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1.
Rev Saude Publica ; 54: 125, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33331522

RESUMEN

OBJECTIVE: To estimate the relation between catastrophic health expenditure (CHE) and multimorbidity in a national representative sample of the Brazilian population aged 50 year or older. METHODS: This study used data from 8,347 participants of the Estudo Longitudinal de Saúde dos Idosos Brasileiros (ELSI - Brazilian Longitudinal Study of Aging) conducted in 2015-2016. The dependent variable was CHE, defined by the ratio between the health expenses of the adult aged 50 years or older and the household income. The variable of interest was multimorbidity (two or more chronic diseases) and the variable used for stratification was the wealth score. The main analyses were based on multivariate logistic regression. RESULTS: The prevalence of CHE was 17.9% and 7.5%, for expenditures corresponding to 10 and 25% of the household income, respectively. The prevalence of multimorbidity was 63.2%. Multimorbidity showed positive and independent associations with CHE (OR = 1.95, 95%CI 1.67-2.28, and OR = 1.40, 95%CI 1.11-1.76 for expenditures corresponding to 10% and 25%, respectively). Expenditures associated with multimorbidity were higher among those with lower wealth scores. CONCLUSIONS: The results draw attention to the need for an integrated approach of multimorbidity in health services, in order to avoid CHE, particularly among older adults with worse socioeconomic conditions.


Asunto(s)
Enfermedad Catastrófica/economía , Enfermedad Crónica/economía , Gastos en Salud/estadística & datos numéricos , Multimorbilidad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Enfermedad Catastrófica/epidemiología , Enfermedad Crónica/epidemiología , Costo de Enfermedad , Estudios Transversales , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores Socioeconómicos
2.
BMJ Glob Health ; 5(11)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33184065

RESUMEN

INTRODUCTION: The COVID-19 pandemic caused a healthcare crisis in China and continues to wreak havoc across the world. This paper evaluated COVID-19's impact on national and regional healthcare service utilisation and expenditure in China. METHODS: Using a big data approach, we collected data from 300 million bank card transactions to measure individual healthcare expenditure and utilisation in mainland China. Since the outbreak coincided with the 2020 Chinese Spring Festival holiday, a difference-in-difference (DID) method was employed to compare changes in healthcare utilisation before, during and after the Spring Festival in 2020 and 2019. We also tracked healthcare utilisation before, during and after the outbreak. RESULTS: Healthcare utilisation declined overall, especially during the post-festival period in 2020. Total healthcare expenditure and utilisation declined by 37.8% and 40.8%, respectively, while per capita expenditure increased by 3.3%. In a subgroup analysis, we found that the outbreak had a greater impact on healthcare utilisation in cities at higher risk of COVID-19, with stricter lockdown measures and those located in the western region. The DID results suggest that, compared with low-risk cities, the pandemic induced a 14.8%, 26.4% and 27.5% reduction in total healthcare expenditure in medium-risk and high-risk cities, and in cities located in Hubei province during the post-festival period in 2020 relative to 2019, an 8.6%, 15.9% and 24.4% reduction in utilisation services; and a 7.3% and 18.4% reduction in per capita expenditure in medium-risk and high-risk cities, respectively. By the last week of April 2020, as the outbreak came under control, healthcare utilisation gradually recovered, but only to 79.9%-89.3% of its pre-outbreak levels. CONCLUSION: The COVID-19 pandemic had a significantly negative effect on healthcare utilisation in China, evident by a dramatic decline in healthcare expenditure. While the utilisation level has gradually increased post-outbreak, it has yet to return to normal levels.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Gastos en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Aceptación de la Atención de Salud/estadística & datos numéricos , Neumonía Viral/epidemiología , Betacoronavirus , China/epidemiología , Humanos , Pandemias
3.
PLoS One ; 15(10): e0239576, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33113548

