, yet hysterectomy became the less dominant choice with increasing socioeconomic status of women. This finding suggests that direct financial costs are a lesser consideration in choice of the procedure with patients, but that surgeons may respond to a financial incentive to perform a more expensive procedure.","PeriodicalId":92074,"journal":{"name":"Journal of health & medical economics","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.36648/2471-9927.5.1.43","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69706712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medicare Oncology Care Bundle Variation in Cost and Use 医疗保险肿瘤护理包的成本和使用变化

Journal of health & medical economics Pub Date : 2019-01-01 DOI: 10.36648/2471-9927.5.1.42

S. Parente, L. Tomai

{"title":"Medicare Oncology Care Bundle Variation in Cost and Use","authors":"S. Parente, L. Tomai","doi":"10.36648/2471-9927.5.1.42","DOIUrl":"https://doi.org/10.36648/2471-9927.5.1.42","url":null,"abstract":"Background: Care bundling is an emerging health financing innovation to change the incentives of care, intended to improve quality of care and promote better resource use. In 2016, Medicare outlined a proposal for changing Medicare reimbursement for outpatient drugs through pre-determined care bundles. To gauge the potential for care bundling, we examine one of the first comprehensive efforts, the Oncology Care Model (OCM). This paper shows that the oncology care bundles likely used by OCM have large variation in cost per patient across the United States. Methods: For this analysis, we utilized five years (2010-2014) of the Medicare 5% limited data set (LDS) of fee for service claims. All seven claims segments were used in the analysis including: physician/carrier Part B, durable medical equipment,outpatient hospital, inpatient, skilled nursing facility, home health, and hospice. The 5% LDS sample of Medicare beneficiaries used to identify patients with cancer bundles totaled 17,143 in 2014. An approximate national estimate would be 20 times 17,143, yielding 342,860 beneficiaries. Results: Our analysis of Medicare claims for the three most expensive bundles (lung cancer, prostate cancer and lymphoma) from 2010 to 2014 shows over a 400% difference in per capita bundle reimbursement between US states. Furthermore, we found that the mix of reimbursements within all bundles of fee for service claim types varies meaningfully. Finally, we show that the rank order of most expensive cancers to treat at a patient level is not correlated with the most expensive cancers at a societal level. Conclusions: There is substantial geographic variation in per capita cancer costs that is not consistent for the top 3 cancer bundles. Therefore, policy-making based on system-wide geography will likely not produce a consistent solution. As a result, policy formulation will be challenging when patient cost management is a goal, especially in a healthcare sector where innovation is likely to move faster than robust and thoughtful cost containment strategies.","PeriodicalId":92074,"journal":{"name":"Journal of health & medical economics","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.36648/2471-9927.5.1.42","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69706697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Does Transparency Matter? The Impact of Provider Quality and Cost Information on Health Care Cost and Preventive Services Use 透明度重要吗?提供者质量和成本信息对医疗保健成本和预防服务使用的影响

Journal of health & medical economics Pub Date : 2019-01-01 DOI: 10.36648/2471-9927.5.1.44

S. Parente, R. Feldman, Suzanna Lewis

{"title":"Does Transparency Matter? The Impact of Provider Quality and Cost Information on Health Care Cost and Preventive Services Use","authors":"S. Parente, R. Feldman, Suzanna Lewis","doi":"10.36648/2471-9927.5.1.44","DOIUrl":"https://doi.org/10.36648/2471-9927.5.1.44","url":null,"abstract":"Background: We tested whether provider quality and cost information had a meaningful impact on health care quality and costs at two large employers that introduced a transparent provider profiling system in 2006. Using retrospective claims from enrollees representing 3,928 covered lives in these two firms where the insurer was the sole provider of health insurance, we addressed two questions: 1) Did patients switch to higher quality and more efficient doctors when the provider rankings became available? 2) What is the effect of switching on total expenditures, out-of-pocket expenditures, and use of preventive services? Methods: We used nonlinear regression to identify factors associated with improvement in quality and cost efficiency of providers seen by covered enrollees. We used difference-in-differences regression to test the impact on expenditures and use of preventive services of those who switched to higher-rated physicians. Results: Age, illness burden, and female are positively associated with improvement in provider quality and efficiency. Provider portfolio improvement had a negative impact on expenditures, but the story with respect to prevention is mixed: preventive visits go up when the patient has an improved provider portfolio, but utilization of diagnostic screening procedures goes down. Conclusions: A common concern in medical markets is the lack of information for consumers to shop for health care. We find consumers exhibit behaviors that suggest they use such information when it is available and useful. These results suggest that consumers could process additional price and quality information to gain more value from their health insurance benefits.","PeriodicalId":92074,"journal":{"name":"Journal of health & medical economics","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.36648/2471-9927.5.1.44","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69706766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

