Determinants of Healthcare Expenditure in Economic Cooperation Organization (ECO) Countries: Evidence from Panel Cointegration Tests

PubMed Central

Samadi, Alihussein; Homaie Rad, Enayatollah

2013-01-01

Background: Over the last decade there has been an increase in healthcare expenditures while at the same time the inequity in distribution of resources has grown. These two issues have urged the researchers to review the determinants of healthcare expenditures. In this study, we surveyed the determinants of health expenditures in Economic Cooperation Organization (ECO) countries. Methods: We used Panel data econometrics methods for the purpose of this research. For long term analysis, we used Pesaran cross sectional dependency test followed by panel unit root tests to show first whether the variables were stationary or not. Upon confirmation of no stationary variables, we used Westerlund panel cointegration test in order to show whether long term relationships exist between the variables. At the end, we estimated the model with Continuous-Updated Fully Modified (CUP-FM) estimator. For short term analysis also, we used Fixed Effects (FE) estimator to estimate the model. Results: A long term relationship was found between the health expenditures per capita and GDP per capita, the proportion of population below 15 and above 65 years old, number of physicians, and urbanisation. Besides, all the variables had short term relationships with health expenditures, except for the proportion of population above 65 years old. Conclusion: The coefficient of GDP was below 1 in the model. Therefore, health is counted as a necessary good in ECO countries and governments must pay due attention to the equal distribution of health services in all regions of the country. PMID:24596838

Chronic Disease Prevalence and Medicare Advantage Market Penetration: Findings From the Medical Expenditure Panel Survey.

PubMed

Howard, Steven W; Bernell, Stephanie Lazarus; Casim, Faizan M; Wilmott, Jennifer; Pearson, Lindsey; Byler, Caitlin M; Zhang, Zidong

2015-01-01

By March 2015, 30% of all Medicare beneficiaries were enrolled in Medicare Advantage (MA) plans. Research to date has not explored the impacts of MA market penetration on individual or population health outcomes. The primary objective of this study is to examine the relationships between MA market penetration and the beneficiary's portfolio of cardiometabolic diagnoses. This study uses 2004 to 2008 Medical Expenditure Panel Survey (MEPS) Household Component data to construct an aggregate index that captures multiple diagnoses in one outcome measure (Chronic Disease Severity Index [CDSI]). The MEPS data for 8089 Medicare beneficiaries are merged with MA market penetration data from Centers for Medicare and Medicaid Services (CMS). Ordinary least squares regressions are run with SAS 9.3 to model the effects of MA market penetration on CDSI. The results suggest that each percentage increase in MA market penetration is associated with a greater than 2-point decline in CDSI (lower burden of cardiometabolic chronic disease). Spill-over effects may be driving improvements in the cardiometabolic health of beneficiary populations in counties with elevated levels of MA market penetration.

Macro determinants of Iranian provincial healthcare expenditures from 2006 to 2013: evidence from panel data.

PubMed

Rezaei, Satar; Fallah, Razieh; Moradi, Khalil; Delavari, Somayeh; Moradi, Siavash Doost; Matin, Behzad Karami

2015-12-01

During the last few decades, healthcare expenditures (HCEs) have increased significantly in Iran and throughout the world. Understanding the determinants of such increases is essential to health policymakers in finding the best policies to manage healthcare costs. This study aimed to determine the impact of some of the key explanatory variables on household healthcare expenditures across the provinces of Iran. A panel data econometric model was used to determine the main factors that affected household healthcare expenditures (HHCEs) across the provinces of Iran from March 21, 2006 to February 19, 2013. The data on household healthcare expenditures per capita, number of physicians per 10,000 population, the degree of urbanization, the proportion of the population that was 65 or older, household income per capita, and literacy rate were obtained from the Household Expenditure and Income Survey (HEIS) data in the Statistical Center of Iran. F-Limer and Hausman tests were used to choose the panel data, and Stata V.12 was used to analyze the data. Our findings indicated that income per capita, physicians per 10,000 population, and the degree of urbanization had significant impacts on healthcare expenditures. Also, the results of the study showed the elasticity of income, physicians, urbanization, proportion of the population 65 or older, and the literacy rate were 0.25 (p < 0.002), 0.37 (p < 0.001), 5.01 (p < 0.001), -0.1 (p < 0.73), and -1.02 (p < 0.082), respectively. The results of the study indicated that the income elasticity of healthcare expenditures was less than 1; health expenditures were considered to be a "necessity good" across the provinces of Iran during the period that was studied. In addition, there were some other factors that affected healthcare expenditures that were not considered in the study, such as the advancement of new technology and the costs of dying. However, it is recommended that future research examine the effect of these factors on

Patient-Provider Communication and Health Outcomes Among Individuals With Atherosclerotic Cardiovascular Disease in the United States: Medical Expenditure Panel Survey 2010 to 2013.

PubMed

Okunrintemi, Victor; Spatz, Erica S; Di Capua, Paul; Salami, Joseph A; Valero-Elizondo, Javier; Warraich, Haider; Virani, Salim S; Blaha, Michael J; Blankstein, Ron; Butt, Adeel A; Borden, William B; Dharmarajan, Kumar; Ting, Henry; Krumholz, Harlan M; Nasir, Khurram

2017-04-01

Consumer-reported patient-provider communication (PPC) assessed by Consumer Assessment of Health Plans Survey in ambulatory settings is incorporated as a complementary value metric for patient-centered care of chronic conditions in pay-for-performance programs. In this study, we examine the relationship of PPC with select indicators of patient-centered care in a nationally representative US adult population with established atherosclerotic cardiovascular disease. The study population consisted of a nationally representative sample of 6810 individuals (aged ≥18 years), representing 18.3 million adults with established atherosclerotic cardiovascular disease (self-reported or International Classification of Diseases, Ninth Edition diagnosis) reporting a usual source of care in the 2010 to 2013 pooled Medical Expenditure Panel Survey cohort. Participants responded to questions from Consumer Assessment of Health Plans Survey that assessed PPC, and we developed a weighted PPC composite score using their responses, categorized as 1 (poor), 2 (average), and 3 (optimal). Outcomes of interest were (1) patient-reported outcomes: 12-item Short Form physical/mental health status, (2) quality of care measures: statin and ASA use, (3) healthcare resource utilization: emergency room visits and hospital stays, and (4) total annual and out-of-pocket healthcare expenditures. Atherosclerotic cardiovascular disease patients reporting poor versus optimal were over 2-fold more likely to report poor outcomes; 52% and 26% more likely to report that they are not on statin and aspirin, respectively, had a significantly greater utilization of health resources (odds ratio≥2 emergency room visit, 1.41 [95% confidence interval, 1.09-1.81]; odds ratio≥2 hospitalization, 1.36 [95% confidence interval, 1.04-1.79]), as well as an estimated $1243 ($127-$2359) higher annual healthcare expenditure. This study reveals a strong relationship between PPC and patient-reported outcomes, utilization of

Educational attainment and health outcomes: Data from the Medical Expenditures Panel Survey.

PubMed

Kaplan, Robert M; Fang, Zhengyi; Kirby, James

2017-06-01

Using data from the nationally representative Medical Expenditures Panel Survey (MEPS), we explored the extent to which health care utilization and health risk-taking, together with previously examined mediators, can explain the education-health gradient above and beyond what can be explained by previously examined mediators such as age, race, and poverty status. Health was measured using the Physical Component Score (PCS) from the Medical Outcomes Study 12-Item Short Form (SF-12). Educational attainment was self-reported and categorized as 1 (less than high school), 2 (high school graduate or GED), 3 (some college), 4 (bachelor's degree), and 5 (graduate degree). In bivariate analysis, we found systematic graded relationships between educational attainment and health including, SF-12 PCS scores, self-rated health, and activity limitations. In addition, education was associated with having more office visits and outpatient visits and less risk tolerance. Those with less education were also more likely to be uninsured throughout the year. Multivariate regression analysis suggested that adjustment for age, race, poverty status and marital status explained part, but not nearly all, of the relationship between education and health. Adding a variety of variables on health care and attitudes to the models provided no additional explanatory power. This pattern of results persisted even after stratifying on the number of self-reported chronic conditions. Our findings provide no evidence that access to and use of health care explains the education-health gradient. However, more research is necessary to conclusively rule out medical care as a mediator between education and health. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Evaluating Excessive Burden of Depression on Health Status and Health Care Utilization Among Patients With Hypertension in a Nationally Representative Sample From the Medial Expenditure Panel Survey (MEPS 2012).

PubMed

Shao, Hui; Mohammed, Mir Umer; Thomas, Nick; Babazadeh, Saleh; Yang, Shuang; Shi, Qian; Shi, Lizheng

2017-05-01

Depression and hypertension frequently present together in clinical practice. Evaluating the interaction between depression and hypertension would help stakeholders better understand the value of depression prevention in primary care. This retrospective study aimed to evaluate the excessive burden of depression on overall health and on health care utilization expenditure among hypertensive patients. A total of 7019 hypertensive patients (ICD-9-CM: 401) were identified from the 2012 Medical Expenditure Panel Survey (MEPS 2012) data, of which 936 patients had depression (ICD-9-CM: 311). Hypertension with depression was associated with worse health status (physical component score, -3.97 [17.9% reduction]; mental component score, -9.14 [9% reduction]), higher utilization of health care services (outpatient visits, 6.4 [63.8% higher]; nights of hospitalization, 0.9 [100% higher]; medication prescription, 22.6 [76.8% higher]), and higher health care expenditures (inpatient, $1953.2 [72% higher]; prescription drugs, $1995.5 [82% higher]).

Estimating the Relationship between Economic Growth and Health Expenditures in ECO Countries Using Panel Cointegration Approach.

PubMed

Hatam, Nahid; Tourani, Sogand; Homaie Rad, Enayatollah; Bastani, Peivand

2016-02-01

Increasing knowledge of people about health leads to raising the share of health expenditures in government budget continuously; although governors do not like this rise because of budget limitations. This study aimed to find the association between health expenditures and economic growth in ECO countries. We added health capital in Solow model and used the panel cointegration approach to show the importance of health expenditures in economic growth. For estimating the model, first we used Pesaran cross-sectional dependency test, after that we used Pesaran CADF unit root test, and then we used Westerlund panel cointegration test to show if there is a long-term association between variables or not. After that, we used chaw test, Breusch-Pagan test and Hausman test to find the form of the model. Finally, we used OLS estimator for panel data. Findings showed that there is a positive, strong association between health expenditures and economic growth in ECO countries. If governments increase investing in health, the total production of the country will be increased, so health expenditures are considered as an investing good. The effects of health expenditures in developing countries must be higher than those in developed countries. Such studies can help policy makers to make long-term decisions.

Racial/Ethnic Disparities in Primary Care Quality Among Type 2 Diabetes Patients, Medical Expenditure Panel Survey, 2012.

PubMed

Hu, Ruwei; Shi, Leiyu; Liang, Hailun; Haile, Geraldine Pierre; Lee, De-Chih

2016-08-04

Racial and ethnic disparities exist in diabetes prevalence, access to diabetes care, diabetes-related complications and mortality rates, and the quality of diabetes care among Americans. We explored racial and ethnic disparities in primary care quality among Americans with type 2 diabetes. We analyzed data on adults with type 2 diabetes derived from the household component of the 2012 Medical Expenditure Panel Survey. Multiple regression and multivariate logistic regressions were used to examine the association between race/ethnicity and primary care attributes related to first contact, longitudinality, comprehensiveness, and coordination, and clusters of confounding factors were added sequentially. Preliminary findings indicated differences in primary care quality between racial/ethnic minorities and whites across measures of first contact, longitudinality, comprehensiveness, and coordination. After controlling for confounding factors, these differences were no longer apparent; all racial/ethnic categories showed similar rates of primary care quality according to the 4 primary care domains of interest in the study. Results indicate equitable primary care quality for type 2 diabetes patients across 4 key domains of primary care after controlling for socioeconomic characteristics. Additional research is necessary to support these findings, particularly when considering smaller racial/ethnic groups and investigating outcomes related to diabetes.

Psychometric investigation of benefit finding among long-term cancer survivors using the Medical Expenditure Panel Survey.

PubMed

Jones, Salene M W; Ziebell, Rebecca; Walker, Rod; Nekhlyudov, Larissa; Rabin, Borsika A; Nutt, Stephanie; Fujii, Monica; Chubak, Jessica

2016-02-01

Benefit finding has been shown to be beneficial for people with cancer and may be an indication that one is coping adequately with the stress of cancer. This study evaluated the psychometric properties of a four-item benefit finding measure from the cancer survivorship supplement of the Medical Expenditure Panel Survey (MEPS). Long-term survivors (5-10 years post-diagnosis) of breast, prostate, colorectal or lung cancer or melanoma (n = 594) completed the MEPS cancer supplement survey in 2013. Four items asked about benefit finding after the cancer: stronger person, coping better, positive changes and having healthier habits. Information on sociodemographics, disease and activity limitations after the cancer was also collected. We examined factor structure, reliability (Kuder-Richardson 20) and validity. The four benefit finding items did not appear to measure one factor. Three of the benefit finding items (stronger person, coping better, positive changes) were related to gender, receipt of chemotherapy and activity limitations but not cancer stage, time since diagnosis or income. Having healthier habits was unrelated to any sociodemographic or disease variable. Three of the items (stronger person, coping better, positive changes) appeared to have validity as they were related to variables that literature has shown are related to benefit finding. However, having healthier habits is likely measuring a separate but related construct. This short instrument may be used in future studies assessing benefit finding post cancer; however, the four items should be analyzed separately. Copyright © 2015 Elsevier Ltd. All rights reserved.

Principal component-based weighted indices and a framework to evaluate indices: Results from the Medical Expenditure Panel Survey 1996 to 2011

PubMed Central

Wu, Chao-Jung

2017-01-01

Producing indices composed of multiple input variables has been embedded in some data processing and analytical methods. We aim to test the feasibility of creating data-driven indices by aggregating input variables according to principal component analysis (PCA) loadings. To validate the significance of both the theory-based and data-driven indices, we propose principles to review innovative indices. We generated weighted indices with the variables obtained in the first years of the two-year panels in the Medical Expenditure Panel Survey initiated between 1996 and 2011. Variables were weighted according to PCA loadings and summed. The statistical significance and residual deviance of each index to predict mortality in the second years was extracted from the results of discrete-time survival analyses. There were 237,832 surviving the first years of panels, represented 4.5 billion civilians in the United States, of which 0.62% (95% CI = 0.58% to 0.66%) died in the second years of the panels. Of all 134,689 weighted indices, there were 40,803 significantly predicting mortality in the second years with or without the adjustment of age, sex and races. The significant indices in the both models could at most lead to 10,200 years of academic tenure for individual researchers publishing four indices per year or 618.2 years of publishing for journals with annual volume of 66 articles. In conclusion, if aggregating information based on PCA loadings, there can be a large number of significant innovative indices composing input variables of various predictive powers. To justify the large quantities of innovative indices, we propose a reporting and review framework for novel indices based on the objectives to create indices, variable weighting, related outcomes and database characteristics. The indices selected by this framework could lead to a new genre of publications focusing on meaningful aggregation of information. PMID:28886057

Robust analysis of the determinants of healthcare expenditure growth: evidence from panel data for low-, middle- and high-income countries.

PubMed

Younsi, Moheddine; Chakroun, Mohamed; Nafla, Amine

2016-10-01

This paper examines the determinants of healthcare expenditure for low-, middle- and high-income countries, and it quantifies their influences in order to assess policies for achieving universal health coverage. We elaborate two models, a fixed-effect model and the dynamic panel model, to estimate the factors associated with the total health expenditure growth as well as its major components for 167 countries over the period of 1993-2013. The panel data on total health expenditure per capita and its components were taken from the World Development Indicators. Overall, our results showed that total health expenditure per capita is rising in all countries over time as a result of rising incomes. However, our estimates showed that the income elasticity of health expenditure ranged from 0.75 to 0.96 in the fixed-effect static panel model, while in the dynamic panel model, it was smaller and ranged from 0.16 to 0.47. Our empirical findings indicate that development assistance for health reduced government domestic spending on health but increased total government health spending. Our results also indicate that the trend in health expenditure growth is significantly depending with the country's economic development. In addition, out-of-pocket expenditure is powerfully influenced by a country's capacity to increase general government revenues and social insurance contributions. Knowledge of factors associated to health expenditure might help policy makers to make wise judgments, plan health reforms and allocate resources efficiently. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

The relationship of disability and employment for veterans from the 2010 Medical Expenditure Panel Survey (MEPS).

PubMed

Smith, Diane L

2015-06-05

Veterans with disabilities, especially those with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) have difficulty obtaining and maintaining competitive employment. To determine if there are significant differences in employment between veterans with and without disability, between veterans with a disability and nonveterans with a disability, and to investigate the association of veteran status and disability with employment. Chi square analyses were conducted on data obtained from the 2010 Medical Expenditure Panel Survey to determine if significant differences in employment occurred between veterans with disabilities, veterans without disabilities and nonveterans with disabilities. Multivariate regression analyses were used to determine how veteran status and disability are associated with employment. Significant differences in employment were found between veterans with and without a disability; however, no significant differences existed in employment between veterans and nonveterans with a disability. Multivariate analysis showed that veteran status (aOR=1.80), having any disability (aOR=7.29), social disability (aOR=3.47) or a cognitive disability (aOR=3.16) were associated with not being employed. Veterans with disabilities are more likely not to be employed than veteran populations without disabilities. Veterans; however have unique disabilities, different than nonveterans with disabilities, that need to be addressed, such as social and cognitive disabilities resulting from TBI and PTSD. Future research should focus on evaluating the effectiveness of employment programs and policies designed to address the unique issues faced by veterans with disabilities.

School Expenditure and School Performance: Evidence from New South Wales Schools Using a Dynamic Panel Analysis

ERIC Educational Resources Information Center

Pugh, G.; Mangan, J.; Blackburn, V.; Radicic, D.

2015-01-01

This article estimates the effects of school expenditure on school performance in government secondary schools in New South Wales, Australia over the period 2006-2010. It uses dynamic panel analysis to exploit time series data on individual schools that only recently has become available. We find a significant but small effect of expenditure on…

Out-of-pocket healthcare expenditures of older Americans with depression.

PubMed

Harman, Jeffrey S; Kelleher, Kelly J; Reynolds, Charles F; Pincus, Harold Alan

2004-05-01

The objective of this study was to estimate mean annual out-of-pocket (OOP) healthcare expenditures of Americans aged 65 and older with self-reported depression and compare these expenditures with the OOP expenditures of older Americans with hypertension, heart disease, diabetes mellitus, and arthritis. Data from the 1999 Medical Expenditure Panel Survey, which employs a nationally representative stratified random sample of households in the United States, were used to estimate mean OOP expenditures for health care during 1999. The data were limited to observations on individuals aged 65 and older living in households in the United States included in the 1999 Medical Expenditure Panel Survey sample (N=2,730). Mean OOP expenditures for older Americans with depression were $1,835 in 1999. Most of the spending ($1,090) was for prescription drugs in this population. For patients with depression, only 8% of total OOP spending was for depression-specific services and treatments. Mean OOP spending was greater for persons with depression than it was for older Americans with hypertension ($1,181) and arthritis ($1,190), whereas OOP spending for depression was similar to spending of older Americans with heart disease ($1,412) and diabetes mellitus ($1,527). Older Americans with depression have high OOP expenditures, with most of this spending for health services and drugs to treat general medical conditions.

No short-term savings in health care expenditures for physically active adults.

PubMed

Chevan, Julia; Roberts, Dawn E

2014-06-01

The purpose of this study was to investigate the association of physical activity and health care expenditures in a nationally representative sample of non-disabled adults. This was a secondary analysis of data from 8843 adults. Physical activity measures were derived from participants in the 2006 and 2007 National Health Interview Survey. Demographic and expenditure variables came from the Medical Expenditure Panel Survey data files for panels 12 (2007-2008) and 13 (2008-2009). Multivariable regression models were used to determine the association between levels of physical activity participation and total health care expenditures, drug expenditures, and out-of-pocket health care expenditures. Unadjusted data revealed lower health care expenditures among those whose activity level met the CDC guidelines with greater savings apparent among those who exercised above recommended guidelines. However, in the models that adjusted for age, sex, race, income and health status these differences disappeared. In the short-term, the amount of physical activity undertaken by an adult may have little effect on the expenditures for health services, drugs and the money expended directly out-of-pocket. However, given the benefits of physical activity in terms of chronic disease prevention there are very likely long-term expenditure savings to be had. Copyright © 2014 Elsevier Inc. All rights reserved.

Unmet dental need in community-dwelling adults with mental illness: Results from the 2007 Medical Expenditure Panel Survey

PubMed Central

Heaton, Lisa J.; Mancl, Lloyd A.; Grembowski, David; Armfield, Jason M.; Milgrom, Peter

2013-01-01

Background Mental illness (MI) affects approximately one in five US adults, and is associated with oral disease and poor dental treatment outcomes. Little is known about dental utilization or unmet dental need in this population. Methods This study examined dental visits and unmet dental need in community-dwelling adults with MI in 2007 Medical Expenditure Panel Survey (MEPS) data. Differences between adults with and without MI were tested using multivariate logistic regression. Results Eighteen percent of adults (N=19,368) had MI; 5.5 percent had unmet dental need. Although individuals with MI were not significantly more likely to have a dental visit (46.3 percent) than those without MI (42.2 percent; OR=1.09, 95 percent CI=.97–1.23), they were significantly more likely to report unmet need (11.0 versus 5.3 percent; OR=2.00, 95 percent CI=1.67–2.41). Those with mood or anxiety disorders were most likely to report unmet need (Ps<.001). Conclusions While individuals with MI did not visit the dentist significantly more than adults without MI, their higher level of unmet need suggests current dental service use is not addressing their needs adequately. Clinical Implications Dentists should be familiar with MI conditions as these patients may have greater unmet dental need. PMID:23449910

Health Care Utilization and Expenditures for Children with Autism: Data from U.S. National Samples

ERIC Educational Resources Information Center

Liptak, Gregory S.; Stuart, Tami; Auinger, Peggy

2006-01-01

Little is known about the use of medical services by children who have autism (ASD). Provide nationally representative data for health service utilization and expenditures of children with ASD. Cross-sectional survey using the Medical Expenditure Panel (MEPS), and National (Hospital) Ambulatory Medical Care Surveys (N(H)AMCS). A total of 80…

Explaining health care expenditure variation: large-sample evidence using linked survey and health administrative data.

PubMed

Ellis, Randall P; Fiebig, Denzil G; Johar, Meliyanni; Jones, Glenn; Savage, Elizabeth

2013-09-01

Explaining individual, regional, and provider variation in health care spending is of enormous value to policymakers but is often hampered by the lack of individual level detail in universal public health systems because budgeted spending is often not attributable to specific individuals. Even rarer is self-reported survey information that helps explain this variation in large samples. In this paper, we link a cross-sectional survey of 267 188 Australians age 45 and over to a panel dataset of annual healthcare costs calculated from several years of hospital, medical and pharmaceutical records. We use this data to distinguish between cost variations due to health shocks and those that are intrinsic (fixed) to an individual over three years. We find that high fixed expenditures are positively associated with age, especially older males, poor health, obesity, smoking, cancer, stroke and heart conditions. Being foreign born, speaking a foreign language at home and low income are more strongly associated with higher time-varying expenditures, suggesting greater exposure to adverse health shocks. Copyright © 2013 John Wiley & Sons, Ltd.

How relevant is environmental quality to per capita health expenditures? Empirical evidence from panel of developing countries.

PubMed

Yahaya, Adamu; Nor, Norashidah Mohamed; Habibullah, Muzafar Shah; Ghani, Judhiana Abd; Noor, Zaleha Mohd

2016-01-01

Developing countries have witnessed economic growth as their GDP keeps increasing steadily over the years. The growth led to higher energy consumption which eventually leads to increase in air pollutions that pose a danger to human health. People's healthcare demand, in turn, increase due to the changes in the socioeconomic life and improvement in the health technology. This study is an attempt to investigate the impact of environmental quality on per capital health expenditure in 125 developing countries within a panel cointegration framework from 1995 to 2012. We found out that a long-run relationship exists between per capita health expenditure and all explanatory variables as they were panel cointegrated. The explanatory variables were found to be statistically significant in explaining the per capita health expenditure. The result further revealed that CO2 has the highest explanatory power on the per capita health expenditure. The impact of the explanatory power of the variables is greater in the long-run compared to the short-run. Based on this result, we conclude that environmental quality is a powerful determinant of health expenditure in developing countries. Therefore, developing countries should as a matter of health care policy give provision of healthy air a priority via effective policy implementation on environmental management and control measures to lessen the pressure on health care expenditure. Moreover more environmental proxies with alternative methods should be considered in the future research.

Disparities in Health Care Access and Receipt of Preventive Services by Disability Type: Analysis of the Medical Expenditure Panel Survey

PubMed Central

Horner-Johnson, Willi; Dobbertin, Konrad; Lee, Jae Chul; Andresen, Elena M

2014-01-01

Objective To examine differences in access to health care and receipt of clinical preventive services by type of disability among working-age adults with disabilities. Data Source Secondary analysis of Medical Expenditure Panel Survey (MEPS) data from 2002 to 2008. Study Design We conducted cross-sectional logistic regression analyses comparing people with different types of disabilities on health insurance status and type; presence of a usual source of health care; delayed or forgone care; and receipt of dental checkups and cancer screening. Data Collection We pooled annualized MEPS data files across years. Our analytic sample consisted of adults (18–64 years) with physical, sensory, or cognitive disabilities and nonmissing data for all variables of interest. Principal Findings Individuals with hearing impairment had better health care access and receipt than people with other disability types. People with multiple types of limitations were especially likely to have health care access problems and unmet health care needs. Conclusions There are differences in health care access and receipt of preventive care depending on what type of disability people have. More in-depth research is needed to identify specific causes of these disparities and assess interventions to address health care barriers for particular disability groups. PMID:24962662

Recognizing the importance of chronic disease in driving healthcare expenditure in Tanzania: analysis of panel data from 1991 to 2010.

PubMed

Counts, Christopher J; Skordis-Worrall, Jolene

2016-05-01

 Despite the growing chronic disease burden in low- and middle-income countries, there are significant gaps in our understanding of the financial impact of these illnesses on households. As countries make progress towards universal health coverage, specific information is needed about how chronic disease care drives health expenditure over time, and how this spending differs from spending on acute disease care.  A 19-year panel dataset was constructed using data from the Kagera Health and Development Surveys. Health expenditure was modelled using multilevel regression for three different sub-populations of households: (1) all households that spent on healthcare, (2) households affected by chronic disease and (3) households affected by acute disease. Explanatory variables were identified from a review of the health expenditure literature, and all variables were analysed descriptively.  Households affected by chronic disease spent 22% more on healthcare than unaffected households. Catastrophic expenditure and zero expenditure are both common in chronic disease-affected households. Expenditure predictors were different between households affected by chronic disease and those unaffected. Expenditure over time is highly heterogeneous and household-dependent.  The financial burden of healthcare is greater for households affected by chronic disease than those unaffected. Households appear unable to sustain high levels of expenditure over time, likely resulting in both irregular chronic disease treatment and impoverishment. The Tanzanian government's current efforts to develop a National Health Financing Strategy present an important opportunity to prioritize policies that promote the long-term financial protection of households by preventing the catastrophic consequences of chronic disease care payments. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Catastrophic household expenditure on health in Nepal: a cross-sectional survey.

PubMed

Saito, Eiko; Gilmour, Stuart; Rahman, Md Mizanur; Gautam, Ghan Shyam; Shrestha, Pradeep Krishna; Shibuya, Kenji

2014-10-01

To determine the incidence of - and illnesses commonly associated with - catastrophic household expenditure on health in Nepal. We did a cross-sectional population-based survey in five municipalities of Kathmandu Valley between November 2011 and January 2012. For each household surveyed, out-of-pocket spending on health in the previous 30 days that exceeded 10% of the household's total expenditure over the same period was considered to be catastrophic. We estimated the incidence and intensity of catastrophic health expenditure. We identified the illnesses most commonly associated with such expenditure using a Poisson regression model and assessed the distribution of expenditure by economic quintile of households using the concentration index. Overall, 284 of the 1997 households studied in Kathmandu, i.e. 13.8% after adjustment by sampling weight, reported catastrophic health expenditure in the 30 days before the survey. After adjusting for confounders, this expenditure was found to be associated with injuries, particularly those resulting from road traffic accidents. Catastrophic expenditure by households in the poorest quintile were associated with at least one episode of diabetes, asthma or heart disease. In an urban area of Nepal, catastrophic household expenditure on health was mostly associated with injuries and noncommunicable diseases such as diabetes and asthma. Throughout Nepal, interventions for the control and management of noncommunicable diseases and the prevention of road traffic accidents should be promoted. A phased introduction of health insurance should also reduce the incidence of catastrophic household expenditure.

Reconciling medical expenditure estimates from the MEPS and NHEA, 2007.

PubMed

Bernard, Didem; Cowan, Cathy; Selden, Thomas; Cai, Liming; Catlin, Aaron; Heffler, Stephen

2012-01-01

Provide a comparison of health care expenditure estimates for 2007 from the Medical Expenditure Panel Survey (MEPS) and the National Health Expenditure Accounts (NHEA). Reconciling these estimates serves two important purposes. First, it is an important quality assurance exercise for improving and ensuring the integrity of each source's estimates. Second, the reconciliation provides a consistent baseline of health expenditure data for policy simulations. Our results assist researchers to adjust MEPS to be consistent with the NHEA so that the projected costs as well as budgetary and tax implications of any policy change are consistent with national health spending estimates. The Medical Expenditure Panel Survey produced by the Agency for Healthcare Research and Quality, and the National Health Center for Health Statistics and the National Health Expenditures produced by the Centers for Medicare & Medicaid Service's Office of the Actuary. In this study, we focus on the personal health care (PHC) sector, which includes the goods and services rendered to treat or prevent a specific disease or condition in an individual. The official 2007 NHEA estimate for PHC spending is $1,915 billion and the MEPS estimate is $1,126 billion. Adjusting the NHEA estimates for differences in underlying populations, covered services, and other measurement concepts reduces the NHEA estimate for 2007 to $1,366 billion. As a result, MEPS is $240 billion, or 17.6 percent, less than the adjusted NHEA total.

Variations in catastrophic health expenditure estimates from household surveys in India

PubMed Central

Dandona, Rakhi; Dandona, Lalit

2013-01-01

Abstract Objective To assess the comparability of out-of-pocket (OOP) payment and catastrophic health expenditure (CHE) estimates from different household surveys in India. Methods Data on CHE, outpatient and inpatient OOP payments and other expenditure from all major national or multi-state surveys since 2000 were compared. These included two consumer expenditure surveys (the National Sample Survey for 2004–05 [NSS 2004–05] and 2009–10 [NSS 2009–10]) and three health-focused surveys (the World Health Survey 2003 [WHS 2003]; the National Sample Survey on Morbidity, Health Care and the Condition of the Aged 2004 [NSS 2004]; and the Study on Global Ageing and Adult Health 2007–08 [SAGE 2007–08]). All but the NSS 2004–05 and the NSS 2009–10 used different questionnaires. Findings CHE estimates from WHS 2003 and SAGE 2007–08 were twice as high as those from NSS 2004–05, NSS 2009–10 and NSS 2004. Inpatient OOP payment estimates were twice as high in WHS 2003 and SAGE 2007–08 because in these surveys a much higher proportion of households reported such payments. However, estimates of expenditures on other items were half as high in WHS 2003 as in the other surveys because a very small number of items was used to capture these expenditures. Conclusion The wide variations observed in CHE and OOP payment estimates resulted from methodological differences. Survey methods used to assess CHE in India need to be standardized and validated to accurately track CHE and assess the impact of recent policies to reduce it. PMID:24115796

Comparison of the effects of public and private health expenditures on the health status: a panel data analysis in eastern mediterranean countries.

PubMed

Homaie Rad, Enayatollah; Vahedi, Sajad; Teimourizad, Abedin; Esmaeilzadeh, Firooz; Hadian, Mohamad; Torabi Pour, Amin

2013-08-01

Health expenditures are divided in two parts of public and private health expenditures. Public health expenditures contain social security spending, taxing to private and public sectors, and foreign resources like loans and subventions. On the other hand, private health expenditures contain out of pocket expenditures and private insurances. Each of these has different effects on the health status. The present study aims to compare the effects of these expenditures on health in Eastern Mediterranean Region (EMR). In this study, infant mortality rate was considered as an indicator of health status. We estimated the model using the panel data of EMR countries between 1995 and 2010. First, we used Pesaran CD test followed by Pesaran's CADF unit root test. After the confirmation of having unit root, we used Westerlund panel cointegration test and found that the model was cointegrated and then after using Hausman and Breusch-Pagan tests, we estimated the model using the random effects. The results showed that the public health expenditures had a strong negative relationship with infant mortality rate. However, a positive relationship was found between the private health expenditures and infant mortality rate (IMR). The relationship for public health expenditures was significant, but for private health expenditures was not. The study findings showed that the public health expenditures in the EMR countries improved health outcome, while the private health expenditures did not have any significant relationship with health status, so often increasing the public health expenditures leads to reduce IMR. But this relationship was not significant because of contradictory effects for poor and wealthy peoples.

Predictors of high out-of-pocket healthcare expenditure: an analysis using Bangladesh household income and expenditure survey, 2010.

PubMed

Molla, Azaher Ali; Chi, Chunhuei; Mondaca, Alicia Lorena Núñez

2017-01-31

Predictors of high out-of-pocket household healthcare expenditure are essential for creating effective health system finance policy. In Bangladesh, 63.3% of health expenditure is out-of-pocket and born by households. It is imperative to know what determines household health expenditure. This study aims to investigate the predicting factors of high out-of-pocket household healthcare expenditure targeting to put forward policy recommendations on equity in financial burden. Bangladesh household income and expenditure survey 2010 provides data for this study. Predictors of high out-of-pocket household healthcare expenditure were analyzed using multiple linear regressions. We have modeled non-linear relationship using logarithmic form of linear regression. Heteroscedasticity and multicollinearity were checked using Breusch-Pagan/Cook-Weishberg and VIF tests. Normality of the residuals was checked using Kernel density curve. We applied required adjustment for survey data, so that standard errors and parameters estimation are valid. Presence of chronic disease and household income were found to be the most influential and statistically significant (p < 0.001) predictors of high household healthcare expenditure. Households in rural areas spend 7% less than urban dwellers. The results show that a 100% increase in female members in a family leads to a 2% decrease in household health expenditure. Household income, health shocks in families, and family size are other statistically significant predictors of household healthcare expenditure. Proportion of elderly and under-five members in the family show some positive influence on health expenditure, though statistically nonsignificant. The findings call for emphasizing prevention of chronic diseases, as it is a strong predictor of household health expenditure. Innovative insurance scheme needs to be devised to prevent household from being impoverished due to health shocks in the family. Policy makers are urged to design an

Rural Panel Surveys in Developing Countries: A Selective Review

PubMed Central

Hao, Lingxin; Wang, Weidong; Xie, Guihua

2017-01-01

Rural panel surveys are the most appropriate means to provide data for studying the unprecedented rapid migration and urbanization currently taking place in China and other developing countries. To maximize heterogeneity in urbanization and development over the last three decades, we selected rural panel surveys from five Asian countries, including India, Indonesia, Nepal, Thailand, and China. This paper provides a selective review, focusing on their panel survey methodology, which is organized based on our proposed four basics of panel surveys – representativeness, retrospect-prospect, multilevel tracking, and temporality. We analyzed the strengths and weaknesses of the selected panel surveys to provide directions for designing future rural panel studies in China and elsewhere in the developing world. PMID:29201494

Catastrophic Health Expenditures for Households with Disabled Members: Evidence from the Korean Health Panel

PubMed Central

2016-01-01

Persons with disabilities use more health care services due to ill health and face higher health care expenses and burden. This study explored the incidence of catastrophic health expenditures of households with persons with disabilities compared to that of those without such persons. We used the Korean Health Panel (KHP) dataset for the years 2010 and 2011. The final sample was 5,610 households; 800 (14.3%) of these were households with a person with a disability and 4,810 (85.7%) were households without such a person. Households with a person with a disability faced higher catastrophic health expenditures, spending about 1.2 to 1.4 times more of their annual living expenditures for out-of-pocket medical expenses, compared to households without persons with disabilities. Households having low economic status and members with chronic disease were more likely to face catastrophic health expenditures, while those receiving public assistance were less likely. Exemption or reduction of out-of-pocket payments in the National Health Insurance and additional financial support are needed so that the people with disabilities can use medical services without suffering financial crisis. PMID:26955233

Catastrophic Health Expenditures for Households with Disabled Members: Evidence from the Korean Health Panel.

PubMed

Lee, Jeong-Eun; Shin, Hyung-Ik; Do, Young Kyung; Yang, Eun Joo

2016-03-01

Persons with disabilities use more health care services due to ill health and face higher health care expenses and burden. This study explored the incidence of catastrophic health expenditures of households with persons with disabilities compared to that of those without such persons. We used the Korean Health Panel (KHP) dataset for the years 2010 and 2011. The final sample was 5,610 households; 800 (14.3%) of these were households with a person with a disability and 4,810 (85.7%) were households without such a person. Households with a person with a disability faced higher catastrophic health expenditures, spending about 1.2 to 1.4 times more of their annual living expenditures for out-of-pocket medical expenses, compared to households without persons with disabilities. Households having low economic status and members with chronic disease were more likely to face catastrophic health expenditures, while those receiving public assistance were less likely. Exemption or reduction of out-of-pocket payments in the National Health Insurance and additional financial support are needed so that the people with disabilities can use medical services without suffering financial crisis.

Aging Baby Boomers and the Rising Cost of Chronic Back Pain: Secular Trend Analysis of Longitudinal Medical Expenditures Panel Survey Data for Years 2000 to 2007

PubMed Central

Smith, Monica; Davis, Matthew A.; Stano, Miron; Whedon, James M.

2013-01-01

Objectives The purposes of this study were to analyze data from the longitudinal Medical Expenditures Panel Survey (MEPS) to evaluate the impact of an aging population on secular trends in back pain and chronicity and to provide estimates of treatment costs for patients who used only ambulatory services. Methods Using the MEPS 2-year longitudinal data for years 2000 to 2007, we analyzed data from all adult respondents. Of the total number of MEPS respondent records analyzed (N = 71 838), we identified 12 104 respondents with back pain and further categorized 3842 as chronic cases and 8262 as nonchronic cases. Results Secular trends from the MEPS data indicate that the prevalence of back pain has increased by 29%, whereas chronic back pain increased by 64%. The average age among all adults with back pain increased from 45.9 to 48.2 years; the average age among adults with chronic back pain increased from 48.5 to 52.2 years. Inflation-adjusted (to 2010 dollars) biennial expenditures on ambulatory services for chronic back pain increased by 129% over the same period, from $15.6 billion in 2000 to 2001 to $35.7 billion in 2006 to 2007. Conclusion The prevalence of back pain, especially chronic back pain, is increasing. To the extent that the growth in chronic back pain is caused, in part, by an aging population, the growth will likely continue or accelerate. With relatively high cost per adult with chronic back pain, total expenditures associated with back pain will correspondingly accelerate under existing treatment patterns. This carries implications for prioritizing health policy, clinical practice, and research efforts to improve care outcomes, costs, and cost-effectiveness and for health workforce planning. PMID:23380209

Life Years Lost and Lifetime Health Care Expenditures Associated With Diabetes in the U.S., National Health Interview Survey, 1997–2000

PubMed Central

Leung, Man-Yee Mallory; Pollack, Lisa M.; Colditz, Graham A.

2015-01-01

OBJECTIVE This study analyzed the lifetime health care expenditures and life years lost associated with diabetes in the U.S. RESEARCH DESIGN AND METHODS Data from the National Health Interview Survey (NHIS), the Medical Expenditure Panel Survey from 1997 to 2000, and the NHIS Linked Mortality Public-use Files with a mortality follow-up to 2006 were used to estimate age-, race-, sex-, and BMI-specific risk of diabetes, mortality, and annual health care expenditures for both patients with diabetes and those without diabetes. A Markov model populated by the risk and cost estimates was used to compute life years and total lifetime health care expenditures by age, race, sex, and BMI classifications for patients with diabetes and without diabetes. RESULTS Predicted life expectancy for patients with diabetes and without diabetes demonstrated an inverted U shape across most BMI classifications, with highest life expectancy being for the overweight. Lifetime health care expenditures were higher for whites than blacks and for females than males. Using U.S. adults aged 50 years as an example, we found that diabetic white females with a BMI >40 kg/m2 had 17.9 remaining life years and lifetime health expenditures of $185,609, whereas diabetic white females with normal weight had 22.2 remaining life years and lifetime health expenditures of $183,704. CONCLUSIONS Our results show that diabetes is associated with large decreases in life expectancy and large increases in lifetime health care expenditures. In addition to decreasing life expectancy by 3.3 to 18.7 years, diabetes increased lifetime health care expenditures by $8,946 to $159,380 depending on age-race-sex-BMI classification groups. PMID:25552420

Comparison of the Effects of Public and Private Health Expenditures on the Health Status: A Panel Data Analysis in Eastern Mediterranean Countries

PubMed Central

Homaie Rad, Enayatollah; Vahedi, Sajad; Teimourizad, Abedin; Esmaeilzadeh, Firooz; Hadian, Mohamad; Torabi Pour, Amin

2013-01-01

Background: Health expenditures are divided in two parts of public and private health expenditures. Public health expenditures contain social security spending, taxing to private and public sectors, and foreign resources like loans and subventions. On the other hand, private health expenditures contain out of pocket expenditures and private insurances. Each of these has different effects on the health status. The present study aims to compare the effects of these expenditures on health in Eastern Mediterranean Region (EMR). Methods: In this study, infant mortality rate was considered as an indicator of health status. We estimated the model using the panel data of EMR countries between 1995 and 2010. First, we used Pesaran CD test followed by Pesaran’s CADF unit root test. After the confirmation of having unit root, we used Westerlund panel cointegration test and found that the model was cointegrated and then after using Hausman and Breusch-Pagan tests, we estimated the model using the random effects. Results: The results showed that the public health expenditures had a strong negative relationship with infant mortality rate. However, a positive relationship was found between the private health expenditures and infant mortality rate (IMR). The relationship for public health expenditures was significant, but for private health expenditures was not. Conclusion: The study findings showed that the public health expenditures in the EMR countries improved health outcome, while the private health expenditures did not have any significant relationship with health status, so often increasing the public health expenditures leads to reduce IMR. But this relationship was not significant because of contradictory effects for poor and wealthy peoples. PMID:24596857

Life years lost and lifetime health care expenditures associated with diabetes in the U.S., National Health Interview Survey, 1997-2000.

PubMed

Leung, Man-Yee Mallory; Pollack, Lisa M; Colditz, Graham A; Chang, Su-Hsin

2015-03-01

This study analyzed the lifetime health care expenditures and life years lost associated with diabetes in the U.S. Data from the National Health Interview Survey (NHIS), the Medical Expenditure Panel Survey from 1997 to 2000, and the NHIS Linked Mortality Public-use Files with a mortality follow-up to 2006 were used to estimate age-, race-, sex-, and BMI-specific risk of diabetes, mortality, and annual health care expenditures for both patients with diabetes and those without diabetes. A Markov model populated by the risk and cost estimates was used to compute life years and total lifetime health care expenditures by age, race, sex, and BMI classifications for patients with diabetes and without diabetes. Predicted life expectancy for patients with diabetes and without diabetes demonstrated an inverted U shape across most BMI classifications, with highest life expectancy being for the overweight. Lifetime health care expenditures were higher for whites than blacks and for females than males. Using U.S. adults aged 50 years as an example, we found that diabetic white females with a BMI >40 kg/m(2) had 17.9 remaining life years and lifetime health expenditures of $185,609, whereas diabetic white females with normal weight had 22.2 remaining life years and lifetime health expenditures of $183,704. Our results show that diabetes is associated with large decreases in life expectancy and large increases in lifetime health care expenditures. In addition to decreasing life expectancy by 3.3 to 18.7 years, diabetes increased lifetime health care expenditures by $8,946 to $159,380 depending on age-race-sex-BMI classification groups. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Inadequate physical activity and health care expenditures in the United States.

PubMed

Carlson, Susan A; Fulton, Janet E; Pratt, Michael; Yang, Zhou; Adams, E Kathleen

2015-01-01

This study estimates the percentage of health care expenditures in the non-institutionalized United States (U.S.) adult population associated with levels of physical activity inadequate to meet current guidelines. Leisure-time physical activity data from the National Health Interview Survey (2004-2010) were merged with health care expenditure data from the Medical Expenditure Panel Survey (2006-2011). Health care expenditures for inactive (i.e., no physical activity) and insufficiently active adults (i.e., some physical activity but not enough to meet guidelines) were compared with active adults (i.e., ≥150minutes/week moderate-intensity equivalent activity) using an econometric model. Overall, 11.1% (95% CI: 7.3, 14.9) of aggregate health care expenditures were associated with inadequate physical activity (i.e., inactive and insufficiently active levels). When adults with any reported difficulty walking due to a health problem were excluded, 8.7% (95% CI: 5.2, 12.3) of aggregate health care expenditures were associated with inadequate physical activity. Increasing adults' physical activity to meet guidelines may reduce U.S. health care expenditures. Published by Elsevier Inc.

Depression as a psychosocial consequence of occupational injury in the US working population: findings from the medical expenditure panel survey

PubMed Central

2013-01-01

Background Empirical evidence describing the psychosocial consequences of occupational injury is still limited. The effect of occupational injury on depression might pose unique challenges in workers compared with other kinds of injury. This study aimed to assess the differential impact of workplace injury compared with non-workplace injury on depression over time, and to identify the potential risk factors associated with post-injury depression in the US working population. Methods Using pooled panel data from the Medical Expenditure Panel Survey 2000–2006, a total of 35,155 workers aged 18–64 years who had been followed for about 18 months in each panel were analyzed. Injuries in the 4–5 months before baseline, and subsequent depression incidence during follow-up, were identified using ICD-9 codes for the medical conditions captured in personal interviews. A discrete time-proportional odds model was used. Results A total of 5.5% of workers with occupational injury at baseline reported depression at follow-up, compared with 4.7% of workers with non-occupational injury and 3.1% of workers without injuries. Those with occupational injuries had more severe injuries and required longer treatment, compared with those with non-occupational injuries. Only 39% of workers with workplace injuries were paid Workers’ Compensation (WC). The association between injury and depression appeared to be stronger for workplace injury, and the adjusted odds ratio for depression was 1.72 for those with occupational injury (95% CI: 1.27–2.32), and 1.36 for those with non-occupational injury (95% CI: 1.07–1.65) compared with the no-injury group, after controlling for relevant covariates. Occupational injury was associated with higher odds of developing depression over time. WC as a source of medical payment was associated with 33% higher odds of developing depression (95% CI: 1.01–1.74). Part-time work, shorter job tenure, and long working hours were independently

Correlates of out-of-pocket and catastrophic health expenditures in Tanzania: results from a national household survey.

PubMed

Brinda, Ethel Mary; Andrés, Antonio Rodríguez; Andrés, Rodriguez Antonio; Enemark, Ulrika

2014-03-05

Inequality in health services access and utilization are influenced by out-of-pocket health expenditures in many low and middle-income countries (LMICs). Various antecedents such as social factors, poor health and economic factors are proposed to direct the choice of health care service use and incurring out-of-pocket payments. We investigated the association of these factors with out-of-pocket health expenditures among the adult and older population in the United Republic of Tanzania. We also investigated the prevalence and associated determinants contributing to household catastrophic health expenditures. We accessed the data of a multistage stratified random sample of 7279 adult participants, aged between 18 and 59 years, as well as 1018 participants aged above 60 years, from the first round of the Tanzania National Panel survey. We employed multiple generalized linear and logistic regression models to evaluate the correlates of out-of-pocket as well as catastrophic health expenditures, accounting for the complex sample design effects. Increasing age, female gender, obesity and functional disability increased the adults' out-of-pocket health expenditures significantly, while functional disability and visits to traditional healers increased the out-of-pocket health expenditures in older participants. Adult participants, who lacked formal education or worked as manual laborers earned significantly less (p < 0.001) and spent less on health (p < 0.001), despite having higher levels of disability. Large household size, household head's occupation as a manual laborer, household member with chronic illness, domestic violence against women and traditional healer's visits were significantly associated with high catastrophic health expenditures. We observed that the prevalence of inequalities in socioeconomic factors played a significant role in determining the nature of both out-of-pocket and catastrophic health expenditures. We propose that investment in social welfare

Impact of Patient-Provider Race, Ethnicity, and Gender Concordance on Cancer Screening: Findings from Medical Expenditure Panel Survey.

PubMed

Malhotra, Jyoti; Rotter, David; Tsui, Jennifer; Llanos, Adana A M; Balasubramanian, Bijal A; Demissie, Kitaw

2017-12-01

Background: Racial and ethnic minorities experience lower rates of cancer screening compared with non-Hispanic whites (NHWs). Previous studies evaluating the role of patient-provider race, ethnicity, or gender concordance in cancer screening have been inconclusive. Methods: In a cross-sectional analysis using the Medical Expenditure Panel Survey (MEPS), data from 2003 to 2010 were assessed for associations between patient-provider race, ethnicity, and/or gender concordance and, screening (American Cancer Society guidelines) for breast, cervical, and colorectal cancer. Multivariable logistic analyses were conducted to examine associations of interest. Results: Of the 32,041 patient-provider pairs in our analysis, more than 60% of the patients were NHW, 15% were non-Hispanic black (NHB), and 15% were Hispanic. Overall, patients adherent to cancer screening were more likely to be non-Hispanic, better educated, married, wealthier, and privately insured. Patient-provider gender discordance was associated with lower rates of breast [OR, 0.83; 95% confidence interval (CI), 0.76-0.90], cervical (OR, 0.83; 95% CI, 0.76-0.91), and colorectal cancer (OR, 0.84; 95% CI, 0.79-0.90) screening in all patients. This association was also significant after adjusting for racial and/or ethnic concordance. Conversely, among NHWs and NHBs, patient-provider racial and/or ethnic concordance was not associated with screening. Among Hispanics, patient-provider ethnic discordant pairs had higher breast (58% vs. 52%) and colorectal cancer (45% vs. 39%) screening rates compared with concordant pairs. Conclusions: Patient-provider gender concordance positively affected cancer screening. Patient-provider ethnic concordance was inversely associated with receipt of cancer screening among Hispanics. This counter-intuitive finding requires further study. Impact: Our findings highlight the importance of gender concordance in improving cancer screening rates. Cancer Epidemiol Biomarkers Prev; 26

Poverty and severe psychiatric disorder in the U.S.: evidence from the Medical Expenditure Panel Survey.

PubMed

Vick, Brandon; Jones, Kristine; Mitra, Sophie

2012-06-01

Previous studies have shown that persons with severe psychiatric disorders are more likely to be poor and face disparities in education and employment outcomes. Poverty rates, the standard measure of poverty, give no information on how far below the poverty line this group falls. This paper compares the poverty rate, poverty depth (distance from the poverty line) and poverty severity (inequality of incomes below the poverty line) of households with and without a working-age member with severe psychiatric disorder in the United States using data from the 2007 Medical Expenditure Panel Survey (MEPS). First, we perform multivariate analysis of the association between severe disorder and poverty depth using MEPS data. Second, we calculate poverty rates, depth, and severity for the subgroup of households having a member with disorder and compare to the subgroup of households without such a member. In multivariate regressions, the presence of a household member with severe psychiatric disorder predicts a 52-percentage point increase in poverty depth and 3.10 times the odds of being poor. Poverty rate, depth, and severity are significantly greater for households of persons with disorder. Mean total incomes are lower for households of persons with severe disorder compared to other households while mean health expenditures are similar. Severe psychiatric disorder is associated with greater depth of poverty and likelihood of being poor. We identify groups who are the most disadvantaged according to severity of income poverty among households with severe psychiatric disorder. These include households whose head has no high school education, who has been without work for the entire year, and who is black or Hispanic. While these characteristics are related to poverty for the overall sample, they correlate to heightened poverty severity when combined with severe disorder. Families face less severity than single persons but poverty rate, depth, and severity increase for both

Use of Internet panels to conduct surveys.

PubMed

Hays, Ron D; Liu, Honghu; Kapteyn, Arie

2015-09-01

The use of Internet panels to collect survey data is increasing because it is cost-effective, enables access to large and diverse samples quickly, takes less time than traditional methods to obtain data for analysis, and the standardization of the data collection process makes studies easy to replicate. A variety of probability-based panels have been created, including Telepanel/CentERpanel, Knowledge Networks (now GFK KnowledgePanel), the American Life Panel, the Longitudinal Internet Studies for the Social Sciences panel, and the Understanding America Study panel. Despite the advantage of having a known denominator (sampling frame), the probability-based Internet panels often have low recruitment participation rates, and some have argued that there is little practical difference between opting out of a probability sample and opting into a nonprobability (convenience) Internet panel. This article provides an overview of both probability-based and convenience panels, discussing potential benefits and cautions for each method, and summarizing the approaches used to weight panel respondents in order to better represent the underlying population. Challenges of using Internet panel data are discussed, including false answers, careless responses, giving the same answer repeatedly, getting multiple surveys from the same respondent, and panelists being members of multiple panels. More is to be learned about Internet panels generally and about Web-based data collection, as well as how to evaluate data collected using mobile devices and social-media platforms.

Lifetime medical expenditures among hypertensive men and women in the United States.