RESUMEN

In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the differences in the level of income and expenditure between chronically-ill people and non-chronic population. Data were gathered from a national level survey conducted namely, the Household Income and Expenditure Survey (HIES) by the Department of Census and Statistics (DCS) of Sri Lanka. These data were statistically analysed with one-way and two-way ANOVA, to identify the factors that cause the differences among different groups. For the first time, this study makes an attempt using survey data, to examine the differences in the level of income and expenditure among chronically-ill people in Sri Lanka. Accordingly, the study discovered that married females who do not engage in any type of economic activity (being unemployed due to the disability associated with the respective chronic illness), in the age category of 40-65, having an educational level of tertiary education or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. If workforce population is compelled to lose jobs, it can lead to income insecurity and impair their quality of lives. Under above findings, it is reasonable to assume that most health care expenses are out of pocket. Furthermore, the study infers that chronic illnesses have a statistically proven significant differences towards the income and expenditure level. This has caused due to the interaction of demographic and socio-economic characteristics associated with chronic illnesses. Considering private-public sector partnerships that enable affordable access to health care services for all as well as implementation of commercial insurance and community-based mutual services that help ease burden to the public, are vital when formulating effective policies and strategies related to the healthcare sector. Sri Lanka is making strong efforts to support its healthcare sector and public, which was affected by the coronavirus (COVID-19) in early 2020. Therefore, findings of this paper will be useful to gain insights on the differences of chronic illnesses towards the income and expenditure of chronically-ill patients in Sri Lanka.


Asunto(s)
Betacoronavirus , Enfermedad Crónica/epidemiología , Infecciones por Coronavirus/epidemiología , Gastos en Salud/estadística & datos numéricos , Renta/estadística & datos numéricos , Pandemias , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Análisis de Varianza , Niño , Preescolar , Enfermedad Crónica/economía , Comorbilidad , Infecciones por Coronavirus/economía , Países en Desarrollo/economía , Personas con Discapacidad/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Composición Familiar , Femenino , Alimentos/economía , Humanos , Lactante , Recién Nacido , Masculino , Indigencia Médica/estadística & datos numéricos , Persona de Mediana Edad , Pandemias/economía , Neumonía Viral/economía , Pobreza , Factores Socioeconómicos , Sri Lanka/epidemiología , Encuestas y Cuestionarios , Adulto Joven
4.
J Manag Care Spec Pharm ; 26(11): 1468-1474, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33119445

RESUMEN

The COVID-19 pandemic and the social unrest pervading U.S. cities in response to the killings of George Floyd and other Black citizens at the hands of police are historically significant. These events exemplify dismaying truths about race and equality in the United States. Racial health disparities are an inexcusable lesion on the U.S. health care system. Many health disparities involve medications, including antidepressants, anticoagulants, diabetes medications, drugs for dementia, and statins, to name a few. Managed care pharmacy has a role in perpetuating racial disparities in medication use. For example, pharmacy benefit designs are increasingly shifting costs of expensive medications to patients, creating affordability crises for lower income workers, who are disproportionally persons of color. In addition, the quest to maximize rebates serves to inflate list prices paid by the uninsured, among which Black and Hispanic people are overrepresented. While medication cost is a foremost barrier for many patients, other factors also propagate racial disparities in medication use. Even when cost sharing is minimal or zero, medication adherence rates have been documented to be lower among Blacks as compared with Whites. Deeper understandings are needed about how racial disparities in medication use are influenced by factors such as culture, provider bias, and patient trust in medical advice. Managed care pharmacy can address racial disparities in medication use in several ways. First, it should be acknowledged that racial disparities in medication use are pervasive and must be resolved urgently. We must not believe that entrenched health system, societal, and political structures are impermeable to change. Second, the voices of community members and their advocates must be amplified. Coverage policies, program designs, and quality initiatives should be developed in consultation with those directly affected by racial disparities. Third, the industry should commit to dramatically reducing patient cost sharing for essential medication therapies. Federal and state efforts to limit annual out-of-pocket pharmacy spending should be supported, even though increased premiums may be an undesirable (yet more equitable) consequence. Finally, information about race should be incorporated into all internal and external reporting and quality improvement activities. DISCLOSURES: No funding was received for the development of this manuscript. Kogut is partially supported by Institutional Development Award Numbers U54GM115677 and P20GM125507 from the National Institute of General Medical Sciences of the National Institutes of Health, which funds Advance Clinical and Translational Research (Advance-CTR), and the RI Lifespan Center of Biomedical Research Excellence (COBRE) on Opioids and Overdose, respectively. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.


