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1.
Medicine (Baltimore) ; 99(2): e18625, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914043

RESUMO

BACKGROUND: Inequality in health and health care remains a rather challenging issue in China, existing both in rural and urban area, and between rural and urban. This study used nationally representative data to assess inequality in both rural and urban China separately and to identify socioeconomic factors that may contribute to this inequality. METHODS: This study used 2008 National Health Services Survey data. Demographic characteristics, income, health status, medical service utilization, and medical expenses were collected. Horizontal inequality analysis was performed using nonlinear regression method. RESULTS: Positive inequity in outpatient services and inpatient service was evident in both rural and urban area of China. Greater inequity of outpatient service use in urban than that in rural areas was evident (horizontal inequity index [HI] = 0.085 vs 0.029). In contrast, rural areas had greater inequity of inpatient service use compared to urban areas (HI = 0.21 vs 0.16). The decomposition analysis found that the household income made the greatest pro-rich contribution in both rural and urban China. However, chronic diseases and aging were also important contributors to the inequality in rural area. CONCLUSION: The inequality in health service in both rural and urban China was mainly attributed to the household income. In addition, chronic disease and aging were associated with inequality in rural population. Those findings provide evidences for policymaker to develop a sustainable social welfare system in China.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , China , Feminino , Gastos em Saúde/estatística & dados numéricos , Nível de Saúde , Humanos , Renda/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto Jovem
2.
JAMA ; 322(21): 2115-2124, 2019 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-31794624

RESUMO

Importance: Although neighborhoods are thought to be an important health determinant, evidence for the relationship between neighborhood poverty and health care use is limited, as prior studies have largely used observational data without an experimental design. Objective: To examine whether housing policies that reduce exposure to high-poverty neighborhoods were associated with differences in long-term hospital use among adults and children. Design, Setting, and Participants: Exploratory analysis of the Moving to Opportunity for Fair Housing Demonstration Program, a randomized social experiment conducted in 5 US cities. From 1994 to 1998, 4604 families in public housing were randomized to 1 of 3 groups: a control condition, a traditional Section 8 voucher toward rental costs in the private market, or a voucher that could only be used in low-poverty neighborhoods. Participants were linked to all-payer hospital discharge data (1995 through 2014 or 2015) and Medicaid data (1999 through 2009). The final follow-up date ranged from 11 to 21 years after randomization. Exposures: Receipt of a traditional or low-poverty voucher vs control group. Main Outcomes and Measures: Rates of hospitalizations and hospital days, and hospital spending. Results: Among 4602 eligible individuals randomized as adults, 4072 (88.5%) were linked to health data (mean age, 33 years [SD, 9.0 years]; 98% female; median follow-up, 11 years). There were no significant differences in primary outcomes among adults randomized to receive a voucher compared with the control group (unadjusted hospitalization rate, 14.0 vs 14.7 per 100 person-years, adjusted incidence rate ratio [IRR], 0.95 [95% CI, 0.84-1.08; P = .45]; hospital days, 62.8 vs 67.0 per 100 person-years; IRR, 0.93 [95% CI, 0.77-1.13; P = .46]; yearly spending, $2075 vs $1977; adjusted difference, -$129 [95% CI, -$497 to $239; P = .49]). Among 11 290 eligible individuals randomized as children, 9118 (80.8%) were linked to health data (mean age, 8 years [SD, 4.6 years]; 49% female; median follow-up, 11 years). Receipt of a housing voucher during childhood was significantly associated with lower hospitalization rates (6.3 vs 7.3 per 100 person-years; IRR, 0.85 [95% CI, 0.73-0.99; P = .03]) and yearly inpatient spending ($633 vs $785; adjusted difference, -$143 [95% CI, -$256 to -$31; P = .01]) and no significant difference in hospital days (25.7 vs 28.8 per 100 person-years; IRR, 0.92 [95% CI, 0.77-1.11; P = .41]). Conclusions and Relevance: In this exploratory analysis of a randomized housing voucher intervention, adults who received a housing voucher did not experience significant differences in hospital use or spending. Receipt of a voucher during childhood was significantly associated with lower rates of hospitalization and less inpatient spending during long-term follow-up.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Habitação/economia , Habitação Popular , Adulto , Criança , Feminino , Seguimentos , Hospitalização/economia , Humanos , Masculino , Áreas de Pobreza , Habitação Popular/economia , Características de Residência , Estados Unidos
3.
J Ment Health Policy Econ ; 22(3): 85-94, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31811752