A Real World Cost Comparison between Chinese Patients with Coronary Heart Disease or Angina Pectoris using Salvianolate and without using Salvianolate: A Retrospective Database Analysis 中国冠心病或心绞痛患者使用丹参酚酸酯和不使用丹参酚酸酯的成本比较:回顾性数据库分析

Journal of health & medical economics Pub Date : 2019-01-01 DOI: 10.36648/2471-9927.4.2.39

J. Xuan, Yingrui Xu, HongYing Liu, Yue Gao, Linguo Li

{"title":"A Real World Cost Comparison between Chinese Patients with Coronary Heart Disease or Angina Pectoris using Salvianolate and without using Salvianolate: A Retrospective Database Analysis","authors":"J. Xuan, Yingrui Xu, HongYing Liu, Yue Gao, Linguo Li","doi":"10.36648/2471-9927.4.2.39","DOIUrl":"https://doi.org/10.36648/2471-9927.4.2.39","url":null,"abstract":"Objective: To assess and compare 1-year cardiovascular events occurrence frequency and treatment cost among Chinese coronary heart disease (CHD) or angina pectoris patients who used salvianolate injection or non-user. Method: Data were obtained from electronic medical record (EMR) database between 2012.01.01~2017.12.31 covering medical encounter records from two tier-3 general hospitals from Shanghai and Guangzhou in China. Patients were followed 12 months after drug initiation. T-test, Chi-square test, negative binomial regression and generalized linear model adjusting for demographics, and baseline characteristics including cardiovascular event (myocardial infarction, angina, transient ischemic attack, stroke, etcs) rate, inpatient length of stay, and healthcare resource consumption were used to test the difference between two groups. Result: A total of 439 and 1848 patients were identified for salvianolate injection and control group, with mean (SD) age 75.42 (12.09) and 69.15 (12.79) (p<0.01) and male 43.28% and 52.38% (p<0.01), respectively. During baseline, the mean frequency of cardiovascular events were 2.05 and 5.82 times for treatment and control group respectively (p<0.01); the treatment cost for cardiovascular event were 4720.04 Chinese Yuan (CNY) and 3700.23 CNY for control group respectively (p=0.11). During the follow-up period, the average number of cardiovascular events were 0.26 and 5.87 times for treatment and control group respectively (p<0.01). Compared with non-user, mean per-year cost for salvianolate injection user was 29.58% lower (4069.21 vs. 5778.17 Chinese Yuan (CNY). Conclusion: Among Chinese coronary heart disease and angina pectoris patients, those who used salvianolate injection had lower per-year cardiovascular event rate and spent less on cardiovascular events treatment.","PeriodicalId":92074,"journal":{"name":"Journal of health & medical economics","volume":"126 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.36648/2471-9927.4.2.39","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69706514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Factors Influencing Willingness to Pay for Multiple Micronutrient Powder (Virutubishi) Supplements for Young Children in Arusha, Tanzania 影响坦桑尼亚阿鲁沙幼儿购买多种微量营养素粉末(Virutubishi)补充剂意愿的因素

Journal of health & medical economics Pub Date : 2019-01-01 DOI: 10.36648/2471-9927.4.2.41

Dyness Kejo, H. Martin, Mosha Tce, P. Petrucka, M. Kimanya

{"title":"Factors Influencing Willingness to Pay for Multiple Micronutrient Powder (Virutubishi) Supplements for Young Children in Arusha, Tanzania","authors":"Dyness Kejo, H. Martin, Mosha Tce, P. Petrucka, M. Kimanya","doi":"10.36648/2471-9927.4.2.41","DOIUrl":"https://doi.org/10.36648/2471-9927.4.2.41","url":null,"abstract":"Background: Multiple micronutrient powders have shown a positive effect on anaemia prevention in children 6-59 months. For the purposes of uptake and sustainability, we explored ‘‘willingness to pay’’ for these health products at the household level for potential of co-investment in multiple micronutrient powders. Methods: During the intervention (six months), household surveys were conducted once with mothers of children 6-59 months in the Arusha District regarding willingness to pay for the multiple micronutrient powders. Results: Results from the survey show that about 66% of the target mothers are willing to pay for multiple micronutrient powders required for feeding of children at 0.068$ per sachet. Willingness to pay was associated with higher paternal education, higher maternal age, and families which do not keep animals. Conclusion: The results findings help to know the market situation of nutritional products. This information is useful for health policy planners in assessing economic viability and sustainability of the distribution of multiple micronutrient powders to consumers to avert micronutrient deficiencies and their effects on young children.","PeriodicalId":92074,"journal":{"name":"Journal of health & medical economics","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.36648/2471-9927.4.2.41","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69706639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Change in Insurance Status and Cost-related Medication Non-adherence among Older U.S. Adults with Diabetes from 2010 to 2014. 2010年至2014年美国老年糖尿病患者保险状况和费用相关药物依从性的变化