Asunto(s)
Grupos de Población Continentales/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Disparidades en el Estado de Salud , Programas Controlados de Atención en Salud/organización & administración , Servicios Farmacéuticos/organización & administración , Neumonía Viral/epidemiología , Afroamericanos , Betacoronavirus , Seguro de Costos Compartidos , Industria Farmacéutica , Grupo de Ascendencia Continental Europea , Honorarios Farmacéuticos , Femenino , Gastos en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Hispanoamericanos , Humanos , Masculino , Programas Controlados de Atención en Salud/economía , Cumplimiento de la Medicación , Pandemias , Servicios Farmacéuticos/economía , Estudios Retrospectivos , Factores Socioeconómicos , Estados Unidos/epidemiología
6.
Int J Equity Health ; 19(1): 152, 2020 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-32887629

RESUMEN

BACKGROUND: General Government Health Expenditure (GGHE) in Mauritius accounted for only 10% of General Government Expenditure for the fiscal year 2018. This is less than the pledge taken under the Abuja 2001 Declaration to allocate at least 15% of national budget to the health sector. The latest National Health Accounts also urged for an expansion in the fiscal space for health. As public hospitals in Mauritius absorb 70% of GGHE, maximising returns of hospitals is essential to achieve Universal Health Coverage. More so, as Mauritius is bracing for its worst recession in 40 years in the aftermath of the COVID-19 pandemic public health financing will be heavily impacted. A thorough assessment of hospital efficiency and its implications on effective public health financing and fiscal space creation is, therefore, vital to inform ongoing health reform agenda. OBJECTIVES: This paper aims to examine the trend in hospital technical efficiency over the period 2001-2017, to measure the elasticity of hospital output to changes in inputs variables and to assess the impact of improved hospital technical efficiency in terms of fiscal space creation. METHODS: Annual health statistics released by the Ministry of Health and Wellness and national budget of the Ministry of Finance, Economic Planning and Development were the principal sources of data. Applying Stochastic Frontier Analysis, technical efficiency of public regional hospitals was estimated under Cobb-Douglas, Translog and Multi-output distance functions, using STATA 11. Hospital beds, doctors, nurses and non-medical staff were used as input variables. Output variable combined inpatients and outpatients seen at Accident Emergency, Sorted and Unsorted departments. Efficiency scores were used to determine potential efficiency savings and fiscal space creation. FINDINGS: Mean technical efficiency scores, using the Cobb Douglas, Translog and Multi-output functions, were estimated at 0.83, 0.84 and 0.89, respectively. Nurses and beds are the most important factors in hospital production, as a 1% increase in the number of beds and nurses, result in an increase in hospital outputs by 0.73 and 0.51%, respectively. If hospitals are to increase their inputs by 1%, their outputs will increase by 1.16%. Hospital output process has an increasing return to scale. With technical efficiencies improving to scores of 0.95 and 1.0 in 2021-2022, potential savings and fiscal space creation at hospital level, would amount to MUR 633 million (US$ 16.2 million) and MUR 1161 million (US$ 29.6 million), respectively. CONCLUSION: Fiscal space creation through full technical efficiency, is estimated to represent 8.9 and 9.2% of GGHE in fiscal year 2021-2022 and 2022-2023, respectively. This will allow without any restrictions the funding of the national response for HIV, vaccine preventable diseases as well as building a resilient health system to mitigate impact of emerging infectious diseases as experienced with COVID-19.


Asunto(s)
Eficiencia Organizacional/estadística & datos numéricos , Financiación Gubernamental/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Hospitales Públicos/economía , Hospitales Públicos/organización & administración , Infecciones por Coronavirus/epidemiología , Reforma de la Atención de Salud , Humanos , Mauricio , Pandemias , Neumonía Viral/epidemiología , Cobertura Universal del Seguro de Salud
7.
Med Care ; 58(9): 770-777, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32826742

RESUMEN

OBJECTIVE: To estimate the average incremental health care expenditures associated with habitual long and short duration of sleep as compared with healthy/average sleep duration. DATA SOURCE: Medical Expenditure Panel Survey data (2012; N=6476) linked to the 2010-2011 National Health Interview Survey. STUDY DESIGN: Annual differences in health care expenditures are estimated for habitual long and short duration sleepers as compared with average duration sleepers using 2-part logit generalized linear regression models. PRINCIPAL FINDINGS: Habitual short duration sleepers reported an additional $1400 in total unadjusted health care expenditures compared to people with average sleep duration (P<0.01). After adjusting for demographics, socioeconomic factors, and health behavior factors, this difference remained significant with an additional $1278 in total health care expenditures over average duration sleepers (P<0.05). Long duration sleepers reported even higher, $2994 additional health care expenditures over average duration sleepers. This difference in health care expenditures remained significantly high ($1500, P<0.01) in the adjusted model. Expenditure differences are more pronounced for inpatient hospitalization, office expenses, prescription expenses, and home health care expenditures. CONCLUSIONS: Habitual short and long sleep duration is associated with higher health care expenditures, which is consistent with the association between unhealthy sleep duration and poorer health outcomes.