RESUMO

BACKGROUND: Since the introduction and soaring popularity of the managed behavioral healthcare (BH) "carve-out" model in the 1980s, policymakers have been concerned with their impact on access. In carve-outs, BH and medical benefits are administered separately. Earlier literature found they reduced intensity of service use while maintaining penetration rates. Recently it has become more common for employers to drop existing carve-out contracts, partly due to the Mental Health Parity and Addiction Equity Act (MHPAEA), which placed a greater administrative burden on carve-outs for parity compliance. Although prior studies focused exclusively on the impact of moving from carve-in to carve-out models, it is now more policy-relevant to understand the effects of the move from carve-out to carve-in, which may not be symmetric. Moreover, the natural experiment resulting from MHPAEA implementation may attenuate concerns about selection bias. STUDY AIMS: This study examines how specialty BH care patterns change when employees and dependents are moved from a "carve-out" plan to a "carve-in" plan. METHODS: Linked insurance claims, eligibility, plan and employer data from 2008-14 were obtained for three Optum( employers who dropped their carve-out contracts but retained their carve-in plans. A longitudinal "difference-in-differences" study design was used to compare changes in BH services use over time among individuals who were: (i) moved to carve-in plans when the employer dropped its carve-out contract (N=177,653); and (ii) enrolled in carve-in plans before and after the transition (N=58,658). Outcomes included total and inpatient expenditures, broken down by plan, patient, and total; outpatient visits for assessment, individual psychotherapy, family psychotherapy, and medication management; and days of structured outpatient care, day treatment, residential care, and acute inpatient care. We pooled person-year observations and estimated regressions including individual fixed effects, year dummies and interactions between indicators for post-transition period and whether transitioned from carve-out to carve-in. RESULTS: Relative to individuals continuously in carve-in plans, those who were transitioned experienced significant increases in inpatient utilization (beta =.02; p=.05) and patient inpatient costs (beta =2.35; p=.01) and decreases in day treatment (beta =-0.01; p=.02). Our conclusions proved robust against potential biases due to differing secular time trends and differential changes in benefits resulting from MHPAEA. DISCUSSION: The increased inpatient utilization associated with switching from carve-out to carve-in plans is consistent with previous literature. Carve-outs may use day treatment to reduce inpatient care so that increased inpatient utilization post-transition reduced demand for day treatment. Limitations include possible selection bias at the employer level; lack of data on medication and generalist use, quality, clinical endpoints and quality of life; and potential lack of generalizability. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The reduction in the use of carve-out contracts by private employers associated with MHPAEA implementation likely did not have a net negative impact and may have actually increased access to care among former carve-out enrollees in need of inpatient services. IMPLICATIONS FOR HEALTH POLICIES: Policymakers should consider and evaluate possible unintended consequences of legislation designed to improve access to care. IMPLICATIONS FOR FURTHER RESEARCH: Future work should replicate these analyses with a more representative sample.


Assuntos
Financiamento Pessoal/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/estatística & dados numéricos , Humanos , Saúde Mental , Psiquiatria , Qualidade de Vida , Estados Unidos
4.
Medicine (Baltimore) ; 98(49): e18082, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804317

RESUMO

OBJECTIVES: Our study provides phase-specific cost estimates for pancreatic cancer based on stage and treatment. We compare treatment costs between the different phases and within the stage and treatment modality subgroups. METHODS: Our cohort included 20,917 pancreatic cancer patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database diagnosed between 2000 and 2011. We allocated costs into four phases of care-staging (or surgery), initial, continuing, and terminal- and calculated the total, cancer-attributable, and patient-liability costs in 2018 US dollars. We fit linear regression models using log transformation to determine whether costs were predicted by age and calendar year. RESULTS: Monthly cost estimates were high during the staging and surgery phases, decreased over the initial and continuing phases, and increased during the three-month terminal phase. Overall, the linear regression models showed that cancer-attributable costs either remained stable or increased by year, and either were unaffected by age or decreased with older age; continuing phase costs for stage II patients increased with age. CONCLUSIONS: Our estimates demonstrate that pancreatic cancer costs can vary widely by stage and treatment received. These cost estimates can serve as an important baseline foundation to guide resource allocation for cancer care and research in the future.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Neoplasias Pancreáticas/economia , Neoplasias Pancreáticas/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Lineares , Masculino , Medicare/estatística & dados numéricos , Modelos Econométricos , Estadiamento de Neoplasias , Programa de SEER , Assistência Terminal/economia , Estados Unidos
5.
BMJ ; 367: l6326, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31776110