Journal of health & medical economics Pub Date : 2018-01-01 DOI: 10.21767/2471-9927.100040

James X Zhang, Deepon Bhaumik, Elbert S Huang, David O Meltzer

{"title":"Change in Insurance Status and Cost-related Medication Non-adherence among Older U.S. Adults with Diabetes from 2010 to 2014.","authors":"James X Zhang, Deepon Bhaumik, Elbert S Huang, David O Meltzer","doi":"10.21767/2471-9927.100040","DOIUrl":"https://doi.org/10.21767/2471-9927.100040","url":null,"abstract":"Objective: Cost-related medication non-adherence (CRN) is a persistent challenge in health care in the U.S. Insurance coverage is a key determinant of access to medical care. We seek to examine the CRN rates among the older diabetes adult population in the U.S. from 2010 to 2014 when the major provisions of the Affordable Care Act came into force.Research design and method: Data from the 2010 and 2014 Health and Retirement Study (HRS) were used for this study. CRN is identified if a respondent indicated taking less medication than was prescribed because of the cost, while diabetes is self-reported. We assessed the change in CRN rates by insurance status using multivariable logistic regression analysis.Results: A total of 4,741 and 4,505 diabetes adults aged 50 or older in 2010 and 2014 were included in the analyses, representing 18.8 million and 19.1 million older adults with diabetes respectively. Overall, the percentage of dual-eligible diabetes patients increased from 8% to 10% and the uninsured decreased from 6% to 4% based on weighted population estimates. The CRN rates decreased from 27% to 21% and from 12% to 10% for those between 50 and 64, and 65 or older, respectively from 2010 to 2014. Race (African American) became a less significant factor for variations in CRN rates in 2014 (p=0.24).Conclusions: There is an encouraging reduction in CRN rates after implementation of the ACA. However, CRN rates among diabetes patients between 50 and 65 of age remained high.","PeriodicalId":92074,"journal":{"name":"Journal of health & medical economics","volume":"4 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322665/pdf/nihms-996958.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36839931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 16

The High Cost-related Medication Non-adherence Rate Among Medicare-Medicaid Dual-Eligible Diabetes Patients. 医疗-医疗补助双重资格糖尿病患者的高费用相关药物不依遵率。

Journal of health & medical economics Pub Date : 2016-01-01 Epub Date: 2016-02-25

James X Zhang, David O Meltzer

{"title":"The High Cost-related Medication Non-adherence Rate Among Medicare-Medicaid Dual-Eligible Diabetes Patients.","authors":"James X Zhang, David O Meltzer","doi":"","DOIUrl":"","url":null,"abstract":"Context: Access barriers to effective medication treatment have been a persistent issue for millions of older Americans despite the establishment of Medicare Part D.Objective: We aimed to assess the prevalence rate of cost-related medication non-adherence (CRN) and the patterns of CRN behaviors in Medicare-Medicaid dual eligibles with diabetes.Design setting patients interventions and main outcome measures: We used data from the 2011 Medicare Current Beneficiary Survey, a nationally representative sample of Medicare beneficiaries. Multivariate logistic regression analysis was performed to assess CRN rate, controlling for demographics and types of Medicare Part D plans.Results: The CRN rate in dual-eligible diabetes patients was 21%, compared to 16% in non-dual-eligible diabetes patients (p<0.01). In 2011, the standardized prevalence rate of CRN in dual-eligible diabetes patients was 21%, of those with CRN 29% reported three or more types of CRN behaviors.Conclusion: Contrary to the common belief that dual eligibles have better insurance coverage for medication due to the assistance from Medicaid to pay some of the out-of-pocket payments, the CRN rate among dual eligibles is high and patients often report multiple types of CRN behaviors. This demonstrates that cost is a significant access barrier for dual-eligible diabetes patients. More research is needed to improve the insurance benefit design and expand insurance coverage for this high-need, high-cost subpopulation.","PeriodicalId":92074,"journal":{"name":"Journal of health & medical economics","volume":"2 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546751/pdf/nihms883771.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35255075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0