Asunto(s)
Gastos en Salud/estadística & datos numéricos , Trastornos del Sueño-Vigilia/economía , Trastornos del Sueño-Vigilia/epidemiología , Sueño/fisiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Conductas Relacionadas con la Salud , Servicios de Salud/economía , Servicios de Salud/estadística & datos numéricos , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Estados Unidos , Adulto Joven
8.
Med Care ; 58(9): 833-841, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32826748

RESUMEN

BACKGROUND: Although one third of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, there is limited information about the cost of treating Alzheimer disease and related dementias (ADRD) in these settings. OBJECTIVE: The objective of this study was to estimate direct health care costs attributable to ADRD among older adults within a large MA plan. RESEARCH DESIGN: A retrospective cohort design was used to estimate direct total, outpatient, inpatient, ambulatory pharmacy, and nursing home costs for 3 years before and after an incident ADRD diagnosis for 927 individuals diagnosed with ADRD relative to a sex-matched and birth year-matched set of 2945 controls. SUBJECT: Adults 65 years of age and older enrolled in the Kaiser Permanente Washington MA plan and the Adult Changes in Thought (ACT) Study, a prospective longitudinal cohort study of ADRD and brain aging. MEASURES: Data on monthly health service use obtained from health system electronic medical records for the period 1992-2012. RESULTS: Total monthly health care costs for individuals with ADRD are statistically greater (P<0.05) than controls beginning in the third month before diagnosis and remain significantly greater through the eighth month following diagnosis. Greater total health costs are driven by significantly (P<0.05) greater nursing home costs among individuals diagnosed with ADRD beginning in the third month prediagnosis. Although total costs were no longer significantly greater at 8 months following diagnosis, nursing home costs remained higher for the people with dementia through the 3 years postdiagnosis we analyzed. CONCLUSION: Greater total health care costs among individuals with ADRD are primarily driven by nursing home costs.


Asunto(s)
Demencia/economía , Gastos en Salud/estadística & datos numéricos , Servicios de Salud/economía , Medicare Part C/economía , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/economía , Femenino , Servicios de Salud/estadística & datos numéricos , Hogares para Ancianos/economía , Humanos , Estudios Longitudinales , Masculino , Casas de Salud/economía , Aceptación de la Atención de Salud/estadística & datos numéricos , Estudios Prospectivos , Estados Unidos
9.
Artículo en Inglés | MEDLINE | ID: mdl-32784771

RESUMEN

Diabetes causes significant disabilities, reduced quality of life and mortality that imposes huge economic burden on societies and governments worldwide. Malaysia suffers a high diabetes burden in Asia, but the magnitude of healthcare expenditures documented to aid national health policy decision-making is limited. This systematic review aimed to document the economic burden of diabetes in Malaysia, and identify the factors associated with cost burden and the methods used to evaluate costs. Studies conducted between 2000 and 2019 were retrieved using three international databases (PubMed, Scopus, EMBASE) and one local database (MyCite), as well as manual searches. Peer reviewed research articles in English and Malay on economic evaluations of adult type 2 diabetes conducted in Malaysia were included. The review was registered with PROSPERO (CRD42020151857), reported according to PRISMA and used a quality checklist adapted for cost of illness studies. Data were extracted using a data extraction sheet that included study characteristics, total costs, different costing methods and a scoring system to assess the quality of studies reviewed. The review identified twelve eligible studies that conducted cost evaluations of type 2 diabetes in Malaysia. Variation exists in the costs and methods used in these studies. For direct costs, four studies evaluated costs related to complications and drugs, and two studies were related to outpatient and inpatient costs each. Indirect and intangible costs were estimated in one study. Four studies estimated capital and recurrent costs. The estimated total annual cost of diabetes in Malaysia was approximately USD 600 million. Age, type of hospitals or health provider, length of inpatient stay and frequency of outpatient visits were significantly associated with costs. The most frequent epidemiological approach employed was prevalence-based (n = 10), while cost analysis was the most common costing approach used. The current review offers the first documented evidence on cost estimates of diabetes in Malaysia.