RESUMO

OBJECTIVE: To determine how the UK National Health Service (NHS) is performing relative to health systems of other high income countries, given that it is facing sustained financial pressure, increasing levels of demand, and cuts to social care. DESIGN: Observational study using secondary data from key international organisations such as Eurostat and the Organization for Economic Cooperation and Development. SETTING: Healthcare systems of the UK and nine high income comparator countries: Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland, and the US. MAIN OUTCOME MEASURES: 79 indicators across seven domains: population and healthcare coverage, healthcare and social spending, structural capacity, utilisation, access to care, quality of care, and population health. RESULTS: The UK spent the least per capita on healthcare in 2017 compared with all other countries studied (UK $3825 (£2972; €3392); mean $5700), and spending was growing at slightly lower levels (0.02% of gross domestic product in the previous four years, compared with a mean of 0.07%). The UK had the lowest rates of unmet need and among the lowest numbers of doctors and nurses per capita, despite having average levels of utilisation (number of hospital admissions). The UK had slightly below average life expectancy (81.3 years compared with a mean of 81.7) and cancer survival, including breast, cervical, colon, and rectal cancer. Although several health service outcomes were poor, such as postoperative sepsis after abdominal surgery (UK 2454 per 100 000 discharges; mean 2058 per 100 000 discharges), 30 day mortality for acute myocardial infarction (UK 7.1%; mean 5.5%), and ischaemic stroke (UK 9.6%; mean 6.6%), the UK achieved lower than average rates of postoperative deep venous thrombosis after joint surgery and fewer healthcare associated infections. CONCLUSIONS: The NHS showed pockets of good performance, including in health service outcomes, but spending, patient safety, and population health were all below average to average at best. Taken together, these results suggest that if the NHS wants to achieve comparable health outcomes at a time of growing demographic pressure, it may need to spend more to increase the supply of labour and long term care and reduce the declining trend in social spending to match levels of comparator countries.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Países Desenvolvidos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Saúde da População/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Produto Interno Bruto , Gastos em Saúde/estatística & dados numéricos , Humanos , Renda , Reino Unido
6.
Med Care ; 57(11): 869-874, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31634268

RESUMO

INTRODUCTION: Surgery accounts for almost half of inpatient spending, much of which is concentrated in a subset of high-cost patients. To study the effects of surgeon and hospital characteristics on surgical expenditures, a way to adjust for patient characteristics is essential. DESIGN: Using 100% Medicare claims data, we identified patients aged 66-99 undergoing elective inpatient surgery (coronary artery bypass grafting, colectomy, and total hip/knee replacement) in 2014. We calculated price-standardized Medicare payments for the surgical episode from admission through 30 days after discharge (episode payments). On the basis of predictor variables from 2013, that is, Elixhauser comorbidities, hierarchical condition categories, Medicare's Chronic Conditions Warehouse (CCW), and total spending, we constructed models to predict the costs of surgical episodes in 2014. RESULTS: All sources of comorbidity data performed well in predicting the costliest cases (Spearman correlation 0.86-0.98). Models on the basis of hierarchical condition categories had slightly superior performance. The costliest quintile of patients as predicted by the model captured 35%-45% of the patients in each procedure's actual costliest quintile. For example, in hip replacement, 44% of the costliest quintile was predicted by the model's costliest quintile. CONCLUSIONS: A significant proportion of surgical spending can be predicted using patient factors on the basis of readily available claims data. By adjusting for patient factors, this will facilitate future research on unwarranted variation in episode payments driven by surgeons, hospitals, or other market forces.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Medicare/economia , Procedimentos Cirúrgicos Operatórios/economia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/economia , Colectomia/economia , Ponte de Artéria Coronária/economia , Cuidado Periódico , Feminino , Humanos , Masculino , Estados Unidos
7.
Int J Equity Health ; 18(1): 161, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640703

RESUMO

PURPOSE: Socioeconomic inequalities in dental care utilization in Iran are rarely documented. This study aimed to provide insight into socioeconomic inequalities in dental care utilization and its main contributing factors among Iranian households. DESIGN/METHODOLOGY/APPROACH: A total of 37,860 households from the 2017 Household Income and Expenditure Survey (HIES) were included in the study. Data on dental care utilization, age, gender and education attainment of the head of household, socioeconomic status of households, health insurance coverage, living areas and provinces were obtained for the survey. The concentration curve and the normalized concentration index (Cn) was used to illustrate and quantify socioeconomic inequalities in dental care utilization among Iranian households. The Cn was decomposed to identify the main determinants of the observed socioeconomic inequality in dental care utilization in Iran. FINDINGS: The study indicated that the prevalence of dental care utilization among Iranian's households was 4.67% (95% confidence interval [CI]: 4.46 to 4.88%). The results suggested a higher concentration of dental care utilization among socioeconomically advantaged households (Cn = 0.2522; 95% CI: 0.2258 to 0.2791) in Iran. Pro-rich inequality in dental care utilization also found in rural (Cn = 0.2659; 95%CI: 0.2221 to 0.3098) and urban (Cn = 0.0.2504; 95% CI: 0.0.2159 to 0.2841) areas. The results revealed socioeconomic status of households, age and education status of head of households and residing provinces as the main contributing factors to the concentration of dental care utilization among the wealthy households. ORIGINALITY/VALUE: This study revealed pro-rich inequalities in dental care utilization among households in Iran and its provinces. Thus, health policymakers should focus on designing effective evidence-based interventions to improve healthcare utilization among household with the older head of households, lower education status, and living in relatively poor provinces to reduce socioeconomic inequality in dental care utilization in Iran.