PubMed

Basu, Rituparna; Krueger, Patrick M; Lairson, David R; Franzini, Luisa

2011-01-01

Our objective was to estimate lifetime medical expenditures that can be attributed to hypertension, by gender, in the United States, given important gender differences in both survival and medical expenditures. We estimated lifetime medical expenditures among hypertensive and nonhypertensive men and women aged 20 and older. Expenditures were estimated from the 2001 to 2004 Medical Expenditure Panel Survey and life expectancies were estimated from the 1986 to 2002 National Health Interview Survey Linked Mortality Files. Assuming that medical technology, the cost of health care services, the incidence of disease, and survival were fixed, the cross-sectional age-specific expenditures and the survival profiles were used to estimate the lifetime expenditures from ages 20 to older than 85. The estimated lifetime expenditure for an average life table individual at age 20 was $188,300 for hypertensive men and $254,910 for hypertensive women; however, a greater share of lifetime expenditures can be attributed to hypertension among men ($88,033) than among women ($40,960). Although hypertensive women had greater lifetime expenditures than hypertensive men, hypertension was associated with a greater increase in lifetime expenditures for men than for women. Gender differences in both survival and health care utilization have important implications for gender differences in lifetime medical expenditures. Copyright © 2011 Jacobs Institute of Women's Health. All rights reserved.

A Summary of Expenditures and Sources of Payment for Personal Health Services from the National Medical Care Expenditure Survey: Data Preview 24. National Health Care Expenditure Study.

ERIC Educational Resources Information Center

Kasper, Judith A.; And Others

The National Center for Health Services Research and Health Care Technology Assessment conducted a study to examine how Americans use health care services and to determine national patterns of health expenditures and insurance coverage. Data were obtained from the National Medical Care Expenditure Survey interviews conducted with 14,000 randomly…

Correlates of out-of-pocket and catastrophic health expenditures in Tanzania: results from a national household survey

PubMed Central

2014-01-01

Background Inequality in health services access and utilization are influenced by out-of-pocket health expenditures in many low and middle-income countries (LMICs). Various antecedents such as social factors, poor health and economic factors are proposed to direct the choice of health care service use and incurring out-of-pocket payments. We investigated the association of these factors with out-of-pocket health expenditures among the adult and older population in the United Republic of Tanzania. We also investigated the prevalence and associated determinants contributing to household catastrophic health expenditures. Methods We accessed the data of a multistage stratified random sample of 7279 adult participants, aged between 18 and 59 years, as well as 1018 participants aged above 60 years, from the first round of the Tanzania National Panel survey. We employed multiple generalized linear and logistic regression models to evaluate the correlates of out-of-pocket as well as catastrophic health expenditures, accounting for the complex sample design effects. Results Increasing age, female gender, obesity and functional disability increased the adults’ out-of-pocket health expenditures significantly, while functional disability and visits to traditional healers increased the out-of-pocket health expenditures in older participants. Adult participants, who lacked formal education or worked as manual laborers earned significantly less (p < 0.001) and spent less on health (p < 0.001), despite having higher levels of disability. Large household size, household head’s occupation as a manual laborer, household member with chronic illness, domestic violence against women and traditional healer’s visits were significantly associated with high catastrophic health expenditures. Conclusion We observed that the prevalence of inequalities in socioeconomic factors played a significant role in determining the nature of both out-of-pocket and catastrophic health

Patient characteristics associated with multiple pharmacy use in the U.S. population: Findings from the Medical Expenditure Panel Survey.

PubMed

Look, Kevin A

2015-01-01

Multiple pharmacy use (MPU) is an important safety and quality issue, as it results in fragmented patient care. However, few studies have examined patient characteristics predicting the use of multiple pharmacies, and the findings have been inconsistent. To identify patient characteristics associated with MPU using national data. Data were obtained from the 2011 U.S. Medical Expenditure Panel Survey. The dependent variable was MPU, or the use of more than one pharmacy. The Andersen Behavioral Model of Health Service Use was used to guide the selection of independent variables, which were categorized as predisposing, enabling, and medical need related characteristics. Multivariable logistic regression analysis was conducted to identify the relationships between predisposing, enabling, and need variables and MPU in a hierarchical fashion. Point estimates were weighted to the U.S. non-institutionalized population, and to adjust standard errors to account for the complex survey design. MPU was common, with a national prevalence of 41.3%. Individuals aged 40-64 and adults 65 and older were significantly less likely to use multiple pharmacies as patients aged 18-39 years (40-64 years OR: 0.67, CI: 0.58-0.77; ≥65 years OR: 0.49, CI: 0.41-0.58). Females were significantly more likely to use multiple pharmacies than males (OR: 1.16, CI: 1.05-1.29). Individuals lacking health insurance were more likely to use multiple pharmacies as individuals with private health insurance (OR: 1.42, CI: 1.16-1.73); in contrast, individuals having drug insurance were more likely to use multiple pharmacies (OR: 1.25, CI: 1.06-1.47) relative to those without drug insurance. Any mail order use was the strongest predictor of MPU (OR: 6.94, CI: 5.90-8.18). Pharmacists and other health care providers need to be aware that their patients may be using multiple pharmacies, especially younger patients, those lacking access to health insurance, or those using mail order pharmacies. The findings from

Food Insecurity and Health Care Expenditures in the United States, 2011-2013.

PubMed

Berkowitz, Seth A; Basu, Sanjay; Meigs, James B; Seligman, Hilary K

2018-06-01

To determine whether food insecurity, limited or uncertain food access owing to cost, is associated with greater health care expenditures. Nationally representative sample of the civilian noninstitutionalized population of the United States (2011 National Health Interview Survey [NHIS] linked to 2012-2013 Medication Expenditure Panel Survey [MEPS]). Longitudinal retrospective cohort. A total of 16,663 individuals underwent assessment of food insecurity, using the 10-item adult 30-day food security module, in the 2011 NHIS. Their total health care expenditures in 2012 and 2013 were recorded in MEPS. Expenditure data were analyzed using zero-inflated negative binomial regression and adjusted for age, gender, race/ethnicity, education, income, insurance, and residence area. Fourteen percent of individuals reported food insecurity, representing 41,616,255 Americans. Mean annualized total expenditures were $4,113 (standard error $115); 9.2 percent of all individuals had no health care expenditures. In multivariable analyses, those with food insecurity had significantly greater estimated mean annualized health care expenditures ($6,072 vs. $4,208, p < .0001), an extra $1,863 in health care expenditure per year, or $77.5 billion in additional health care expenditure annually. Food insecurity was associated with greater subsequent health care expenditures. Future studies should determine whether food insecurity interventions can improve health and reduce health care costs. © Health Research and Educational Trust.

Gender Difference in Health-Care Expenditure: Evidence from India Human Development Survey

PubMed Central

Saikia, Nandita; Moradhvaj; Bora, Jayanta Kumar

2016-01-01

Background While the gender disparity in health and mortality in various stages of life in India is well documented, there is limited evidence on female disadvantage in health-care expenditure (HCE). Aims Examine the gender difference in HCE in short-term and major morbidity in India, and understand the role of factors underlying the difference. Data and Methods Using two rounds of nationally representative panel data—the India Human Development Survey (IHDS) 2004–2005 and 2011–2012 (IHDS I & II)—we calculate morbidity prevalence rate and mean HCE by gender, and examine the adjusted effect of gender on major morbidity-related HCE by using a two-part regression model. Further, we performed Oaxaca-Blinder decomposition of the gender gap in HCE in major morbidity to understand the contribution of demographic and socio-economic factors. Results Health-care expenditure on females was systematically lower than on males across all demographic and socio-economic groups. Multivariate analysis confirms that female HCE is significantly lower than male HCE even after controlling demographic and socio-economic factors (β = -0.148, p = 0.000, CI:-0.206–0.091). For both short-term and major morbidity, a female disadvantage on HCE increased from IHDS I to IHDS II. For instance, the male–female gap in major morbidity related expenditure increased from INR 1298 to INR 4172. A decomposition analysis of gender gap in HCE demonstrates that about 48% of the gap is attributable to differences in demographic and socio-economic factors (endowment effect), whereas 50% of the gap is due to the differential effect of the determinants (coefficient effect). Interpretation Indians spend less on female health care than on male health care. Most of the gender gap in HCE is not due to differential distribution of factors affecting HCE. PMID:27391322

Gender Difference in Health-Care Expenditure: Evidence from India Human Development Survey.

PubMed

Saikia, Nandita; Moradhvaj; Bora, Jayanta Kumar

2016-01-01

While the gender disparity in health and mortality in various stages of life in India is well documented, there is limited evidence on female disadvantage in health-care expenditure (HCE). Examine the gender difference in HCE in short-term and major morbidity in India, and understand the role of factors underlying the difference. Using two rounds of nationally representative panel data-the India Human Development Survey (IHDS) 2004-2005 and 2011-2012 (IHDS I & II)-we calculate morbidity prevalence rate and mean HCE by gender, and examine the adjusted effect of gender on major morbidity-related HCE by using a two-part regression model. Further, we performed Oaxaca-Blinder decomposition of the gender gap in HCE in major morbidity to understand the contribution of demographic and socio-economic factors. Health-care expenditure on females was systematically lower than on males across all demographic and socio-economic groups. Multivariate analysis confirms that female HCE is significantly lower than male HCE even after controlling demographic and socio-economic factors (β = -0.148, p = 0.000, CI:-0.206-0.091). For both short-term and major morbidity, a female disadvantage on HCE increased from IHDS I to IHDS II. For instance, the male-female gap in major morbidity related expenditure increased from INR 1298 to INR 4172. A decomposition analysis of gender gap in HCE demonstrates that about 48% of the gap is attributable to differences in demographic and socio-economic factors (endowment effect), whereas 50% of the gap is due to the differential effect of the determinants (coefficient effect). Indians spend less on female health care than on male health care. Most of the gender gap in HCE is not due to differential distribution of factors affecting HCE.

Smoking Behavior and Healthcare Expenditure in the United States, 1992–2009: Panel Data Estimates

PubMed Central

Lightwood, James; Glantz, Stanton A.

2016-01-01

Background Reductions in smoking in Arizona and California have been shown to be associated with reduced per capita healthcare expenditures in these states compared to control populations in the rest of the US. This paper extends that analysis to all states and estimates changes in healthcare expenditure attributable to changes in aggregate measures of smoking behavior in all states. Methods and Findings State per capita healthcare expenditure is modeled as a function of current smoking prevalence, mean cigarette consumption per smoker, other demographic and economic factors, and cross-sectional time trends using a fixed effects panel data regression on annual time series data for each the 50 states and the District of Columbia for the years 1992 through 2009. We found that 1% relative reductions in current smoking prevalence and mean packs smoked per current smoker are associated with 0.118% (standard error [SE] 0.0259%, p < 0.001) and 0.108% (SE 0.0253%, p < 0.001) reductions in per capita healthcare expenditure (elasticities). The results of this study are subject to the limitations of analysis of aggregate observational data, particularly that a study of this nature that uses aggregate data and a relatively small sample size cannot, by itself, establish a causal connection between smoking behavior and healthcare costs. Historical regional variations in smoking behavior (including those due to the effects of state tobacco control programs, smoking restrictions, and differences in taxation) are associated with substantial differences in per capita healthcare expenditures across the United States. Those regions (and the states in them) that have lower smoking have substantially lower medical costs. Likewise, those that have higher smoking have higher medical costs. Sensitivity analysis confirmed that these results are robust. Conclusions Changes in healthcare expenditure appear quickly after changes in smoking behavior. A 10% relative drop in smoking in every

Iatrogenic effects of COX-2 inhibitors in the US population: findings from the Medical Expenditure Panel Survey.

PubMed

Vaithianathan, Rhema; Hockey, Peter M; Moore, Thomas J; Bates, David W

2009-01-01

Selective cyclo-oxygenase 2 inhibitors ('coxibs') have been demonstrated to increase cardiovascular risk, but the cumulative burden of adverse effects in the US population is uncertain. To quantify cardiovascular and gastrointestinal (GI) haemorrhage disease burden from coxibs and traditional 'non-selective' non-steroidal anti-inflammatory drugs (t-NSAIDs) in the US population. Adult respondents from the 1999-2003 Medical Expenditure Panel Survey, a representative sample of the US population which first became available in December 2006, were included. Respondents were followed for 2 years. Exposure was defined by two or more prescriptions of rofecoxib, celecoxib or a t-NSAID in the first year. Acute myocardial infarction (AMI), stroke and/or GI haemorrhage in the year following exposure. Exposure to rofecoxib was associated with an adjusted odds ratio (OR) of 3.30 for AMI (95% CI 1.41, 7.68; p=0.01) and 4.28 for GI haemorrhage (95% CI 1.33, 13.71; p=0.02). Celecoxib was not associated with a statistically significant effect on AMI (OR 1.44; 95% CI 0.57, 3.69; p=0.44), but there was an OR of 2.43 for stroke (95% CI 1.05, 5.58; p=0.04) and 4.98 for GI haemorrhage (95% CI 2.22, 11.17; p<0.001). The group of t-NSAIDs was not associated with a significant adverse effect on AMI (OR 1.47; 95% CI 0.76, 2.84; p=0.25) or stroke (OR 1.26; 95% CI 0.42, 3.81; p=0.68), and was associated with an OR of 2.38 for GI haemorrhage (CI 1.04, 5.46; p=0.04). In the 1999-2004 period rofecoxib was associated with 46 783 AMIs and 31 188 GI haemorrhages; celecoxib with 21 832 strokes and 69 654 GI haemorrhages; resulting in an estimated 26 603 deaths from both coxibs. The t-NSAID group was associated with an excess of 87 327 GI haemorrhages and 9606 deaths in the same period. Iatrogenic effects of coxibs in the US population were substantial, posing an important public health risk. Drugs that were rapidly accepted for assumed safety advantages proved instead to have caused substantial

Affordability of the Health Expenditures of Insured Americans Before the Affordable Care Act.

PubMed

Nyman, John A; Trenz, Helen M

2016-02-01

Central to the Affordable Care Act is the notion of affordability and the role of health insurance in making otherwise unaffordable health care affordable. We used data from the 1996 to 2008 versions of the Medical Expenditure Panel Survey to estimate the portion of overall health care expenditures by insured respondents that would otherwise have been beyond their disposable incomes and assets. We found that about one third of insured expenditures would have been unaffordable, with a much higher percentage among publicly insured individuals. This result suggests that one of the main functions of insurance is to cover expenses that insured individuals would not otherwise be able to afford.

Health care expenditures of overweight and obese U.S. adults with intellectual and developmental disabilities.

PubMed

Li, Henan; Fujiura, Glenn; Magaña, Sandra; Parish, Susan

2018-04-01

U.S. adults with intellectual and developmental disabilities (IDD) have poorer health status and greater risks for being overweight and obese, which are major drivers of health care expenditures in the general population. Health care expenditures and IDD have not been studied using nationally representative samples, and the impact of overweight and obesity have not been examined. Using nationally representative data, we aimed to compare the health care expenditures of not-overweight, overweight and obese U.S. adults with IDD, and calculate model-adjusted expenditures. Pooled data from the 2002-2011 Medical Expenditure Panel Survey linked to National Health Interview Survey (n = 1224) were analyzed. Two-part model regressions were conducted, with covariates being year of survey, age, sex, race/ethnicity, household income status, geographical region, urban/rural, marital status, insurance coverage, perceived health status, and perceived mental health status. Overall, obese adults with intellectual and developmental disabilities had higher expenditures than their non-obese peers. Being obese was associated with an estimated additional $2516 in mean expenditures and $1200 in median expenditures compared with the reference group, who were neither overweight nor obese. Obesity is an important predictor of higher health care costs among community-living adults with IDD Finding effective strategies and interventions to address obesity in this population has great financial and policy significance. Copyright © 2018 Elsevier Ltd. All rights reserved.

Racial and ethnic differences in health care utilization for childhood eczema: An analysis of the 2001-2013 Medical Expenditure Panel Surveys.

PubMed

Fischer, Alexander H; Shin, Daniel B; Margolis, David J; Takeshita, Junko

2017-12-01

Eczema is a common chronic inflammatory disease of the skin. Studies suggest differences in disease prevalence and severity by race/ethnicity. Our knowledge of health care utilization for eczema among different racial/ethnic groups remains limited. To evaluate health care utilization for childhood eczema among different racial/ethnic groups in the United States. We performed a cohort study of non-Hispanic white (reference), non-Hispanic black, and Hispanic white individuals under the age of 18 years with caregiver-reported eczema (N = 2043) pooled from the 2-year longitudinal cohorts of the 2001-2013 Medical Expenditure Panel Surveys. Health care utilization outcomes were evaluated over the 2-year follow-up period by race/ethnicity using multivariable regression. Among all children with eczema, non-Hispanic blacks were less likely than whites to report an ambulatory visit for eczema (adjusted odds ratio [OR adj ] 0.69; 95% confidence interval [CI] 0.51-0.92). Among those with ≥1 ambulatory visit for eczema, non-Hispanic blacks reported more visits (adjusted incidence rate ratio [IRR adj ] 1.68; 95% CI 1.10-2.55) and prescriptions (IRR adj 1.22; 95% CI 1.01-1.46) than whites and were more likely than whites to report a dermatology visit (OR adj 1.82; 95% CI 1.06-3.14) for eczema. We used caregiver- or self-reported data. Our findings suggest disparities in health care utilization for eczema among non-Hispanic black children despite utilization patterns suggestive of more severe disease. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Selection bias of Internet panel surveys: a comparison with a paper-based survey and national governmental statistics in Japan.

PubMed

Tsuboi, Satoshi; Yoshida, Honami; Ae, Ryusuke; Kojo, Takao; Nakamura, Yosikazu; Kitamura, Kunio

2015-03-01

To investigate the selection bias of an Internet panel survey organized by a commercial company. A descriptive study was conducted. The authors compared the characteristics of the Internet panel survey with a national paper-based survey and with national governmental statistics in Japan. The participants in the Internet panel survey were composed of more women, were older, and resided in large cities. Regardless of age and sex, the prevalence of highly educated people in the Internet panel survey was higher than in the paper-based survey and the national statistics. In men, the prevalence of heavy drinkers among the 30- to 49-year-old population and of habitual smokers among the 20- to 49-year-old population in the Internet panel survey was lower than what was found in the national statistics. The estimated characteristics of commercial Internet panel surveys were quite different from the national statistical data. In a commercial Internet panel survey, selection bias should not be underestimated. © 2012 APJPH.

Receipt of preventive oral health care by U.S. children: a population-based study of the 2005-2008 medical expenditure panel surveys.

PubMed

Huebner, Colleen E; Bell, Janice F; Reed, Sarah C

2013-11-01

This study provides estimates of the annual use of preventive oral health care by U.S. children ages 6 months-17 years. We estimated the annual use of preventive oral health care with data from the Medical Expenditure Panel Survey for the years 2005 through 2008 (n = 18,218). Additionally, we tested associations between use of preventive oral health care and predisposing factors, enabling factors and health need within three age groups: young children, school-age children and youth. Overall, 21 % of the sample was reported to have received preventive oral health care in the prior year. More school-age children received preventive care than did young children or youth regardless of gender, race/ethnicity, health status, residence, or family size. Among the youngest children, low parental education and lack of health insurance were associated with lower odds of receiving preventive care. School-age children of racial and ethnic minority groups had a higher odds of receiving preventive care than did non-Hispanic Whites. Youth with special health care needs were less likely to receive care than their peers. Within each age group, use of preventive care increased significantly from 2005 to 2008. In the U.S. there has been an increase in use of pediatric preventive dental care. Continued effort is needed to achieve primary prevention. Outreach and education should include all parents and especially parents with low levels of education, parents of children with special health care needs and those without health insurance.

Health care expenditures associated with pediatric pain-related conditions in the United States.

PubMed

Groenewald, Cornelius B; Wright, Davene R; Palermo, Tonya M

2015-05-01

The primary objective of this study was to assess the impact of pediatric pain-related conditions on health care expenditures. We analyzed data from a nationally representative sample of 6- to 17-year-old children captured in the 2007 National Health Interview Survey and 2008 Medical Expenditure Panel Survey. Health care expenditures of children with pain-related conditions were compared with those of children without pain-related conditions. Pain-related conditions were associated with incremental health care expenditures of $1339 (95% confidence interval [CI], $248-$2447) per capita. Extrapolated to the nation, pediatric pain-related conditions were associated with $11.8 billion (95% CI, $2.18-$21.5 billion) in total incremental health care expenditures. The incremental health care expenditures associated with pediatric pain-related conditions were similar to those of attention deficit and hyperactivity disorder ($9.23 billion; 95% CI, $1.89-$18.1 billion), but more than those associated with asthma ($5.35 billion; 95% CI, $0-$12.3 billion) and obesity ($0.73 billion; 95% CI, $6.28-$8.81 billion). Health care expenditures for pediatric pain-related conditions exert a considerable economic burden on society. Efforts to prevent and treat pediatric pain-related conditions are urgently needed.

The impact of health insurance programs on out-of-pocket expenditures in Indonesia: an increase or a decrease?

PubMed

Aji, Budi; De Allegri, Manuela; Souares, Aurelia; Sauerborn, Rainer

2013-07-18

We used panel data from the Indonesian Family Life Survey to investigate the impact of health insurance programs on reducing out-of-pocket expenditures. We employed three linear panel data models, two of which accounted for endogeneity: pooled ordinary least squares (OLS), pooled two-stage least squares (2SLS) for instrumental variable (IV), and fixed effects (FE). The study revealed that two health insurance programs had a significantly negative impact on out-of-pocket expenditures by using IV estimates. In the IV model, Askeskin decreased out-of-pocket expenditures by 34% and Askes by 55% compared with non-Askeskin and non-Askes, respectively, while Jamsostek was found to bear a nonsignificant effect on out-of-pocket expenditures. In the FE model, only Askeskin had a significant negative effect with an 11% reduction on out-of-pocket expenditures. This study showed that two large existing health insurance programs in Indonesia, Askeskin and Askes, effectively reduced household out-of-pocket expenditures. The ability of programs to offer financial protection by reducing out-of-pocket expenditures is likely to be a direct function of their benefits package and co-payment policies.

The Impact of Health Insurance Programs on Out-of-Pocket Expenditures in Indonesia: An Increase or a Decrease?

PubMed Central

Aji, Budi; De Allegri, Manuela; Souares, Aurelia; Sauerborn, Rainer

2013-01-01

We used panel data from the Indonesian Family Life Survey to investigate the impact of health insurance programs on reducing out-of-pocket expenditures. We employed three linear panel data models, two of which accounted for endogeneity: pooled ordinary least squares (OLS), pooled two-stage least squares (2SLS) for instrumental variable (IV), and fixed effects (FE). The study revealed that two health insurance programs had a significantly negative impact on out-of-pocket expenditures by using IV estimates. In the IV model, Askeskin decreased out-of-pocket expenditures by 34% and Askes by 55% compared with non-Askeskin and non-Askes, respectively, while Jamsostek was found to bear a nonsignificant effect on out-of-pocket expenditures. In the FE model, only Askeskin had a significant negative effect with an 11% reduction on out-of-pocket expenditures. This study showed that two large existing health insurance programs in Indonesia, Askeskin and Askes, effectively reduced household out-of-pocket expenditures. The ability of programs to offer financial protection by reducing out-of-pocket expenditures is likely to be a direct function of their benefits package and co-payment policies. PMID:23873263

Obesity and People with Disabilities: The Implications for Health Care Expenditures

PubMed Central

Anderson, Wayne L.; Wiener, Joshua M.; Khatutsky, Galina; Armour, Brian S.

2015-01-01

Objective This study estimates additional average health care expenditures for overweight and obesity for adults with disabilities vs. without. Design and Methods Descriptive and multivariate methods were used to estimate additional health expenditures by service type, age group, and payer using 2004–2007 Medical Expenditure Panel Survey data. Results In 2007, 37% of community-dwelling Americans with disabilities were obese vs. 27% of the total population. People with disabilities had almost three times ($2,459) the additional average obesity cost of people without disabilities ($889). Prescription drug expenditures for obese people with disabilities were three times as high and outpatient expenditures were 74% higher. People with disabilities in the 45- to 64-year age group had the highest obesity expenditures. Medicare had the highest additional average obesity expenditures among payers. Among people with prescription drug expenditures, obese people with disabilities had nine times the prevalence of diabetes as normal weight people with disabilities. Overweight people with and without disabilities had lower expenditures than normal-weight people with and without disabilities. Conclusions Obesity results in substantial additional health care expenditures for people with disabilities. These additional expenditures pose a serious current and future problem, given the potential for higher obesity prevalence in the coming decade. PMID:23804319

Obesity and people with disabilities: the implications for health care expenditures.

PubMed

Anderson, Wayne L; Wiener, Joshua M; Khatutsky, Galina; Armour, Brian S

2013-12-01

This study estimates additional average health care expenditures for overweight and obesity for adults with disabilities vs. without. Descriptive and multivariate methods were used to estimate additional health expenditures by service type, age group, and payer using 2004-2007 Medical Expenditure Panel Survey data. In 2007, 37% of community-dwelling Americans with disabilities were obese vs. 27% of the total population. People with disabilities had almost three times ($2,459) the additional average obesity cost of people without disabilities ($889). Prescription drug expenditures for obese people with disabilities were three times as high and outpatient expenditures were 74% higher. People with disabilities in the 45- to 64-year age group had the highest obesity expenditures. Medicare had the highest additional average obesity expenditures among payers. Among people with prescription drug expenditures, obese people with disabilities had nine times the prevalence of diabetes as normal weight people with disabilities. Overweight people with and without disabilities had lower expenditures than normal-weight people with and without disabilities. Obesity results in substantial additional health care expenditures for people with disabilities. These additional expenditures pose a serious current and future problem, given the potential for higher obesity prevalence in the coming decade. Copyright © 2013 The Obesity Society.

Racial, Ethnic, and Nativity Differences in Mental Health Visits to Primary Care and Specialty Mental Health Providers: Analysis of the Medical Expenditures Panel Survey, 2010-2015.

PubMed

Jones, Audrey L; Cochran, Susan D; Leibowitz, Arleen; Wells, Kenneth B; Kominski, Gerald; Mays, Vickie M

2018-03-22

Black and Latino minorities have traditionally had poorer access to primary care than non-Latino Whites, but these patterns could change with the Affordable Care Act (ACA). To guide post-ACA efforts to address mental health service disparities, we used a nationally representative sample to characterize baseline race-, ethnicity-, and nativity-associated differences in mental health services in the context of primary care. Data were obtained from the Medical Expenditures Panel Survey (MEPS), a two-year panel study of healthcare use, satisfaction with care, and costs of services in the United States (US). We pooled data from six waves (14-19) of participants with serious psychological distress to examine racial, ethnic, and nativity disparities in medical and mental health visits to primary care (PC) and specialty mental health (SMH) providers around the time of ACA reforms, 2010-2015. Of the 2747 respondents with serious psychological distress, 1316 were non-Latino White, 632 non-Latino Black, 532 identified as Latino with Mexican, Central American, or South American (MCS) origins, and 267 as Latino with Caribbean island origins; 525 were foreign/island born. All racial/ethnic groups were less likely than non-Latino Whites to have any PC visit. Of those who used PC, non-Latino Blacks were less likely than Whites to have a PC mental health visit, while foreign born MCS Latinos were less likely to visit an SMH provider. Conditional on any mental health visit, Latinos from the Caribbean were more likely than non-Latino Whites to visit SMH providers versus PC providers only, while non-Latino Blacks and US born MCS Latinos received fewer PC mental health visits than non-Latino Whites. Racial-, ethnic-, and nativity-associated disparities persist in PC provided mental health services.

A basket two-part model to analyze medical expenditure on interdependent multiple sectors.

PubMed

Sugawara, Shinya; Wu, Tianyi; Yamanishi, Kenji

2018-05-01

This study proposes a novel statistical methodology to analyze expenditure on multiple medical sectors using consumer data. Conventionally, medical expenditure has been analyzed by two-part models, which separately consider purchase decision and amount of expenditure. We extend the traditional two-part models by adding the step of basket analysis for dimension reduction. This new step enables us to analyze complicated interdependence between multiple sectors without an identification problem. As an empirical application for the proposed method, we analyze data of 13 medical sectors from the Medical Expenditure Panel Survey. In comparison with the results of previous studies that analyzed the multiple sector independently, our method provides more detailed implications of the impacts of individual socioeconomic status on the composition of joint purchases from multiple medical sectors; our method has a better prediction performance.

Chronic conditions and medical expenditures among non-institutionalized adults in the United States.

PubMed

Lee, De-Chih; Shi, Leiyu; Pierre, Geraldine; Zhu, Jinsheng; Hu, Ruwei

2014-11-26

This study sought to examine medical expenditures among non-institutionalized adults in the United States with one or more chronic conditions. Using data from the 2010 Medical Expenditure Panel Survey (MEPS) Household Component (HC), we explored total and out-of-pocket medical, hospital, physician office, and prescription drug expenditures for non-institutionalized adults 18 and older with and without chronic conditions. We examined relationships between expenditure differences and predisposing, enabling, and need factors using recent, nationally representative data. Individuals with chronic conditions experienced higher total spending than those with no chronic conditions, even after controlling for confounding factors. This relationship persisted with age. Out-of-pocket spending trends mirrored total expenditure trends across health care categories. Additional population characteristics that were associated with high health care expenditures were race/ethnicity, marital status, insurance status, and education. The high costs associated with having one or more chronic conditions indicates a need for more robust interventions to target population groups who are most at risk.

77 FR 21086 - Patents External Quality Survey (formerly Customer Panel Quality Survey)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-09

... DEPARTMENT OF COMMERCE United States Patent and Trademark Office Patents External Quality Survey (formerly Customer Panel Quality Survey) ACTION: Proposed collection; comment request. SUMMARY: The United...: [email protected] . Include ``0651- 0057 Patents External Quality Survey comment'' in the...

The impact of environmental pollution on public health expenditure: dynamic panel analysis based on Chinese provincial data.

PubMed

Hao, Yu; Liu, Shuang; Lu, Zhi-Nan; Huang, Junbing; Zhao, Mingyuan

2018-05-01

In recent years, along with rapid economic growth, China's environmental problems have become increasingly prominent. At the same time, the level of China's pollution has been growing rapidly, which has caused huge damages to the residents' health. In this regard, the public health expenditure ballooned as the environmental quality deteriorated in China. In this study, the effect of environmental pollution on residents' health expenditure is empirically investigated by employing the first-order difference generalized method of moments (GMM) method to control for potential endogeneity. Using a panel data of Chinese provinces for the period of 1998-2015, this study found that the environmental pollution (represented by SO 2 and soot emissions) would indeed lead to the increase in the medical expenses of Chinese residents. At the current stage of economic development, an increase in SO 2 and soot emissions per capita would push up the public health expenditure per capita significantly. The estimation results are quite robust for different types of regression specifications and different combinations of control variables. Some social and economic variables such as public services and education may also have remarkable influences on residential medical expenses through different channels.

Measuring racial/ethnic disparities across the distribution of health care expenditures.

PubMed

Cook, Benjamin Lê; Manning, Willard G

2009-10-01

To assess whether black-white and Hispanic-white disparities increase or abate in the upper quantiles of total health care expenditure, conditional on covariates. Nationally representative adult population of non-Hispanic whites, African Americans, and Hispanics from the 2001-2005 Medical Expenditure Panel Surveys. We examine unadjusted racial/ethnic differences across the distribution of expenditures. We apply quantile regression to measure disparities at the median, 75th, 90th, and 95th quantiles, testing for differences over the distribution of health care expenditures and across income and education categories. We test the sensitivity of the results to comparisons based only on health status and estimate a two-part model to ensure that results are not driven by an extremely skewed distribution of expenditures with a large zero mass. Black-white and Hispanic-white disparities diminish in the upper quantiles of expenditure, but expenditures for blacks and Hispanics remain significantly lower than for whites throughout the distribution. For most education and income categories, disparities exist at the median and decline, but remain significant even with increased education and income. Blacks and Hispanics receive significantly disparate care at high expenditure levels, suggesting prioritization of improved access to quality care among minorities with critical health issues.

Relationship Between Catastrophic Health Expenditures and Income Quintile Decline

PubMed Central

Kang, Jeong-Hee; Kim, Chul-Woung

2018-01-01

Objectives The aims of this study were to investigate the proportion of households facing catastrophic health expenditures based on household income quintiles, and to analyze the relationship between expenditures and household income quintile decline. Methods Study data were obtained from an annually conducted survey of the 2012–2013 Korean health panel. There were 12,909 subjects aged 20–64 years from economically active households, whose income quintile remained unchanged or declined by more than one quintile from 2012 to 2013. Logistic regression analysis was performed to determine whether catastrophic health expenditures in 2012 were related to more than one quintile income decline in 2013. Results Households facing catastrophic health expenditures of ≥ 40%, ≥ 30%, and ≥ 10% of a household’s capacity to pay, were 1.58 times (p < 0.003), 1.75 times (p < 0.000), and 1.23 times (p < 0.001) more likely to face a decline in income quintile, respectively. Conclusion Over a 1 year period, the proportion of households facing more than one quintile income decline was 16.4%, while 2.1% to 2.5% of households in Korea faced catastrophic health expenditures. Catastrophic health expenditure experienced in 2012 was significantly associated with income quintile decline 1 year later. Therefore, lowering the proportion of households with catastrophic health expenditure may reduce the proportion of households with income quintiles decline. PMID:29740531

Trends in prescription drug expenditures by Medicaid enrollees.

PubMed

Banthin, Jessica S; Miller, G Edward

2006-05-01

As prescription drug expenditures consume an increasingly larger portion of Medicaid budgets, states are anxious to control drug costs without endangering enrollees' health. In this report, we analyzed recent trends in Medicaid prescription drug expenditures by therapeutic classes and subclasses. Identifying the fastest growing categories of drugs, where drugs are grouped into clinically relevant classes and subclasses, can help policymakers decide where to focus their cost containment efforts. We used data from the Medical Expenditure Panel Survey linked to a prescription drug therapeutic classification system, to examine trends between 1996/1997 and 2001/2002 in utilization and expenditures for the noninstitutionalized Medicaid population. We separated aggregate trends into changes in population with use and changes in expenditures per user, and percent generic. We also highlighted differences within the Medicaid population, including children, adults, disabled, and elderly. We found rapid growth in expenditures for antidepressants, antipsychotics, antihyperlipidemics, antidiabetic agents, antihistamines, COX-2 inhibitors, and proton pump inhibitors and found evidence supporting the rapid take-up of new drugs. In some cases these increases are the result of increased expenditures per user and in other cases the overall growth also comes from an increase in the population with use. Medicaid programs may want to reassess their cost-containment policies in light of the rapid take-up of new drugs. Our analysis also identifies areas in which more information is needed on the comparative effectiveness of new versus existing treatments.

A Note on Improving Process Efficiency in Panel Surveys with Paradata

ERIC Educational Resources Information Center

Kreuter, Frauke; Müller, Gerrit

2015-01-01

Call scheduling is a challenge for surveys around the world. Unlike cross-sectional surveys, panel surveys can use information from prior waves to enhance call-scheduling algorithms. Past observational studies showed the benefit of calling panel cases at times that had been successful in the past. This article is the first to experimentally assign…

Dental Use and Expenditures for Older Uninsured Americans: The Simulated Impact of Expanded Coverage

PubMed Central

Manski, Richard J; Moeller, John F; Chen, Haiyan; Schimmel, Jody; Pepper, John V; St Clair, Patricia A

2015-01-01

Objective To determine if providing dental insurance to older Americans would close the current gaps in dental use and expenditure between insured and uninsured older Americans. Data Sources/Study Setting We used data from the 2008 Health and Retirement Survey (HRS) supplemented by data from the 2006 Medical Expenditure Panel Survey (MEPS). Study Design We compared the simulated dental use and expenditures rates of newly insured persons against the corresponding rates for those previously insured. Data Collection/Extraction Methods The HRS is a nationally representative survey administered by the Institute for Social Research (ISR). The MEPS is a nationally representative household survey sponsored by the Agency for Healthcare Research and Quality (AHRQ). Principal Findings We found that expanding dental coverage to older uninsured Americans would close previous gaps in dental use and expense between uninsured and insured noninstitutionalized Americans 55 years and older. Conclusions Providing dental coverage to previously uninsured older adults would produce estimated monthly costs net of markups for administrative costs that comport closely to current market rates. Estimates also suggest that the total cost of providing dental coverage targeted specifically to nonusers of dental care may be less than similar costs for prior users. PMID:25040355

Panel Conditioning in the General Social Survey

ERIC Educational Resources Information Center

Halpern-Manners, Andrew; Warren, John Robert; Torche, Florencia

2017-01-01

Does participation in one wave of a survey have an effect on respondents' answers to questions in subsequent waves? In this article, we investigate the presence and magnitude of "panel conditioning" effects in one of the most frequently used data sets in the social sciences: the General Social Survey (GSS). Using longitudinal records…

Estimating annual medical and out-of-pocket expenditures associated with traumatic injuries in the United States.

PubMed

Alghnam, Suliman; Vanness, David J; Gaskin, Darrell J; Thorpe, Roland J; Castillo, Renan

2016-02-01

Every year, as many as 31 million Americans sustain traumatic injuries, leaving survivors with risks of disabilities and health settings with staggering medical costs. Little is known on the societal burden of injuries in terms of medical and out-of-pocket expenditures. Therefore, we used a nationally representative sample to evaluate the association between injuries and health expenditures among a nationally representative US sample. This study used years 2006 to 2010 (Panels 11-14; n = 53,065) of the Medical Expenditure Panel Survey. Each panel was followed up for 2 years. Total expenditures included insurance payments and out-of-pocket costs. Two-part models were constructed to examine differences in annual medical expenditures between injured and noninjured populations controlling for confounding effects. A total of 4,210 individuals (7.9%) reported injuries representing 21.5 million individuals. Injured individuals were more likely to be males, to be white, and to report higher medical expenditures in the second year than the reference population (p < 0.01). Adjusted analyses showed that reporting any injury was associated with $2,577 (95% confidence interval [CI], $2,049-$3,103) and $186 (95% CI, $142-$230) increase in total and out-of-pocket costs, respectively. While a moderate or severe injury was associated with $4,779 (95% CI, $3,947-$5,610) increase in the average of medical expenditures and $256 (95% CI, $190-$322) increase in out-of-pocket costs adjusting for covariates. Our adjusted national medical cost of injuries was estimated at $56 billion and out-of-pocket cost to be approximately $4 billion. Injuries pose a substantial burden on medical expenditures in the United States. Investment in injury prevention can facilitate reducing medical expenditures and save resources. Prevention programs may use the out-of-pocket findings to highlight injury burden on individual's prosperity and thus facilitate engagement of the public in prevention. Economic

Health care expenditures among working-age adults with physical disabilities: variations by disability spans.

PubMed

Pumkam, Chaiporn; Probst, Janice C; Bennett, Kevin J; Hardin, James; Xirasagar, Sudha

2013-10-01

Data on health care costs for working-age adults with physical disabilities are sparse and the dynamic nature of disability is not captured. To assess the effect of 3 types of disability status (persistent disability, temporary disability, and no disability) on health care expenditures, out-of-pocket (OOP) spending, and financial burden. Data from Medical Expenditure Panel Survey panel 12 (2007-2008) were used. Respondents were classified into 3 groups. Medians of average annual expenditures, OOP expenditures, and financial ratios were weighted. The package R was used for quantile regression analyses. Fifteen percent of the working-age population reported persistent disabilities and 7% had temporary disabilities. The persistent disability group had the greatest unadjusted annual medians for total expenditures ($4234), OOP expenses ($591), and financial burden ratios (1.59), followed by the temporary disability group ($1612, $388, 0.71 respectively). The persistent disability group paid approximately 15% of total health care expenditures out-of-pocket, while the temporary disability group and the no disability group each paid 22% out-of-pocket. After adjusting for other factors, quantile regression shows that the persistent disability group had significantly higher total expenditures, OOP expenses, and financial burden ratios (coefficients 1664, 156, 0.58 respectively) relative to the no disability group at the 50th percentile. Results for the temporary disability group show a similar trend except for OOP expenses. People who have disabling conditions for a longer period have better financial protection against OOP health care expenses but face greater financial burdens because of their higher out-of-pocket expenditures and their socioeconomic disadvantages. Copyright © 2013 Elsevier Inc. All rights reserved.

Hyperlipidemia and Medical Expenditures by Cardiovascular Disease Status in US Adults.

PubMed

Zhang, Donglan; Wang, Guijing; Fang, Jing; Mercado, Carla

2017-01-01

Hyperlipidemia is a major risk factor for cardiovascular disease (CVD), affecting 73.5 million American adults. Information about health care expenditures associated with hyperlipidemia by CVD status is needed to evaluate the economic benefit of primary and secondary prevention programs for CVD. The study sample includes 48,050 men and nonpregnant women ≥18 from 2010 to 2012 Medical Expenditure Panel Survey. A 2-part econometric model was used to estimate annual hyperlipidemia-associated medical expenditures by CVD status. The estimation results from the 2-part model were used to calculate per-capita and national medical expenditures associated with hyperlipidemia. We adjusted the medical expenditures into 2012 dollars. Among those with CVD, per person hyperlipidemia-associated expenditures were $1105 [95% confidence interval (CI), $877-$1661] per year, leading to an annual national expenditure of $15.47 billion (95% CI, $5.23-$27.75 billion). Among people without CVD, per person hyperlipidemia-associated expenditures were $856 (95% CI, $596-$1211) per year, resulting in an annual national expenditure of $23.11 billion (95% CI, $16.09-$32.71 billion). Hyperlipidemia-associated expenditures were attributable mostly to the costs of prescription medication (59%-90%). Among people without CVD, medication expenditures associated with hyperlipidemia were $13.72 billion (95% CI, $10.55-$15.74 billion), higher in men than in women. Hyperlipidemia significantly increased medical expenditures and the increase was higher in people with CVD than without. The information on estimated expenditures could be used to evaluate and develop effective programs for CVD prevention.

Integrated corridor management initiative: survey Dallas traveler response panel

DOT National Transportation Integrated Search

2017-03-01

This report presents findings from the Integrated Corridor Management (ICM) traveler behavior surveys, a set of panel surveys of US-75 corridor users, conducted before and after the deployment of ICM. The purpose of the surveys was to measure the imp...

Healthcare Expenditures Associated with Depression Among Individuals with Osteoarthritis: Post-Regression Linear Decomposition Approach.

PubMed

Agarwal, Parul; Sambamoorthi, Usha

2015-12-01

Depression is common among individuals with osteoarthritis and leads to increased healthcare burden. The objective of this study was to examine excess total healthcare expenditures associated with depression among individuals with osteoarthritis in the US. Adults with self-reported osteoarthritis (n = 1881) were identified using data from the 2010 Medical Expenditure Panel Survey (MEPS). Among those with osteoarthritis, chi-square tests and ordinary least square regressions (OLS) were used to examine differences in healthcare expenditures between those with and without depression. Post-regression linear decomposition technique was used to estimate the relative contribution of different constructs of the Anderson's behavioral model, i.e., predisposing, enabling, need, personal healthcare practices, and external environment factors, to the excess expenditures associated with depression among individuals with osteoarthritis. All analysis accounted for the complex survey design of MEPS. Depression coexisted among 20.6 % of adults with osteoarthritis. The average total healthcare expenditures were $13,684 among adults with depression compared to $9284 among those without depression. Multivariable OLS regression revealed that adults with depression had 38.8 % higher healthcare expenditures (p < 0.001) compared to those without depression. Post-regression linear decomposition analysis indicated that 50 % of differences in expenditures among adults with and without depression can be explained by differences in need factors. Among individuals with coexisting osteoarthritis and depression, excess healthcare expenditures associated with depression were mainly due to comorbid anxiety, chronic conditions and poor health status. These expenditures may potentially be reduced by providing timely intervention for need factors or by providing care under a collaborative care model.

Out-of-pocket expenditures for pharmaceuticals: lessons from the Austrian household budget survey.

PubMed

Sanwald, Alice; Theurl, Engelbert

2017-05-01

Paying pharmaceuticals out of pocket is an important source of financing pharmaceutical consumption. Only limited empirical knowledge is available on the determinants of these expenditures. In this article we analyze which characteristics of private households influence out-of-pocket pharmaceutical expenditure (OOPPE) in Austria. We use cross-sectional information on OOPPE and household characteristics provided by the Austrian household budget survey 2009/10. We split pharmaceutical expenditures into the two components prescription fees and over-the-counter (OTC) expenditures. To adjust for the specific characteristics of the data, we compare different econometric approaches: a two-part model, hurdle model, generalized linear model and zero-inflated negative binomial regression model. The finally selected econometric approaches give a quite consistent picture. The probability of expenditures of both types is strongly influenced by the household structure. It increases with age, doctoral visits and the presence of a female householder. The education level and income only increase the probability of OTC pharmaceuticals. The level of OTC expenditures remains widely unexplained while the household structure and age influence the expenditures for prescription fees. Insurance characteristics of private households, either private or public, play a minor role in explaining the expenditure levels in all specifications. This refers to a homogeneous and comprehensive provision of pharmaceuticals in the public part of the Austrian health care system. The article gives useful insights into the determinants of pharmaceutical expenditures of private households and supplements the previous research that focuses on the individual level.

The association between asthma and absenteeism among working adults in the United States: results from the 2008 medical expenditure panel survey.

PubMed

Wu, Chung-Hsuen; Erickson, Steven R

2012-09-01

The purpose of this study was to evaluate the association between asthma status and the occurrence and length of work absences among the US working adults. A cross-sectional study was conducted using the 2008 Medical Expenditure Panel Survey (MEPS). Employed respondents between ages 18 and 55 years were included. The association between asthma status (whether respondents have asthma or not) and occurrence of absences and the length of time per absence was evaluated using a two-part model. A multivariate logistic regression as the first part of the model was to estimate the probability of being absent from work at least once during the observation period as a function of asthma status. A multivariate negative binomial regression as the second part of the model was used to assess whether the length of each absence from work was associated with asthma status among respondents who reported at least one absence from work. Sociodemographic, socioeconomic, employment-related, health status, and comorbidity variables were included in each model as covariates. Of 12,161 respondents, 8.2% reported having asthma, which accounted for 10.4 million working adults in the United States in 2008. Employed adults with asthma were more likely to report having at least one absence from work compared to those without asthma in bivariate analyses (26.2% vs. 16.2%, p < .01). After adjusting for the number of comorbid chronic conditions and other covariates, there was no significant difference between having asthma and absenteeism among respondents (odds ratio (OR) = 1.31, 95% confidence interval (CI) = 0.99-1.72, rate ratio (RR) = 1.25, 95% CI = 0.91-1.72). Overall burden of illness as measured by comorbidity indices and perceived health status, but not asthma alone, contributes to absenteeism as well as the number of days off during each occurrence among employed people. It is important for health services researchers to consider overall burden of illness when examining the association

United States Port Development Expenditure Report

DOT National Transportation Integrated Search

2003-03-01

This report analyzes the results of the American Association of Port Authorities (AAPA) capital expenditure survey for 2001. The survey included the capital expenditures for 2001 and proposed expenditures for the period 2002 through 2006 along with t...

The Effect of Medicaid Physician Fee Increases on Health Care Access, Utilization, and Expenditures.

PubMed

Callison, Kevin; Nguyen, Binh T

2018-04-01

To evaluate the effect of Medicaid fee changes on health care access, utilization, and spending for Medicaid beneficiaries. We use the 2008 and 2012 waves of the Medical Expenditure Panel Survey linked to state-level Medicaid-to-Medicare primary care reimbursement ratios obtained through surveys conducted by the Urban Institute. We also incorporate data from the Current Population Survey and the Area Resource Files. Using a control group made up of the low-income privately insured, we conduct a difference-in-differences analysis to assess the relationship between Medicaid fee changes and access to care, utilization of health care services, and out-of-pocket medical expenditures for Medicaid enrollees. We find that an increase in the Medicaid-to-Medicare payment ratio for primary care services results in an increase in outpatient physician visits, emergency department utilization, and prescription fills, but only minor improvements in access to care. In addition, we report an increase in total annual out-of-pocket expenditures and spending on prescription medications. Compared to the low-income privately insured, increased primary care reimbursement for Medicaid beneficiaries leads to higher utilization and out-of-pocket spending for Medicaid enrollees. © Health Research and Educational Trust.

Relationship between catastrophic health expenditures and household incomes and expenditure patterns in South Korea.

PubMed

Kim, Younhee; Yang, Bongmin

2011-05-01

The compositions of health expenditures by households in South Korea with and without catastrophic health expenditures were compared. Also, relationships between catastrophic health expenditures and household incomes, and between such health expenditures and expenditure patterns were explored. Data from the 2006 South Korean Household Income & Expenditure Survey, a representative survey of 90,696 households were analyzed. We used a double-hurdle model to assess each income source and expenditure category. The independent variable was the presence of catastrophic health expenditure. After adjusting for household characteristics, the results showed that earned, business, and property incomes were significantly lower, but transfer and loan incomes were significantly higher in households with catastrophic health expenditures than in those without such health expenditures. All consumption categories, other than health expenditure, were significantly lower in households with catastrophic health expenditures than in those without catastrophic health expenditures. This suggests that households with catastrophic health expenditures faced challenges in offset by the potentially excessive health expenditure and may have been obliged to reduce consumption of other items. The expansion of insurance coverage and lowering of out-of-pocket rates in the South Korean Health Insurance benefits could be a necessary first step in protecting households from the occurrence of health related economic catastrophes. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

76 FR 18517 - Proposed Information Collection; Comment Request; Survey: Expenditures Incurred by Recipients of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-04

... Request; Survey: Expenditures Incurred by Recipients of Biomedical Research and Development Awards From... research budget and analyzing future NIH programs. A survey of award recipient entities is currently the... CONTACT: Steven Payson, Chief of Research, Government Division (BE-57), Bureau of Economic Analysis, U.S...

Incremental health care utilization and expenditures for chronic rhinosinusitis in the United States.

PubMed

Bhattacharyya, Neil

2011-07-01

I determined incremental increases in health care expenditures and utilization associated with chronic rhinosinusitis (CRS). Patients with a reported diagnosis of CRS were extracted from the 2007 Medical Expenditure Panel Survey medical conditions file and linked to the consolidated expenditures file. The patients with CRS were then compared to patients without CRS to determine differences in health care utilization (office visits,emergency facility visits, and prescriptions filled), as well as differences in health care expenditures (total health care costs, office visit costs, prescription medication costs, and self-expenditures) by use of demographically adjusted and comorbidity-adjusted multivariate models. An estimated 11.1+/-0.48 million adult patients reported having CRS in 2007 (4.9%+/-0.2% of the US population). The additional incremental health care utilizations associated with CRS relative to patients without CRS for office visits, emergency facility visits, and number of prescriptions filled were 3.45+/-0.42, 0.09+/-0.03, and 5.5+/-0.8, respectively (all pexpenditures associated with CRS for total health care expenses, office-based expenditures, prescription expenditures, and self-expenditures were $772+/-$300, $346+/-$130, $397+/-$88, and $90+/-$24, respectively (all pexpenditures due to increases in office-based and prescription expenditures. The national health care costs of CRS remain very high, at an estimated $8.6 billion per year.

Estimates of state-level health-care expenditures associated with disability.

PubMed

Anderson, Wayne L; Armour, Brian S; Finkelstein, Eric A; Wiener, Joshua M

2010-01-01

We estimated state-level disability-associated health-care expenditures (DAHE) for the U.S. adult population. We used a two-part model to estimate DAHE for the noninstitutionalized U.S. civilian adult population using data from the 2002-2003 Medical Expenditure Panel Survey and state-level data from the Behavioral Risk Factor Surveillance System. Administrative data for people in institutions were added to generate estimates for the total adult noninstitutionalized population. Individual-level data on total health-care expenditures along with demographic, socioeconomic, geographic, and payer characteristics were used in the models. The DAHE for all U.S. adults totaled $397.8 billion in 2006, with state expenditures ranging from $598 million in Wyoming to $40.1 billion in New York. Of the national total, the DAHE were $118.9 billion for the Medicare population, $161.1 billion for Medicaid recipients, and $117.8 billion for the privately insured and uninsured populations. For the total U.S. adult population, 26.7% of health-care expenditures were associated with disability, with proportions by state ranging from 16.9% in Hawaii to 32.8% in New York. This proportion varied greatly by payer, with 38.1% for Medicare expenditures, 68.7% for Medicaid expenditures, and 12.5% for nonpublic health-care expenditures associated with disability. DAHE vary greatly by state and are borne largely by the public sector, and particularly by Medicaid. Policy makers need to consider initiatives that will help reduce the prevalence of disabilities and disability-related health disparities, as well as improve the lives of people with disabilities.

Using quantile regression to examine health care expenditures during the Great Recession.

PubMed

Chen, Jie; Vargas-Bustamante, Arturo; Mortensen, Karoline; Thomas, Stephen B

2014-04-01

To examine the association between the Great Recession of 2007-2009 and health care expenditures along the health care spending distribution, with a focus on racial/ethnic disparities. Secondary data analyses of the Medical Expenditure Panel Survey (2005-2006 and 2008-2009). Quantile multivariate regressions are employed to measure the different associations between the economic recession of 2007-2009 and health care spending. Race/ethnicity and interaction terms between race/ethnicity and a recession indicator are controlled to examine whether minorities encountered disproportionately lower health spending during the economic recession. The Great Recession was significantly associated with reductions in health care expenditures at the 10th-50th percentiles of the distribution, but not at the 75th-90th percentiles. Racial and ethnic disparities were more substantial at the lower end of the health expenditure distribution; however, on average the reduction in expenditures was similar for all race/ethnic groups. The Great Recession was also positively associated with spending on emergency department visits. This study shows that the relationship between the Great Recession and health care spending varied along the health expenditure distribution. More variability was observed in the lower end of the health spending distribution compared to the higher end. © Health Research and Educational Trust.

A comparison of Australian families' expenditure on active and screen-based recreation using the ABS Household Expenditure Survey 2003/04.

