Impact of postherpetic neuralgia and painful diabetic peripheral neuropathy on health care costs.
Dworkin Robert H,Malone Daniel C,Panarites Christopher J,Armstrong Edward P,Pham Sissi V
The journal of pain : official journal of the American Pain Society
UNLABELLED:Knowledge of the health care costs associated with neuropathic pain is limited. Existing studies have not directly compared the health care costs of different neuropathic pain conditions, and patients with neuropathic pain have not been compared with control subjects with the same underlying conditions (for example, diabetes). To determine health care costs associated with postherpetic neuralgia (PHN) and painful diabetic peripheral neuropathy (DPN), patients with these conditions were selected from 2 different administrative databases of health care claims and respectively matched to control subjects who had a diagnosis of herpes zoster without persisting pain or a diagnosis of diabetes without neurological complications using propensity scores for demographic and clinical factors. Total excess health care costs attributable to PHN and painful DPN and excess costs for inpatient care, outpatient/professional services, and pharmacy expenses were calculated. The results indicated that the annual excess health care costs associated with peripheral neuropathic pain in patients of all ages range from approximately $1600 to $7000, depending on the specific pain condition. Total excess health care costs associated with painful DPN were substantially greater than those associated with PHN, which might reflect the great medical comorbidity associated with DPN. PERSPECTIVE:The data demonstrate that the health care costs associated with 1 peripheral neuropathic pain condition cannot be extrapolated to other neuropathic pain conditions. The results also increase understanding of the economic burden of PHN and painful DPN and provide a basis for evaluating the impact on health care costs of new interventions for their treatment and prevention.
Out-of-pocket payments in the context of a free maternal health care policy in Burkina Faso: a national cross-sectional survey.
Meda Ivlabèhiré Bertrand,Baguiya Adama,Ridde Valéry,Ouédraogo Henri Gautier,Dumont Alexandre,Kouanda Seni
Health economics review
BACKGROUND:In April 2016, Burkina Faso introduced a free health care policy for women. Instead of reimbursing health facilities, as many sub-Saharan countries do, the government paid them prospectively for covered services to avoid reimbursement delays, which are cited as a reason for the persistence of out-of-pocket (OOP) payments. This study aimed to (i) estimate the direct expenditures of deliveries and covered obstetric care, (ii) determine the OOP payments, and (iii) identify the patient and health facility characteristics associated with OOP payments. METHODS:A national cross-sectional study was conducted in September and October 2016 in 395 randomly selected health facilities. A structured questionnaire was administered to women (n = 593) who had delivered or received obstetric care on the day of the survey. The direct health expenditures included fees for consultations, prescriptions, paraclinical examinations, hospitalization and ambulance transport. A two-part model with robust variances was performed to identify the factors associated with OOP payments. RESULTS:A total of 587 women were included in the analysis. The median direct health expenses were US$5.38 [interquartile range (IQR):4.35-6.65], US$24.72 [IQR:16.57-46.09] and US$136.39 [IQR: 108.36-161.42] for normal delivery, dystocia and cesarean section, respectively. Nearly one-third (29.6%, n = 174) of the women reported having paid for their care. OOP payments ranged from US$0.08 to US$98.67, with a median of US$1.77 [IQR:0.83-7.08]). Overall, 17.5% (n = 103) of the women had purchased drugs at private pharmacies, and 11.4% (n = 67) had purchased cleaning products for a room or equipment. OOP payments were more frequent with age, for emergency obstetric care and among women who work. The women's health region of origin was also significantly associated with OOP payments. For those who made OOP payments, the amounts paid decreased with age but were higher in urban areas, in hospitals, and among the most educated women. The amounts paid were lower among students and were associated with health region. CONCLUSION:The policy is effective for financial protection. However, improvements in the management and supply system of health facilities' pharmacies could further reduce OOP payments in the context of the free health care policy in Burkina Faso.
Research on diagnosis-related group grouping of inpatient medical expenditure in colorectal cancer patients based on a decision tree model.
Wu Suo-Wei,Pan Qi,Chen Tong
World journal of clinical cases
BACKGROUND:In 2018, the diagnosis-related groups prospective payment system (DRGs-PPS) was introduced in a trial operation in Beijing according to the requirements of medical and health reform. The implementation of the system requires that more than 300 disease types pay through the DRGs-PPS for medical insurance. Colorectal cancer (CRC), as a common malignant tumor with high prevalence in recent years, was among the 300 disease types. AIM:To investigate the composition and factors related to inpatient medical expenditure in CRC patients based on disease DRGs, and to provide a basis for the rational economic control of hospitalization expenses for the diagnosis and treatment of CRC. METHODS:The basic material and cost data for 1026 CRC inpatients in a Grade-A tertiary hospital in Beijing during 2014-2018 were collected using the medical record system. A variance analysis of the composition of medical expenditure was carried out, and a multivariate linear regression model was used to select influencing factors with the greatest statistical significance. A decision tree model based on the exhaustive automatic interaction detector (E-CHAID) algorithm for DRG grouping was built by setting chosen factors as separation nodes, and the payment standard of each diagnostic group and upper limit cost were calculated. The correctness and rationality of the data were re-evaluated and verified by clinical practice. RESULTS:The average hospital stay of the 1026 CRC patients investigated was 18.5 d, and the average hospitalization cost was 57872.4 RMB yuan. Factors including age, gender, length of hospital stay, diagnosis and treatment, as well as clinical operations had significant influence on inpatient expenditure ( < 0.05). By adopting age, diagnosis, treatment, and surgery as the grouping nodes, a decision tree model based on the E-CHAID algorithm was established, and the CRC patients were divided into 12 DRG cost groups. Among these 12 groups, the number of patients aged ≤ 67 years, and underwent surgery and chemotherapy or radiotherapy was largest; while patients aged > 67 years, and underwent surgery and chemotherapy or radiotherapy had the highest medical cost. In addition, the standard cost and upper limit cost in the 12 groups were calculated and re-evaluated. CONCLUSION:It is important to strengthen the control over the use of drugs and management of the hospitalization process, surgery, diagnosis and treatment to reduce the economic burden on patients. Tailored adjustments to medical payment standards should be made according to the characteristics and treatment of disease types to improve the comprehensiveness and practicability of the DRGs-PPS.
Cost of illness of inflammatory bowel disease in the UK: a single centre retrospective study.
Bassi A,Dodd S,Williamson P,Bodger K
BACKGROUND AND AIMS:The potentially high costs of care associated with inflammatory bowel disease (IBD) are recognised but we have little knowledge of the scale, profile, or determinants of these costs in the UK. This study aimed to describe costs of illness for a group of IBD patients and determine factors associated with increased healthcare costs. SETTING:A university hospital serving a target population of approximately 330 000. PATIENTS AND METHODS:A six month cohort of IBD patients receiving any form of secondary care was identified, comprising 307 cases of ulcerative (or indeterminate) colitis and 172 cases of Crohn's disease. Demographic and clinical data were abstracted from clinical records and individual resource use was itemised for all attributable costs (including extraintestinal manifestations). Item costs were derived from national and local sources. Cost data were expressed as mean six month costs per patient (with 95% confidence interval (CI)) obtained using non-parametric bootstrapping. Determinants of cost were analysed using generalised linear regression modelling. A postal survey of patients was undertaken to examine indirect costs, out of pocket expenses, and primary care visits. RESULTS:Inpatient services (medical and/or surgical) were required by 67 patients (14%) but accounted for 49% of total secondary care costs. Drug costs accounted for less than a quarter of total costs. Individual patient costs ranged from 73 to 33,254 UK pounds per six months. Mean (95% CI) six month costs per patient were 1256 UK pounds ( 988 pounds, 1721 pounds) for colitis and 1652 UK pounds (1221 pounds, 2239 pounds) for Crohn's disease. Hospitalisation, disease severity grade, and disease extent correlated positively with cost of illness but costs were independent of age or sex. Compared with quiescent cases of IBD, disease relapse was associated with a 2-3-fold increase in costs for non-hospitalised cases and a 20-fold increase in costs for hospitalised cases. Survey data suggested average six month costs were < 30 UK pounds per patient for primary care visits (both diseases) and median loss of earnings were 239 UK pounds for colitis and 299 UK pounds for Crohn's disease. CONCLUSIONS:This study represents the first detailed characterisation of the scale and determinants of costs of illness for IBD in a British hospital. Hospitalisation affected a minority of sufferers but accounted for half of the total direct costs falling on the healthcare system.
Diagnosis related group grouping study of senile cataract patients based on E-CHAID algorithm.
Luo Ai-Jing,Chang Wei-Fu,Xin Zi-Rui,Ling Hao,Li Jun-Jie,Dai Ping-Ping,Deng Xuan-Tong,Zhang Lei,Li Shao-Gang
International journal of ophthalmology
AIM:To figure out the contributed factors of the hospitalization expenses of senile cataract patients (HECP) and build up an area-specified senile cataract diagnosis related group (DRG) of Shanghai thereby formulating the reference range of HECP and providing scientific basis for the fair use and supervision of the health care insurance fund. METHODS:The data was collected from the first page of the medical records of 22 097 hospitalized patients from tertiary hospitals in Shanghai from 2010 to 2012 whose major diagnosis were senile cataract. Firstly, we analyzed the influence factors of HECP using univariate and multivariate analysis. DRG grouping was conducted according to the exhaustive Chi-squared automatic interaction detector (E-CHAID) model, using HECP as target variable. Finally we evaluated the grouping results using non-parametric test such as Kruskal-Wallis test, RIV, CV, RESULTS:The 6 DRGs were established as well as criterion of HECP, using age, sex, type of surgery and whether complications/comorbidities occurred as the key variables of classification node of senile cataract cases. CONCLUSION:The grouping of senile cataract cases based on E-CHAID algorithm is reasonable. And the criterion of HECP based on DRG can provide a feasible way of management in the fair use and supervision of medical insurance fund.
[Direct and indirect costs of fractures due to osteoporosis in Austria].
Dimai H-P,Redlich K,Schneider H,Siebert U,Viernstein H,Mahlich J
Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany))
OBJECTIVES:We examined the financial burden of osteoporosis in Austria. METHODS:We took both direct and indirect costs into consideration. Direct costs encompass medical costs such as expenses for pharmaceuticals, inpatient and outpatient medical care costs, as well as other medical services (e.g., occupational therapies). Non-medical direct costs include transportation costs and medical devices (e.g., wheel chairs or crutches). Indirect costs refer to costs of productivity losses due to absence of work. Moreover, we included costs for early retirement and opportunity costs of informal care provided by family members. While there exist similar studies for other countries, this is the first comprehensive study for Austria. For our analysis, we combined data of official statistics, expert estimates as well as unique patient surveys that are currently conducted in the course of an international osteoporotic fracture study in Austria. RESULTS:Our estimation of the total annual costs in the year 2008 imposed by osteoporosis in Austria is 707.4 million €. The largest fraction of this amount is incurred by acute hospital treatment. Another significant figure, accounting for 29% of total costs, is the opportunity cost of informal care. CONCLUSIONS:The financial burden of osteoporosis in Austria is substantial. Economic evaluations of preventive and therapeutic interventions for the specific context of Austria are needed to inform health policy decision makers.
Direct and indirect costs of adult patients with chronic rhinosinusitis with nasal polyps.
Lourijsen E S,Fokkens W J,Reitsma S
BACKGROUND:European direct and indirect cost data is missing for patients with chronic rhinosinusitis with nasal polyps (CRSwNP). This study was aimed to establish the economic burden of CRSwNP based on a Dutch cohort of patients. METHODS:A cross-sectional study was performed in adult patients with CRSwNP (N=115) to calculate mean annual direct medical costs and indirect costs per patient with CRSwNP. Outpatient visits, general practitioner visits, first aid visits, hospitalisation and patient travel expenses were measured with the iMTA medical consumption questionnaire. Missed workdays (absenteeism) and decreased productivity during paid work (presenteeism) or during daily life were measured with the and the iMTA productivity cost questionnaire. RESULTS:Total direct costs were €1501 per patient/year, primarily due to outpatient department visits and hospitalisation. Indirect costs were €5659 per patient/year, with productivity losses as major cost expense. CONCLUSION:Adult patients with CRSwNP have higher indirect costs than direct costs and this forms a substantial burden to society. Total annual costs of patients with CRSwNP are estimated to be 1,9 billion/year in the Netherlands.
Cost analysis and related factors in patients with traumatic hand injury.
Şahin F,Akca H,Akkaya N,Zincir Ö D,Işik A
The Journal of hand surgery, European volume
The aim of this study was to measure the direct and indirect costs and factors influencing these costs in patients presenting following traumatic hand injury. We assessed patients aged 18-65 years who were in work. Hand injury severity and functional status were assessed. Direct costs, including medical care expenses, and indirect costs, including lost productivity, were calculated. Seventy-nine patients of a mean age of 32 years were included. The mean direct cost for each patient was $1772 (47% of total cost), and the indirect cost was $1891 (53% of total cost). Injury severity, time to return to work, and hospitalization time were the main parameters of increased total cost in a linear regression analysis.
A population-based estimate of the economic burden of influenza in Peru, 2009-2010.
Tinoco Yeny O,Azziz-Baumgartner Eduardo,Rázuri Hugo,Kasper Matthew R,Romero Candice,Ortiz Ernesto,Gomez Jorge,Widdowson Marc-Alain,Uyeki Timothy M,Gilman Robert H,Bausch Daniel G,Montgomery Joel M,
Influenza and other respiratory viruses
INTRODUCTION:Influenza disease burden and economic impact data are needed to assess the potential value of interventions. Such information is limited from resource-limited settings. We therefore studied the cost of influenza in Peru. METHODS:We used data collected during June 2009-December 2010 from laboratory-confirmed influenza cases identified through a household cohort in Peru. We determined the self-reported direct and indirect costs of self-treatment, outpatient care, emergency ward care, and hospitalizations through standardized questionnaires. We recorded costs accrued 15-day from illness onset. Direct costs represented medication, consultation, diagnostic fees, and health-related expenses such as transportation and phone calls. Indirect costs represented lost productivity during days of illness by both cases and caregivers. We estimated the annual economic cost and the impact of a case of influenza on a household. RESULTS:There were 1321 confirmed influenza cases, of which 47% sought health care. Participants with confirmed influenza illness paid a median of $13 [interquartile range (IQR) 5-26] for self-treatment, $19 (IQR 9-34) for ambulatory non-medical attended illness, $29 (IQR 14-51) for ambulatory medical attended illness, and $171 (IQR 113-258) for hospitalizations. Overall, the projected national cost of an influenza illness was $83-$85 millions. Costs per influenza illness represented 14% of the monthly household income of the lowest income quartile (compared to 3% of the highest quartile). CONCLUSION:Influenza virus infection causes an important economic burden, particularly among the poorest families and those hospitalized. Prevention strategies such as annual influenza vaccination program targeting SAGE population at risk could reduce the overall economic impact of seasonal influenza.
Economic burden of schizophrenia in Italy: a probabilistic cost of illness analysis.
Marcellusi Andrea,Fabiano Gianluca,Viti Raffaella,Francesa Morel Pier Cesare,Nicolò Giuseppe,Siracusano Alberto,Mennini Francesco Saverio
OBJECTIVES:Schizophrenia is a chronic, debilitating psychiatric disease with highly variable treatment pathways and consequent economic impacts on resource utilisation. The aim of the study was to estimate the economic burden of schizophrenia in Italy for both the societal and Italian National Healthcare perspective. METHODS:A probabilistic cost of illness model was applied. A systematic literature review was carried out to identify epidemiological and economic data. Direct costs were calculated in terms of drugs, hospitalisations, specialist services, residential and semiresidential facilities. Indirect costs were calculated on the basis of patients' and caregivers' loss of productivity. In addition, the impact of disability compensation was taken into account using a database from the Italian National Social Security Institute -Italy (INPS). RESULTS:Overall, 303 913 prevalent patients with schizophrenia were estimated. Of these, 212 739 (70%) were diagnosed and 175 382 (82%) were treated with antipsychotics. The total economic burden was estimated at €2.7 billion (95% CI €1771.93 to €3988.65), 50.5% due to indirect costs and 49.5% to direct costs. Drugs corresponded to 10% of direct costs and hospitalisations (including residential and semiresidential facilities) accounted for 81%. CONCLUSIONS:This study highlighted that indirect costs and hospitalisations (including residential and semiresidential facilities) play a major role within the expenses associated with schizophrenia in Italy, and this may be considered as a tool for public decision-makers.
Medical Service Quality, Efficiency and Cost Control Effectiveness of Upgraded Case Payment in Rural China: A Retrospective Study.
He Ruibo,Ye Ting,Wang Jing,Zhang Yan,Li Zhong,Niu Yadong,Zhang Liang
International journal of environmental research and public health
As the principal means of reimbursing medical institutions, the effects of case payment still need to be evaluated due to special environments and short exploration periods, especially in rural China. Xi County was chosen as the intervention group, with 36,104, 48,316, and 59,087 inpatients from the years 2011 to 2013, respectively. Huaibin County acted as the control group, with 33,073, 48,122, and 51,325 inpatients, respectively, from the same period. The inpatients' information was collected from local insurance agencies. After controlling for age, gender, institution level, season fixed effects, disease severity, and compensation type, the generalised additive models (GAMs) and difference-in-differences approach (DID) were used to measure the changing trends and policy net effects from two levels (the whole county level and each institution level) and three dimensions (cost, quality and efficiency). At the whole-county level, the cost-related indicators of the intervention group showed downward trends compared to the control group. Total spending, reimbursement fee and out-of-pocket expense declined by ¥346.59 ( < 0.001), ¥105.39 ( < 0.001) and ¥241.2 ( < 0.001), respectively (the symbol ¥ represents Chinese yuan). Actual compensation ratio, length of stay, and readmission rates exhibited ascending trends, with increases of 7% ( < 0.001), 2.18 days ( < 0.001), and 1.5% ( < 0.001), respectively. The intervention group at county level hospital had greater length of stay reduction (¥792.97 < 0.001) and readmission rate growth (3.3% < 0.001) and lower reimbursement fee reduction (¥150.16 < 0.001) and length of stay growth (1.24 days < 0.001) than those at the township level. Upgraded case payment is more reasonable and suitable for rural areas than simple quota payment or cap payment. It has successfully curbed the growth of medical expenses, improved the efficiency of medical insurance fund utilisation, and alleviated patients' economic burden of disease. However, no positive effects on service quality and efficiency were observed. The increase in readmission rate and potential hidden dangers for primary health care institutions should be given attention.
Incremental Health Care Expenditure of Chronic Cutaneous Ulcers in the United States.
Tripathi Raghav,Knusel Konrad D,Ezaldein Harib H,Honaker Jeremy S,Bordeaux Jeremy S,Scott Jeffrey F
Importance:Despite the increasing incidence of chronic cutaneous ulcers (CCUs), limited information exists regarding their incremental economic burden. Objective:To provide nationally representative estimates regarding the incremental health care cost of CCUs, controlling for comorbidities and sociodemographic characteristics. Design, Setting, and Participants:This retrospective analysis used 9 years of longitudinal data from the Medical Expenditure Panel Survey (MEPS; January 1, 2007, through December 31, 2015). Patients with CCUs were identified using Agency for Healthcare Research and Quality-produced software that included several codes from the International Classification of Disease, 9th Revision Clinical Modification, for chronic ulcers of the skin. A cross-validated 2-part generalized linear model estimated the adjusted incremental expenditure for individuals with CCUs while controlling for comorbidities and sociodemographic covariates. Data were analyzed from July 1 through September 1, 2018. Main Outcomes and Measures:Incremental cost of CCUs, total cost of care, and expenditures associated with inpatient care, outpatient care, prescription medications, emergency department visits, and home health care. Results:A total of 288 698 patients (52.4% female; mean [SD] age, 38.2 [22.4] years) were included, of whom 1786 had CCUs and 286 912 did not. Patients with CCUs were more likely to be female (1078 [60.4%]), non-Hispanic (1388 [77.7%]), previously or currently married (1440 [80.6%]), and covered by Medicaid/Medicare (852 [47.7%]) and had a lower income (954 [53.4%]) when compared with patients without CCUs (P < .001 for all). The mean (SD) annual cost of care per patient with CCUs was greater than 4 times that of patients without CCUs ($17 958 [$1031.90] vs $4373.20 [$48.48]). After controlling for Charlson comorbidity index and sociodemographic factors measured in MEPS, the cost of care for patients with CCUs was 1.73 times as high as that of patients without CCUs (95% CI, 1.53-1.96; P < .001), and patients with CCUs were estimated to incur $7582.00 (95% CI, $6201.47-$8800.45) more in annual health care expenditures. When accounting for the prevalence of CCUs (0.6%), CCUs were associated with more than $16.7 billion per year in population-level US health care expenditures. Among patients with CCUs, mean annual expenditures rose from the 2010-2012 to 2013-2015 periods in association with prescription medications ($3117.26 to $6169.12), outpatient care ($3568.06 to $5920.75), and home health care ($1039.54 to $1670.56). Conclusions and Relevance:Results of this study suggest that chronic cutaneous ulcers are associated with substantial incremental increases in annual health care expenditure. Expenses for patients with CCUs are increasing, particularly with regard to outpatient cost of care and prescription medication expenditure. As health care costs rise, investigators must identify strategies to prevent and treat CCUs.