Assuntos
Assistência Odontológica/economia , Assistência Odontológica/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Características da Família , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
8.
Health Serv Res ; 54(6): 1184-1192, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31657002

RESUMO

OBJECTIVE: To investigate the impact of Medicare's skilled nursing facility (SNF) copayment policy, with a large increase in the daily copayment rate on the 20th day of a benefit period, on length of stay, patient outcomes, and costs. DATA SOURCES AND STUDY SETTING: Retrospective cohort study from 2012 to 2016 using Medicare claims and SNF assessment data, including SNF admissions for Medicare fee-for-service beneficiaries. STUDY DESIGN: We first estimate how changes in Medicare's SNF copayment on the 21st day of a patient's benefit period affect length of SNF stay. We then use benefit day on admission as an instrumental variable to estimate the impact of SNF length of stay related to the copayment policy on readmission and Medicare payment. PRINCIPAL FINDINGS: From 2012 to 2016, we examined 291 134 SNF admissions. Higher benefit day on SNF admission was strongly associated with shorter SNF stays. A 1-day shorter SNF stay was associated with higher readmission rate within 30 days of hospital discharge (1.5 percentage points; 95% CI 1.4-1.6, P < .001) and within 30 days of SNF discharge (0.9 percentage points; 95% CI 0.8-1.0), lower total Medicare payment for the 90-day episode after hospital discharge ($396; 95% CI 361-431, P < .001), but $179 higher payment for the 90 days after SNF discharge (95% CI 149-210, P < .001), offsetting the lower payment for the shorter index SNF stay. CONCLUSIONS: Medicare's SNF copayment policy is associated with shorter lengths of stay and worse patient outcomes, suggesting the copayment policy has unintended and negative effects on patient outcomes.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Hospitalização/economia , Tempo de Internação/economia , Medicare/economia , Alta do Paciente/economia , Instituições de Cuidados Especializados de Enfermagem/economia , Cuidados Semi-Intensivos/economia , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Medicare/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Cuidados Semi-Intensivos/estatística & dados numéricos , Estados Unidos
9.
BMC Health Serv Res ; 19(1): 703, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619229

RESUMO

BACKGROUND: In the United States, there is well-documented regional variation in prescription drug spending. However, the specific role of physician adoption of brand name drugs on the variation in patient-level prescription drug spending is still being investigated across a multitude of drug classes. Our study aims to add to the literature by determining the association between physician adoption of a first-in-class anti-diabetic (AD) drug, sitagliptin, and AD drug spending in the Medicare and Medicaid populations in Pennsylvania. METHODS: We obtained physician-level data from QuintilesIMS Xponent™ database for Pennsylvania and constructed county-level measures of time to adoption and share of physicians adopting sitagliptin in its first year post-introduction. We additionally measured total AD drug spending for all Medicare fee-for-service and Part D enrollees (N = 125,264) and all Medicaid (N = 50,836) enrollees with type II diabetes in Pennsylvania for 2011. Finite mixture model regression, adjusting for patient socio-demographic/clinical characteristics, was used to examine the association between physician adoption of sitagliptin and AD drug spending. RESULTS: Physician adoption of sitagliptin varied from 44 to 99% across the state's 67 counties. Average per capita AD spending was $1340 (SD $1764) in Medicare and $1291 (SD $1881) in Medicaid. A 10% increase in the share of physicians adopting sitagliptin in a county was associated with a 3.5% (95% CI: 2.0-4.9) and 5.3% (95% CI: 0.3-10.3) increase in drug spending for the Medicare and Medicaid populations, respectively. CONCLUSIONS: In a medication market with many choices, county-level adoption of sitagliptin was positively associated with AD spending in Medicare and Medicaid, two programs with different approaches to formulary management.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/economia , Medicaid/economia , Medicare/economia , Padrões de Prática Médica/economia , Fosfato de Sitagliptina/economia , Administração Oral , Idoso , Diabetes Mellitus Tipo 2/economia , Planos de Pagamento por Serviço Prestado , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Hipoglicemiantes/administração & dosagem , Masculino , Pessoa de Meia-Idade , Pennsylvania , Fosfato de Sitagliptina/administração & dosagem , Estados Unidos
10.
Medicine (Baltimore) ; 98(39): e17302, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574856

RESUMO

With the deepening population aging process in China, the medical expenses of older adults has become a widespread concerned. Medical insurance is a major source of Chinese medical financing and payment. The study aims to understand the current status of medical expenses for older adults and explore the effect of different types of health insurance on medical expenses in China.The data came from the Chinese Longitudinal Health Longevity Survey (CLHLS) in 2014. The Kruskal-Wallis test and general multivariate linear regression model were applied to analyze the current situation and to explore how medical insurance as the main payment impacts medical expenses.A total of 4376 older participants were included in this study. The median of medical expenses of a total was 1500 Yuan per year. The proportions of participants who had the urban employee-based basic medical insurance (UE-BMI), the urban residents basic medical insurance (UR-BMI), the new rural cooperative medical insurance scheme (NCMS), and the commercial medical insurance were 10.8%, 8.4%, 72.7%, and 0.9%, respectively. 34.8% of older adults paid the health care service via the NCMS and 11.9% paid via the UE-BMI. Participating in the NCMS and UR-BMI are significantly related to the level of the medical fees of older adults. UE-BMI, UR-BMI, and NCMS as main payment eased the pressure of medical expenses.The influence of different types of medical insurances as main payments on the medical expenses of older adults is varied. Implementation of medical insurance should be taken to further relieve the medical expenses of older adults.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Idoso , China/epidemiologia , Feminino , Disparidades nos Níveis de Saúde , Inquéritos Epidemiológicos , Transição Epidemiológica , Humanos , Longevidade , Estudos Longitudinais , Masculino , Inquéritos e Questionários
11.
Medicine (Baltimore) ; 98(39): e17376, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574887