PubMed

Aitken, Robert; King, Lesley; Bauman, Adrian

2008-06-01

This study aimed to investigate how much households with dependent children spend on active recreation (physical activity) compared with screen-based (sedentary) recreation, according to their household socioeconomic and demographic characteristics. The study analysed data from the 2003-04 Australian Bureau of Statistics Household Expenditure Survey, which collected information on household expenditure from a representational cross-section of private dwellings across Australia. In 2003-04, Australian households with dependent children spent an average of 1.5% and 3.3% of their weekly disposable income on active and screen recreation respectively, and 24.9% of their total active and screen recreation expenditure on active recreation. There was significant variation across household characteristics, with higher income and socioeconomic status households, and families with more than one dependent child more likely to spend a larger portion of their recreation budget on active recreation instead of screen recreation. Overall, Australian families spend more money on screen recreation items than they do on active recreation, although there are strong economic and cultural gradients in their patterns of expenditure on both active and screen recreation. This suggests that while the costs of active recreation may be a barrier to participation for some families, there are also social and cultural values influencing recreational choices. For the first time, specific information on Australian families' expenditure on active and screen recreation is available. These results contribute to identifying cultural and economic barriers influencing families' health-related behaviours and their participation in organised physical activity.

Effects of comorbid health conditions on healthcare expenditures among people with severe mental illness.

PubMed

Lee, Sungkyu; Rothbard, Aileen; Choi, Sunha

2016-08-01

Little is known about the incremental cost burden associated with treating comorbid health conditions among people with severe mental illness (SMI). This study compares the extent to which each individual medical condition increases healthcare expenditures between people with SMI and people without mental illness. Data were obtained from the 2011 Medical Expenditure Panel Survey (MEPS; N = 17 764). Mental illness and physical health conditions were identified through ICD-9 codes. Guided by the Andersen's behavioral model of health services utilization, generalized linear models were conducted. Total healthcare expenditures among individuals with SMI were approximately 3.3 times greater than expenditures by individuals without mental illness ($11 399 vs. $3449, respectively). Each additional physical health condition increased the total healthcare expenditure by 17.4% for individuals with SMI compared to the 44.8% increase for individuals without mental illness. The cost effect of having additional health conditions on the total healthcare expenditures among individuals with SMI is smaller than those individuals without mental illness. Whether this is due to limited access to healthcare for the medical problems or better coordination between medical and mental health providers, which reduces duplicated medical procedures or visits, requires future investigation.

Estimated annual health care expenditures in individuals with peripheral arterial disease.

PubMed

Scully, Rebecca E; Arnaoutakis, Dean J; DeBord Smith, Ann; Semel, Marcus; Nguyen, Louis L

2018-02-01

The clinical impact of peripheral arterial disease (PAD) is well characterized and is associated with significant morbidity and mortality. Health care-related expenditures among individuals with PAD, particularly for patients, are not well described. Health care-related expenditure data from the 2011 to 2014 Agency for Healthcare Research and Quality Medical Expenditure Panel Surveys were analyzed for individuals with a diagnosis of PAD compared with U.S. adults 40 years of age and older. Weighted average annual expenditures were estimated using a multivariable generalized linear model. Subanalyses were also performed for out-of-pocket (OOP) expenditures by insurance type. Adjusted for age, gender, and race, individuals with a diagnosis of PAD (weighted n = 640,098) had significantly higher average annual health care-related expenditures compared with the U.S. adult population as a whole (weighted n = 148,387,362). Average annual expenditures per individual for patients with PAD were $11,553 (95% confidence interval [CI], $8137-$14,968) compared with only $4219 (95% CI, $4064-$4375; P < .001) for those without. Expenditures were driven by increased prescription medication expenditures as well as by expenditures for inpatient care, outpatient hospital-based care, and outpatient office-based care. Individuals with PAD had significantly higher OOP prescription medication expenditures ($386 [95% CI, $258-$515] vs $192 [95% CI, $183-$202]; P = .003), which varied by insurance type, ranging from $179 (95% CI, $70-$288) for those with Medicare to $1196 (95% CI, $106-$2244) for those without insurance, although this difference did not reach significance. Individuals with a diagnosis of PAD have higher health care-related expenditures and OOP expenses compared with other US adults. These expenditures compound lost wages, care by family members, and lost opportunity costs, increasing the burden carried by patients with PAD. Copyright © 2017 Society for Vascular Surgery

Co-occurring mental illness and health care utilization and expenditures in adults with obesity and chronic physical illness.

PubMed

Shen, Chan; Sambamoorthi, Usha; Rust, George

2008-06-01

The objectives of the study were to compare health care expenditures between adults with and without mental illness among individuals with obesity and chronic physical illness. We performed a cross-sectional analysis of 2440 adults (older than age 21) with obesity using a nationally representative survey of households, the Medical Expenditure Panel Survey. Chronic physical illness consisted of self-reported asthma, diabetes, heart disease, hypertension, or osteoarthritis. Mental illness included affective disorders; anxiety, somatoform, dissociative, personality disorders; and schizophrenia. Utilization and expenditures by type of service (total, inpatient, outpatient, emergency room, pharmacy, and other) were the dependent variables. Chi-square tests, logistic regression on likelihood of use, and ordinary least squares regression on logged expenditures among users were performed. All regressions controlled for gender, race/ethnicity, age, martial status, region, education, employment, poverty status, health insurance, smoking, and exercise. All analyses accounted for the complex design of the survey. We found that 25% of adults with obesity and physical illness had a mental illness. The average total expenditures for obese adults with physical illness and mental illness were $9897; average expenditures were $6584 for those with physical illness only. Mean pharmacy expenditures for obese adults with physical illness and mental illness and for those with physical illness only were $3343 and $1756, respectively. After controlling for all independent variables, among adults with obesity and physical illness, those with mental illness were more likely to use emergency services and had higher total, outpatient, and pharmaceutical expenditures than those without mental illness. Among individuals with obesity and chronic physical illness, expenditures increased when mental illness is added. Our study findings suggest cost-savings efforts should examine the reasons for

Trends in health care expenditures, utilization, and health status among US adults with spine problems, 1997-2006.

PubMed

Martin, Brook I; Turner, Judith A; Mirza, Sohail K; Lee, Michael J; Comstock, Bryan A; Deyo, Richard A

2009-09-01

Analysis of nationally representative survey data for spine-related health care expenditures, utilization and self-reported health status. To study trends from 1997 to 2006 in per-user expenditures for spine-related inpatient, outpatient, pharmacy, and emergency services; and to compare these trends to changes in health status. Although prior work has shown overall spine-related expenditures accounted for $86 billion in 2005, increasing 65% since 1997, the study did not report per-user expenditures. Understanding population-level per-user expenditure for specific services relative to changes in the health status may help assess the value of these services. We analyzed data from the Medical Expenditure Panel Survey, a multistage survey sample designed to produce unbiased national estimates of health care utilization and expenditure. Spine-related hospitalizations, outpatient visits, prescription medications and emergency department visits were identified using ICD-9-CM diagnosis codes. Regression analyses controlling for age, sex, comorbidity, and time (years) were used to examine trends from 1997 to 2006 in inflation-adjusted per-user expenditures, and utilization, and self-reported health status. An average of 1774 respondents with spine problems was surveyed per year; the proportion suggested an increase in the number of people who sought treatment for spine problems in the United States from 14.8 million in 1997 to 21.9 million in 2006. From 1997 to 2006, the mean adjusted per-user expenditures were the largest component of increasing total costs for inpatient hospitalizations, prescription medications, andemergency department visits, increasing 37% (from $13,040 in 1997 to $17,909 in 2006), 139% (from $166 to $397), and 84% (from $81 to $149), respectively. A 49% increase in the number of patients seeking spine-related care (from 12.2 million in 1997 to 18.2 million in 2006) was the largest contributing factor to increased outpatient expenditures. Population

Gender disparities in medical expenditures attributable to hypertension in the United States.

PubMed

Basu, Rituparna; Franzini, Luisa; Krueger, Patrick M; Lairson, David R

2010-01-01

We sought to examine and attempt to explain gender disparities in hypertension-attributable expenditure among noninstitutionalized individuals in the United States. Using the 2001-2004 Medical Expenditure Panel Survey and the Aday and Andersen health care use model, we estimated hypertension-attributable health care expenditures for inpatient stay, outpatient visits, prescription drugs, office visits, and emergency room (ER) visits among men and women by applying the method of recycled prediction. Hypertensive individuals were identified using International Classification of Diseases, 9th edition, codes or self-report of a diagnosis of hypertension. The adjusted mean hypertension-attributable expenditure per individual was significantly higher for women than for men for prescription drugs, inpatient stays, office visits, outpatient visits and ER visits expenditures. However, as age increased, the gender difference in adjusted mean expenditures became smaller and eventually reversed. This reversal occurred at different ages for different expenditures. For prescription drugs, office visits and outpatient expenditures, the reversal in expenditures occurred around age 50 to 59. The maximum difference was observed in outpatient expenditures, where women's average expenditure was $102 more than men's below age 45 but $103 less than men's above age 75. These differences remained significant even after controlling for predisposing, enabling, and need predictors of health care use. Our findings imply that there are gender disparities in hypertension-related expenditures, but that this disparity depends on age. These findings support recent findings on gender disparities in heart diseases and raise the question of physicians' bias in their diagnostic or prognostic approaches to hypertension in men and women. Copyright 2010 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

78 FR 65971 - Proposed Information Collection; Comment Request; Marine Recreational Fishing Expenditure Survey

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-04

... Collection; Comment Request; Marine Recreational Fishing Expenditure Survey AGENCY: National Oceanic and... their purchases of durable goods such as fishing gear, boats, vehicles, and second homes. The second... recreational fishing trip. As specified in the Magnuson-Stevenson Fishery Conservation and Management Act of...

Utilization and expenditures on chiropractic care in the United States from 1997 to 2006.

PubMed

Davis, Matthew A; Sirovich, Brenda E; Weeks, William B

2010-06-01

To investigate national utilization and expenditures on chiropractic care between 1997 and 2006. The nationally representative Medical Expenditure Panel Survey (MEPS). We performed descriptive analyses and generated national estimates from data obtained from U.S. adult (>or=18 years) MEPS respondents who reported having visited a chiropractor (annual sample size between 789 and 1,082). For each year, we examined the estimated total national expenditure, the total number of U.S. adults who received chiropractic care, the total number of ambulatory visits to U.S. chiropractors, and the inflation-adjusted charges and expenditures per U.S. adult chiropractic patient. The total number of U.S. adults who visited a chiropractor increased 57 percent from 7.7 million in 2000 to 12.1 million in 2003. From 1997 to 2006, the inflation-adjusted national expenditures on chiropractic care increased 56 percent from U.S.$3.8 billion to U.S.$5.9 billion. Inflation-adjusted total mean expenditures per patient and expenditures per office visit remained unchanged. The large increase in U.S. adult expenditures on chiropractic care between 1997 and 2006 was due to a 57 percent increase in the total number of U.S. adult chiropractic patients that occurred from 2000 to 2003. From 2003 to 2006, the total number of U.S. adult chiropractic patients has remained stable.

Health Care Expenditure and GDP in Oil Exporting Countries: Evidence From OPEC Data, 1995-2012.

PubMed

Fazaeli, Ali Akbar; Ghaderi, Hossein; Salehi, Masoud; Fazaeli, Ali Reza

2015-06-11

There is a large body of literature examining income in relation to health expenditures. The share of expenditures in health sector from GDP in developed countries is often larger than in non-developed countries, suggesting that as the level of economic growth increases, health spending increase, too. This paper estimates long-run relationships between health expenditures and GDP based on panel data of a sample of 12 countries of the Organization of the Petroleum Exporting Countries (OPEC), using data for the period 1995-2012. We use panel data unit root tests, cointegration analysis and ECM model to find long-run and short-run relation. This study examines whether health is a luxury or a necessity for OPEC countries within a unit root and cointegration framework. Panel data analysis indicates that health expenditures and GDP are co-integrated and have Engle and Granger causality. In addition, in oil countries that have oil export income, the share of government expenditures in the health sector is often greater than in private health expenditures similar developed countries. The findings verify that health care is not a luxury good and income has a robust relationship to health expenditures in OPEC countries.

Using Quantile Regression to Examine Health Care Expenditures during the Great Recession

PubMed Central

Chen, Jie; Vargas-Bustamante, Arturo; Mortensen, Karoline; Thomas, Stephen B

2014-01-01

Objective To examine the association between the Great Recession of 2007–2009 and health care expenditures along the health care spending distribution, with a focus on racial/ethnic disparities. Data Sources/Study Setting Secondary data analyses of the Medical Expenditure Panel Survey (2005–2006 and 2008–2009). Study Design Quantile multivariate regressions are employed to measure the different associations between the economic recession of 2007–2009 and health care spending. Race/ethnicity and interaction terms between race/ethnicity and a recession indicator are controlled to examine whether minorities encountered disproportionately lower health spending during the economic recession. Principal Findings The Great Recession was significantly associated with reductions in health care expenditures at the 10th–50th percentiles of the distribution, but not at the 75th–90th percentiles. Racial and ethnic disparities were more substantial at the lower end of the health expenditure distribution; however, on average the reduction in expenditures was similar for all race/ethnic groups. The Great Recession was also positively associated with spending on emergency department visits. Conclusion This study shows that the relationship between the Great Recession and health care spending varied along the health expenditure distribution. More variability was observed in the lower end of the health spending distribution compared to the higher end. PMID:24134797

Incremental and comparative health care expenditures for head and neck cancer in the United States.

PubMed

Dwojak, Sunshine M; Bhattacharyya, Neil

2014-10-01

Determine the incremental costs associated with head and neck cancer (HNCa) and compare the costs with other common cancers. Cross-sectional analysis of a healthcare expenditure database. The Medical Expenditure Panel Survey is a national survey of US households. All cases of HNCa were extracted for 2006, 2008, and 2010. The incremental expenditures associated with HNCa were determined by comparing the healthcare expenditures of individuals with HNCa to the population without cancer, controlling for age, sex, education, insurance status, marital status, geographic region, and comorbidities. Healthcare expenditures for HNCa were then compared to individuals with lung cancer and colon cancer to determine relative healthcare expenditures. An estimated 264,713 patients (annualized) with HNCa were identified. The mean annual healthcare expenditures per individual for HNCa were $23,408 ± $3,397 versus $3,860 ± $52 for those without cancer. The mean adjusted incremental cost associated with HNCa was $15,852 ± $3,297 per individual (P < .001). Within this incremental cost, there was an increased incremental outpatient services cost of $3,495 ± $1,044 (P = .001) and an increased incremental hospital inpatient cost of $6,783 ± $2,894 (P = .020) associated with HNCa. The annual healthcare expenditures per individual fell in between those for lung cancer ($25,267 ± $2,375, P = .607) and colon cancer ($16,975 ± $1,291, P = .055). Despite its lower relative incidence, HNCa is associated with a significant incremental increase in annual healthcare expenditures per individual, which is comparable to or higher than other common cancers. In aggregate, the estimated annual costs associated with HNCa are $4.20 billion. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Differences in medical care expenditures for adults with depression compared to adults with major chronic conditions.

PubMed

Lurie, Ithai Z; Manheim, Larry M; Dunlop, Dorothy D

2009-06-01

Approximately 17.1 million adults report having a major depressive episode in 2004 which represents 8% of the adult population in the U.S. Of these, more than one-third did not seek treatment. In spite of the large and extensive literature on the cost of mental health, we know very little about the differences in out-of-pocket expenditures between adults with depression and adults with other major chronic disease and the sources of those expenditures. For persons under age 65, compare total and out-of-pocket expenditures of those with depression to non-depressed individuals who have another major chronic disease. This study uses two linked, nationally representative surveys, the 1999 National Health Interview Survey (NHIS) and the 2000 Medical Expenditure Panel Survey (MEPS), to identify the population of interest. Depression was systematically assessed using a short form of the World Health Organization's (WHO) Composite International Diagnostic Interview--Short Form (CIDI-SF). To control for differences from potentially confounding factors, we matched depressed cases to controls using propensity score matching. We estimate that persons with depression have about the same out-of-pocket expenditures while having 11.8% less total medical expenditures (not a statistically significant difference) compared to non-depressed individuals with at least one chronic disease. High out-of-pocket expenditures are a concern for individuals with chronic diseases. Our study shows that those with depression have comparable out-of-pocket expenses to those with other chronic diseases, but given their lower income levels, this may result in a more substantial financial burden. IMPLICATION FOR POLICY: High out-of-pocket expenditures are a concern for individuals with depression and other chronic diseases. For both depressed individuals and non-depressed individuals with other chronic diseases, prescription drug expenditures contribute most to out-of-pocket expenses. Given the important

Asthma expenditures in the United States comparing 2004 to 2006 and 1996 to 1998.

PubMed

Rank, Matthew A; Liesinger, Juliette T; Ziegenfuss, Jeanette Y; Branda, Megan E; Lim, Kaiser G; Yawn, Barbara P; Li, James T; Shah, Nilay D

2012-09-01

To describe how the types of healthcare expenditures for patients with asthma have changed over the past decade. Cross-sectional comparison between individuals from 1996 to 1998 and 2004 to 2006. Expenditures among US individuals (aged 5 to 56 years) with asthma were compared using the 1996 to 1998 and the 2004 to 2006 Medical Expenditure Panel Surveys. Direct expenditures (medications, inpatient, outpatient, and emergency services) and changes in productivity (missed school and work days) were compared over this time frame. The adjusted analyses controlled for age, education level, race/ethnicity, gender, poverty, region, metropolitan statistical area, self-reported health, and Charlson Comorbidity Index. Mean annual per capita healthcare expenditures increased between 1996 to 1998 and 2004 to 2006 ($3802 vs $5322 inflated to 2010 US dollars, P <.0001). Annual medication expenditures doubled from $974 to $2010 per person (P <.0001) and outpatient visit expenditures increased from $861 to $1174 (P <.0001) while hospitalization and emergency department (ED) visit expenditures were similar over the same time period. Missed school and work days decreased between the 2 periods (9.23 days in 1996-1998 vs 6.39 days in 2004-2006, P = .001). An increase in total direct expenditures in individuals with asthma was largely driven by an increase in spending on medications comparing 2004 to 2006 and 1996 to 1998 data. However, this increase was not offset by lower spending on hospitalization and ED visits.

Cost-offsets of prescription drug expenditures: data analysis via a copula-based bivariate dynamic hurdle model.

PubMed

Deb, Partha; Trivedi, Pravin K; Zimmer, David M

2014-10-01

In this paper, we estimate a copula-based bivariate dynamic hurdle model of prescription drug and nondrug expenditures to test the cost-offset hypothesis, which posits that increased expenditures on prescription drugs are offset by reductions in other nondrug expenditures. We apply the proposed methodology to data from the Medical Expenditure Panel Survey, which have the following features: (i) the observed bivariate outcomes are a mixture of zeros and continuously measured positives; (ii) both the zero and positive outcomes show state dependence and inter-temporal interdependence; and (iii) the zeros and the positives display contemporaneous association. The point mass at zero is accommodated using a hurdle or a two-part approach. The copula-based approach to generating joint distributions is appealing because the contemporaneous association involves asymmetric dependence. The paper studies samples categorized by four health conditions: arthritis, diabetes, heart disease, and mental illness. There is evidence of greater than dollar-for-dollar cost-offsets of expenditures on prescribed drugs for relatively low levels of spending on drugs and less than dollar-for-dollar cost-offsets at higher levels of drug expenditures. Copyright © 2013 John Wiley & Sons, Ltd.

Comparing Medical Ecology, Utilization, and Expenditures Between 1996-1997 and 2011-2012.

PubMed

Johansen, Michael E

2017-07-01

This study compared ecology (number of individuals using a service), utilization (number of services used), and expenditures (dollars spent) for various categories of medical services between primarily 1996-1997 and 2011-2012. A repeated cross-sectional study was performed using nationally representative data mainly from the 1996, 1997, 2011, and 2012 Medical Expenditure Panel Survey (MEPS). These data were augmented with the 2002-2003 MEPS as well as the 1999-2000 and 2011-2012 National Heath and Nutrition Examination Survey. Individuals (number per 1,000 people), utilization, and expenditures during an average month in 1996-1997 and 2011-2012 were determined for 15 categories of services. The number of individuals who used various medical services was unchanged for many categories of services (total, outpatient, outpatient physician, users of prescribed medications, primary care and specialty physicians, inpatient hospitalization, and emergency department). It was, however, increased for others (optometry/podiatry, therapy, and alternative/complementary medicine) and decreased for a few (dental and home health). The number of services used (utilization) largely mirrored the findings for individual use, with the exception of an increase in the number of prescribed medications and a decrease in number of primary care physician visits. There were large increases in dollars spent (expenditures) in every category with the exception of primary care physician and home health; the largest absolute increases were in prescribed medications, specialty physicians, emergency department visits, and likely inpatient hospitalizations. Although the number of individuals with visits during an average month and the total utilization of medical services were largely unchanged between the 2 time periods, total expenditures increased markedly. The increases in expenditure varied dramatically by category. © 2017 Annals of Family Medicine, Inc.

Medical Expenditures and Earnings Losses Among US Adults With Arthritis in 2013.

PubMed

Murphy, Louise B; Cisternas, Miriam G; Pasta, David J; Helmick, Charles G; Yelin, Edward H

2018-06-01

We estimated the economic impact of arthritis using 2013 US Medical Expenditure Panel Survey (MEPS) data. We calculated arthritis-attributable and all-cause medical expenditures for adults age ≥18 years and arthritis-attributable earnings losses among those ages 18-64 years who had ever worked. We calculated arthritis-attributable costs using multistage regression-based methods, and conducted sensitivity analyses to estimate costs for 2 other arthritis definitions in MEPS. In 2013, estimated total national arthritis-attributable medical expenditures were $139.8 billion (range $135.9-$157.5 billion). Across expenditure categories, ambulatory care expenditures accounted for nearly half of arthritis-attributable expenditures. All-cause expenditures among adults with arthritis represented 50% of the $1.2 trillion national medical expenditures among all US adults in MEPS. Estimated total national arthritis-attributable earning losses were $163.7 billion (range $163.7-$170.0 billion). The percentage with arthritis who worked in the past year was 7.2 percentage points lower than those without arthritis (76.8% [95% confidence interval (95% CI)] 75.0-78.6 and 84.0% [95% CI 82.5-85.5], respectively, adjusted for sociodemographics and chronic conditions). Total arthritis-attributable medical expenditures and earnings losses were $303.5 billion (range $303.5-$326.9 billion). Total national arthritis-attributable medical care expenditures and earnings losses among adults with arthritis were $303.5 billion in 2013. High arthritis-attributable medical expenditures might be reduced by greater efforts to reduce pain and improve function. The high earnings losses were largely attributable to the substantially lower prevalence of working among those with arthritis compared to those without, signaling the need for interventions that keep people with arthritis in the workforce. © 2017, American College of Rheumatology.

Health care expenditures associated with overweight and obesity among US adults: importance of age and race.

PubMed

Wee, Christina C; Phillips, Russell S; Legedza, Anna T R; Davis, Roger B; Soukup, Jane R; Colditz, Graham A; Hamel, Mary Beth

2005-01-01

We estimated health care expenditures associated with overweight and obesity and examined the influence of age, race, and gender. Using 1998 Medical Expenditure Panel Survey data, we employed 2-stage modeling to estimate annual health care expenditures associated with high body mass index (BMI) and examine interactions between demographic factors and BMI. Overall, the mean per capita annual health care expenditure (converted to December 2003 dollars) was $3338 before adjustment. While the adjusted expenditure was $2127 (90% confidence interval [CI]=$1927, $2362) for a typical normal-weight White woman aged 35 to 44 years, expenditures were $2358 (90% CI=$2128, $2604) for women with BMIs of 25 to 29.9 kg/m(2), $2873 (90% CI=$2530, $3236) for women with BMIs of 30 to 34.9 kg/m(2), $3058 (90% CI=$2529, $3630) for women with BMIs of 35 to 39.9 kg/m(2), and $3506 (90% CI=$2912, $4228) for women with BMIs of 40 kg/m(2) or higher. Expenditures related to higher BMI rose dramatically among White and older adults but not among Blacks or those younger than 35 years. We found no interaction between BMI and gender. Health care costs associated with overweight and obesity are substantial and vary according to race and age.

Health Care Expenditure and GDP in Oil Exporting Countries: Evidence from OPEC Data, 1995-2012

PubMed Central

Fazaeli, Ali Akbar; Ghaderi, Hossein; Salehi, Masoud; Fazaeli, Ali Reza

2016-01-01

Background: There is a large body of literature examining income in relation to health expenditures. The share of expenditures in health sector from GDP in developed countries is often larger than in non-developed countries, suggesting that as the level of economic growth increases, health spending increase, too. Objectives: This paper estimates long-run relationships between health expenditures and GDP based on panel data of a sample of 12 countries of the Organization of the Petroleum Exporting Countries (OPEC), using data for the period 1995-2012. Patients & Methods: We use panel data unit root tests, cointegration analysis and ECM model to find long-run and short-run relation. This study examines whether health is a luxury or a necessity for OPEC countries within a unit root and cointegration framework. Results: Panel data analysis indicates that health expenditures and GDP are co-integrated and have Engle and Granger causality. In addition, in oil countries that have oil export income, the share of government expenditures in the health sector is often greater than in private health expenditures similar developed countries. Conclusions: The findings verify that health care is not a luxury good and income has a robust relationship to health expenditures in OPEC countries. PMID:26383195

Trends in Health Care Expenditure in U.S. Adults With Diabetes: 2002–2011

PubMed Central

Ozieh, Mukoso N.; Bishu, Kinfe G.; Dismuke, Clara E.

2015-01-01

OBJECTIVE Direct medical cost of diabetes in the U.S. has been estimated to be 2.3 times higher relative to individuals without diabetes. This study examines trends in health care expenditures by expenditure category in U.S. adults with diabetes between 2002 and 2011. RESEARCH DESIGN AND METHODS We analyzed 10 years of data representing a weighted population of 189,013,514 U.S. adults aged ≥18 years from the Medical Expenditure Panel Survey. We used a novel two-part model to estimate adjusted mean and incremental medical expenditures by diabetes status, while adjusting for demographics, comorbidities, and time. RESULTS Relative to individuals without diabetes ($5,058 [95% CI 4,949–5,166]), individuals with diabetes ($12,180 [11,775–12,586]) had more than double the unadjusted mean direct expenditures over the 10-year period. After adjustment for confounders, individuals with diabetes had $2,558 (2,266–2,849) significantly higher direct incremental expenditures compared with those without diabetes. For individuals with diabetes, inpatient expenditures rose initially from $4,014 in 2002/2003 to $4,183 in 2004/2005 and then decreased continuously to $3,443 in 2010/2011, while rising steadily for individuals without diabetes. The estimated unadjusted total direct expenditures for individuals with diabetes were $218.6 billion/year and adjusted total incremental expenditures were approximately $46 billion/year. CONCLUSIONS Our findings show that compared with individuals without diabetes, individuals with diabetes had significantly higher health expenditures from 2002 to 2011 and the bulk of the expenditures came from hospital inpatient and prescription expenditures. PMID:26203060

Association between serious psychological distress and health care use and expenditures by cancer history.

PubMed

Han, Xuesong; Lin, Chun Chieh; Li, Chunyu; de Moor, Janet S; Rodriguez, Juan L; Kent, Erin E; Forsythe, Laura P

2015-02-15

Serious psychological distress (SPD) is associated with adverse health outcomes such as poor quality of life and shorter survival in cancer survivors, but to the authors' knowledge, the relationship between SPD and health care use and medical expenditures is not clear. A total of 4326 cancer survivors and 57,109 noncancer participants were identified from the 2008 through 2010 Medical Expenditure Panel Survey, a nationwide population-based survey, and their psychological distress was assessed with the 6-item Kessler Psychological Distress Scale (SPD defined by a score ≥13). The association between SPD and use and medical expenditures of various types of health care (office-based, outpatient, hospital inpatient, emergency department, dental, and prescriptions) was examined using a 2-part modeling approach that adjusted for demographic, personal, and comorbidity factors. The marginal effects of SPD on health care use and expenditures were calculated for cancer survivors and were compared with those of noncancer participants. The weighted prevalence of SPD in cancer survivors was 8.2% compared with 4.8% in the noncancer participants. SPD was significantly associated with higher use of all care types except dental care in cancer survivors. Cancer survivors with SPD spent $4431 (95% confidence interval, $3419-$5443) more than survivors without SPD on medical services each year, whereas this extra expenditure associated with SPD for participants without cancer was $2685 (95% confidence interval, $2099-$3271). In a national representative sample of cancer survivors, SPD was found to be associated with higher health care use and medical expenditures. Distress screening and psychosocial care in cancer survivors may help reduce the economic burden of cancer in the United States. © 2014 American Cancer Society.

Financial burden of household out-of pocket health expenditure in Viet Nam: findings from the National Living Standard Survey 2002-2010.

PubMed

Van Minh, Hoang; Kim Phuong, Nguyen Thi; Saksena, Priyanka; James, Chris D; Xu, Ke

2013-11-01

In Viet Nam, household direct out-of-pocket (OOP) health expenditure as a share of the total health expenditure has been always high, ranging from 50% to 70%. The high share of OOP expenditure has been linked to different inequity problems such as catastrophic health expenditure (households must reduce their expenditure on other necessities) and impoverishment. This paper aims to examine catastrophic and poverty impacts of household out-of-pocket health expenditure in Viet Nam over time and identify socio-economic indicators associated with them. Data used in this research were obtained from a nationally representative household survey, Viet Nam Living Standard Survey 2002, 2004, 2006, 2008 and 2010. The findings revealed that there were problems in health care financing in Viet Nam - many households encountered catastrophic health expenditure and/or were pushed into poverty due to health care payments. The issues were pervasive over time. Catastrophic expenditure and impoverishment problems were more common among the households who had more elderly people and those located in rural areas. Importantly, the financial protection aspect of the national health insurance schemes was still modest. Given these findings, more attention is needed on developing methods of financial protection in Viet Nam. Copyright © 2012 Elsevier Ltd. All rights reserved.

Tobacco expenditure, smoking-induced deprivation and financial stress: results from the International Tobacco Control (ITC) Four-Country Survey.

PubMed

Siahpush, Mohammad; Borland, Ron; Yong, Hua-Hie; Cummings, K Michael; Fong, Geoffrey T

2012-07-01

While higher tobacco prices lead to a reduction in smoking prevalence, there is a concern that paying more for cigarettes can lead to excess financial burden. Our primary aim was to examine the association of daily cigarette expenditure with smoking-induced deprivation (SID) and financial stress (FS). We used data from wave 7 (2008-2009) of the International Tobacco Control (ITC) Four-Country Survey which is a survey of smokers in Canada, the USA, the UK and Australia (n = 5887). Logistic regressions were used to assess the association of daily cigarette expenditure with SID and FS. In multivariate analyses, a one standard deviation increase in daily cigarette expenditure was associated with an increase of 24% (P = 0.004) in the probability of experiencing SID. While we found no association between daily cigarette expenditure and FS, we found that SID is a strong predictor of FS (odds ratio 6.25; P < 0.001). This suggests that cigarette expenditure indirectly affects FS through SID. Results showed no evidence of an interaction between cigarette expenditure and income or education in their effect on SID or FS. Our results imply that spending more on tobacco may result in SID but surprisingly has no direct effect on FS. While most smokers may be adjusting their incomes and consumption to minimise FS, some fail to do so occasionally as indexed by the SID measure. Future studies need to prospectively examine the effect of increased tobacco expenditure on financial burden of smokers. © 2012 Australasian Professional Society on Alcohol and other Drugs.

Depression treatment and short-term healthcare expenditures among elderly Medicare beneficiaries with chronic physical conditions.

PubMed

Shen, Chan; Shah, Neel; Findley, Patricia A; Sambamoorthi, Usha

2013-10-22

Research on the impact of depression treatment on expenditures is nascent and shows results that vary from negative associations with healthcare expenditures to increased expenditures. However many of these studies did not include psychotherapy as part of the depression treatment. None of these studies included "no treatment" as a comparison group. In addition, no study has included a broad group of chronic physical conditions in studying depression treatment expenditures. We determined the association between depression treatment and short-term healthcare expenditures using a nationally representative sample of Medicare beneficiaries with chronic physical conditions and depression. In this retrospective cohort study, we examined the association between depression treatment in the baseline year and healthcare expenditures in the following year using data from 2000 through 2005 of the Medicare Current Beneficiary Survey (MCBS), a nationally representative survey of Medicare beneficiaries. Using the rotating panel design of MCBS, we derived five two-year cohorts: 2000-2001, 2001-2002, 2002-2003, 2003-2004, and 2004-2005. The study sample included 1,055 elderly Medicare beneficiaries aged 65 or over. We compared healthcare expenditures of no depression treatment group with depression treatment groups using t-tests. Linear regressions of log-transformed dollars were used to assess the relationship between depression treatment and healthcare expenditures after controlling for demographic, socio-economic, health status, lifestyle risk factors, year of observation and baseline expenditures. Compared to no depression treatment ($16,795), the average total expenditures were higher for those who used antidepressants only ($17,425) and those who used psychotherapy with or without antidepressants ($19,733). After controlling for the independent variables, antidepressant use and psychotherapy with or without antidepressants were associated with 20.2% (95% CI: 14.1-26.7%) and 29

Dental care utilization and expenditures in children with special health care needs.

PubMed

Beil, Heather; Mayer, Michelle; Rozier, R Gary

2009-09-01

The authors compared children with special health care needs (CSHCN) and children without special health care needs (SHCN) with respect to the odds, amount and determinants of having any dental care and dental care expenditures. The authors assessed data from the 2004 Medical Expenditures Panel Survey, Agency for Healthcare Research and Quality, to identify a sample of 8,518 children aged 2 to 17 years. The authors used logistic regression to determine the effect of having SHCN on the probability of having any dental care expenditure, for total dental care expenditures and procedure-specific expenditures. They tested the modifying effect between CSHCN and other variables on the probability of having any dental care expenditure. Compared with children without SHCN, CSHCN did not differ in the probability (odds ratio = 0.91, 95 percent confidence interval [CI] = 0.76 to 1.09) or amount (beta = 30.17, 95 percent CI = -162.93 to 223.27) of total dental care expenditures. Likewise, CSHCN did not differ in their likelihood of having undergone a preventive, restorative, diagnostic or other procedure. Known determinants of dental care utilization did not modify the relationships between having SCHN and any dental care expenditure. Despite the reported difficulty in CSHCN's accessing dental care, the authors found that CSHCN had dental care utilization and expenditures that were comparable with those of children without SHCN. Furthermore, the association of CSHCN status and any dental care expenditure was not modified by known determinants of dental care utilization. Future research should focus on characterizing risk for dental disease among CSHCN more accurately and identifying factors that affect dental care utilization in CSHCN, including provider and parent characteristics. The study results highlight low rates of dental care utilization among all young children, including CSHCN. Efforts to increase dental care utilization among children are warranted and need to

Supplemental Nutrition Assistance Program (SNAP) Participation and Health Care Expenditures Among Low-Income Adults.

PubMed

Berkowitz, Seth A; Seligman, Hilary K; Rigdon, Joseph; Meigs, James B; Basu, Sanjay

2017-11-01

Food insecurity is associated with high health care expenditures, but the effectiveness of food insecurity interventions on health care costs is unknown. To determine whether the Supplemental Nutrition Assistance Program (SNAP), which addresses food insecurity, can reduce health care expenditures. This is a retrospective cohort study of 4447 noninstitutionalized adults with income below 200% of the federal poverty threshold who participated in the 2011 National Health Interview Survey (NHIS) and the 2012-2013 Medical Expenditure Panel Survey (MEPS). Self-reported SNAP participation in 2011. Total health care expenditures (all paid claims and out-of-pocket costs) in the 2012-2013 period. To test whether SNAP participation was associated with lower subsequent health care expenditures, we used generalized linear modeling (gamma distribution, log link, with survey design information), adjusting for demographics (age, gender, race/ethnicity), socioeconomic factors (income, education, Social Security Disability Insurance disability, urban/rural), census region, health insurance, and self-reported medical conditions. We also conducted sensitivity analyses as a robustness check for these modeling assumptions. A total of 4447 participants (2567 women and 1880 men) were enrolled in the study, mean (SE) age, 42.7 (0.5) years; 1889 were SNAP participants, and 2558 were not. Compared with other low-income adults, SNAP participants were younger (mean [SE] age, 40.3 [0.6] vs 44.1 [0.7] years), more likely to have public insurance or be uninsured (84.9% vs 67.7%), and more likely to be disabled (24.2% vs 10.6%) (P < .001 for all). In age- and gender-adjusted models, health care expenditures between those who did and did not participate in SNAP were similar (difference, $34; 95% CI, -$1097 to $1165). In fully adjusted models, SNAP was associated with lower estimated annual health care expenditures (-$1409; 95% CI, -$2694 to -$125). Sensitivity analyses were consistent with

Maternal depressive symptoms and healthcare expenditures for publicly insured children with chronic health conditions.

PubMed

Brooks, Jada L; Beil, Heather; Beeber, Linda S

2015-04-01

This study estimated the prevalence of maternal depressive symptoms and tested associations between maternal depressive symptoms and healthcare utilization and expenditures among United States publicly insured children with chronic health conditions (CCHC). A total of 6,060 publicly insured CCHC from the 2004-2009 Medical Expenditure Panel Surveys were analyzed using negative binomial models to compare healthcare utilization for CCHC of mothers with and without depressive symptoms. Annual healthcare expenditures for both groups were compared using a two-part model with a logistic regression and generalized linear model. The prevalence of depressive symptoms among mothers with CCHC was 19 %. There were no differences in annual healthcare utilization for CCHC of mothers with and without depressive symptoms. Maternal depressive symptoms were associated with greater odds of ED expenditures [odds ratio (OR) 1.26; 95 % CI 1.03-1.54] and lesser odds of dental expenditures (OR 0.81; 95 % CI 0.66-0.98) and total expenditures (OR 0.71; 95 % CI 0.51-0.98). Children of symptomatic mothers had lower predicted outpatient expenditures and higher predicted expenditures for total health, prescription medications, dental care; and office based, inpatient and ED visits. Mothers with CCHC were more likely to report depressive symptoms than were mothers with children without chronic health conditions. There were few differences in annual healthcare utilization and expenditures between CCHC of mothers with and without depressive symptoms. However, having a mother with depressive symptoms was associated with higher ED expenditures and higher predicted healthcare expenditures in a population of children who comprise over three-fourths of the top decile of Medicaid spending.

Hypertension-associated expenditures for medication among US adults.

PubMed

Wang, Guijing; Yan, Lili; Ayala, Carma; George, Mary G; Fang, Jing

2013-11-01

We sought to estimate how much the presence of hypertension adds to annual per capita and total expenditures for medication among US adults. The sample included 21,782 civilian noninstitutionalized adults aged ≥ 18 years who participated in the 2007 Medical Expenditure Panel Survey. Hypertension was defined as having a diagnosis of high blood pressure (except during pregnancy) or taking a blood pressure medication. We used a 2-part model to examine all-cause medication expenditure associated with hypertension. The prevalence of hypertension was 32.2%. Overall, 66.7% of adults purchased prescribed medications, with this proportion higher among hypertensive (93.0%) than normotensive (54.4%) adults (P < 0.001). Hypertensive adults were more likely to have medication expenditures than were normotensive adults (odds ratio (OR) = 6.42; P < 0.001). Among hypertensive adults, those aged ≥ 45 years were more likely to incur medication expenditure than those aged 18-44 years (OR = 3.00, P < 0.001 for those aged 45-64 years; OR = 5.95, P < 0.001 for those aged ≥ 65 years), whereas women were 2.91 times as likely as men to have medication spending (P < 0.001). Hispanics were less likely than non-Hispanic whites to have such spending (OR = 0.51; P < 0.001). Among those purchasing medications, the average cost was $1,510 higher among hypertensive persons ($2,337) than normotensive persons ($827). Hypertension-associated expenditures for medication were estimated at $68 billion in the US civilian non-institutionalized population in 2007. The presence of hypertension among US adults is associated with an increase of all-cause expenditures for medication, with this increase varying across groups by age and sex. © Published by Oxford University Press on behalf of American Journal of Hypertension Ltd 2013. This work is written by (a) US Government employees(s) and is in the public domain in the US.

Physician utilization and expenditures in a Medicaid Population

PubMed Central

Buczko, William

1986-01-01

The determinants of physician visit utilization and expenditures for the full-year Medicaid enrollees in the State Medicaid household survey portion of the National Medical Care Utilization and Expenditure Survey are analyzed in this article. The regression analyses for the probability of a physician visit, for number of physician visits, and for physician visit expenditures underscore the importance of perceived health status as a determinant of both physician utilization and expenditures. Other important determinants of physician utilization and expenditures were regular source of care, State, enrollment group, sex, and family size. PMID:10312009

Integrated corridor management initiative : overview of the Dallas traveler response panel survey.

DOT National Transportation Integrated Search

2017-03-01

This report presents findings from the Integrated Corridor Management (ICM) traveler behavior surveys, a set of panel surveys of US-75 corridor users, conducted before and after the deployment of ICM. The purpose of the surveys was to measure the imp...

Medical Expenditures Associated With Hypertension in the U.S., 2000-2013.

PubMed

Zhang, Donglan; Wang, Guijing; Zhang, Ping; Fang, Jing; Ayala, Carma

2017-12-01

Trends of prevalence, treatment, and control of hypertension have been documented in the U.S., but changes in medical expenditures associated with hypertension over time have not been evaluated. This study analyzed these expenditures during 2000-2013 among U.S. adults. Data from the Medical Expenditure Panel Survey were analyzed in 2016. The study population was non-institutionalized men and non-pregnant women aged ≥18 years. Hypertension was defined as ever been diagnosed with hypertension or currently taking antihypertensive medications. Medical expenditures included all payments to medical care providers. Expenditures associated with hypertension were estimated by two-part regression models and adjusted into 2015 U.S. dollars. Controlling variables included sociodemographic characteristics, marital status, insurance, region, smoking status, weight status, health status, and comorbidities. Trends were analyzed using joinpoint method. Total per-person annual expenditures associated with hypertension in 2000-2001 ($1,399) were not significantly different from those in 2012-2013 ($1,494) (average annual percent change [AAPC]= -0.6%, p=0.794), but annual national spending increased significantly from $58.7 billion to $109.1 billion (AAPC=8.3%, p=0.015), mainly because of the increase in the number of people treated for hypertension. Per-person outpatient payments were 22.7% higher in 2012-2013 than in 2000-2001 ($416 vs $322, p<0.05; AAPC=0.8%, p-trend=0.826). Payments for prescription medications took up a larger proportion of the medical expenditures associated with hypertension, compared to payments for outpatient or other services (33%-46%). During 2000-2013, annual national medical expenditures associated with hypertension increased significantly. Preventing hypertension could alleviate hypertension-associated economic burden. Copyright © 2017 American Journal of Preventive Medicine. All rights reserved.

Trends in Healthcare Expenditures Among US Adults With Hypertension: National Estimates, 2003-2014.

PubMed

Kirkland, Elizabeth B; Heincelman, Marc; Bishu, Kinfe G; Schumann, Samuel O; Schreiner, Andrew; Axon, R Neal; Mauldin, Patrick D; Moran, William P

2018-05-30

One in 3 US adults has high blood pressure, or hypertension. As prior projections suggest hypertension is the costliest of all cardiovascular diseases, it is important to define the current state of healthcare expenditures related to hypertension. We used a nationally representative database, the Medical Expenditure Panel Survey, to calculate the estimated annual healthcare expenditure for patients with hypertension and to measure trends in expenditure longitudinally over a 12-year period. A 2-part model was used to estimate adjusted incremental expenditures for individuals with hypertension versus those without hypertension. Sex, race/ethnicity, education, insurance status, census region, income, marital status, Charlson Comorbidity Index, and year category were included as covariates. The 2003-2014 pooled data include a total sample of 224 920 adults, of whom 36.9% had hypertension. Unadjusted mean annual medical expenditure attributable to patients with hypertension was $9089. Relative to individuals without hypertension, individuals with hypertension had $1920 higher annual adjusted incremental expenditure, 2.5 times the inpatient cost, almost double the outpatient cost, and nearly triple the prescription medication expenditure. Based on the prevalence of hypertension in the United States, the estimated adjusted annual incremental cost is $131 billion per year higher for the hypertensive adult population compared with the nonhypertensive population. Individuals with hypertension are estimated to face nearly $2000 higher annual healthcare expenditure compared with their nonhypertensive peers. This trend has been relatively stable over 12 years. Healthcare costs associated with hypertension account for about $131 billion. This warrants intense effort toward hypertension prevention and management. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Cigarette prices, cigarette expenditure and smoking-induced deprivation: findings from the International Tobacco Control Mexico survey

PubMed Central

Siahpush, Mohammad; Thrasher, James F; Yong, Hua H; Cummings, K Michael; Fong, Geoffrey T; de Miera, Belén Saenz; Borland, Ron

2015-01-01

Aim Mexico implemented annual tax increases between 2009 and 2011. We examined among current smokers the association of price paid per cigarette and daily cigarette expenditure with smoking-induced deprivation (SID) and whether the association of price or expenditure with SID varies by income. Methods We used data (n = 2410) from three waves of the International Tobacco Control Mexico survey (ie, 2008, 2010, 2011) and employed logistic regression to estimate the association of price paid per cigarette and daily cigarette expenditure with the probability of SID (‘In the last 6 months, have you spent money on cigarettes that you knew would be better spent on household essentials like food?’). Results Price paid per cigarette increased from Mex $1.24 in 2008, to Mex$1.36 in 2010, to Mex$1.64 in 2011. Daily cigarette expenditure increased from Mex $6.9, to Mex$7.6 and to Mex$8.4 in the 3 years. There was no evidence of an association between price and SID. However, higher expenditure was associated with a higher probability of SID. There was no evidence that the association of price or expenditure with SID varied by income. Conclusion Tax increases in Mexico have resulted in smokers paying more and spending more for their cigarettes. Those with higher cigarette expenditure experience more SID, with no evidence that poorer smokers are more affected. PMID:22923478

Cigarette prices, cigarette expenditure and smoking-induced deprivation: findings from the International Tobacco Control Mexico survey.

PubMed

Siahpush, Mohammad; Thrasher, James F; Yong, Hua H; Cummings, K Michael; Fong, Geoffrey T; de Miera, Belén Saenz; Borland, Ron

2013-07-01

Mexico implemented annual tax increases between 2009 and 2011. We examined among current smokers the association of price paid per cigarette and daily cigarette expenditure with smoking-induced deprivation (SID) and whether the association of price or expenditure with SID varies by income. We used data (n=2410) from three waves of the International Tobacco Control Mexico survey (ie, 2008, 2010, 2011) and employed logistic regression to estimate the association of price paid per cigarette and daily cigarette expenditure with the probability of SID ('In the last 6 months, have you spent money on cigarettes that you knew would be better spent on household essentials like food?'). Price paid per cigarette increased from Mex$1.24 in 2008, to Mex$1.36 in 2010, to Mex$1.64 in 2011. Daily cigarette expenditure increased from Mex$6.9, to Mex$7.6 and to Mex$8.4 in the 3 years. There was no evidence of an association between price and SID. However, higher expenditure was associated with a higher probability of SID. There was no evidence that the association of price or expenditure with SID varied by income. Tax increases in Mexico have resulted in smokers paying more and spending more for their cigarettes. Those with higher cigarette expenditure experience more SID, with no evidence that poorer smokers are more affected.

Impact of Provider Participation in ACO Programs on Preventive Care Services, Patient Experiences, and Health Care Expenditures in US Adults Aged 18-64.

PubMed

Hong, Young-Rock; Sonawane, Kalyani; Larson, Samantha; Mainous, Arch G; Marlow, Nicole M

2018-05-15

Little is known about the impact of accountable care organization (ACO) on US adults aged 18-64. To examine whether having a usual source of care (USC) provider participating in an ACO affects receipt of preventive care services, patient experiences, and health care expenditures among nonelderly Americans. A cross-sectional analysis of the 2015 Medical Organizations Survey linked with the Medical Expenditure Panel Survey. Survey respondents aged 18-64 with an identified USC and continuous health insurance coverage during 2015. Preventative care services (routine checkup, flu vaccination, and cancer screening), patient experiences with health care (access to care, interaction quality with providers, and global satisfaction), and health care expenditures (total and out-of-pocket expenditures) for respondents with USC by ACO and non-ACO provider groups. Among 1563, nonelderly Americans having a USC, we found that nearly 62.7% [95% confidence interval (CI), 58.6%-66.7%; representing 15,722,208 Americans] were cared for by ACO providers. Our analysis showed no significant differences in preventive care services or patient experiences between ACO and non-ACO groups. Adjusted mean total health expenditures were slightly higher for the ACO than non-ACO group [$7016 (95% CI, $4949-$9914) vs. $6796 (95% CI, $4724-$9892)]; however, this difference was not statistically significant (P=0.250). Our findings suggest that having a USC provider participating in an ACO is not associated with preventive care services use, patient experiences, or health care expenditures among a nonelderly population.

Medical expenditure for liver cancer in urban China: A 10-year multicenter retrospective survey (2002-2011).

PubMed

Qiu, Wu-Qi; Shi, Ju-Fang; Guo, Lan-Wei; Mao, A-Yan; Huang, Hui-Yao; Hu, Guang-Yu; Dong, Pei; Bai, Fang-Zhou; Yan, Xiao-Ling; Liao, Xian-Zhen; Liu, Guo-Xiang; Bai, Ya-Na; Ren, Jian-Song; Sun, Xiao-Jie; Zhu, Xin-Yu; Zhou, Jin-Yi; Gong, Ji-Yong; Zhu, Lin; Mai, Ling; Du, Ling-Bing; Zhou, Qi; Xing, Xiao-Jing; Song, Bing-Bing; Liu, Yu-Qin; Lou, Pei-An; Sun, Xiao-Hua; Wu, Shou-Ling; Cao, Rong; Qi, Xiao; Lan, Li; Ren, Ying; Zhang, Kai; He, Jie; Qu, Chunfeng; Dai, Min

2018-01-01

This study aims to understand the medical expenditure for liver cancer during 2002-2011 in urban areas of China. This is a retrospective study. Based on a stratified cluster sampling method, a medical expenditure survey collected basic personal information from related medical records. Two-tailed independent sample t-test, variance analysis, and Student-Newman-Keuls Tests were used in cost analysis for the corresponding data types. A total of 12,342 liver cancer patients were included in the analysis. Overall average medical expenditure per case for liver cancer diagnosis and treatment in China has increased from ¥21, 950 to ¥40, 386 over the study period. For each liver cancer patient diagnosed between 2009 and 2011, the average expenditures were 29,332 CNY for stage I, 35,754 CNY for stage II, 34,288 CNY for stage III, and 30,275 CNY for stage IV diseases (P < 0.001). Pharmaceuticals accounted for the biggest part of the medical expenditure and it rose from 48.01% to 52.96% during these ten years, and the share of nursing fee expenses was the lowest (around 1%). Over the entire 10-year data period, the per capita expenditure of the east region (32,983 CNY) was higher than that of the west region (26,219 CNY) and slightly higher than the central region (31,018 CNY, P < 0.001). As a major cancer in China, liver cancer accounts for a large portion of health economic burden and its medical expenditure is heavy for families. Early diagnosis and treatment for liver cancer will save medical expenditure. The economic burden of liver cancer is high in China and related medical expenditure has increased.

Parent-Reported Health Consequences and Relationship to Expenditures in Children with ADHD.

PubMed

deJong, Neal A; Williams, Christianna S; Thomas, Kathleen C

2016-04-01

(1) To describe parents' report of special needs for children with ADHD on the Children with Special Health Care Needs (CSHCN) Screener; and (2) to assess the association between responses to Screener items and annual mental health and total health expenditures per child. In pooled 2002-2011 Medical Expenditure Panel Survey (MEPS) data, we identify children ages 4-17 years with ADHD. We use OLS and two-part regressions to model the relationship between CSHCN Screener items and mental health and total health expenditures. Based on these models we estimate adjusted, average total health expenditures for children with ADHD-both with and without a co-morbid mental health condition-and different combinations of endorsed Screener items. This research was conducted in accordance with prevailing ethical principles. There were 3883 observations on 2591 children with ADHD. Without a co-morbid mental health condition, average total expenditures per year from adjusted, model-based estimates were $865 for those meeting no Screener items, $2664 for those meeting only the medication item, $3595 for those meeting the medication and counseling items, and $4203 for those meeting the medication, counseling, and use of more health services items. Children with a co-morbid mental health condition had greater total health expenditures for each combination of Screener items. The associations between Screener items and mental health expenditures were similar, but with a slightly lower marginal effect of the medication item (p < 0.001 for all comparisons). Parents' responses on the CSHCN Screener are associated with meaningful variation in expenditures for children with ADHD. Though cross-sectional, this study suggests that the CSHCN Screener can be a useful categorization scheme for children with ADHD. It may be an efficient, standardized tool at the point of care for identifying children who need more resources and for targeting intensive interventions in the context of population health

Meaningful Use of Electronic Health Records and Medicare Expenditures: Evidence from a Panel Data Analysis of U.S. Health Care Markets, 2010-2013.

PubMed

Lammers, Eric J; McLaughlin, Catherine G

2017-08-01

To determine if recent growth in hospital and physician electronic health record (EHR) adoption and use is correlated with decreases in expenditures for elderly Medicare beneficiaries. American Hospital Association (AHA) General Survey and Information Technology Supplement, Health Information Management Systems Society (HIMSS) Analytics survey, SK&A Information Services, and the Centers for Medicare & Medicaid Services (CMS) Chronic Conditions Data Warehouse Geographic Variation Database for 2010 through 2013. Fixed effects model comparing associations between hospital referral region (HRR) level measures of hospital and physician EHR penetration and annual Medicare expenditures for beneficiaries with one of four chronic conditions. Calculated hospital penetration rates as the percentage of Medicare discharges from hospitals that satisfied criteria analogous to Meaningful Use (MU) Stage 1 requirements and physician rates as the percentage of physicians using ambulatory care EHRs. An increase in the hospital penetration rate was associated with a small but statistically significant decrease in total Medicare and Medicare Part A acute care expenditures per beneficiary. An increase in physician EHR penetration was also associated with a significant decrease in total Medicare and Medicare Part A acute care expenditures per beneficiary as well as a decrease in Medicare Part B expenditures per beneficiary. For the study population, we estimate approximately $3.8 billion in savings related to hospital and physician EHR adoption during 2010-2013. We also found that an increase in physician EHR penetration was associated with an increase in lab test expenses. Health care markets that had steeper increases in EHR penetration during 2010-2013 also had steeper decreases in total Medicare and acute care expenditures per beneficiary. Markets with greater increases in physician EHR had greater declines in Medicare Part B expenditures per beneficiary. © Health Research and

Changes in economic status of households associated with catastrophic health expenditures for cancer in South Korea.