Cost Analysis of 48 Burn Patients in a Mass Casualty Explosion Treated at Chang Gung Memorial Hospital.
Mathews Alexandra L,Cheng Ming-Huei,Muller John-Michael,Lin Miffy Chia-Yu,Chang Kate W C,Chung Kevin C
INTRODUCTION:Little is known about the costs of treating burn patients after a mass casualty event. A devastating Color Dust explosion that injured 499 patients occurred on June 27, 2015 in Taiwan. This study was performed to investigate the economic effects of treating burn patients at a single medical center after an explosion disaster. METHODS:A detailed retrospective analysis on 48 patient expense records at Chang Gung Memorial Hospital after the Color Dust explosion was performed. Data were collected during the acute treatment period between June 27, 2015 and September 30, 2015. The distribution of cost drivers for the entire patient cohort (n=48), patients with a percent total body surface area burn (%TBSA)≥50 (n=20), and those with %TBSA <50 (n=28) were analyzed. RESULTS:The total cost of 48 burn patients over the acute 3-month time period was $2,440,688, with a mean cost per patient of $50,848 ±36,438. Inpatient ward fees (30%), therapeutic treatment fees (22%), and medication fees (11%) were found to be the three highest cost drivers. The 20 patients with a %TBSA ≥50 consumed $1,559,300 (63.8%) of the total expenses, at an average cost of $77,965±34,226 per patient. The 28 patients with a %TBSA <50 consumed $881,387 (36.1%) of care expenses, at an average cost of $31,478±23,518 per patient. CONCLUSIONS:In response to this mass casualty event, inpatient ward fees represented the largest expense. Hospitals can reduce this fee by ensuring wound dressing and skin substitute materials are regionally stocked and accessible. Medication fees may be higher than expected when treating a mass burn cohort. In preparation for a future event, hospitals should anticipate patients with a %TBSA≥50 will contribute the majority of inpatient expenses.
Direct cost associated with acquired brain injury in Ontario.
Chen Amy,Bushmeneva Ksenia,Zagorski Brandon,Colantonio Angela,Parsons Daria,Wodchis Walter P
BACKGROUND:Acquired Brain Injury (ABI) from traumatic and non traumatic causes is a leading cause of disability worldwide yet there is limited research summarizing the health system economic burden associated with ABI. The objective of this study was to determine the direct cost of publicly funded health care services from the initial hospitalization to three years post-injury for individuals with traumatic (TBI) and non-traumatic brain injury (nTBI) in Ontario Canada. METHODS:A population-based cohort of patients discharged from acute hospital with an ABI code in any diagnosis position in 2004 through 2007 in Ontario was identified from administrative data. Publicly funded health care utilization was obtained from several Ontario administrative healthcare databases. Patients were stratified according to traumatic and non-traumatic causes of brain injury and whether or not they were discharged to an inpatient rehabilitation center. Health system costs were calculated across a continuum of institutional and community settings for up to three years after initial discharge. The continuum of settings included acute care emergency departments inpatient rehabilitation (IR) complex continuing care home care services and physician visits. All costs were calculated retrospectively assuming the government payer's perspective. RESULTS:Direct medical costs in an ABI population are substantial with mean cost in the first year post-injury per TBI and nTBI patient being $32132 and $38018 respectively. Among both TBI and nTBI patients those discharged to IR had significantly higher treatment costs than those not discharged to IR across all institutional and community settings. This tendency remained during the entire three-year follow-up period. Annual medical costs of patients hospitalized with a brain injury in Ontario in the first follow-up year were approximately $120.7 million for TBI and $368.7 million for nTBI. Acute care cost accounted for 46-65% of the total treatment cost in the first year overwhelming all other cost components. CONCLUSIONS:The main finding of this study is that direct medical costs in ABI population are substantial and vary considerably by the injury cause. Although most expenses occur in the first follow-up year ABI patients continue to use variety of medical services in the second and third year with emphasis shifting over time from acute care and inpatient rehabilitation towards homecare physician services and long-term institutional care. More research is needed to capture economic costs for ABI patients not admitted to acute care.
Cost analysis of chronic intestinal failure.
Canovai Emilio,Ceulemans Laurens J,Peers Guido,De Pourcq Lutgart,Pijpops Marleen,De Hertogh Gert,Hiele Martin,Pirenne Jacques,Vanuytsel Tim
Clinical nutrition (Edinburgh, Scotland)
BACKGROUND & AIMS:Chronic intestinal failure is a complex medical condition which is associated with high costs. These patients require long-term home parenteral nutrition (HPN) and costs are compounded by frequent admissions for the underlying disease and HPN. However, it is unknown what the specific costs subdivisions are and how they evolve over time. The aim of the study was to evaluate the cost dynamics of HPN care in a cohort of stable, long-term intestinal failure patients. METHODS:A retrospective analysis of our single-center long-term (>2 years), benign HPN population was performed. All relevant clinical and financial data were collected: costs of hospital admissions, diagnostics, treatments, out-patient clinics, home care, medication, materials and HPN education. The costs were tabulated and assigned by cause (HPN related, underlying disease-related or -unrelated). Patients with complicated intestinal failure (defined as impending loss of vascular access, liver failure or recurrent fluid/electrolyte disorders) were excluded. Data are presented as median (range). RESULTS:Thirty-seven patients (24 female; age 58.6 ± 13.3 years) were included in the study. HPN duration was 5.3 years (2.1-15.1) at 4.3 infusion days per week (1.5-7). Total cost of the first HPN year was €83,503 (35,364-256,780). HPN-related costs accounted for 69% (€57,593) vs 27% for underlying disease-related costs (€22,505) and 4% for disease-unrelated costs (€3065). HPN complications cost €16,077 in the first year and accounted for 31% of HPN costs. The total cost dropped by 15% in the second year to €71,311. This reduction was due to fewer hospital admissions and fewer HPN complications. This trend continued and by year 5 the annual cost was 40% cheaper compared to year 1 (€58,187 vs €83,503). CONCLUSIONS:HPN related costs accounted for the majority of the total expenses in IF patients. The costs declined after the first year due to a reduction in complications and hospital admissions.
The household economic burden for acute coronary syndrome survivors in Australia.
Hyun Karice K,Essue Beverley M,Woodward Mark,Jan Stephen,Brieger David,Chew Derek,Nallaiah Kellie,Howell Tegwen,Briffa Tom,Ranasinghe Isuru,Astley Carolyn,Redfern Julie
BMC health services research
BACKGROUND:Studies of chronic diseases are associated with a financial burden on households. We aimed to determine if survivors of acute coronary syndrome (ACS) experience household economic burden and to quantify any potential burden by examining level of economic hardship and factors associated with hardship. METHODS:Australian patients admitted to hospital with ACS during 2-week period in May 2012, enrolled in SNAPSHOT ACS audit and who were alive at 18 months after index admission were followed-up via telephone/paper survey. Regression models were used to explore factors related to out-of-pocket expenses and economic hardship. RESULTS:Of 1833 eligible patients at baseline, 180 died within 18 months, and 702 patients completed the survey. Mean out-of-pocket expenditure (n = 614) in Australian dollars was A$258.06 (median: A$126.50) per month. The average spending for medical services was A$120.18 (SD: A$310.35) and medications was A$66.25 (SD: A$80.78). In total, 350 (51 %) of patients reported experiencing economic hardship, 78 (12 %) were unable to pay for medical services and 81 (12 %) could not pay for medication. Younger age (18-59 vs ≥80 years (OR): 1.89), no private health insurance (OR: 2.04), pensioner concession card (OR: 1.80), residing in more disadvantaged area (group 1 vs 5 (OR): 1.77), history of CVD (OR: 1.47) and higher out-of-pocket expenses (group 4 vs 1 (OR): 4.57) were more likely to experience hardship. CONCLUSION:Subgroups of ACS patients are experiencing considerable economic burden in Australia. These findings provide important considerations for future policy development in terms of the cost of recommended management for patients.
A novel hybrid modeling approach for the evaluation of integrated care and economic outcome in heart failure treatment.
Lassnig Alexander,Rienmueller Theresa,Kramer Diether,Leodolter Werner,Baumgartner Christian,Schroettner Joerg
BMC medical informatics and decision making
BACKGROUND:Demographic changes, increased life expectancy and the associated rise in chronic diseases pose challenges to public health care systems. Optimized treatment methods and integrated concepts of care are potential solutions to overcome increasing financial burdens and improve quality of care. In this context modeling is a powerful tool to evaluate potential benefits of different treatment procedures on health outcomes as well as health care budgets. This work presents a novel modeling approach for simulating different treatment procedures of heart failure patients based on extensive data sets from outpatient and inpatient care. METHODS:Our hybrid heart failure model is based on discrete event and agent based methodologies and facilitates the incorporation of different therapeutic procedures for outpatient and inpatient care on patient individual level. The state of health is modeled with the functional classification of the New York Heart Association (NYHA), strongly affecting discrete state transition probabilities alongside age and gender. Cooperation with Austrian health care and health insurance providers allowed the realization of a detailed model structure based on clinical data of more than 25,000 patients. RESULTS:Simulation results of conventional care and a telemonitoring program underline the unfavorable prognosis for heart failure and reveal the correlation of NYHA classes with health and economic outcomes. Average expenses for the treatment of NYHA class IV patients of €10,077 ± €165 were more than doubled compared to other classes. The selected use case of a telemonitoring program demonstrated potential cost savings within two years of application. NYHA classes II and III revealed most potential for additional treatment measures. CONCLUSION:The presented model allows performing extensive simulations of established treatment procedures for heart failure patients and evaluating new holistic methods of care and innovative study designs. This approach offers health care providers a unique, adaptable and comprehensive tool for decision making in the complex and socioeconomically challenging field of cardiovascular diseases.
Trend of disparity between coastland and inland in medical expenditure burden for rural inpatients with malignant tumor in southeast of China from 2007 to 2016.
Fu Rong,Lin Zheng,He Fei,Jiang Yixian,Zheng Zhenquan,Hu Zhijian
BACKGROUND:New Rural Cooperative Medical Scheme (NRCMS) was developed to improve the health security for rural residents. This study aimed to assess the trend of disparity between coastland and inland in medical expenditure burden for rural inpatients with malignant tumor from 2007 to 2016 under the effect of NRCMS. METHODS:The data from medical records of 1,306,895 patients with malignant tumor who had NRCMS in 2932 hospitals was collected. The relative differences [95% confidence intervals (CIs)] between coastland and inland in four medical expense indicators were calculated using generalized linear models to assess the trend of disparity over time. RESULTS:In total, there were 769,484 (58.88%) coastland patients and 537,411 (41.12%) inland patients. Male and patients aged older than 44 years accounted for 56.87 and 80% of 1,306,895 patients, respectively. After adjusting for gender, age, tumor site and hospital level, coastland patients had higher hospitalization expenses which were all medical expenses incurred during the hospitalization, lower reimbursement ratio and ratio of out-of-pocket expenses to disposable income than inland patients in most years. The surgery expenses of coastland patients were lower than those of inland patients in 2016. The relative differences (95% CIs) between coastland and inland in medical expense indicators were moving closer to 1.0 from 2007 to 2010 among patients without surgery, implying that the disparity between two areas significantly narrowed. The range of change was similar between two areas from 2011 to 2016 whether among patients without or with surgery, implying that the disparity did not significantly change. The disparity between coastland and inland depended on the household income situation. For low-income patients, the differences between two areas in medical expense indicators were not statistically significance in most cases and the disparity between two areas did not significantly change over time. CONCLUSIONS:Under the effect of NRCMS, the medical expenditure burden of rural inpatients reduced but suffering from malignant tumor was still catastrophic. As a whole, the inland patients had heavier medical expenditure burden than coastland patients. Because of economic factors and medical assistance policies, the medical expenditure burden was similar between coastland and inland low-income patients.
The integration of urban and rural medical insurance to reduce the rural medical burden in China: a case study of a county in Baoji City.
Liu Pei,Guo Wei,Liu Hao,Hua Wei,Xiong Linping
BMC health services research
BACKGROUND:In 2003, the Chinese government launched the New Rural Cooperative medical System(NRCMS) for its rural population. In 2007, the Urban Resident Basic Medical Insurance Scheme(URBMS) was inaugurated, which aimed to cover all urban residents who are out of the labor market. However, the accessibility and fairness of the healthcare service have hindered the progress of universal healthcare. At the beginning of 2010, the Integration of Urban and Rural Medical Insurance Scheme(IURMIS) was implemented to bridge the gap in medical care between urban and rural areas. The main objective of this study is to determine the extent to which the IURMIS has been successful. METHODS:The statistical software packages SPSS 19.0 and STATA 12.0 were used for all analyses, and P < 0.05 was set as the required level of significance. Data were collected from outpatients from 2009 (July to December, n = 20,459) through 2011 (n = 65,258 in 2010, n = 59,036 in 2011) and from inpatients in 2011 (n = 3662). Due to the enormous amount of data and the short time span, most of our analysis was descriptive. However, regression discontinuity (RD) and the chi-squared (χ) test were used to compare the ratios of medical expenses before and after the IURMIS. RESULTS:In the RD analysis, there was a downward trend in the mean medical expense (Coef. = - 0.66, P < 0.001), and rural outpatients flowed to township hospitals and village clinics after the implementation of the IURMIS (Coef. = - 0.45, P < 0.001). However, compensation expenses showed an upward trend (Coef. = 11.59, P < 0.001). In the analysis of inpatient expenses, the average expenses (CNY 2067) and hospitalization days (10.0) for all the hospitals were less than those in the Chinese Fourth National Health Services Survey (CNY 3412 and 10.3, respectively). CONCLUSIONS:Rural residents' healthcare options and quality were improved and medical expenses were significantly reduced after implementation of the scheme. These results provide an evidence-based reference for improving the integration of the urban and rural medical security systems throughout China.
The disease burden of human cystic echinococcosis based on HDRs from 2001 to 2014 in Italy.
Piseddu Toni,Brundu Diego,Stegel Giovanni,Loi Federica,Rolesu Sandro,Masu Gabriella,Ledda Salvatore,Masala Giovanna
PLoS neglected tropical diseases
BACKGROUND:Cystic echinococcosis (CE) is an important neglected zoonotic parasitic infection belonging to the subgroup of seven Neglected Zoonotic Disease (NZDs) included in the World Health Organization's official list of 18 Neglected Tropical Diseases (NTDs). CE causes serious global human health concerns and leads to significant economic losses arising from the costs of medical treatment, morbidity, life impairments and fatality rates in human cases. Moreover, CE is endemic in several Italian Regions. The aim of this study is to perform a detailed analysis of the economic burden of hospitalization and treatment costs and to estimate the Disability Adjusted Life Years (DALYs) of CE in Italy. METHODS AND FINDINGS:In the period from 2001 to 2014, the direct costs of 21,050 Hospital Discharge Records (HDRs) belonging to 12,619 patients with at least one CE-related diagnosis codes were analyzed in order to quantify the economic burden of CE. CE cases average per annum are 901 (min-max = 480-1,583). Direct costs include expenses for hospitalizations, medical and surgical treatment incurred by public and private hospitals and were computed on an individual basis according to Italian Health Ministry legislation. Moreover, we estimated the DALYs for each patient. The Italian financial burden of CE is around € 53 million; the national average economic burden per annum is around € 4 million; the DALYs of the population from 2001 to 2014 are 223.35 annually and 5.26 DALYs per 105 inhabitants. CONCLUSION:In Italy, human CE is responsible for significant economic losses in the public health sector. In humans, costs associated with CE have been shown to have a great impact on affected individuals, their families and the community as a whole. This study could be used as a tool to prioritize and make decisions with regard to a surveillance system for this largely preventable yet neglected disease. It demonstrates the need of implementing a CE control program aimed at preventing the considerable economic and social losses it causes in high incidence areas.
Effect of a typical systemic hospital reform on inpatient expenditure for rural population: the Sanming model in China.
Meng Zhaolin,Zhu Min,Cai Yuanyi,Cao Xiaohong,Wu Huazhang
BMC health services research
BACKGROUND:Considering catastrophic health expenses in rural households with hospitalised members were unproportionally high, in 2013, China developed a model of systemic reform in Sanming by adjusting payment method, pharmaceutical system, and medical services price. The reform was expected to control the excessive growth of hospital expenditures by reducing inefficiency and waste in health system or shortening the length of stay. This study analyzed the systemic reform's impact on the financial burden and length of stay for the rural population in Sanming. METHODS:A total of 1,113,615 inpatient records for the rural population were extracted from the rural new cooperative medical scheme (NCMS) database in Sanming from 2007 to 2012 (before the reform) and from 2013 to 2016 (after the reform). We calculated the average growth rate of total inpatient expenditures and costs of different medical service categories (medications, diagnostic testing, physician services and therapeutic services) in these two periods. Generalized linear models (GLM) were employed to examine the effect of reform on out-of-pocket (OOP) expenditures and length of stay, controlling for some covariates. Furthermore, we controlled the fixed effects of the year and hospitals, and included cluster standard errors by hospital to assess the robustness of the findings in the GLM analysis. RESULTS:The typical systemic reform decreased the average growth rate of total inpatient expenditures by 1.34%, compared with the period before the reform. The OOP expenditures as a share of total expenditures showed a downward trend after the reform (42.34% in 2013). Holding all else constant, individuals after the reform spent ¥308.42 less on OOP expenditures (p < 0.001) than they did before the reform. Moreover, length of stay had a decrease of 0.67 days after the reform (p < 0.001). CONCLUSIONS:These results suggested that the typical systemic hospital reform of the Sanming model had some positive effects on cost control and reducing financial burden for the rural population. Considering the OOP expenditures as a share of total expenditures was still high, China still has a long way to go to improve the benefits rural people have enjoyed from the NCMS.
Direct economic burden of hepatitis B virus related diseases: evidence from Shandong, China.
Lu Jingjing,Xu Aiqiang,Wang Jian,Zhang Li,Song Lizhi,Li Renpeng,Zhang Shunxiang,Zhuang Guihua,Lu Mingshan
BMC health services research
BACKGROUND:Although the expenses of liver cirrhosis are covered by a critical illness fund under the current health insurance program in China, the economic burden associated with hepatitis B virus (HBV) related diseases is not well addressed. In order to provide evidence to address the economic disease burden of HBV, we conducted a survey to investigate the direct economic burden of acute and chronic hepatitis B, cirrhosis and liver cancer caused by HBV-related disease. METHODS:From April 2010 to November 2010, we conducted a survey of inpatients with HBV-related diseases and who were hospitalized for seven or more days in one of the seven tertiary and six secondary hospitals in Shandong, China. Patients were recorded consecutively within a three-to-five month time period from each sampled hospital; an in-person survey was conducted to collect demographic and socio-economic information, as well as direct medical and nonmedical expenses during the last month and last year prior to the current hospitalization. Direct medical costs included total outpatient, inpatient, and self-treatment expenditures; direct nonmedical costs included spending on nutritional supplements, transportation, and nursing. Direct medical costs during the current hospitalization were also obtained from the hospital financial database. The direct economic cost was calculated as the sum of direct medical and nonmedical costs. Our results call for the importance of implementing clinical guideline, improving system accountability, and helping secondary and smaller hospitals to improve efficiency. This has important policy implication for the on-going hospital reform in China. RESULTS:Our data based on inpatients with HBV-related diseases suggested that the direct cost in US dollars for acute hepatitis B, severe hepatitis B, chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis and primary liver cancer was $2954, $10834, $4552, $7400.28, $6936 and $10635, respectively. These costs ranged from 30.72% (for acute hepatitis B) to 297.85% (for primary liver cancer) of the average annual household income in our sample. Even for patients with health insurance, direct out-of-pocket cost of all HBV-related diseases except acute hepatitis B exceeded 40.00% of the patient's disposable household income, making it a catastrophic expenditure for the household. CONCLUSION:Hepatitis B imposes considerable economic burden on a family. Our findings will help health policy makers' understanding of the magnitude of the economic burden of HBV-related diseases in China. Evidence from our study also contributes to our understanding of potential benefits to society from allocating more resources to preventing and treating HBV infection, as well as increasing insurance coverage in China. These findings have important policy implications for health care reform efforts currently underway in China focusing on how to reduce the burden of catastrophic disease for its citizens.
Comorbidity Burden of Dementia: A Hospital-Based Retrospective Study from 2003 to 2012 in Seven Cities in China.
