Decisions regarding surgery are complex and economic influences affect choices made both by patients and their doctors. There is evidence that surgeons’ decisions to offer operations are affected by financial incentives, yet we could find no studies addressing whether, once a decision to operate is made and a choice of procedures is available, operations offering greater financial reward are favoured. The choice between endometrial ablation or hysterectomy in heavy menstrual bleeding offers an opportunity to study decision-making. We obtained on all private hospital claims made in Australia for either endometrial ablation or hysterectomy for women aged 30 to 50 years for the five-year period 2012 to 2016 inclusive, according to socioeconomic status. The overall incidence rates and the ratio between hysterectomy and ablation, and the association between socio-economic factors, were examined using linear regression. We found that the surgery with the greatest economic impact on the patient (hysterectomy) was more commonly performed than ablation, yet hysterectomy became the less dominant choice with increasing socioeconomic status of women. This finding suggests that direct financial costs are a lesser consideration in choice of the procedure with patients, but that surgeons may respond to a financial incentive to perform a more expensive procedure.
Background: Care bundling is an emerging health financing innovation to change the incentives of care, intended to improve quality of care and promote better resource use. In 2016, Medicare outlined a proposal for changing Medicare reimbursement for outpatient drugs through pre-determined care bundles. To gauge the potential for care bundling, we examine one of the first comprehensive efforts, the Oncology Care Model (OCM). This paper shows that the oncology care bundles likely used by OCM have large variation in cost per patient across the United States. Methods: For this analysis, we utilized five years (2010-2014) of the Medicare 5% limited data set (LDS) of fee for service claims. All seven claims segments were used in the analysis including: physician/carrier Part B, durable medical equipment,outpatient hospital, inpatient, skilled nursing facility, home health, and hospice. The 5% LDS sample of Medicare beneficiaries used to identify patients with cancer bundles totaled 17,143 in 2014. An approximate national estimate would be 20 times 17,143, yielding 342,860 beneficiaries. Results: Our analysis of Medicare claims for the three most expensive bundles (lung cancer, prostate cancer and lymphoma) from 2010 to 2014 shows over a 400% difference in per capita bundle reimbursement between US states. Furthermore, we found that the mix of reimbursements within all bundles of fee for service claim types varies meaningfully. Finally, we show that the rank order of most expensive cancers to treat at a patient level is not correlated with the most expensive cancers at a societal level. Conclusions: There is substantial geographic variation in per capita cancer costs that is not consistent for the top 3 cancer bundles. Therefore, policy-making based on system-wide geography will likely not produce a consistent solution. As a result, policy formulation will be challenging when patient cost management is a goal, especially in a healthcare sector where innovation is likely to move faster than robust and thoughtful cost containment strategies.
Objective: While the clinical effect of rhTNK-tPA in STEMI treatment has been established, the economic effect of adopting the new therapy (rh-TNK-tPA) is still unclear. The present study aimed to examine the cost-effectiveness of rhTNK-tPA compared with rt-PA in the Chinese setting. Methods: A Markov model was constructed to conduct the cost-effectiveness analysis from a third-party payer perspective. Costs of PCI, rehabilitation after discharge, CABG, myocardial ischemia recurrence, cardiac shock, reinfarction, and adverse events were considered. Clinical effectiveness data were obtained from the pivotal phase II clinical trial. Sensitivity analyses were conducted to examine the robustness of the base-case findings. Results: The total cost of treatment for the 30 days after STEMI onset in the rhTNK-tPA and rt-PA arms were ¥30,846 and ¥31,314, respectively. The QALYs of rhTNK-tPA and rt- PA arms were 0.0345 and 0.0343 respectively. RhTNK-tPA was dominant. The total cost of lifetime in the rhTNK-tPA and rt-PA arms were ¥134,519 and ¥134,311, respectively. The corresponding QALYs in the rhTNK-tPA and rt-PA arms were 6.397 and 6.356, respectively. The ICER of rhTNK-tPA vs. rt-PA treatment was ¥5,020/QALY. The sensitivity analyses showed that rhTNK-tPA was dominant in most scenarios. Conclusions: RhTNK-tPA therapy is cost-saving and more effective compared with rt-PA for STEMI treatment in the Chinese population.