Asunto(s)
Costo de Enfermedad , Diabetes Mellitus Tipo 2/economía , Costos de la Atención en Salud/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Adulto , Complicaciones de la Diabetes/economía , Diabetes Mellitus Tipo 2/psicología , Humanos , Malasia , Calidad de Vida , Perfil de Impacto de Enfermedad
11.
N Engl J Med ; 383(6): 558-566, 2020 08 06.
Artículo en Inglés | MEDLINE | ID: mdl-32757524

RESUMEN

BACKGROUND: Specialty drugs are used to treat complex or life-threatening conditions, often at high financial costs to both patients and health plans. Three states - Delaware, Louisiana, and Maryland - passed legislation to cap out-of-pocket payments for specialty drugs at $150 per prescription. A concern is that these caps could shift costs to health plans, increasing insurance premiums. Estimates of the effect of the caps on patient and health-plan spending could inform future policies. METHODS: We analyzed a sample that included 27,161 persons under 65 years of age who had rheumatoid arthritis, multiple sclerosis, hepatitis C, psoriasis, psoriatic arthritis, Crohn's disease, or ulcerative colitis and who were in commercial health plans from 2011 through 2016 that were administered by three large nationwide insurers. The primary outcome was the change in out-of-pocket spending among specialty-drug users who were in the 95th percentile for spending on specialty drugs. Other outcomes were changes in mean out-of-pocket and health-plan spending for specialty drugs, nonspecialty drugs, and nondrug health care and utilization of specialty drugs. We compared outcomes in the three states that enacted caps with neighboring control states that did not, 3 years before and up to 3 years after enactment of the spending cap. RESULTS: Caps were associated with an adjusted change in out-of-pocket costs of -$351 (95% confidence interval, -554 to -148) per specialty-drug user per month, representing a 32% reduction in spending, among users in the 95th percentile of spending on specialty drugs. This finding was supported by multiple sensitivity analyses. Caps were not associated with changes in other outcomes. CONCLUSIONS: Caps for spending on specialty drugs were associated with substantial reductions in spending on specialty drugs among patients with the highest out-of-pocket costs, without detectable increases in health-plan spending, a proxy for future insurance premiums. (Funded by the Robert Wood Johnson Foundation Health Data for Action Program.).


Asunto(s)
Enfermedad Crónica/tratamiento farmacológico , Seguro de Costos Compartidos/legislación & jurisprudencia , Costos de los Medicamentos/legislación & jurisprudencia , Gastos en Salud/estadística & datos numéricos , Seguro de Servicios Farmacéuticos/economía , Gobierno Estatal , Adulto , Enfermedad Crónica/economía , Seguro de Costos Compartidos/economía , Delaware , Humanos , Seguro de Servicios Farmacéuticos/legislación & jurisprudencia , Louisiana , Maryland , Persona de Mediana Edad , Honorarios por Prescripción de Medicamentos/legislación & jurisprudencia , Estados Unidos
12.
Artículo en Inglés | MEDLINE | ID: mdl-32806775

RESUMEN

In South Korea, 4.5% patients of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were readmitted to hospitals after discharge. However, there is insufficient research on risk factors for readmission and management of patients after discharge is poor. In this study, 7590 confirmed coronavirus disease (COVID-19) patients were defined as a target for analysis using nationwide medical claims data. The demographic characteristics, underlying diseases, and the use of medical resources were used to examine the association with readmission through the chi-square test and then logistic regression analysis was performed to analyze factors affecting readmission. Of the 7590 subjects analyzed, 328 patients were readmitted. The readmission rates of men, older age and patients with medical benefits showed a high risk of readmission. The Charlson Comorbidity Index score was also related to COVID-19 readmission. Concerning requiring medical attention, there was a higher risk of readmission for the patients with chest radiographs, computed tomography scans taken and lopinavir/ritonavir at the time of their first admission. Considering the risk factors presented in this study, classifying patients with a high risk of readmission and managing patients before and after discharge based on priority can make patient management and medical resource utilization more efficient. This study also indicates the importance of lifestyle management after discharge.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Readmisión del Paciente/estadística & datos numéricos , Neumonía Viral/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Betacoronavirus , Distribución de Chi-Cuadrado , Niño , Preescolar , Comorbilidad , Coronavirus , Femenino , Gastos en Salud/estadística & datos numéricos , Recursos en Salud/estadística & datos numéricos , Humanos , Lactante , Revisión de Utilización de Seguros/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pandemias , República de Corea/epidemiología , Factores de Riesgo , Factores Sexuales , Factores Socioeconómicos , Adulto Joven
13.
Public Health ; 186: 101-106, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32795768