Wang Qing-Hua,Wang Xin,Bu Xian-Le,Lian Yan,Xiang Yang,Luo Hong-Bo,Zou Hai-Qiang,Pu Jie,Zhou Zhong-He,Cui Xiao-Ping,Wang Qing-Song,Shi Xiang-Qun,Han Wei,Wu Qiang,Chen Hui-Sheng,Lin Hang,Gao Chang-Yue,Zhang Li-Li,Xu Zhi-Qiang,Zhang Meng,Zhou Hua-Dong,Wang Yan-Jiang
Dementia is increasing dramatically and imposes a huge burden on society. To date, there is a lack of data on the health status of patients with dementia in China. In an attempt to investigate the comorbidity burden of dementia patients in China at the national level, we enrolled 2,938 patients with Alzheimer's disease (AD), vascular dementia (VaD), or other types of dementia, who were admitted to tertiary hospitals in seven regions of China from January 2003 to December 2012. The Charlson Comorbidity Index (CCI) was used to evaluate the comorbidity burden of the patients with dementia. Among these patients, 53.4% had AD, 26.3% had VaD, and 20.3% had other types of dementia. The CCI was 3.0 ± 1.9 for all patients, 3.4 ± 1.8 for those with VaD, and 3.0 ± 2.1 for those with AD. The CCI increased with age in all patients, and the length of hospital stay and daily expenses rose with age and CCI. Males had a higher CCI and a longer stay than females. Moreover, patients admitted in the last 5 years of the study had a higher CCI than those admitted in the first 5 years. We found that the comorbidity burden of patients with dementia is heavy. These findings provide a better understanding of the overall health status of dementia patients, and help to increase the awareness of clinicians and policy-makers to improve medical care for patients.
Intravenous ceftriaxone at home versus intravenous flucloxacillin in hospital for children with cellulitis: a cost-effectiveness analysis.
Ibrahim Laila F,Huang Li,Hopper Sandy M,Dalziel Kim,Babl Franz E,Bryant Penelope A
The Lancet. Infectious diseases
BACKGROUND:Outpatient parenteral antibiotic therapy after hospital admission is increasingly popular, but its use to avoid admission to hospital altogether by treating patients wholly as outpatients remains uncommon in children. One reason for the low use of treatment at home is the scarcity of evidence of its cost-effectiveness. In this planned follow-up analysis of the Cellulitis at Home or Inpatient in Children from the Emergency Department (CHOICE) trial, we aimed to assess the cost-effectiveness of an admission avoidance pathway, in which children were treated at home, compared with standard hospital care for the intravenous treatment of moderate or severe cellulitis. METHODS:We did a cost-effectiveness analysis to compare home treatment with intravenous ceftriaxone versus hospital treatment with intravenous flucloxacillin in children aged 6 months to 18 years who had presented to the emergency department at The Royal Children's Hospital, Melbourne, VIC, Australia, with moderate or severe uncomplicated cellulitis. We included costs from two sources: institutional costs at a patient level and expenses incurred by families. We measured effectiveness with quality-adjusted life years (QALYs), which we derived from the Child Health Utility 9D questionnaire, and a clinical outcome of treatment failure, which was the primary outcome of the CHOICE trial. We planned to calculate the incremental cost-effectiveness ratio, defined as the difference between groups in total cost divided by the difference between groups in effectiveness. The CHOICE trial is registered at ClinicalTrials.gov, number NCT02334124. FINDINGS:We included 180 children who comprised the per-protocol population in the CHOICE trial: 89 children in the home group and 91 children in the hospital group. The institutional cost per patient per episode was significantly lower in the home group than in the hospital group (AUS$1965 vs $3775; p<0·0001). The mean cost incurred per family was $182 for the home group and $593 for the hospital group (p<0·0001). Both measures of effectiveness were significantly better in the home group than in the hospital group: QALYs were 0·005 for the home group versus 0·004 for the hospital group (p<0·0001), and treatment failure occurred in one (1%) patient in the home group versus seven (8%) patients in the hospital group (risk difference -6·5%, 95% CI -12·4 to -0·7; p=0·029). Calculating the incremental cost-effectiveness ratio was thus deemed redundant. INTERPRETATION:Treatment at home was less costly and more effective than standard hospital care for children with moderate or severe cellulitis. These findings support development of this admission avoidance pathway in hospitals. FUNDING:The Royal Children's Hospital Foundation, Murdoch Children's Research Institute.
The direct and indirect costs of epilepsy in Poland estimates for 2014-2016 years.
Mela Aneta,Staniszewska Anna,Wrona Witold,Poniatowski Łukasz A,Jaroszyński Janusz,Niewada Maciej
Expert review of pharmacoeconomics & outcomes research
BACKGROUND:According to the current data, around 1% of the Poland population have epilepsy, which comprises about 400,000 people. This group of patients requires life-long therapy including both drug therapy and hospitalization. The character of the epilepsy has a significant impact on the expenses borne by individual patients, and the prevalence of the disease has a significant impact on the health care system. METHODS:This article aims to measure the direct and indirect costs of epilepsy in Poland estimates for the years 2014-2016 (top-down approach). We use a modified human capital approach and a unique dataset provided by the number of Polish institutions including National Health Fund, Social Insurance Institution, and Central Statistical Office. RESULTS:Epilepsy burden in Poland is significant. In the years 2014-2016, the total direct cost of epilepsy amounted to, respectively, 355 mln PLN (84 mln EUR), 368 mln PLN (87 mln EUR), and 373 mln PLN (88 mln EUR), but the total indirect cost amounted to 1 bn PLN (239 mln EUR), 949 mln PLN (224 mln EUR), and 848 mln PLN (200 mln EUR). CONCLUSIONS:Direct and indirect costs of epilepsy can be a useful input for health technology analyses of drugs or economic impact assessments of public health programs.
Direct costs for retinoblastoma treatment during the first year of comprehensive therapy in China.
Ji Xunda,Xuan Yi,Li Jing,Zhao Junyang,Lu Shanglin,Zhang Jing,Yan Hui,Zhao Peiquan
Journal of pediatric ophthalmology and strabismus
PURPOSE:To evaluate the direct costs and analyze the potential cost-driving factors in the first year of retinoblastoma treatment in China. METHODS:Sixty-nine pediatric patients who received multidisciplinary treatment for retinoblastoma in three tertiary hospitals from 2006 to 2011 were included in this retrospective study. The direct costs, including costs for chemotherapy, focal therapy, anesthetic procedure, enucleation, fundus examination, hospitalization and outpatient appointment, transportation, and accommodation for family members, were obtained from medical records and interviews. RESULTS:The average direct costs for retinoblastoma treatment was U.S. $9,422 ± 3,709 per patient during the first year. Of this amount, chemotherapy-related expenses were $2,991 ± 3,083 (31.74%), transportation and accommodation expenses were $2,560 ± 1,348 (27.17%), general anesthetic procedure was $1,081 ± 2,711 (11.48%), and enucleation was $900 ± 1,015 (9.56%). The costs for intra-arterial chemotherapy ($1,224 ± 754) and chemotherapy drugs ($517 ± 134) were major components in chemotherapy-related expenses. The retinoblastoma clinical stage and family income positively correlated with the total direct costs (P = .0358 and .0185, respectively). CONCLUSION:Comprehensive treatment involving chemotherapy imposes an enormous economical burden on families affected by retinoblastoma in China.
Economic burden of pneumococcal infections in children under 5 years of age.
Ceyhan Mehmet,Ozsurekci Yasemin,Aykac Kubra,Hacibedel Basak,Ozbilgili Egemen
Human vaccines & immunotherapeutics
The present study aimed to determine the cost of childhood pneumococcal infections under 5 years of age and to provide further data for future health economy studies. Electronic medical records of children diagnosed with meningitis caused by S. pneumoniae and all-cause pneumonia, and acute otitis media (AOM) between January 2013-April 2014 were retrospectively evaluated. Direct costs for the treatments of hospitalized patients (pneumonia and pneumococcal meningitis) including costs of healthcare services consisted of costs of hospital bed, examination, laboratory analyses, scanning methods, consultation, vascular access procedures, and infusion and intravenous treatments. Direct costs for patients (AOM) treated in outpatient setting included constant price paid for the examination and cost of prescribed antibiotics. Indirect costs included cost of work loss of parents and their transportation expenses. Data of 130 children with pneumococcal meningitis (n = 10), pneumonia (n = 53), and AOM (n = 67) were analyzed. The total median cost was €4,060.38 (direct cost: €3,346.38 and indirect cost: €829.18) for meningitis, €835.91 (direct cost: €480.66 and indirect cost: €330.09) for pneumonia, and €117.32 (direct cost: €17.59 and indirect cost: €99.73) for AOM. The medication cost (p = 0.047), indirect cost (p = 0.032), and total cost (p = 0.011) were significantly higher in pneumonia patients aged ≥36 months than those aged <36 months; however, direct cost of AOM were significantly higher in the patients aged <36 months (p = 0.049). Results of the present study revealed that the treatment cost was significantly enhanced for hospitalization and for advanced disease. Thus, preventive actions, mainly vaccination, should be conducted regularly.
The cost of outpatient pneumonia in children <5 years of age in Fiji.
Temple Beth,Griffiths Ulla Kou,Mulholland Edward Kim,Ratu Felisita Tupou,Tikoduadua Lisi,Russell Fiona Mary
Tropical medicine & international health : TM & IH
OBJECTIVES:Pneumonia is the most common reason for visiting an outpatient facility among children <5 years old in Fiji. The objective of this study is to describe for the first time the costs associated with an episode of outpatient pneumonia in Fiji, in terms of cost both to the government health sector and to the household. METHODS:Costs were estimated for 400 clinically diagnosed pneumonia cases from two outpatient facilities, one in the capital, Suva, and one in a peri-urban and rural area, Nausori. Household expenses relating to transport costs, treatment costs and indirect costs were determined primarily through structured interview with the caregiver. Unit costs were collected from a variety of sources. Patient-specific costs were summarised as average costs per facility. RESULTS:The overall average societal cost associated with an episode of outpatient pneumonia was $18.98, ranging from $14.33 in Nausori to $23.67 in Suva. Household expenses represent a significant proportion of the societal cost (29% in Nausori and 45% in Suva), with transport costs the most important household cost item. Health sector expenses were dominated by personnel costs at both sites. Both the average total household expenses and the average total health sector expenses were significantly greater in Suva than Nausori. CONCLUSIONS:A single episode of outpatient pneumonia represents a significant cost both to the government health sector and to affected households. Given the high incidence of this disease in Fiji, this places a considerable burden on society.
[An empirical analysis on the substitution effect of outpatient services on inpatient services].
Jian Wei-yan,Fang Hai
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences
OBJECTIVE:To study the substitution effect of outpatient services on inpatient services and provide suggestions on designing outpatient policies. METHODS:The data were from 13 districts/counties in one area of eastern China from 2007 to 2013 for the new cooperative medical scheme. This study employed a fixed effects model to analyze the impacts of outpatient visit times, expenditure amounts and reimbursements on inpatient services. RESULTS:One outpatient visit reduced the total amount of inpatient services by 20 Yuan. An increase of 10,000 Yuan outpatient reimbursements saved 9,700 Yuan inpatient expenses. An increase of 10,000 Yuan outpatient expenses led to a decrease of 3,000 Yuan inpatient reimbursements. The outpatient services did not increase the inpatient hospitalization times significantly. In particular, the effects of the outpatient services were mainly on the inpatient services at the district/county levels, and no significant impacts on the outpatient services at the city levels. CONCLUSION:There is a substitution effect of outpatient services on inpatient services. The health insurance departments should take this substitution effect into account and shift more funds on outpatient series, when they design outpatient and inpatient reimbursement policies.
Atopic Dermatitis in US Adults: From Population to Health Care Utilization.
Silverberg Jonathan I,Gelfand Joel M,Margolis David J,Boguniewicz Mark,Fonacier Luz,Grayson Mitchell H,Ong Peck Y,Chiesa Fuxench Zelma,Simpson Eric L
The journal of allergy and clinical immunology. In practice
BACKGROUND:Little is known about the predictors of health care utilization among US adults with atopic dermatitis (AD). OBJECTIVE:To determine the proportion and predictors of utilization in outpatient, urgent care, emergency department (ED), and hospital settings in US adults with AD. METHODS:A cross-sectional, population-based study of 3495 adults was performed. AD was determined using modified United Kingdom Working Party criteria. AD severity was assessed using the Patient-Oriented Eczema Measure (POEM), the Patient-Oriented Scoring AD (PO-SCORAD), and the Numeric Rating Scale (NRS)-itch. Weighted frequency and prevalence (95% CIs) of utilization were determined. RESULTS:Overall, 10.42% (95% CI, 8.55%-12.28%; weighted frequency, 25,844,871) reported a diagnosis of AD or eczema, 7.39% (95% CI, 5.81%-8.97%; weighted frequency, 18,324,869) met United Kingdom Working Party criteria, and 3.56% (95% CI, 2.40%-4.72%; weighted frequency, 8,830,095) met both. A total of 31.8% (2,711,690) had a severe score for POEM, PO-SCORAD, and/or NRS-itch, with 4.0% (337,586) having severe scores for all 3. Outpatient utilization for AD was low for mild disease (29.3%-34.7%) and increased by severity (moderate: 36.2%-49.8%; severe: 50.6%-86.6%). Timeliness of appointments, expenses, and insurance coverage were also predictors of outpatient utilization. Severe POEM, PO-SCORAD, and/or NRS-itch were associated with being uninsured, not having full prescription coverage, AD prescriptions being denied by insurers, and costs of AD medications being problematic. One in 10 adults with AD had 1 or more urgent care, ED, or hospital visit in the past year. Urgent care or ED visits were significantly more common among blacks and Hispanics, those with lower household income, those with lower education level, and those with AD prescriptions being denied by the insurance company. CONCLUSIONS:Adults with AD had low rates of outpatient and high rates of urgent care, ED, and hospital visits. The major predictor of outpatient utilization for AD care was AD severity. Racial/ethnic, socioeconomic, and/or health care disparities reduce outpatient utilization and increase urgent care, ED, and hospital utilization.
Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study.
Toscano Cristiana M,Sugita Tatiana H,Rosa Michelle Q M,Pedrosa Hermelinda C,Rosa Roger Dos S,Bahia Luciana R
International journal of environmental research and public health
The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP) (1 Int$ = 1.748 BRL). We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13%) was for inpatient, and Int$ 333.5 million (87%) for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients. Although we have various reasons to believe that the hospital costs are underestimated, the estimated DFD burden is significant. As such, public health preventive strategies to reduce DFD related morbidity and mortality and costs are of utmost importance.
DIRECT COSTS OF TYPE 2 DIABETES: A BRAZILIAN COST-OF-ILLNESS STUDY.
Henriques Ricardo Saad,Steimbach Laiza Maria,Baptista Deise Regina,Lenzi Luana,Tonin Fernanda S,Pontarolo Roberto,Wiens Astrid
International journal of technology assessment in health care
OBJECTIVES:The aim of this study was to evaluate the direct costs of type 2 diabetes mellitus patients treated in a Brazilian public hospital. METHODS:This was an exploratory retrospective cost-of-illness study with quantitative approach, using medical records of patients treated in a public hospital (2012-14), with at least one consultation over a period of 12 months. Data on patient's profile, exams, number of consultations, medications, hospitalizations, and comorbidities were collected. The cost per patient per year (pppy) was calculated as well as the costs related to glycated hemoglobin (HbA1c) values, using thresholds of 7 and 8 percent. RESULTS:Data of 726 patients were collected with mean age of 62 ± 11 years (68.3 percent female). A total of 67.1 percent presented HbA1c > 7 percent and 44.9 percent > 8 percent. The median cost of diabetes was United States dollar (USD) 197 pppy. The median costs of medication were USD 152.49 pppy, while costs of exams and consultations were USD 40.57 pppy and 8.70 pppy, respectively. Thirty-eight patients (4 percent) were hospitalized and presented a median cost of 3,656 per patient per hospitalization with a cost equivalent to 53.1 percent of total expenses. Total costs of patients with HbA1c ≤ 7 percent were lower for this group and also costs of medications and consultations, whereas for patients with HbA1c ≤ 8 percent, only total costs and costs of medications were lower when compared with HbA1c > 8 percent patients. CONCLUSIONS:Medications and hospitalizations were the major contributor of diabetes expenses. Preventing T2DM, or reducing its complications through adequate control, may help avoid the substantial costs related to this disease.
Health and economic burden of influenza-associated illness in South Africa, 2013-2015.
Tempia Stefano,Moyes Jocelyn,Cohen Adam L,Walaza Sibongile,Edoka Ijeoma,McMorrow Meredith L,Treurnicht Florette K,Hellferscee Orienka,Wolter Nicole,von Gottberg Anne,Nguweneza Athermon,McAnerney Johanna M,Dawood Halima,Variava Ebrahim,Cohen Cheryl
Influenza and other respiratory viruses
BACKGROUND:Economic burden estimates are essential to guide policy-making for influenza vaccination, especially in resource-limited settings. METHODS:We estimated the cost, absenteeism, and years of life lost (YLL) of medically and non-medically attended influenza-associated mild and severe respiratory, circulatory and non-respiratory/non-circulatory illness in South Africa during 2013-2015 using a modified version of the World Health Organization (WHO) worksheet based tool for estimating the economic burden of seasonal influenza. Additionally, we restricted the analysis to influenza-associated severe acute respiratory illness (SARI) and influenza-like illness (ILI; subsets of all-respiratory illnesses) as suggested in the WHO manual. RESULTS:The estimated mean annual cost of influenza-associated illness was $270.5 million, of which $111.3 million (41%) were government-incurred costs, 40.7 million (15%) were out-of-pocket expenses, and $118.4 million (44%) were indirect costs. The cost of influenza-associated medically attended mild illness ($107.9 million) was 2.3 times higher than that of severe illness ($47.1 million). Influenza-associated respiratory illness costs ($251.4 million) accounted for 93% of the total cost. Estimated absenteeism and YLL were 13.2 million days and 304 867 years, respectively. Among patients with influenza-associated WHO-defined ILI or SARI, the costs ($95.3 million), absenteeism (4.5 million days), and YLL (65 697) were 35%, 34%, and 21% of the total economic and health burden of influenza. CONCLUSION:The economic burden of influenza-associated illness was substantial from both a government and a societal perspective. Models that limit estimates to those obtained from patients with WHO-defined ILI or SARI substantially underestimated the total economic and health burden of influenza-associated illness.
Preventable hospitalizations from ambulatory care sensitive conditions in nursing homes: evidence from Switzerland.
Muench Ulrike,Simon Michael,Guerbaai Raphaëlle-Ashley,De Pietro Carlo,Zeller Andreas,Kressig Reto W,Zúñiga Franziska,
International journal of public health
OBJECTIVES:Reducing nursing home hospitalizations for ambulatory care sensitive conditions (ACSC) has been identified as an opportunity to improve patient well-being and reduce costs. The aim of this study was to identify number of hospitalizations for ACSCs for nursing home residents in a Swiss national sample, examine demographic characteristics of nursing home hospitalizations due to ACSCs, and calculate hospital expenses from these hospitalizations. METHODS:Using merged hospital administrative data with payment data based on diagnosis-related groups (DRGs) for the year 2013, we descriptively examined nursing home residents who were 65 years of age or older and were admitted to an acute care hospital. RESULTS:Approximately 42% of all nursing home admissions were due to ACSCs. Payments to Swiss hospitals for ACSCs can be estimated at between 89 and 105 million Swiss francs in 2013. CONCLUSIONS:A sizable share of hospitalizations for nursing home residents is for ACSCs, and the associated costs are substantial. Programs and policies designed to reduce these potentially avoidable hospitalizations from the nursing home setting could lead to an increased patient well-being and lower costs.
Hip Fractures and the Bundle: A Cost Analysis of Patients Undergoing Hip Arthroplasty for Femoral Neck Fracture vs Degenerative Joint Disease.
Grace Trevor R,Patterson Joseph T,Tangtiphaiboontana Jennifer,Krogue Justin D,Vail Thomas P,Ward Derek T
The Journal of arthroplasty
BACKGROUND:The purpose of this study is to determine whether episode Target Prices in the Bundled Payment for Care Improvement (BPCI) initiative sufficiently match the complexities and expenses expected for patients undergoing hip arthroplasty for femoral neck fracture (FNF) as compared to hip degenerative joint disease (DJD). METHODS:Claims data under BPCI Model 2 were collected for patients undergoing hip arthroplasty at a single institution over a 2-year period. Payments from the index hospitalization to 90 days postoperatively were aggregated by Medicare Severity Diagnosis-Related Group (469 or 470), indication (DJD vs FNF), and categorized as index procedure, postacute services, and related hospital readmissions. Actual episode costs and Target Prices were compared in both the FNF and DJD cohorts undergoing hip arthroplasty to gauge the cost discrepancy in each group. RESULTS:A total of 183 patients were analyzed (31 with FNFs, 152 with DJD). In total, the FNF cohort incurred a $415,950 loss under the current episode Target Prices, whereas the DJD cohort incurred a $172,448 gain. Episode Target Prices were significantly higher than actual episode prices for the DJD cohort ($32,573 vs $24,776, P < .001). However, Target Prices were significantly lower than actual episode prices for the FNF cohort ($32,672 vs $49,755, P = .021). CONCLUSION:Episode Target Prices in the current BPCI model fall dramatically short of the actual expenses incurred by FNF patients undergoing hip arthroplasty. Better risk-adjusting Target Prices for this fragile population should be considered to avoid disincentives and delays in care.
Out of Pocket Expenditure for Sick Newborn Care in Referral Hospitals of Nepal.