PubMed

Choi, Jae-Woo; Cho, Kyoung-Hee; Choi, Young; Han, Kyu-Tae; Kwon, Jeoung-A; Park, Eun-Cheol

2014-01-01

Cancer imposes significant economic challenges for individuals, families, and society. Households of cancer patients often experience income loss due to change in job status and/or excessive medical expenses. Thus, we examined whether changes in economic status for such households is affected by catastrophic health expenditures. We used the Korea Health Panel Survey (KHPS) Panel 1st-4th (2008- 2011 subjects) data and extracted records from 211 out of 5,332 households in the database for this study. To identify factors associated with catastrophic health expenditures and, in particular, to examine the relationship between change in economic status and catastrophic health expenditures, we conducted a generalized linear model analysis. Among 211 households with cancer patients, 84 (39.8%) experienced catastrophic health expenditures, while 127 (40.2%) did not show evidence of catastrophic medical costs. If a change in economic status results from a change in job status for head of household (job loss), these households are more likely to incur catastrophic health expenditure than households who have not experienced a change in job status (odds ratios (ORs)=2.17, 2.63, respectively). A comparison between households with a newly-diagnosed patient versus households with patients having lived with cancer for one or two years, showed the longer patients had cancer, the more likely their households incurred catastrophic medical costs (OR=1.78, 1.36, respectively). Change in economic status of households in which the cancer patient was the head of household was associated with a greater likelihood that the household would incur catastrophic health costs. It is imperative that the Korean government connect health and labor policies in order to develop economic programs to assist households with cancer patients.

Distribution of alcohol consumption and expenditures and the impact of improved measurement on coverage of alcohol sales in the 2000 National Alcohol Survey.

PubMed

Kerr, William C; Greenfield, Thomas K

2007-10-01

To validate improved survey estimates of alcohol volume and new expenditures questions, these measures were aggregated and evaluated through comparison to sales data. Using the new measures, we examined their distributions by estimating the proportion of mean intake, heavy drinking days, and alcohol expenditures among drinkers grouped by volume. The 2000 National Alcohol Survey is a random digit dialed telephone survey of the United States with 7,612 respondents including 323 who were recontacted for drink ethanol measurement. Among drinkers, we utilized improved drink ethanol content estimates and beverage-specific graduated frequency measures to assess alcohol consumption and past month beverage-specific spending reports to estimate expenditures. Coverage of alcohol sales by the new measures was estimated to be 52.3% for consumption and 59.3% for expenditures. Coverage was best for wine at 92.1% of sales, but improved most for spirits from 37.2% to 55.2%, when empirical drink ethanol content was applied. Distribution estimates showed that the top 10% of drinkers drank 55.3% of the total alcohol consumed, accounted for 61.6% of all 5+ and nearly 80% of all 12+ drinking days. Spirits consumption was the most concentrated with the top decile consuming 62.9% of the total for this beverage. This decile accounted for 33% of total expenditures, even though its mean expenditure per drink was considerably lower ($0.79) than the bottom 50% of drinkers ($4.75). The distributions of mean alcohol intake and heavy drinking days are highly concentrated in the U.S. population. Lower expenditures per drink by the heaviest drinkers suggest substantial downward quality substitution, drinking in cheaper contexts or other bargain pricing strategies. Empirical drink ethanol estimates improved survey coverage of sales particularly for spirits, but significant under-coverage remains, highlighting need for further self-report measurement improvement.

Favorable cardiovascular risk factor profile is associated with lower healthcare expenditure and resource utilization among adults with diabetes mellitus free of established cardiovascular disease: 2012 Medical Expenditure Panel Survey (MEPS).

PubMed

Feldman, David I; Valero-Elizondo, Javier; Salami, Joseph A; Rana, Jamal S; Ogunmoroti, Oluseye; Osondu, Chukwuemeka U; Spatz, Erica S; Virani, Salim S; Blankstein, Ron; Blaha, Michael J; Veledar, Emir; Nasir, Khurram

2017-03-01

Given the prevalence and economic burden of diabetes mellitus (DM), we studied the impact of a favorable cardiovascular risk factor (CRF) profile on healthcare expenditures and resource utilization among individuals without cardiovascular disease (CVD), by DM status. 25,317 participants were categorized into 3 mutually-exclusive strata: "Poor", "Average" and "Optimal" CRF profiles (≥4, 2-3, 0-1 CRF, respectively). Two-part econometric models were utilized to study cost data. Mean age was 45 (48% male), with 54% having optimal, 39% average, and 7% poor CRF profiles. Individuals with DM were more likely to have poor CRF profile vs. those without DM (OR 7.7, 95% CI 6.4, 9.2). Individuals with DM/poor CRF profile had a mean annual expenditure of $9,006, compared to $6,461 among those with DM/optimal CRF profile (p < 0.001). A favorable CRF profile is associated with significantly lower healthcare expenditures and utilization in CVD-free individuals across DM status, suggesting that these individuals require aggressive individualized prescriptions targeting lifestyle modifications and therapeutic treatments. Copyright © 2017 Elsevier B.V. All rights reserved.

Residential Energy Consumption Survey (RECS): National interim energy consumption survey, 1978-1979, household monthly energy consumption and expenditures. Shopper's guide

NASA Astrophysics Data System (ADS)

Windell, P.

1981-08-01

The data from the National Interim Energy Consumption Survey (NIECS) is available to the public on machine readable magnetic tapes. Brief overviews of the Residential Energy Consumption Survey as a whole and of the NIECS in particular is a brief description of each of the files included in this tape, and a list of the variables in the data set are included. A copy of the fuel supplier record form used to collect consumption and expenditure data for each of the sample households is also included.

Expenditures for Scientific Research Equipment at Ph.D. Granting Institutions, FY 1978.

ERIC Educational Resources Information Center

Gomberg, Irene L.; Atelsek, Frank J.

At the request of the National Science Foundation (NSF), the Higher Education Panel (a stratified sample of 760 colleges and universities) collected information on the level of institutional expenditures for research equipment, the federal contribution to those expenditures, and the share of funds expended for high-cost items. The data were…

Health care resource use, health care expenditures and absenteeism costs associated with osteoarthritis in US healthcare system.

PubMed

Menon, J; Mishra, P

2018-04-01

We determined incremental health care resource utilization, incremental health care expenditures, incremental absenteeism, and incremental absenteeism costs associated with osteoarthritis. Medical Expenditure Panel Survey (MEPS) for 2011 was used as data source. Individuals 18 years or older and employed during 2011 were eligible for inclusion in the sample for analyses. Individuals with osteoarthritis were identified based on ICD-9-CM codes. Incremental health care resource utilization included annual hospitalization, hospital days, emergency room visits and outpatient visits. Incremental health expenditures included annual inpatient, outpatient, emergency room, medications, miscellaneous and annual total expenditures. Of the total sample, 1354 were diagnosed with osteoarthritis, and compared to non osteoarthritis individuals. Incremental resource utilization, expenditures, absenteeism and absenteeism costs were estimated using regression models, adjusting for age, gender, sex, region, marital status, insurance coverage, comorbidities, anxiety, asthma, hypertension and hyperlipidemia. Regression models revealed incremental mean annual resource use associated with osteoarthritis of 0.07 hospitalizations, equal to 70 additional hospitalizations per 100 osteoarthritic patients annually, and 3.63 outpatient visits, equal to 363 additional visits per 100 osteoarthritic patients annually. Mean annual incremental total expenditures associated with osteoarthritis were $2046. Annually, mean incremental expenditures were largest for inpatient expenditures at $826, followed by mean incremental outpatient expenditures of $659, and mean incremental medication expenditures of $325. Mean annual incremental absenteeism was 2.2 days and mean annual incremental absenteeism costs were $715.74. Total direct expenditures were estimated at $41.7 billion. Osteoarthritis was associated with significant incremental health care resource utilization, expenditures, absenteeism and

Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study.

PubMed

Hung, Man; Zhang, Weiping; Chen, Wei; Bounsanga, Jerry; Cheng, Christine; Franklin, Jeremy D; Crum, Anthony B; Voss, Maren W; Hon, Shirley D

2015-01-01

Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties.

Medical expenditure for esophageal cancer in China: a 10-year multicenter retrospective survey (2002-2011).

PubMed

Guo, Lan-Wei; Huang, Hui-Yao; Shi, Ju-Fang; Lv, Li-Hong; Bai, Ya-Na; Mao, A-Yan; Liao, Xian-Zhen; Liu, Guo-Xiang; Ren, Jian-Song; Sun, Xiao-Jie; Zhu, Xin-Yu; Zhou, Jin-Yi; Gong, Ji-Yong; Zhou, Qi; Zhu, Lin; Liu, Yu-Qin; Song, Bing-Bing; Du, Ling-Bin; Xing, Xiao-Jing; Lou, Pei-An; Sun, Xiao-Hua; Qi, Xiao; Wu, Shou-Ling; Cao, Rong; Lan, Li; Ren, Ying; Zhang, Kai; He, Jie; Zhang, Jian-Gong; Dai, Min

2017-09-07

Esophageal cancer is associated with substantial disease burden in China, and data on the economic burden are fundamental for setting priorities in cancer interventions. The medical expenditure for the diagnosis and treatment of esophageal cancer in China has not been fully quantified. This study aimed to examine the medical expenditure of Chinese patients with esophageal cancer and the associated trends. From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 37 hospitals in 13 provinces/municipalities across China as a part of the Cancer Screening Program of Urban China. For each esophageal cancer patient diagnosed between 2002 and 2011, clinical information and expense data were extracted by using structured questionnaires. All expense data were reported in Chinese Yuan (CNY; 1 CNY = 0.155 USD) based on the 2011 value and inflated using the year-specific health care consumer price index for China. A total of 14,967 esophageal cancer patients were included in the analysis. It was estimated that the overall average expenditure per patient was 38,666 CNY, and an average annual increase of 6.27% was observed from 2002 (25,111 CNY) to 2011 (46,124 CNY). The average expenditures were 34,460 CNY for stage I, 39,302 CNY for stage II, 40,353 CNY for stage III, and 37,432 CNY for stage IV diseases (P < 0.01). The expenditure also differed by the therapy type, which was 38,492 CNY for surgery, 27,933 CNY for radiotherapy, and 27,805 CNY for chemotherapy (P < 0.05). Drugs contributed to 45.02% of the overall expenditure. These conservative estimates suggested that medical expenditures for esophageal cancer in China substantially increased in the last 10 years, treatment for early-stage esophageal cancer costs less than that for advanced cases, and spending on drugs continued to account for a considerable proportion of the overall expenditure.

Health care expenditures among elderly patients with epilepsy in the United States.

PubMed

Lekoubou, Alain; Bishu, Kinfe G; Ovbiagele, Bruce

2018-06-19

The purpose of this study was to evaluate health care expenditures among elderly patients with epilepsy in the United States. We performed an analysis of weighted 37 738 607 US participants aged 65 years to estimate health care expenditures in the elderly with and without epilepsy using the Medical Expenditure Panel Survey Household Component, with 2003-2014 data. Unadjusted health care expenditures were estimated. Independent health care expenditures were estimated, using a 2-part model. We identified 416 496 (1.1%) older individuals with epilepsy. Comorbidities were more prevalent among older individuals with epilepsy versus younger individuals. Mean unadjusted yearly medical cost of epilepsy in elderly patients with epilepsy was $18 712 (95% confidence interval [CI] = $15 947-$21 476) during the pooled period 2003-2014, which was nearly double the equivalent cost in elderly subjects without epilepsy at $10 168 (95% CI = $9925-$10 410). Mean unadjusted annual medical cost of epilepsy in the elderly increased by $2135 from $15 850 (95% CI = $10 668-$21 032) in 2003-2006 to $17 985 (95% CI = $13 710-$22 260) in 2011-2014. Adjusted mean total health care expenditures per person per year for elderly patients with epilepsy were $12 526 in 2003-2006, $13 423 in 2007-2010, and $10 569 in 2011-2014. Adjusted incremental health care costs associated with epilepsy in the elderly accrued by $4595 (95% CI = $2399-$6791) when compared to elderly subjects without epilepsy. We estimated the mean annual aggregate cost of epilepsy at $7.8 billion to the US population. Epilepsy is common among elderly individuals, and health care expenditures among this growing group are 2 times higher than in those without epilepsy. Wiley Periodicals, Inc. © 2018 International League Against Epilepsy.

The effect of insurance type on prescription drug use and expenditures among elderly Medicare beneficiaries.

PubMed

Saleh, Shadi S; Weller, Wendy; Hannan, Edward

2007-01-01

The debate over the impact of the new Medicare prescription drug benefit (Part D) has intensified in anticipation of its implementation. This paper contributes additional information related to the effect of different types of prescription drug coverage plans on use and expenditures among elderly Medicare beneficiaries. Cross-sectional design using data from the 2002 Medical Expenditures Panel Survey (MEPS). The two dependent variables were (1) prescription drug use and (2) expenditures. The main independent variable was the type of drug insurance (Medicare FFS only [no Rx insurance], Medicare FFS + Rx insurance and Medicare HMO). Bivariate and multivariate analyses were used to test the effect of insurance type, and beneficiaries' characteristics, on likelihood and level of drug use, as well as expenditures. The findings showed that average total drug expenditures among Medicare FFS enrollees who had Rx insurance (non-HMO) were higher ($182.51) than that of Medicare FFS enrollees with no Rx insurance. In addition, the former group had a higher likelihood (any use) of using prescribed medications. On the other hand, no differences in the likelihood of use were detected between Medicare HMO and Medicare FFS (no Rx insurance) enrollees. However, Medicare HMO enrollees had a higher level of drug use. In conclusion, The differences in drug use and expenditures by insurance type imply that each party (Medicare, Medicare Advantage plans, employers) will have a different set of disincentives for involvement in Medicare Part D.

Does Medicare Managed Care reduce racial/ethnic disparities in diabetes preventive care and healthcare expenditures?

PubMed

Mahmoudi, Elham; Tarraf, Wassim; Maroukis, Brianna L; Levy, Helen G

2016-10-01

Large and persistent racial/ethnic disparities exist in diabetes care. Considering the rapid rate of growth of Medicare Managed Care (MMC) plans among minority populations, our aim was to investigate whether disparities in diabetes management and healthcare expenditures are smaller in MMC versus Medicare fee-for-service (MFFS) plans. We hypothesized that racial/ethnic disparities in diabetes care and in health expenditures would be less pronounced in MMC compared with MFFS plans. Nationally representative data from the 2006 to 2011 Medical Expenditure Panel Survey on white, African American, and Hispanic seniors with diabetes were analyzed. We examined 4 measures of diabetes care-regular foot check, eye exam, cholesterol check, and flu vaccine-and total and out-of-pocket (OOP) healthcare expenditures. We implemented the Institute of Medicine's definition of disparity, applied propensity score weighting to adjust for potential differential selection, and used a difference-in-differences generalized linear framework to estimate outcome measures. For African Americans, MMC was associated with a $1183 (P <.036) reduction and a $547 (P <.001) increase in disparities in total and OOP healthcare expenditures, respectively. For Hispanics, disparities in foot exam, flu shot, and cholesterol check decreased by 5, 10, and 7 percentage points (P <.001); additionally, disparities in total and OOP healthcare expenditures were reduced by $3588 and $276 (P <.001), respectively. MMC plans spend less on everyone, including whites. Hispanic/white disparities in diabetes management and healthcare expenditures were smaller in MMC than in MFFS plans. African American/white disparities were not consistently larger in 1 setting than the other.

Malaria related care-seeking-behaviour and expenditures in urban settings: A household survey in Ouagadougou, Burkina Faso.

PubMed

Beogo, Idrissa; Huang, Nicole; Drabo, Maxime K; Yé, Yazoumé

2016-08-01

In Sub-Sahara Africa, malaria inflicts a high healthcare expenditure to individuals. However, little is known about healthcare expenditure to individual affected by malaria and determinants of healthcare seeking behaviour in urban settings where private sector is thriving. This study investigated the level and correlates of expenditure among individuals with self-reported malaria episode in Ouagadougou, Burkina Faso. A cross-sectional household survey conducted in August-November 2011 in Ouagadougou covered 8,243 individuals (1,600 households). Using Generalized Estimating Equations, the analysis included 1082 individuals from 715 households, who reported an episode of malaria. Of individuals surveyed, 38.3% sought care from public, 27.4% from private providers, and, 34.2% self-medicated. The median cost for malaria treatment was USD10.1 (4,850.0XOF) with significant different between public, private and self-medication (p<0.001). In public primary care health facilities, the median cost was USD8.4 (4,050.0XOF) for uncomplicated malaria and USD15.2 (7,333.5XOF) for severe malaria. In private-for-profit facilities run by a medical doctor, the median cost was USD30.3 (14,600.0XOF) for uncomplicated malaria and USD 43.0 (20,725.0XOF) for severe malaria. Regardless of the source of care, patients with insurance incurred significantly higher expenditure compared to those without insurance (p<0.001) and medicine accounted for the largest share of the expenditure. The type of provider, having insurance, and the severity of the malaria predict the amount of money spent. The high financial cost of malaria treatment regardless of the providers poses threat to the goal of universal access to malaria interventions, the unique way to achieve elimination goals. Copyright © 2016 Elsevier B.V. All rights reserved.

Incremental health care services and expenditures associated with depression among individuals with cutaneous lupus erythematosus (CLE).

PubMed

Ogunsanya, M E; Nduaguba, S O; Brown, C M

2018-06-01

Objectives The objective of this paper is to describe the annual direct medical expenditures for cutaneous lupus erythematosus (CLE) patients, and to estimate the incremental health care expenditures and utilization associated with depression among adults with CLE, while controlling for covariates. Methods Using the 2014 Medical Expenditure Panel Survey (MEPS), we compared CLE patients with and without depression to determine differences in: (a) health care utilization-inpatient, outpatient, office-based and emergency room (ER) visits, and prescriptions filled; and (b) expenditures-total costs, inpatient, outpatient, office-based, ER, and prescription medication costs, and other costs using demography-adjusted and comorbidity-adjusted multivariate models (age, gender, race/ethnicity, marital status, education, perception of health status, poverty category, smoking status, and Charlson Comorbidity Index). Results The total direct medical expenditure associated with CLE is estimated at approximately $29.7 billion in 2014 US dollars. After adjusting for covariates, adults with CLE and depression had more hospital discharges (utilization ratio (UR) = 1.13, 95% confidence interval (CI) (1.00-1.28)), ER visits (UR = 1.17, 95% CI (1.09-1.37)), and prescribed medicines (UR = 2.15, 95% CI (1.51-3.05)) than those without depression. Adults with CLE and depression had significantly higher average annual total expenditure that those without depression ($19,854 vs. $9735). Conclusions High health care expenditures are significant for patients with CLE, especially among those with depression. Prescription drugs, inpatient visits, and ER visits contributed most to the total expenditures in CLE patients with depression. Early diagnosis and treatment of depression in CLE patients may reduce total health care expenditures and utilization in this population.

A Feasibility Study on Using an Internet-Panel Survey to Measure Perceptions of E-cigarettes in 3 Metropolitan Areas, 2015.

PubMed

Miller, Eric A; Berman, Lewis; Atienza, Audie; Middleton, Deirdre; Iachan, Ronaldo; Tortora, Robert; Boyle, John

Internet-panel surveys are emerging as a means to quickly and cost-effectively collect health data, and because of their large memberships, they could be used for community-level surveys. To determine the feasibility of using an internet-panel survey to quickly provide community-level data, we conducted a pilot test of a health survey in 3 US metropolitan areas. We conducted internet-panel surveys in Cleveland, Ohio; New York, New York; and Seattle, Washington, in 2015. Slightly more than 500 people responded to the survey in each city. We compared weighted unadjusted prevalence estimates from the internet-panel data with estimates from the 2014 Health Information National Trends Survey (HINTS) for the following question in each survey: "Compared to smoking cigarettes, would you say that electronic cigarettes are…much less harmful, less harmful, just as harmful, more harmful, much more harmful, or I've never heard of electronic cigarettes." We used multivariable logistic regression to compare associations of respondents' demographic and health characteristics with perceived harm from e-cigarettes. The prevalence of the perception that e-cigarettes are less harmful than smoking cigarettes ranged from 35.9% to 39.9% in the internet-panel sites and was 43.0% in HINTS. Most patterns of beliefs and respondent characteristics in the internet-panel data were consistent with patterns in HINTS. We found inconsistent patterns between internet-panel sites and HINTS by race/ethnicity and education. This feasibility study found that internet-panel surveys could quickly produce community-level data for targeted public health interventions and evaluation, but they may be limited in producing estimates among subgroups.

Correlation Results for a Mass Loaded Vehicle Panel Test Article Finite Element Models and Modal Survey Tests

NASA Technical Reports Server (NTRS)

Maasha, Rumaasha; Towner, Robert L.

2012-01-01

High-fidelity Finite Element Models (FEMs) were developed to support a recent test program at Marshall Space Flight Center (MSFC). The FEMs correspond to test articles used for a series of acoustic tests. Modal survey tests were used to validate the FEMs for five acoustic tests (a bare panel and four different mass-loaded panel configurations). An additional modal survey test was performed on the empty test fixture (orthogrid panel mounting fixture, between the reverb and anechoic chambers). Modal survey tests were used to test-validate the dynamic characteristics of FEMs used for acoustic test excitation. Modal survey testing and subsequent model correlation has validated the natural frequencies and mode shapes of the FEMs. The modal survey test results provide a basis for the analysis models used for acoustic loading response test and analysis comparisons

The Within-Year Concentration of Medical Care: Implications for Family Out-of-Pocket Expenditure Burdens

PubMed Central

Selden, Thomas M

2009-01-01

Objective To examine the within-year concentration of family health care and the resulting exposure of families to short periods of high expenditure burdens. Data Source Household data from the pooled 2003 and 2004 Medical Expenditure Panel Survey (MEPS) yielding nationally representative estimates for the nonelderly civilian noninstitutionalized population. Study Design The paper examines the within-year concentration of family medical care use and the frequency with which family out-of-pocket expenditures exceeded 20 percent of family income, computed at the annual, quarterly, and monthly levels. Principal Findings On average among families with medical care, 49 percent of all (charge-weighted) care occurred in a single month, and 63 percent occurred in a single quarter). Nationally, 27 percent of the study population experienced at least 1 month in which out-of-pocket expenditures exceeded 20 percent of income. Monthly 20 percent burden rates were highest among the poor, at 43 percent, and were close to or above 30 percent for all but the highest income group (families above four times the federal poverty line). Conclusions Within-year spikes in health care utilization can create financial pressures missed by conventional annual burden analyses. Within-year health-related financial pressures may be especially acute among lower-income families due to low asset holdings. PMID:19674431

Gender differences in drug use and expenditures in a privately insured population of older adults.

PubMed

Correa-de-Araujo, Rosaly; Miller, G Edward; Banthin, Jessica S; Trinh, Yen

2005-01-01

We examine gender differences in use and expenditures for prescription drugs among Medicare and privately insured older adults aged 65 and over, using data on a nationally representative sample of prescription drug purchases collected for the Medical Expenditure Panel Survey Household Component. Overall, women spent about $1,178 for drugs, about 17% more than the $1,009 in average expenditures by men. Older women constituted 50.7% of the population and had average annual aggregate expenditures for prescribed medicines of $6.93 billion compared to $5.77 billion for men. Women were more likely than men to use drugs from a number of therapeutic classes-analgesics, hormones and psychotherapeutic agents-and therapeutic subclasses-thyroid drugs, COX-2 inhibitors and anti-depressants. Women also had higher average prescriptions per user for a number of therapeutic classes-hormones, psychotherapeutic agents and analgesics-and therapeutic subclasses-anti-diabetic drugs and beta blockers. Prescribed medications are, arguably, the most important healthcare technology in preventing illness, disability, and death in older adults. It is critical that older women and men have proper access to prescribed medicines. Given the financial vulnerability of this priority population, particularly women, the expanded drug coverage available under the Medicare Modernization Act is of particular relevance in meeting this goal.

Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study

PubMed Central

Zhang, Weiping; Chen, Wei; Bounsanga, Jerry; Cheng, Christine; Franklin, Jeremy D; Crum, Anthony B; Voss, Maren W; Hon, Shirley D

2015-01-01

Background Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. Objective The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Methods Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. Results The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. Conclusions We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties. PMID:27227131

Health status, emotional/behavioral problems, health care use, and expenditures in overweight/obese US children/adolescents.

PubMed

Turer, Christy Boling; Lin, Hua; Flores, Glenn

2013-01-01

To examine the association of overweight/obesity with health, health care utilization, and expenditures in a national sample of 10- to 17-year-old children and adolescents. Secondary analysis of 2005 to 2009 Medical Expenditure Panel Survey data (n = 17,224). Outcome measures included suboptimal health, emotional/behavioral problems, health care utilization, and expenditures. Overweight and obese children and adolescents had greater risk of suboptimal health (adjusted risk ratio [ARR], 1.4 and 1.7; P < .01), use of prescriptions (ARR, both 1.1; P = .01), and emergency department visits (ARR, 1.2 and 1.1; P = .01); overweight children/adolescents had lower mean out-of-pocket expenditures (∼$100, P < .01); and obese children/adolescents had greater risk of emotional/behavioral problems (ARR, 1.2; P < .01) and specialist visits (ARR, 1.1; P = .01). The most common specialty referral among obese children/adolescents was psychiatry. Overweight and obesity were not associated with office visits or total expenditures. A greater proportions of children and adolescents with suboptimal health and emotional/behavioral problems had health care expenditures, and those with suboptimal health were more likely to have out-of-pocket expenditures. Pediatric overweight and obesity affect child and adolescent health status, emotional/behavioral problems, and specific domains of health care utilization, but do not appear to be associated with total health care expenditures. Out-of-pocket expenditures are lower among overweight children and adolescents. These findings highlight the need for early intervention in overweight children/adolescents, when health care expenditures may not be greater, and suggest that it may prove useful to pay special attention to the health status and emotional/behavioral problems of overweight and obese children/adolescents in weight-management interventions. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Expenditure and financial burden for the diagnosis and treatment of colorectal cancer in China: a hospital-based, multicenter, cross-sectional survey.

PubMed

Huang, Hui-Yao; Shi, Ju-Fang; Guo, Lan-Wei; Bai, Ya-Na; Liao, Xian-Zhen; Liu, Guo-Xiang; Mao, A-Yan; Ren, Jian-Song; Sun, Xiao-Jie; Zhu, Xin-Yu; Wang, Le; Song, Bing-Bing; Du, Ling-Bin; Zhu, Lin; Gong, Ji-Yong; Zhou, Qi; Liu, Yu-Qin; Cao, Rong; Mai, Ling; Lan, Li; Sun, Xiao-Hua; Ren, Ying; Zhou, Jin-Yi; Wang, Yuan-Zheng; Qi, Xiao; Lou, Pei-An; Shi, Dian; Li, Ni; Zhang, Kai; He, Jie; Dai, Min

2017-04-28

The increasing prevalence of colorectal cancer (CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment. We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China. We conducted a multicenter, cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014. Each enrolled patient was interviewed using a structured questionnaire. All expenditure data were inflated to the 2014 Chinese Yuan (CNY; 1 CNY = 0.163 USD). We quantified the overall expenditure and financial burden and by subgroup (hospital type, age at diagnosis, sex, education, occupation, insurance type, household income, clinical stage, pathologic type, and therapeutic regimen). We then performed generalized linear modeling to determine the factors associated with overall expenditure. A total of 2356 patients with a mean age of 57.4 years were included, 57.1% of whom were men; 13.9% of patients had stage I cancer; and the average previous-year household income was 54,525 CNY. The overall average direct expenditure per patient was estimated to be 67,408 CNY, and the expenditures for stage I, II, III, and IV disease were 56,099 CNY, 59,952 CNY, 67,292 CNY, and 82,729 CNY, respectively. Non-medical expenditure accounted for 8.3% of the overall expenditure. The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY, which accounted for 59.9% of their previous-year household income and caused 75.0% of families to suffer an unmanageable financial burden. Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups (P < 0.05), except for sex. Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later

A Survey of Out-of-Pocket Expenditures for Children with Autism Spectrum Disorder in Israel

ERIC Educational Resources Information Center

Raz, Raanan; Lerner-Geva, Liat; Leon, Odelia; Chodick, Gabriel; Gabis, Lidia V.

2013-01-01

We describe a survey of children with ASD aged 4-10 years. The main dependent variables were out-of-pocket expenditures for health services and hours of therapy. Multivariable logistic regression models were used in order to find independent predictors for service utilization. Parents of 178 of the children (87%) agreed to participate. The average…

Young Adults' Health Care Utilization and Expenditures Prior to the Affordable Care Act

PubMed Central

Lau, Josephine S.; Adams, Sally H.; Boscardin, W. John; Irwin, Charles E.

2014-01-01

Purpose Examine young adults' health care utilization and expenditures prior to the ACA. Methods We used 2009 Medical Expenditure Panel Survey (MEPS) to 1) compare young adults' health care utilization and expenditures of a full-spectrum of health services to children and adolescents and 2) identify disparities in young adults' utilization and expenditures, based on access (insurance and usual source of care) and other socio-demographic factors, including race/ethnicity and income. Results Young adults had: 1) significantly lower rates of overall utilization (72%) than other age groups (83-88%, P<.001) and 2), the lowest rate of office-based utilization (55% vs. 67-77%, P<.001) and higher rate of ER visits compared to adolescents (15% v. 12%, P<.01). Uninsured young adults had high out-of-pocket expenses. Compared to the young adults with private insurance, the uninsured spent less than half on health care ($1,040 vs. $2,150/ person, P<.001), but essentially the same out-of-pocket expenses ($403 vs. $380/person, p =.57). Among young adults, we identified significant disparities in utilization and expenditures based on the presence/absence of a usual source of care, race/ethnicity, home language and sex. Conclusions Young adults may not be utilizing the health care system optimally by having low rates of office-based visits and high rates of ER visits. The ACA provision of insurance for those previously uninsured or under-insured will likely increase their utilization and expenditures and lower their out-of-pocket expenses. Further effort is needed to address non-insurance barriers and ensure equal access to health services. PMID:24702839

Where the United States spends its spine dollars: expenditures on different ambulatory services for the management of back and neck conditions.

PubMed

Davis, Matthew A; Onega, Tracy; Weeks, William B; Lurie, Jon D

2012-09-01

Serial, cross-sectional, nationally representative surveys of noninstitutionalized US adults. To examine expenditures on common ambulatory health services for the management of back and neck conditions. Although it is well recognized that national costs associated with back and neck conditions have grown considerably in recent years, little is known about the costs of care for specific ambulatory health services that are used to manage this population. We used the Medical Expenditure Panel Survey to examine adult (aged 18 yr or older) respondents from 1999 to 2008 who sought ambulatory health services for the management of back and neck conditions. We used complex survey design methods to make national estimates of mean inflation-adjusted annual expenditures on medical care, chiropractic care, and physical therapy per user for back and neck conditions. Approximately 6% of US adults reported an ambulatory visit for a primary diagnosis of a back or neck condition (13.6 million in 2008). Between 1999 and 2008, the mean inflation-adjusted annual expenditures on medical care for these patients increased by 95% (from $487 to $950); most of the increase was accounted for by increased costs for medical specialists, as opposed to primary care physicians. During the study period, the mean inflation-adjusted annual expenditures on chiropractic care were relatively stable; although physical therapy was the most costly service overall, in recent years those costs have contracted. Although this study did not explore the relative effectiveness of different ambulatory services, recent increasing costs associated with providing medical care for back and neck conditions (particularly subspecialty care) are contributing to the growing economic burden of managing these conditions.

Expenditures on health research in sub-Saharan African countries: results of a questionnaire-based survey.

PubMed

Kebede, Derege; Zielinski, Chris; Mbondji, Peter Ebongue; Sanou, Issa; Kouvividila, Wenceslas; Lusamba-Dikassa, Paul-Samson

2014-05-01

To estimate the sources of funds for health research (revenue) and the uses of these funds (expenditure). A structured questionnaire was used to solicit financial information from health research institutions. Forty-two sub-Saharan African countries. Key informants in 847 health research institutions in the 42 sub-Saharan African countries. Expenditure on health research by institutions, funders and subject areas. An estimated total of US$ 302 million was spent on health research by institutions that responded to the survey in the World Health Organization (WHO) African Region for the biennium 2005-2006. The most notable funders for health research activities were external funding, ministries of health, other government ministries, own funds and non-profit institutions. Most types of health research performers spent significant portions of their resources on in-house research, with medical schools spending 82% and government agencies 62%. Hospitals spent 38% of their resources on management, and other institutions (universities, firms, etc.) spent 87% of their resources on capital investment. Research on human immunodeficiency virus/tuberculosis and malaria accounted for 30% of funds, followed by research on other communicable diseases and maternal, perinatal and nutritional conditions (23%). Research on major health problems of the Region, such as communicable diseases, accounts for most of the research expenditures. However, the total expenditure is very low compared with other WHO regions. © The Royal Society of Medicine.

Recent revisions to and recommendations for national health expenditures accounting

PubMed Central

Haber, Susan G.; Newhouse, Joseph P.

1991-01-01

The Health Care Financing Administration (HCFA) has importantly revised the methodology for estimating annual national health expenditures. Among other changes, the revisions estimated out-of-pocket spending directly, disaggregated expenditures to a greater degree, and reduced undercounting and double counting. Estimates of total spending and out-of-pocket spending changed. This article summarizes a meeting of a technical advisory panel, convened by HCFA, that reviewed the modifications adopted and made recommendations for future revisions. PMID:10114932

Gender, Marital Status, and Commercially Prepared Food Expenditure

ERIC Educational Resources Information Center

Kroshus, Emily

2008-01-01

Objective: Assess how per capita expenditure on commercially prepared food as a proportion of total food expenditure varies by the sex and marital status of the head of the household. Design: Prospective cohort study, data collected by the United States Bureau of Labor Statistics 2004 Consumer Expenditure Survey. Setting: United States.…

Effect of involvement level on mail panel survey response rates

Treesearch

Mark E. Havitz; Dennis R. Howard

1995-01-01

A panel survey of golfers, skiers and windsurfers was conducted using mail questionnaires which were distributed three times over the course of a calendar year; in-season, off-season, and preseason. Respondents' levels of enduring activity involvement were measured using Laurent and Kapferer's (1985) Involvement Profile scale. No support was found for the...

Young adults' health care utilization and expenditures prior to the Affordable Care Act.

PubMed

Lau, Josephine S; Adams, Sally H; Boscardin, W John; Irwin, Charles E

2014-06-01

To examine young adults' health care utilization and expenditures prior to the Affordable Care Act. We used 2009 Medical Expenditure Panel Survey to (1) compare young adults' health care utilization and expenditures of a full-spectrum of health services to children and adolescents and (2) identify disparities in young adults' utilization and expenditures, based on access (insurance and usual source of care) and other sociodemographic factors, including race/ethnicity and income. Young adults had (1) significantly lower rates of overall utilization (72%) than other age groups (83%-88%, p < .001), (2) the lowest rate of office-based utilization (55% vs. 67%-77%, p < .001) and (3) higher rate of emergency room visits compared with adolescents (15% vs. 12%, p < .01). Uninsured young adults had high out-of-pocket expenses. Compared with the young adults with private insurance, the uninsured spent less than half on health care ($1,040 vs. $2,150/person, p < .001) but essentially the same out-of-pocket expenses ($403 vs. $380/person, p = .57). Among young adults, we identified significant disparities in utilization and expenditures based on the presence/absence of a usual source of care, race/ethnicity, home language, and sex. Young adults may not be utilizing the health care system optimally by having low rates of office-based visits and high rates of emergency room visits. The Affordable Care Act provision of insurance for those previously uninsured or under-insured will likely increase their utilization and expenditures and lower their out-of-pocket expenses. Further effort is needed to address noninsurance barriers and ensure equal access to health services. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Examination of Parent Insurance Ratings, Child Expenditures, and Financial Burden Among Children With Autism: A Mismatch Suggests New Hypotheses to Test.

PubMed

Thomas, Kathleen C; Williams, Christianna S; deJong, Neal; Morrissey, Joseph P

2016-02-01

Families raising children with autism contribute significant amounts to the cost of care. In this era of health care reform, families have more insurance choices, but people are unfamiliar with health insurance terms. This study uses 2 national data sets to examine health insurance ratings from parents raising children with autism and child expenditures to explore how these measures align. Children with autism who met criteria for special health care needs and were continuously insured were examined. Data from the National Survey of Children With Special Health Care Needs 2009-2010 were used to examine parent report of adequate insurance (n = 3702). Pooled data from the Medical Expenditure Panel Survey 2002-2011 were used to examine expenditures (n = 346). Types of health insurance included private alone, Medicaid alone, and combined private and wrap-around Medicaid. Having Medicaid doubled the odds of reporting adequate insurance compared with private insurance alone (P < .0001), and children on Medicaid had the lowest out-of-pocket costs ($150, P < .0001). Children covered by combined private and wrap-around Medicaid had the highest total expenditures ($11 596, P < .05) and the highest expenditures paid by their insurance ($10 638, P < .05). These findings highlight a mismatch between parent ratings of insurance adequacy, child expenditures, and relative financial burden. Findings generate a number of questions to address within single sources of data. By elaborating the frameworks families use to judge the adequacy of their insurance, future research can develop policy strategies to improve both their satisfaction with their insurance coverage and the service use of children with autism. Copyright © 2016 by the American Academy of Pediatrics.

Patient-Centered Medical Home Features and Health Care Expenditures of Medicare Beneficiaries with Chronic Disease Dyads.

PubMed

Philpot, Lindsey M; Stockbridge, Erica L; Padrón, Norma A; Pagán, José A

2016-06-01

Three out of 4 Medicare beneficiaries have multiple chronic conditions, and managing the care of this growing population can be complex and costly because of care coordination challenges. This study assesses how different elements of the patient-centered medical home (PCMH) model may impact the health care expenditures of Medicare beneficiaries with the most prevalent chronic disease dyads (ie, co-occurring high cholesterol and high blood pressure, high cholesterol and heart disease, high cholesterol and diabetes, high cholesterol and arthritis, heart disease and high blood pressure). Data from the 2007-2011 Medical Expenditure Panel Survey suggest that increased access to PCMH features may differentially impact the distribution of health care expenditures across health care service categories depending on the combination of chronic conditions experienced by each beneficiary. For example, having no difficulty contacting a provider after regular hours was associated with significantly lower outpatient expenditures for beneficiaries with high cholesterol and diabetes (n = 635; P = 0.038), but it was associated with significantly higher inpatient expenditures for beneficiaries with high blood pressure and high cholesterol (n = 1599; P = 0.015), and no significant differences in expenditures in any category for beneficiaries with high blood pressure and heart disease (n = 1018; P > 0.05 for all categories). However, average total health care expenditures are largely unaffected by implementing the PCMH features considered. Understanding how the needs of Medicare beneficiaries with multiple chronic conditions can be met through the adoption of the PCMH model is important not only to be able to provide high-quality care but also to control costs. (Population Health Management 2016;19:206-211).

The economic burden of opioid prescription by dentists: A 12-month survey of consumer expenditure in Brazil.

PubMed

Nogueira, Tulio Eduardo; Lino, Patrícia Azevedo; Martins, Maria Auxiliadora Parreiras; Silva, Maria Elisa Souza; Leles, Claudio Rodrigues; Abreu, Mauro Henrique Nogueira Guimarães

2017-09-01

To describe consumer expenditure on opioids prescribed by dentists in Brazil during a 12-month period. We surveyed individual dispensed prescriptions of opioids in private pharmacies from October 2012 to September 2013. A descriptive analysis of costs included a calculation of the overall and mean maximum price to consumers. Monetary costs were converted from local currency units (Brazilian Real - BRL) to international dollars using purchasing power parity (PPP) exchanging rates. 129,708 prescriptions were retrieved from the database. The overall expenditure on opioids was R$4,316,383.46 BRL or $2,721,315.82 (PPP). The mean cost of an individual prescription was R$33.27 BRL ($20.98 PPP), ranging from 14.19 to 3,255.60 BRL. Codeine was frequently prescribed (87.2 percent). The expenditure on opioids is a significant cost to Brazilian patients, especially given that the Brazilian Public Health System should dispense these drugs free of charge. Codeine was the most prescribed opioid. © 2017 American Association of Public Health Dentistry.

Where the United States Spends its Spine Dollars: Expenditures on different ambulatory services for the management of back and neck conditions

PubMed Central

Davis, Matthew A.

2012-01-01

Study Design Serial, cross-sectional, nationally representative surveys of non-institutionalized adults. Objective To examine expenditures on common ambulatory health services for the management of back and neck conditions. Summary of Background Data Although it is well recognized that national costs associated with back and neck conditions have grown considerably in recent years, little is known about the costs of care for specific ambulatory health services that are used to manage this population. Methods We used the Medical Expenditure Panel Survey (MEPS) to examine adult (age ≥ 18 years) respondents from 1999 to 2008 who sought ambulatory health services for the management of back and neck conditions. We used complex survey design methods to make national estimates of mean inflation-adjusted annual expenditures on medical care, chiropractic care, and physical therapy per user for back and neck conditions. Results Approximately 6% of US adults reported an ambulatory visit for a primary diagnosis of a back or neck condition (13.6 million in 2008). Between 1999 and 2008, the mean inflation-adjusted annual expenditures on medical care for these patients increased by 95% (from $487 to $950); most of the increase was accounted for by increased costs for medical specialists, as opposed to primary care physicians. Over the study period, the mean inflation-adjusted annual expenditures on chiropractic care were relatively stable; while physical therapy was the most costly service overall, in recent years those costs have contracted. Conclusion Although this study did not explore the relative effectiveness of different ambulatory services, recent increasing costs associated with providing medical care for back and neck conditions (particularly subspecialty care) are contributing to the growing economic burden of managing these conditions. PMID:22433497

Household Expenditures on Private Tutoring: Emerging Evidence from Malaysia

ERIC Educational Resources Information Center

Kenayathulla, Husaina Banu

2013-01-01

Private tutoring has been a burgeoning phenomenon in Malaysia for decades. This study examines the determinants of private tutoring expenditures in Malaysia using the 2004/2005 Household Expenditures Survey and applies hurdle regression models to the data. The results indicate that total household expenditures, household head's level of education,…

Online and Social Media Data As an Imperfect Continuous Panel Survey

PubMed Central

2016-01-01

There is a large body of research on utilizing online activity as a survey of political opinion to predict real world election outcomes. There is considerably less work, however, on using this data to understand topic-specific interest and opinion amongst the general population and specific demographic subgroups, as currently measured by relatively expensive surveys. Here we investigate this possibility by studying a full census of all Twitter activity during the 2012 election cycle along with the comprehensive search history of a large panel of Internet users during the same period, highlighting the challenges in interpreting online and social media activity as the results of a survey. As noted in existing work, the online population is a non-representative sample of the offline world (e.g., the U.S. voting population). We extend this work to show how demographic skew and user participation is non-stationary and difficult to predict over time. In addition, the nature of user contributions varies substantially around important events. Furthermore, we note subtle problems in mapping what people are sharing or consuming online to specific sentiment or opinion measures around a particular topic. We provide a framework, built around considering this data as an imperfect continuous panel survey, for addressing these issues so that meaningful insight about public interest and opinion can be reliably extracted from online and social media data. PMID:26730933

Online and Social Media Data As an Imperfect Continuous Panel Survey.

PubMed

Diaz, Fernando; Gamon, Michael; Hofman, Jake M; Kıcıman, Emre; Rothschild, David

2016-01-01

There is a large body of research on utilizing online activity as a survey of political opinion to predict real world election outcomes. There is considerably less work, however, on using this data to understand topic-specific interest and opinion amongst the general population and specific demographic subgroups, as currently measured by relatively expensive surveys. Here we investigate this possibility by studying a full census of all Twitter activity during the 2012 election cycle along with the comprehensive search history of a large panel of Internet users during the same period, highlighting the challenges in interpreting online and social media activity as the results of a survey. As noted in existing work, the online population is a non-representative sample of the offline world (e.g., the U.S. voting population). We extend this work to show how demographic skew and user participation is non-stationary and difficult to predict over time. In addition, the nature of user contributions varies substantially around important events. Furthermore, we note subtle problems in mapping what people are sharing or consuming online to specific sentiment or opinion measures around a particular topic. We provide a framework, built around considering this data as an imperfect continuous panel survey, for addressing these issues so that meaningful insight about public interest and opinion can be reliably extracted from online and social media data.

The Impact of State Medical Malpractice Reform on Individual-Level Health Care Expenditures.

PubMed

Yu, Hao; Greenberg, Michael; Haviland, Amelia

2017-12-01

Past studies of the impact of state-level medical malpractice reforms on health spending produced mixed findings. Particularly salient is the evidence gap concerning the effect of different types of malpractice reform. This study aims to fill the gap. It extends the literature by examining the general population, not a subgroup or a specific health condition, and controlling for individual-level sociodemographic and health status. We merged the Database of State Tort Law Reforms with the Medical Expenditure Panel Survey between 1996 and 2012. We took a difference-in-differences approach to specify a two-part model for analyzing individual-level health spending. We applied the recycled prediction method and the bootstrapping technique to examining the difference in health spending growth between states with and without a reform. All expenditures were converted to 2010 U.S. dollars. Only two of the 10 major state-level malpractice reforms had significant impacts on the growth of individual-level health expenditures. The average annual expenditures in states with caps on attorney contingency fees increased less than that in states without the reform (p < .05). Compared with states with traditional contributory negligence rule, the average annual expenditures increased more in both states with a pure comparative fault reform (p < .05) and states with a comparative fault reform that barred recovery if the plaintiff's fault was equal to or greater than the defendant's (p < .05). A few state-level malpractice reforms had significantly affected the growth of individual-level health spending, and the direction and magnitude of the effects differed by type of reform. © Health Research and Educational Trust.

Has the Financial Protection Been Materialized in Iranian Health System? Analyzing Household Income and Expenditure Survey 2003-2014.

PubMed

Ghiasvand, Hesam; Olyaeemanesh, Alireza; Majdzadeh, Reza; Abdi, Zhaleh; Mobinizadeh, Mohammadreza

2018-01-03

The financial protection against catastrophic and impoverishing health expenditures is one of the main aspects of the universal health coverage. This study aimed to present a clear picture of the financial protection situation in Iran from 2003-2014. This is an analytical study on secondary data of Statistical Center of Iran (SCI). The study has some policy implications for policy makers; therefore, it is an applied one. Data related to the Iranian rural and urban household payments on health expenditures was obtained from annual surveys of the SCI. WHO researchers' approach was used to calculate the Fairness of Financial Contribution Indicator (FFCI), the headcount and overshoot ratios of catastrophic and impoverishing health expenditures. A logistic regression was conducted to identify the determinants of probability of occurrence of catastrophic health expenditure among Iranian households in 2014. The mean of FFCI for rural and urban households was 0.854 (0.41) and 0.867 (0.32), respectively. The average headcount ratios of catastrophic and impoverishing health expenditures were 1.32% (0.24) and 0.33% (P=0.006) for rural households and 1.4% (0.6) and 0.28% (P=0.001) for urban households. Concerning rural households, the overshoot of catastrophic and impoverishing health expenditures was 14.94% (P=0.001) and 7.22% (0.53); it was 15.59% (1.54) and 7.76% (0.52) for urban households. No significant and considerable change was found in the headcount ratios of catastrophic and impoverishing health expenditure and in their overshoot or gap amounts. This suggested a lack of well-designed and effective schemes for materializing the financial protection in Iran.

Health Literacy Impact on National Healthcare Utilization and Expenditure.

PubMed

Rasu, Rafia S; Bawa, Walter Agbor; Suminski, Richard; Snella, Kathleen; Warady, Bradley

2015-08-17

Health literacy presents an enormous challenge in the delivery of effective healthcare and quality outcomes. We evaluated the impact of low health literacy (LHL) on healthcare utilization and healthcare expenditure. Database analysis used Medical Expenditure Panel Survey (MEPS) from 2005-2008 which provides nationally representative estimates of healthcare utilization and expenditure. Health literacy scores (HLSs) were calculated based on a validated, predictive model and were scored according to the National Assessment of Adult Literacy (NAAL). HLS ranged from 0-500. Health literacy level (HLL) and categorized in 2 groups: Below basic or basic (HLS <226) and above basic (HLS ≥226). Healthcare utilization expressed as a physician, nonphysician, or emergency room (ER) visits and healthcare spending. Expenditures were adjusted to 2010 rates using the Consumer Price Index (CPI). A P value of 0.05 or less was the criterion for statistical significance in all analyses. Multivariate regression models assessed the impact of the predicted HLLs on outpatient healthcare utilization and expenditures. All analyses were performed with SAS and STATA® 11.0 statistical software. The study evaluated 22 599 samples representing 503 374 648 weighted individuals nationally from 2005-2008. The cohort had an average age of 49 years and included more females (57%). Caucasian were the predominant racial ethnic group (83%) and 37% of the cohort were from the South region of the United States of America. The proportion of the cohort with basic or below basic health literacy was 22.4%. Annual predicted values of physician visits, nonphysician visits, and ER visits were 6.6, 4.8, and 0.2, respectively, for basic or below basic compared to 4.4, 2.6, and 0.1 for above basic. Predicted values of office and ER visits expenditures were $1284 and $151, respectively, for basic or below basic and $719 and $100 for above basic (P < .05). The extrapolated national estimates show that the annual

Health Care Use, Health Behaviors, and Medical Conditions Among Individuals in Same-Sex and Opposite-Sex Partnerships: A Cross-Sectional Observational Analysis of the Medical Expenditures Panel Survey (MEPS), 2003-2011.

PubMed

Blosnich, John R; Hanmer, Janel; Yu, Lan; Matthews, Derrick D; Kavalieratos, Dio

2016-06-01

Prior research documents disparities between sexual minority and nonsexual minority individuals regarding health behaviors and health services utilization. However, little is known regarding differences in the prevalence of medical conditions. To examine associations between sexual minority status and medical conditions. We conducted multiple logistic regression analyses of the Medical Expenditure Panel Survey (2003-2011). We identified individuals who reported being partnered with an individual of the same sex, and constructed a matched cohort of individuals in opposite-sex partnerships. A total of 494 individuals in same-sex partnerships and 494 individuals in opposite-sex partnerships. Measures of health risk (eg, smoking status), health services utilization (eg, physician office visits), and presence of 15 medical conditions (eg, cancer, diabetes, arthritis, HIV, alcohol disorders). Same-sex partnered men had nearly 4 times the odds of reporting a mood disorder than did opposite-sex partnered men [adjusted odds ratio (aOR)=3.96; 95% confidence interval (CI), 1.85-8.48]. Compared with opposite-sex partnered women, same-sex partnered women had greater odds of heart disease (aOR=2.59; 95% CI, 1.19-5.62), diabetes (aOR=2.75; 95% CI, 1.10-6.90), obesity (aOR=1.92; 95% CI, 1.26-2.94), high cholesterol (aOR=1.89; 95% CI, 1.03-3.50), and asthma (aOR=1.90; 95% CI, 1.02-1.19). Even after adjusting for sociodemographics, health risk behaviors, and health conditions, individuals in same-sex partnerships had 67% increased odds of past-year emergency department utilization and 51% greater odds of ≥3 physician visits in the last year compared with opposite-sex partnered individuals. A combination of individual-level, provider-level, and system-level approaches are needed to reduce disparities in medical conditions and health care utilization among sexual minority individuals.

National Trends in Direct Health Care Expenditures Among US Adults With Migraine: 2004 to 2013.

PubMed

Raval, Amit D; Shah, Anal

2017-01-01

Migraine is a common neurological disorder with significant economic burden in the United States. However, changes in the economic burden of migraine in the past decade have not been examined considering therapeutic advances at the national level. Therefore, we estimated cross-sectional trends in the incremental total and types of direct health care expenditures among individuals with migraine using nationally representative data, the Medical Expenditures Panel Survey. The analytic sample was comprised of an annually weighted population of 228,010,000 adults aged 18 years and older from 2004 to 2013. Two-part models were used to estimate the incremental total and types of annual direct health care expenditures (adjusted to 2013 US dollars) among individuals with migraine after adjusting for predisposing, enabling, need, personal health practice, and external environment factors selected on the basis of the Anderson Healthcare Behavior Model. The unadjusted average annual total health care expenditure for individuals with migraine was $8,033 (standard error [SE] = $292) which comprised major proportions of outpatient ($2,952, SE = $128), prescription drugs ($2,207, SE = $91), and inpatient ($1,784, SE = $178) expenditures. Individuals with migraine had $866 (SE = $298) and $1,519 (SE = $400) greater adjusted annual total direct health care expenditures in 2004/2005 and 2012/2013 compared with those without migraine. However, those with migraine in 2012/2013 did not have significant changes in the total direct health care expenditures compared with those having migraine in 2004/2005 (changes: -$330, SE = $480). The estimated adjusted incremental total direct health care expenditures for individuals with migraine was approximately $9.20 billion per year compared with those without migraine. Although annual incremental total direct health care expenditures among individuals with migraine did not change significantly from 2004 to 2013, expenditures

Does government expenditure reduce inequalities in infant mortality rates in low- and middle-income countries?: A time-series, ecological analysis of 48 countries from 1993 to 2013.