RESUMO

This study aimed to compare the catastrophic health expenditure (CHE) and impoverishment of type 2 diabetes mellitus (T2DM) patients between 2 ethnic groups and explore the contribution of associated factors to ethnic differences in CHE and impoverishment in Ningxia Hui Autonomous Region, China.A cross-sectional study was conducted in 2 public hospitals from October 2016 to June 2017. Data were collected by interviewing eligible Hui and Han T2DM inpatients and reviewing the hospital electronic records. Both CHE and impoverishment were measured by headcount and gap. The contributions of associated factors to ethnic differences were analyzed by the Blinder-Oaxaca decomposition technique.Both the CHE and impoverishment of Hui patients before and after reimbursement were significantly higher than those of Han patients. The ethnic differences in CHE and impoverishment headcount after reimbursement were 11.9% and 9.8%, respectively. The different distributions of associated factors between Hui and Han patients contributed to 60.5% and 35.7% of ethnic differences in CHE and impoverishment, respectively. Household income, occupation, and region were significant contributing factors.Hui T2DM patients suffered greater CHE and impoverishment than Han patients regardless of reimbursements from health insurance. Differences in socioeconomic status between Hui and Han patients were the main factors behind the ethnic differences.


Assuntos
Doença Catastrófica/economia , Diabetes Mellitus Tipo 2/economia , Gastos em Saúde/estatística & dados numéricos , Seguro Saúde/economia , Pobreza/economia , Idoso , China , Estudos Transversais , Diabetes Mellitus Tipo 2/etnologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
12.
Medicine (Baltimore) ; 98(40): e17395, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577748

RESUMO

To date, few studies have examined the end-of-life (EOL) care for patients with hematological malignancies (HMs). We evaluated the effects of palliative care on the quality of EOL care and health care costs for adult patients with HMs in the final month of life.We conducted a population-based study and analyzed data from Taiwan's Longitudinal Health Insurance Database, which contains claims information for patient medical records, health care costs, and insurance system exit dates (our proxy for death) between 2000 and 2011.A total of 724 adult patients who died of HMs were investigated. Of these patients, 43 (5.9%) had received only inpatient palliative care (i-Pal group), and 19 (2.6%) received home palliative care (h-Pal group). The mean health care costs during the final month of life were not significantly different between the non-Pal and Pal groups (p=0.315) and between the non-Pal, i-Pal, and h-Pal groups (p=0.293) either. By the multivariate regression model, the i-Pal group had lower risks of chemotherapy, ICU admission, and receipt of CPR, but higher risks of at least two hospitalizations and dying in hospital after adjustments. The h-Pal group had the similar trends as the i-Pal group but lower risk of dying in hospital after adjustments.Patients with HMs who had received palliative care could benefit from less aggressive EOL cancer care in the final month of life. However, 8.6% patients with HMs received palliative care. The related factors of more hospitalizations and dying in hospital warrant further investigation.


Assuntos
Neoplasias Hematológicas/epidemiologia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Cuidados Paliativos/organização & administração , Assistência Terminal/organização & administração , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Comorbidade , Feminino , Gastos em Saúde/estatística & dados numéricos , Neoplasias Hematológicas/tratamento farmacológico , Neoplasias Hematológicas/economia , Serviços de Assistência Domiciliar/economia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/economia , Cuidados Paliativos/estatística & dados numéricos , Características de Residência , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Taiwan , Assistência Terminal/economia , Assistência Terminal/estatística & dados numéricos
13.
Health Serv Res ; 54(6): 1305-1315, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31571222

RESUMO

OBJECTIVE: There is relative consensus that chronic conditions, disability, and time-to-death are key drivers of age-related health care expenditures. In this paper, we analyze the specific impact of frailty transitions on a wide range of health care outcomes comprising hospital, ambulatory care, and dental care use. DATA SOURCE: Five regular waves of the SHARE survey collected between 2004 and 2015. STUDY DESIGN: We estimate dynamic panel data models on the balanced panel (N = 6078; NT = 30 390 observations). Our models account for various sources of selection into frailty, that is, observed and unobserved time-varying and time-invariant characteristics. PRINCIPAL FINDINGS: We confirm previous evidence showing that frailty transitions have a statistically significant and positive impact on hospital use. We find new evidence on ambulatory and dental care use. Becoming frail has greater impact on specialist compared to GP visit, and frail elderly are less likely to access dental care. CONCLUSIONS: By preventing transitions toward frailty, policy planners could prevent hospital and ambulatory care uses. Further research is needed to investigate the relationship between frailty and dental care by controlling for reverse causation.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Assistência Odontológica/estatística & dados numéricos , Pessoas com Deficiência/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Europa (Continente) , Feminino , Humanos , Masculino
14.
Health Serv Res ; 54(6): 1295-1304, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31566732