Sunny Avinash K,Gurung Rejina,Gurung Abhishek,Basnet Omkar,Kc Ashish
Maternal and child health journal
BACKGROUND:Almost all preventable neonatal deaths take place in low- and middle-income countries and affect the poorest who have the least access to high quality health services. Cost of health care is one of the factors preventing access to quality health services and universal health coverage. In Nepal, the majority of expenses related to newborn care are borne by the caregiver, regardless of socioeconomic status. We conducted a study to assess the out of pocket expenditure (OOPE) for sick newborn care in hospitals in Nepal. METHODS:This cross-sectional study of hospital care for newborns was conducted in 11 hospitals in Nepal and explored OOPE incurred by caregivers for sick newborn care. Data were collected from the caregivers of the sick newborn on the topics of cost of travel, accommodation, treatment (drugs, diagnosis) and documented on a sick newborn case record form. RESULTS:Data were collected from 814 caregivers. Cost of caregivers' stay accounted for more than 40% of the OOPE for sick newborn care, followed by cost of travel, and the baby's stay and treatment. The overall OOPE ranged from 13.6 to 226.1 US dollars (USD). The median OOPE was highest for preterm complications ($33.2 USD; CI 14.0-226.1), followed by hyperbilirubinemia ($31.9 USD; CI 14.0-60.7), respiratory distress syndrome ($26.9 USD; 15.3-121.5), neonatal sepsis ($ 25.8 USD; CI 13.6-139.8) and hypoxic ischemic encephalopathy ($23.4 USD; CI 13.6-97.7). DISCUSSION FOR PRACTICE:In Nepal, OOPE for sick newborn care in hospitals varied by neonatal morbidity and duration of stay. The largest proportion of OOPE were for accommodation and travel. Affordable and accessible health care will substantially reduce the OOPE for sick newborn care in hospitals.
Burden of Respiratory Syncytial Virus Hospitalizations in Canada.
Mitchell Ian,Defoy Isabelle,Grubb ElizaBeth
Canadian respiratory journal
Objective:To examine the socioeconomic burden of respiratory syncytial virus (RSV) disease for Canadian infants hospitalized for the condition. Data and Methods:The descriptive study used data collected in Alberta, Canada, during 2 consecutive RSV seasons. Infants (<1 year of age) were included if they had not received palivizumab and were hospitalized with a confirmed diagnosis of RSV. Hospitalization resource use and parental time burden, out-of-pocket costs, lost work productivity, and stress and anxiety were assessed. Results:13.4% of all infants ( = 67) had intensive care unit (ICU) admission, and average ICU stay for these infants was 6.5 days. Families had average out-of-pocket expenses of 736.69 Canadian dollars (CAD $), and the average time both parents spent in hospital was nearly 7 days (164.0 hours). For working parents ( = 43), average absenteeism was 49% and overall work impairment was 77.8%. Parents also exhibited significant parental stress (3.6 on the Parental Stressor Scale: 43.9 state anxiety and 36.9 trait anxiety scores). Conclusions:Results indicate a high burden associated with the hospitalization of an infant due to RSV disease in terms of resource use, time, productivity, costs, and stress, even among a population of infants not considered to be at risk for the condition.
Predictors of preventable nursing home hospitalizations: the role of mental disorders and dementia.
Becker Marion A,Boaz Timothy L,Andel Ross,Gum Amber M,Papadopoulos Airia S
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
OBJECTIVES:Nursing home (NH) hospitalizations place an enormous economic burden on an already overtaxed American healthcare system. Hospitalizations for "ambulatory care-sensitive" (ACS) conditions are considered preventable, as these are physical health conditions that can potentially be treated safely in a NH. The authors examined risk factors, including mental disorders and dementia, for hospitalization of Medicaid-enrolled NH residents with ACS conditions during fiscal year 2003-2006. METHODS:The authors merged Medicaid claims and enrollment data and Online Survey Certification and Reporting information for 72,251 Medicaid-enrolled NH residents in 647 NHs in Florida. The authors identified at least one ACS hospitalization in 8,382 residents for a total of 10,091 hospital admissions (18.5% of all hospitalizations). The authors used Cox proportional hazard regression to assess time to the first ACS hospitalization. RESULTS:In a fully adjusted model, younger age, non-white race, dementia, and serious mental disorder were associated with greater risk of ACS hospitalization. In addition, residents with a diagnosed mental disorder and no dementia incurred relatively high expenditures for ACS hospitalizations. Among facility characteristics, participants from for-profit facilities, facilities that were not a member of a chain, had more Medicaid recipients, and fewer than 120 beds had greater risk of ACS hospitalizations. CONCLUSIONS:Attention to the identified predictors of hospitalization for ACS conditions, which are potentially preventable, could reduce the risk and cost of these hospitalizations among Medicaid-enrolled NH residents. The need to reduce unnecessary hospitalization will become only more urgent as the population ages and healthcare expenses continue to escalate.
Assessment of hospital length of stay and direct costs of type 2 diabetes in Hubei Province, China.
Chen Dajie,Liu Shuai,Tan Xiaodong,Zhao Qihan
BMC health services research
BACKGROUND:The incidence of type 2 diabetes is increasing, creating a huge burden for China's social healthcare system. This study aimed to evaluate hospital length of stay (LOS) based on admission characteristics and direct costs correlated with various types of complications for type 2 diabetic inpatients in Hubei Province, China. METHODS:A total of 1528 inpatients diagnosed with type 2 diabetes discharged between April 1, 2013, and March 31, 2014, were included in this study. Information regarding patients' admission and hospitalization were obtained from the hospital information system. The relationship between admission characteristics and LOS, distribution of total costs, and types of complications were described and analysed. RESULTS:(1) The mean LOS was 11.65 days (median: 10 days). Multiple linear regression analysis demonstrated that inpatients with New Cooperative Medical Scheme (NCMS), aged 80 and above, had longer LOS than the reference group, and inpatients with chronic or acute + chronic complications had shorter LOS than those without. (2) Mean total costs per patient were US$159.72 ± 130.83 (median: US$135.33), US$240.60 ± 166.58 (median: US$192.09), and US$247.98 ± 166.22 (median: US$200.99) for inpatients with no complications, chronic complications, and acute + chronic complications, respectively. Total and individual costs were significantly less for patients without complications than for those with the two types of complications (p < 0.001). (3) Mean total costs per patient were US$225.40 ± 115.32 (median: US$200.34), US$221.25 ± 177.64 (median: US$170.05), and US$275.18 ± 193.14 (median: US$217.91) for inpatients with microvascular complications, macrovascular complications, and microvascular + macrovascular complications, respectively. Total costs were significantly higher for patients with microvascular + macrovascular complications than for those with other types of chronic complications (p < 0.001). (4) Drugs were the greatest expense for patients, and the least expensive treatment was nursing care. CONCLUSIONS:Medical insurance status, age, and type of complication may help to predict LOS for patients with type 2 diabetes in Hubei Province, China. The total and individual costs for patients with complications were higher than for those without, and hospitalization expenses posed a heavy burden. Efforts should be made to reduce the financial impact on patients by integrating the medical insurance system of urban and rural areas, and by reducing the risk of complications, especially microvascular complications.
The financial burden of malnutrition in hospitalized pediatric patients under five years of age.
Kittisakmontri Kulnipa,Sukhosa Onwaree
Clinical nutrition ESPEN
BACKGROUND:Under-five children are a medically fragile group which is compromised by hospitalization. Malnutrition in those patients not only increases complications and mortality but also affects hospital resource utilization. Therefore, this study was conducted to clarify the impact of malnutrition on hospital expenditures. METHODS:This prospective cohort study was performed at a tertiary hospital in Thailand. Under-five children who were admitted to general pediatric wards were included. Demographic data, the length of stay (LOS), and anthropometric measurements at admission were recorded. The classification of wasting and stunting were defined according to the World Health Organization (WHO) classification. Moreover, all hospital expenses were calculated directly based on the actual billing including the total hospital cost, cost of bed, enteral formula, medications, medical apparatus and procedures, nursing care, investigations and surgery. RESULTS:One-hundred and five patients with a mean age of 26.8 ± 1.8 months were included. The majority of them were males (61%) with the leading cause of infectious disease. According to the prevalence of malnutrition, the percentage of patients who had only stunting or wasting were 24.8% and 10.5%, respectively while 15.2% of all patients had both stunting and wasting. Regardless of stunting, the wasting patients had a significantly higher cost of bed, enteral formula, nursing care, and medical apparatus. Particularly, the highest costs of all expenditures including the total hospital cost were found in patients who were both stunted and wasting. Apart from the financial burdens, the wasting patients stayed longer in the hospital and the LOS also significantly correlated with the total hospital cost (r = 0.84, p = 0.01). CONCLUSIONS:The present study underscores the high prevalence of malnutrition in under-five pediatric patients. The malnourished patients, in particular the wasting group, had longer LOS and consequently had increased hospital expenses.
Comorbidity burden of patients with Parkinson's disease and Parkinsonism between 2003 and 2012: A multicentre, nationwide, retrospective study in China.
Wang Xin,Zeng Fan,Jin Wang-Sheng,Zhu Chi,Wang Qing-Hua,Bu Xian-Le,Luo Hong-Bo,Zou Hai-Qiang,Pu Jie,Zhou Zhong-He,Cui Xiao-Ping,Wang Qing-Song,Shi Xiang-Qun,Han Wei,Wu Qiang,Chen Hui-Sheng,Lin Hang,Zhang Li-Li,Zhang Meng,Lian Yan,Xu Zhi-Qiang,Zhou Hua-Dong,Zhang Tao,Wang Yan-Jiang
Parkinson's disease (PD) and Parkinsonism are common neurodegenerative disorders with continuously increasing prevalence, causing high global burdens. However, data concerning the comorbidity burden of patients with PD or Parkinsonism in China are lacking. To investigate the health condition and comorbidity burden, a total of 3367 PD and 823 Parkinsonism patients were included from seven tertiary hospitals in seven cities across China from 2003 to 2012. Their comorbidity burden was collected and quantified by the Elixhauser Comorbidity Index (ECI) and Charlson Comorbidity Index (CCI). The comorbidity spectra differed between PD and Parkinsonism patients. Compared with PD patients, Parkinsonism patients were older (69.8 ± 11.5 vs. 67.9 ± 11.4, P < 0.001); had a higher comorbidity burden, including ECI (1.1 ± 1.2 vs. 1.0 ± 1.2, P < 0.001) and CCI (1.3 ± 1.6 vs. 1.1 ± 1.5, P < 0.001); and had higher hospitalization expenses. The ECI (1.1 ± 1.3 vs. 0.9 ± 1.1, P < 0.001) and CCI (1.3 ± 1.6 vs. 0.9 ± 1.2, P < 0.001) were higher in males than in females. The average length of stay and daily hospitalization expenses increased with age, as did ECI and CCI. This is the first study to report the disease burden of Chinese PD and Parkinsonism patients. It provides useful information to better understand their health status, and to raise the awareness of clinicians for providing better health care.
Hospitalizations Due to Cirrhosis: Clinical Aspects in a Large Cohort of Italian Patients and Cost Analysis Report.
Di Pascoli Marco,Ceranto Elena,De Nardi Paolo,Donato Daniele,Gatta Angelo,Angeli Paolo,Pontisso Patrizia
Digestive diseases (Basel, Switzerland)
BACKGROUND AND AIM:Liver cirrhosis is characterized by high morbidity and mortality rates. This study was addressed to evaluate the epidemiological and economic impact of cirrhosis on hospitalizations in a large population in Italy. METHODS:Epidemiological analysis was performed using hospital discharge sheets of 57,720 hospitalizations due to liver disease from 2006 to 2008, selected from the Veneto regional archive. In a sample of 100 randomly selected hospitalizations, a detailed cost analysis was performed and a comparison was made with sets of patients admitted for heart failure (HF) and chronic obstructive pulmonary disease (COPD). RESULTS:Among patients with cirrhosis, ascites emerged as the most frequent cause of admission, followed by hepatic encephalopathy, hepatocellular carcinoma, and upper gastrointestinal bleeding. Encephalopathy and ascites were the complications with the highest rates of readmission. The detailed cost analysis of hospitalizations revealed that economic expenses in the set of patients admitted for cirrhosis were about 30% higher than those for patients admitted for HF or COPD, mainly due to the longer duration of hospitalization. CONCLUSIONS:Cirrhosis has a relevant epidemiological and economic impact on hospitalizations and preventive strategies for its clinical management are warranted.
Cost-effectiveness analysis of two kinds of bladder cancer urinary diversion: Studer versus Bricker.
Translational andrology and urology
BACKGROUND:The purpose of our study was to evaluated the cost-effectiveness of two bladder cancer (BCa) urinary diversions: Studer and Bricker. METHODS:The study included 44 patients with Studer and 40 patients with Bricker. Collected and analyzed the patient's basic characteristics, health care costs, and prognosis survival. The quality-adjusted life-year (QALY) were calculated and verified by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30, Version 3, Chinese version). Cost-effectiveness depends on the incremental cost per QALY. The incremental cost-effectiveness ratio (ICER) was determined using the cost/QALY. RESULTS:We found the average total cost of the Studer group was $7,173.7±1,390.8, and the Bricker group was $6,545.2±1,458.4. There were significant differences in hospitalization time, total hospitalization expenses, bed cost, comprehensive medical service charge and drugs cost (all P<0.05). The hospitalization time, total hospitalization expenses, bed cost, comprehensive medical service charge, surgical treatment cost and drugs cost in Studer group were higher than those in Bricker group, while there was no significant difference in postoperative complications between the two groups (P=0.858). The ICER of Studer group and Bricker group were $8,535.6±2,027.6/QALY and $11,158.2±2,944.9/QALY, respectively. The ICER of Studer group over Bricker group was $2,514.0/QALY. CONCLUSIONS:We found the Studer group had higher hospitalization time, total hospitalization expenses, bed cost, comprehensive medical service charge, surgical treatment cost, and drugs cost than the Bricker group, but the Studer group had a higher ICER than the Bricker group.
Vascular cognitive impairment and dementia expenditures: 7-year inpatient cost description in community dwellers.
Ramos-Estebanez Ciro,Moral-Arce Ignacio,Rojo Fernando,Gonzalez-Macias Jesus,Hernandez Jose Luis
BACKGROUND:Vascular cognitive impairment (VCI) and vascular dementia (VaD) are prevalent conditions with a growing impact on health care expenses. Few studies have addressed expenditures on cognitive vascular disease. We quantify the expenses of tertiary-care inpatients with VCI and VaD and provide the first report on the specific cost of care in community-dwelling patients with small- and large-vessel ischemic cognitive disease. METHODS:This is a cost-description study of inpatient expenditures from the Spanish National Health Institute and regional government perspectives. We retrospectively analyzed the expenses in a prospective cohort of 122 community dwellers with VCI who developed small-vessel disease with ischemic white matter disease (Binswanger's disease) (n = 60), lacunar state (n = 26), or large-vessel disease (n = 36). Admissions with a primary or secondary diagnosis of transient ischemic attack or stroke, cognitive impairment or dementia, and other diagnoses related to cerebrovascular disease were assessed. RESULTS:The average cost per patient was $33 740. The costs per VCI admission were similar across groups (~$9545). The average number of admissions increased during the progression of the disease (VCI, 1.2; VaD, 2.5) and contributed to higher expenses per patient during the VaD stage (~$22 631) compared with the VCI stage (~$11 110). Half of patients (n = 61; 50%) progressed without ischemic events during the VCI stage. These patients incurred lower per-patient costs during the VCI stage ($9750 vs $12 464), and costs increased during the post-VaD diagnosis stage ($28 528 vs $16 734). CONCLUSION:Large- and small-vessel cerebrovascular diseases are common and costly conditions. Vascular cognitive impairment presenting with stroke may incur greater expenses than VCI onset without stroke. Thus, patients with large-vessel disease incurred higher costs during the VCI stage. Care became more onerous at an advanced VaD stage in all groups. During the VaD stage, the expenditures of patients with Binswanger's disease were significantly higher and eventually counterbalanced the initially lower costs seen during the VCI stage.
Costs and length of sepsis-related hospitalizations in Taiwan.
Chen Yen-Jung,Chen Fu-Lun,Chen Jin-Hua,Wu Man-Tzu Marcie,Chien Du-Shieng,Ko Yu
To investigate the healthcare expenditures and length of stay (LOS) of sepsis-related hospitalizations in Taiwan.This is a retrospective claim database study. Data were obtained from the two-million-sample longitudinal health and welfare database (LHWD). Adult patients hospitalized with sepsis between 2010 and 2014 were identified by International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM) codes, and these patients were divided into three levels of sepsis severity. The amount and distribution of their total medical expenditures were investigated.In total, 62,517 patients with 97,790 sepsis-related hospitalizations were included in the present study. It was found that ward fees and medicines comprised the largest component of expenses for sepsis-related hospitalizations. In addition, our study results indicated that the median sepsis-related hospitalization cost was 66.4 thousand New Taiwan Dollar (NT dollars) in 2014, and a significant temporal change was found between 2010 and 2014. The median LOS in a hospital and in an intensive care unit were 11 and 7 days, respectively. Both expenditures and LOS were found to increase with sepsis severity.This study provides an updated and better understanding of the costs and LOS of sepsis-related hospitalizations in Taiwan. It was found that ward fees and medicine fees were the major components of hospital costs.
Out-of-Pocket Spending for Hospitalizations Among Nonelderly Adults.
Adrion Emily R,Ryan Andrew M,Seltzer Amanda C,Chen Lena M,Ayanian John Z,Nallamothu Brahmajee K
JAMA internal medicine
IMPORTANCE:Patients' out-of-pocket spending for major health care expenses, such as inpatient care, may result in substantial financial distress. Limited contemporary data exist on out-of-pocket spending among nonelderly adults. OBJECTIVES:To evaluate out-of-pocket spending associated with hospitalizations and to assess how this spending varied over time and by patient characteristics, region, and type of insurance. DESIGN, SETTING, AND PARTICIPANTS:A retrospective analysis of medical claims for 7.3 million hospitalizations using 2009-2013 data from Aetna, UnitedHealthcare, and Humana insurance companies representing approximately 50 million members was performed. Out-of-pocket spending was evaluated by age, sex, type of insurance, region, and principal diagnosis or procedure for hospitalized adults aged 18 to 64 years who were enrolled in employer-sponsored and individual-market health insurance plans from January 1, 2009, to December 31, 2013. The study was conducted between July 1, 2015, and March 1, 2016. MAIN OUTCOMES AND MEASURES:Primary outcomes were total out-of-pocket spending and spending attributed to deductibles, copayments, and coinsurance for all hospitalizations. Other outcomes included out-of-pocket spending associated with 7 commonly occurring inpatient diagnoses and procedures: acute myocardial infarction, live birth, pneumonia, appendicitis, coronary artery bypass graft, total knee arthroplasty, and spinal fusion. RESULTS:From 2009 to 2013, total cost sharing per inpatient hospitalization increased by 37%, from $738 in 2009 (95% CI, $736-$740) to $1013 in 2013 (95% CI, $1011-$1016), after adjusting for inflation and case-mix differences. This rise was driven primarily by increases in the amount applied to deductibles, which grew by 86% from $145 in 2009 (95% CI, $144-$146) to $270 in 2013 (95% CI, $269-$271), and by increases in coinsurance, which grew by 33% over the study period from $518 in 2009 (95% CI, $516-$520) to $688 in 2013 (95% CI, $686-$690). In 2013, total cost sharing was highest for enrollees in individual market plans ($1875 per hospitalization; 95% CI, $1867-$1883) and consumer-directed health plans ($1219; 95% CI, $1216-$1223). Cost sharing varied substantially across regions, diagnoses, and procedures. CONCLUSIONS AND RELEVANCE:Mean out-of-pocket spending among commercially insured adults exceeded $1000 per inpatient hospitalization in 2013. Wide variability in out-of-pocket spending merits greater attention from policymakers.
Evaluation of the effectiveness of comprehensive drug price reform: a case study from Shihezi city in Western China.
Lin Taoyu,Wu Zhaohui,Liu Menming,Wu Xiangwei,Zhang Xinping
International journal for equity in health
BACKGROUND:China carried out a comprehensive drug price reform (CDPR) in 2017 to control the growing expense of drug effectively and reduce the financial burden of inpatients. However, early studies in pilot regions found the heterogeneity in the effectiveness of CDPR from different regions and other negative effects. This study aimed to evaluate the effects of the reform on medical expenses, medical service utilisation and government financial reimbursement for inpatients in economically weaker regions. METHODS:Shihezi was selected as the sample city, and 238,620 inpatients, who were covered by basic medical insurance (BMI) and had complete information from September 2016 to August 2018 in public hospitals, were extracted by cluster sampling. An interrupted series design was used to compare the changing trends in medical expenses, medical service utilisation and reimbursement of BMI for inpatients before and after the reform. RESULTS:Compared with the baseline trends before the CDPR, those after the CDPR were observed with decreased per capita hospitalisation expenses (HE) by ¥301.9 per month (p < 0.001), decreased drug expense (DE) ratio at a rate of 0.32% per month (p < 0.05) and increased ratio of diagnosis and treatment expenses (DTE) at a rate of 0.25% per month (p < 0.01). The number of inpatients in secondary and tertiary hospitals declined by 458 (p < 0.001) and 257 (p < 0.05) per month, respectively. The BMI reimbursement in tertiary hospitals decreased by ¥254.7 per month (p < 0.001). CONCLUSION:The CDPR controlled the increase in medical expenses effectively and adjusted its structure reasonably. However, it also reduced the medical service utilisation of inpatients in secondary and tertiary hospitals and financial reimbursement for inpatients in tertiary hospitals.