RESUMEN

OBJECTIVES: This study investigated the magnitude of catastrophic health expenditure (CHE) among ex-Gazan households in Jerash camp in Jordan. STUDY DESIGN: This retrospective survey used a systematic sample. METHODS: A systematic sample was used wherein every fifth house in Jerash camp was invited to participate in the study. The camp represents the largest community of ex-Gazan refugees in Jerash camp. Of the 1038 households who were invited, 976 households agreed to participate (response rate = 94%) and filled the pilot-structured questionnaire with information related to their socio-economic characteristics, health status, and their healthcare and total household expenditures. van Doorslaer's method was used to calculate the frequency of CHE, wherein the expenditure on health care was considered catastrophic if it exceeded 10% of a household's total expenditure. RESULTS: Of the sample, 41.8% suffered from CHE. Moreover, we calculated the frequency of CHE using 15%, 20%, 30%, and 40% as threshold values, and the total rates were 14.7, 6.3, 1, and 0.3%, respectively. In addition, the statistical analysis of the results showed higher frequencies of CHE in households with larger number of dependents, those headed by widowed women, and those with history of hospitalizations. CONCLUSIONS: The study shows that the rate of CHE in Jerash camp is very high and mainly due to the cost of hospitalization. Special attention should be paid for the residents of that area.


Asunto(s)
Gastos en Salud/estadística & datos numéricos , Campos de Refugiados/estadística & datos numéricos , Adulto , Composición Familiar , Femenino , Servicios de Salud , Estado de Salud , Hospitalización , Humanos , Jordania , Masculino , Persona de Mediana Edad , Medio Oriente , Campos de Refugiados/economía , Refugiados , Estudios Retrospectivos , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
14.
Med Care ; 58(9): 826-832, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32826747

RESUMEN

BACKGROUND: In 2003, national disability-associated health care expenditures (DAHE) were $398 billion. Updated estimates will improve our understanding of current DAHE. OBJECTIVE: The objective of this study was to estimate national DAHE for the US adult population and analyze spending by insurance and service categories and to assess changes in spending over the past decade. RESEARCH DESIGN: Data from the 2013-2015 Medical Expenditure Panel Survey were used to estimate DAHE for noninstitutionalized adults. These estimates were reconciled with National Health Expenditure Accounts (NHEA) data and adjusted to 2017 medical prices. Expenditures for institutionalized adults were added from NHEA data. MEASURES: National DAHE in total, by insurance and service categories, and percentage of total expenditures associated with disability. RESULTS: DAHE in 2015 were $868 billion (at 2017 prices), representing 36% of total national health care spending (up from 27% in 2003). DAHE per person with disability increased from $13,395 in 2003 to $17,431 in 2015, whereas nondisability per-person spending remained constant (about $6700). Public insurers paid 69% of DAHE. Medicare paid the largest portion ($324.7 billion), and Medicaid DAHE were $277.2 billion. More than half (54%) of all Medicare expenditures and 72% of all Medicaid expenditures were associated with disability. CONCLUSIONS: The share of health care expenditures associated with disability has increased substantially over the past decade. The high proportion of DAHE paid by public insurers reinforces the importance of public programs designed to improve health care for people with disabilities and emphasizes the need for evaluating programs and health services available to this vulnerable population.


Asunto(s)
Personas con Discapacidad/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Actividades Cotidianas , Adulto , Factores de Edad , Anciano , Enfermedad Crónica , Grupos de Población Continentales , Femenino , Humanos , Masculino , Medicaid/estadística & datos numéricos , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Rendimiento Físico Funcional , Características de la Residencia , Factores Sexuales , Servicio Social/economía , Factores Socioeconómicos , Estados Unidos , Evaluación de Capacidad de Trabajo
15.
Med Care ; 58(9): 757-762, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32732786

RESUMEN

BACKGROUND: The Affordable Care Act's Medicaid expansions (ME) increased insurance coverage for low-income Americans, among whom unmet need for mental health care is high. Empirical evidence regarding the impact of expanding insurance coverage on use of mental health services among low income and minority populations is lacking. METHODS: Data on mental health service use collected between 2007 and 2015 by the Medical Expenditures Panel Survey from nationally representative cross-sectional samples of low income (income<138% of the federal poverty line) adults were analyzed. Use trends among people in states that expanded Medicaid (ME states; n=29,827) were compared with concurrent trends among people in states that did not (non-ME states; n=22,873), with statistical adjustment for demographic characteristics and psychological distress. RESULTS: Annual outpatient visits for mental health conditions increased by 0.513 (0.053-0.974) visits per person, from a baseline rate in ME states of 0.894 visits per person. However, no significant changes were observed in number of mental health related hospital stays, emergency department visits or prescription fills. The increase outpatient visits was limited to Hispanics and non-Hispanic Whites, with no increase in service use observed among non-Hispanic Blacks. There was no apparent increase in the number of users of outpatient mental health care (AOR=0.992, P=0.942) and a marginally significant (P=0.096) increase of 3.144 visits per user. DISCUSSION: ME had a limited but positive impact on use of mental health services by low income Americans, although it may also have increased racial/ethnic disparities.