RESUMO

OBJECTIVE: To test the hypothesis that the earned income tax credit (EITC)-the largest US poverty alleviation program-affects short-term health care expenditures among US adults. DATA SOURCES: Adult participants in the 1997-2012 waves of the US Medical Expenditure Panel Survey (MEPS) (N = 1 282 080). STUDY DESIGN: We conducted difference-in-differences analyses, comparing health care expenditures among EITC-eligible adults in February (immediately following EITC refund receipt) with expenditures during other months, using non-EITC-eligible individuals to difference out seasonal variation in health care expenditures. Outcomes included total out-of-pocket expenditures as well as spending on specific categories such as outpatient visits and inpatient hospitalizations. We conducted subgroup analyses to examine heterogeneity by insurance status. PRINCIPAL FINDINGS: EITC refund receipt was not associated with short-term changes in total expenditures, nor any expenditure subcategories. Results were similar by insurance status and robust to numerous alternative specifications. CONCLUSIONS: EITC refunds are not associated with short-term changes in health care expenditures among US adults. This may be because the refund is spent on other expenses, because of income smoothing, or because of similar refund-related variation in health care expenditures among noneligible adults. Future studies should examine whether other types of income supplementation affect health care expenditures, particularly among individuals in poverty.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Imposto de Renda/legislação & jurisprudência , Imposto de Renda/estatística & dados numéricos , Vigilância da População , Pobreza/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Fatores Socioeconômicos , Estados Unidos
15.
Artigo em Inglês | MEDLINE | ID: mdl-31540463

RESUMO

A high mortality rate is an issue with acute cerebrovascular disease (ACVD), as it often leads to a high medical expenditure, and in particular to high costs of treatment for emergency medical conditions and critical care. In this study, we used group-based trajectory modeling (GBTM) to study the characteristics of various groups of patients hospitalized with ACVD. In this research, the patient data were derived from the 1 million sampled cases in the National Health Insurance Research Database (NHIRD) in Taiwan. Cases who had been admitted to hospitals fewer than four times or more than eight times were excluded. Characteristics of the ACVD patients were collected, including age, mortality rate, medical expenditure, and length of hospital stay for each admission. We then performed GBTM to examine hospitalization patterns in patients who had been hospitalized more than four times and fewer than or equal to eight times. The patients were divided into three groups according to medical expenditure: high, medium, and low groups, split at the 33rd and 66th percentiles. After exclusion of unqualified patients, a total of 27,264 cases (male/female = 15,972/11,392) were included. Analysis of the characteristics of the ACVD patients showed that there were significant differences between the two gender groups in terms of age, mortality rate, medical expenditure, and total length of hospital stay. In addition, the data were compared between two admissions, which included interval, outpatient department (OPD) visit after discharge, OPD visit after hospital discharge, and OPD cost. Finally, the differences in medical expenditure between genders and between patients with different types of stroke-ischemic stroke, spontaneous intracerebral hemorrhage (sICH), and subarachnoid hemorrhage (SAH)-were examined using GBTM. Overall, this study employed GBTM to examine the trends in medical expenditure for different groups of stroke patients at different admissions, and some important results were obtained. Our results demonstrated that the time interval between subsequent hospitalizations decreased in the ACVD patients, and there were significant differences between genders and between patients with different types of stroke. It is often difficult to decide when the time has been reached at which further treatment will not improve the condition of ACVD patients, and the findings of our study may be used as a reference for assessing outcomes and quality of care for stroke patients. Because of the characteristics of NHIRD, this study had some limitations; for example, the number of cases for some diseases was not sufficient for effective statistical analysis.


Assuntos
Transtornos Cerebrovasculares/economia , Transtornos Cerebrovasculares/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/economia , Isquemia Encefálica/epidemiologia , Hemorragia Cerebral/economia , Hemorragia Cerebral/epidemiologia , Transtornos Cerebrovasculares/mortalidade , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Fatores Sexuais , Acidente Vascular Cerebral/epidemiologia , Hemorragia Subaracnóidea/economia , Hemorragia Subaracnóidea/epidemiologia , Taiwan/epidemiologia
16.
Int J Equity Health ; 18(1): 145, 2019 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533723