Inpatient Cost of Stroke in Beijing: A Descriptive Analysis.
Yin Xuejun,Huang Lieyu,Man Xiaowei,Jiang Yan,Zhao Xuan,Zhao Liying,Cheng Wei
BACKGROUND:Stroke has been the leading cause of death in China and contributed almost one-third to stroke deaths worldwide. The rising cost of stroke treatment is of great concern, but has not been thoroughly studied. This study aimed to analyze stroke in-hospital charges by subtypes, age, and sex and investigate potential factors associated with the cost of per stay. METHODS:The research was a retrospective observational study based on patients with a primary diagnosis of stroke from 31 hospitals in Beijing. Characteristics of total treatment cost and cost of per stay were analyzed. The potential influences on hospital charges were explored using a stepwise multiple regression model. RESULTS:A total of 16,111 stroke in-patient admissions were identified among which 8.3% was subarachnoid hemorrhage, 22.4% intracerebral hemorrhage, and 69.1% cerebral infarction. The average length of stay (LoS) was 14.5 (11.9) days. The cost of per stay was USD 4,423.9 (6,684.4) among which the out-of-pocket expenses were USD 1,640.2 (3,118.0). Stroke type, age, medical insurance, treatment results, and hospital level were significantly associated with the cost of stroke (p < 0.001). CONCLUSION:Hospitalization cost of stroke was substantial. These findings provide health policymakers and healthcare professionals with evidence to help guide future spending.
A tale of two cities: hospitalization costs in 1897 and 1997.
Boonen Annelies,Severens Johannes L,van der Linden Sjef
International journal of technology assessment in health care
OBJECTIVES:To compare the hospitalization day price, and the hospitalization costs 100 years ago with the present situation. METHODS:Municipal and hospital archives of two cities, Maastricht in The Netherlands and Tongeren in Belgium, were studied systematically for reports of costs. These were compared with the present accounts. RESULTS:Starting from the second part of the nineteenth century, an official day price was calculated each year by averaging the total hospital expenditures by the total number of hospitalization days. Of all expenditures, nutrition accounted for nearly 50% of expenses. Differences with the current situation are striking. Nowadays, the day price is a negotiated tariff. Management and salaries make up more than 70% of the present expenditures. CONCLUSIONS:Hospitalization day prices have been used for approximately 150 years to determine hospitalization costs. Since then, the total hospital expenditures and the relative cost components have changed considerably. Compared with the spending power of people, the cost of one day in the hospital increased substantially.
Evolution of cost structures in rheumatoid arthritis over the past decade.
Huscher Dörte,Mittendorf Thomas,von Hinüber Ulrich,Kötter Ina,Hoese Guido,Pfäfflin Andrea,Bischoff Sascha,Zink Angela,
Annals of the rheumatic diseases
OBJECTIVE:To estimate the changes in direct and indirect costs induced by patients with rheumatoid arthritis (RA) in German rheumatology, between 2002 and 2011. To examine the impact of functional status on various cost domains. To compare the direct costs incurred by patients at working age (18-64 years) to patients at an age of retirement (≥65 years). METHODS:We analysed data from the National Database of the German Collaborative Arthritis Centres with about 3400 patients each year. Costs were calculated using fixed prices as well as annually updated cost factors. Indirect costs were calculated using the human capital as well as the friction cost approaches. RESULTS:There was a considerable increase in direct costs: from €4914 to €8206 in patients aged 18-64, and from €4100 to €6221 in those aged ≥65, attributable to increasing prescription of biologic agents (18-64 years from 5.6% to 31.2%, ≥65 years from 2.8% to 19.2%). This was accompanied by decreasing inpatient treatment expenses and indirect costs due to sick leave and work disability. The total growth of cost, on average, was €2437-2981 for patients at working age, and €2121 for patients at retirement age. CONCLUSIONS:The increase in treatment costs for RA over the last decade was associated with lower hospitalisation rates, better functional status and a lower incidence of work disability, offsetting a large proportion of risen drug costs. Since the rise in drug costs has manifested a plateau from 2009 onwards, no relevant further increase in total costs for patients with RA treated in German rheumatology is expected.
Health Care Costs of Post-traumatic Osteomyelitis in China: Current Situation and Influencing Factors.
Jiang Nan,Wu Hang-Tian,Lin Qing-Rong,Hu Yan-Jun,Yu Bin
The Journal of surgical research
BACKGROUND:Currently, very limited information is available regarding the economic burdens of patients with extremity post-traumatic osteomyelitis (OM). This study aimed to investigate direct health care costs and utilization for inpatients with extremity post-traumatic OM and analyze its constituent ratios and influencing factors in Southern China. METHODS:We searched in the electronic medical record system for inpatients who had received surgical interventions at our department between 2013 and 2016 for extremity post-traumatic OM. Data of direct health care costs incurred during their hospitalizations were collected in six main categories (service, diagnosis, treatment, materials, pharmaceuticals, and miscellaneous expenses). In addition, data of total medical costs for contemporaneous inpatients with non-post-traumatic OM were also collected as controls. RESULTS:A total of 278 post-traumatic OM and 10,420 controls were included. The median cost for the post-traumatic OM inpatients was $10,504 US dollars, 4.8-fold higher than that for those with non-post-traumatic OM ($2189, P < 0.001). The direct cost in the category of materials accounted for the largest proportion (61%), followed by that in pharmaceuticals (12%) and treatment (11%). The median number of hospital admissions for post-traumatic OM patients was 1 time, with a median length-of-stay of 22 d. The most influencing factors for the health care costs of the post-traumatic OM inpatients were use of an external fixator ($16,016 for those who used versus $4956 for those who did not, P < 0.001), external fixator type ($19,563 for ring fixator versus $14,966 for rail fixator, P < 0.001), infection site ($13,755 for tibia, $14,216 for femur and $5673 for calcaneus, P < 0.001), and infection-associated injury type ($12,890 for infection after open fracture versus $8087 for infection after closed fracture, P = 0.001). CONCLUSIONS:An unexpectedly large proportion of the direct health care costs for inpatients with extremity post-traumatic OM went to cover an external fixator, with expenses for pharmaceuticals and treatment accounting for only a little more than the tenth of the total health care costs. Use of external fixator, external fixator type, infection site, and infection-associated injury type directly influenced the health care costs.
The threat of Asian dust storms on asthma patients: a population-based study in Taiwan.
Wang Chien-Ho,Chen Chin-Shyan,Lin Chung-Liang
Global public health
This study explores the relationship between Asian dust storms (ADSs), asthma hospital admissions and average medical cost discharge. We adopt the hospitalisation data from the Taiwan National Health Insurance research database covering the period from 2000 to 2009. The autoregressive integrated moving average with exogenous variables (ARIMAX) analyses were performed to explore the relationship between ADS and asthma hospital admissions, adjusting for temperature, air pollutants and season dummy. The results show that ADS events do generate a critical influence upon the occurrences of asthma on post-ADS events from days 1 through 3, with an average of 17-20 more hospitalised admissions, and have stronger effects on preschool children, middle-aged people and the elderly. From the perspective of medical expenses, the cost of hospitalised admissions for asthma substantially rises daily, on average, by NT$634,698 to NT$787,407 during ADS event days. This study suggests that government should establish a forecast and alert system and release warnings about dust storms, so that the individuals predisposed to asthma can take precautionary measures to reduce their outdoor exposure. Consequently, personal risk and medical expenditure could be reduced significantly, especially for preschool children, middle-aged people and the elderly with asthma.
Economic burden of gastrointestinal cancer under the protection of the New Rural Cooperative Medical Scheme in a region of rural China with high incidence of oesophageal cancer: cross-sectional survey.
Li Xiang,Cai Hong,Wang Chaoyi,Guo Chuanhai,He Zhonghu,Ke Yang
Tropical medicine & international health : TM & IH
OBJECTIVE:To evaluate the financial burden of oesophageal cancer under the protection of the new Rural Cooperative Medical Scheme (NCMS) and to provide evidence and suggestions to policymakers in a high-incidence region in China. METHODS:We analysed inpatient claim data for oesophageal cancer, gastric cancer and colorectal cancer from 1 January to 31 December 2013. The data were extracted from the NCMS management system of Hua County, Henan Province, a typical high-risk region for oesophageal cancer in China. Cancer-specific health economic indicators were calculated to evaluate the financial burden under the protection of the local NCMS. RESULTS:The total cost of oesophageal cancer was 2.7-3.6 times higher than that of gastric cancer and colorectal cancer, respectively, due to high incidence of oesophageal cancer. For each hospitalisation to treat oesophageal cancer, the average total cost and out-of-pocket expenses after reimbursement equalled an entire year's gross domestic product per capita and per capita disposable income, respectively, for the local area. The average total cost per hospitalisation for oesophageal cancer increased monotonically with hospital level for surgical hospitalisations, and it increased more rapidly for non-surgical hospitalisations (from $301 to $2589, 860%) than for gastric cancer (from $289 to $1453, 503%) and colorectal cancer (from $359 to $1610, 448%). Vulnerable groups with less access to high-level hospitals were found in different gender and age groups. CONCLUSIONS:Oesophageal cancer imposes serious financial burdens on communities and patients' households in this high-incidence region, and no preferential policy from the local NCMS has been designed to address this issue. A special supportive policy should be developed on the basis of local disease profiles and population characteristics to alleviate the financial burden of populations at high risk for certain high-cost diseases.
The cost-effectiveness analysis of laparoscopic treatment of ectopic pregnancy: a single-center review of a five-year experience.
Tao M F,Rong R,Shao H F,Xia J
Clinical and experimental obstetrics & gynecology
PURPOSE:The aim of this study was to investigate the cost-effectiveness of laparoscopic treatment for ectopic pregnancy by comparing the medical expenses and time of hospitalization of laparoscopic and open surgery for ectopic pregnancy in partial area of Shanghai, China. MATERIALS AND METHODS:Clinical data of 762 cases with ectopic pregnancy undergoing surgical treatment (307 cases for laparoscopic surgery and 455 cases for open surgery) were analyzed retrospectively. The clinical information including the medical expenses and time of hospitalization was compared. The patients were divided into three groups according to the treatments of different lesions (lesions resection, conservative laparotomy, and exploration group) and were analyzed. RESULTS:The total hospitalization expenses and the top three single costs including surgery, exams, and medicine expenses were higher in laparoscopic group than in open surgery group. There was no significant difference between the two groups on the total time of hospitalization. The hospital days of preoperation were higher but the postoperative hospital days were lower in laparoscopic group than in open surgery group. Compared with the open surgery treatment, the hospitalization expenses of laparoscopic treatment for ectopic pregnancy increased. There was no significant difference on the total hospitalization days. CONCLUSION:The preoperative waiting period of inpatients increased and the post-operative hospital days reduced in laparoscopic group.
Cost of hospitalization and length of stay in people with Down syndrome: evidence from a national hospital discharge claims database.
Hung Wen-Jiu,Lin Lan-Ping,Wu Chia-Ling,Lin Jin-Ding
Research in developmental disabilities
The present paper aims to describe the hospitalization profiles which include medical expenses and length of stays, and to determine their possible influencing factors of hospital admission on persons with Down syndrome in Taiwan. We employed a population-based, retrospective analyses used national health insurance hospital discharge data of the year 2005 in this study. Subject inclusion criteria included residents of Taiwan, and diagnosed with Down syndrome (ICD code is 758.0; N=375). Inpatient records included personal characteristics, admissions, length of stay, and medical expenses of study subjects. The results found that Down syndrome patients used 2 hospital admissions and their annual length of stay in hospital was 22.26 days, and the mean medical cost of admissions was 143,257 NT$. The admission figures show that Down syndrome individuals used two times of hospital days and nearly three times of medical expenses comparing to the general population in Taiwan. Finally, the multiple regression models revealed that factors of age, hold a serious illness card, low income family member, frequency of hospital admission, high medical expense user were more likely to use longer inpatient days (R2=0.36). Annual inpatient expense of people with Down syndrome was significantly affected by factors of severe illness card holder, low income family member, frequency of hospital admission and longer hospital stays (R2=0.288). Based on these findings, we suggest the further study should focus on the effects of medical problems among persons with Down syndrome admitted for hospital care is needed.
How were situations of preventive and curative care expenditure for AIDS and medical burden of patients? Research based on "System of Health Accounts 2011".
Zhan Huan,Wu Qiong,Zang Shuang,Zhou Liangrong,Wang Xin
BMC public health
BACKGROUND:The problem of AIDS response has not only involved public health, but also had a great impact on the family burden.The objective of this study was to estimate the preventive and curative care expenditure(PCE)for AIDS of Hunan Province in 2017 based on System of Health Accounts 2011(SHA2011)by quantity,financing scheme,health provider,health function,and to analyses the factors affecting patients' medical burden. METHODS:Through stratified multi-stage sampling method, 1336 institutions were surveyed to obtain AIDS prevention and control data, and the official data collected from Health Statistical Yearbook, Health Financial Annual Reports and Government Input Monitoring System were used to estimate the AIDS PCE based on SHA2011. Univariate analyses and ordered logistic regression were used to evaluate the factors affecting the medical burden of AIDS patients. RESULTS:The AIDS PCE of Hunan Province in 2017 was 266.67 million, mainly flowed to hospitals and disease prevention and control institutions. The proportions of curative care expenditure(CCE) and prevention expenditure were 51.39 and 48.61% respectively. Prevention expenditure were mainly used for traditional prevention methods. All prevention expenditure and 88.52% of CCE were borne by public financing scheme. Family health expenditure accounted for 11.12% of CCE, but there were still some people with heavy burden of treatment. Non insurance, co-infection and length of stay are risk factors to the total hospitalization expenses(Totalexp)and the out-of-pocket payments(OOPs)(all p < 0.05,OR > 1). Taking the age group under 30 as the reference, the partial regression coefficient of the age group over 60 was statistically significant (OR = 1.809, OR = 0.30). CONCLUSION:The financing structure of the PCE for AIDS in Hunan Province was relatively stable and the flow of institutions was reasonable. The functional flow of expenditure embodied the principle of "prevention first". China should incorporate oral PrEP into the national guidelines as soon as possible to improve the allocation efficiency of AIDS prevention resources. Meantime, several measures should be taken to reduce the medical burden of AIDS patients, including expanding the scope of government assistance, adjusting insurance compensation measures, increasing the rate of patients participating in insurance,encouraging commercial insurance to join the AIDS insurance system,and controlling length of stay in hospital.
Healthcare costs of Type 2 diabetes in Germany.
Jacobs E,Hoyer A,Brinks R,Icks A,Kuß O,Rathmann W
Diabetic medicine : a journal of the British Diabetic Association
AIM:To describe for the first time the direct costs of Type 2 diabetes treatment by analysing nationwide routine data from statutory health insurance in Germany. METHODS:This cost-of-illness-study was based on a 6.8% random sample of all German people with statutory health insurance (4.3 out of 70 million people). The healthcare expenses show direct per capita costs from the payer perspective. Healthcare expenses for physicians, dentists, pharmacies, hospitals, sick benefits and other healthcare costs were considered. Per capita costs, cost ratios for people with Type 2 diabetes and without diabetes as well as diabetes-attributable costs were calculated. RESULTS:Per capita costs for people with Type 2 diabetes amounted to €4,957 in 2009 and €5,146 in 2010. People with Type 2 diabetes had 1.7-fold higher health expenses than people without diabetes. The largest differences in health expenses were found for prescribed medication from pharmacies (cost ratio diabetes/no diabetes: 2.2) and inpatient treatment (1.8). Ten percent of the total statutory health insurance expense, in total €16.1 billion, was attributable to the medical care of people with Type 2 diabetes. CONCLUSIONS:This nationwide study indicates that one in 10 Euros of healthcare expenses is spent on people with Type 2 diabetes in Germany. In the future, national statutory health insurance data can be used to quantify time trends of costs in the healthcare system.
Mental health inpatient treatment expenditure trends in China, 2005-2012: evidence from Shandong.
Xu Junfang,Wang Jian,Liu Ruiyun,Xing Jinshui,Su Lei,Yu Fenghua,Lu Mingshan
The journal of mental health policy and economics
BACKGROUND:Mental health is increasingly becoming a huge public health issue in China. Yet for various cultural, healthcare system, and social economic reasons, people with mental health need have long been under-served in China. In order to inform the current on-going health care reform, empirical evidences on the economic burden of mental illnesses in China are urgently needed to contribute to health policy makers' understanding of the potential benefits to society from allocating more resources to preventing and treating mental illness. However, the cost of mental illnesses and particularly its trend in China remains largely unknown. AIMS OF THE STUDY:To investigate the trend of health care resource utilization among inpatients with mental illnesses in China, and to analyze what are the factors influencing the inpatient costs. METHOD:Our study sample included 15,721 patients, both adults and children, who were hospitalized over an eight-year period (2005-2012) in Shandong Center for Mental Health (SCMH), the only provincial psychiatric hospital in Shandong province, China. Data were extracted from the Health Information System (HIS) at SCMH, with detailed and itemized cost data on all inpatient expenses incurred during hospitalization. The identification of the patients was based on the ICD-10 diagnoses recorded in the HIS. Descriptive analysis was done to analyze the trend of hospitalization cost and length of stay during the study period. Multivariate stepwise regression analysis was conducted to assess the factors that influence hospitalization cost. RESULTS:Among the inpatients in our sample, the most common mental disorders were schizophrenia, schizotypal and delusional disorders. The disease which had the highest per capita hospital expense was behavioral and emotional disorders with onset usually occurring in childhood and adolescence (RMB 8,828.4; US$ 1,419.4, as compared to the average reported household annual income of US$ 2,095.3 in China). The average annual growth rate of per capita hospitalization cost was 23.6%, with the inpatient cost reaching RMB 11,949 (US$ 1921.1) in 2012. The hospitalization cost was found to be strongly associated with hospital length of stay, level of care, age, employment status, admission diagnoses, and frequency of hospitalization. DISCUSSION:Our study found that mental health inpatient resources use, particularly hospitalization cost, has been growing at an increasing rate. In our sample, hospitalization cost nearly tripled from 2005 to 2012. Mental illnesses and the related economic burden on the population will continue to grow, making mental health a major public health issue in China. Hospital length of stay was found to be increasing in our sample, and positively correlated with hospitalization cost. Childhood and adolescence behavioral and emotional disorders were found to be significantly associated with higher inpatient cost. IMPLICATIONS FOR HEALTH POLICIES AND FUTURE RESEARCH:The policy implications generated from the results of this study are two-fold: first of all, in order to meet the growing need of mental health care in China, the government needs to significantly increase its spending in preventing and treating mental illnesses. Second, cost containment in inpatient care would become a major challenge for mental health policy makers in China. Government support, clinical practices and guideline development, as well as research are urgently needed to promote mental health prevention and improve the efficiency of mental health system in China. The current mental health system, like the overall healthcare system in China, relies heavily on hospital inpatient care. In order to build a sustainable mental health care system to meet increasing population need in China, it is crucial to integrate mental health care reform with the ongoing primary health care reform. Future mental health policy reform and research in China should put more focus on how to strengthen primary care system as well as community support, establish effective two-tier referring mechanism between hospital and primary care system, and to ensure continuity of care.
Impact of ill-health on household consumption in Sri Lanka: Evidence from household survey data.
Kumara Ajantha Sisira,Samaratunge Ramanie
Social science & medicine (1982)
With significant increases in chronic non-communicable diseases (NCDs) in recent years, Sri Lanka has witnessed a growing trend of increased out-of-pocket payments for healthcare, imposing a severe burden on household budgets. This is exacerbated by limited government health funding and inadequate financial security from formal social security. We examine the association of NCD-prevalence and healthcare utilization with household consumption, using the most recent Sri Lanka Household Income and Expenditure Survey 2012/2013. The unit of analysis is the household. We use data for 20,535 households to apply two-part models. Findings suggest that financial constraints induced by NCD-prevalence and hospitalization compel households primarily to sacrifice food consumption. Analysis further shows that poorer households are more vulnerable to food insecurity arising from these. Households sacrifice the basic needs of housing and clothing, and the burden on poorer households is higher, whereas richer households have the option of sacrificing more from non-basic needs to cope with NCDs and hospitalization and thereby to secure basic needs to a certain extent. Moreover, the burden of out-of-pocket healthcare expenses is found to be positively associated with NCDs and hospitalization. In addition to the direct association, public hospitalization favorably moderates the associations between NCDs and the allocations for food and healthcare. Private hospitalization is adversely associated with a wider range of consumption, creating negative welfare consequences. These findings provide valuable information on what needs to be done to reform Sri Lanka's health sector. The study contributes to international discussions on frameworks and national-level policies for effectively allocating public and private funds to the health sector to mitigate hardships faced by the poorest households.