Asunto(s)
Servicios de Salud/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Servicios de Salud Mental/estadística & datos numéricos , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Pobreza/estadística & datos numéricos , Adulto , Grupos de Población Continentales/estadística & datos numéricos , Estudios Transversales , Grupos Étnicos/estadística & datos numéricos , Femenino , Gastos en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/estadística & datos numéricos , Pobreza/etnología , Factores Socioeconómicos , Estrés Psicológico/epidemiología , Estados Unidos
16.
PLoS One ; 15(8): e0237217, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32780758

RESUMEN

This study examines catastrophic health expenditures and the potential for such payments to impoverish South African households. The analysis applies three different catastrophic expenditure measurements, and we apply them across four South African Income and Expenditure Surveys. Since households have limited resources, they are also limited in their capacity to purchase health care. Thus, if a household devotes a large share of that capacity to health care, it may not be able to cover other necessary expenses, which could be catastrophic. The measurements differ in their definition of household capacity. Despite the differences in measurements, and, therefore, results, we find limited incidence of health care expenditure catastrophe, although larger shares of capacity are being devoted to health care in more recent years. In line with the finding that catastrophe is rare, we find that very few households are subsequently impoverished, because of health care costs.


Asunto(s)
Financiación Personal , Gastos en Salud , Pobreza , Composición Familiar , Financiación Personal/economía , Financiación Personal/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Humanos , Renta/estadística & datos numéricos , Pobreza/economía , Pobreza/estadística & datos numéricos , América del Sur
17.
Value Health ; 23(8): 1027-1033, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32828214

RESUMEN

OBJECTIVES: In many countries, future unrelated medical costs occurring during life-years gained are excluded from economic evaluation, and benefits of unrelated medical care are implicitly included, leading to life-extending interventions being disproportionately favored over quality of life-improving interventions. This article provides a standardized framework for the inclusion of future unrelated medical costs and demonstrates how this framework can be applied in England and Wales. METHODS: Data sources are combined to construct estimates of per-capita National Health Service spending by age, sex, and time to death, and a framework is developed for adjusting these estimates for costs of related diseases. Using survival curves from 3 empirical examples illustrates how our estimates for unrelated National Health Service spending can be used to include unrelated medical costs in cost-effectiveness analysis and the impact depending on age, life-years gained, and baseline costs of the target group. RESULTS: Our results show that including future unrelated medical costs is feasible and standardizable. Empirical examples show that this inclusion leads to an increase in the ICER of between 7% and 13%. CONCLUSIONS: This article contributes to the methodology debate over unrelated costs and how to systematically include them in economic evaluation. Results show that it is both important and possible to include future unrelated medical costs.


Asunto(s)
Análisis Costo-Beneficio/métodos , Gastos en Salud/estadística & datos numéricos , Proyectos de Investigación , Medicina Estatal/organización & administración , Factores de Edad , Inglaterra , Humanos , Esperanza de Vida , Modelos Econométricos , Años de Vida Ajustados por Calidad de Vida , Factores Sexuales , Medicina Estatal/economía , Gales
18.
J Infect Public Health ; 13(10): 1438-1445, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32773211

RESUMEN

OBJECTIVE: This study retrospectively examined the health and social determinants of the COVID-19 outbreak in 175 countries from a spatial epidemiological approach. METHODS: We used spatial analysis to examine the cross-national determinants of confirmed cases of COVID-19 based on the World Health Organization official COVID-19 data and the World Bank Indicators of Interest to the COVID-19 outbreak. All models controlled for COVID-19 government measures. RESULTS: The percentage of the population age between 15-64 years (Age15-64), percentage smokers (SmokTot.), and out-of-pocket expenditure (OOPExp) significantly explained global variation in the current COVID-19 outbreak in 175 countries. The percentage population age group 15-64 and out of pocket expenditure were positively associated with COVID-19. Conversely, the percentage of the total population who smoke was inversely associated with COVID-19 at the global level. CONCLUSIONS: This study is timely and could serve as a potential geospatial guide to developing public health and epidemiological surveillance programs for the outbreak in multiple countries. Removal of catastrophic medical expenditure, smoking cessation, and observing public health guidelines will not only reduce illness related to COVID-19 but also prevent unecessary deaths.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Adolescente , Adulto , Factores de Edad , Betacoronavirus , Bases de Datos Factuales , Gastos en Salud/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Modelos Estadísticos , Estudios Retrospectivos , Fumar/epidemiología , Regresión Espacial , Adulto Joven
19.
Arch Phys Med Rehabil ; 101(10): 1720-1730, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32653582