Objective: While the clinical effect of regorafenib for third-line metastatic colorectal cancer has been established, the economic effect of adopting the new therapy (regorafenib) is still unclear. The present study aimed to examine the costeffectiveness of regorafenib compared to cetuximab plus irinotecan in the Chinese setting. Methods: A Markov model was constructed to conduct the cost-effectiveness analysis from a third-party payer perspective. The cost of oncology drug, utilization of both in-hospital and outpatient care facilities, administration of medications via parenteral routes, use of supportive care medications, clinical monitoring with lab tests and diagnostic imaging, and care for treatment-emergent severe adverse events were considered. Clinical effectiveness data were obtained from the clinical trials. One-way sensitivity and probability sensitivity analyses were conducted to examine the robustness of the base-case findings. Results: The model projected patients on regorafenib had an incremental gain of 0.03 QALYs relative to cetuximab plus irinotecan (0.68 Vs 0.65) at a cost-saving of ¥195,756 (¥221,860Vs¥417,616). For the subpopulation who received no previous targeted treatment, compared to cetuximab plus irinotecan, regorafenib was expected to result in additional gains of 0.15 QALYs at cost-saving of ¥95,987. Probability sensitivity analyses show that at the threshold of 3 times of GDP per capita of China (¥53,980*3), regorafenib has the probability of 82% to be costeffective against with cetuximab plus irinotecan. Conclusions: Regorafenib monotherapy is cost-saving and more effective compared with cetuximab plus irinotecan regimen in treatment patients with mCRC at third-line treatment setting in China.
Introduction: On October 1, 2015, the United States made a major transition in its medical billing and coding system, by switching from ICD-9-CM to ICD-10-CM. Several cost-analysis studies have attempted to estimate the eventual impact of the ICD-10-CM transition on medical practices, but all were completed prior to the actual transition deadline. Our study seeks to assess the post-implementation financial impact of the transition on small and medium medical practices which used a set of non-profit resources for their implementation. Methods: 6,000 medical practices were randomly selected from the approximately 70,000 user database of a non-profit ICD-10 provider and emailed a seven question survey. 419 practices completed the full survey (8.5% response rate), providing practice demographics, as well as estimates for the hours spent and cost accrued on the implementation. Results: Based on the reported data, the average total explicit cost of the ICD- 10-CM implementation was $1,206 for small medical practices and $2,462 for medium medical practices. The average total number of staff hours spent was 61.2 hours for small practices and 139 hours for medium-sized practices. The average total number of physician hours spent was 35.6 hours and 75.1 hours, respectively. Discussion: The total average cost of the ICD-10-CM implementation was calculated to be between $6,748 to $9,564 for a small medical practice and between $14,577 to $23,062 for a medium-sized medical practice. The results of this study suggest that for practices which used a set of free online resources, the eventual financial impact of the ICD-10-CM transition was less than predicted by the landmark Nachimson report for the American Medical Association (AMA), but greater than the study by Kravis et al (3M).
ObjectiveCost-related medication non-adherence (CRN) is a persistent challenge in health care in the U.S. Insurance coverage is a key determinant of access to medical care. We seek to examine the CRN rates among the older diabetes adult population in the U.S. from 2010 to 2014 when the major provisions of the Affordable Care Act came into force.Research Design and MethodData from the 2010 and 2014 Health and Retirement Study (HRS) were used for this study. CRN is identified if a respondent indicated taking less medication than was prescribed because of the cost, while diabetes is self-reported. We assessed the change in CRN rates by insurance status using multivariable logistic regression analysis.ResultsA total of 4,741 and 4,505 diabetes adults aged 50 or older in 2010 and 2014 were included in the analyses, representing 18.8 million and 19.1 million older adults with diabetes respectively. Overall, the percentage of dual-eligible diabetes patients increased from 8% to 10% and the uninsured decreased from 6% to 4% based on weighted population estimates. The CRN rates decreased from 27% to 21% and from 12% to 10% for those between 50 and 64, and 65 or older, respectively from 2010 to 2014. Race (African American) became a less significant factor for variations in CRN rates in 2014 (p=0.24).ConclusionsThere is an encouraging reduction in CRN rates after implementation of the ACA. However, CRN rates among diabetes patients between 50 and 65 of age remained high.
In July 2011 Colorado Medicaid decreased its hospital reimbursement for uncomplicated cesarean deliveries to the same level as its payments for complicated vaginal deliveries to discourage medically unnecessary cesarean deliveries and reduce expenditures. This study seeks to understand why that fee change had such a modest impact on Medicaid cesarean rates. Our approach is novel in that we investigate the fee change in a broader context that includes the hospital-physician relationship. We find the fee change has a statistically significant, but modest, effect, on the rate of cesarean delivery. However, hospital ownership type and the presence of salaried employee physicians, also appear to have statistically significant and substantive effects on cesarean rates. We conclude that, if rate changes are to achieve their desired effects, policy makers must take into account network relationships and how incentives work within those relationships.