Determinants of inappropriate admissions of children to county hospitals: a cross-sectional study from rural China.
Lei Shi-Han,Zhang Yan,Li Hao-Miao,Su Dai,Chang Jing-Jing,Hu Xiao-Mei,Ye Qing,Jiang Di,Chen Ying-Chun
BMC health services research
BACKGROUND:The incidence of inappropriate admissions in China has become the shackle of its' service supply system. This research aims to assess the level of children's inappropriate admissions to county hospitals in rural China and identify the characteristics and determinants of children's inappropriate admissions. METHODS:A retrospective review was conducted on data of children aged 0-14 years. A total of 771 children medical records in four county hospitals was collected by stratified random sampling in Midwestern China and was evaluated through the Rural Appropriateness Evaluation Protocol. A questionnaire survey was conducted among doctors whose names were shown in medical records. Chi-square test was used to analyse the characteristics of inappropriate admissions, and a binary logistic regression model was used to examine the determinants of inappropriate admissions. RESULTS:Inappropriate admissions indicate that patients who could have been treated as outpatients received services as inpatients. The average rate for inappropriate admissions of children in county hospitals was 61.35%. The highest rate of inappropriate admissions was found among children aged 1-5 years (68.42%). Inappropriate admissions mostly occurred in children with respiratory diseases (72.45%), circulatory diseases (72.22%) and certain infectious diseases and parasitic diseases (70.37%). Binary logistic regression analysis showed that county, normal health status, treating department, disease, the length of hospital stay and the doctor's self-evaluation on the understanding about the degree of the patient's feelings were determinants for children's inappropriate admissions. CONCLUSIONS:County hospitals have a high rate of inappropriate admissions of children. The relationship of children's inappropriate admissions to age distribution and the insurance compensation is affected by disease and hospitalisation expenses, respectively. The determinants of children's inappropriate admissions are directly related to the weak level of primary care services in the health service system, the initial requirements requested by children's admission decision makers and the interests among medical institutions and doctors.
Economic burden of dengue in four major cities of Pakistan during 2011.
Rafique Ibrar,Nadeem Saqib Muhammad Arif,Munir Muhammad Arif,Qureshi Huma,Siddiqui Shajee,Habibullah Sultana,Bashir Saira,Rehman Sana,Ashraf Sajjad
JPMA. The Journal of the Pakistan Medical Association
OBJECTIVE:To assess the economic burden of dengue infection by calculating cost per patient and disability adjusted life years lost. METHODS:The cross-sectional study was conducted in Islamabad, Lahore, Faisalabad and Karachi from July 2012 to March 2013. Residential addresses and telephonic numbers of dengue patients were taken from the records of Pakistan Institute of Medical Sciences, Islamabad, Mayo and Ganga Ram Hospital, Lahore, Civil Hospital, Karachi, and Allied Hospital, Faisalabad. A total of 250 dengue confirmed cases - 50 from each hospital - were randomly selected. Information regarding duration of illness and out-of-pocket expenses were collected to estimate the direct cost, while indirect cost (number of work days missed by the patient) was calculated from disability adjusted life years using Murray's formula. RESULTS:Overall, there were 162(65%) men and 88(35%) with a mean age of 30.4±13.5years. More than half 138(55%) were below 30 years of age. Socio-economically, 145(58%) belonged to low, 70(28%) middle and 35(14%) to high socioeconomic groups. Of the total, 210(84%) cases had dengue fever followed by 32(12.8%) dengue haemorrhagic fever and 8(3.2%) dengue shock syndrome cases. Average duration of illness was 32±7.1 days. Overall direct cost per patient was Rs.35,823 (US$358) and average pre-hospitalisation, hospitalisation and post-hospitalisation was Rs.6154, Rs.21,242 and Rs.8,427 respectively. The overall disability adjusted life years per million population was 133.76. CONCLUSIONS:Although the government had provided free treatment for dengue in public-sector hospitals, still patients had to pay Rs.21,242 during hospital stay, resulting in substantial burden which needs to be addressed.
How Serious is the Economic Burden of Diabetes Mellitus in Hainan Province? A Study Based on "System of Health Account 2011".
Dong Yuanyuan,Liu Chunping,Zhou Peng,Zhu Yalan,Tang Qingcheng,Wang Siyu,Wang Xin
Diabetes therapy : research, treatment and education of diabetes and related disorders
INTRODUCTION:The treatment of diabetes requires extensive use of healthcare resources, resulting in high medical costs, which in turn places a heavy economic burden on society, patients and their families. METHODS:A multi-stage stratified random sampling method was used to investigate 283 medical and health institutions in Hainan Province. The total medical expenses relating to diabetes in Hainan Province in 2016, institutional flow directions, the composition of service functions and the distribution of the healthcare costs to beneficiaries were analyzed based on the System of Health Account 2011. The STATA version 12.0 statistical software package was used to collate operation data, and SPSS software was used to carry out regression analysis on the factors affecting hospitalization costs. RESULTS:In 2016, the total medical expenses for the treatment of diabetes in Hainan Province was 242.17 billion renminbi (RMB), of which 81.95% was spent in high-level hospitals and 14.71% was spent in medical institutions providing primary care. There was little difference between outpatient and hospitalization expenses (53.01 and 46.99%, respectively). Hospitalization accounted for 77.62% of the expenses of medical institutions providing primary care. Older patients were found to spend more on medical and drug expenditure. CONCLUSION:The economic burden of healthcare expenses for the treatment of diabetes in Hainan Province is massive, and patient treatment is concentrated in large hospitals. It is necessary to inform patients to focus more on medical institutions that provide primary care, adjust the proportion of medical insurance reimbursement, control the cost of hospitalization and strengthen the healthcare management of middle-aged and elderly diabetic patients. Only in this way can costs be reduced and the economic burden be eased.
Burden of herpes zoster requiring hospitalization in Spain during a seven-year period (1998-2004).
Gil Angel,Gil Ruth,Alvaro Alejendro,San Martín María,González Antonio
BMC infectious diseases
BACKGROUND:A thorough epidemiological surveillance and a good understanding of the burden of diseases associated to VZV are crucial to asses any potential impact of a prevention strategy. A population-based retrospective epidemiological study to estimate the burden of herpes zoster requiring hospitalization in Spain was conducted. METHODS:This study was conducted by using data from the national surveillance system for hospital data, Conjunto Mínimo Básico de Datos (CMBD). Records of all patients admitted to hospital with a diagnosis of herpes zoster (ICD-9-MC codes 053.0-053.9) during a 7-year period (1998-2004) were selected. RESULTS:A total of 23,584 hospitalizations with a primary or secondary diagnosis of herpes zoster in patients > or = 30 years of age were identified during the study period. Annually there were 13.4 hospitalizations for herpes zoster per 100,000 population in patients > or = 30 years of age. The rate increases with age reaching a maximum in persons > or = 80 years of age (54.3 admissions per 100,000 population >80 years of age). The mean cost of a hospitalization for herpes zoster in adult patients was 3,720 euro. The estimated annual cost of hospitalizations for herpes zoster in patients > or = 30 years of age in Spain was 12,731,954 euro. CONCLUSION:Herpes zoster imposes an important burden of hospitalizations and result in large cost expenses to the Spanish National Health System, especially in population older than 50 years of age.
The impact of medical insurance policies on the hospitalization services utilization of people with schizophrenia: A case study in Changsha, China.
Feng Yi,Xiong Xianjun,Xue Qiuji,Yao Lan,Luo Fei,Xiang Li
Pakistan journal of medical sciences
OBJECTIVE:To evaluate the impact of two medical insurers' policies on the hospitalization of people with schizophrenia and the economic burden they faced during a period of rapid health services reform in China. METHODOLOGY:A comparative analysis was made of Urban Employee-Basic Medical Insurance (UE-BMI) and Urban Residents-Basic Medical Insurance (UR-BMI) policies on the medical management of schizophrenics, and was compared with hospitalization expenses, insurer reimbursement data and other information collected from the HMO (health maintenance organization) and social insurance agencies on the care of people with schizophrenia in Changsha in 2010. In-depth interviews were also conducted with relevant managers. RESULTS:Compared with inpatients covered by UR-BMI, the inpatients of UE-BMI were admitted to higher level medical institutions and were prescribed expensive second generation antipsychotics (SGA) medicines. Nevertheless, the hospitalization service utilization and cost of inpatients' hospitalization under UE-BMI were far less than that of inpatients under UR-BMI. CONCLUSIONS:The insurance level difference between two medical insurance schemes influences the treatment regimens and benefits received by patients. Furthermore, the integration of schizophrenia management into the outpatient services pooling fund for special diseases(OS-PFSD) can appropriately reduce hospitalization utilization, which, together with the payment way reform and the prescription of reasonable medications, can significantly reduce the overall hospitalization cost for patients.
Ischemic heart disease. Hospitalization, length of stay and expenses in Brazil from 1993 to 1997.
Laurenti R,Buchalla C M,Caratin V de S
Arquivos brasileiros de cardiologia
OBJECTIVE:To identify characteristics of the hospitalizations due to ischemic heart disease (IHD) made by the Single Health System--"Sistema Unico de Saúde (SUS) in Brazil from 1993 to 1997. METHODS:The information used came from records of permissions for hospitalization due to IHD (diseases codified from 410 to 414 by the International Disease Classification--9th Revision) furnished by the data bank DATA-SUS. The material studied was classified according to age, sex and length of hospitalization of the patients, and expenses to the system for IHD. RESULTS:IHD represents 1.0% of total hospitalizations. Angina pectoris was the most frequent type, occurring in 53.3% of the cases, followed by acute myocardial infarct (26.6%). This later was more frequent in men and angina in women. The majority of patients with IHD stayed hospitalized from 5 to 8 days. In the years of 1997 the expenses due to hospital treatment for IHD reach to 0.01% of Brazil's Gross Internal Product. In the studied period (1993-1997), IHD was responsible by 1.0% of hospitalizations, however it was 3.3% of the expenses of SUS. CONCLUSION:IHD is an important cause of hospitalization by the SUS; it has a rather high cost, indicating the need for preventive measures aimed at reducing exposure to risk factors and to decrease the incidence of this group of diseases in the nation.
Assessment of healthcare costs of amputation and prosthesis for upper and lower extremities in a Qatari healthcare institution: a retrospective cohort study.
Al-Thani Hassan,Sathian Brijesh,El-Menyar Ayman
OBJECTIVES:To evaluate the healthcare cost of amputation and prosthesis for management of upper and lower extremities in a single institute. DESIGN:Retrospective cohort study conducted between 2000 and 2014. PARTICIPANTS:All patients who underwent upper (UEA) and lower extremities amputation (LEA) were identified retrospectively from the operating theatre database. Collected data included patient demographics, comorbidities, interventions, costs of amputations including hospitalisation expenses, length of hospital stay and mortality. OUTCOME MEASURES:Incidence, costs of amputation and hospitalisation according to the level of the amputation and cost per bed days, length of hospital stay and mortality. RESULTS:A total of 871 patients underwent 1102 (major 357 and minor 745) UEA and LEA. The mean age of patients was 59.4±18.3, and 77.2% were males. Amputations were most frequent among elderly (51.1%). Two-third of patients (75.86%, 95% CI 72.91% to 78.59%) had diabetes mellitus. Females, Qatari nationals and non-diabetics were more likely to have higher mean amputation and hospital stay cost. The estimated total cost for major and minor amputations were US$3 797 930 and US$2 344 439, respectively. The cumulative direct healthcare cost comprised total cost of all amputations, bed days cost and prosthesis cost and was estimated to be US$52 126 496 and per patient direct healthcare procedure cost was found to be US$59 847. The total direct related therapeutic cost was estimated to be US$26 096 046 with per patient cost of US$29 961. Overall per patient cost for amputation was US$89 808. CONCLUSIONS:The economic burden associated with UEA and LEA-related hospitalisations is considerable. Diabetes mellitus, advanced age and sociodemographic factors influence the incidence of amputation and its associated healthcare cost. The findings will help to showcase the economic burden of amputation for better management strategies to reduce healthcare costs. Furthermore, larger prospective studies focused on cost-effectiveness of primary prevention strategies to minimise diabetic complication are warranted.
Gap analysis on hospitalized health service utilization in floating population covered by different medical insurances ----- case study from Jiangsu Province, China.
Cai Xinzhao,Yang Fan,Bian Ying
International journal for equity in health
OBJECTIVE:By analyzing the gap of hospitalization service among floating population covered by different medical insurance in Jiangsu Province, this paper aimed to understand the current situation of hospitalized health service utilization (HHSU) among floating population, and to provide policy suggestions for improving HHSU of floating population with different health insurance. METHODS:The data of this study were obtained from "the National Dynamic Monitoring Survey of Floating Population in 2014". A total of 12,000 samples of floating population in Jiangsu Province were selected. 57.15% for men and 42.85% for women; 46.95% for those under 30 years old, 39.67% for 30 to 45 years old, 13.38% for over the age of forty-five. Using descriptive statistical analysis, chi-square test, exploratory factor analysis, logistic regression and stepwise multiple linear regression, the paper analyzed the difference of HHSU of floating population with different medical insurance in 2014. This study divided basic medical insurance into 3 categories: MIUE (Medical Insurance of Urban Employee), other medical insurances (including new rural cooperative medical system and the medical insurance for urban residents) and no medical insurance. RESULTS:The hospitalization rate of floating population with MIUE (89.95%) was higher than the rate of floating population with other medical insurances (74.76%) and the gap is 15.19%. It was also higher than the rate of floating population with no medical insurance (67.57%) and the gap is 22.38%. (chi-square = 24.958, p = 0.000). 15.34% of floating population with MIUE spent more than 1600 dollars during hospitalization. It was lower than floating population with other medical insurances (16.19%) and no medical insurance (21.62%). The gaps respectively were 0.85 and 6.28% (chi-square = 10.000, p = 0.040). There existed significant differences among hospitalization medical expenses that floating population with different basic medical insurances spent. (chi-square = 225.206, p = 0.000) The type of basic medical insurance had statistical significance on whether the patients were hospitalized (p = 0.003) and whether they were hospitalized (p = 0.014). Logistic regression analysis results showed that "Social structure" (Education, Hukou, Insurance status and Work status) were significantly associated with Should be hospitalized but not and "Education" were significantly associated with Inpatient facilities selection. The stepwise multiple linear regression results presented that "Demography" and "Floating area" influenced In-hospital medical cost and "Social structure" and "Gender" influenced Reimbursement of in-hospital medical cost. CONCLUSION:Medical insurance type affects the hospitalization health service utilization of floating population, including Should be hospitalized but not and Reimbursement of in-hospital medical cost.
Medical costs in patients with heart failure after acute heart failure events: one-year follow-up study.
Kim Eugene,Kwon Hye-Young,Baek Sang Hong,Lee Haeyoung,Yoo Byung-Su,Kang Seok-Min,Ahn Youngkeun,Yang Bong-Min
Journal of medical economics
AIMS:This study investigated annual medical costs using real-world data focusing on acute heart failure. METHODS:The data were retrospectively collected from six tertiary hospitals in South Korea. Overall, 330 patients who were hospitalized for acute heart failure between January 2011 and July 2012 were selected. Data were collected on their follow-up medical visits for 1 year, including medical costs incurred toward treatment. Those who died within the observational period or who had no records of follow-up visits were excluded. Annual per patient medical costs were estimated according to the type of medical services, and factors contributing to the costs using Gamma Generalized Linear Models (GLM) with log link were analyzed. RESULTS:On average, total annual medical costs for each patient were USD 6,199 (±9,675), with hospitalization accounting for 95% of the total expenses. Hospitalization cost USD 5,904 (±9,666) per patient. Those who are re-admitted have 88.5% higher medical expenditure than those who have not been re-admitted in 1 year, and patients using intensive care units have 19.6% higher expenditure than those who do not. When the number of hospital days increased by 1 day, medical expenses increased by 6.7%. LIMITATIONS:Outpatient drug costs were not included. There is a possibility that medical expenses for AHF may have been under-estimated. CONCLUSION:It was found that hospitalization resulted in substantial costs for treatment of heart failure in South Korea, especially in patients with an acute heart failure event. Prevention strategies and appropriate management programs that would reduce both frequency of hospitalization and length of stay for patients with the underlying risk of heart failure are needed.
Evaluation of the cost of atrial fibrillation during emergency hospitalization.
Pirson Magali,Di Pierdomenico Lionel,Gusman Julie,Baré Benoît,Fontaine David,Motte Serge
OBJECTIVE:The number of hospitalizations for atrial fibrillation has increased dramatically. This increase, in the number of hospital stays will continue, given the growth projections based on epidemiological data, and will contribute to significantly increase expenses for the social security system.The objective of this study was to evaluate the length of hospital stay, the average cost borne by social security, and the types of hospital stay expenditures for patients admitted through the emergency department for atrial fibrillation. METHODS:Patients were identified by using the minimal clinical summaries of seven general hospitals in Belgium in 2008. Only hospitalized patients having as primary diagnosis code ICD-9-CM 42731 'atrial fibrillation'were selected for this study. Hospital billing files were analysed in order to isolate the costs borne by social security. Outliers were isolated in order not to have results influenced by patients having an atypical length of stay. RESULTS:Results show that the mean length of stay was 8.6 days and the mean cost charged to social security was euro 3,066.02 per hospital stay.The mean cost of care was strongly associated with the degree of severity index related to the APR-DRG. Approximately 85% of the total cost was related to the cost of hospital days and medical procedures with medical imaging and laboratory tests being the two main cost inductors. 18% of patients had cardioversion during their hospital stay, including 4% who had only that treatment. 19% of patients used amiodarone. Flecainide and propafenone were also used, but less frequently. CONCLUSIONS:The mean cost of care for AF patients admitted via the emergency department is strongly associated with the degree of severity. Approximately 85% of the total cost is related to the cost of hospital days and medical procedures. Hypertension is the most common secondary diagnosis. An optimal treatment of this risk factor could help to reduce the risk of atrial fibrillation, and thereby reduce the morbidity and costs associated with this disease.
What does delirium cost? An economic evaluation of hyperactive delirium.
Weinrebe W,Johannsdottir E,Karaman M,Füsgen I
Zeitschrift fur Gerontologie und Geriatrie
BACKGROUND:Demographic changes have resulted in an increase in the number of older (> 75 years) multimorbid patients in clinics. In addition to the primary acute diagnoses that lead to hospitalization, this group of patients often has cognitive dysfunctions, such as delirium. According to clinical experience, delirium patients are more time-consuming for clinicians and their function is often poor. The costs caused by delirium patients are currently unknown. In the present study, a retrospective examination of a database was carried out to calculate the costs that arise during the clinical treatment of documented delirium patients. SETTING AND METHODS:The purpose of this retrospective analysis was to collect information recorded by nursing personnel trained in the treatment of delirium and information from a manual documentation matrix for additional time expenditure. In the database analysis anonymous data of previously discharged patients for a time window of 3 months were analyzed. Documented additional expenditure for patients with hyperactive delirium at hospitalization were analyzed by personnel. Material costs, the duration of hospitalization by main diagnosis and age clusters during hospitalization until discharge were also examined. The analysis was performed in a hospital with internal wards. RESULTS:Data for 82 hyperactive delirium patients were examined and an average of approximately 240 min of additional personnel expenditure for these patients was found. These patients were approximately 10 years older (p < 0.01) and were hospitalized for an average of 4.2 days longer (p < 0.01) than non-delirium patients. Hyperactive delirium usually developed within the first 5 days of hospitalization and lasted 1.6 days on average. Patients for whom hyperactive delirium was detected early were hospitalized for significantly less time than those for whom it was detected late (6.85 versus 13.61 days, p = 0.002). Additionally, calculated personnel and material costs, including costs affecting the hospitalization period, amounted to approximately 1200 € per hyperactive delirium patient. This corresponds to approximately 0.3 CMP (casemix points) per patient. CONCLUSION:The calculations of personnel and material costs and duration of hospitalization in patients with hyperactive delirium demonstrated significant additional costs. Early routine detection of delirium can be achieved through training and this approach leads to a shortening of the hospitalization period and lower costs.
Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil.
Cavassini Ana Claudia Molina,Lima Silvana Andréa Molina,Calderon Iracema Mattos Paranhos,Rudge Marilza Vieira Cunha
Sao Paulo medical journal = Revista paulista de medicina
CONTEXT AND OBJECTIVE:Pregnancies complicated by diabetes are associated with increased numbers of maternal and neonatal complications. Hospital costs increase according to the type of care provided. This study aimed to estimate the cost-benefit relationship and social profitability ratio of hospitalization, compared with outpatient care, for pregnant women with diabetes or mild hyperglycemia. STUDY DESIGN:This was a prospective observational quantitative study conducted at a university hospital. It included all pregnant women with pregestational or gestational diabetes, or mild hyperglycemia, who did not develop clinical intercurrences during pregnancy and who delivered at the Botucatu Medical School Hospital (Hospital das Clínicas, Faculdade de Medicina de Botucatu, HC-FMB) of Universidade Estadual de São Paulo (Unesp). METHODS:Thirty pregnant women treated with diet were followed as outpatients, and twenty treated with diet plus insulin were managed through frequent short hospitalizations. Direct costs (personnel, materials and tests) and indirect costs (general expenses) were ascertained from data in the patients' records and the hospital's absorption costing system. The cost-benefit was then calculated. RESULTS:Successful treatment of pregnant women with diabetes avoided expenditure of US$ 1,517.97 and US$ 1,127.43 for patients treated with inpatient and outpatient care, respectively. The cost-benefit of inpatient care was US$ 143,719.16, and outpatient care, US$ 253,267.22, with social profitability of 1.87 and 5.35, respectively. CONCLUSION:Decision-tree analysis confirmed that successful treatment avoided costs at the hospital. Cost-benefit analysis showed that outpatient management was economically more advantageous than hospitalization. The social profitability of both treatments was greater than one, thus demonstrating that both types of care for diabetic pregnant women had positive benefits.