PubMed

Baker, Peter; Hone, Thomas; Reeves, Aaron; Avendano, Mauricio; Millett, Christopher

2018-06-27

Inequalities in infant mortality rates (IMRs) are rising in some low- and middle-income countries (LMICs) and decreasing in others, but the explanation for these divergent trends is unclear. We investigate whether government expenditures and redistribution are associated with reductions in inequalities in IMRs. We estimated country-level fixed-effects panel regressions for 48 LMICs (142 country observations). Slope and Relative Indices of Inequality in IMRs (SII and RII) were calculated from Demographic and Health Surveys between 1993 and 2013. RII and SII were regressed on government expenditure (total, health and non-health) and redistribution, controlling for gross domestic product (GDP), private health expenditures, a democracy indicator, country fixed effects and time. Mean SII and RII was 39.12 and 0.69, respectively. In multivariate models, a 1 percentage point increase in total government expenditure (% of GDP) was associated with a decrease in SII of -2.468 [95% confidence intervals (CIs): -4.190, -0.746] and RII of -0.026 (95% CIs: -0.048, -0.004). Lower inequalities were associated with higher non-health government expenditure, but not higher government health expenditure. Associations with inequalities were non-significant for GDP, government redistribution, and private health expenditure. Understanding how non-health government expenditure reduces inequalities in IMR, and why health expenditures may not, will accelerate progress towards the Sustainable Development Goals.

Redesign of the Pollution Abatement Costs and Expenditures (PACE) Survey: Findings and Recommendations from Pretest and Follow-up; and MA-200 Survey and Instructions (2006)

EPA Pesticide Factsheets

First phase: redesigning the survey included three key activities 1) consultation with an expert panel,2) on-site visits with four facilities; and 3) one-on-one interviews. Second phase included a pretest and pilot of the 2004 PACE survey form and guidance

Association between local government social expenditures and mortality levels in Korea.

PubMed

Ko, Hansoo; Kim, Jinseob; Kim, Donggil; Kim, Saerom; Park, Yukyung; Kim, Chang-yup

2013-01-01

We examined the association between social expenditures of the local government and the mortality level in Korea, 2004 to 2010. We used social expenditure data of 230 local governments during 2004 to 2010 from the Social Expenditure Database prepared by the Korean Institute for Health and Social Affairs. Fixed effect panel data regression analysis was adopted to look for associations between social expenditures and age-standardized mortality and the premature death index. Social expenditures of local governments per capita was not significantly associated with standardized mortality but was associated with the premature death index (decline of 1.0 [for males] and 0.5 [for females] for each expenditure of 100 000 Korean won, i.e., approximately 100 US dollar). As an index of the voluntary effort of local governments, the self-managed project ratio was associated with a decline in the standardized mortality in females (decline of 0.4 for each increase of 1%). The share of health care was not significant. There were associations between social expenditures of the local government and the mortality level in Korea. In particular, social expenditures per capita were significantly associated with a decline in premature death. However, the voluntary efforts of local governments were not significantly related to the decline in premature death.

Health care expenditure in the Islamic Republic of Iran versus other high spending countries

PubMed Central

Khosravi, Bahman; Soltani, Shahin; Javan-Noughabi, Javad; Faramarzi, Ahmad

2017-01-01

Background: In all countries, health expenditures are a main part of government expenditure, and governments try to find policies and strategies to reduce this expenditure. Overall expenditure index has been raised 30 times during the past 20 years in Iran, while in the health sector, the growth in health expenditures index has been 71 times. The present study aimed at examining health care expenditure in the Islamic Republic of Iran versus other high spending countries. Methods: A comparative panel study was conducted in selected countries with the high mean of health expenditure per capita. Data were collected from the WORLD BANK. Out- of- pocket (OOP), health expenditure per capita, public and private health expenditure, and total health expenditure were compared among the selected counties. Results: Iran has the lowest health expenditure per capita compared to other countries and the USA has the highest health expenditures per capita. In Iran, out- of- pocket expenditure, with more than 50%, was the most cost, while in Luxembourg it was the least cost during 2004 to 2014, with less than 12%. Conclusion: Our findings revealed that politicians and health care executives should find a stable source to finance the health system. Stable sources of financing lead to having a steady trend in health expenditure. PMID:29445700

Health care expenditure in the Islamic Republic of Iran versus other high spending countries.

PubMed

Khosravi, Bahman; Soltani, Shahin; Javan-Noughabi, Javad; Faramarzi, Ahmad

2017-01-01

Background: In all countries, health expenditures are a main part of government expenditure, and governments try to find policies and strategies to reduce this expenditure. Overall expenditure index has been raised 30 times during the past 20 years in Iran, while in the health sector, the growth in health expenditures index has been 71 times. The present study aimed at examining health care expenditure in the Islamic Republic of Iran versus other high spending countries. Methods: A comparative panel study was conducted in selected countries with the high mean of health expenditure per capita. Data were collected from the WORLD BANK. Out- of- pocket (OOP), health expenditure per capita, public and private health expenditure, and total health expenditure were compared among the selected counties. Results: Iran has the lowest health expenditure per capita compared to other countries and the USA has the highest health expenditures per capita. In Iran, out- of- pocket expenditure, with more than 50%, was the most cost, while in Luxembourg it was the least cost during 2004 to 2014, with less than 12%. Conclusion: Our findings revealed that politicians and health care executives should find a stable source to finance the health system. Stable sources of financing lead to having a steady trend in health expenditure.

[Out-of-pocket health care expenditures among population groups in Iceland].

PubMed

Vilhjálmsson, Rúnar

2009-10-01

Out-of-pocket health expenditures affect access to health care. The study investigated trends in these expenditures, and whether certain population groups spent more than others. The data come from two national health surveys among Icelandic adults from 1998 and 2006. The response rate was 69% in the former survey (N=1924), and 60% in the latter (N= 1532). Average household health expenditures and household expenditure burden (expenditures as % of total household income) were compared over time and between groups. Household health expenditures increased by 29% in real terms between 1998 and 2006. The biggest items in 2006 were drugs and dental care. Women, younger and older individuals, the single and divorced, smaller households, the unemployed and non-employed, individuals with low education and income, the chronically ill, and the disabled, had the highest household expenditure burden. Comparison between 1998 and 2006 indicated increased expenditure burden among young people, students, the unemployed, and the least educated, but decreased burden among the elderly, the widowed, and parents of young children. Household health expenditures differ substantially between groups, suggesting reconsideration of current health insurance policies, especially with regard to disabled, non-employed, low-income, and young individuals.

What drives public health care expenditure growth? Evidence from Swiss cantons, 1970-2012.

PubMed

Braendle, Thomas; Colombier, Carsten

2016-09-01

A better understanding of the determinants of public health care expenditures is key to designing effective health policies. We integrate demand and supply-side determinants and factors from political economy into an empirical analysis of the highly decentralized Swiss health care system and control for major health care finance reforms. We compile a novel data set of the cantonal health care expenditure in Switzerland, which currently amounts to about one fifth of total health care expenditure. We analyze the period 1970-2012 and use dynamic panel estimation methods. We find that per capita income, the unemployment rate and the share of foreigners are positively related to public health care expenditure growth. With regard to political economy aspects, public health care expenditures increase with the share of women elected to parliament. However, institutional restrictions for politicians, such as fiscal rules, do not appear to limit public health care expenditure growth. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Healthcare expenditures and patient satisfaction: cost and quality from the consumer's perspective in the US.

PubMed

Fu, Alex Z; Wang, Nan

2008-05-01

Both cost and quality of healthcare are major concerns in the United States. Using patient satisfaction as a quality indicator, we seek to identify the relationship between healthcare cost and quality from the perspective of the community-dwelling population in the United States. We examined a nationally representative sample of 13,980 adults (age >or= 18 years) in the 2003 Medical Expenditure Panel Survey (MEPS). Given the idiosyncrasies of the cost data distribution, a recently developed extended estimating equation (EEE) model was employed to identify the relationship between patient satisfaction and healthcare expenditure, after controlling for individual demographic covariates, co-morbidity profile, and functional and activity limitations. A series of sensitivity analyses were conducted, in addition, to verify the identified relationship. All statistics were adjusted using the proper sampling weight from the MEPS data. Average annual healthcare expenditures for 2003 ranged between $3923 and $6073 when grouped by patient satisfaction ratings with a mean value $4779 for all individuals who rated perceived satisfaction of their healthcare. We found that there is no statistically significant relationship between patient satisfaction and total healthcare expenditure (p = 0.60) and a non-monotonic relationship is not identified either. All sensitivity analyses results revealed a lack of relationship between patient satisfaction and healthcare expenditures. Patient satisfaction might not reflect the quality of healthcare from an objective clinical standpoint. The identified cost-satisfaction relationship may not be extrapolated to other quality indicators. Due to the cross-sectional study design, no causal relationship could be inferred between patient satisfaction and healthcare expenditure. Our study adds to the literature on health care cost and quality by suggesting that the improvement of patient satisfaction may not require additional health care spending.

HMO selection and Medicare costs: Bayesian MCMC estimation of a robust panel data tobit model with survival.

PubMed

Hamilton, B H

1999-08-01

The fraction of US Medicare recipients enrolled in health maintenance organizations (HMOs) has increased substantially over the past 10 years. However, the impact of HMOs on health care costs is still hotly debated. In particular, it is argued that HMOs achieve cost reduction through 'cream-skimming' and enrolling relatively healthy patients. This paper develops a Bayesian panel data tobit model of HMO selection and Medicare expenditures for recent US retirees that accounts for mortality over the course of the panel. The model is estimated using Markov Chain Monte Carlo (MCMC) simulation methods, and is novel in that a multivariate t-link is used in place of normality to allow for the heavy-tailed distributions often found in health care expenditure data. The findings indicate that HMOs select individuals who are less likely to have positive health care expenditures prior to enrollment. However, there is no evidence that HMOs disenrol high cost patients. The results also indicate the importance of accounting for survival over the panel, since high mortality probabilities are associated with higher health care expenditures in the last year of life.

Heterogeneity in the Effect of Common Shocks on Healthcare Expenditure Growth.

PubMed

Hauck, Katharina; Zhang, Xiaohui

2016-09-01

Healthcare expenditure growth is affected by important unobserved common shocks such as technological innovation, changes in sociological factors, shifts in preferences, and the epidemiology of diseases. While common factors impact in principle all countries, their effect is likely to differ across countries. To allow for unobserved heterogeneity in the effects of common shocks, we estimate a panel data model of healthcare expenditure growth in 34 OECD countries over the years 1980 to 2012, where the usual fixed or random effects are replaced by a multifactor error structure. We address model uncertainty with Bayesian model averaging, to identify a small set of robust expenditure drivers from 43 potential candidates. We establish 16 significant drivers of healthcare expenditure growth, including growth in GDP per capita and in insurance premiums, changes in financing arrangements and some institutional characteristics, expenditures on pharmaceuticals, population ageing, costs of health administration, and inpatient care. Our approach allows us to provide robust evidence to policy makers on the drivers that were most strongly associated with the growth in healthcare expenditures over the past 32 years. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Assessing the need for a new nationally representative household panel survey in the United States

PubMed Central

Moffitt, Robert; Schoeni, Robert F.; Brown, Charles; Chase-Lansdale, P. Lindsay; Couper, Mick P.; Diez-Roux, Ana V.; Hurst, Erik; Seltzer, Judith A.

2015-01-01

We introduce this special issue on the critical matter of whether the existing household panel surveys in the U.S. are adequate to address the important emerging social science and policy questions of the next few decades. We summarize the conference papers which address this issue in different domains. The papers detail many new and important emerging research questions but also identify key limitations in existing panels in addressing those questions. To address these limitations, we consider the advantages and disadvantages of initiating a new, general-purpose omnibus household panel in the U.S. We also discuss the particular benefits of starting new panels that have specific targeted domains such as child development, population health and health care. We also develop a list of valuable enhancements to existing panels which could address many of their limitations. PMID:26688609

78 FR 76285 - Proposed Information Collection; Comment Request; Panel Member Survey To Develop Indicators of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-17

... Collection; Comment Request; Panel Member Survey To Develop Indicators of Resilient Coastal Tourism AGENCY... survey is to better understand the factors that shape the tourism industry's ability to adapt to or.... resiliency) in order to develop a set of indicators to measure the resiliency of coastal tourism. To help...

The relationship between gambling expenditure, socio-demographics, health-related correlates and gambling behaviour-a cross-sectional population-based survey in Finland.

PubMed

Castrén, Sari; Kontto, Jukka; Alho, Hannu; Salonen, Anne H

2018-01-01

To investigate gambling expenditure and its relationship with socio-demographics, health-related correlates and past-year gambling behaviour. Cross-sectional population survey. Population-based survey in Finland. Finnish people aged 15-74 years drawn randomly from the Population Information System. The participants in this study were past-year gamblers with gambling expenditure data available (n = 3251, 1418 women and 1833 men). Expenditure shares, means of weekly gambling expenditure (WGE, €) and monthly gambling expenditure as a percentage of net income (MGE/NI, %) were calculated. The correlates used were perceived health, smoking, mental health [Mental Health Inventory (MHI)-5], alcohol use [Alcohol Use Disorders Identification Test (AUDIT)-C], game types, gambling frequency, gambling mode and gambling severity [South Oaks Gambling Screen (SOGS)]. Gender (men versus women) was found to be associated significantly with gambling expenditure, with exp(β) = 1.40, 95% confidence interval (CI) = 1.29, 1.52 and P < 0.005 for WGE, and exp(β) = 1.39, 95% CI = 1.27, 1.51 and P < 0.005 for MGE/NI. All gambling behaviour correlates were associated significantly with WGE and MGE/NI: gambling frequency (several times a week versus once a month/less than monthly, exp(β) = 30.75, 95% CI = 26.89, 35.17 and P < 0.005 for WGE, and exp(β) = 31.43, 95% CI = 27.41, 36.03 and P < 0.005 for MGE/NI), gambling severity (probable pathological gamblers versus non-problem gamblers, exp(β) = 2.83, 95% CI = 2.12, 3.77 and P < 0.005 for WGE, and exp(β) = 2.67, 95% CI = 2.00, 3.57 and P < 0.005 for MGE/NI) and on-line gambling (on-line and land-based versus land-based only, exp(β) = 1.35, 95% CI = 1.24, 1.47 and P < 0.005 for WGE, and exp(β) = 1.35, 95% CI = 1.24, 1.47 and P < 0.005 for MGE/NI). In Finland, male gender is associated significantly with both weekly gambling expenditure and monthly gambling expenditure related to net income. People in Finland with lower

[Catastrophic health expenditures in Mexico: magnitude, distribution and determinants].

PubMed

Sesma-Vázquez, Sergio; Pérez-Rico, Raymundo; Sosa-Manzano, Carlos Lino; Gómez-Dantés, Octavio

2005-01-01

To describe the magnitude, distribution, and determinants of catastrophic health expenditures in Mexico. The information source was the National Performance Assessment Survey and the methodology, the one developed by the World Health Organization for assessing fair financing. Households with catastrophic expenditures were defined as those with health expenditures over 30% of their ability to pay. Multivariate analysis by logistic and linear regression were used to identify the determinants of catastrophic expenditures. A total of 3.8% of the households incurred in catastrophic health expenditures. There were huge differences by state. The uninsured, poor, and rural households showed a higher impoverishment risk. Sixty percent of the catastrophic expenditures were attributable to outpatient care and medication. A 10% increase of insured households could result in a 9.6% decrease in catastrophic expenditures. Disability, adults 60 years of age and older, and pregnancy increased the probability of catastrophic expenditures. The insurance of older adults, pregnant women, and persons with disabilities could reduce catastrophic health expenditures in Mexico.

Persons with Mental Retardation and Related Conditions in Mental Retardation Facilities: Selected Findings from the 1987 National Medical Expenditure Survey. Project Report 29.

ERIC Educational Resources Information Center

Lakin, K. Charlie; And Others

This report presents statistics on residential facilities for the mentally retarded and on the residents themselves, derived from the Institutional Population Component of the 1987 National Medical Expenditure Survey (NMES). Part 1 presents an overview of the NMES and discusses previous efforts to survey persons residing in mental retardation…

Social class related inequalities in household health expenditure and economic burden: evidence from Kerala, south India

PubMed Central

2011-01-01

Background In the Indian context, a household's caste characteristics are most relevant for identifying its poverty and vulnerability status. Inadequate provision of public health care, the near-absence of health insurance and increasing dependence on the private health sector have impoverished the poor and the marginalised, especially the scheduled tribe population. This study examines caste-based inequalities in households' out-of-pocket health expenditure in the south Indian state of Kerala and provides evidence on the consequent financial burden inflicted upon households in different caste groups. Methods Using data from a 2003-2004 panel survey in Kottathara Panchayat that collected detailed information on health care consumption from 543 households, we analysed inequality in per capita out-of-pocket health expenditure across castes by considering households' health care needs and types of care utilised. We used multivariate regression to measure the caste-based inequality in health expenditure. To assess health expenditure burden, we analysed households incurring high health expenses and their sources of finance for meeting health expenses. Results The per capita health expenditures reported by four caste groups accord with their status in the caste hierarchy. This was confirmed by multivariate analysis after controlling for health care needs and influential confounders. Households with high health care needs are more disadvantaged in terms of spending on health care. Households with high health care needs are generally at higher risk of spending heavily on health care. Hospitalisation expenditure was found to have the most impoverishing impacts, especially on backward caste households. Conclusion Caste-based inequality in household health expenditure reflects unequal access to quality health care by different caste groups. Households with high health care needs and chronic health care needs are most affected by this inequality. Households in the most

Estimating population food and nutrient exposure: a comparison of store survey data with household panel food purchases.

PubMed

Eyles, Helen; Neal, Bruce; Jiang, Yannan; Ni Mhurchu, Cliona

2016-05-28

Population exposure to food and nutrients can be estimated from household food purchases, but store surveys of foods and their composition are more available, less costly and might provide similar information. Our aim was to compare estimates of nutrient exposure from a store survey of packaged food with those from household panel food purchases. A cross-sectional store survey of all packaged foods for sale in two major supermarkets was undertaken in Auckland, New Zealand, between February and May 2012. Longitudinal household food purchase data (November 2011 to October 2012) were obtained from the nationally representative, population-weighted New Zealand Nielsen HomeScan® panel. Data on 8440 packaged food and non-alcoholic beverage products were collected in the store survey. Food purchase data were available for 1229 households and 16 812 products. Store survey data alone produced higher estimates of exposure to Na and sugar compared with estimates from household panel food purchases. The estimated mean difference in exposure to Na was 94 (95 % CI 72, 115) mg/100 g (20 % relative difference; P<0·01), to sugar 1·6 (95 % CI 0·8, 2·5) g/100 g (11 %; P<0·01), to SFA -0·3 (95 % CI -0·8, 0·3) g/100 g (6 %; P=0·3) and to energy -18 (-71, 35) kJ/100 g (2 %; P=0·51). Compared with household panel food purchases, store survey data provided a reasonable estimate of average population exposure to key nutrients from packaged foods. However, caution should be exercised in using such data to estimate population exposure to Na and sugar and in generalising these findings to other countries, as well as over time.

Expenditures on Children by Families: 2001 Annual Report.

ERIC Educational Resources Information Center

Lino, Mark

Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 2001 dollars using the Consumer Price Index. Data and…

Expenditures on Children by Families: 2002 Annual Report.

ERIC Educational Resources Information Center

Lino, Mark

Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 2002 dollars using the Consumer Price Index. Data and…

Expenditures on Children by Families: 1999 Annual Report.

ERIC Educational Resources Information Center

Lino, Mark

Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 1999 dollars using the Consumer Price Index. Data and…

Expenditures on Children by Families: 1997 Annual Report.

ERIC Educational Resources Information Center

Lino, Mark

Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 1997 dollars using the Consumer Price Index. Data and…

Expenditures on Children by Families: 1998 Annual Report.

ERIC Educational Resources Information Center

Lino, Mark

Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 1998 dollars using the Consumer Price Index. Data and…

Expenditures on Children by Families: 2000 Annual Report.

ERIC Educational Resources Information Center

Lino, Mark

Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 2000 dollars using the Consumer Price Index. Data and…

Selection of key financial indicators: a literature, panel and survey approach.

PubMed

Pink, George H; Daniel, Imtiaz; Hall, Linda McGillis; McKillop, Ian

2007-01-01

Since 1998, most hospitals in Ontario have voluntarily participated in one of the largest and most ambitious publicly available performance-reporting initiatives in the world. This article describes the method used to select key financial indicators for inclusion in the report including the literature review, panel and survey approaches that were used. The results for five years of recent data for Ontario hospitals are also presented.

Testing for Statistical Discrimination by Race/Ethnicity in Panel Data for Depression Treatment in Primary Care

PubMed Central

McGuire, Thomas G; Ayanian, John Z; Ford, Daniel E; Henke, Rachel E M; Rost, Kathryn M; Zaslavsky, Alan M

2008-01-01

Objective To test for discrimination by race/ethnicity arising from clinical uncertainty in treatment for depression, also known as “statistical discrimination.” Data Sources We used survey data from 1,321 African-American, Hispanic, and white adults identified with depression in primary care. Surveys were administered every six months for two years in the Quality Improvement for Depression (QID) studies. Study Design To examine whether and how change in depression severity affects change in treatment intensity by race/ethnicity, we used multivariate cross-sectional and change models that difference out unobserved time-invariant patient characteristics potentially correlated with race/ethnicity. Data Collection/Extraction Methods Treatment intensity was operationalized as expenditures on drugs, primary care, and specialty services, weighted by national prices from the Medical Expenditure Panel Survey. Patient race/ethnicity was collected at baseline by self-report. Principal Findings Change in depression severity is less associated with change in treatment intensity in minority patients than in whites, consistent with the hypothesis of statistical discrimination. The differential effect by racial/ethnic group was accounted for by use of mental health specialists. Conclusions Enhanced physician–patient communication and use of standardized depression instruments may reduce statistical discrimination arising from clinical uncertainty and be useful in reducing racial/ethnic inequities in depression treatment. PMID:18370966

Annual Report on Children's Health Care: Dental and Orthodontic Utilization and Expenditures for Children, 2010-2012.

PubMed

Berdahl, Terceira; Hudson, Julie; Simpson, Lisa; McCormick, Marie C

2016-01-01

To examine general dental and orthodontic utilization and expenditures by health insurance status, public health insurance eligibility, and sociodemographic characteristics among children aged 0 to 17 years using data from 2010-2012. Nationally representative data from the Medical Expenditure Panel Survey (2010-2012) provided data on insurance status, public health insurance eligibility, and visits to dental providers for both general dental care and orthodontic care. Overall, 41.9% of US children reported an annual dental office-based visit for general (nonorthodontic) dental care. Fewer Hispanic (34.7%) and non-Latino black children (34.8%) received dental care compared to non-Hispanic whites (47.3%) and Asians (40.3%). Children living in families with the lowest income were also the least likely to have a visit (32.9%) compared to children in the highest-income families (54.7%). Among children eligible for public coverage, Medicaid-eligible children had the lowest percentage of preventive dental visits (29.2%). Socioeconomic and racial/ethnic disparities in use and expenditures for orthodontic care are much greater than those for general and preventive dental care. Average expenditures for orthodontic care were $1,823, of which 56% ($1,023) was paid out of pocket by families. Our findings provide a baseline assessment for examining trends in the future, especially as coverage patterns for children may change as the Affordable Care Act is implemented and the future of the State Child Health Insurance Program remains uncertain beyond 2017. Published by Elsevier Inc.

The contributions of family care-givers at end of life: A national post-bereavement census survey of cancer carers' hours of care and expenditures.

PubMed

Rowland, Christine; Hanratty, Barbara; Pilling, Mark; van den Berg, Bernard; Grande, Gunn

2017-04-01

Family members provide vital care at end of life, enabling patients to remain at home. Such informal care contributes significantly to the economy while supporting patients' preferences and government policy. However, the value of care-givers' contributions is often underestimated or overlooked in evaluations. Without information on the activities and expenditures involved in informal care-giving, it is impossible to provide an accurate assessment of carers' contribution to end-of-life care. The aim of this study was to investigate the contributions and expenditure of informal, family care-giving in end-of-life cancer care. A national census survey of English cancer carers was conducted. Survey packs were mailed to 5271 people who registered the death of a relative to cancer during 1-16 May 2015. Data were collected on decedents' health and situation, care support given, financial expenditure resulting from care, carer well-being and general background information. In all, 1504 completed surveys were returned (28.5%). Over 90% of respondents reported spending time on care-giving in the last 3 months of the decedent's life, contributing a median 69 h 30 min of care-giving each week. Those who reported details of expenditure (72.5%) spent a median £370 in the last 3 months of the decedent's life. Carers contribute a great deal of time and money for day-to-day support and care of patients. This study has yielded a unique, population-level data set of end-of-life care-giving and future analyses will provide estimates of the economic value of family care-givers' contributions.

The utility of online panel surveys versus computer-assisted interviews in obtaining substance-use prevalence estimates in the Netherlands.

PubMed

Spijkerman, Renske; Knibbe, Ronald; Knoops, Kim; Van De Mheen, Dike; Van Den Eijnden, Regina

2009-10-01

Rather than using the traditional, costly method of personal interviews in a general population sample, substance-use prevalence rates can be derived more conveniently from data collected among members of an online access panel. To examine the utility of this method, we compared the outcomes of an online survey with those obtained with the computer-assisted personal interviews (CAPI) method. Data were gathered from a large sample of online panellists and in a two-stage stratified sample of the Dutch population using the CAPI method. The Netherlands. Participants  The online sample comprised 57 125 Dutch online panellists (15-64 years) of Survey Sampling International LLC (SSI), and the CAPI cohort 7204 respondents (15-64 years). All participants answered identical questions about their use of alcohol, cannabis, ecstasy, cocaine and performance-enhancing drugs. The CAPI respondents were asked additionally about internet access and online panel membership. Both data sets were weighted statistically according to the distribution of demographic characteristics of the general Dutch population. Response rates were 35.5% (n = 20 282) for the online panel cohort and 62.7% (n = 4516) for the CAPI cohort. The data showed almost consistently lower substance-use prevalence rates for the CAPI respondents. Although the observed differences could be due to bias in both data sets, coverage and non-response bias were higher in the online panel survey. Despite its economic advantage, the online panel survey showed stronger non-response and coverage bias than the CAPI survey, leading to less reliable estimates of substance use in the general population. © 2009 The Authors. Journal compilation © 2009 Society for the Study of Addiction.

Family Formation Processes: Assessing the Need for a New Nationally Representative Household Panel Survey in the United States

PubMed Central

Manning, Wendy D.

2015-01-01

The American family has undergone rapid transformation. Careful measurement attention to family formation is important because families are at the heart of numerous decisions, roles, and responsibilities with implications for understanding the well-being of families, adults and children. This paper considers whether there is a need for a new household panel study that addresses family formation. This paper consists of a review of the recent body of population-based, American surveys and finds a considerable gap in the ability to study the implications of families for the health and well-being of Americans. Earlier panel surveys used to assess family life anchored questions around marital events, but changes in family patterns require attention to a more diverse set of family forms. The paper concludes with recommendations for a multi-purpose panel study. The key challenge is to keep to pace with complexity and changes in American family life while at the same time maintaining a parsimonious set of survey questions. PMID:26612969

Cumulative incidence, distribution, and determinants of catastrophic health expenditure in Nepal: results from the living standards survey.

PubMed

Ghimire, Mamata; Ayer, Rakesh; Kondo, Masahide

2018-02-14

Nepal has committed to the global community to achieve universal health coverage by 2030. Nevertheless, Nepal still has a high proportion of out-of-pocket health payment and a limited risk-pooling mechanism. Out-of-pocket payment for the healthcare services could result in catastrophic health expenditure (CHE). Evidence is required to effectively channel the efforts to lower those expenses in order to achieve universal health coverage. However, little is known about CHE and its determinants in a broad national context in Nepal. Therefore, this study was conducted to explore the cumulative incidence, distribution, and determinants of CHE in Nepal. Data were obtained from the nationally representative survey, the Nepal Living Standards Survey-third undertaken in 2010/11. Information from 5988 households was used for the analyses. Households were classified as having CHE when their out-of-pocket health payment was greater than or equal to 40% of their capacity to pay. Remaining households were classified as not having CHE. Logistic regression analyses were used to identify determinants of CHE. Based on household-weighted sample, the cumulative incidence of CHE was 10.3% per month in Nepal. This incidence was concentrated in the far-western region and households in the poorer expenditure quartiles. Multivariable logistic regression revealed that households were more likely to face CHE if they; consisted of chronically ill member(s), have a higher burden of acute illness and injuries, have elderly (≥60 years) member(s), belonged to the poor expenditure quartile, and were located in the far-western region. In contrast, households were less likely to incur CHE when their household head was educated. Having children (≤5 years) in households did not significantly affect catastrophic health expenditure. This study identified a high cumulative incidence of CHE. CHE was disproportionately concentrated in the poor households and households located in the far

Catastrophic expenditure on medicines in Brazil

PubMed Central

Luiza, Vera Lucia; Tavares, Noemia Urruth Leão; Oliveira, Maria Auxiliadora; Arrais, Paulo Sergio Dourado; Ramos, Luiz Roberto; Pizzol, Tatiane da Silva Dal; Mengue, Sotero Serrate; Farias, Mareni Rocha; Bertoldi, Andréa Dâmaso

2016-01-01

ABSTRACT OBJECTIVE To describe the magnitude of the expenditure on medicines in Brazil according to region, household size and composition in terms of residents in a situation of dependency. METHODS Population-based data from the national household survey were used, with probabilistic sample, applied between September 2013 and February 2014 in urban households. The expenditure on medicines was the main outcome of interest. The prevalence and confidence intervals (95%CI) of the outcomes were stratified according to socioeconomic classification and calculated according to the region, the number of residents dependent on income, the presence of children under five years and residents in a situation of dependency by age. RESULTS In about one of every 17 households (5.3%) catastrophic health expenditure was reported and, in 3.2%, the medicines were reported as one of the items responsible for this situation. The presence of three or more residents (3.6%) and resident in a situation of dependency (3.6%) were the ones that most reported expenditure on medicines. Southeast was the region with the lowest prevalence of expenditure on medicines. The prevalence of households with catastrophic health expenditure and on medicines in relation to the total of households showed a regressive tendency for economic classes. CONCLUSIONS Catastrophic health expenditure was present in 5.3%, and catastrophic expenditure on medicines in 3.2% of the households. Multi-person households, presence of residents in a situation of economic dependency and belonging to the class D or E had the highest proportion of catastrophic expenditure on medicines. Although the problem is important, permeated by aspects of iniquity, Brazilian policies seem to be protecting families from catastrophic expenditure on health and on medicine. PMID:27982383

Catastrophic health expenditure and impoverishment in Mongolia.

PubMed

Dorjdagva, Javkhlanbayar; Batbaatar, Enkhjargal; Svensson, Mikael; Dorjsuren, Bayarsaikhan; Kauhanen, Jussi

2016-07-11

The social health insurance coverage is relatively high in Mongolia; however, escalation of out-of-pocket payments for health care, which reached 41 % of the total health expenditure in 2011, is a policy concern. The aim of this study is to analyse the incidence of catastrophic health expenditures and to measure the rate of impoverishment from health care payments under the social health insurance scheme in Mongolia. We used the data from the Household Socio-Economic Survey 2012, conducted by the National Statistical Office of Mongolia. Catastrophic health expenditures are defined an excess of out-of-pocket payments for health care at the various thresholds for household total expenditure (capacity to pay). For an estimate of the impoverishment effect, the national and The Wold Bank poverty lines are used. About 5.5 % of total households suffered from catastrophic health expenditures, when the threshold is 10 % of the total household expenditure. At the threshold of 40 % of capacity to pay, 1.1 % of the total household incurred catastrophic health expenditures. About 20,000 people were forced into poverty due to paying for health care. Despite the high coverage of social health insurance, a significant proportion of the population incurred catastrophic health expenditures and was forced into poverty due to out-of-pocket payments for health care.

Household energy consumption and expenditures 1993

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1995-10-05

This presents information about household end-use consumption of energy and expenditures for that energy. These data were collected in the 1993 Residential Energy Consumption Survey; more than 7,000 households were surveyed for information on their housing units, energy consumption and expenditures, stock of energy-consuming appliances, and energy-related behavior. The information represents all households nationwide (97 million). Key findings: National residential energy consumption was 10.0 quadrillion Btu in 1993, a 9% increase over 1990. Weather has a significant effect on energy consumption. Consumption of electricity for appliances is increasing. Houses that use electricity for space heating have lower overall energy expendituresmore » than households that heat with other fuels. RECS collected data for the 4 most populous states: CA, FL, NY, TX.« less

What drives health care expenditure?--Baumol's model of 'unbalanced growth' revisited.

PubMed

Hartwig, Jochen

2008-05-01

The share of health care expenditure in GDP rises rapidly in virtually all OECD countries, causing increasing concern among politicians and the general public. Yet, economists have to date failed to reach an agreement on what the main determinants of this development are. This paper revisits Baumol's [Baumol, W.J., 1967. Macroeconomics of unbalanced growth: the anatomy of urban crisis. American Economic Review 57 (3), 415-426] model of 'unbalanced growth', showing that the latter offers a ready explanation for the observed inexorable rise in health care expenditure. The main implication of Baumol's model in this context is that health care expenditure is driven by wage increases in excess of productivity growth. This hypothesis is tested empirically using data from a panel of 19 OECD countries. Our tests yield robust evidence in favor of Baumol's theory.

A Comparative Analysis of Information on National Industrial R&D Expenditures. Special Report.

ERIC Educational Resources Information Center

Burke, Mary V.

The National Science Foundation (NSF) annually publishes information generated by its survey of research and development (R&D) expenditures by United States industry. These data are collected for NSF by the U.S. Bureau of the Census. Other organizations also publish information on industrial R&D expenditures collected by surveys or derived…

Validating self-reported food expenditures against food store and eating-out receipts.

PubMed

Tang, W; Aggarwal, A; Liu, Z; Acheson, M; Rehm, C D; Moudon, A V; Drewnowski, A

2016-03-01

To compare objective food store and eating-out receipts with self-reported household food expenditures. The Seattle Obesity Study II was based on a representative sample of King County adults, Washington, USA. Self-reported household food expenditures were modeled on the Flexible Consumer Behavior Survey (FCBS) Module from 2007 to 2009 National Health and Nutrition Examination Survey (NHANES). Objective food expenditure data were collected using receipts. Self-reported food expenditures for 447 participants were compared with receipts using paired t-tests, Bland-Altman plots and κ-statistics. Bias by sociodemographics was also examined. Self-reported expenditures closely matched with objective receipt data. Paired t-tests showed no significant differences between receipts and self-reported data on total food expenditures, expenditures at food stores or eating out. However, the highest-income strata showed weaker agreement. Bland-Altman plots confirmed no significant bias across both methods-mean difference: 6.4; agreement limits: -123.5 to 143.4 for total food expenditures, mean difference 5.7 for food stores and mean difference 1.7 for eating out. The κ-statistics showed good agreement for each (κ 0.51, 0.41 and 0.49 respectively. Households with higher education and income had significantly more number of receipts and higher food expenditures. Self-reported food expenditures using NHANES questions, both for food stores and eating out, serve as a decent proxy for objective household food expenditures from receipts. This method should be used with caution among high-income populations, or with high food expenditures. This is the first validation of the FCBS food expenditures question using food store and eating-out receipts.

Validating self-reported food expenditures against food store and eating-out receipts

PubMed Central

Tang, Wesley; Aggarwal, Anju; Liu, Zhongyuan; Acheson, Molly; Rehm, Colin D; Moudon, Anne Vernez; Drewnowski, Adam

2015-01-01

Objectives To compare objective food store and eating-out receipts with self-reported household food expenditures. Design and setting The Seattle Obesity Study (SOS II) was based on a representative sample of King County adults, Washington, USA. Self-reported household food expenditures were modeled on the Flexible Consumer Behavior Survey (FCBS) Module from 2007–2009 National Health and Nutrition Examination Survey (NHANES). Objective food expenditure data were collected using receipts. Self-reported food expenditures for 447 participants were compared to receipts using paired t-tests, Bland-Altman plots, and kappa statistics. Bias by socio-demographics was also examined. Results Self-reported expenditures closely matched with objective receipt data. Paired t-tests showed no significant differences between receipts and self-reported data on total food expenditures, expenditures at food stores, or eating out. However, the highest income strata showed weaker agreement. Bland Altman plots confirmed no significant bias across both methods - mean difference: 6.4; agreement limits: −123.5, 143.4 for total food expenditures, mean difference 5.7 for food stores, and mean difference 1.7 for eating-out. Kappa statistics showed good agreement for each (kappa 0.51, 0.41 and 0.49 respectively. Households with higher education and income had significantly more number of receipts and higher food expenditures. Conclusion Self-reported food expenditures using NHANES questions, both for food stores and eating-out, serve as a decent proxy for objective household food expenditures from receipts. This method should be used with caution among high income populations, or with high food expenditures. This is the first validation of the FCBS food expenditures question using food store and eating-out receipts. PMID:26486299

Expenditures on family dental care by active duty soldiers.

PubMed

Chisick, M C

1996-01-01

Expenditures on family dental care by U.S. active duty soldiers were explored in this 1992 worldwide survey. Of 9,560 respondents (62% response rate), 7,187 claimed dependents and 5,569 provided reliable data. Mean annual expenditures and multinomial regression on a distribution of expenditures were calculated. Results show average family dental care expenditures were as follows: total sample, $135; childless couples, $59; couples with children, $154; and single parents, $120. Between 72 and 83% of families spent $0 on dental care. Excluding non-spenders, overall expenditures averaged as follows: total sample, $531; childless couples, $354; couples with children, $560; and single parents, $470. Regression results show that expenditures on family dental care by soldiers are influenced by different factors depending on family composition. Policy measures to encourage optimal dental care by families of active duty soldiers should focus on increasing insurance coverage and use.

Income and Expenditures of Arizona Postsecondary Students.

ERIC Educational Resources Information Center

Erbschloe, R. Ross; And Others

Results of a spring 1983 survey of the sources and amounts of income, the expenditures, and the background characteristics of Arizona postsecondary students are presented. Survey questionnaires were sent to 4,821 randomly selected students at 36 schools, and 1,694 usable responses were obtained. The responses were cross-analyzed by four…

Income elasticity of health expenditures in Iran.

PubMed

Zare, Hossein; Trujillo, Antonio J; Leidman, Eva; Buttorff, Christine

2013-09-01

Because of its policy implications, the income elasticity of health care expenditures is a subject of much debate. Governments may have an interest in subsidizing the care of those with low income. Using more than two decades of data from the Iran Household Expenditure and Income Survey, this article investigates the relationship between income and health care expenditure in urban and rural areas in Iran, a resource rich, upper-middle-income country. We implemented spline and quantile regression techniques to obtain a more robust description of the relationship of interest. This study finds non-uniform effects of income on health expenditures. Although the results show that health care is a necessity for all income brackets, spline regression estimates indicate that the income elasticity is lowest for the poorest Iranians in urban and rural areas. This suggests that they will show low flexibility in medical expenses as income fluctuates. Further, a quantile regression model assessing the effect of income at different level of medical expenditure suggests that households with lower medical expenses are less elastic.

Annual direct health care expenditures and employee absenteeism costs in high-risk, low-income mothers with major depression.

PubMed

Ammerman, Robert T; Chen, Jie; Mallow, Peter J; Rizzo, John A; Folger, Alonzo T; Van Ginkel, Judith B

2016-01-15

To determine the health care and labor productivity costs associated with major depressive disorder in high-risk, low-income mothers. This study was conducted using the 1996-2011 Medical Expenditure Panel Survey (MEPS). The MEPS is a nationally-representative database that includes information on health care utilization and expenditures for the civilian, non-institutionalized population in the United States. High-risk mothers were between the ages of 18-35 years, and either unmarried, receiving Medicaid, or with incomes less than 300% of the Federal Poverty Level. Mothers were categorized as being depressed if they had an ICD-9 diagnosis code of 296 or 311 (N=2310) or not depressed (N=18,221). Insurer expenditures, out-of-pocket (OOP) expenses, and lost wage earnings were calculated. After controlling for comorbidities, demographics, region, and year, high-risk depressed mothers were more likely to incur insurer (0.84 vs. 0.79) and OOP expenses (0.84 vs. 0.81) and to have higher insurer ($4448 vs. $3072) and OOP expenses ($794 vs. $523). Depression significantly increased the likelihood of missing work days (OR=1.40; p<0.01). Depression increased overall direct health care expenditures by $1.89 billion (range=$1.28-$2.60 billion) and indirect costs by $523 million annually, with a range of $353-$719 million. In this high-risk population, the direct and indirect aggregate costs of depression-related to health care expenditures and lost work productivity were substantial. These findings establish a quantifiable cost for policy makers and highlight the need to target this population for prevention and treatment efforts. Copyright © 2015 Elsevier B.V. All rights reserved.

Impact of Illness and Medical Expenditure on Household Consumptions: A Survey in Western China

PubMed Central

Fang, Kuangnan; Jiang, Yefei; Shia, BenChang; Ma, Shuangge

2012-01-01

Background The main goal of this study is to examine the associations between illness conditions and out-of-pocket medical expenditure with other types of household consumptions. In November and December of 2011, a survey was conducted in three cities in western China, namely Lan Zhou, Gui Lin and Xi An, and their surrounding rural areas. Results Information on demographics, income and consumption was collected on 2,899 households. Data analysis suggested that the presence of household members with chronic diseases was not associated with characteristics of households or household heads. The presence of inpatient treatments was significantly associated with the age of household head (p-value 0.03). The level of per capita medical expense was significantly associated with household size, presence of members younger than 18, older than 65, basic health insurance coverage, per capita income, and household head occupation. Adjusting for confounding effects, the presence of chronic diseases was negatively associated with the amount of basic consumption (p-value 0.02) and the percentage of basic consumption (p-value 0.01), but positively associated with the percentage of insurance expense (p-value 0.02). Medical expenditure was positively associated with all other types of consumptions, including basic, education, saving and investment, entertainment, insurance, durable goods, and alcohol/tobacco. It was negatively associated with the percentage of basic consumption, saving and investment, and insurance. Conclusions Early studies conducted in other Asian countries and rural China found negative associations between illness conditions and medical expenditure with other types of consumptions. This study was conducted in three major cities and surrounding areas in western China, which had not been well investigated in published literature. The observed consumption patterns were different from those in early studies, and the negative associations were not observed. This

Measuring the Displacement and Replacement of Government Health Expenditure

PubMed Central

Dieleman, Joseph L; Hanlon, Michael

2014-01-01

Research assessing the relationship between government health expenditure and development assistance for health channeled to governments (DAHG) has not considered that this relationship may depend on whether DAHG is increasing or decreasing. We explore this issue using general method of moments estimation and a panel of financial flows data spanning 119 countries and 16 years. Our primary concern is how DAHG affects government health expenditure as source (GHES). We disaggregate the average effect of DAHG and separately identify the effects of increases versus decreases in DAHG. We find that a $1 year-over-year increase in DAHG leads to a $0.62 (90% confidence interval (CI): 0.15, 1.09) decrease in GHES, whereas a $1 year-over-year decrease in DAHG does not have an effect on GHES that is statistically different from zero (CI: −0.67, 1.17). Simulation shows that the displacement of GHES between 1995 and 2010 reduced total government health expenditure by $152.8 billion (CI: 46.9, 277.6). Moreover, the irregular disbursement of DAHG reduced total government expenditure by $96.9 billion (CI: 0.5, 212.4). Thus, this research shows that health aid is fungible and highlights the cost of displacement and erratic aid disbursement. PMID:24327240

Medical expenditure and unmet need of the pre-elderly and the elderly according to job status in Korea: Are the elderly indeed most vulnerable?

PubMed Central

Lee, Hwa-Young; Kondo, Naoki

2018-01-01

Increase in the elderly population and early retirement imposes immense economic burden on societies. Previous studies on the association between medical expenditure and working status in the elderly population have not adequately addressed reverse causality problem. In addition, the pre-elderly group has hardly been discussed in this regard. This study assessed possible causal association between employment status and medical expenditure as well as employment status and medical unmet needs in a representative sample of the Korean elderly (aged≧65) and the pre-elderly (aged ≧50 and < 65) adults from the Korea Health Panel Data (KHP). Dynamic panel Generalized Method of Moments (GMM) estimation was employed for the analysis of medical expenditure to address reverse causality, and fixed effect panel logistic regression was used for the analysis of unmet need. The results showed no significant association between job status and medical expenditure in the elderly, but a negative and significant influence on the level of medical expenditure in the pre-elderly. Unemployment was a significant determinant of lowering unmet need from lack of time while it was not associated with unmet need from financial burden in the fixed-effect panel model for both the elderly and pre-elderly groups. The pre-elderly adults were more likely to reduce necessary health service utilization due to unemployment compared to the elderly group because there is no proper financial safety net for the pre-elderly, which may cause non-adherence to treatment and therefore lead to negative health effects. The policy dialogue on safety net currently centers only on the elderly, but should be extended to the pre-elderly population. PMID:29570736

Health Insurance Dynamics: Methodological Considerations and a Comparison of Estimates from Two Surveys.

PubMed

Graves, John A; Mishra, Pranita

2016-10-01

To highlight key methodological issues in studying insurance dynamics and to compare estimates across two commonly used surveys. Nonelderly uninsured adults and children sampled between 2001 and 2011 in the Medical Expenditure Panel Survey and the Survey of Income and Program Participation. We utilized nonparametric Kaplan-Meier methods to estimate quantiles (25th, 50th, and 75th percentiles) in the distribution of uninsured spells. We compared estimates obtained across surveys and across different methodological approaches to address issues like attrition, seam bias, censoring and truncation, and survey weighting method. All data were drawn from publicly available household surveys. Estimated uninsured spell durations in the MEPS were longer than those observed in the SIPP. There were few changes in spell durations between 2001 and 2011, with median durations of 14 months among adults and 5-7 months among children in the MEPS, and 8 months (adults) and 4 months (children) in the SIPP. The use of panel survey data to study insurance dynamics presents a unique set of methodological challenges. Researchers should consider key analytic and survey design trade-offs when choosing which survey can best suit their research goals. © Health Research and Educational Trust.

Determinants of catastrophic health expenditure in Nigeria.

PubMed

Aregbeshola, Bolaji Samson; Khan, Samina Mohsin

2018-05-01

Catastrophic health expenditure is a measure of financial risk protection and it is often incurred by households who have to pay out of pocket for health care services that are not affordable. The study assessed the determinants of catastrophic health expenditure among households in Nigeria. Secondary data from the Harmonized Nigeria Living Standard Survey (HNLSS) of 2009/10 was utilized to assess factors associated with catastrophic health expenditure in Nigeria. Household and individual characteristics associated with catastrophic health expenditure were determined using bivariate analysis and multivariate logistic regression. Results showed that irrespective of the threshold for the two concepts of total household expenditure and non-food expenditure, having household members aged between 6 and 14 years, having household members aged between 15 and 24 years, having household members aged between 25 and 54 years, having no education, having primary education, having secondary education, lack of health insurance coverage, visiting a private health facility, households living in north central zone, households living in north east zone and having household members with non-chronic illnesses were factors that increase the risk of incurring catastrophic health expenditure among households. Policy-makers and political actors need to design equitable health financing policies that will increase financial risk protection for people in both the formal and informal sectors of the economy.

The temporal association of excessive health expenditure with suicidal ideation among primary income earners: a cross-sectional design using the Korean Welfare Panel Survey (KoWePS)

PubMed Central

Shin, Jaeyong; Choi, Jae Woo; Jang, Sung-in; Choi, Young; Lee, Sang Gyu; Ihm, Tae Hwan; Park, Eun-Cheol

2015-01-01

Objective Excessive health expenditure (EHE) is a global issue for households suffering from high-cost medical conditions, low incomes and limited insurance coverage. After the international financial crisis of 2008, EHE became a social problem in developed countries. Such economic crisis might induce severe mental stress, resulting in suicidal ideation. Methods We used the Korean Welfare Panel Study (KoWePS) from 2011 to 2013 and selected primary income earners, who were defined as practical and economic representatives of households; the total number of analysed samples was 4247 of 5717 households in the database. We only included households that had never experienced EHE before 2011. To examine the temporal relationship between EHE and suicidal ideation, we conducted a logistic regression analysis. Results Among 4247 participants, 146 (3.4%) experienced suicidal ideation, whereas 4101 (96.6%) did not. One scale of depression score (OR=1.28, CI 1.23 to 1.34, p<0.001) was associated with increased suicidal ideation. Such ideation was influenced to a greater extent by a recent EHE above 10% of disposable income (OR=1.91, CI 1.16 to 3.15, p=0.012) than by either a remote EHE (OR=1.29, CI 0.71 to 2.32) or one in 2011 and 2012 (OR=1.67, CI 1.01 to 2.78, p=0.048). Conclusions In this study, more recent EHE resulted in more suicidal ideation. In conclusion, we suggest that recent household EHE might be considered as an important factor to prevent suicidal ideation and to improve the mental health of individuals. PMID:26082463

Medicine and democracy: The importance of institutional quality in the relationship between health expenditure and health outcomes in the MENA region.

PubMed

Bousmah, Marwân-Al-Qays; Ventelou, Bruno; Abu-Zaineh, Mohammad

2016-08-01

Evidence suggests that the effect of health expenditure on health outcomes is highly context-specific and may be driven by other factors. We construct a panel dataset of 18 countries from the Middle East and North Africa region for the period 1995-2012. Panel data models are used to estimate the macro-level determinants of health outcomes. The core finding of the paper is that increasing health expenditure leads to health outcomes improvements only to the extent that the quality of institutions within a country is sufficiently high. The sensitivity of the results is assessed using various measures of health outcomes as well as institutional variables. Overall, it appears that increasing health care expenditure in the MENA region is a necessary but not sufficient condition for health outcomes improvements. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

United States Port Development Expenditure Report

DOT National Transportation Integrated Search

2001-12-01

This report is the eleventh in a series of reports that continues the capital expenditure survey first begun by the Port Authority of New York and New Jersey in 1956. Subsequent reports were published by the American Association of Port Authorities (...

Access to care and medicines, burden of health care expenditures, and risk protection: results from the World Health Survey.

PubMed

Wagner, Anita K; Graves, Amy Johnson; Reiss, Sheila K; Lecates, Robert; Zhang, Fang; Ross-Degnan, Dennis

2011-05-01

We assessed the contribution of health insurance and a functioning public sector to access to care and medicines and household economic burden. We used descriptive and logistic regression analyses on 2002/3 World Health Survey data in 70 countries. Across countries, 286,803 households and 276,362 respondents contributed data. More than 90% of households had access to acute care. However, less than half of respondents with a chronic condition reported access. In 51 low and middle income countries (LMIC), health care expenditures accounted for 13-32% of total 4-week household expenditures. One in four poor households in low income countries incurred potentially catastrophic health care expenses and more than 40% used savings, borrowed money, or sold assets to pay for care. Between 41% and 56% of households in LMIC spent 100% of health care expenditures on medicines. Health insurance and a functioning public sector were both associated with better access to care and lower risk of economic burden. To improve access, policy makers should improve public sector provision of care, increase health insurance coverage, and expand medicines benefit policies in health insurance systems. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Illness, medical expenditure and household consumption: observations from Taiwan

PubMed Central

2013-01-01

Background Illness conditions lead to medical expenditure. Even with various types of medical insurance, there can still be considerable out-of-pocket costs. Medical expenditure can affect other categories of household consumptions. The goal of this study is to provide an updated empirical description of the distributions of illness conditions and medical expenditure and their associations with other categories of household consumptions. Methods A phone-call survey was conducted in June and July of 2012. The study was approved by ethics review committees at Xiamen University and FuJen Catholic University. Data was collected using a Computer-Assisted Telephone Survey System (CATSS). “Household” was the unit for data collection and analysis. Univariate and multivariate analyses were conducted, examining the distributions of illness conditions and the associations of illness and medical expenditure with other household consumptions. Results The presence of chronic disease and inpatient treatment was not significantly associated with household characteristics. The level of per capita medical expenditure was significantly associated with household size, income, and household head occupation. The presence of chronic disease was significantly associated with levels of education, insurance and durable goods consumption. After adjusting for confounders, the associations with education and durable goods consumption remained significant. The presence of inpatient treatment was not associated with consumption levels. In the univariate analysis, medical expenditure was significantly associated with all other consumption categories. After adjusting for confounding effects, the associations between medical expenditure and the actual amount of entertainment expenses and percentages of basic consumption, savings, and insurance (as of total consumption) remained significant. Conclusion This study provided an updated description of the distributions of illness conditions and

Using Comparative Expenditure Data for Institutional Planning. SAIR Conference Paper.

ERIC Educational Resources Information Center

Sanford, Timothy R.; Sadler, James C.

The use of Higher Education General Information Survey (HEGIS) data and a software program to compare public university expenditures is discussed. Financial expenditures at the University of North Carolina, Chapel Hill, (UNC) and other public universities were compared using 1981-1982 and 1982-1983 HEGIS data for public university members of the…

Making sense of the labor market height premium: Evidence from the British Household Panel Survey.

PubMed

Case, Anne; Paxson, Christina; Islam, Mahnaz

2009-03-01

We use data from the British Household Panel Survey to examine the labor market premium in height. Most of the premium is explained by higher average educational attainment and sorting into higher-status occupations and industries by those who are taller.

Expenditures of medicine use in hypertensive/diabetic elderly and physical activity and engagement in walking: cross secctional analysis of SABE Survey.