Demand by definition is an economic concept that describes consumer's desire to pay a price for goods or services.If all other factors are constant, a rise in the price of a good or service will reduce demand and a decrease in the price of a good or service will increase demand [1].Healthcare demand is gradually rising.According to Dixon-Fyle and Kowallik [2], many countries will spend more than 20% of Gross Domestic Product (GDP) on health care by 2050.Two main contributors to this growth are the increasing prevalence of preventable illness and the suboptimal use of healthcare resources.These factors are influenced by choices consumers make.For instance, obesity is on the rise in the United States.Obesity is preventable and can increase the risk of diabetes, stroke, and heart disease.Some patients do not take appropriate control of their health and seek treatment when conditions become chronic.The lack of initiate to live a healthy life and prevent chronic illness such as obesity has led to misuse of the healthcare system, hence, increased cost [2].This article will review how demand for healthcare differs from demand for other services and the reasons why consumers make irrational decisions in their healthcare choices.
In this study, as a secondary use of data stored on the hospital’s information system, we developed a tool for calculating scan time and personnel cost based on patient condition with a view to realizing safe photographic testing that is tailored to the needs of the aging society, and improving the labour environment. We also calculated personnel costs-as a medical resources input-with the aim to promote the appropriate placement of medical staff and the objective evaluations of work. We utilized data accumulated in the hospital information system to ascertain patient conditions and classified the patients according to patient condition. We calculated the non-enhanced head CT scan times, and then obtained scan time coefficients and personnel cost coefficients. The mean scan time per non-enhanced head CT scan was 5.82 ± 3.83 minutes. The equivalent figure for “carried/freedom level 1” patients was, at 6.59 ± 4.27 minutes, longer than the mean examination time. The personnel costs for scans administered to “unassisted walking” patients were one third of the costs for scans administered to “carried/freedom level 1” patients, suggesting that personnel costs for the same type of scan vary depending on patient condition. Thus, more accurate scan time predictions can be achieved by referring to conveyance category, and especially to freedom level. Furthermore, personnel cost coefficients can serve as a yardstick for making objective evaluations of work.
Background: Significant challenges exist to detecting kidney injury early in patients with kidney transplants. The current standard of care includes monitoring serum creatinine levels and immunosuppressive drug levels, both of which are poor early predictors of kidney graft damage. Protocol (surveillance) biopsies provide an accurate assessment of the transplanted kidney but are expensive, invasive, risking infection and bleeding and even graft loss, such that they are unsuited for frequent monitoring. Objectives: An economic analysis was performed to assess the economic impact of replacing protocol biopsies with blood molecular gene profiling in kidney transplant recipients. Methods: For the economic analysis, we utilized CMS fee schedule data, actual patient billing examples and published literature to estimate the per-patient tested savings of replacing protocol biopsies with the TruGraf blood test to monitor kidney transplant recipients. Results: The TruGraf test provides a net savings of $1,302 per patient per year, including the TruGraf test costs. In 2016, 19,060 kidney transplants were performed; replacing protocol biopsies with TruGraf testing could save $24.8 million in direct treatment costs per year. Conclusions: Use of the TruGraf blood test could spare patients unnecessary protocol biopsies. The healthcare system will realize significant economic benefits; in addition, the ability to intervene early with therapies to fend off clinical acute rejection may provide the added benefit of improving long term outcomes.
Objective: To evaluate the impact of soft tissue factors in dental implants. Data: Studies evaluating the role of soft tissues in dental implants were included in this review. Sources: A comprehensive literature search of English and Chinese language articles was performed via electronic databases (PubMed, Cochrane Library, Web of Science, CNKI and VIP) using the appropriate key words(esthetic; evaluation; impact factor; soft tissue). The most recent search took place in January 2016. Study selection: Potentially appropriate articles were identified and evaluated for eligibility through a predefined review process conducted by two examiners. Only 16 out of the 346 identified records met criteria and were included in the final analysis. Conclusion: The success of dental implants depends on two outcomes, the functional utility of the implant and its beauty. During the early phase of treatment, the main objective of a dental implant is to achieve adequate function. In clinical practice, however, subsequent soft tissue retraction and implant exposure have a significantly negative impact on implant esthetics, especially in young women's teeth, which can also be considered as implant failure. It is particularly important to understand how to support the surrounding soft tissue so that it is esthetically pleasing.