Long-term medical utilization following ventilator-associated pneumonia in acute stroke and traumatic brain injury patients: a case-control study.
Yang Chih-Chieh,Shih Nai-Ching,Chang Wen-Chiung,Huang San-Kuei,Chien Ching-Wen
BMC health services research
BACKGROUND:The economic burden of ventilator-associated pneumonia (VAP) during the index hospitalization has been confirmed in previous studies. However, the long-term economic impact is still unclear. The aim of this study is to examine the effect of VAP on medical utilization in the long term. METHODS:This is a retrospective case-control study. Study subjects were patients experiencing their first traumatic brain injury, acute hemorrhagic stroke, or acute ischemic stroke during 2004. All subjects underwent endotracheal intubation in the emergency room (ER) on the day of admission or the day before admission, were transferred to the intensive care unit (ICU) and were mechanically ventilated for 48 hours or more. A total of 943 patients who developed VAP were included as the case group, and each was matched with two control patients without VAP by age ( ± 2 years), gender, diagnosis, date of admission ( ± 1 month) and hospital size, resulting in a total of 2,802 patients in the study. Using robust regression and Poisson regression models we examined the effect of VAP on medical utilization including hospitalization expenses, outpatient expenses, total medical expenses, number of ER visits, number of readmissions, number of hospitalization days and number of ICU days, during the index hospitalization and during the following 2-year period. RESULTS:Patients in the VAP group had higher hospitalization expenses, longer length of stay in hospital and in ICU, and a greater number of readmissions than the control group patients. CONCLUSIONS:VAP has a significant impact on medical expenses and utilization, both during the index hospitalization during which VAP developed and in the longer term.
Current status of the medical expenses for the treatment of arteriosclerosis obliterans in Japan.
Isaji T,Takayama T,Endo A,Akai A,Kudo M,Kagaya H,Suzuki J,Hashimoto T,Hoshina K,Kimura H,Okamoto H,Shigematsu K,Miyata T
International angiology : a journal of the International Union of Angiology
AIM:We aimed to determine the current status of the medical expenses for the treatment of arteriosclerosis obliterans (ASO) and evaluate the cost effectiveness of the medical practices employed in ASO treatment in Japan. METHODS:We performed a prospective observational study using 140 ASO patients. The cost of the medical practices comprised the costs of outpatient treatment, pharmacological agents, and hospitalization. To compare the average monthly costs, the patients were divided into preintervention, postintervention, or conservative-therapy groups. To compare the total costs and effectiveness of each treatment, the patients who had first visited our division during the study period were classified into surgery, endovascular-revascularization (EVR), or conservative-therapy groups. The adverse reactions of the 4 most popular agents for ASO were investigated, and bleeding events were assessed specifically. RESULTS:The average monthly costs for outpatient treatment and pharmacological agents were yen 168,002 in conservative cases, yen 149,871 in preoperation cases, and yen 128,527 in postoperation cases. The mean total costs were yen 5,407,950 in conservative cases, yen 7,375,290 in surgical cases, and yen 2,631,650 in EVR cases. The average change of the gauge in clinical status was 0.57 in conservative cases, 2.13 in surgical cases, and 2.25 in EVR cases. Warfarin induced more bleeding complications than the other agents. CONCLUSION:The costs of pharmacological agents represented much of the medical costs in any treatment groups.
Hospitalization costs of lung cancer diagnosis in Turkey: Is there a difference between histological types and stages?
Türk Murat,Yıldırım Fatma,Yurdakul Ahmet Selim,Öztürk Can
Tuberkuloz ve toraks
INTRODUCTION:To establish the direct costs of diagnosing lung cancer in hospitalized patients. MATERIALS AND METHODS:Hospital data of patients who were hospitalized and diagnosed as lung cancer between September 2013 and August 2014 were retrospectively analyzed. Patients who underwent surgery for diagnosis and who were initiated with cancer treatment during the same hospital stay were excluded from study. Histological types and stages of lung cancer were determined. Expenses were grouped as laboratory costs, pathology costs, diagnostic imaging costs, overnight room charges, medication costs, blood center costs, consumable expenditures' costs and inpatient service charges (including consultants' service, electrocardiogram, follow-up, nursing services, diagnostic interventions). RESULT:Of the 68 patients, 55 (81%) had non-small cell lung cancer (NSCLC), 13 (19%) had small cell lung cancer (SCLC). 47% of patients with NSCLC had stage 4 disease and 86% of patients with SCLC had extensive stage disease. Median total cost per patient was 910 (95% CI= 832-1291) Euros (€). Of all costs, 37% were due to inpatient service charges and 22% were medication costs. Median total cost per patient was 912 (95% CI= 783-1213) € in NSCLC patients and 908 (95% CI= 456-2203) € in SCLC patients (p> 0.05). In NSCLC group, total cost per patient was 873 (95% CI= 591-1143) € in stage 1-2-3 diseases and 975 (95% CI= 847-1536) € in stage 4 disease (p> 0.05). In SCLC group total cost per patient was 937 € in limited stage and 502 (95% CI= 452-2508) € in extensive stage (p> 0.05). CONCLUSIONS:There is no significant difference between costs related to diagnosis of different lung cancer types and stages in patients hospitalized in a university hospital.
Clinical features of heart failure hospitalization in younger and elderly patients in Taiwan.
European journal of clinical investigation
BACKGROUND: This study compared the comorbidities, drugs, expenses and in-hospital mortality between younger and elderly patients hospitalized with heart failure. METHODS:A random sample of 1,000.000 insurants of the National Health Insurance program of Taiwan in 2005 was used. Comparisons were made between younger (20-64years) and elderly (≥65years) patients. RESULTS:Heart failure hospitalization was identified in 2692 patients. Ageing, female sex, diabetes, hypertension, chronic obstructive pulmonary disease, nephropathy, infection and ischaemic heart disease were significantly associated with heart failure hospitalization. The incidence was 88 and 2181 per 100,000 population, in younger and elderly people, respectively. The most common comorbidity in the elderly was hypertension (38·3%), followed by infection (32·0%) and ischaemic heart disease (31·9%). In younger patients, hypertension (41·3%), diabetes (35·5%) and ischaemic heart disease (29·8%) were the most common comorbidity. Diuretics were the most common drugs for both the younger (74·4%) and the elderly (76·9%) patients, followed by angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers and aspirin. The length of stay was longer (17·1 vs. 11·0days, P<0·0001), total expense higher (105,290·5 vs. 85,473·6 New Taiwan Dollars, P<0·05) and in-hospital mortality higher (4·2% vs. 2·7%, P=0·0823) in the elderly. Length of stay, nephropathy, infection, ischaemic heart disease and peripheral arterial disease were associated with expenses. In-hospital mortality was associated with age, length of stay, cancer, infection and peripheral arterial disease. CONCLUSIONS:The elderly have a 25-fold higher risk of heart failure hospitalization, longer length of in-hospital stay, higher total medical expense and higher in-hospital mortality.
Predictors of hospital expenses and hospital stay among patients undergoing total laryngectomy: Cost effectiveness analysis.
Tsai Ming-Hsien,Chuang Hui-Ching,Lin Yu-Tsai,Lu Hui,Fang Fu-Min,Huang Tai-Lin,Chiu Tai-Jan,Li Shau-Hsuan,Chien Chih-Yen
OBJECTIVE:To determine the predictive factors of postoperative hospital stay and total hospital medical cost among patients who underwent total laryngectomy. METHODS:A total of 213 patients who underwent total laryngectomy in a tertiary referral center for tumor ablation were enrolled retrospectively between January 2009 and May 2018. Statistical analyses including Pearson's chi-squared test were used to determine whether there was a significant difference between each selected clinical factors and outcomes. The outcomes of interest including postoperative length of hospital stay and inpatient total medical cost. Logistic regression analyses were performed to reveal the relationship between clinical factors and postoperative length of hospital stay or total inpatient medical cost. RESULTS:Preoperative radiotherapy (p = 0.007), method of wound closure (p < 0.001), postoperative serum albumin level (p = 0.025), and postoperative serum hemoglobin level (p = 0.04) were significantly associated with postoperative hospital stay in univariate analysis. Postoperative hypoalbuminemia (odds ratio [OR]: 2.477; 95% confidence interval [CI]: 1.189-5.163; p = 0.015) and previous radiotherapy history (OR 2.194; 95% CI: 1.228-3.917; p = 0.008) are independent predictors of a longer postoperative hospital stay in multiple regression analysis. With respect to total inpatient medical cost, method of wound closure (p < 0.001), preoperative serum albumin level (p = 0.04), postoperative serum albumin level (p < 0.001), and history of liver cirrhosis (p = 0.037) were significantly associated with total inpatient medical cost in univariate analysis. Postoperative hypoalbuminemia (OR: 6.671; 95% CI: 1.927-23.093; p = 0.003) and microvascular free flap reconstruction (OR: 5.011; 95% CI: 1.657-15.156; p = 0.004) were independent predictors of a higher total inpatient medical cost in multiple regression analysis. CONCLUSIONS:Postoperative albumin status is a significant factor in predicting prolonged postoperative hospital stay and higher inpatient medical cost among patients who undergo total laryngectomy. In this cohort, the inpatient medical cost was 48% higher and length of stay after surgery was 35% longer among hypoalbuminemia patients.
Tolvaptan Reduces Long-Term Total Medical Expenses and Length of Stay in Aquaporin-Defined Responders.
Imamura Teruhiko,Kinugawa Koichiro,Nitta Daisuke,Komuro Issei
International heart journal
The vasopressin type-2 antagonist tolvaptan (TLV) has clinical advantages including amelioration of congestion and normalization of hyponatremia in patients with decompensated heart failure (HF). However, there have been no studies on the cost-effectiveness of TLV therapy. We enrolled 60 consecutive hospitalized patients with stage D HF who received TLV [TLV (+) group], and 60 propensity score-matched HF patients without TLV treatment [TLV (-) group]. We excluded 54 patients who died or received cardiac replacement therapy within 1 year, and finally enrolled 32 patients who received TLV and 34 who did not, who were followed for > 1 year. Among 45 aquaporin-defined responders, whose urine aquaporin-2 relative to plasma arginine vasopressin level was > 1.4 × 10(3) L/g Cre, the TLV (+) group required significantly lower total medical expenses and shorter lengths of stay (LOS) compared with the TLV (-) group [11.2 (1.233.3) versus 31.2 (2.2-71.4) × 10(5) JPY/year, P < 0.001; 30 (0-304) versus 70 (20-221) days, P = 0.030]. In contrast, among the remaining 21 aquaporin-defined non-responders, medical expenses and LOS were comparable irrespective of TLV administration (P = 0.087 and P = 0.407). In conclusion, TLV therapy may reduce total medical expenses in aquaporin-defined responders with stage D HF.
Is There A Non-Essential Hospitalization Day In Inpatients With Diabetes Under Medical Insurance? Evidence From An Observational Study In China.
Diabetes, metabolic syndrome and obesity : targets and therapy
PURPOSE:Non-essential hospitalization day of inpatient diabetes threatens health seriously and contributes to great economic burden on individuals and the society. Studying the essential utilization of hospitalization services is conducive to the reduction in the burden of diabetes. The purpose of this study is to identify the existence of non-essential hospitalization days during hospitalization in diabetic patients through exploring the use of health care in different types of insured patients. PATIENTS AND METHODS:A sample of 6731 admission records from 5929 hospitalized patients was studied. Binary logistic regression was performed to estimate the adjusted effects of health insurance status on readmission. Multiple stepwise linear regression was performed to estimate the adjusted effects of health insurance status on length of stay (LOS), direct medical expenses (DME), out-of-pocket (OOP) expenditures, and percentage of individual payment after reimbursement (PIPAR). Adjusted odds ratios (with 95% CI) were reported as the results of logistic regression models and linear regression models, respectively. RESULTS:Adjusted 7-day readmission rate and 30-day readmission rate were not significantly different between urban and rural resident basic medical insurance (URRBMI) and urban employee basic medical insurance (UEBMI). Compared with inpatients under URRBMI, the adjusted LOS and DME were significantly higher for UEBMI inpatients (adjusted OR of 2.6, 95% CI=1.9-3.2, adjusted OR of 1870.85, 95% CI=1370.97-2370.73, respectively). Adjusted OOP and PIPAR were significantly lower for UEBMI inpatients (adjusted OR of－970.86, 95% CI =-1111.63--830.10, adjusted OR of -0.19, 95% CI=-0.20--0.18, respectively). CONCLUSION:There was a non-essential hospitalization day existing in the treatment of diabetes. Moral hazard has been found in UEBMI which would trigger overtreatment in hospitalization of diabetics, and the lower PIPAR of UEBMI was one of the main causes of moral hazard.
Cost analysis of oral and maxillofacial free flap reconstruction for patients at an institution in China.
Yang Y,Li P-J,Shuai T,Wang Y,Mao C,Yu G-Y,Guo C-B,Peng X
International journal of oral and maxillofacial surgery
Free flap transplantation has become a mainstay for the restoration of oral and maxillofacial defects. However, the complexity of the surgical procedure and long hospitalization time result in high hospitalization costs. This study was performed to retrospectively analyse the composition of hospitalization expenses and factors influencing this for 507 patients who underwent oral and maxillofacial free flap transplantation at a representative medical institution in China. The aim was to provide evidence for the reasonable control of expenditure and effective utilization of medical resources, and to gain an indirect reflection of the healthcare model characteristics of public hospitals in China. The average hospitalization cost was found to be US$ 9265±2284. Factors affecting hospitalization expenses were the type of free flap, tracheotomy, postoperative complications, and length of stay. The largest proportion of hospitalization expenses was the cost of materials (44.94%). Although the total hospitalization cost was lower than that in Western countries, the medical burden of patients was higher, and the corresponding medical charges do not fully reflect the value of medical services. We recommend reducing hospitalization expenses and the medical burden by shortening the hospital stay, selecting reasonably priced medical materials, strengthening airway management of patients undergoing tracheotomy, and enhancing the control and treatment of comorbidities in order to reduce the incidence of postoperative complications.
Impact of BMI on exacerbation and medical care expenses in subjects with mild to moderate airflow obstruction.
Jo Yong Suk,Kim Yee Hyung,Lee Jung Yeon,Kim Kyungjoo,Jung Ki-Suck,Yoo Kwang Ha,Rhee Chin Kook
International journal of chronic obstructive pulmonary disease
Background and objective:The rate of obesity is increasing in Asia, but the clinical impact of body mass index (BMI) on the outcome of chronic obstructive pulmonary disease (COPD) remains unknown. We aimed to assess this impact while focusing on the risk of exacerbation, health-care utilization, and medical costs. Methods:We examined 43,864 subjects registered in the Korean National Health and Nutrition Examination Survey (KNHANES) database from 2007 to 2012, and linked the data of COPD patients who had mild to moderate airflow obstruction (n = 1,320) to National Health Insurance (NHI) data. COPD was confirmed by spirometry. BMI was used to stratify patients into four categories: underweight (BMI <18.5 kg/m), normal range (18.5-22.9 kg/m), overweight (23-24.9 kg/m), and obese (≥25 kg/m). Results:Of the 1,320 patients with COPD with mild to moderate airflow obstruction, 27.8% had a BMI ≥25 kg/m. Compared with normal-weight patients, obese patients tended to experience fewer exacerbations (incidence rate ratio [IRR] 0.88; 95% CI 0.77-0.99; = 0.04), although this association was not significant in a multivariable analysis. COPD-related health-care utilization and medical expenses were higher among underweight patients than the other groups. After adjustment, the risk of COPD-related hospitalization was highest among underweight and higher among overweight patients vs normal-weight patients (adjusted IRRs: 7.12, 1.00, 1.26, and 1.02 for underweight, normal, overweight, and obese groups, respectively; = 0.01). Conclusion:Decreased weight tends to negatively influence prognosis of COPD with mild to moderate airflow obstruction, whereas higher BMI was not significantly related to worse outcomes.
Patient characteristics and hospitalisation costs of spinal muscular atrophy in Spain: a retrospective multicentre database analysis.
Darbà Josep,Marsà Alicia
OBJECTIVES:To analyse the characteristics of patients diagnosed with spinal muscular atrophy in Spain, and to revise data on disease management and use of resources in both public and private healthcare centres. DESIGN:A retrospective multicentre database analysis. SETTING:870 admission records registered between 1997 and 2015 with a diagnosis of spinal muscular atrophy were extracted from a Spanish claims database that includes hospital inpatient and outpatient admissions from 313 public and 192 private hospitals in Spain. RESULTS:Admission files corresponded to 705 patients; 61.99% were males and 38.01% females. Average patient age was 37 years. Disease comorbidities registered during the admission consistently included hypertension, scoliosis and respiratory failures, all associated with the standard disease course. Regarding disease management at the hospital level, patients were mostly admitted through scheduled appointments (58.16%), followed by emergency admissions (41.72%), and into neurology services in 17% of the cases. Mean hospitalisation time was 10.45 days and in-hospital mortality reached 5.29%. The overall direct medical costs of spinal muscular atrophy were €291 525, excluding medication. The average annual cost per admission was €6274, with large variations likely to reflect disease complexity and that increases with length of stay. CONCLUSIONS:The rarity of the disease difficulties the study of demographics and management; yet, an analysis of patient characteristics provides necessary information that can be used by governments to establish more efficient healthcare protocols. This study reflects the impact that individual needs and disease severity can have in disease burden calculations. Forthcoming decision-making policies should take into account medical costs and its variability, as well as pharmaceutical expenses and indirect costs. To our knowledge, this is the first study evaluating the use of healthcare resources of patients with spinal muscular atrophy in Spain.
The development, implementation and evaluation of a transitional care programme to improve outcomes of frail older patients after hospitalisation.
Heim Noor,Rolden Herbert,van Fenema Esther M,Weverling-Rijnsburger Annelies W E,Tuijl Jolien P,Jue Peter,Oleksik Anna M,de Craen Anton J M,Mooijaart Simon P,Blauw Gerard Jan,Westendorp Rudi G J,van der Mast Roos C,van Everdinck Irma E C
Age and ageing
BACKGROUND:fragmented healthcare systems are poorly suited to treat the increasing number of older patients with multimorbidity. OBJECTIVE:to report on the development, implementation and evaluation of a regional transitional care programme, aimed at improving the recovery rate of frail hospitalised older patients. METHODS:the programme was drafted in co-creation with organisations representing older adults, care providers and knowledge institutes. Conducting an action research project, the incidence of adverse outcomes within 3 months after hospital admission, and long-term care expenses (LTCE) were compared between samples in 2010-11 (pre-programme) and 2012-13 (post-programme) in frail and non-frail patients. Hospitalised patients aged ≥70 years were included in four hospitals in the targeted region. RESULTS:developed innovations addressed (i) improved risk management; (ii) delivery of integrated, function-oriented care; (iii) specific geriatric interventions; and (iv) optimisation of transfers. The incidence of adverse outcomes was compared in 813 and 904 included patients respectively in the two samples. In frail patients, the incidence of adverse outcomes decreased from 49.2% (149/303) in the pre-programme sample to 35.5% (130/366) in the post-programme sample. The risk ratio (RR), adjusted for heterogeneity between hospitals, was 0.72 (95% CI: 0.60-0.87). In non-frail patients the incidence of adverse outcomes remained unchanged (RR: 1.02, 95% CI: 0.76-1.36). LTCE were similar in the two samples. CONCLUSIONS:by involving stakeholders in designing and developing the transitional care programme, commitment of healthcare providers was secured. Feasible innovations in integrated transitional care for frail older patients after hospitalisation were sustainably implemented from within healthcare organisations.
Out-of-pocket medical expenses for inpatient care among beneficiaries of the National Health Insurance Program in the Philippines.