PubMed

Bueno, Denise Rodrigues; de Fátima Nunes Marucci, Maria; Gobbo, Luis Alberto; de Almeida-Roediger, Manuela; de Oliveira Duarte, Yeda Aparecida; Lebrão, Maria Lucia

2017-03-20

The literature shows the inverse association between physical activity level (PAL) and chronic diseases that have a significant burden over health care costs. However, in upper-middle income countries and in elderly population this information are scarce. To describe the annual drug expenditures for the hypertensive and diabetic elderly population in Brazil and to analyze the association with PAL and engagement in walking. This cross sectional study is part of SABE Survey and comprised 806 hypertensive and/or diabetic elderly (≥60 years old). The annual expenditures of medicine use was estimated for all medications for hypertension and/or diabetes they were taking. The PAL was considered insufficient when moderate physical activity was <150 min/week or vigorous physical activity was < 75 min/week. Engagement in walking was considered by at least 1 day a week. All expenditures were presented through the descriptive values (in American Dollars US$) according PAL and engagement in walking. The association analysis between annual expenditures, PAL and engagement in walking were performed by multiple logistic regression models adjusted for gender, age and body mass index. The average annual cost was higher in diabetic and insufficient physically activity elderly. The 1-year estimated.cost was US$ 73386,09 and 295% higher in insufficiently physically active. Older people who reported not walking had a higher risk to higher annual expenditures of medicine use (OR = 1.57, 95% CI 1.03-2.40). The annual expenditures of medicine use for controlling hypertension and diabetes of Brazilian elderly were higher and inversely associated with physical activity level and engagement in walking.

Profile of and expenditure on morbidity and hospitalizations among elderly-Analysis of a nationally representative sample survey in India.

PubMed

Jeyashree, Kathiresan; Suliankatchi Abdulkader, Rizwan; Kathirvel, Soundappan; Chinnakali, Palanivel; Kumar Mv, Ajay

2018-01-01

Understanding morbidity pattern and associated expenditure is essential for implementation of appropriate healthcare and social security measures for the elderly. This study aims to assess the proportion of ailing persons (PAP) in the last 15days, the utilization of hospitalization services in the last 365days and the expenditure incurred for hospitalizations among the elderly in India. This study analysed data from a nationally representative survey by the National Sample Survey Office (NSSO) in 2014-15 on 36,480 rural and 29,452 urban households. Distribution of morbidity and in-patient health care utilisation were analysed by subgroups of sex, residence, wealth quintile and type of health care provider. All estimates were weighted to account for the complex sampling design. Among 27,245 elderly persons, 30.3% reported having suffered an ailment in the past 15days and 8% reported at least one hospitalisation episode in the last 365days. All quintiles, except the lowest, utilized private sector more than the public sector for hospitalisations. The distribution of PAP (Concentration Index (CI)=+0.11; +0.07,+0.15) and the utilization of hospitalisation services (CI=+0.18; +0.11,+0.25) were found to be significantly pro-rich. The median (IQR) expenditure on hospitalization was INR 7370 (2600, 18,060). The wealthiest quintile spent 3.1 times more than the poorest quintile on hospitalisation. Efforts to reduce inequity among elderly persons in health status and healthcare utilization should be integral to any strategy targeting achievement of third sustainable development goal- "ensuring healthy lives and promoting well-being for all at all ages". Copyright © 2017 Elsevier B.V. All rights reserved.

United States Port Development Expenditure Report

DOT National Transportation Integrated Search

1997-10-01

This report is the seventh edition in a series of reports that continues the capital expenditure survey first begun by the Port Authority of New York and New Jersey in 1956. Subsequent reports were published by the American Association of Port Author...

United States Port Development Expenditure Report

DOT National Transportation Integrated Search

2000-12-01

This report is the tenth in a series of reports that continues the capital expenditure survey first begun by the Port Authority of New York and New Jersey in 1956. Subsequent reports were published by the American Association of Port Authorities (AAP...

Medical Care Expenditures and Earnings Losses Among Persons With Arthritis and Other Rheumatic Conditions in 2003, and Comparisons With 1997

PubMed Central

Yelin, Edward; Murphy, Louise; Cisternas, Miriam G.; Foreman, Aimee J.; Pasta, David J.; Helmick, Charles G.

2010-01-01

Objective To obtain estimates of medical care expenditures and earnings losses associated with arthritis and other rheumatic conditions and the increment in such costs attributable to arthritis and other rheumatic conditions in the US in 2003, and to compare these estimates with those from 1997. Methods Estimates for 2003 were derived from the Medical Expenditures Panel Survey (MEPS), a national probability sample of households. We tabulated medical care expenditures of adult MEPS respondents, stratified by arthritis and comorbidity status, and used regression techniques to estimate the increment of medical care expenditures attributable to arthritis and other rheumatic conditions. We also estimated the earnings losses sustained by working-age adults with arthritis and other rheumatic conditions. Estimates for 2003 were compared with those from 1997, inflated to 2003 terms. Results In 2003, there were 46.1 million adults with arthritis and other rheumatic conditions (versus 36.8 million in 1997). Adults with arthritis and other rheumatic conditions incurred mean medical care expenditures of $6,978 in 2003 (versus $6,346 in 1997), of which $1,635 was for prescriptions ($899 in 1997). Expenditures for adults with arthritis and other rheumatic conditions totaled $321.8 billion in 2003 ($233.5 billion in 1997). In 2003, the mean increment in medical care expenditures attributable to arthritis and other rheumatic conditions was $1,752 ($1,762 in 1997), for a total of $80.8 billion ($64.8 billion in 1997). Persons with arthritis and other rheumatic conditions ages 18–64 years earned $3,613 less than other persons (versus $4,551 in 1997), for a total of $108.0 billion (versus $99.0 billion). Of this amount, $1,590 was attributable to arthritis and other rheumatic conditions (versus $1,946 in 1997), for a total of $47.0 billion ($43.3 billion in 1997). Conclusion Our findings indicate that the increase in medical care expenditures and earnings losses between 1997 and

Comparing Twitter and Online Panels for Survey Recruitment of E-Cigarette Users and Smokers

PubMed Central

Kim, Annice; Murphy, Joe; Bradfield, Brian; Nonnemaker, James; Hsieh, Yuli

2016-01-01

Background E-cigarettes have rapidly increased in popularity in recent years, driven, at least in part, by marketing and word-of-mouth discussion on Twitter. Given the rapid proliferation of e-cigarettes, researchers need timely quantitative data from e-cigarette users and smokers who may see e-cigarettes as a cessation tool. Twitter provides an ideal platform for recruiting e-cigarette users and smokers who use Twitter. Online panels offer a second method of accessing this population, but they have been criticized for recruiting too few young adults, among whom e-cigarette use rates are highest. Objective This study compares effectiveness of recruiting Twitter users who are e-cigarette users and smokers who have never used e-cigarettes via Twitter to online panelists provided by Qualtrics and explores how users recruited differ by demographics, e-cigarette use, and social media use. Methods Participants were adults who had ever used e-cigarettes (n=278; male: 57.6%, 160/278; age: mean 34.26, SD 14.16 years) and smokers (n=102; male: 38.2%, 39/102; age: mean 42.80, SD 14.16 years) with public Twitter profiles. Participants were recruited via online panel (n=190) or promoted tweets using keyword targeting for e-cigarette users (n=190). Predictor variables were demographics (age, gender, education, race/ethnicity), e-cigarette use (eg, past 30-day e-cigarette use, e-cigarette puffs per day), social media use behaviors (eg, Twitter use frequency), and days to final survey completion from survey launch for Twitter versus panel. Recruitment method (Twitter, panel) was the dependent variable. Results Across the total sample, participants were recruited more quickly via Twitter (incidence rate ratio=1.30, P=.02) than panel. Compared with young adult e-cigarette users (age 18-24 years), e-cigarette users aged 25 to 34 years (OR 0.01, 95% CI 0.00-0.60, P=.03) and 35 to 44 years (OR 0.01, 95% CI 0.00-0.51, P=.02) were more likely to be recruited via Twitter than panel

The Impact of HbA1c Testing on Total Annual Healthcare Expenditures Among Newly Diagnosed Patients with Diabetes.

PubMed

Bhounsule, Prajakta; Peterson, Andrew M

2015-09-01

In 2010, diabetes was the seventh leading cause of death in the United States. Diabetes also imposes a huge financial burden on the US economy. In 2009, the American Diabetes Association International Expert Committee recommended the use of the glycated hemoglobin (HbA1c) test as a uniform diagnostic measure to identify patients with diabetes. Although HbA1c is a convenient diagnostic test, it is also more expensive than older tests and could, therefore, have an impact on patients' healthcare expenditures. To determine if HbA1c testing has an impact on total annual healthcare expenditures among newly diagnosed patients with diabetes and to analyze the factors that are associated with the total healthcare expenditures among diabetic patients before and after HbA1c was implemented as a standard diagnostic factor. This was an observational, retrospective, cross-sectional study. The Medical Expenditure Panel Survey-Household Component 2009 and 2011 databases were used to form the study cohort of patients with diabetes. The total mean healthcare expenditures among patients with diabetes formed the dependent variable. A proxy variable representing a diagnosis of diabetes with and without the use of HbA1c testing in 2009 and in 2011, respectively, formed the main independent variable along with demographic factors, comorbidities, and healthcare services utilization in both years. A generalized linear regression was conducted to determine the association of HbA1c testing with total diabetes-related healthcare expenditures. The mean total healthcare expenditure decreased in 2011 compared with 2009. The HbA1c test did not show an association with the total healthcare expenditures versus earlier diabetes-related diagnostic factors. The total expenditures were associated with private insurance, the incidence of a previous heart attack, prescription drug refills, inpatient hospital stays, home care, hospital discharges, and visits to outpatient providers and physicians in both

Methodological issues using household budget survey expenditure data for individual food availability estimation: Irish experience in the DAFNE pan-European project. DAta Food NEtworking.

PubMed

Friel, S; Nelson, M; McCormack, K; Kelleher, C; Thriskos, P

2001-10-01

Irish participation in the EU-supported DAta Food NEtworking (DAFNE) project required compliance with the overall aims and objectives. The Irish Household Budget Survey (HBS) expenditure data had to be transformed into a format compatible with the collaborative effort, by converting them into quantities of foodstuffs available per person per day. The Irish 1987 HBS expenditure data on all commodities for 7705 households in the Republic of Ireland, collected using a 14-day diary kept by all members of the household aged 15 years and over. Following identification of 188 food items in the HBS dataset, retail prices per unit weight were sought for each food. Adjustment of prices, collected from a number of different sources, was made to those of 1987 using the Consumer Price Index. Simple models were used to estimate household food availability through application of the adjusted retail prices per unit weight to the expenditure data. The household level data were converted to food availability per person per day. An internal validation of quantities estimated using the retail prices was made using the 12 foodstuffs for which the Irish HBS collects expenses and quantities. The comparison of quantities published by the Irish Central Statistics Office for 12 foodstuffs in the Irish 1987 Household Budget Survey with the quantities estimated using equivalent expenditure data and corresponding retail prices showed agreement, with less than a 10% margin of error for 10 of the foods. In spite some difficulty in converting HBS food expenditure data into food availability per person per day, the DAFNE approach is potentially useful for Irish nutrition surveillance purposes and for facilitating comparisons of the Irish HBS food data with those of other European countries.

Cross-Sectional and Panel Data Analyses of an Incompletely Observed Variable Derived from the Nonrandomized Method for Surveying Sensitive Questions

ERIC Educational Resources Information Center

Yamaguchi, Kazuo

2016-01-01

This article describes (1) the survey methodological and statistical characteristics of the nonrandomized method for surveying sensitive questions for both cross-sectional and panel survey data and (2) the way to use the incompletely observed variable obtained from this survey method in logistic regression and in loglinear and log-multiplicative…

Can the health insurance reforms stop an increase in medical expenditures for middle- and old-aged persons in Japan?

PubMed

Matsuura, Tamie; Sasaki, Masaru

2012-06-01

Using two-period panel data from the Nippon Life Insurance Research Institute, this paper tests the hypothesis that an increase in the self-pay ratio of medical expenditures associated with the Japanese health insurance reforms of April 2003 reduced household medical expenditures. We find that the increase in the self-pay ratio had a positive but insignificant effect on the share of medical expenses in household expenditure. However, when we employ the data as repeated cross-sectional observations to increase the sample size, the increase in the self-pay ratio has a significantly positive effect on the share of medical expenditures. This provides corroborating evidence that middle- and old-aged persons were unable to reduce their demand for medical services with the increase in the self-pay ratio. An additional finding is that medical services are a necessary good, particularly for those aged 61 years or older and those with medical expenditures accounting for a relatively high share of medical expenditures in high household expenditure.

Effects of Energy Needs and Expenditures on U.S. Public Schools. Statistical Analysis Report.

ERIC Educational Resources Information Center

Smith, Timothy; Porch, Rebecca; Farris, Elizabeth; Fowler, William

This report provides national estimates on energy needs and expenditures of U.S. public school districts. The survey provides estimates of Fiscal Year (FY) 2000 energy expenditures, FY 2001 energy budgets and expenditures, and FY 2002 energy budgets; methods used to cover energy budget shortfalls in FY 2001; and possible reasons for those…

Measuring the displacement and replacement of government health expenditure.

PubMed

Dieleman, Joseph L; Hanlon, Michael

2014-02-01

Research assessing the relationship between government health expenditure and development assistance for health channeled to governments (DAHG) has not considered that this relationship may depend on whether DAHG is increasing or decreasing. We explore this issue using general method of moments estimation and a panel of financial flows data spanning 119 countries and 16 years. Our primary concern is how DAHG affects government health expenditure as source (GHES). We disaggregate the average effect of DAHG and separately identify the effects of increases versus decreases in DAHG. We find that a $1 year-over-year increase in DAHG leads to a $0.62 (90% confidence interval (CI): 0.15, 1.09) decrease in GHES, whereas a $1 year-over-year decrease in DAHG does not have an effect on GHES that is statistically different from zero (CI: -0.67, 1.17). Simulation shows that the displacement of GHES between 1995 and 2010 reduced total government health expenditure by $152.8 billion (CI: 46.9, 277.6). Moreover, the irregular disbursement of DAHG reduced total government expenditure by $96.9 billion (CI: 0.5, 212.4). Thus, this research shows that health aid is fungible and highlights the cost of displacement and erratic aid disbursement. © 2013 The Authors. Health Economics published by John Wiley & Sons, Ltd.

[Study on correction of data bias caused by different missing mechanisms in survey of medical expenditure among students enrolling in Urban Resident Basic Medical Insurance].

PubMed

Zhang, Haixia; Zhao, Junkang; Gu, Caijiao; Cui, Yan; Rong, Huiying; Meng, Fanlong; Wang, Tong

2015-05-01

The study of the medical expenditure and its influencing factors among the students enrolling in Urban Resident Basic Medical Insurance (URBMI) in Taiyuan indicated that non response bias and selection bias coexist in dependent variable of the survey data. Unlike previous studies only focused on one missing mechanism, a two-stage method to deal with two missing mechanisms simultaneously was suggested in this study, combining multiple imputation with sample selection model. A total of 1 190 questionnaires were returned by the students (or their parents) selected in child care settings, schools and universities in Taiyuan by stratified cluster random sampling in 2012. In the returned questionnaires, 2.52% existed not missing at random (NMAR) of dependent variable and 7.14% existed missing at random (MAR) of dependent variable. First, multiple imputation was conducted for MAR by using completed data, then sample selection model was used to correct NMAR in multiple imputation, and a multi influencing factor analysis model was established. Based on 1 000 times resampling, the best scheme of filling the random missing values is the predictive mean matching (PMM) method under the missing proportion. With this optimal scheme, a two stage survey was conducted. Finally, it was found that the influencing factors on annual medical expenditure among the students enrolling in URBMI in Taiyuan included population group, annual household gross income, affordability of medical insurance expenditure, chronic disease, seeking medical care in hospital, seeking medical care in community health center or private clinic, hospitalization, hospitalization canceled due to certain reason, self medication and acceptable proportion of self-paid medical expenditure. The two-stage method combining multiple imputation with sample selection model can deal with non response bias and selection bias effectively in dependent variable of the survey data.

Genetic Predisposition to Obesity and Medicare Expenditures.

PubMed

Wehby, George L; Domingue, Benjamin W; Ullrich, Fred; Wolinsky, Fredric D

2017-12-12

The relationship between obesity and health expenditures is not well understood. We examined the relationship between genetic predisposition to obesity measured by a polygenic risk score for body mass index (BMI) and Medicare expenditures. Biennial interview data from the Health and Retirement Survey for a nationally representative sample of older adults enrolled in fee-for-service Medicare were obtained from 1991 through 2010 and linked to Medicare claims for the same period and to Genome-Wide Association Study (GWAS) data. The study included 6,628 Medicare beneficiaries who provided 68,627 complete person-year observations during the study period. Outcomes were total and service-specific Medicare expenditures and indicators for expenditures exceeding the 75th and 90th percentiles. The BMI polygenic risk score was derived from GWAS data. Regression models were used to examine how the BMI polygenic risk score was related to health expenditures adjusting for demographic factors and GWAS-derived ancestry. Greater genetic predisposition to obesity was associated with higher Medicare expenditures. Specifically, a 1 SD increase in the BMI polygenic risk score was associated with a $805 (p < .001) increase in annual Medicare expenditures per person in 2010 dollars (~15% increase), a $370 (p < .001) increase in inpatient expenses, and a $246 (p < .001) increase in outpatient services. A 1 SD increase in the polygenic risk score was also related to increased likelihood of expenditures exceeding the 75th percentile by 18% (95% CI: 10%-28%) and the 90th percentile by 27% (95% CI: 15%-40%). Greater genetic predisposition to obesity is associated with higher Medicare expenditures. © The Author(s) 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Household food insecurity and food expenditure in Bolivia, Burkina Faso, And the Philippines.

PubMed

Melgar-Quinonez, Hugo R; Zubieta, Ana C; MkNelly, Barbara; Nteziyaremye, Anastase; Gerardo, Maria Filipinas D; Dunford, Christopher

2006-05-01

This study examined the association between food insecurity, determined by a modified version of the U.S. Household Food Security Survey Module (US HFSSM), and total daily per capita (DPC) consumption (measured as household expenditures) in Bolivia, Burkina Faso, and the Philippines. Household food insecurity was determined by an adapted 9-item US HFSSM version. A short version of the World Bank's Living Standards Measurement Study (LSMS) consumption module measured household expenditures. Focus groups were used to adapt the survey instrument to each local context. The sample (n approximately 330 per country) includes residents of urban and rural areas. A 12-month food expenditure aggregate was generated as part of the total household expenditures calculation. DPC food expenditure, which represented over 60% of the total household consumption, as well as expenditures on specific food groups correlated with food insecurity both as a continuous Food Insecurity Score (FinSS) and a tricategorical food insecurity status variable. ANOVA and regression analysis were executed adjusting for social and demographic covariates. Food-secure households have significantly higher (P < 0.05) total DPC food expenditures as well as expenditures on animal source foods, vegetables, and fats and oils than moderately and severely food-insecure households. The results offer evidence that the US HFSSM is able to discriminate between households at different levels of food insecurity status in diverse developing world settings.

[The federal health expenditure on the uninsured population: Mexico 1980-1995].

PubMed

Lara, A; Gómez-Dantés, O; Urdapilleta, O; Bravo, M L

1997-01-01

In the last fifteen years Mexico suffered several economic crisis which have negatively affected public expenditure in social welfare and, as a consequence, public expenditure in health. This paper discusses the relationship between the adjustment policies adopted to confront these crisis and public expenditure in health care for the non-insured population, as well as the regional distribution of this expenditure. In part one, the evolution of general public expenditure, public expenditure in social welfare, and public expenditure in health between 1980 and 1995 is described. In part two, the distribution of public health expenditure for the non-insured population among the five regions in which the country was divided by the National Health Survey II is discussed. The main conclusion of this paper is that, between 1980 and 1995, the public expenditure gaps that have existed for a long time in Mexico among regions remained unchanged. These gaps basically affect the southern states of the country, are not related to health needs, and may deepen in view of the new relative cuts in public expenditure in social welfare announced by the new administration.

76 FR 81944 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-29

... comprehensive data on health care and health care expenditures from all payors (including private payors... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Agency... MEPS Cancer SAQ The Medical Expenditure Panel Survey (MEPS) is a nationally representative survey of...

Gambling expenditure predicts harm: evidence from a venue-level study.

PubMed

Markham, Francis; Young, Martin; Doran, Bruce

2014-09-01

The Total Consumption Theory of gambling suggests that gambling expenditure is positively associated with gambling-related harm. We test the hypothesis that electronic gaming machine (EGM) expenditure predicts gambling-related harm at the level of the EGM venue. Cross-sectional analysis of survey and administrative data. General urban adult population of the Northern Territory of Australia. The sample consisted of 7049 respondents to a mail-survey about venue visitation and gambling behaviour across 62 EGM venues. Gambling-related harm was defined as the endorsement of two or more items on the Problem Gambling Severity Index. We obtained venue-level EGM expenditure data from the local licensing authority for all venues in the study area. We compared the prevalence of gambling-related harm among patrons aggregated at the venue level with the estimated mean EGM expenditure for each adult resident in the venue's service area using a Huff model, correlation analysis and multivariate binomial regression. Aggregated to the venue level (n = 62), per-capita EGM expenditure was correlated significantly with rates of gambling-related harm (r = 0.27, n = 62, P = 0.03). After adjusting for venue type and number of EGMs, an increase in mean per-capita monthly EGM expenditure from $AU10 to $AU150 was associated with a doubling in the prevalence of gambling-related harm from 9% (95% CI = 6-12%) to 18% (95% CI = 13-23%). As suggested by the Total Consumption Theory of gambling, aggregate patron electronic gaming machine expenditure predicts the prevalence of gambling-related harm at the venue level. © 2014 Society for the Study of Addiction.

Relationship Between General Illness and Mental Health Service Use and Expenditures Among Racially-Ethnically Diverse Adults ≥65 Years.

PubMed

Jimenez, Daniel E; Cook, Benjamin Lê; Kim, Giyeon; Reynolds, Charles F; Alegría, Margarita; Coe-Odess, Sarah; Bartels, Stephen J

2015-07-01

The association of general medical illness and mental health service use among older adults from racial-ethnic minority groups is an important area of study given the disparities in mental health and general medical services and the low use of mental health services in this population. The purpose of this report is to describe the impact of comorbid general medical illness on mental health service use and expenditures among older adults and to evaluate disparities in mental health service use and expenditures in a racially-ethnically diverse sample of older adults with and without comorbid general medical illness. Data were obtained from the Medical Expenditure Panel Survey (years 2004-2011). The sample included 1,563 whites, 519 African Americans, and 642 Latinos (N=2,724) age ≥65 with probable mental illness. Two-part generalized linear models were used to estimate and compare mental health service use among adults with and without a comorbid general medical illness. Mental health service use was more likely for older adults with comorbid general medical illness than for those without it. Once mental health services were accessed, no differences in mental health expenditures were found. Comorbid general medical illness increased the likelihood of mental health service use by older whites and Latinos. However, the presence of comorbidity did not affect racial-ethnic disparities in mental health service use. This study highlighted the important role of comorbid general medical illness as a potential contributor to using mental health services and suggests intervention strategies to enhance engagement in mental health services by older adults from racial-ethnic minority groups.

Comparing Twitter and Online Panels for Survey Recruitment of E-Cigarette Users and Smokers.

PubMed

Guillory, Jamie; Kim, Annice; Murphy, Joe; Bradfield, Brian; Nonnemaker, James; Hsieh, Yuli

2016-11-15

E-cigarettes have rapidly increased in popularity in recent years, driven, at least in part, by marketing and word-of-mouth discussion on Twitter. Given the rapid proliferation of e-cigarettes, researchers need timely quantitative data from e-cigarette users and smokers who may see e-cigarettes as a cessation tool. Twitter provides an ideal platform for recruiting e-cigarette users and smokers who use Twitter. Online panels offer a second method of accessing this population, but they have been criticized for recruiting too few young adults, among whom e-cigarette use rates are highest. This study compares effectiveness of recruiting Twitter users who are e-cigarette users and smokers who have never used e-cigarettes via Twitter to online panelists provided by Qualtrics and explores how users recruited differ by demographics, e-cigarette use, and social media use. Participants were adults who had ever used e-cigarettes (n=278; male: 57.6%, 160/278; age: mean 34.26, SD 14.16 years) and smokers (n=102; male: 38.2%, 39/102; age: mean 42.80, SD 14.16 years) with public Twitter profiles. Participants were recruited via online panel (n=190) or promoted tweets using keyword targeting for e-cigarette users (n=190). Predictor variables were demographics (age, gender, education, race/ethnicity), e-cigarette use (eg, past 30-day e-cigarette use, e-cigarette puffs per day), social media use behaviors (eg, Twitter use frequency), and days to final survey completion from survey launch for Twitter versus panel. Recruitment method (Twitter, panel) was the dependent variable. Across the total sample, participants were recruited more quickly via Twitter (incidence rate ratio=1.30, P=.02) than panel. Compared with young adult e-cigarette users (age 18-24 years), e-cigarette users aged 25 to 34 years (OR 0.01, 95% CI 0.00-0.60, P=.03) and 35 to 44 years (OR 0.01, 95% CI 0.00-0.51, P=.02) were more likely to be recruited via Twitter than panel. Smokers aged 35 to 44 years were less

Financial burden of household out-of-pocket expenditures for prescription drugs: Cross-sectional analysis based on national survey data

PubMed Central

McLeod, Logan; Bereza, Basil G; Shim, Minsup; Grootendorst, Paul

2011-01-01

Background Commentaries on the adequacy of insurance coverage for prescription drugs available to Canadians have emphasized differences in the coverage provided by different provincial governments. Less is known about the actual financial burden of prescription drug spending and how this burden varies by province of residence, affluence and source of primary drug coverage. Methods We used data from a nationally representative household expenditure survey to analyze the financial burden of prescription drugs. We focused on the drug budget share (defined as the share of the household budget spent on prescription drugs), considering how it varied by province, total household budget and likely primary source of drug insurance coverage (i.e., provincial government plan for senior citizens, social assistance plan or private coverage). We examined both “typical” households (at the median of the distribution of the drug budget share) and households with relatively large shares (in the top 5%). Finally, we estimated the percentage of households with catastrophic drug expenditures (defined as a drug budget share of 10% or more) and the average catastrophic drug expenditures. Results Senior, social assistance and general population households accounted for 21.1%, 8.9% and 69.9% of the sample of 14 430 respondents to the 2006 Survey of Household Spending, respectively. The median drug budget share in Canada was 1.1% for senior households (range 0.4% [Ontario] to 3.6% [Saskatchewan]) and 0.1% for both social assistance households and general population households, with little appreciable variation across provinces for these latter 2 categories. The 95th percentile drug budget share in Canada was 7.4% for senior households (range 3.5% [Ontario] to 12.7% [Saskatchewan]), 5.4% for social assistance households (range 2.3% [British Columbia] to 13.0% [Prince Edward Island]) and 2.6% for general population households (range 2.1% [Ontario] to 5.4% [Prince Edward Island]). The

Risk-adjusted capitation based on the Diagnostic Cost Group Model: an empirical evaluation with health survey information.

PubMed Central

Lamers, L M

1999-01-01

OBJECTIVE: To evaluate the predictive accuracy of the Diagnostic Cost Group (DCG) model using health survey information. DATA SOURCES/STUDY SETTING: Longitudinal data collected for a sample of members of a Dutch sickness fund. In the Netherlands the sickness funds provide compulsory health insurance coverage for the 60 percent of the population in the lowest income brackets. STUDY DESIGN: A demographic model and DCG capitation models are estimated by means of ordinary least squares, with an individual's annual healthcare expenditures in 1994 as the dependent variable. For subgroups based on health survey information, costs predicted by the models are compared with actual costs. Using stepwise regression procedures a subset of relevant survey variables that could improve the predictive accuracy of the three-year DCG model was identified. Capitation models were extended with these variables. DATA COLLECTION/EXTRACTION METHODS: For the empirical analysis, panel data of sickness fund members were used that contained demographic information, annual healthcare expenditures, and diagnostic information from hospitalizations for each member. In 1993, a mailed health survey was conducted among a random sample of 15,000 persons in the panel data set, with a 70 percent response rate. PRINCIPAL FINDINGS: The predictive accuracy of the demographic model improves when it is extended with diagnostic information from prior hospitalizations (DCGs). A subset of survey variables further improves the predictive accuracy of the DCG capitation models. The predictable profits and losses based on survey information for the DCG models are smaller than for the demographic model. Most persons with predictable losses based on health survey information were not hospitalized in the preceding year. CONCLUSIONS: The use of diagnostic information from prior hospitalizations is a promising option for improving the demographic capitation payment formula. This study suggests that diagnostic

43 CFR 3861.2-3 - Mineral surveyor's report of expenditures and improvements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Mineral surveyor's report of expenditures... Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) MINERAL PATENT APPLICATIONS Surveys and Plats § 3861.2-3 Mineral surveyor's report of expenditures and...

43 CFR 3861.2-3 - Mineral surveyor's report of expenditures and improvements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Mineral surveyor's report of expenditures... Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) MINERAL PATENT APPLICATIONS Surveys and Plats § 3861.2-3 Mineral surveyor's report of expenditures and...

43 CFR 3861.2-3 - Mineral surveyor's report of expenditures and improvements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Mineral surveyor's report of expenditures... Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) MINERAL PATENT APPLICATIONS Surveys and Plats § 3861.2-3 Mineral surveyor's report of expenditures and...

A Single Father's Shopping Bag: Purchasing Decisions in Single-Father Families

ERIC Educational Resources Information Center

Ziol-Guest, Kathleen M.

2009-01-01

Using data from the 1980 to 2003 panels of the Consumer Expenditure Survey, this article examines purchasing decisions in father-headed single-parent families. Single-father expenditures are compared to both married-parent expenditures and single-mother expenditures on 17 broad categories of household-level goods and services. Multivariate…

Expenditures on Children by Families, 2007. Miscellaneous Publication Number 1528-2007

ERIC Educational Resources Information Center

Lino, Mark

2008-01-01

Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families using data from the 1990-92 Consumer Expenditure Survey, updated to 2007 dollars using the Consumer Price Index. Data and…

[Pattern changes in food and beverages expenditure in Mexican households (1984-2014)].

PubMed

Garza-Montoya, Beatriz Gabriela; Ramos-Tovar, María Elena

2017-01-01

To analyze the proportion of expenditure and its frequency in food and beverages consumed inside and outside of households, at national and regional level, in Mexico between 1984 and 2014. It analyzes data of household expenditure of food and beverages taken from the National Survey of Mexican Household Income and Expenditures 1984, 1994, 2005 and 2014. It conducted descriptive statistics analyses such as percentages, growth rates and crosstabs. There were changes in food expenditure patterns at national and regional level. The proportion of expenditure and its frequency increased in non-alcoholic beverages, prepared food, meals made outside home and cereals. The proportion of expenditure and its frequency decreased in oils and fats, fruits, vegetables, sugar and honeys. These changes can be related to political, economic, social and cultural transformations experienced in the last decades.

A smooth mixture of Tobits model for healthcare expenditure.

PubMed

Keane, Michael; Stavrunova, Olena

2011-09-01

This paper develops a smooth mixture of Tobits (SMTobit) model for healthcare expenditure. The model is a generalization of the smoothly mixing regressions framework of Geweke and Keane (J Econometrics 2007; 138: 257-290) to the case of a Tobit-type limited dependent variable. A Markov chain Monte Carlo algorithm with data augmentation is developed to obtain the posterior distribution of model parameters. The model is applied to the US Medicare Current Beneficiary Survey data on total medical expenditure. The results suggest that the model can capture the overall shape of the expenditure distribution very well, and also provide a good fit to a number of characteristics of the conditional (on covariates) distribution of expenditure, such as the conditional mean, variance and probability of extreme outcomes, as well as the 50th, 90th, and 95th, percentiles. We find that healthier individuals face an expenditure distribution with lower mean, variance and probability of extreme outcomes, compared with their counterparts in a worse state of health. Males have an expenditure distribution with higher mean, variance and probability of an extreme outcome, compared with their female counterparts. The results also suggest that heart and cardiovascular diseases affect the expenditure of males more than that of females. Copyright © 2011 John Wiley & Sons, Ltd.

Comorbidity and the concentration of healthcare expenditures in older patients with heart failure.

PubMed

Zhang, James X; Rathouz, Paul J; Chin, Marshall H

2003-04-01

To examine comorbidity and concentration of healthcare expenditures in older patients with heart failure (HF) in the Medicare program. Retrospective analysis of older fee-for-service HF patients, using the 1996 Medicare Current Beneficiary Survey and linked Medicare claims. Variety of clinical settings. One thousand two hundred sixty-six older HF patients from a nationally representative survey. Medicare expenditure per person and by types of healthcare services, prevalence of comorbid conditions, and multivariate regression on the association between comorbidities and healthcare expenditure. Medicare spent an average of 16,514 dollars on medical reimbursement for each HF patient in 1996. Eighty-one percent of patients had one or more comorbid diseases according to a 17-disease grouping index. The top 20% of HF patients accounted for 63% of total expenditure. Comorbidity was associated with significantly higher Medicare expenditure. HF patients with more-expensive comorbidities included those with peripheral vascular disease (24% of patients, mean total expenditure 26,954 dollars), myocardial infarction (16% of patients, mean total expenditure 29,867 dollars), renal disease (8% of patients, mean total expenditure 33,014 dollars), and hemiplegia or paraplegia (5% of patients, mean total expenditure 33,234 dollars). Diseases and disorders other than heart failure constituted a significant fraction of the causes of inpatient admissions. Comorbid conditions were more likely to be associated with expensive inpatient care, and patients with these diseases were more likely to spend more overall and more on other types of Medicare services including home health aid, skilled nursing facility, and hospice care. Disease management should consider comorbid conditions for improving care and reducing expenditures in older patients with HF.

Main Determinants of Catastrophic Health Expenditures: A Bayesian Logit Approach on Iranian Household Survey Data (2010)

PubMed Central

Fazaeli, Ali Akbar; Ghaderi, Hossein; Fazaeli, Amir Abbas; Lotfi, Farhad; Salehi, Masoud; Mehrara, Mohsen

2015-01-01

Background: During recent decades, increase in both health care expenditures and improvement of the awareness as well as health expectations have created some problems with regard to finance healthcare expenditures so that the issue of health financing by households has been determined as a major challenge in health sector. According to the definition by the World Health Organization, catastrophic health expenditure is considered if financial contribution for health service is more than 40% of income remaining after subsistence needs have been met. Objectives: The purpose of our study was determination of Main factors on catastrophic health expenditures in Iranian households. Patients and Methods: In this study, using an econometrics Bayesian logit model, determinants of the appearance of catastrophic health expenditure based on household budget data collected in 2010 were evaluated. Results: Among Iranian households, the following groups were more likely to encounter with unsustainable health expenditures: rural households, households with the numbers of the elderly more than 65 years, illiterate householders, unemployed householders, households with some unemployed persons, households in upper rank and households with larger equivalent household size were higher than the average of community could significantly predict catastrophic health expenditures. Conclusions: About 2.1% of households were faced with catastrophic health expenditures in 2010. Thus, the implemented policies could not make considerable and significant change in improving justice in financing in health systems. PMID:25946936

Main determinants of catastrophic health expenditures: a Bayesian logit approach on Iranian household survey data (2010).

PubMed

Fazaeli, Ali Akbar; Ghaderi, Hossein; Abbas Fazaeli, Amir; Lotfi, Farhad; Salehi, Masoud; Mehrara, Mohsen

2015-01-26

During recent decades, increase in both health care expenditures and improvement of the awareness as well as health expectations have created some problems with regard to finance healthcare expenditures so that the issue of health financing by households has been determined as a major challenge in health sector. According to the definition by the World Health Organization, catastrophic health expenditure is considered if financial contribution for health service is more than 40% of income remaining after subsistence needs have been met. The purpose of our study was determination of Main factors on catastrophic health expenditures in Iranian households. In this study, using an econometrics Bayesian logit model, determinants of the appearance of catastrophic health expenditure based on household budget data collected in 2010 were evaluated. Among Iranian households, the following groups were more likely to encounter with unsustainable health expenditures: rural households, households with the numbers of the elderly more than 65 years, illiterate householders, unemployed householders, households with some unemployed persons, households in upper rank and households with larger equivalent household size were higher than the average of community could significantly predict catastrophic health expenditures. About 2.1% of households were faced with catastrophic health expenditures in 2010. Thus, the implemented policies could not make considerable and significant change in improving justice in financing in health systems.

Prevalence and intensity of catastrophic health care expenditures in Iran from 2008 to 2015: a study on Iranian household income and expenditure survey.

PubMed

Yazdi-Feyzabadi, Vahid; Bahrampour, Mina; Rashidian, Arash; Haghdoost, Ali-Akbar; Akbari Javar, Mohammadreza; Mehrolhassani, Mohammad Hossein

2018-04-13

Households exposure to catastrophic health expenditure is a valuable measure to monitor financial protection in health sector payments. The present study had two aims: first, to estimate the prevalence and intensity of catastrophic health expenditures (CHE) in Iran. Second, to investigate main factors that influence the probability of CHE. CHE is defined as an occasion in which a household's out-of-pocket (OOP) spending exceeds 40% of the total income that remains after subtraction of living expenses. This study used the data from eight national repeated cross-sectional surveys on households' income and expenditure. The proportion of households facing CHE, as a prevalence measure, was estimated for rural and urban areas. The intensity of CHE was also calculated using overshoot and mean positive overshoot (MPO) measures. The factors affecting the CHE were also analyzed using logistic random effects regression model. We also used ArcMap 10.1 to display visually disparities across the country. An increasing number of Iranians has been subject to catastrophic health care costs over the study period in both rural and urban areas (CHE = 2.57% in 2008 and 3.25% in 2015). In the same period, the overshoot of CHE and the mean positive overshoot ranged from 0.26% to 0.65% and from 12.26% to 20.86%, respectively. The average absolute monetary value of OOP spending per month has been low in rural areas over the years, but the prevalence of CHE has been higher than urban areas. Generally put, rural settlement, higher income, receiving inpatient and outpatient services, and existence of elderly people in the household led to increase in CHE prevalence (p < 0.05). Interestingly, provinces with more limited geographical and cultural accessibility had the lowest CHE. According to the findings, Iran's healthcare system has failed to realize the aim of five-year national development plan regarding CHE prevalence (1% CHE prevalence according to the plan). Therefore, revision

Evaluating the Impact of Parent-Reported Medical Home Status on Children's Health Care Utilization, Expenditures, and Quality: A Difference-in-Differences Analysis with Causal Inference Methods.

PubMed

Han, Bing; Yu, Hao; Friedberg, Mark W

2017-04-01

To evaluate the effects of the parent-reported medical home status on health care utilization, expenditures, and quality for children. Medical Expenditure Panel Survey (MEPS) during 2004-2012, including a total of 9,153 children who were followed up for 2 years in the survey. We took a causal difference-in-differences approach using inverse probability weighting and doubly robust estimators to study how changes in medical home status over a 2-year period affected children's health care outcomes. Our analysis adjusted for children's sociodemographic, health, and insurance statuses. We conducted sensitivity analyses using alternative statistical methods, different approaches to outliers and missing data, and accounting for possible common-method biases. Compared with children whose parents reported having medical homes in both years 1 and 2, those who had medical homes in year 1 but lost them in year 2 had significantly lower parent-reported ratings of health care quality and higher utilization of emergency care. Compared with children whose parents reported having no medical homes in both years, those who did not have medical homes in year 1 but gained them in year 2 had significantly higher ratings of health care quality, but no significant differences in health care expenditures and utilization. Having a medical home may help improve health care quality for children; losing a medical home may lead to higher utilization of emergency care. © Health Research and Educational Trust.

Time discounting and smoking behavior: evidence from a panel survey(*).

PubMed

Kang, Myong-Il; Ikeda, Shinsuke

2014-12-01

By using a panel survey of Japanese adults, we show that smoking behavior is associated with personal time discounting and its biases, such as hyperbolic discounting and the sign effect, in the way that theory predicts: smoking depends positively on the discount rate and the degree of hyperbolic discounting and negatively on the presence of the sign effect. Positive effects of hyperbolic discounting on smoking are salient for naïve people, who are not aware of their self-control problem. By estimating smoking participation and smokers' cigarette consumption in Cragg's two-part model, we find that the two smoking decisions depend on different sets of time-discounting variables. Particularly, smoking participation is affected by being a naïve hyperbolic discounter, whereas the discount rate, the presence of the sign effect, and a hyperbolic discounting proxy constructed from procrastination behavior vis-à-vis doing homework assignments affect both types of decision making. The panel data enable us to analyze the over-time instability of elicited discount rates. The instability is shown to come from measurement errors, rather than preference shocks on time preference. Several evidences indicate that the detected associations between time preferences and smoking behavior are interpersonal one, rather than within-personal one. Copyright © 2013 John Wiley & Sons, Ltd.

Obesity and health expenditures: evidence from Australia.

PubMed

Buchmueller, Thomas C; Johar, Meliyanni

2015-04-01

Rising rates of obesity are a public health concern in every industrialized country. This study investigates the relationship between obesity and health care expenditure in Australia, where the rate of obesity has tripled in the last three decades. Now one in four Australians is considered obese, defined as having a body mass index (BMI, kg/m(2)) of 30 or over. The analysis is based on a random sample survey of over 240,000 adults aged 45 and over that is linked at the individual-level to comprehensive administrative health care claims for the period 2006-2009. This sub-population group has an obesity rate that is nearly 30% and is a major consumer of health services. Relative to the average annual health expenditures of those with normal weight, we find that the health expenditures of those with a BMI between 30 and 35 (obese type I) are 19% higher and expenditures of those with BMI greater than 35 (obese type II/III) are 51% higher. We find large and significant differences in all types of care: inpatient, emergency department, outpatient and prescription drugs. The obesity-related health expenditures are higher for obese type I women than men, but in the obese type II/III state, obesity-related expenditures are higher for men. When we stratify further by age groups, we find that obesity has the largest impact among men over age 75 and women aged 60-74 years old. In addition, we find that obesity impacts health expenditures not only through its link to chronic diseases, but also because it increases the cost of recovery from acute health shocks. Copyright © 2015 Elsevier B.V. All rights reserved.

US Trends in Quality-Adjusted Life Expectancy From 1987 to 2008: Combining National Surveys to More Broadly Track the Health of the Nation

PubMed Central

Cutler, David M.; Rosen, Allison B.

2013-01-01

Objectives. We used data from multiple national health surveys to systematically track the health of the US adult population. Methods. We estimated trends in quality-adjusted life expectancy (QALE) from 1987 to 2008 by using national mortality data combined with data on symptoms and impairments from the National Medical Expenditure Survey (1987), National Health Interview Survey (1987, 1994–1995, 1996), Medical Expenditure Panel Survey (1992, 1996, 2000–2008), National Nursing Home Survey (1985, 1995, and 1999), and Medicare Current Beneficiary Survey (1992, 1994–2008). We decomposed QALE into changes in life expectancy, impairments, symptoms, and smoking and body mass index. Results. Years of QALE increased overall and for all demographic groups—men, women, Whites, and Blacks—despite being slowed by increases in obesity and a rising prevalence of some symptoms and impairments. Overall QALE gains were large: 2.4 years at age 25 years and 1.7 years at age 65 years. Conclusions. Understanding and consistently tracking the drivers of QALE change is central to informed policymaking. Harmonizing data from multiple national surveys is an important step in building this infrastructure. PMID:24028235

Household catastrophic health expenditure: evidence from Georgia and its policy implications

PubMed Central

Gotsadze, George; Zoidze, Akaki; Rukhadze, Natia

2009-01-01

Background To quantify extent of catastrophic household health expenditures, determine factors influencing it and estimate Fairness in Financial Contribution (FFC) index in Georgia to establish the baseline for expected reforms and contribute to the design and fine-tuning of the major reforms in health care financing initiated by the government mid-2007. Methods The research is based on the nationally representative Health Care Utilization and Expenditure survey conducted during May-June 2007, prior to preparing for new phase of implementation for the health care financing reforms. Households' catastrophic health expenditures were estimated according to the methodology proposed by WHO – Ke Xu [1]. A logistic regression (logit) model was used to predict probability of catastrophic health expenditure occurrence. Results In Georgia between 2000 and 2007 access to care for poor has improved slightly and the share of households facing catastrophic health expenditures have seemingly increased from 2.8% in 1999 to 11.7% in 2007. However, this variance may be associated with the methodological differences of the respective surveys from which the analysis were derived. The high level of the catastrophic health expenditure may be associated with the low share of prepayment in national health expenditure, adequate availability of services and a high level of poverty in the country. Major factors determining the financial catastrophe related to ill health were hospitalization, household members with chronic illness and poverty status of the household. The FFC for Georgia appears to have improved since 2004. Conclusion Reducing the prevalence of catastrophic health expenditure is a policy objective of the government, which can be achieved by focusing on increased financial protection offered to poor and expanding government financed benefits for poor and chronically ill by including and expanding inpatient coverage and adding drug benefits. This policy recommendation may also

Medical expenditures associated with nonfatal occupational injuries among immigrant and U.S.-born workers

PubMed Central

2012-01-01

Background No national study has investigated whether immigrant workers are less likely than U.S.-workers to seek medical treatment after occupational injuries and whether the payment source differs between two groups. Methods Using the 2004–2009 Medical Expenditure Panel Survey (MEPS) data, we estimated the annual incidence rate of nonfatal occupational injuries per 100 workers. Logistic regression models were fitted to test whether injured immigrant workers were less likely than U.S.-born workers to seek professional medical treatment after occupational injuries. We also estimated the average mean medical expenditures per injured worker during the 2 year MEPS reference period using linear regression analysis, adjusting for gender, age, race, marital status, education, poverty level, and insurance. Types of service and sources of payment were compared between U.S.-born and immigrant workers. Results A total of 1,909 injured U.S.-born workers reported 2,176 occupational injury events and 508 injured immigrant workers reported 560 occupational injury events. The annual nonfatal incidence rate per 100 workers was 4.0% (95% CI: 3.8%-4.3%) for U.S.-born workers and 3.0% (95% CI: 2.6%-3.3%) for immigrant workers. Medical treatment was sought after 77.3% (95% CI: 75.1%-79.4%) of the occupational injuries suffered by U.S.-born workers and 75.6% (95% CI: 69.8%-80.7%) of the occupational injuries suffered by immigrant workers. The average medical expenditure per injured worker in the 2 year MEPS reference period was $2357 for the U.S.-born workers and $2,351 for immigrant workers (in 2009 U.S. dollars, P = 0.99). Workers’ compensation paid 57.0% (95% CI: 49.4%-63.6%) of the total expenditures for U.S.-born workers and 43.2% (95% CI: 33.0%-53.7%) for immigrant workers. U.S.-born workers paid 6.7% (95% CI: 5.5%-8.3%) and immigrant workers paid 7.1% (95% CI: 5.2%-9.6%) out-of-pocket. Conclusions Immigrant workers had a statistically significant lower incidence rate

Personality Measurement and Assessment in Large Panel Surveys*

PubMed Central

Roberts, Brent; Jackson, Joshua J.; Duckworth, Angela L.; Von Culin, Katherine

2013-01-01

Personality tests are being added to large panel studies with increasing regularity, such as the Health and Retirement Study (HRS). To facilitate the inclusion and interpretation of these tests, we provide some general background on personality psychology, personality assessment, and the validity of personality tests. In this review, we provide background on definitions of personality, the strengths and weaknesses of the self-report approaches to personality testing typically used in large panel studies, and the validity of personality tests for three outcomes: genetics, income, and health. We conclude with recommendations on how to improve personality assessment in future panel studies. PMID:23503719

Socioeconomic inequalities in the healthiness of food choices: Exploring the contributions of food expenditures.

PubMed

Pechey, Rachel; Monsivais, Pablo

2016-07-01

Investigations of the contribution of food costs to socioeconomic inequalities in diet quality may have been limited by the use of estimated (vs. actual) food expenditures, not accounting for where individuals shop, and possible reverse mediation between food expenditures and healthiness of food choices. This study aimed to explore the extent to which food expenditure mediates socioeconomic inequalities in the healthiness of household food choices. Observational panel data on take-home food and beverage purchases, including expenditure, throughout 2010 were obtained for 24,879 UK households stratified by occupational social class. Purchases of (1) fruit and vegetables and (2) less-healthy foods/beverages indicated healthiness of choices. Supermarket choice was determined by whether households ever visited market-defined high-price and/or low-price supermarkets. Results showed that higher occupational social class was significantly associated with greater food expenditure, which was in turn associated with healthier purchasing. In mediation analyses, 63% of the socioeconomic differences in choices of less-healthy foods/beverages were mediated by expenditure, and 36% for fruit and vegetables, but these figures were reduced to 53% and 31% respectively when controlling for supermarket choice. However, reverse mediation analyses were also significant, suggesting that 10% of socioeconomic inequalities in expenditure were mediated by healthiness of choices. Findings suggest that lower food expenditure is likely to be a key contributor to less-healthy food choices among lower socioeconomic groups. However, the potential influence of cost may have been overestimated previously if studies did not account for supermarket choice or explore possible reverse mediation between expenditure and healthiness of choices. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Patterns of Health Expenditures and Financial Protections in Vietnam 1992-2012.

PubMed

Hoang, Van Minh; Oh, Juhwan; Tran, Tuan Anh; Tran, Thi Giang Huong; Ha, Anh Duc; Luu, Ngoc Hoat; Nguyen, Thi Kim Phuong

2015-11-01

Health financing has been considered as an important building block of a health system and has a key role in promoting universal health coverage in the Vietnam. This paper aims to describe the pattern of health expenditure, including total health expenditure and composition of health expenditure, over the last two decades in Vietnam. The paper mainly uses the data from Vietnam National Health Account and Vietnam Living Standards Survey. We also included data from other relevant published literature, reports and statistics about health care expenditure in Vietnam. The per capita health expenditure in Vietnam increased from US$ 14 in 1995 to US$ 86 in 2012. The total health expenditure as a share of GDP also rose from 5.2% in 1995 to 6.9% in 2012. Public health expenditure as percentage of government expenditure rose from 7.4% in 1995 to nearly 10% in 2012. The coverage of health insurance went up from 10% in 1995 to 68.5% in 2012. However, health financing in Vietnam was depending on private expenditures (57.4% in 2012). As a result, the proportion of households with catastrophic expenditure in 2012 was 4.2%. The rate of impoverishment in 2012 was 2.5%. To ensure equity and efficient goal of health system, policy actions for containing the health care out-of-pocket payments and their poverty impacts are urgently needed in Vietnam.

Assessing the Relationship between Physical Illness and Mental Health Service Use and Expenditures among Older Adults from Racial/Ethnic Minority Groups

PubMed Central

Jimenez, Daniel E; Cook, Benjamin; Kim, Giyeon; Reynolds, Charles F.; Alegria, Margarita; Coe-Odess, Sarah; Bartels, Stephen J.

2015-01-01

Objective The association of physical illness and mental health service use in older adults from racial/ethnic minority groups is an important area of study given the mental and physical health disparities and the low use of mental health services in this population. The purpose of this study is to describe the impact of comorbid physical illness on mental health service use and expenditures in older adults; and to evaluate disparities in mental health service use and expenditures among a racially/ethnically diverse sample of older adults with and without comorbid physical illness. Methods Data were obtained from the Medical Expenditure Panel Survey (years 2004–2011). The sample included 1563 whites, 519 African-Americans, and 642 Latinos and (N=2,724) aged 65+ with probable mental illness. Using two-part generalized linear models, we estimated and compared mental health service use among those with and without a comorbid physical illness. Results Mental health service use was greater for older adults with comorbid physical illness compared to those without a comorbid physical illness. Once mental health services were accessed, no differences in mental health expenditures were found. Comorbid physical illness increased the likelihood of mental health service use in older whites and Latinos. However, the presence of a comorbidity did not impact racial/ethnic disparities in mental health service use. Conclusions This study highlighted the important role of comorbid physical illness as a potential contributor to using mental health services and suggests intervention strategies to enhance engagement in mental health services by older adults from racial/ethnic minority groups. PMID:25772763

Determinants of catastrophic health expenditure in iran.

PubMed

Abolhallaje, M; Hasani, Sa; Bastani, P; Ramezanian, M; Kazemian, M

2013-01-01

This study will provide detailed specification of those variables and determinants of unpredictable health expenditure in Iran, and the requirements to reduce extensive effects of the factors affecting households' payments for health and other goods and services inappropriately. This study aims to identify measures of fair financing of health services and determinants of fair financing contribution, regarding the required share of households that prevents their catastrophic payments. In this regard, analysis of shares of households' expenditures on main groups of goods and services in urban and rural areas and in groups of deciles in the statistics from households' expenditure surveys was applied. The growth of spending in nominal values within the years 2002-2008 was considerably high and the rate for out-of-pocket payments is nearly the same or greater than the rate for total health expenditure. In 2008, urban and rural households in average pay 6.4% and 6.35% of their total expenditure on health services. Finally three categories of determinants of unfair and catastrophic payments by households were recognized in terms of households' socio-economic status, equality/inequality conditions of the distribution of risk of financing, and economic aspects of health expenditure distribution. While extending the total share of government and prepayment sources of financing health services are considered as the simplest policy for limiting out-of-pocket payments, indicators and policies introduced in this study could also be considered important and useful for the development of health sector and easing access to health services, irrespective of health financing fairness.