RESUMO

BACKGROUND: Catastrophic health expenditure (CHE) is well established as an indicator of financial protection on which there is extensive literature. However, most works analyse mainly low to middle income countries and do not address the different distributional dimensions of CHE. We argue that, besides incidence, the latter are crucial to better grasp the scope and nature of financial protection problems. Our objectives are therefore to analyse the evolution of CHE in a high income country, considering both its incidence and distribution. METHODS: Data are taken from the last three waves of the Portuguese Household Budget Survey conducted in 2005/2006, 2010/2011 and 2015/2016. To identify CHE, the approach adopted is capacity to pay/normative food spending, at the 40% threshold. To analyse distribution, concentration curves and indices (CI) are used and adjusted odds ratios are calculated. RESULTS: The incidence of CHE was 2.57, 1.79 and 0.46%, in 2005, 2010 and 2015, respectively. CHE became highly concentrated among the poorest (the respective CI evolved from - 0.390 in 2005 to - 0.758 in 2015) and among families with elderly people (the absolute CI evolved from 0.520 in 2005 to 0.740 in 2015). Absolute CI in geographical context also increased over time (0.354 in 2015, 0.019 in 2005). Medicines represented by far the largest share of catastrophic payments, although, in this case concentration decreased (the median share of medicines diminished from 93 to 43% over the period analysed). Contrarily, the weight of expenses incurred with consultation fees has been growing (even for General Practitioners, despite the NHS coverage of primary care). CONCLUSIONS: The incidence of CHE and inequality in its distribution might progress in the same direction or not, but most importantly policy makers should pay attention to the distributional dimensions of CHE as these might provide useful insight to target households at risk. Greater concentration of CHE can actually be regarded as an opportunity for policy making, because interventions to tackle CHE become more confined. Monitoring the distribution of payments across services can also contribute to early detection of emerging (and even, unexpected) drivers of catastrophic payments.


Assuntos
Doença Catastrófica/economia , Gastos em Saúde/estatística & dados numéricos , Humanos , Incidência , Portugal , Fatores Socioeconômicos
17.
Artigo em Japonês | MEDLINE | ID: mdl-31534066

RESUMO

OBJECTIVES: The purpose of this study was to confirm the association of the status of implementation of nonsmoking at eating and drinking establishments with the prevalence of persons with subjective symptoms, the prevalence of persons with diseases under treatment, medical expenses, and mortality rate using prefectural data. METHODS: The prefectural rate of eating and drinking establishments implementing nonsmoking (hereafter, nonsmoking rate) was calculated using the data from "Tabelog®". The variables of interest were the prevalence of persons with subjective symptoms, the prevalence of persons with diseases under treatment, medical expenses (total, hospitalization and nonhospitalization expenses), and the mortality rates of malignant neoplasms (lung cancer, stomach cancer, and colon cancer), heart disease, acute myocardial infarction, cerebrovascular disease, cerebral infarction, and pneumonia in each prefecture. The partial correlation coefficient was estimated between the nonsmoking rate and the variable of interest using the smoking rate by prefectural as the control variable. RESULTS: The nonsmoking rate showed a significantly negative correlation with the medical expenses. When eating and drinking establishments were divided into "restaurant", "café", and "bar", the nonsmoking rate also indicated a significantly negative correlation with the medical expenses in any category. It was negatively related to the mortality rates of cerebrovascular disease, cerebral infarction, and pneumonia. The negative correlation was stronger in females than in males. CONCLUSIONS: These results suggest that the implementation of nonsmoking at eating and drinking establishments may reduce the mortality rates of diseases, such as cerebrovascular disease, cerebral infarction, and pneumonia, and medical expenses. Thus, it is important to implement nonsmoking at eating and drinking establishments in line with the Revised Health Promotion Act.


Assuntos
Transtornos Cerebrovasculares/mortalidade , Gastos em Saúde/estatística & dados numéricos , Promoção da Saúde/estatística & dados numéricos , Cardiopatias/mortalidade , Neoplasias/mortalidade , não Fumantes/estatística & dados numéricos , Restaurantes/estatística & dados numéricos , Prevenção do Hábito de Fumar/estatística & dados numéricos , Humanos , Japão/epidemiologia , Infarto do Miocárdio/mortalidade , Pneumonia/mortalidade , Prevalência
18.
Artigo em Inglês | MEDLINE | ID: mdl-31500288

RESUMO

The aim of this study is to measure universal health coverage in Emerging 7 (E7) economies. Within this framework, five different dimensions and 14 different criteria are selected by considering the explanations of World Health Organization and United Nations regarding universal health coverage. While weighting the dimensions and criteria, the Decision-making Trial and Evaluation Laboratory (DEMATEL) is considered with the triangular fuzzy numbers. Additionally, Multi-Objective Optimization on the basis of Ratio Analysis (MOORA) approach is used to rank E7 economies regarding Universal Health Coverage (UHC) performance. The novelty of this study is that both service and financial based factors are taken into consideration at the same time. Additionally, fuzzy DEMATEL and MOORA methodologies are firstly used in this study with respect to the evaluation of universal health coverage. The findings show that catastrophic out of pocket health spending, pushed below an international poverty line and annual growth rate of real Gross Domestic Product (GDP) per capita are the most significant criteria for universal health coverage performance. Moreover, it is also concluded that Russia is the country that has the highest universal health coverage performance whereas China, India and Brazil are in the last ranks. It can be understood that macroeconomic conditions play a very significant role on the performance of universal health coverage. Hence, economic conditions should be improved in these countries to have better universal health coverage performance. Furthermore, it is necessary to establish programs that provide exemptions or lower out-of-pocket expenditures which will not prevent the use of health services. This situation can protect people against the financial risks related to health expenditures. In addition to them, it is also obvious that high population has also negative influence on the countries such as, China and India. It indicates that it would be appropriate for these countries to make population planning for this purpose.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Administração de Serviços de Saúde/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/organização & administração , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Tomada de Decisões , Humanos , Organização Mundial da Saúde
19.
BMC Health Serv Res ; 19(1): 610, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470846