Tobe Makoto,Stickley Andrew,del Rosario Rodolfo B,Shibuya Kenji
Health policy and planning
OBJECTIVE The National Health Insurance Program (NHIP) in the Philippines is a social health insurance system partially subsidized by tax-based financing which offers benefits on a fee-for-service basis up to a fixed ceiling. This paper quantifies the extent to which beneficiaries of the NHIP incur out-of-pocket expenses for inpatient care, and examines the characteristics of beneficiaries making these payments and the hospitals in which these payments are typically made. METHODS Probit and ordinary least squares regression analyses were carried out on 94 531 insurance claims from Benguet province and Baguio city during the period 2007 to 2009. RESULTS Eighty-six per cent of claims involved an out-of-pocket payment. The median figure for out-of-pocket payments was Philippine Pesos (PHP) 3016 (US$67), with this figure varying widely [inter-quartile range (IQR): PHP 9393 (US$209)]. Thirteen per cent of claims involved very large out-of-pocket payments exceeding PHP 19 213 (US$428)-the equivalent of 10% of the average annual household income in the region. Membership type, disease severity, age and residential location of the patient, length of hospitalization, and ownership and level of the hospital were all significantly associated with making out-of-pocket payments and/or the size of these payments. CONCLUSION Although the current NHIP reduces the size of out-of-pocket payments, NHIP beneficiaries are not completely free from the risk of large out-of-pocket payments (as the size of these payments varies widely and can be extremely large), despite NHIP's attempts to mitigate this by setting different benefit ceilings based on the level of the hospital and the severity of the disease. To reduce these large out-of-pocket payments and to increase financial risk protection further, it is essential to ensure more investment for health from social health insurance and/or tax-based government funding as well as shifting the provider payment mechanism from a fee-for-service to a case-based payment method (which up until now has only been partially implemented).
Impact of Critical Illness Insurance on the Burden of High-Cost Rural Residents in Central China: An Interrupted Time Series Study.
Li Lu,Jiang Junnan,Xiang Li,Wang Xuefeng,Zeng Li,Zhong Zhengdong
International journal of environmental research and public health
Critical illness insurance (CII) in China was introduced to protect high-cost groups from health expenditure shocks for the purpose of mutual aid. This study aimed to evaluate the impact of CII on the burden of high-cost groups in central rural China. Data were extracted from the basic medical insurance (BMI) hospitalization database of Xiantao City from January 2010 to December 2016. A total of 77,757 hospitalization records were included in our analysis. The out-of-pocket (OOP) expenses and reimbursement ratio (RR) were the two main outcome variables. Interrupted time series analysis with a segmented regression approach was adopted. Level and slope changes were reported to reflect short- and long-term effects, respectively. Results indicated that the number of high-cost inpatient visits, the average monthly hospitalization expenses, and OOP expenses per high-cost inpatient visit were increased after CII introduction. By contrast, the RR from BMI and non-reimbursable expenses ratio were decreased. The OOP expenses and RR covered by CII were higher than those uncovered. We estimated a significant level decrease in OOP expenses ( < 0.01) and rise in RR ( < 0.01), whereas the slope decreases of OOP expenses ( = 0.19) and rise of RR ( = 0.11) after the CII were non-significant. We concluded that the short-term effect of the CII policy is significant and contributes to decreasing OOP expenses and raising RR for high-cost groups, whereas the long-term effect is non-significant. These findings can be explained by increasing hospitalization expenses, many non-reimbursable expenses, low coverage for high-cost groups, and the unsustainability of the financing methods.
Short-term air pollution exposure is associated with hospital length of stay and hospitalization costs among inpatients with type 2 diabetes: a hospital-based study.
Li Xiang,Tang Kai,Jin Xu-Rui,Xiang Ying,Xu Jing,Yang Li-Li,Wang Nan,Li Ya-Fei,Ji Ai-Ling,Zhou Lai-Xin,Cai Tong-Jian
Journal of toxicology and environmental health. Part A
Air pollution is a risk factor for type 2 diabetes (T2D), exerting heavy economic burden on both individuals and societies. However, there is no apparent report regarding the influence of air pollutants such as particulate matter (PM and PM), sulfur dioxide (SO), carbon monoxide (CO), nitrogen dioxide (NO), and ozone (O) on financial burden to individuals and societies suffering from T2D. This study aimed to determine whether short-term (no more than 16 d) air pollution exposure was associated with T2D-related length of stay (LOS) and hospitalization expenses incurred by patients. This investigation examined 2840 T2D patients hospitalized from December 17, 2013 to May 31, 2016 in China. Multiple linear regression analysis was applied to determine the association between short-term (no more than 16 d) ambient air pollution, LOS, and hospitalization expenses, controlling for age, gender, ethnicity, marital status, and weather conditions. Sulfur dioxide (SO) and carbon monoxide (CO) were significantly positively while nitrogen dioxide (NO) was negatively associated with presence of T2D, LOS, and expenses. A 10-μg/m rise in 16-d (lag 0-15) average concentrations of SO and CO prior to hospitalization was correlated with a significant elevation in LOS and elevation in expenses in T2D patients. However, a 10-μg/m rise in 16-d average NO was associated with marked negative alterations in LOS and hospital costs in T2D patients. Taken together, data demonstrate that exposure to air pollutants impacts differently on LOS and hospitalization costs for T2D patients. This is the first apparent report regarding the correlation between air pollution exposure and clinical costs of T2D in China. It is of interest that air pollutants affected T2D patients differently as evidenced by LOS and clinical expenses where SO and CO exhibited a positive adverse relationship in contrast to NO.
Economic burden of hospitalisation for congestive heart failure among adults in the Philippines.
Tumanan-Mendoza Bernadette A,Mendoza Victor L,Bermudez-Delos Santos April Ann A,Punzalan Felix Eduardo R,Pestano Noemi S,Natividad Rudy Boy,Shiu Louie Alfred,Macabeo Renelene,Lam Hilton Y
OBJECTIVES:Hospitalisation for congestive heart failure (CHF) was reported to be 1648 cases for every 100 000 patient claims in 2014 in the Philippines; however, there are no data regarding its economic impact. This study determined CHF hospitalisation cost and its total economic burden. It compared the healthcare-related hospitalisation cost from the societal perspective with the payer's perspective, the Philippine Health Insurance Corporation (PhilHealth). METHODS:This is a cost analysis study. Data were obtained from representative government/private hospitals and a drugstore in all regions of the country. Healthcare costs included cost of diagnostics/treatment, professional fees and other CHF-related hospital charges, while non-healthcare costs included production losses, transportation and food expenses. RESULTS:The overall mean healthcare-related cost for CHF hospitalisation (class III) in government hospitals in the Philippines in 2014 was PHP19 340-PHP28 220 (US$436-US$636). In private hospitals, it was PHP28 370-PHP41 800 (US$639-US$941). In comparison, PhilHealth's coverage/CHF case rate payment is PHP15 700 (US$354). The mean non-healthcare cost was PHP10 700-PHP14 600 (US$241-US$329). Using PhilHealth's case rate payment and the prevalence of CHF hospitalisation in 2014, the total economic burden was PHP691 522 200 (US$15 574 824). Using the study results on healthcare-related cost meant that the total economic burden for CHF hospitalisation would instead be PHP851 850 000-PHP1 841 563 000 (US$19 185 811-US$41 476 644). CONCLUSIONS:The calculated healthcare-related hospitalisation cost for CHF in the Philippines in 2014 demonstrates the disparity between the actual cost and PhilHealth's coverage. This implies a need for policymakers to review its coverage to make healthcare delivery affordable.
Household catastrophic medical expenses in eastern China: determinants and policy implications.
Li Xiaohong,Shen Jay J,Lu Jun,Wang Ying,Sun Mei,Li Chengyue,Chang Fengshui,Hao Mo
BMC health services research
BACKGROUND:Much of research on household catastrophic medical expenses in China has focused on less developed areas and little is known about this problem in more developed areas. This study aimed to analyse the incidence and determinants of catastrophic medical expenses in eastern China. METHODS:Data were obtained from a health care utilization and expense survey of 11,577 households conducted in eastern China in 2008. The incidence of household catastrophic medical expenses was calculated using the method introduced by the World Health Organization. A multi-level logistic regression model was used to identify the determinants. RESULTS:The incidence of household catastrophic medical expenses in eastern China ranged from 9.24% to 24.79%. Incidence of household catastrophic medical expenses was lower if the head of household had a higher level of education, labor insurance coverage, while the incidence was higher if they lived in rural areas, had a family member with chronic diseases, had a child younger than 5 years old, had a person at home who was at least 65 years old, and had a household member who was hospitalized. Moreover, the impact of the economic level on catastrophic medical expenses was non-linear. The poorest group had a lower incidence than that of the second lowest income group and the group with the highest income had a higher incidence than that of the second highest income group. In addition, region was a significant determinant. CONCLUSIONS:Reducing the incidence of household catastrophic medical expenses should be one of the priorities of health policy. It can be achieved by improving residents' health status to reduce avoidable health services such as hospitalization. It is also important to design more targeted health insurance in order to increase financial support for such vulnerable groups as the poor, chronically ill, children, and senior populations.
Estimating cardiovascular hospitalizations and associated expenses attributable to ambient carbon monoxide in Lanzhou, China: Scientific evidence for policy making.
Cheng Jian,Xu Zhiwei,Zhang Xiaoru,Zhao Hui,Hu Wenbiao
The Science of the total environment
OBJECTIVES:Air pollution is an important trigger of cardiovascular disease worldwide, but few studies have determined the cardiovascular disease, health, and economic burdens attributable to ambient carbon monoxide (CO). This study aimed to examine the association between CO and CVD hospitalizations, and quantified the attributable CVD hospitalizations, associated hospital stays and hospitalization costs for CO in Lanzhou, one of the most air-polluted Chinese cities historically. METHODS:Daily data on CVD hospitalizations, air pollutants, and weather records from 2013 to 2017 were obtained for Lanzhou, China. Generalized additive model with a quasi-Poisson link was used to model the association between CO and CVD hospitalizations, after controlling for other air pollutants, weather conditions, day of week, long-term trend, influenza and pneumonia incidence. The effects of CO on hospital stays and hospitalization expenses from CVD were also quantified. RESULTS:CO concentrations below the current Chinese ambient air quality standard had a significant impact on CVD hospitalizations. Each 1 mg/m increase in CO concentration on the present day and previous 4 days (lag 0-4) was associated with an 11% (95% confidence interval: 3%-20%) increase in total CVD hospitalizations. During the study period, CO was responsible for 11.74% of total CVD hospitalizations, equating to 62,792 inpatient days and 149 million RMB. Each adult patient on average spent approximately 5% of annual salary on medicine from CO-related CVD treatment during hospitalization. Maintaining the historical CO concentration within 1 to 3 mg/m could avert hundreds of total CVD hospitalizations and save millions of RMB annually in Lanzhou, China. CONCLUSIONS:Exposure to low-level ambient CO concentration increased the risk of CVD hospitalizations and resulted in substantial health and economic burdens in Lanzhou, China. Our findings can be used for evidence-based practice and policy making to assess the cost-effectiveness of prevention measures.
The impact of population aging on medical expenses: A big data study based on the life table.
Wang Changying,Li Fen,Wang Linan,Zhou Wentao,Zhu Bifan,Zhang Xiaoxi,Ding Lingling,He Zhimin,Song Peipei,Jin Chunlin
This study shed light on the amount and structure of utilization and medical expenses on Shanghai permanent residents based on big data, simulated lifetime medical expenses through combining of expenses data and life table model, and explored the dynamic pattern of aging on medical expenditures. 5 years were taken as the class interval, the study collected and did the descriptive analysis on the medical services utilization and medical expenses information for all ages of Shanghai permanent residents in 2015, simulated lifetime medical expenses by using current life table and cross-section expenditure data. The results showed that in 2015, outpatient and emergency visits per capita in the elderly group (aged 60 and over) was 4.1 and 4.5 times higher than the childhood group (aged 1-14), and the youth and adult group (aged 15-59); hospitalization per capita in the elderly group was 3.0 and 3.5 times higher than the childhood group, and the youth and adult group. People survived in the 60-64 years group, their expected whole medical expenses (105,447 purchasing power parity Dollar) in the rest of their lives accounted for 75.6% of their lifetime. A similar study in Michigan, US showed that the expenses of the population aged 65 and over accounted for 1/2 of lifetime medical expenses, which is much lower than Shanghai. The medical expenses of the advanced elderly group (aged 80 and over) accounted for 38.8% of their lifetime expenses, including 38.2% in outpatient and emergency, and 39.5% in hospitalization, which was slightly higher than outpatient and emergency. There is room to economize in medical expenditures of the elderly people in Shanghai, especially controlling hospitalization expenses is the key to saving medical expenses of elderly people aged over 80 and over.
Integrating traditional Chinese medicine healthcare into dementia care plan by reducing the need for special nursing care and medical expenses.
Lin Shun-Ku,Lo Pei-Chia,Chen Wang-Chuan,Lai Jung-Nien
Reducing the need for advanced nursing care and medical expenses is an essential concern of dementia care. We investigated the impact of traditional Chinese medicine (TCM) on advanced nursing care and medical costs.We used Longitudinal Health Insurance Database to implement a cohort study of patients with dementia between 1997 and 2012 in Taiwan. Data from the onset of dementia to 1st advanced nursing care for the endotracheal tube, urinal indwelling catheterization, and nasogastric tube were assessed using Cox regression proportional hazards model, and independent t test was used to determine the difference of hospitalization costs and days. We also used ANOVA test to compare the hospital cost, hospital stay, and numbers according to different duration of TCM.We assessed 9438 new diagnosed patients with dementia without advanced nursing care were categorized into 2 groups: 4094 (43.4%) TCM users, and 5344 (56.6%) non-TCM users. In the TCM groups, 894 (21.8%) patients were declared as advanced nursing care, while 1683 (31.5%) patients were in non-TCM group. Cox proportional hazard regression indicated that using TCM may decrease the need for advanced nursing care (adjusted hazard ratio (aHR) = 0.61, 95% confidence interval [95% CI]: 0.56-0.66) compared to non-TCM. The TCM users have lower hospitalization costs and hospitalization time compared to non-TCM users.Integrating TCM healthcare into dementia care was found to be associated with a lower need for advanced nursing care, hospitalization costs, and admission time with more benefits from longer durations of TCM use.
Effect of health insurance on direct hospitalisation costs for in-patients with ischaemic stroke in China.
Yong Ma,Xianjun Xiong,Jinghu Li,Yunyun Fang
Australian health review : a publication of the Australian Hospital Association
Objectives The aim of the present study was to determine the direct medical costs of hospitalisations for ischaemic stroke (IS) in-patients with different types of health insurance in China and to analyse the demographic characteristics of hospitalised patients, based on data supplied by the China Health Insurance Research Association (CHIRA). Methods A nationwide and cross-sectional sample of IS in-patients with International Classifications of Diseases 10th Revision (ICD-10) Code I63 who were ensured under either the Basic Medical Insurance Scheme for Employees (BMISE) or the Basic Medical Insurance Scheme for Urban Residents (BMISUR) was extracted from the CHIRA claims database. A retrospective analysis was used with regard to patient demographics, total hospital charges and costs. Results Of the 49588 hospitalised patients who had been diagnosed with IS in the CHIRA claims database, 28850 (58.2%) were men (mean age 67.34 years) and 20738 (41.8%) were women (mean age 69.75 years). Of all patients, 40347 (81.4%) were insured by the BMISE, whereas 8724 (17.6%) were insured by the BMISUR; the mean age of these groups was 68.55 and 67.62 years respectively. For BMISE-insured in-patients, the cost per hospitalisation was RMB10131 (95% confidence interval (CI) 10014-10258), the cost per hospital day was RMB787 (95% CI 766-808), the out-of-pocket costs per patient were RMB2346 (95% CI 2303-2388) and the reimbursement rate was 74.61% (95% CI 74.48-74.73%). For BMISUR-insured in-patients the cost per hospitalisation was RMB7662 (95% CI 7473-7852), the cost per hospital day was RMB744 (95% CI 706-781), the out-of-pocket costs per patient were RMB3356 (95% CI 3258-3454) and the reimbursement rate was 56.46% (95% CI 56.08-56.84%). Conclusions Costs per hospitalisation, costs per hospital day and the reimbursement rate were higher for BMISE- than BMISUR-insured in-patients, but BMISE-insured patients had lower out-of-pocket costs. The financial burden was higher for BMISUR- than BMISE-insured in-patients. For BMISUR-insured in-patients, the out-of-pocket payment was 43.54% of total expenses, which means the government should increase the financial investment, raise reimbursement rates and set up differential reimbursements to meet the health needs of in-patients with different income levels. What is known about the topic? Cardiovascular and cerebrovascular diseases are major non-communicable diseases affecting the health of the Chinese population. The China Health Statistics Yearbook (2013) reported that across all in-patients, 195million (5.82%) had been discharged with a diagnosis of cerebrovascular disease. Of these, 118million had IS, accounting for 60.51% of all in-patients with cerebrovascular disease and 54.97% of hospitalisation costs for all cerebrovascular disease in-patients. After the two basic insurance systems, namely the BMISE and BMISUR, had been established, the out-of-pocket expenses for patients were reduced. However, to date there have been no studies investigating how the different types of health insurance (i.e. the BMISE and the BMISUR) affected the costs of treatment of IS in-patients in China. What does this paper add? This paper reports the direct costs for patients diagnosed with IS based on data supplied by the CHIRA. Direct hospitalisation costs depending on the type of insurance cover, age and gender were also evaluated. What are the implications for practitioners? The present study found that the personal financial burden of disease treatment was higher for in-patients insured under the BMISUR than BMISE. For in-patients insured under the BMISUR, the out-of-pocket payment was 43.54% of total expenses, which means the government should increase the financial investment, raise reimbursement rates and set up differential reimbursement rates to meet the health needs of patients with different incomes.
Impacts of the zero mark-up drug policy on hospitalization expenses of COPD inpatients in Sichuan province, western China: an interrupted time series analysis.
Wang Junman,Li Peiyi,Wen Jin
BMC health services research
BACKGROUND:Since 1950, the hospitals had been permitted to take a 15% mark-up of drug purchase price to remedy the loss of public hospitals and doctors' salaries in China due to tight government budget. This policy resulted in an increasing over-prescriptions which increased burden for patients eventually. The soaring medical expenditures prompted Chinese government to launch the zero mark-up drug policy (ZMDP) in 2009, which aims to eliminate physicians' financial incentives and lighten patients' economic burden through cancelling the 15% mark-up. The purpose of this study is to assess the impacts of the ZMDP on hospitalization expenses for inpatients with chronic obstructive pulmonary disease (COPD) in western China. METHOD:An interrupted time series was used to assess the impact of the ZMDP in 25 tertiary hospitals of Sichuan province, in which the policy was implemented in 2017. Monthly average total hospitalization expenses including drug expenses, medical service expenses and diagnosis expenses of COPD inpatients were analyzed with segmented regression model developed from January 2015 to June 2018. RESULTS:After the intervention of the ZMDP, the total hospitalization expenses of COPD patients significantly decreased immediately by 1022.06 CNY (P = .011). The post-policy long-term trend was decreasing by 125.32 CNY (P < .001) per month compared to the pre-policy period. The drug expenses kept downward trend both before and after the policy implementation. It had decreased by 46.42 CNY (P < .001) per month on average before the policy implementation and then dropped 1073.58 CNY (P < .001) immediately after the policy was implemented. Meanwhile, the medical service expenses had an increasing baseline trend of 14.93 CNY (P < .001) per month before the policy intervention, but it increased 197.75 CNY immediately after the policy was implemented (P = .011). The pre-policy period long-term trend of diagnosis expenses had increased by 25.78 CNY (P < .001) per month and decreased immediately by 310.78 CNY (P = .010). The post-policy trend was decreasing by 35.60 CNY (P = .001) per month compared to the pre-policy period. CONCLUSION:Our study suggested that the ZMDP have been an effective intervention to curb the increase of hospitalization expenses for inpatients with COPD, especially the drug expenses in western region of China.
Hospitalization expenses of acute ischemic stroke patients with atrial fibrillation relative to those with normal sinus rhythm.
Li Jiming,Luo Weiliang
Journal of medical economics
BACKGROUND AND OBJECTIVE:Atrial fibrillation (AF) is a risk factor for acute ischemic stroke (AIS). In mainland China, little is known of the hospitalization expenses of AIS patients with AF compared to those with normal sinus rhythm (SR). This study compared the itemized expenses of AIS patients with or without AF in a hospital in Huizhou City. METHODS:Patients hospitalized for AIS from March 2014 to March 2015 were enrolled, including 73 with AF and 751 with normal SR. Stroke severity was scored using the National Institutes of Health Stroke Scale (NIHSS). Non-parametric statistical tests were used to determine differences in hospital expenses between the two groups, of which influencing factors were analyzed using single factor and multiple stepwise linear regression analyses. RESULTS:Medicine was the predominant expense during hospitalization of all AIS patients. Patients with AF incurred significantly higher expenses for medicine, bed, treatments, examinations, laboratory tests, and nursing than patients with normal SR (p < .05); however, the medicine and bed expenses of patients at the same stroke level in the two groups were similar. Independent factors influencing the higher costs of AF patients were hospital length of stay, pulmonary infection, urinary-tract infection, NIHSS scoring, gastrointestinal bleeding, and congestive heart failure (p < .05). Independent predictors of hospital length of stay were NIHSS scoring, pulmonary infection, and urinary-tract infection (p < .05). CONCLUSION:AIS patients with AF incurred higher expenses during hospitalization compared with those with normal SR, due to greater stroke severity, higher rates of pulmonary infection and congestive heart failure, and longer hospital stays.