An Analysis of Gender Differences in Household Education Expenditure: The Case of Thailand

ERIC Educational Resources Information Center

Wongmonta, Sasiwooth; Glewwe, Paul

2017-01-01

This study uses data on educational expenditure, including specific types of educational expenditure, from the 2009 Socioeconomic Survey of Thailand to investigate gender bias in the allocation of educational resources. Empirical Engel's curves are estimated to test for gender bias. The results show that girls receive more education expenditure…

Energy expenditure in caving

PubMed Central

Antoni, Giorgia; Marini, Elisabetta; Curreli, Nicoletta; Tuveri, Valerio; Comandini, Ornella; Cabras, Stefano; Gabba, Silvia; Madeddu, Clelia; Crisafulli, Antonio

2017-01-01

The aim of this study was to determine the energy expenditure of a group of cavers of both genders and different ages and experience during a 10 hour subterranean exploration, using portable metabolimeters. The impact of caving activity on body composition and hydration were also assessed through bioelectrical impedance, and nutritional habits of cavers surveyed. During cave activity, measured total energy expenditure (TEE) was in the range 225–287 kcal/h for women-men (MET = 4.1), respectively; subjects had an energy intake from food in the range 1000–1200 kcal, thus inadequate to restore lost calories. Bayesian statistical analysis estimated the effect of predictive variables on TEE, revealing that experienced subjects had a 5% lower TEE than the less skilled ones and that women required a comparatively larger energy expenditure than men to perform the same task. BIVA (bioelectrical impedance vector analysis) showed that subjects were within the range of normal hydration before and after cave activity, but bioelectrical changes indicated a reduction of extracellular water in men, which might result in hypo-osmolal dehydration in the case of prolonged underground exercise. All these facts should be considered when planning cave explorations, preparing training programs for subjects practising caving, and optimizing a diet for cavers. Further, information gathered through this study could be of value to reduce accidents in caves related to increase in fatigue. PMID:28158208

Energy expenditure in caving.

PubMed

Antoni, Giorgia; Marini, Elisabetta; Curreli, Nicoletta; Tuveri, Valerio; Comandini, Ornella; Cabras, Stefano; Gabba, Silvia; Madeddu, Clelia; Crisafulli, Antonio; Rinaldi, Andrea C

2017-01-01

The aim of this study was to determine the energy expenditure of a group of cavers of both genders and different ages and experience during a 10 hour subterranean exploration, using portable metabolimeters. The impact of caving activity on body composition and hydration were also assessed through bioelectrical impedance, and nutritional habits of cavers surveyed. During cave activity, measured total energy expenditure (TEE) was in the range 225-287 kcal/h for women-men (MET = 4.1), respectively; subjects had an energy intake from food in the range 1000-1200 kcal, thus inadequate to restore lost calories. Bayesian statistical analysis estimated the effect of predictive variables on TEE, revealing that experienced subjects had a 5% lower TEE than the less skilled ones and that women required a comparatively larger energy expenditure than men to perform the same task. BIVA (bioelectrical impedance vector analysis) showed that subjects were within the range of normal hydration before and after cave activity, but bioelectrical changes indicated a reduction of extracellular water in men, which might result in hypo-osmolal dehydration in the case of prolonged underground exercise. All these facts should be considered when planning cave explorations, preparing training programs for subjects practising caving, and optimizing a diet for cavers. Further, information gathered through this study could be of value to reduce accidents in caves related to increase in fatigue.

[Factor associated with medicines utilization and expenditure in Mexico].

PubMed

Wirtz, Veronika J; Serván-Mori, Edson; Heredia-Pi, Ileana; Dreser, Anahí; Ávila-Burgos, Leticia

2013-01-01

To analyze medicine utilization and expenditure and associated factors in Mexico, as well as to discuss their implications for pharmaceutical policy. Analysis of a sample of 193,228 individuals from the Mexican National Health and Nutrition Survey 2012. Probability and amount of expenditure were estimated using logit, probit and quantile regression models, evaluating three dimensions of access to medicines: (1) likelihood of utilization of medicines in the event of a health problem, (2) probability of incurring expenses and (3) amount spent on medicines. Individuals affiliated to IMSS were more likely to use medicines (OR=1.2, p<0.05). Being affiliated to the IMSS, ISSSTE or SP reduced the likelihood of spending compared to those without health insurance (about RM 0.7, p<0.01). Median expenditures varied between 195.3 and 274.2 pesos. Factors associated with the use and expenditure on medicines indicate that inequities in the access to medicines persist.

Ageing in India: Financial hardship from health expenditures.

PubMed

Lee, Ting-Hsuan J; Saran, Indrani; Rao, Krishna D

2018-04-01

India's rapidly ageing population raises concerns about the burden of health care payments among older individuals who may have both limited income and greater health care needs. Using a nationally representative household survey, we investigate the association between age and financial hardship due to health expenditures. We find that both the probability of experiencing health problems and mean total out-of-pocket health expenditures increase with age. Second, the probability of households experiencing catastrophic health expenditures increases with each additional member aged 60 and above-33% of households with one 60+ member and 38% of households with 2 or more 60+ members experienced catastrophic health expenditures, compared to only 20% in households with all members under the age of 60 years. Lastly, we show that individuals aged 60 and above had a much higher probability of becoming impoverished as a result of health expenditures-the probability of impoverishment for 60+ individuals was 3 percentage points higher than for individuals under the age of 60. Overall, around 4.8% of the older population, representing 4.1 million people, fell into poverty. The results suggest that there is an urgent need for public investments in financial protection programs for older people in India. Copyright © 2017 John Wiley & Sons, Ltd.

Comparing state-only expenditures for AIDS.

PubMed Central

Rowe, M J; Ryan, C C

1988-01-01

The State AIDS Policy Center at the Inter-governmental Health Policy Project (IHPP) at George Washington University surveyed all 50 states to determine state AIDS (acquired immunodeficiency syndrome) expenditures, without Medicaid or federal funds, for fiscal 1984-88. During this period, state-only expenditures increased 15-fold, to $156.3 million. Between fiscal 1986-1988, the distribution of state funding for AIDS patient care and support services doubled from 16 to 35 per cent and the number of states supplementing federal funds for testing and counseling increased from eight to 20. Five states continue to account for the largest AIDS appropriations. Of these, California leads in funding research; New York, Florida, and New Jersey have directed funds to provide care and services to IV (intravenous) drug users, prisoners, and children. The average state expenditure per diagnosed AIDS case is $3,323 and an increasing number of states with relatively low case loads are appropriating funds beyond this level. Across states, AIDS expenditures per person average $.65 and $.21 for education, testing and counseling--below the level recommended by the Institute of Medicine for AIDS prevention activities. Some jurisdictions support AIDS activities indirectly by shifting resources, often from their STD (sexually transmitted disease) programs--this trend deserves continuing review given the rise in STD cases and their relationship to diagnosed AIDS. PMID:3126674

Targeted health department expenditures benefit birth outcomes at the county level.

PubMed

Bekemeier, Betty; Yang, Youngran; Dunbar, Matthew D; Pantazis, Athena; Grembowski, David E

2014-06-01

Public health leaders lack evidence for making decisions about the optimal allocation of resources across local health department (LHD) services, even as limited funding has forced cuts to public health services while local needs grow. A lack of data has also limited examination of the outcomes of targeted LHD investments in specific service areas. This study used unique, detailed LHD expenditure data gathered from state health departments to examine the influence of maternal and child health (MCH) service investments by LHDs on health outcomes. A multivariate panel time-series design was used in 2013 to estimate ecologic relationships between 2000-2010 LHD expenditures on MCH and county-level rates of low birth weight and infant mortality. The unit of analysis was 102 LHD jurisdictions in Washington and Florida. Results indicate that LHD expenditures on MCH services have a beneficial relationship with county-level low birth weight rates, particularly in counties with high concentrations of poverty. This relationship is stronger for more targeted expenditure categories, with expenditures in each of the three specific examined MCH service areas demonstrating the strongest effects. Findings indicate that specific LHD investments in MCH have an important effect on related health outcomes for populations in poverty and likely help reduce the costly burden of poor birth outcomes for families and communities. These findings underscore the importance of monitoring the impact of these evolving investments and ensuring that targeted, beneficial investments are not lost but expanded upon across care delivery systems. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Policy implications of using a household consumption and expenditures survey versus an observed-weighed food record survey to design a food fortification program.

PubMed

Lividini, Keith; Fiedler, John L; Bermudez, Odilia I

2013-12-01

Observed-Weighed Food Record Surveys (OWFR) are regarded as the most precise dietary assessment methodology, despite their recognized shortcomings, which include limited availability, high cost, small samples with uncertain external validity that rarely include all household members, Hawthorne effects, and using only 1 or 2 days to identify "usual intake." Although Household Consumption and Expenditures Surveys (HCES) also have significant limitations, they are increasingly being used to inform nutrition policy To investigate differences in fortification simulations based on OWFR and HCES from Bangladesh. The pre- and postfortification nutrient intake levels from the two surveys were compared. The total population-based rank orderings of oil, wheat flour, and sugar coverage were identical for the two surveys. OWFR found differences in women's and children's coverage rates and average quantities consumed for all three foods that were not detected by HCES. Guided by the Food Fortification Formulator, we found that these differences did not result in differences in recommended fortification levels. Differences were found, however, in estimated impacts: although both surveys found that oil would be effective in reducing the prevalence of inadequate vitamin A intake among both subpopulations, only OWFR also found that sugar and wheat flour fortification would significantly reduce inadequate vitamin A intake among children. Despite the less precise measure of food consumption from HCES, the two surveys provide similar guidance for designing a fortification program. The external validity of these findings is limited. With relatively minor modifications, the precision of HCES in dietary assessment and the use ofHCES in fortification programming could be strengthened.

Determinants of Medical and Health Care Expenditure Growth for Urban Residents in China: A Systematic Review Article.

PubMed

Zhu, Xiaolong; Cai, Qiong; Wang, Jin; Liu, Yun

2014-12-01

In recent years, medical and health care consumption has risen, making health risk an important determinant of household spending and welfare. We aimed to examine the determinants of medical and health care expenditure to help policy-makers in the improvement of China's health care system, benefiting the country, society and every household. This paper employs panel data from China's provinces from 2001 to 2011 with all possible economic variations and studies the determinants of medical and healthcare expenditure for urban residents. CPI (consumer price index) of medical services and the resident consumption level of urban residents have positive influence on medical and health care expenditures for urban residents, while the local medical budget, the number of health institutions, the incidence of infectious diseases, the year-end population and the savings of urban residents will not have effect on medical and health care expenditure for urban residents. This paper proposed three relevant policy suggestions for Chinese governments based on the findings of the research.

Determinants of Medical and Health Care Expenditure Growth for Urban Residents in China: A Systematic Review Article

PubMed Central

ZHU, Xiaolong; CAI, Qiong; WANG, Jin; LIU, Yun

2014-01-01

In recent years, medical and health care consumption has risen, making health risk an important determinant of household spending and welfare. We aimed to examine the determinants of medical and health care expenditure to help policy-makers in the improvement of China’s health care system, benefiting the country, society and every household. This paper employs panel data from China’s provinces from 2001 to 2011 with all possible economic variations and studies the determinants of medical and healthcare expenditure for urban residents. CPI (consumer price index) of medical services and the resident consumption level of urban residents have positive influence on medical and health care expenditures for urban residents, while the local medical budget, the number of health institutions, the incidence of infectious diseases, the year-end population and the savings of urban residents will not have effect on medical and health care expenditure for urban residents. This paper proposed three relevant policy suggestions for Chinese governments based on the findings of the research. PMID:26171351

Households across all income quintiles, especially the poorest, increased animal source food expenditures substantially during recent Peruvian economic growth.

PubMed

Humphries, Debbie L; Behrman, Jere R; Crookston, Benjamin T; Dearden, Kirk A; Schott, Whitney; Penny, Mary E

2014-01-01

Relative to plant-based foods, animal source foods (ASFs) are richer in accessible protein, iron, zinc, calcium, vitamin B-12 and other nutrients. Because of their nutritional value, particularly for childhood growth and nutrition, it is important to identify factors influencing ASF consumption, especially for poorer households that generally consume less ASFs. To estimate differential responsiveness of ASF consumption to changes in total household expenditures for households with different expenditures in a middle-income country with substantial recent income increases. The Peruvian Young Lives household panel (n = 1750) from 2002, 2006 and 2009 was used to characterize patterns of ASF expenditures. Multivariate models with controls for unobserved household fixed effects and common secular trends were used to examine nonlinear relationships between changes in household expenditures and in ASF expenditures. Households with lower total expenditures dedicated greater percentages of expenditures to food (58.4% vs.17.9% in 2002 and 24.2% vs. 21.5% in 2009 for lowest and highest quintiles respectively) and lower percentages of food expenditures to ASF (22.8% vs. 33.9% in 2002 and 30.3% vs. 37.6% in 2009 for lowest and highest quintiles respectively). Average percentages of overall expenditures spent on food dropped from 47% to 23.2% between 2002 and 2009. Households in the lowest quintiles of expenditures showed greater increases in ASF expenditures relative to total consumption than households in the highest quintiles. Among ASF components, meat and poultry expenditures increased more than proportionately for households in the lowest quintiles, and eggs and fish expenditures increased less than proportionately for all households. Increases in household expenditures were associated with substantial increases in consumption of ASFs for households, particularly households with lower total expenditures. Increases in ASF expenditures for all but the top quintile of

Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural-urban and state level in India.

PubMed

Garg, Charu C; Karan, Anup K

2009-03-01

Out-of-pocket (OOP) expenditure on health care has significant implications for poverty in many developing countries. This paper aims to assess the differential impact of OOP expenditure and its components, such as expenditure on inpatient care, outpatient care and on drugs, across different income quintiles, between developed and less developed regions in India. It also attempts to measure poverty at disaggregated rural-urban and state levels. Based on Consumer Expenditure Survey (CES) data from the National Sample Survey (NSS), conducted in 1999-2000, the share of households' expenditure on health services and drugs was calculated. The number of individuals below the state-specific rural and urban poverty line in 17 major states, with and without netting out OOP expenditure, was determined. This also enabled the calculation of the poverty gap or poverty deepening in each region. Estimates show that OOP expenditure is about 5% of total household expenditure (ranging from about 2% in Assam to almost 7% in Kerala) with a higher proportion being recorded in rural areas and affluent states. Purchase of drugs constitutes 70% of the total OOP expenditure. Approximately 32.5 million persons fell below the poverty line in 1999-2000 through OOP payments, implying that the overall poverty increase after accounting for OOP expenditure is 3.2% (as against a rise of 2.2% shown in earlier literature). Also, the poverty headcount increase and poverty deepening is much higher in poorer states and rural areas compared with affluent states and urban areas, except in the case of Maharashtra. High OOP payment share in total health expenditures did not always imply a high poverty headcount; state-specific economic and social factors played a role. The paper argues for better methods of capturing drugs expenditure in household surveys and recommends that special attention be paid to expenditures on drugs, in particular for the poor. Targeted policies in just five poor states to reduce

Willingness to pay for other individuals' healthcare expenditures.

PubMed

Borges, A P; Reis, A; Anjos, J

2017-03-01

The need to improve the sustainability of public health expenditure, in a climate of growing pressure on national budgets, inevitably leads to a discussion about resource rationing, and the extent of society's responsibility for those expenditures. To contribute to this discussion empirically, this study evaluated the willingness of Portuguese respondents to pay for other individuals' healthcare expenditures through out-of-pocket payments. A questionnaire addressed to the general public was developed, with 296 respondents. The survey was divided into three sections: (i) sociodemographic characteristics of the respondents; (ii) health-related habits; and (iii) willingness to pay other individuals' healthcare expenditures and, if so, how much. Logit and ordered logit models were applied. Respondents were divided fairly even between those who were willing to pay for other individuals' healthcare expenditures and those who were not. Respondents with health insurance contracts were more willing to contribute, and the contribution value was higher. Having a degree-level education was associated with reduced willingness to pay for other individuals' healthcare expenditures, and reduced probability of paying a larger amount, which may be associated with holding individuals accountable for their choices. Considering self-reported risky behaviours, the respondents who consumed alcohol were more likely to be willing to pay for other individuals' healthcare expenditures, and to a greater extent, whereas smokers were less likely to pay larger amounts. These effects suggest that respondents with different unhealthy behaviours are not equally altruistic. These findings highlight the need to combine health policy and social beliefs. The respondents seem to be interested to discuss healthcare funding, given that they agreed to reveal their willingness to pay for other individuals' healthcare expenditures. Moreover, respondents' sociodemographic characteristics and health

Health insurance for the poor: impact on catastrophic and out-of-pocket health expenditures in Mexico

PubMed Central

Galárraga, Omar; Salinas-Rodríguez, Aarón; Sesma-Vázquez, Sergio

2009-01-01

The goal of Seguro Popular (SP) in Mexico was to improve the financial protection of the uninsured population against excessive health expenditures. This paper estimates the impact of SP on catastrophic health expenditures (CHE), as well as out-of-pocket (OOP) health expenditures, from two different sources. First, we use the SP Impact Evaluation Survey (2005–2006), and compare the instrumental variables (IV) results with the experimental benchmark. Then, we use the same IV methods with the National Health and Nutrition Survey (ENSANUT 2006). We estimate naïve models, assuming exogeneity, and contrast them with IV models that take advantage of the specific SP implementation mechanisms for identification. The IV models estimated included two-stage least squares (2SLS), bivariate probit, and two-stage residual inclusion (2SRI) models. Instrumental variables estimates resulted in comparable estimates against the “gold standard.” Instrumental variables estimates indicate a reduction of 54% in catastrophic expenditures at the national level. SP beneficiaries also had lower expenditures on outpatient and medicine expenditures. The selection-corrected protective effect is found not only in the limited experimental dataset, but also at the national level. PMID:19756796

Health insurance for the poor: impact on catastrophic and out-of-pocket health expenditures in Mexico.

PubMed

Galárraga, Omar; Sosa-Rubí, Sandra G; Salinas-Rodríguez, Aarón; Sesma-Vázquez, Sergio

2010-10-01

The goal of Seguro Popular (SP) in Mexico was to improve the financial protection of the uninsured population against excessive health expenditures. This paper estimates the impact of SP on catastrophic health expenditures (CHE), as well as out-of-pocket (OOP) health expenditures, from two different sources. First, we use the SP Impact Evaluation Survey (2005-2006), and compare the instrumental variables (IV) results with the experimental benchmark. Then, we use the same IV methods with the National Health and Nutrition Survey (ENSANUT 2006). We estimate naïve models, assuming exogeneity, and contrast them with IV models that take advantage of the specific SP implementation mechanisms for identification. The IV models estimated included two-stage least squares (2SLS), bivariate probit, and two-stage residual inclusion (2SRI) models. Instrumental variables estimates resulted in comparable estimates against the "gold standard." Instrumental variables estimates indicate a reduction of 54% in catastrophic expenditures at the national level. SP beneficiaries also had lower expenditures on outpatient and medicine expenditures. The selection-corrected protective effect is found not only in the limited experimental dataset, but also at the national level.

Development of post-disaster psychosocial evaluation and intervention for children: Results of a South Korean delphi panel survey

PubMed Central

Lee, Mi-Sun; Hwang, Jun-Won; Lee, Cheol-Soon; Kim, Ji-Youn; Lee, Ju-Hyun; Kim, Eunji; Chang, Hyoung Yoon; Bae, SeungMin; Park, Jang-Ho

2018-01-01

Objective This study aimed to administer a Delphi panel survey and provide evidence for the development of a psychological intervention protocol for use after disasters in South Korea. Method A three-round Delphi survey was conducted. In all rounds, respondents answered open- or closed-ended questions regarding their views on i) the concept of disaster, ii) evaluation, iii) intervention, and iv) considerations in a disaster. Data from Round 1 were subjected to content analysis. In Round 2, items with content validity ratios (CVRs) greater than 0.49 were included, and in Round 3, items with a CVR≥0.38 were accepted. Results The response rates for the Delphi survey were high: 83% (n = 15, Round 1), 80% (n = 16, Round 2), and 86% (n = 24, Round 3). The data collected during this survey showed a need for a support system for children; for preventive strategies, including disaster readiness plans; for the protection of children's safety; and for the development of post-disaster psychosocial care. Conclusions The panel experts reached a consensus regarding the steps they considered critical in post-disaster evaluation and intervention. The findings suggest a unified model for advancing the development of the Korean version of an intervention protocol for children and adolescents exposed to traumatic events. PMID:29596483

Caregiver stress: does states' expenditure on home- and community-based services matter?

PubMed

Hong, Michin; Casado, Banghwa Lee

2015-01-01

This study examined how state expenditure on home- and community-based services (HCBS) and individual factors are associated with caregiver stress. A total of 1,849 cases from the 2004 National Long-Term Care Survey were included. Gender, education, perceived physical strain, and economic hardship, as well as the number of limitations in instrumental activities of daily living (IADL) for the care recipient, were associated with caregiver stress. The cross-level interaction between service utilization and state expenditure on HCBS was significant, suggesting that living in states with a higher expenditure on HCBS is associated with reduced stress regardless of service utilization.

42 CFR 100.2 - Average cost of a health insurance policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Research and Educational Trust (KFF/HRET) Employer Health Benefits survey or other authoritative source... most recent Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) data available as the...

42 CFR 100.2 - Average cost of a health insurance policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Research and Educational Trust (KFF/HRET) Employer Health Benefits survey or other authoritative source... most recent Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) data available as the...

42 CFR 100.2 - Average cost of a health insurance policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Research and Educational Trust (KFF/HRET) Employer Health Benefits survey or other authoritative source... most recent Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) data available as the...

42 CFR 100.2 - Average cost of a health insurance policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Research and Educational Trust (KFF/HRET) Employer Health Benefits survey or other authoritative source... most recent Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) data available as the...

Financial Burden of Health Care Expenditures: Turkey

PubMed Central

Sulku, S Nur; Bernard, D Minbay

2012-01-01

In this study, we examine whether and to what extent the health insurance system in Turkey provided adequate protection against high out of pocket expenditures in the period prior to “The Health Transformation Programme”. Furthermore, we examine the distribution of out of pocket expenditures by demographic characteristics, poverty status, health service type, access to health care and self-reported health status. We employ the 2002/03 National Household Health Expenditure Survey data to analyze financial burden of health care expenditure. Following the literature, we define high burdens as expenses above 10 and 20% of income. We find that 19% of the nonelderly population were living in families spending more than 10% of family income and that 14% of the nonelderly population were living in families spending more than 20% of family income on health care. Furthermore, the poor and those living in economically less developed regions had the greatest risk of high out of pocket burdens. The risk of high financial burdens varied by the type of insurance among the insured due to differences in benefits among the five separate public schemes that provided health insurance in the pre-reform period. Our results are robust to three alternative specifications of the burden measure and including elderly adults in the sample population. We see that prior to the reforms there were not adequate protection against high health expenditures. Our study provides a baseline against which policymakers can measure the success of the health care reform in terms of providing financial protection. PMID:23113149

[Changes in processed food expenditure in the population of Metropolitan Santiago in the last twenty years].

PubMed

Crovetto, Mirta; Uauy, Ricardo

2012-03-01

During recent decades household incomes have increased steadily, leading to changes in dietary habits and food expenditure. To report changes in household food expenditure focusing on trends in processed food across income quintiles in Metropolitan Santiago. Information obtained from the Fourth (1986-1987), Fifth (1996-1997) and Sixth National Institute of Statistics (INE) Surveys (2006-2007) were used. Food expenditure data over the study periods was extracted from household expenditure surveys (HES) after verifying and adjusting food prices registered by the INE to current 2007 prices. Absolute food expenditure over the study period increased for all groups; the largest increase was found in lowest income quintiles; however, the proportion of total family budget spent on food decreased in all groups. The largest increases in food expenditure corresponded to sweetened beverages, processed fruit juices, alcoholic drinks, ready meals and "eating out". Expenditure on fish rose slightly whereas the absolute spending on legumes, eggs and oils decreased. Expenditure in processed food as percentage of total food expenditure increased from 42% to 57% of total for mean household. For the 2nd quintile it rose from 31% to 48% and for the lowest quintile increased from 53% to 68% over the three decades (1987-2007). Changes were greatest in energy rich processed foods such as bread, pastries, confectioneries and granulated sugar. These particular foods are of high energy density and contain high amounts of saturated fat, sodium and added sugars. These results confirm that food consumption patterns over the past decades have progressively departed from the recommended dietary guidelines given by national and international health organizations.

Generalizing observational study results: applying propensity score methods to complex surveys.

PubMed

Dugoff, Eva H; Schuler, Megan; Stuart, Elizabeth A

2014-02-01

To provide a tutorial for using propensity score methods with complex survey data. Simulated data and the 2008 Medical Expenditure Panel Survey. Using simulation, we compared the following methods for estimating the treatment effect: a naïve estimate (ignoring both survey weights and propensity scores), survey weighting, propensity score methods (nearest neighbor matching, weighting, and subclassification), and propensity score methods in combination with survey weighting. Methods are compared in terms of bias and 95 percent confidence interval coverage. In Example 2, we used these methods to estimate the effect on health care spending of having a generalist versus a specialist as a usual source of care. In general, combining a propensity score method and survey weighting is necessary to achieve unbiased treatment effect estimates that are generalizable to the original survey target population. Propensity score methods are an essential tool for addressing confounding in observational studies. Ignoring survey weights may lead to results that are not generalizable to the survey target population. This paper clarifies the appropriate inferences for different propensity score methods and suggests guidelines for selecting an appropriate propensity score method based on a researcher's goal. © Health Research and Educational Trust.

Medical care expenditures for selected circulatory diseases: opportunities for reducing national health expenditures.

PubMed

Hodgson, T A; Cohen, A J

1999-10-01

Circulatory system diseases are a significant burden in terms of morbidity, mortality, and use of health care services. This article presents total, per capita, and per condition US medical care expenditures in 1995 for circulatory diseases according to sex, age, and type of health service. Total personal health care expenditures estimated by the Health Care Financing Administration for each type of health care service are separated into components to estimate patient expenditures by age, sex, primary medical diagnosis, and health care service for all diseases of the circulatory system, heart disease, coronary heart disease, congestive heart failure, hypertensive disease, and cerebrovascular disease. Expenditures for circulatory diseases totaled $127.8 billion in 1995 (17% of all personal health care expenditures), $486 per capita, and $1,636 per condition. Approximately one half of expenditures was for hospital care and 20% was for nursing home care. Heart disease accounted for 60% of circulatory expenditures. Expenditures increased with age and reached 35% of expenditures among persons aged 85 years and older, which was almost $7,000 per capita. These relationships vary somewhat according to the specific circulatory disease, type of health care, and age. Expenditures increase with age and circulatory diseases can be expected to command an increasing share of national health expenditures as the number and proportion of the population that is elderly grows. The alteration of lifestyles and medical interventions provide many opportunities to prevent circulatory diseases and to reduce national health expenditures.

Determinants and Equity Evaluation for Health Expenditure Among Patients with Rare Diseases in China.

PubMed

Xin, Xiao-Xiong; Zhao, Liang; Guan, Xiao-Dong; Shi, Lu-Wen

2016-06-20

China has not established social security system for rare diseases. Rare diseases could easily impoverish patients and their families. Little research has studied the equity and accessibility of health services for patients with rare diseases in China. This study aimed to explore the factors that influence health expenditure of rare diseases and evaluate its equity. Questionnaire survey about living conditions and cost burden of patients with rare diseases was conducted. Individual and family information, health expenditure and reimbursement in 2014 of 982 patients were collected. The impact of medical insurance, individual sociodemographic characteristics, family characteristics, and healthcare need on total and out-of-pocket (OOP) health expenditures was analyzed through the generalized linear model. Equity of health expenditure was evaluated by both concentration index and Lorenz curve. Of all the surveyed patients, 11.41% had no medical insurance and 92.10% spent money to seek medical treatment in 2014. It was suggested female (P = 0.048), over 50 years of age (P = 0.062), high-income group (P = 0.021), hospitalization (P = 0.000), and reimbursement ratio (RR) (P = 0.000) were positively correlated with total health expenditure. Diseases not needing long-term treatment (P = 0.000) was negatively correlated with total health expenditure. Over 50 years of age (P = 0.065), high-income group (P = 0.018), hospitalization (P = 0.000) and having Urban Employee Basic Medical Insurance (UEBMI) (P = 0.022) were positively correlated with OOP health expenditure. Patient or the head of the household having received higher education (P = 0.044 and P = 0.081) and reimbursement ratio (P = 0.078) were negatively correlated with OOP health expenditure. The equity evaluation found concentration indexes of health expenditure before and after reimbursement were 0.0550 and 0.0539, respectively. OOP health expenditure of patients with UEBMI was significantly more than that of

Associations Between Magnitude of Child Maltreatment and Medicaid Expenditures for Psychotropic Medications.

PubMed

Raghavan, Ramesh; Brown, Derek S; Allaire, Benjamin T; Ross, Raven E; Landsverk, John

2016-08-01

This study examined relationships between various measures of the severity of child maltreatment and expenditures on psychotropic drugs among children in the welfare system. Child participants (N=4,453) in the first National Survey of Child and Adolescent Well-Being (NSCAW) were linked to their Medicaid claims from 36 states. Three specifications for severity of maltreatment were developed. A two-part regression of logistic and generalized linear models of expenditures on psychotropic medications was estimated for each specification. Physically abused children had higher odds (odds ratio [OR]=1.34) and neglected children had lower odds (OR=.76) of incurring psychotropic drug expenditures. Children who experienced the most severe level of harm had higher odds (OR=1.33) of medication use, compared with children without appreciable harm. No maltreatment specifications were associated with increased expenditures on psychotropic drugs. The magnitude of maltreatment affected odds of use of psychotropic drugs but had no effect on Medicaid expenditures for these drugs.

Projecting future drug expenditures--2009.

PubMed

Hoffman, James M; Shah, Nilay D; Vermeulen, Lee C; Doloresco, Fred; Martin, Patrick K; Blake, Sharon; Matusiak, Linda; Hunkler, Robert J; Schumock, Glen T

2009-02-01

Drug expenditure trends in 2007 and 2008, projected drug expenditures for 2009, and factors likely to influence drug expenditures are discussed. Various factors are likely to influence drug expenditures in 2009, including drugs in development, the diffusion of new drugs, drug safety concerns, generic drugs, Medicare Part D, and changes in the drug supply chain. The increasing availability of important generic drugs and drug safety concerns continue to moderate growth in drug expenditures. The drug supply chain remains dynamic and may influence drug expenditures, particularly in specialized therapeutic areas. Initial data suggest that the Medicare Part D benefit has influenced drug expenditures, but the ultimate impact of the benefit on drug expenditures remains unclear. From 2006 to 2007, total U.S. drug expenditures increased by 4.0%, with total spending rising from $276 billion to $287 billion. Drug expenditures in clinics continue to grow more rapidly than in other settings, with a 9.9% increase from 2006 to 2007. Hospital drug expenditures increased at a moderate rate of only 1.6% from 2006 to 2007; through the first nine months of 2008, hospital drug expenditures increased by only 2.8% compared with the same period in 2007. In 2009, we project a 0-2% increase in drug expenditures in outpatient settings, a 1-3% increase in expenditures for clinic-administered drugs, and a 1-3% increase in hospital drug expenditures.

Gambling expenditure by game type among weekly gamblers in Finland.

PubMed

Salonen, Anne H; Kontto, Jukka; Perhoniemi, Riku; Alho, Hannu; Castrén, Sari

2018-06-05

Excessive expenditure and financial harms are core features of problem gambling. There are various forms of gambling and their nature varies. The aim was to measure gambling expenditure by game type while controlling for demographics and other gambling participation factors. A further aim was to find out how each game type was associated with gambling expenditure when the number of game types played is adjusted for. Using data from the 2015 Finnish Gambling survey on adult gamblers (n = 3555), multiple log-linear regression was used to examine the effects of demographics, gambling participation, and engaging in different game types on weekly gambling expenditure (WGE) and relative gambling expenditure (RGE). Male gender, lower education level, higher gambling frequency and higher number of game types increased both WGE and RGE, while younger age decreased WGE but increased RGE. Furthermore, seven specific game types increased both WGE and RGE. Weekly horse race betting and non-monopoly gambling had the strongest increasing effect on expenditure. Betting games and online poker were associated with higher expenditure even when they were played less often than weekly. Among weekly gamblers the highest mean WGE was recorded for those who played non-monopoly games (146.84 €/week), online poker (59.61 €/week), scratch games (51.77 €/week) and horse race betting (48.67 €/week). Those who played only 1-2 game types a week had the highest mean WGE and RGE on horse race betting and other betting games. It seems that overall gambling frequency is the strongest indicator of high gambling expenditure. Our results showed that different game types had different effect sizes on gambling expenditure. Weekly gambling on horse races and non-monopoly games had the greatest increasing effect on expenditure. However, different game types also varied based on their popularity. The extent of potential harms caused by high expenditure therefore also varies on the population level

Projecting future drug expenditures--2012.

PubMed

Hoffman, James M; Li, Edward; Doloresco, Fred; Matusiak, Linda; Hunkler, Robert J; Shah, Nilay D; Vermeulen, Lee C; Schumock, Glen T

2012-03-01

Factors likely to influence drug expenditures, drug expenditure trends in 2010 and 2011, and projected drug expenditures for 2012 are discussed. Data were analyzed to provide drug expenditure trends for total drug expenditures and the hospital and clinic sectors. Data were obtained from the IMS Health National Sales Perspectives database. From 2009 to 2010, total U.S. drug expenditures increased by 2.7%, with total spending rising from $299.2 billion to $307.5 billion. Drug expenditures in clinics grew by 6.0% from 2009 to 2010. Hospital drug expenditures increased at the moderate rate of 1.5% from 2009 to 2010; through the first nine months of 2011, hospital drug expenditures increased by only 0.3% compared with the same period in 2010. The dominant trend over the past several years is substantial moderation in expenditure growth for widely used drugs, primarily due to the ongoing introduction and wide use of generic versions of high-cost, frequently used medications. At the end of 2010, generic drugs accounted for 78% of all retail prescriptions dispensed. Another pattern is substantial increases in expenditures for specialized medications, particularly in the outpatient setting as growth in prescription drug expenditures for clinic-administered drugs consistently outpaces growth in total expenditures. Various factors are likely to influence drug expenditures in 2012, including drugs in development, the diffusion of new drugs, generic drugs, drug shortages, and biosimilars. For 2012, we project a 3-5% increase in total drug expenditures across all settings, a 5-7% increase in expenditures for clinic-administered drugs, and a 0-2% increase in hospital drug expenditures.

Households across All Income Quintiles, Especially the Poorest, Increased Animal Source Food Expenditures Substantially during Recent Peruvian Economic Growth

PubMed Central

Humphries, Debbie L.; Behrman, Jere R.; Crookston, Benjamin T.; Dearden, Kirk A.; Schott, Whitney; Penny, Mary E.

2014-01-01

Background Relative to plant-based foods, animal source foods (ASFs) are richer in accessible protein, iron, zinc, calcium, vitamin B-12 and other nutrients. Because of their nutritional value, particularly for childhood growth and nutrition, it is important to identify factors influencing ASF consumption, especially for poorer households that generally consume less ASFs. Objective To estimate differential responsiveness of ASF consumption to changes in total household expenditures for households with different expenditures in a middle-income country with substantial recent income increases. Methods The Peruvian Young Lives household panel (n = 1750) from 2002, 2006 and 2009 was used to characterize patterns of ASF expenditures. Multivariate models with controls for unobserved household fixed effects and common secular trends were used to examine nonlinear relationships between changes in household expenditures and in ASF expenditures. Results Households with lower total expenditures dedicated greater percentages of expenditures to food (58.4% vs.17.9% in 2002 and 24.2% vs. 21.5% in 2009 for lowest and highest quintiles respectively) and lower percentages of food expenditures to ASF (22.8% vs. 33.9% in 2002 and 30.3% vs. 37.6% in 2009 for lowest and highest quintiles respectively). Average percentages of overall expenditures spent on food dropped from 47% to 23.2% between 2002 and 2009. Households in the lowest quintiles of expenditures showed greater increases in ASF expenditures relative to total consumption than households in the highest quintiles. Among ASF components, meat and poultry expenditures increased more than proportionately for households in the lowest quintiles, and eggs and fish expenditures increased less than proportionately for all households. Conclusions Increases in household expenditures were associated with substantial increases in consumption of ASFs for households, particularly households with lower total expenditures. Increases in ASF

Combined Effects of Chewing Ability and Dietary Diversity on Medical Service Use and Expenditures.

PubMed

Lo, Yuan-Ting C; Wahlqvist, Mark L; Chang, Yu-Hung; Lee, Meei-Shyuan

2016-06-01

To examine whether chewing ability affects healthcare use and expenditure and whether improving dietary quality alleviates any such effects. Prospective cohort. The Elderly Nutrition and Health Survey in Taiwan (1999-2000), a nationwide community-based survey of people aged 65 and older. Individuals aged 65 and older (N = 1,793; 903 men, 890 women). Chewing ability (satisfactory or unsatisfactory) was assessed using a questionnaire, and dietary quality was assessed using a 24-hour dietary recall as a dietary diversity score. Data on annual medical use and expenditures from the interview date until December 31, 2006, were collected from National Health Insurance claims. Generalized linear models were used to assess the associations between chewing ability, dietary quality, and annual medical usage or expenditure. After 8 years of follow-up, older adults with unsatisfactory chewing ability had considerably higher emergency, hospitalization, and total medical expenditures. Older adults with unsatisfactory chewing ability and a poor diet used fewer annual preventive care and dental services than those with satisfactory chewing ability but had longer hospital stays and higher expenditures. After adjusting for covariates, unsatisfactory chewing ability resulted in significantly longer hospital stays in participants with a poor diet (β = 2.34, 95% confidence interval = 2.02-2.71, P < .001). Unsatisfactory chewing ability and a less-diverse diet together are associated with longer hospital stays and higher medical expenditures. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Projecting future drug expenditures--2010.

PubMed

Hoffman, James M; Doloresco, Fred; Vermeulen, Lee C; Shah, Nilay D; Matusiak, Linda; Hunkler, Robert J; Schumock, Glen T

2010-06-01

Drug expenditure trends in 2008 and 2009, projected drug expenditures for 2010, and factors likely to influence drug expenditures are discussed. Various factors are likely to influence drug expenditures in 2010, including drugs in development, the diffusion of new drugs, generic drugs, health care reform, drug safety concerns, and comparative effectiveness research. The increasing availability of important generic drugs continues to moderate growth in drug expenditures. Health care reform initiatives, including the potential for biosimilars legislation, will influence drug expenditures in all settings. From 2007 to 2008, total U.S. drug expenditures increased by 1.8%, with total spending rising from $279.6 billion to $284.7 billion. Growth in drug expenditures in clinics declined to the lowest level in a decade, a 1.0% increase from 2007 to 2008. Hospital drug expenditures increased at a moderate rate of only 2.1% from 2007 to 2008; through the first nine months of 2009, hospital drug expenditures increased by 3.0% compared with the same period in 2008. In 2010, we project a 3-5% increase in drug expenditures in outpatient settings, a 6-8% increase in expenditures for clinic-administered drugs, and a 2-4% increase in hospital drug expenditures.

Dynamics of Adult Participation in Part-Time Education and Training: Results from the British Household Panel Survey

ERIC Educational Resources Information Center

Macleod, Flora; Lambe, Paul

2008-01-01

In this paper we analyse the dynamics of adult participation in part-time education and training throughout the 90s and into the 2000s using data from 14 waves (1992-2005) of the British Household Panel Survey (BHPS). We study the volume (stocks) of participation and non-participation and the gross flows between states. This analysis provides a…

Activity limitations predict health care expenditures in the general population in Belgium.

PubMed

Van der Heyden, Johan; Van Oyen, Herman; Berger, Nicolas; De Bacquer, Dirk; Van Herck, Koen

2015-03-19

Disability and chronic conditions both have an impact on health expenditures and although they are conceptually related, they present different dimensions of ill-health. Recent concepts of disability combine a biological understanding of impairment with the social dimension of activity limitation and resulted in the development of the Global Activity Limitation Indicator (GALI). This paper reports on the predictive value of the GALI on health care expenditures in relation to the presence of chronic conditions. Data from the Belgian Health Interview Survey 2008 were linked with data from the compulsory national health insurance (n = 7,286). The effect of activity limitation on health care expenditures was assessed via cost ratios from multivariate linear regression models. To study the factors contributing to the difference in health expenditure between persons with and without activity limitations, the Blinder-Oaxaca decomposition method was used. Activity limitations are a strong determinant of health care expenditures. People with severe activity limitations (5.1%) accounted for 16.9% of the total health expenditure, whereas those without activity limitations (79.0%), were responsible for 51.5% of the total health expenditure. These observed differences in health care expenditures can to some extent be explained by chronic conditions, but activity limitations also contribute substantially to higher health care expenditures in the absence of chronic conditions (cost ratio 2.46; 95% CI 1.74-3.48 for moderate and 4.45; 95% CI 2.47-8.02 for severe activity limitations). The association between activity limitation and health care expenditures is stronger for reimbursed health care costs than for out-of-pocket payments. In the absence of chronic conditions, activity limitations appear to be an important determinant of health care expenditures. To make projections on health care expenditures, routine data on activity limitations are essential and complementary to data

Incremental impact of body mass status with modifiable unhealthy lifestyle behaviors on pharmaceutical expenditure.

PubMed

Kim, Tae Hyun; Lee, Eui-Kyung; Han, Euna

Overweight/obesity is a growing health risk in Korea. The impact of overweight/obesity on pharmaceutical expenditure can be larger if individuals have multiple risk factors and multiple comorbidities. The current study estimated the combined effects of overweight/obesity and other unhealthy behaviors on pharmaceutical expenditure. An instrumental variable quantile regression model was estimated using Korea Health Panel Study data. The current study extracted data from 3 waves (2009, 2010, and 2011). The final sample included 7148 person-year observations for adults aged 20 years or older. Overweight/obese individuals had higher pharmaceutical expenditure than their non-obese counterparts only at the upper quantiles of the conditional distribution of pharmaceutical expenditure (by 119% at the 90th quantile and 115% at the 95th). The current study found a stronger association at the upper quantiles among men (152%, 144%, and 150% at the 75th, 90th, and 95th quantiles, respectively) than among women (152%, 150%, and 148% at the 75th, 90th, and 95th quantiles, respectively). The association at the upper quantiles was stronger when combined with moderate to heavy drinking and no regular physical check-up, particularly among males. The current study confirms that the association of overweight/obesity with modifiable unhealthy behaviors on pharmaceutical expenditure is larger than with overweight/obesity alone. Assessing the effect of overweight/obesity with lifestyle risk factors can help target groups for public health intervention programs. Copyright © 2015 Elsevier Inc. All rights reserved.

Impact of healthcare reforms on out-of-pocket health expenditures in Turkey for public insurees.

PubMed

Erus, Burcay; Aktakke, Nazli

2012-06-01

The Turkish healthcare system has been subject to major reforms since 2003. During the reform process, access to public healthcare providers was eased and private providers were included in the insurance package for public insurees. This study analyzes data on out-of-pocket (OOP) healthcare expenditures to look into the impact of reforms on the size of OOP health expenditures for premium-based public insurees. The study uses Household Budget Surveys that provide a range of individual- and household-level data as well as healthcare expenditures for the years 2003, before the reforms, and 2006, after the reforms. Results show that with the reforms ratio of households with non-zero OOP expenditure has increased. Share and level of OOP expenditures have decreased. The impact varies across income levels. A semi-parametric analysis shows that wealthier individuals benefited more in terms of the decrease in OOP health expenditures.

Measuring the relationship between sportfishing trip expenditures and anglers’ species preferences

USGS Publications Warehouse

Long, James M.; Melstrom, Richard T.

2016-01-01

We examined the relationship between fishing trip expenditures and anglers’ species preferences from a survey of Oklahoma resident anglers conducted in 2014. Understanding patterns in fishing trip expenditures is important because a significant share of state wildlife agency revenue comes from taxes on purchases of fishing equipment. Presently, there is little research that addresses the question of how spending levels vary within groups of sportspersons, including anglers. We used regression analysis to identify a relationship between trip spending and several preference variables, and included controls for other characteristics of fishing trips, such as location, party size, and duration. We received 780 surveys for a response rate of 26%, but only 506 were useable due to missing data or nonfishing responses. Average trip expenditures were approximately US$140, regardless of species preferences, but anglers who preferred to fish for trout and black bass tended to spend more than those who preferred to fish for catfish and panfish. These results were even more pronounced when location was considered, those who last fished at lakes spending more than those who fished at rivers or ponds. The results underscore the differences in spending among anglers with different preferred species and fishing locations.

The Efficiency of Split Panel Designs in an Analysis of Variance Model

PubMed Central

Wang, Wei-Guo; Liu, Hai-Jun

2016-01-01

We consider split panel design efficiency in analysis of variance models, that is, the determination of the cross-sections series optimal proportion in all samples, to minimize parametric best linear unbiased estimators of linear combination variances. An orthogonal matrix is constructed to obtain manageable expression of variances. On this basis, we derive a theorem for analyzing split panel design efficiency irrespective of interest and budget parameters. Additionally, relative estimator efficiency based on the split panel to an estimator based on a pure panel or a pure cross-section is present. The analysis shows that the gains from split panel can be quite substantial. We further consider the efficiency of split panel design, given a budget, and transform it to a constrained nonlinear integer programming. Specifically, an efficient algorithm is designed to solve the constrained nonlinear integer programming. Moreover, we combine one at time designs and factorial designs to illustrate the algorithm’s efficiency with an empirical example concerning monthly consumer expenditure on food in 1985, in the Netherlands, and the efficient ranges of the algorithm parameters are given to ensure a good solution. PMID:27163447

Can eHealth Reduce Medical Expenditures of Chronic Diseases?

PubMed

Tsuji, Masatsugu; Taher, Sheikh Abu; Kinai, Yusuke

2015-01-01

The objective of this research is to evaluate empirically the effectiveness of eHealth in Nishi-aizu Town, Fukushima Prefecture, based on a mail survey to the residents and their receipt data of National Health Insurance from November 2006 to February 2007. The residents were divided into two groups, users and non-users, and sent questionnaires to ask their characteristics or usage of the system. Their medical expenditures paid by National Health Insurance for five years from 2002 to 2006 are examined. The effects were analyzed by comparison of medical expenditures between users and non-users. The interests are focused on four chronic diseases namely heart diseases, high blood pressure, diabetes, and strokes. A regression analysis is employed to estimate the effect of eHealth to users who have these diseases and then calculate the monetary effect of eHealth on reduction of medical expenditures. The results are expected to be valid for establishment of evidence-based policy such as reimbursement from medical insurance to eHealth.

Health care expenditure of households in magway, myanmar.

PubMed

Khaing, Inn Kynn; Malik, Amonov; Oo, Myo; Hamajima, Nobuyuki

2015-02-01

Myanmar has a high proportion of out-of-pocket (OOP) health care expenditures with limited cost-sharing mechanisms. In Myanmar, there were limited data on the frequency of catastrophic health expenditure (CHE) due to OOP payments, as well as on the factors associated with CHE. This study aimed to investigate health care expenditure, the frequency of CHE, and the factors influencing CHE among households in Magway, Myanmar. A cross-sectional household survey was conducted in 2012 for 700 households (350 in urban areas and 350 in rural areas) in Magway. CHE was defined as a condition wherein the total amount of household health care expenditure was 40% or more of non-food expenditure in the past year. Multiple logistic regression analysis was applied to estimate odds ratios (ORs) and 95% confident intervals (CIs) of CHE. In the previous year, 28.3% of 350 urban households and 51.4% of 350 rural households utilized outpatient services. Households with at least one member admitted to a medical facility were 10.0% and 12.9%, respectively. Those with CHE were 25.2% in the urban areas and 22.7% in the rural areas. The adjusted OR of CHE was 7.79 (95% CI 3.73-16.26) for hospitalization and 1.08 (95% CI 0.36-3.23) for outpatient care, relative to no services used. These findings indicated that nearly one fourth of households in Magway faced CHE due to inpatient care. A safety-net mechanism to protect households from CHE in Myanmar seems essential.

HEALTH CARE EXPENDITURE OF HOUSEHOLDS IN MAGWAY, MYANMAR

PubMed Central

KHAING, INN KYNN; MALIK, AMONOV; OO, MYO; HAMAJIMA, NOBUYUKI

2015-01-01

ABSTRACT Myanmar has a high proportion of out-of-pocket (OOP) health care expenditures with limited cost-sharing mechanisms. In Myanmar, there were limited data on the frequency of catastrophic health expenditure (CHE) due to OOP payments, as well as on the factors associated with CHE. This study aimed to investigate health care expenditure, the frequency of CHE, and the factors influencing CHE among households in Magway, Myanmar. A cross-sectional household survey was conducted in 2012 for 700 households (350 in urban areas and 350 in rural areas) in Magway. CHE was defined as a condition wherein the total amount of household health care expenditure was 40% or more of non-food expenditure in the past year. Multiple logistic regression analysis was applied to estimate odds ratios (ORs) and 95% confident intervals (CIs) of CHE. In the previous year, 28.3% of 350 urban households and 51.4% of 350 rural households utilized outpatient services. Households with at least one member admitted to a medical facility were 10.0% and 12.9%, respectively. Those with CHE were 25.2% in the urban areas and 22.7% in the rural areas. The adjusted OR of CHE was 7.79 (95% CI 3.73–16.26) for hospitalization and 1.08 (95% CI 0.36–3.23) for outpatient care, relative to no services used. These findings indicated that nearly one fourth of households in Magway faced CHE due to inpatient care. A safety-net mechanism to protect households from CHE in Myanmar seems essential. PMID:25797985

[The effect of Seguro Popular de Salud on catastrophic and impoverishing expenditures in Mexico, 2004-2012].

PubMed

Knaul, Felicia Marie; Arreola-Ornelas, Héctor; Wong, Rebeca; Lugo-Palacios, David G; Méndez-Carniado, Oscar

2018-01-01

To determine the impact of Seguro Popular (SPS) on catastrophic and impoverishing household expenditures and on the financial protection of the Mexican health system. The propensity score matching (PSM) method was applied to the population affiliated to SPS to determine the program's attributable effect on health expenditure. This analysis uses the National Household Income and Expenditure Survey (ENIGH) during 2004-2012, conducted by Mexico's National Institute of Statistics andGeography (INEGI). It was found that SPS has a significant effect on reducing the likelihood that households will incur impoverishing expenditures. A negative effect on catastrophic expenditures was also found, but it was not statistically significant. This paper shows the effect that SPS, in particular health insurance, has as an instrument of financial protection. Future studies using longer periods of ENIGH data should analyze the persistence of high out-of-pocket expenditure.

Review of the magnetic fusion program by the 1986 ERAB Fusion Panel

NASA Astrophysics Data System (ADS)

Davidson, Ronald C.

1987-09-01

The 1986 ERAB Fusion Panel finds that fusion energy continues to be an attractive energy source with great potential for the future, and that the magnetic fusion program continues to make substantial technical progress. In addition, fusion research advances plasma physics, a sophisticated and useful branch of applied science, as well as technologies important to industry and defense. These factors fully justify the substantial expenditures by the Department of Energy in fusion research and development (R&D). The Panel endorses the overall program direction, strategy, and plans, and recognizes the importance and timeliness of proceeding with a burning plasma experiment, such as the proposed Compact Ignition Tokamak (CIT) experiment.

Trends in E&G Expenditure Allocations: Indicators of Recession or Increased Productivity?

ERIC Educational Resources Information Center

Minter, John

1992-01-01

Findings of a survey of 300 financial officers at public and independent 4-year and 2-year institutions of higher education concerning budget allocation trends since 1987 are presented in narrative and 24 charts. The survey documents changes in growth rates in allocations by various categories and distribution of expenditures by institution type.…

Decadal Survey: Planetary Rings Panel

NASA Astrophysics Data System (ADS)

Gordon, M. K.; Cuzzi, J. N.; Lissauer, J. J.; Poulet, F.; Brahic, A.; Charnoz, S.; Ferrari, C.; Burns, J. A.; Nicholson, P. D.; Durisen, R. H.; Rappaport, N. J.; Spilker, L. J.; Yanamandra-Fisher, P.; Bosh, A. S.; Olkin, C.; Larson, S. M.; Graps, A. L.; Krueger, H.; Black, G. J.; Festou, M.; Karjalainen, R.; Salo, H. J.; Murray, C. D.; Showalter, M. R.; Dones, L.; Levison, H. F.; Namouni, F.; Araki, S.; Lewis, M. C.; Brooks, S.; Colwell, J. E.; Esposito, L. W.; Horanyi, M.; Stewart, G. R.; Krivov, A.; Schmidt, J.; Spahn, F.; Hamilton, D. P.; Giuliatti-Winter, S.; French, R. G.

2001-11-01

The National Research Council's Committee on Planetary and Lunar Exploration(COMPLEX) met earlier this year to begin the organization of a major activity, "A New Strategy for Solar System Exploration." Several members of the planetary rings community formed an ad hoc panel to discuss the current state and future prospects for the study of planetary rings. In this paper we summarize fundamental questions of ring science, list the key science questions expected to occupy the planetary rings community for the decade 2003-2013, outline the initiatives, missions, and other supporting activities needed to address those questions, and recommend priorities.

Monetary and nonmonetary household consumption of health services and the role of insurance benefits: An analysis of the Mexico's National Household Income and Expenditure Survey.

PubMed

Serván-Mori, Edson; Wirtz, Veronika J

2018-05-23

To study the monetary and nonmonetary consumption of healthcare services at household level in Mexico and the magnitude of the contribution of public programs. By using the National Household Income and Expenditure Survey 2012, we performed a cross-sectional and observational analysis of actual household consumption of health services by insurance type (no insurance, social security, Seguro Popular (SP)). Household consumption was divided into 2 categories: consumption related to "monetary" expenditure in health care and "nonmonetary" consumption in health care by the household. Nonmonetary included self-consumption or gifts received from other households and institutional contributions such as government payments or private organization transfers. In SP households, monetary and nonmonetary consumption of health services represented the highest proportion of available household expenditure (11.2%) compared to uninsured (8.4%) and social security (5.9%) households. The prevalence of outpatient consultation and medicine use is the highest among the health service consumption categories regardless of insurance status. Distribution of nonmonetary versus monetary consumption of health services was pro-poor: The poorer the households, the larger the proportion of nonmonetary consumption. The higher probability of receiving nonmonetary resources as a component of health service consumption in SP households is likely to increase the affordability to health services and likely to reduce healthcare expenditures. Future research should focus on the type of nonmonetary consumption of health services at household level to better understand financial protection and access to health care in Mexico. Copyright © 2018 John Wiley & Sons, Ltd.