RESUMEN

OBJECTIVE: To compare Veterans Health Administration (VHA) diagnoses, health services utilization, and costs by mild traumatic brain injury (mTBI) group (blast-related [BR] mTBI vs non-blast-related [NBR] mTBI vs no mTBI) among Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) veterans in the Chronic Effects of Neurotrauma Consortium multicenter observational study. DESIGN: Prospective cohort study. SETTING: Four Veterans Affairs Medical Centers. PARTICIPANTS: OEF/OIF/OND veterans (N=472) who used Veterans Affairs Medical Centers services between 2002-2017. INTERVENTIONS: Not applicable. Lifetime mTBI history was assessed via semistructured interviews. MAIN OUTCOME MEASURES: VHA diagnoses, health services utilization, and costs. RESULTS: Relative to NBR mTBI and no mTBI, veterans with BR mTBI were more likely to be male, have greater combat, and have controlled and uncontrolled detonations exposures (median BR, 15.0 vs NBR, 3.0 vs no mTBI, 3.0). They also had higher prevalence of headache, posttraumatic stress disorder, and anxiety diagnoses. Veterans with BR had the highest site-adjusted mean annual VHA utilization (26.31 visits; 95% confidence interval [CI], 26.01-26.61) relative to NBR (20.43 visits; 95% CI, 20.15-20.71) and no mTBI (16.62 visits; 95% CI, 16.21-17.04) and highest site adjusted mean annual VHA outpatient costs ($6480; 95% CI, $5842-$7187) relative to NBR ($4901; 95% CI, $4392-$5468) and no mTBI ($4069; 95% CI, $3404-$4864). CONCLUSIONS: Veterans with BR mTBI had higher exposure to combat and detonation. BR was associated with greater prevalence of select diagnoses and higher health services utilization and costs relative to NBR and no mTBI. The role of health care needs from mTBI polytrauma, other deployment-related exposures, and VHA access warrants future research.


Asunto(s)
Conmoción Encefálica/epidemiología , Gastos en Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Trastornos por Estrés Postraumático/epidemiología , Veteranos/estadística & datos numéricos , Adolescente , Adulto , Conmoción Encefálica/economía , Enfermedad Crónica , Femenino , Servicios de Salud/economía , Servicios de Salud/estadística & datos numéricos , Estado de Salud , Humanos , Guerra de Irak 2003-2011 , Masculino , Salud Mental , Personal Militar/psicología , Personal Militar/estadística & datos numéricos , Estudios Prospectivos , Factores Sexuales , Factores Socioeconómicos , Índices de Gravedad del Trauma , Estados Unidos , Veteranos/psicología , Servicios de Salud para Veteranos/estadística & datos numéricos , Adulto Joven
20.
J Gen Intern Med ; 35(10): 3036-3039, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32700223

RESUMEN

As the COVID-19 pandemic continues to unfold, payers across the USA have stepped up to alleviate patients' financial burden by waiving cost-sharing for COVID-19 testing and treatment. However, there has been no substantive discussion of potential long-term effects of COVID-19 on patient health or their financial and policy implications. After recovery, patients remain at risk for lung disease, heart disease, frailty, and mental health disorders. There may also be long-term sequelae of adverse events that develop in the course of COVID-19 and its treatment. These complications are likely to place additional medical, psychological, and economic burdens on all patients, with lower-income individuals, the uninsured and underinsured, and individuals experiencing homelessness being most vulnerable. Thus, there needs to be a comprehensive plan for preventing and managing post-COVID-19 complications to quell their clinical, economic, and public health consequences and to support patients experiencing delayed morbidity and disability as a result.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Gastos en Salud/estadística & datos numéricos , Neumonía Viral/complicaciones , Sobrevivientes , Betacoronavirus , Técnicas de Laboratorio Clínico/economía , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/economía , Política de Salud/economía , Política de Salud/legislación & jurisprudencia , Humanos , Seguro de Salud/economía , Seguro de Salud/legislación & jurisprudencia , Pandemias/economía , Neumonía Viral/economía , Estados Unidos/epidemiología
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