Investigation was conducted to examine the significant impact of screening on total phosphate and total nitrogen in soil and water environment polluted by crude oil in Niger Delta area of Nigeria. Matrix Laboratory (MATLAB) computer programme language technique’s was inputted from date obtained experimentally as presented in this research work. The effect of screening on sampling of some parameters in terms of colour change on the effective measures to improve bioremediation of pollutants in water and soil environment is a matter of urgent concern to the Chemical engineers, since the intersurface contact is a contributing factor for efficiency of the process. This research demonstrates the significance of screening effect when sampling suspension in bioremediation process using the application of mat lab computer programme language in examining the functional parameters. This research is also aimed at comparing the bioremediation and the effect of screening in suspension of physicochemical in the suspended components to check for the effect and the rate of contributing factors as presented in this research work.
In the past decade, wearable sensors and devices have evolved as key technological objects which have dramatically revolutionized the next generation healthcare solutions. This is the era of cut-throat competition filled with immense stress which leads to the detection of various diseases even in the people of early age. Moreover, people are becoming more health conscious in developed as well as developing countries. The miniaturization of sensors and devices and tendency of people to be physician-independent have lead the researchers across the globe to come up with numerous healthcare solutions which are not only ubiquitous but are affordable also. Wearable medical devices (WMDs) capable of monitoring some of the most common physiological parameters- pulse, blood oxygen saturation, 2 lead ECG, heart rhythm, skin temperature etc. have already been popular. Ambulatory and long-term health monitoring for elderly people is another aspect, particularly for countries like China and Japan where population aging is increasing. With the development of networks, collected health information can be sent to the cloud server of the nearest clinic or hospital. Doctors can then provide patients with medical advice. Thus, WMDs or WMD-based applications can help both patients and doctors in daily health monitoring. The paradigm has gradually shifted to the mobile health (mHealth) - an integration of ever advancing wireless communication, ubiquitous computing, and wearable device technologies. The mHealth can be regarded as the most advanced version of healthcare monitoring.
CONTEXT:Access barriers to effective medication treatment have been a persistent issue for millions of older Americans despite the establishment of Medicare Part D.OBJECTIVE:We aimed to assess the prevalence rate of cost-related medication non-adherence (CRN) and the patterns of CRN behaviors in Medicare-Medicaid dual eligibles with diabetes.DESIGN SETTING PATIENTS INTERVENTIONS AND MAIN OUTCOME MEASURES:We used data from the 2011 Medicare Current Beneficiary Survey, a nationally representative sample of Medicare beneficiaries. Multivariate logistic regression analysis was performed to assess CRN rate, controlling for demographics and types of Medicare Part D plans.RESULTS:The CRN rate in dual-eligible diabetes patients was 21%, compared to 16% in non-dual-eligible diabetes patients (p<0.01). In 2011, the standardized prevalence rate of CRN in dual-eligible diabetes patients was 21%, of those with CRN 29% reported three or more types of CRN behaviors.CONCLUSION:Contrary to the common belief that dual eligibles have better insurance coverage for medication due to the assistance from Medicaid to pay some of the out-of-pocket payments, the CRN rate among dual eligibles is high and patients often report multiple types of CRN behaviors. This demonstrates that cost is a significant access barrier for dual-eligible diabetes patients. More research is needed to improve the insurance benefit design and expand insurance coverage for this high-need, high-cost subpopulation.
Context: Recent research in Europe and the USA revealed that the number of patients who have experienced a medical error in healthcare has increased worryingly since the last decade, while over half of harm refers to medical errors reasonably preventable. At the same time, surveys indicate that medical errors constitute a significant financial burden on Health Care Systems. Objectives: The aim of this paper is to present the current situation regarding the medical errors in Greece and to identify the underlying factor contributing to their presence. Method: We performed an extensive analysis of 287 cases of medical malpractice presented in front of the Greek courts over the last 15 years. The research process included a detailed review of the case while economic and other data where recorded. Then simple descriptive statistical analysis, cross-tabs analysis, ANOVA and logistic regression analysis was applied to unveil information relevant to our research. Results: The findings from our analysis showed that some 45% of medical errors occur during treatment while most incidents of medical error related to death (37%) or permanent disability (36%). Further, the analysis unveiled that on top of the list of specialties who are involved in cases of medical errors and with higher awarded compensation are those of General Surgery and Obstetrics - Gynecology. In Greece, unlike other countries in the world, the assessment of an overall burden of medical errors is not achievable, mainly due to the absence of any medical error reporting system.
Aims: Economical conditions were compared between individual human fetal monitoring and computerized montoring of intrapartum fetus. Methods: Economical conditions were compared in personal monitoring with obstetrical staffs and the central computerized simultaneous monitoring in multiple births. Results: Clinical results were the decrease of perinatal mortality and the zero case of cerebral palsy in the present update computer system comparing previous computer system.. Economical expense calculation showed 4292 USD lower expense in the computerized monitoring than the visual CTG watching monitoring.