RESUMO

BACKGROUND: Even though China launched a series of measures to alleviate several financial burdens (including health insurance scheme, increased government investment, and so on), the economic burden of health expenditure has still not been alleviated. Out-of-pocket payments (OPPs) show not only a time correlation but also some degree of spatial correlation. The aims of the current study were thus to identify the spatial cluster of OPPs, to investigate the main factors affecting variation, and to explore the spatial spillover sources of China's OPP. METHODS: Global and local spatial autocorrelation tests were validated to identify the spatial cluster of OPPs using the panel data of 31 provinces in China from 2005 to 2016. The Spatial Durbin Model, established in this paper, measured the spatial spillover effect of OPPs and analyzed the possible spillover sources (demand, supply, and socio-economic factors. RESULTS: OPPs were found to have a significant and positive spatial correlation. The results of the Spatial Durbin Model showed the direct and indirect effects of demand, supply, and socio- economic factors on China's OPPs. Among the demand factors, the direct and indirect correlation (elasticity) coefficients were positive. Among the supply factors, the direct and indirect effects of the share of primary health beds on residents' OPPs were negative. The ratio of health technicians in hospitals to those in primary health institutions on per capital OPPs had a significant indirect effect. Among the socio-economic factors, the direct effects of GDP, government health expenditure, and urbanization on OPPs were found to be positive. There were no significant indirect effects of socio-economic factors on OPPs. CONCLUSION: This paper finds that China's OPPs are not randomly distributed but, overall, present a positive spatial cluster, even though a series of measures have been launched to promote health equity. Socio-economic factors and those associated with demand were found to be the main influences of variation in OPPs, while demand was seen to be the driver of the positive spatial spillover of OPPs, whereby effective supply could inhibit these positive spillover effects.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , China , Equidade em Saúde/economia , Equidade em Saúde/estatística & dados numéricos , Humanos , Seguro Saúde/economia , Investimentos em Saúde , Análise Espaço-Temporal , Urbanização
20.
BMC Health Serv Res ; 19(1): 569, 2019 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412848

RESUMO

BACKGROUND: Ensuring financial protection of the community against health care expenditures is one of the fundamental goals of the health system. Catastrophic health expenditures (CHE) occurs when out-of-pocket health expenditures due to health care expenses considerably affect family life. The main purpose of this study was to analyze CHE trend over time and to determine its determinants. METHODS: The last round of a three part study over time was conducted in June to September 2015 on 600 households in a non-affluent area of Tehran. The World Health Survey questionnaire was used to collect information. Health expenditure was considered to be catastrophic when OOP health expenditures exceed 40% of household's capacity to paysubsistence expenditures. After calculating the amount of households' exposure to CHE, determinants resulting in CHE using logistic regression and the amount of economic inequality in the exposure of households to CHE using the concentration index were calculated. Then, performing a decomposition analysis, the contribution of each of the studied variables to the observed economic inequality was determined. All the findings were compared with the results of studies carried out in the years 2003 and 2008. RESULTS: In the year 2015, 29.9% of households incurred CHE. This amount was 12.6 and 11.8% in the 2003 and 2008 studies, respectively. The concentration index was - 0.017(confidence interval; - 0.086 to 0.051), which, unlike the CI calculated in the years 2003 and 2008, was not significant. The most important determinant affecting the exposure to CHE was inpatient service utilization (OR = 1.64). CONCLUSION: Comparing to the whole national wide findings in sum, in 2015, the amount of the exposure of the studied households to CHE was significant, and it in comparison with the results of the previous studies was increased. However, there was no significant economic inequality and the observed levels of inequalityin comparison with the results of the previous studies conducted in 2003 and 2008 were decreased.


Assuntos
Doença Catastrófica/economia , Reforma dos Serviços de Saúde , Gastos em Saúde/tendências , Estudos Transversais , Feminino , Financiamento Pessoal , Reforma dos Serviços de Saúde/tendências , Pesquisas sobre Serviços de Saúde , Gastos em Saúde/estatística & dados numéricos , Humanos , Irã (Geográfico)/epidemiologia , Fatores Socioeconômicos , Inquéritos e Questionários
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