Determinants of Catastrophic Dental Health Expenditure in China

PubMed Central

Liu, Xuenan; Gallagher, Jennifer Elizabeth; Zheng, Shuguo

2016-01-01

This study explored catastrophic health expenditure in China, due to out-of-pocket payments for dental care, and its associated individual- and contextual-level factors. We pooled data from 31,566 adults who participated in the third National Oral Health Survey with province-level data from different sources. We defined catastrophic dental health expenditure (CDHE) as payments for dental services and/or medication for dental problems during the last year that exceeded the 10% and 20% of the household income. The association of individual and contextual factors with catastrophic dental health expenditure was evaluated using two-level logistic regression models with individuals nested within provinces. Socioeconomic position (education and household income), household size and dental status (pain in teeth or mouth and number of teeth) were the individual-level factors associated with CDHE among the full sample of participants; and, also, among those who used dental services in the past year. Greater gross domestic product per capita was the only contextual factor associated with CDHE, and only at the lower income threshold. This study shows that out-of-pocket expenses for dental services may put a considerable, and unnecessary, burden on households’ finances. Our findings also help characterise those households more likely to face catastrophic expenditure on health if they have to pay for dental services. PMID:27977756

Generalizing Observational Study Results: Applying Propensity Score Methods to Complex Surveys

PubMed Central

DuGoff, Eva H; Schuler, Megan; Stuart, Elizabeth A

2014-01-01

ObjectiveTo provide a tutorial for using propensity score methods with complex survey data. Data SourcesSimulated data and the 2008 Medical Expenditure Panel Survey. Study DesignUsing simulation, we compared the following methods for estimating the treatment effect: a naïve estimate (ignoring both survey weights and propensity scores), survey weighting, propensity score methods (nearest neighbor matching, weighting, and subclassification), and propensity score methods in combination with survey weighting. Methods are compared in terms of bias and 95 percent confidence interval coverage. In Example 2, we used these methods to estimate the effect on health care spending of having a generalist versus a specialist as a usual source of care. Principal FindingsIn general, combining a propensity score method and survey weighting is necessary to achieve unbiased treatment effect estimates that are generalizable to the original survey target population. ConclusionsPropensity score methods are an essential tool for addressing confounding in observational studies. Ignoring survey weights may lead to results that are not generalizable to the survey target population. This paper clarifies the appropriate inferences for different propensity score methods and suggests guidelines for selecting an appropriate propensity score method based on a researcher’s goal. PMID:23855598

Dental Treatment and Expenditures Under General Anesthesia Among Medicaid-Enrolled Children in North Carolina.

PubMed

Meyer, Beau D; Lee, Jessica Y; Casey, Mark W

2017-11-01

Many studies reporting dental utilization under general anesthesia (GA) are dated. The purpose of this study was to provide contemporaneous data about children receiving dental GA by: (1) determining trends in utilization and associated expenditures; and (2) examining the effects of provider distribution. This time series cross-sectional study of Medicaid-eligible children ages zero to eight years old in North Carolina used aggregate Medicaid claims from State Fiscal Years (SFY) 2011 to 2015 to collect demographic and dental treatment information. Descriptive statistics were stratified by age and year to examine trends over time. Panel analysis techniques were used to explore regional effects of provider distribution on dental GA utilization. For SFY 2011 to 2015, the overall dental utilization rate was 517.1 per 1,000 (total enrolled equals 632,941 children/year), and the dental GA utilization rate was 15.8 per 1,000. Total dental expenditures averaged $113 million per year, and dental GA averaged $16.7 million per year. The dental GA proportion of expenditures increased over time (P<.001). Provider distribution did not affect dental GA utilization rate (P=.178) but did increase the number of children receiving dental GA (P<.001). Utilization and expenditures associated with dental treatment under general anesthesia continue to increase. While this reflects increased access to care, interventions should be examined to provide preventive care earlier in a child's life.

Prescription drug coverage and effects on drug expenditures among elderly Medicare beneficiaries.

PubMed

Huh, Soonim; Rice, Thomas; Ettner, Susan L

2008-06-01

To identify determinants of drug coverage among elderly Medicare beneficiaries and to investigate the impact of drug coverage on drug expenditures with and without taking selection bias into account. The primary data were from the 2000 Medicare Current Beneficiary Survey (MCBS) Cost and Use file, linked to other data sources at the county or state-level that provided instrumental variables. Community-dwelling elderly Medicare beneficiaries who completed the survey were included in the study (N=7,525). A probit regression to predict the probability of having drug coverage and the effects of drug coverage on drug expenditures was estimated by a two-part model, assuming no correlation across equations. In addition, the discrete factor model estimated choice of drug coverage and expenditures for prescription drugs simultaneously to control for self-selection into drug coverage, allowing for correlation of error terms across equations. Findings indicated that unobservable characteristics leading elderly Medicare beneficiaries to purchase drug coverage also lead them to have higher drug expenditures on conditional use (i.e., adverse selection), while the same unobservable factors do not influence their decisions whether to use any drugs. After controlling for potential selection bias, the probability of any drug use among persons with drug coverage use was 4.5 percent higher than among those without, and drug coverage led to an increase in drug expenditures of $308 among those who used prescription drugs. Given significant adverse selection into drug coverage before the implementation of the Medicare Prescription Drug Improvement and Modernization Act, it is essential that selection effects be monitored as beneficiaries choose whether or not to enroll in this voluntary program.

Health Care Expenditure among People with Disabilities: Potential Role of Workplace Health Promotion and Implications for Rehabilitation Counseling

ERIC Educational Resources Information Center

Karpur, Arun; Bruyere, Susanne M.

2012-01-01

Workplace health-promotion programs have the potential to reduce health care expenditures, especially among people with disabilities. Utilizing nationally representative survey data, the authors provide estimates for health care expenditures related to secondary conditions, obesity, and health behaviors among working-age people with disabilities.…

[The effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea].

PubMed

Song, Eun Cheol; Shin, Young Jeon

2010-09-01

The low benefit coverage rate of South Korea's health security system has been continually pointed out. A low benefit coverage rate inevitably causes catastrophic health expenditure, which can be the cause of the transition to poverty and the persistence of poverty. This study was conducted to ascertain the effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea. To determine the degree of social mobility, this study was conducted among the 6311 households that participated in the South Korea Welfare Panel Study in both 2006 and 2008. The effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea was assessed via multiple logistic regression analysis. The poverty rate in South Korea was 21.6% in 2006 and 20.0% in 2008. 25.1 - 7.3% of the households are facing catastrophic health expenditure. Catastrophic health expenditure was found to affect the transition to poverty even after adjusting for the characteristics of the household and the head of the household, at the threshold of 28% or above. 25.1% of the households in this study were found to be currently facing catastrophic health expenditure, and it was determined that catastrophic health expenditure is a cause of transition to poverty. This result shows that South Korea's health security system is not an effective social safety net. As such, to prevent catastrophic health expenditure and transition to poverty, the benefit coverage of South Korea's health security system needs to the strengthened.

Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh.

PubMed

Mahumud, Rashidul Alam; Sarker, Abdur Razzaque; Sultana, Marufa; Islam, Ziaul; Khan, Jahangir; Morton, Alec

2017-03-01

As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.

The Roles of Public Higher Education Expenditure and the Privatization of the Higher Education on U.S. States Economic Growth

ERIC Educational Resources Information Center

Curs, Bradley R.; Bhandari, Bornali; Steiger, Christina

2011-01-01

Previous empirical literature finds that government expenditure on higher education has a negative, or null, effect on U.S. economic growth rates. This empirical result may be driven by omission of an important variable--the privatization of higher education. Using state-level panel data from 1970 to 2005, this analysis investigates whether the…

Annual report on health care for children and youth in the United States: national estimates of cost, utilization and expenditures for children with mental health conditions.

PubMed

Torio, Celeste Marie; Encinosa, William; Berdahl, Terceira; McCormick, Marie C; Simpson, Lisa A

2015-01-01

To examine national trends in hospital utilization, costs, and expenditures for children with mental health conditions. The analyses of children aged 1 to 17 are based on AHRQ's 2006 and 2011 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS) databases, and on AHRQ's pooled 2006 to 2011 Medical Expenditure Panel Survey (MEPS). All estimates are nationally representative, and standard errors account for the complex survey designs. Although overall all-cause children's hospitalizations did not increase between 2006 and 2011, hospitalizations for all listed mental health conditions increased by nearly 50% among children aged 10 to 14 years, and by 21% for emergency department (ED) visits. Behavioral disorders experienced a shift in underlying patterns between 2006 and 2011: inpatient stays for alcohol-related disorders declined by 44%, but ED visits increased by 34% for substance-related disorders and by 71% for impulse control disorders. Inpatient visits for suicide, suicidal ideation, and self-injury increased by 104% for children ages 1 to 17 years, and by 151% for children ages 10 to 14 years during this period. A total of $11.6 billion was spent on hospital visits for mental health during this period. Medicaid covered half of the inpatient visits, but with 50% to 30% longer length of stays in 2006 and 2011, respectively, than private payers. Medicaid's overall share of the ED visits increased from 45% in 2006 to 53% in 2011. These alarming trends highlight the renewed need for research on mental health care for children. This study also provides a baseline for evaluating the impact of the Affordable Care Act and the mental health parity legislation on mental health utilization and expenditures for children. Published by Elsevier Inc.

Trade as a structural driver of dietary risk factors for noncommunicable diseases in the Pacific: an analysis of household income and expenditure survey data

PubMed Central

2014-01-01

Background Noncommunicable diseases are a health and development challenge. Pacific Island countries are heavily affected by NCDs, with diabetes and obesity rates among the highest in the world. Trade is one of multiple structural drivers of NCDs in the Pacific, but country-level data linking trade, diets and NCD risk factors are scarce. We attempted to illustrate these links in five countries. The study had three objectives: generate cross-country profiles of food consumption and expenditure patterns; highlight the main ‘unhealthy’ food imports in each country to inform targeted policymaking; and demonstrate the potential of HCES data to analyze links between trade, diets and NCD risk factors, such as obesity. Methods We used two types of data: obesity rates as reported by WHO and aggregated household-level food expenditure and consumption from Household Income and Expenditure Survey reports. We classified foods in HIES data into four categories: imported/local, ‘unhealthy’/’healthy’, nontraditional/traditional, processed/unprocessed. We generated cross-country profiles and cross-country regressions to examine the relationships between imported foods and unhealthy foods, and between imported foods and obesity. Results Expenditure on imported foods was considerable in all countries but varied across countries, with highest values in Kiribati (53%) and Tonga (52%) and lowest values in Solomon Islands and Vanuatu (30%). Rice and sugar accounted for significant amounts of imported foods in terms of expenditure and calories, ranking among the top 3 foods in most countries. We found significant or near-significant associations in expenditure and caloric intake between ‘unhealthy’ and imported foods as well as between imported foods and obesity, though inferences based on these associations should be made carefully due to data constraints. Conclusions While additional research is needed, this study supports previous findings on trade as a structural

Does Negative Interaction in the Church Increase Psychological Distress? Longitudinal Findings from the Presbyterian Panel Survey*

PubMed Central

Ellison, Christopher G.; Zhang, Wei; Krause, Neal; Marcum, John P.

2009-01-01

This study examines the effects of negative interaction in church on psychological distress. After outlining a series of theoretical arguments linking negative interaction with health and well-being, relevant hypotheses are tested using longitudinal data from two surveys of the 1997–1999 Presbyterian Panel, a nationwide panel of members and elders (lay leaders) in congregations of the Presbyterian Church (USA). Findings confirm that negative interaction appears to foster or exacerbate distress over the study period. In addition, specific dimensions of social negativity have distinctive effects; the impact of criticisms on distress surface only in cross-sectional models, while the effects of excessive demands emerge only in the longitudinal models. No subgroup variations in these effects are detected. Implications of these findings are discussed with regard to (a) research on religion and health and (b) congregational life, and a number of promising directions for future research are elaborated. PMID:20694051

Toward estimating the impact of changes in immigrants' insurance eligibility on hospital expenditures for uncompensated care

PubMed Central

Castel, Liana D; Timbie, Justin W; Sendersky, Veronica; Curtis, Lesley H; Feather, Keith A; Schulman, Kevin A

2003-01-01

Background The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 gave states the option to withdraw Medicaid coverage of nonemergency care from most legal immigrants. Our goal was to assess the effect of PRWORA on hospital uncompensated care in the United States. Methods We collected the following state-level data for the period from 1994 through 1999: foreign-born, noncitizen population and health uninsurance rates (US Census Current Population Survey); percentage of teaching hospitals (American Hospital Association Annual Survey of Hospitals); and each state's decision whether to implement the PRWORA Medicaid bar for legal permanent residents or to continue offering nonemergency Medicaid coverage using state-only funds (Urban Institute). We modeled uncompensated care expenditures by state (also from the Annual Survey of Hospitals) in both univariate and multivariable regression analyses. Results When measured at the state level, there was no significant relationship between uncompensated care expenditures and states' percentage of noncitizen immigrants. Uninsurance rates were the only significant factor in predicting uncompensated hospital care expenditures by state. Conclusions Reducing the number of uninsured patients would most surely reduce hospital expenditures for uncompensated care. However, data limitations hampered our efforts to obtain a monetary estimate of hospitals' financial losses due specifically to the immigrant eligibility changes in PRWORA. Quantifying the impact of these provisions on hospitals will require better data sources. PMID:12523939

Has income-related inequity in health care utilization and expenditures been improved? Evidence from the Korean National Health and Nutrition Examination Survey of 2005 and 2010.

PubMed

Kim, Eunkyoung; Kwon, Soonman; Xu, Ke

2013-09-01

The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea. We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners. The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010. We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care.

Out-of-Pocket Household Expenditures on Medical Injections in Cambodia.

PubMed

Ozawa, Sachiko; Yemeke, Tatenda T; Tawah, Alie F; Kulkarni, Vivek; Villar Uribe, Manuela

2018-02-09

Cambodia has one of the highest rates of overall medical injection usage worldwide. Therapeutic injections, which are often unnecessary, contribute to the spread of blood-borne diseases. This study describes injection practices and associated household expenditures in rural northwest Cambodia. We assessed care-seeking patterns of surveyed adult family members who sought healthcare in the previous 30 days, including location of care, medical injection use, and out-of-pocket household expenditures for treatment. A regression model was used to explore the impact of injection use on out-of-pocket household expenditures. Among 480 households sampled, 298 included members who had been sick within the previous 30 days; a total of 342 episodes of care had been sought. Private providers accounted for over 66% (n = 226) of all episodes of care, with public and informal providers accounting for 20% (n = 69) and 14% (n = 47), respectively. Injections were administered in over 120 (35%) episodes of care, with 81% of injections administered by private providers. Patients who received injections incurred total out-of-pocket household expenditures that were, on average, 126,590 Cambodian Riel (KHR) (US$31.65) higher than those who did not receive injections (p < 0.01), equivalent to nearly half of the country's total annual health expenditure per capita. Receiving injections and perceived severity of illness were significantly associated with higher out-of-pocket household expenditures. This study found high levels of medical injection use, particularly among private healthcare providers, which was significantly associated with high healthcare expenditures. Reducing the number of medical injections would not only reduce disease transmission risk but also contribute to reduced healthcare costs and greater financial protection.

Selection of population controls for a Salmonella case-control study in the UK using a market research panel and web-survey provides time and resource savings.

PubMed

Mook, P; Kanagarajah, S; Maguire, H; Adak, G K; Dabrera, G; Waldram, A; Freeman, R; Charlett, A; Oliver, I

2016-04-01

Timely recruitment of population controls in infectious disease outbreak investigations is challenging. We evaluated the timeliness and cost of using a market research panel as a sampling frame for recruiting controls in a case-control study during an outbreak of Salmonella Mikawasima in the UK in 2013. We deployed a web-survey by email to targeted members of a market research panel (panel controls) in parallel to the outbreak control team interviewing randomly selected public health staff by telephone and completing paper-based questionnaires (staff controls). Recruitment and completion of exposure history web-surveys for panel controls (n = 123) took 14 h compared to 15 days for staff controls (n = 82). The average staff-time cost per questionnaire for staff controls was £13·13 compared to an invoiced cost of £3·60 per panel control. Differences in the distribution of some exposures existed between these control groups but case-control studies using each group found that illness was associated with consumption of chicken outside of the home and chicken from local butchers. Recruiting market research panel controls offers time and resource savings. More rapid investigations would enable more prompt implementation of control measures. We recommend that this method of recruiting controls is considered in future investigations and assessed further to better understand strengths and limitations.

The comparison of road safety survey answers between web-panel and face-to-face; Dutch results of SARTRE-4 survey.

PubMed

Goldenbeld, C; de Craen, S

2013-09-01

In the Netherlands, a comparison of an online and a face-to-face sample of car drivers was made to study differences on a number of selected questions from the SARTRE-4 road safety survey. Contrary to expectations, there was no indication that online respondents were more likely to come from higher educated or more privileged social groups. Confirming earlier research, the results indicated that online respondents were less inclined to give socially desirable answers and were less inclined to use more extreme ratings in their opinions about measures. Contrary to expectations, face-to-face respondents did not tend to give more positive answers in judgment of road safety measures. Weighting to make samples comparable on gender, age, and education had almost no effect on outcomes. The implications for a transition from face-to-face survey to online panel method are discussed. Copyright © 2013 National Safety Council and Elsevier Ltd. All rights reserved.

Household Expenditure for Dental Care in Low and Middle Income Countries

PubMed Central

Masood, Mohd; Sheiham, Aubrey; Bernabé, Eduardo

2015-01-01

This study assessed the extent of household catastrophic expenditure in dental health care and its possible determinants in 41 low and middle income countries. Data from 182,007 respondents aged 18 years and over (69,315 in 18 low income countries, 59,645 in 15 lower middle income countries and 53,047 in 8 upper middle income countries) who participated in the WHO World Health Survey (WHS) were analyzed. Expenditure in dental health care was defined as catastrophic if it was equal to or higher than 40% of the household capacity to pay. A number of individual and country-level factors were assessed as potential determinants of catastrophic dental health expenditure (CDHE) in multilevel logistic regression with individuals nested within countries. Up to 7% of households in low and middle income countries faced CDHE in the last 4 weeks. This proportion rose up to 35% among households that incurred some dental health expenditure within the same period. The multilevel model showed that wealthier, urban and larger households and more economically developed countries had higher odds of facing CDHE. The results of this study show that payments for dental health care can be a considerable burden on households, to the extent of preventing expenditure on basic necessities. They also help characterize households more likely to incur catastrophic expenditure on dental health care. Alternative health care financing strategies and policies targeted to improve fairness in financial contribution are urgently required in low and middle income countries. PMID:25923691

Out-of-pocket expenditure on institutional delivery in India.

PubMed

Mohanty, Sanjay K; Srivastava, Akanksha

2013-05-01

Though promotion of institutional delivery is used as a strategy to reduce maternal and neonatal mortality, about half of the deliveries in India are conducted at home without any medical care. Among women who deliver at home, one in four cites cost as barrier to facility-based care. The relative share of deliveries in private health centres has increased over time and the associated costs are often catastrophic for poor households. Though research has identified socio-economic, demographic and geographic barriers to the utilization of maternal care, little is known on the cost differentials in delivery care in India. The objective of this paper is to understand the regional pattern and socio-economic differentials in out-of-pocket (OOP) expenditure on institutional delivery by source of provider in India. The study utilizes unit data from the District Level Household and Facility Survey (DLHS-3), conducted in India during 2007-08. Descriptive statistics, principal component analyses and a two-part model are used in the analyses. During 2004-08, the mean OOP expenditure for a delivery in a public health centre in India was US$39 compared with US$139 in a private health centre. The predicted expenditure for a caesarean delivery was six times higher than for a normal delivery. With an increase in the economic status and educational attainment of mothers, the propensity and rate of OOP expenditure increases, linking higher OOP expenditure to quality of care. The OOP expenditure in public health centres, adjusting for inflation, has declined over time, possibly due to increased spending under the National Rural Health Mission. Based on these findings, we recommend that facilities in public health centres of poorly performing states are improved and that public-private partnership models are developed to reduce the economic burden for households of maternal care in India.

Revenues and Expenditures for Public Elementary and Secondary School Districts: School Year 2005-06 (Fiscal Year 2006). First Look. NCES 2008-345

ERIC Educational Resources Information Center

Zhou, Lei

2008-01-01

This brief publication contains basic revenue and expenditure data, by state, for public elementary and secondary education for school year 2005-06. It contains state-level data on revenues by source and expenditures by function, including expenditures per pupil. It presents data from the School District Finance Survey for School Year 2005-06…

Attrition Bias in Panel Data: A Sheep in Wolf's Clothing? A Case Study Based on the Mabel Survey.

PubMed

Cheng, Terence C; Trivedi, Pravin K

2015-09-01

This paper investigates the nature and consequences of sample attrition in a unique longitudinal survey of medical doctors. We describe the patterns of non-response and examine if attrition affects the econometric analysis of medical labour market outcomes using the estimation of physician earnings equations as a case study. We compare the econometric gestimates obtained from a number of different modelling strategies, which are as follows: balanced versus unbalanced samples; an attrition model for panel data based on the classic sample selection model; and a recently developed copula-based selection model. Descriptive evidence shows that doctors who work longer hours, have lower years of experience, are overseas trained and have changed their work location are more likely to drop out. Our analysis suggests that the impact of attrition on inference about the earnings of general practitioners is small. For specialists, there appears to be some evidence for an economically significant bias. Finally, we discuss how the top-up samples in the Medicine in Australia: Balancing Employment and Life survey can be used to address the problem of panel attrition. Copyright © 2015 John Wiley & Sons, Ltd.

Working Papers: Astronomy and Astrophysics Panel Reports

NASA Technical Reports Server (NTRS)

Bahcall, John N.; Beichman, Charles A.; Canizares, Claude; Cronin, James; Heeschen, David; Houck, James; Hunten, Donald; Mckee, Christopher F.; Noyes, Robert; Ostriker, Jeremiah P.

1991-01-01

The papers of the panels appointed by the Astronomy and Astrophysics survey Committee are compiled. These papers were advisory to the survey committee and represent the opinions of the members of each panel in the context of their individual charges. The following subject areas are covered: radio astronomy, infrared astronomy, optical/IR from ground, UV-optical from space, interferometry, high energy from space, particle astrophysics, theory and laboratory astrophysics, solar astronomy, planetary astronomy, computing and data processing, policy opportunities, benefits to the nation from astronomy and astrophysics, status of the profession, and science opportunities.

Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh

PubMed Central

2017-01-01

Objectives As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. Methods A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. Results The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. Conclusions The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes. PMID:28372353

A Four-State Comparison of Expenditures and Income Sources of Financial Aid Recipients in Public Colleges and Universities.

ERIC Educational Resources Information Center

Stampen, Jacob O.; Fenske, Robert H.

The way public college students finance college was studied, based on student resource and expenditure surveys from four states: Arizona, California, New York, and Wisconsin. Comparisons were made of demographic and academic variables, as well as expenditure patterns of students receiving different kinds of aid. The following four aid recipient…

A study of the influence of regional environmental expenditure on air quality in China: the effectiveness of environmental policy.

PubMed

He, Lingyun; Wu, Meng; Wang, Deqing; Zhong, Zhangqi

2018-03-01

Based on the panel data model, data on environmental expenditures, the air quality index, economic aggregates, industrial structures, etc., of seven seriously polluted cities in China, from the period 2007-2015, were collected, and this paper estimates the general relationship between environmental expenditures and the air quality index. Besides, the impact of the fuel tax policy on air quality as well as on the relationship between environmental expenditure and the air quality index is tested using the method of regression discontinuity. We find that there is a long-term equilibrium relationship between environmental expenditure and air quality index as well as a 0.0507% positive effect of the former on the latter. Second, for Beijing, Taiyuan, Chongqing, and Lanzhou, a 1% increase in environmental expenditure leads to 0.0773, 0.0125, 0.0965, and 0.0912% decreases in the air quality index, respectively; however, for Shijiazhuang, Ji'nan, and Urumqi, effect of environmental expenditure on air quality is insignificant. Third, both economic growth and optimization of the industrial structure can lead to an improvement of air quality. Fourth, since the implementation of the fuel tax policy in 2009, the air quality of the sample cities has improved, and the pulling effect of environmental expenditure on the air quality index has decreased from 0.0507 to 0.0048%. Our findings cannot only clarify the effect of environmental expenditures on air quality but can also objectively judge the effectiveness of environmental policies of China to a certain extent. It may benefit Chinese government to effectively govern air pollution with fiscal tools in conjunction with economic and environmental characteristics.

Revenues and Expenditures of Institutions of Higher Education: Fiscal Years 1983-1985. OERI Bulletin.

ERIC Educational Resources Information Center

Center for Education Statistics (ED/OERI), Washington, DC.

Information on revenues and expenditures at U.S. colleges and universities are reported for fiscal years (FY) 1983, 1984, and 1985, based on findings from the Financial Statistics of Institutions of Higher Education survey, which is part of the Higher Education General Information Survey. Narrative and statistical information is presented on:…

The President's Panel Recommendations - Today

ERIC Educational Resources Information Center

Luckey, Robert E.; Neman, Ronald S.

1975-01-01

State mental retardation program coordinators were surveyed regarding their opinions with respect to progress in achieving the President's Panel recommendations of 1962, and the continuing relevance of these recommendations today. (Author)

Effect of e-health on medical expenditures of outpatients with lifestyle-related diseases.

PubMed

Minetaki, Kazunori; Akematsu, Yuji; Tsuji, Masatsugu

2011-10-01

We analyzed the effect of e-health on medical expenditures in Nishi-aizu Town, Fukushima Prefecture, Japan, using panel data of medical expenditures for about 400 residents from 2002 to 2006. The Nishi-aizu Town system was introduced in 1994 and is still successfully operating as one of the longest running implementations of e-health in Japan. The town office maintains a register of receipts for medical expenditures paid by the National Health Insurance system and provides data on e-health users, allowing users and nonusers of e-health and their respective costs to be distinguished. Here, we focus on patients with lifestyle-related diseases such as high blood pressure, diabetes, stroke, heart failure, etc. This article postulates that e-health reduces medical expenditures via two mechanisms, decreasing travel expenses and preventing symptoms from worsening. The former implies that e-health monitoring allows patients at home to visit medical institutions less frequently, and the latter that the symptoms experienced by e-health users are less severe than those experienced by nonusers. We termed these the travel cost effect and opportunity cost effect, respectively. Chronic conditions tend not to occur singly, and many patients have more than one; for example, patients with high blood pressure or diabetes also likely have heart disease at the same time. This multiplicity of conditions hampers cost analysis. Among methodological issues, a number of recent empirical health analyses have focused on the endogenous problem of explanatory variables. Here, we solved this problem using the generalized method moments (GMM) system, which allows treatment of not only the endogenous problem of explanatory variables but also the dynamic relationship among variables, which arise due to the chronic time-lagged effect of lifestyle-related diseases on patients. We also examined a second important methodological problem related to reverse correlation between the medical expenditures of

Poverty and private health expenditures in Italian households during the recent crisis.

PubMed

Sarti, Simone; Terraneo, Marco; Tognetti Bordogna, Mara

2017-03-01

The global financial crisis that began in 2008 had an overall effect on the health behaviours of Italian households. Aggregate private health expenditures have decreased while the citizens have increasingly been asked to share health costs. The reduction of households' health expenditure could have serious consequences for health, especially if it concerns the most vulnerable people. The aim of this paper is to analyse the relation between poverty and household health expenditure, considering regional and social group variations. The data used stem from the "Family Expenditure Survey" collected by the Italian Statistical Institute (ISTAT) from 1997 to 2013. Results of multivariate analysis controlling for potential socio-demographic confounders show that the propensity to spend for poor families is decreased in the last years compared to not poor households. Meanwhile, among the households who spend, the average expenditure in euro seems to have been more stable over time. This is an alarming signal for the health of the most vulnerable households. These conditions could result in a gradual deterioration of health in poor families, which is likely to increase the burden on health systems in future. Hence, at this moment public intervention does not seem able to alleviate this situation. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Household catastrophic health expenditures: a comparative analysis of twelve Latin American and Caribbean Countries.

PubMed

Knaul, Felicia Marie; Wong, Rebeca; Arreola-Ornelas, Héctor; Méndez, Oscar

2011-01-01

Compare patterns of catastrophic health expenditures in 12 countries in Latin America and the Caribbean. Prevalence of catastrophic expenses was estimated uniformly at the household level using household surveys. Two types of prevalence indicators were used based on out-of-pocket health expense: a) relative to an international poverty line, and b) relative to the household's ability to pay net of their food basket. Ratios of catastrophic expenditures were estimated across subgroups defined by economic and social variables. The percent of households with catastrophic health expenditures ranged from 1 to 25% in the twelve countries. In general, rural residence, lowest quintile of income, presence of older adults, and lack of health insurance in the household are associated with higher propensity of catastrophic health expenditures. However, there is vast heterogeneity by country. Cross national studies may serve to examine how health systems contribute to the social protection of Latin American households.

Families with High Out-of-Pocket Health Services Expenditures Relative to Their Income. Final Report on Phase II.

ERIC Educational Resources Information Center

Berki, S. E.

This paper presents high-cost illness data from the first public use data file released on the 1977 National Medical Care Expenditure Survey. Characteristics of families which incurred out-of-pocket expenditures for personal health services that exceeded 5, 10, and 20 percent of their income in 1977 are described including: (1) demographics; (2)…

National Health Expenditures, 1993

PubMed Central

Levit, Katharine R.; Sensenig, Arthur L.; Cowan, Cathy A.; Lazenby, Helen C.; McDonnell, Patricia A.; Won, Darleen K.; Sivarajan, Lekha; Stiller, Jean M.; Donham, Carolyn S.; Stewart, Madie S.

1994-01-01

This article presents data on health care spending for the United States, covering expenditures for various types of medical services and products and their sources of funding from 1960 to 1993. Although these statistics show a slowing in the growth of health care expenditures over the past few years, spending continues to increase faster than the overall economy. The share of the Nation's health care bill funded by the Federal Government through the Medicaid and Medicare programs steadily increased from 1991 to 1993. This significant change in the share of health expenditures funded by the public sector has caused Federal health expenditures as a share of all Federal spending to increase dramatically. PMID:10140156

Welfare Attitudes and Social Expenditure: Do Regimes Shape Public Opinion?

ERIC Educational Resources Information Center

Jakobsen, Tor Georg

2011-01-01

This article examines the link between regime types, social expenditure, and welfare attitudes. By employing data on 19 countries taken from the World Values Survey, the main aim is to see to what degree the institutions of a country affect the attitudes of its citizens. According to Esping-Andersen ("The three worlds of welfare…

Out-of-pocket expenditure and its determinants in the context of private healthcare sector expansion in sub-Saharan Africa urban cities: evidence from household survey in Ouagadougou, Burkina Faso.

PubMed

Beogo, Idrissa; Huang, Nicole; Gagnon, Marie-Pierre; Amendah, Djesika D

2016-01-21

Conventional wisdom suggests that out-of-pocket (OOP) expenditure reduces healthcare utilization. However, little is known about the expenditure borne in urban settings with the current development of the private health sector in sub-Saharan Africa. In an effort to update knowledge on medical expenditure, this study investigated the level and determinants of OOP among individuals reporting illness or injury in Ouagadougou, Burkina Faso and who either self-treated or received healthcare in either a private or public facility. A cross-sectional study was conducted with a representative sample of 1017 households (5638 individuals) between August and November 2011. Descriptive statistics and multivariate techniques including generalized estimating equations were used to analyze the data. Among the surveyed sample, 29.6% (n = 1666) persons reported a sickness or injury. Public providers were the single most important providers of care (36.3%), whereas private and informal providers (i.e.: self-treatment, traditional healers) accounted for 29.8 and 34.0%, respectively. Almost universally (96%), households paid directly for care OOP. The average expenditure per episode of illness was 8404XOF (17.4USD) (median 3750XOF (7.8USD). The total expenditure was higher for those receiving care in private facilities compared to public ones [14,613.3XOF (30.3USD) vs. 8544.1XOF (17.7USD); p < 0.001], and the insured patients' bill almost tripled uninsured (p < 0.001). Finally, medication was the most expensive component of expenditure in both public and private facilities with a mean of 8022.1XOF (16.7USD) and 12,270.5 (25.5USD), respectively. OOP was the principal payment mechanism of households. A significant difference in OOP was found between public and private provider users. Considering the importance of private healthcare in Burkina Faso, regulatory oversight is necessary. Furthermore, an extensive protection policy to shield households from catastrophic health expenditure is

Response problems in a vacation panel study

Treesearch

Christine A. Vogt; Susan I. Stewart

2001-01-01

This paper investigates response problems encountered in a panel study of travel behavior. Though the overall response rate to the three-wave panel study was acceptable (over 60%), three types of response problems were encountered: refusal, non-response, and attrition. In a follow-up phone survey, a sample of individuals from each problem response group was questioned...

[Fair health financing and catastrophic health expenditures: potential impact of the coverage extension of the popular health insurance in Mexico].

PubMed

Knaul, Felicia; Arreola-Ornelas, Héctor; Méndez, Oscar; Martínez, Alejandra

2005-01-01

To assess the impact on fair health financing and household catastrophic health expenditures of the implementation of the Popular Health Insurance (Seguro Popular de Salud). Data analyzed in this study come from the National Income and Expenditure Household Survey (Encuesta Nacional de Ingresos y Gastos de los Hogares, ENIGH), 2000, and the National Health Insurance and Expenditure Survey, (Encuesta Nacional de Aseguramiento y Gasto en Salud, ENAGS), 2001. Estimations are based on projections of extension of the Popular Health Insurance under different conditions of coverage and out-of-pocket expenditure reductions in the uninsured population. The mathematic simulation model assumes applying the new Popular Health Insurance financial structure to the 2000 expenditure values reported by ENIGH, given the probability of affiliation by households. The model of determinants of affiliation to the Popular Health Insurance yielded three significant variables: being in income quintiles I and II, being a female head of household, and that a household member had a medical visit in the past year. Simulation results show that important impacts on the performance of the Mexican Health System will occur in terms of fair financing and catastrophic expenditures, even before achieving the universal coverage goal in 2010. A reduction of 40% in out-of-pocket expenditures and a Popular Health Insurance coverage of 100% will decrease catastrophic health expenditures from 3.4% to 1.6%. Our results show that the reduction of out-of-pocket expenditures generated by the new financing and health provision Popular Health Insurance model, will improve the financial fairness index and the financial contribution to the health system, and will decrease the percentage of households with catastrophic expenditures, even before reaching universal coverage. A greater impact may be expected due to coverage extension initiating in the poorest communities that have a very restricted and progressive

Tobacco expenditures and child health and nutritional outcomes in rural Bangladesh.

PubMed

Nonnemaker, James; Sur, Mona

2007-12-01

This study examined the relationship between tobacco prices and child health outcomes so as to assess the potential of improved child health outcomes resulting from less tobacco expenditure. In part, this paper was motivated by a study by. Efroymson et al. [(2001). Hungry for tobacco: An analysis of the economic impact of tobacco consumption on the poor in Bangladesh. Tobacco Control, 10, 212-217] suggesting that for the poorest households in Bangladesh, amongst whom malnutrition is widespread, shifting tobacco expenditures to expenditures on food would significantly improve the nutritional status of the household. We used data from a survey of 956 households conducted in rural Bangladesh between June 1996 and September 1997. The households were surveyed four times at approximately 4-month intervals during the 16-month period. We restricted our sample to households with children aged 2-10, and 600 households satisfied this criterion. The primary dependent variables for this study are three anthropometric indicators of child health and nutritional status: a standardized measure of height for age, a standardized measure of weight for height, and a standardized measure of weight for age. We also used measures of self-reported morbidity, including the incidence and duration of respiratory illness. We used regression methods on data averaged across survey rounds to estimate the relationship between tobacco prices and the outcome variables. Tobacco prices were found to be a significant determinant of height for age and weight for height for both boys and girls. Furthermore, the price of tobacco products is a significant predictor of weight for age for girls and the pooled sample. Our results suggest that higher tobacco prices would, for the most part, improve child health.

Catastrophic expenditure on medicines in Brazil.

PubMed

Luiza, Vera Lucia; Tavares, Noemia Urruth Leão; Oliveira, Maria Auxiliadora; Arrais, Paulo Sergio Dourado; Ramos, Luiz Roberto; Pizzol, Tatiane da Silva Dal; Mengue, Sotero Serrate; Farias, Mareni Rocha; Bertoldi, Andréa Dâmaso

2016-12-01

To describe the magnitude of the expenditure on medicines in Brazil according to region, household size and composition in terms of residents in a situation of dependency. Population-based data from the national household survey were used, with probabilistic sample, applied between September 2013 and February 2014 in urban households. The expenditure on medicines was the main outcome of interest. The prevalence and confidence intervals (95%CI) of the outcomes were stratified according to socioeconomic classification and calculated according to the region, the number of residents dependent on income, the presence of children under five years and residents in a situation of dependency by age. In about one of every 17 households (5.3%) catastrophic health expenditure was reported and, in 3.2%, the medicines were reported as one of the items responsible for this situation. The presence of three or more residents (3.6%) and resident in a situation of dependency (3.6%) were the ones that most reported expenditure on medicines. Southeast was the region with the lowest prevalence of expenditure on medicines. The prevalence of households with catastrophic health expenditure and on medicines in relation to the total of households showed a regressive tendency for economic classes. Catastrophic health expenditure was present in 5.3%, and catastrophic expenditure on medicines in 3.2% of the households. Multi-person households, presence of residents in a situation of economic dependency and belonging to the class D or E had the highest proportion of catastrophic expenditure on medicines. Although the problem is important, permeated by aspects of iniquity, Brazilian policies seem to be protecting families from catastrophic expenditure on health and on medicine. Descrever a magnitude do gasto catastrófico em medicamentos no Brasil segundo região, tamanho das famílias e composição familiar em termos de moradores em situação de dependência. Utilizados dados de inqu

Out-of-pocket health care expenditures due to excess of body weight in Portugal.

PubMed

Veiga, Paula

2008-03-01

The prevalence for excessive weight has also been increasing dramatically in Portugal over the last decades. The consequences for families as well as for the publicly funded Portuguese health care system are a matter of policy interest. This paper uses an econometric model to compute the fraction of the national out-of-pocket health care expenditures attributable to overweight and obesity among Portuguese adults. Given that public health care system pays for a substantial share of the national health care expenditures, the estimated the out-of-pocket expenditures is only a share of the total expenditures. Per-capita expenditures and the burden that obesity and overweight impose on families are also estimated. Two waves of the Portuguese National Health Survey (NHS), namely; 1995/1996 and 1998/1999 are considered. The results suggest that out-of-pocket expenditures due to excess weight have increased sharply during these 3 years. The two-part model estimates suggest that the obese and overweight are more likely to incur out-of-pocket health care expenditures but, in the restricted sample of those that incur expenditures, there is weak or no evidence that the obese or overweight spend, on average, more than those of normal weight. Overall, it is estimated that in 1995/1996, more than 1.8% out-of-pocket health care expenditures were attributable to obesity and 2% to overweight (although not statistically significant). The estimated percentages are over 2.9% for obesity and 4% for overweight in 1998/1999. Combined, the estimated attributable percentage of national out-of-pocket expenditures due to excess weight was 3.8% in 1995/1996 and 6.9% in 1998/1999. Per-capita expenditures due to obesity or overweight are small, on average, in absolute terms, but they can be a significant cost for low income families. With respect to public policy concerns, the results suggest that measures which only slightly increase the out-of-pocket health care expenditures of being obese

Earnings and Expenditures on Household Services in Married and Cohabiting Unions

ERIC Educational Resources Information Center

Treas, Judith; de Ruijter, Esther

2008-01-01

Despite the rise in women's paid employment, little is known about how women and their partners allocate money to outsource domestic tasks, especially in unmarried unions. Tobit analyses of 6,170 married and cohabiting couples in the 1998 Consumer Expenditure Survey test hypotheses that recognize gender inequality between partners, gender typing…

Increased hospital and emergency department utilization by individuals with recent criminal justice involvement: results of a national survey.

PubMed

Frank, Joseph W; Linder, Jeffrey A; Becker, William C; Fiellin, David A; Wang, Emily A

2014-09-01

Individuals involved with the criminal justice system have increased health needs and poor access to primary care. To examine hospital and emergency department (ED) utilization and related costs by individuals with recent criminal justice involvement. Cross-sectional survey. Non-institutionalized, civilian U.S. adult participants (n = 154,356) of the National Survey on Drug Use and Health (2008-2011). Estimated proportion of adults who reported past year 1) hospitalization or 2) ED utilization according to past year criminal justice involvement, defined as 1) parole or probation, 2) arrest without subsequent correctional supervision, or 3) no criminal justice involvement; estimated annual expenditures using unlinked data from the Medical Expenditure Panel Survey. An estimated 5.7 million adults reported parole or probation and an additional 3.9 million adults reported an arrest in the past year. Adults with recent parole or probation and those with a recent arrest, compared with the general population, had higher rates of hospitalization (12.3 %, 14.3 %, 10.5 %; P < 0.001) and higher rates of ED utilization (39.3 %, 47.2 %, 26.9 %; P < 0.001). Recent parole or probation was an independent predictor of hospitalization (adjusted odds ratio [AOR], 1.21; 95 % confidence interval [CI], 1.02-1.44) and ED utilization (AOR, 1.35; 95 % CI, 1.12-1.63); Recent arrest was an independent predictor of hospitalization (AOR, 1.26; 95 % CI, 1.08-1.47) and ED utilization (AOR, 1.81; 95 % CI, 1.53-2.15). Individuals with recent criminal justice involvement make up 4.2 % of the U.S. adult population, yet account for an estimated 7.2 % of hospital expenditures and 8.5 % of ED expenditures. Recent criminal justice involvement is associated with increased hospital and ED utilization and costs. The criminal justice system may offer an important point of contact for efforts to improve the healthcare utilization patterns of a large and vulnerable population.

Panel workload assessment in US primary care: accounting for non-face-to-face panel management activities.

PubMed

Arndt, Brian; Tuan, Wen-Jan; White, Jennifer; Schumacher, Jessica

2014-01-01

An understanding of primary care provider (PCP) workload is an important consideration in establishing optimal PCP panel size. However, no widely acceptable measure of PCP workload exists that incorporates the effort involved with both non-face-to-face patient care activities and face-to-face encounters. Accounting for this gap is critical given the increase in non-face-to-face PCP activities that has accompanied electronic health records (EHRs) (eg, electronic messaging). Our goal was to provide a comprehensive assessment of perceived PCP workload, accounting for aspects of both face-to-face and non-face-to-face encounters. Internal medicine, family medicine, and pediatric PCPs completed a self-administered survey about the perceived workload involved with face-to-face and non-face-to-face panel management activities as well as the perceived challenge associated with caring for patients with particular biomedical, demographic, and psychosocial characteristics (n = 185). Survey results were combined with EHR data at the individual patient and PCP service levels to assess PCP panel workload, accounting for face-to-face and non-face-to-face utilization. Of the multiple face-to-face and non-face-to-face activities associated with routine primary care, PCPs considered hospital admissions, obstetric care, hospital discharges, and new patient preventive health visits to be greater workload than non-face-to-face activities such as telephone calls, electronic communication, generating letters, and medication refills. Total workload within PCP panels at the individual patient level varied by overall health status, and the total workload of non-face-to-face panel management activities associated with routine primary care was greater than the total workload associated with face-to-face encounters regardless of health status. We used PCP survey results coupled with EHR data to assess PCP workload associated with both face-to-face as well as non-face-to-face panel management

Acutely Decreased Thermoregulatory Energy Expenditure or Decreased Activity Energy Expenditure Both Acutely Reduce Food Intake in Mice

PubMed Central

Kaiyala, Karl J.; Morton, Gregory J.; Thaler, Joshua P.; Meek, Thomas H.; Tylee, Tracy; Ogimoto, Kayoko; Wisse, Brent E.

2012-01-01

Despite the suggestion that reduced energy expenditure may be a key contributor to the obesity pandemic, few studies have tested whether acutely reduced energy expenditure is associated with a compensatory reduction in food intake. The homeostatic mechanisms that control food intake and energy expenditure remain controversial and are thought to act over days to weeks. We evaluated food intake in mice using two models of acutely decreased energy expenditure: 1) increasing ambient temperature to thermoneutrality in mice acclimated to standard laboratory temperature or 2) exercise cessation in mice accustomed to wheel running. Increasing ambient temperature (from 21°C to 28°C) rapidly decreased energy expenditure, demonstrating that thermoregulatory energy expenditure contributes to both light cycle (40±1%) and dark cycle energy expenditure (15±3%) at normal ambient temperature (21°C). Reducing thermoregulatory energy expenditure acutely decreased food intake primarily during the light cycle (65±7%), thus conflicting with the delayed compensation model, but did not alter spontaneous activity. Acute exercise cessation decreased energy expenditure only during the dark cycle (14±2% at 21°C; 21±4% at 28°C), while food intake was reduced during the dark cycle (0.9±0.1 g) in mice housed at 28°C, but during the light cycle (0.3±0.1 g) in mice housed at 21°C. Cumulatively, there was a strong correlation between the change in daily energy expenditure and the change in daily food intake (R2 = 0.51, p<0.01). We conclude that acutely decreased energy expenditure decreases food intake suggesting that energy intake is regulated by metabolic signals that respond rapidly and accurately to reduced energy expenditure. PMID:22936977

Alcohol consumption and household expenditure on alcohol in a rural district in Vietnam.

PubMed

Giang, Kim Bao; Van Minh, Hoang; Allebeck, Peter

2013-01-28

Alcohol use and alcohol-related problems are on the rise in low- and middle-income countries. Expenditure on alcohol is an important problem for families and communities and needs to be assessed. This study examines level of alcohol consumption and expenditure on alcohol in a district in Vietnam. A cross-sectional survey was conducted in a rural district in northern Vietnam. Multi-stage sampling was employed to randomly select participants from 20 communities and a town in the same district. One thousand five hundred and sixty-four adults (765 males and 799 females) aged 18-60 years were interviewed. Information about alcohol use as well as expenditure on alcohol consumption four weeks prior to the interview was gathered. Non-parametric tests and log-linear regression were employed to compare expenditure on alcohol consumption across socioeconomic groups. The prevalence of alcohol use one month prior to interview was 35% (66% among men and 5% among women). The median alcohol consumption among those who reported use of alcohol in the week prior to the interview was 7.9 standard drinks. Excessive drinking (more than 14 standard drinks per week for men and more than seven standard drinks per week for women) occurred among 35% of those who used alcohol. Median expenditure for alcohol consumption during one month by those who drank alcohol was USD 3.5, accounting for 4.6% of household food expenditure, 2.7% of total household expenditure, and 1.8% of household income. The differences in alcohol consumption and expenditure between sexes and between socioeconomic groups are also presented. Our study confirms that alcohol consumption and alcohol-related problems are common among men in Vietnam. The share of alcohol expenditure in total household expenditure is substantial, especially among poor households. This should be considered an important public health issue, which needs to be taken into account in the alcohol policy debate.

Segregation and Disparities in Health Services Use

PubMed Central

Gaskin, Darrell J.; Price, Adrian; Brandon, Dwayne T.; LaVeist, Thomas A.

2011-01-01

We compared race disparities in health services use in a national sample of adults from the 2002 Medical Expenditure Panel Survey and data from the Exploring Health Disparities in Integrated Communities Project, a 2003 survey of adult residents from a low-income integrated urban community in Maryland. In the Medical Expenditure Panel Survey data, African Americans were less likely to have a health care visit compared with Whites. However, in the Exploring Health Disparities in Integrated Communities Project, the integrated community, African Americans were more likely to have a health care visit than Whites. The race disparities in the incidence rate of health care use among persons who had at least one visit were similar in both samples. Our findings suggest that disparities in health care utilization may differ across communities and that residential segregation may be a confounding factor. PMID:19460811

Projecting future drug expenditures--2006.

PubMed

Hoffman, James M; Shah, Nilay D; Vermeulen, Lee C; Schumock, Glen T; Grim, Penny; Hunkler, Robert J; Hontz, Karrie M

2006-01-15

Drug expenditure trends in 2004 and 2005, projected drug expenditures for 2006, and factors likely to influence drug costs are discussed. Various factors are likely to affect drug costs, including drug prices, drugs in development, and generic drugs. In 2004 there was a continued moderation of the increase in drug expenditures. Drug expenditures increased by 8.7% from 2003 to 2004. Through the first nine months of 2005, expenditures increased by only 8.1% compared with 2004. This moderation can be attributed to several factors, including the continued trend toward higher prescription drug cost sharing for insured consumers, growing availability of generic drugs, and lack of "blockbuster" new drugs in recent years. Drug expenditures in 2006 will likely be influenced by similar factors, with few costly new products reaching the market, increased concern over product safety slowing the diffusion of those new agents that do reach the market, and several important patent expirations, leading to slower growth in expenditures. Forecasting and managing rising drug expenditures remains a challenge. Pharmacy managers must remain vigilant in monitoring drug costs in their health system and take a proactive role in pursuing efficient drug utilization. The dynamic health policy environment further complicates drug budgeting and must be considered, especially in integrated health systems responsible for managing inpatient, outpatient, and clinic drug costs. The comparison of health-system-specific data and trends with the national information presented in this article may provide a useful context when presenting institutional drug costs to senior management.

Out-of-pocket expenditure on maternity care for hospital births in Uttar Pradesh, India.

PubMed

Goli, Srinivas; Rammohan, Anu; Moradhvaj

2018-02-27

The studies measured Out-of-Pocket Expenditure (OOPE) for hospital births previously suffer from serious data limitations. To overcome such limitations, we designed a hospital-based study for measuring the levels and factors of OOPE on maternity care for hospital births by its detailed components. Data were collected from women for non-complicated deliveries 24-h before the survey and complicated deliveries 48-h prior to the survey at the hospital settings in Uttar Pradesh, India during 2014. The simple random sampling design was used in the selection of respondents. Bivariate analyses were used to estimate mean expenditure on Antenatal care services (ANCs), Delivery care and Total Maternity Expenditure (TME). Multivariate linear regression was employed to examine the factor associated with the absolute and relative share of expenditure in couple's annual income on ANCs, delivery care, and TME. The findings show that average expenditure on maternal health care is high ($155) in the study population. Findings suggest that factors such as income, place, and number of ANCs, type, and place of institutional delivery are significantly associated with both absolute and relative expenditure on maternity care. The likelihood of incidence of catastrophic expenditure on maternity care is significantly higher for women delivered in private hospitals (β = 2.427, p < 0.001) compared to the government hospital (β = 0). Also, it is higher among caesarean or forceps deliveries (β = 0.617, p < 0.01), deliveries conducted on doctor advise (β = 0.598, p < 0.01), than in normal deliveries (β = 0) and self or family planned deliveries (β = 0). The findings of this study suggest that the OOPE on maternity care for hospital births reported in this study is much higher as it was collected with a better methodology, although with smaller sample size. Therefore, ongoing maternity benefit scheme in India in general and Uttar Pradesh in particular

Manufacturing Energy Consumption Survey (MECS)

EIA Publications

2028-01-01

The Manufacturing Energy Consumption Survey (MECS) is a national sample survey that collects information on the stock of U.S. manufacturing establishment, their energy-related building characteristics, and their energy consumption and expenditures.

State Action Analysis of Tax Expenditures

ERIC Educational Resources Information Center

Brown, Robert Clarke

1977-01-01

Recent judicial treatment of tax expenditures in both state action and establishment clause cases is analyzed and it is argued that tax expenditures and direct expenditures should be treated as constitutional equivalents. (LBH)

[Sedentary lifestyle: physical activity duration versus percentage of energy expenditure].

PubMed

Cabrera de León, Antonio; Rodríguez-Pérez, María del C; Rodríguez-Benjumeda, Luis M; Anía-Lafuente, Basilio; Brito-Díaz, Buenaventura; Muros de Fuentes, Mercedes; Almeida-González, Delia; Batista-Medina, Marta; Aguirre-Jaime, Armando

2007-03-01

To compare different definitions of a sedentary lifestyle and to determine which is the most appropriate for demonstrating its relationship with the metabolic syndrome and other cardiovascular risk factors. A cross-sectional study of 5814 individuals was carried out. Comparisons were made between two definitions of a sedentary lifestyle: one based on active energy expenditure being less than 10% of total energy expenditure, and the other, on performing less than 25-30 minutes of physical activity per day. Reported levels of physical activity, anthropometric measurements, and biochemical markers of cardiovascular risk were recorded. The associations between a sedentary lifestyle and metabolic syndrome and other risk factors were adjusted for gender, age and tobacco use. The prevalence of a sedentary lifestyle was higher in women (70%) than in men (45-60%, according to the definition used). The definitions based on physical activity duration and on energy expenditure were equally useful: there were direct associations between a sedentary lifestyle and metabolic syndrome, body mass index, abdominal and pelvic circumferences, systolic blood pressure, heart rate, apolipoprotein B, and triglycerides, and inverse associations with high-density lipoprotein cholesterol and paraoxonase activity, which demonstrated the greatest percentage difference between sedentary and active individuals. An incidental finding was that both definitions of a sedentary lifestyle were more strongly associated with the metabolic syndrome as defined by International Diabetes Federation criteria than by Adult Treatment Panel III criteria. Given that it is relatively easy to determine whether a patient performs less than 25 minutes of physical activity per day, use of this definition of a sedentary lifestyle is recommended for clinical practice. The serum paraoxonase activity level could provide a useful marker for studying sedentary lifestyles.

Gender, marital status, and commercially prepared food expenditure.

PubMed

Kroshus, Emily

2008-01-01

Assess how per capita expenditure on commercially prepared food as a proportion of total food expenditure varies by the sex and marital status of the head of the household. Prospective cohort study, data collected by the United States Bureau of Labor Statistics 2004 Consumer Expenditure Survey. United States. Randomly selected nationally representative sample of 5744 US citizens. Per capita spending on commercially prepared food (dependent variable) for every $1 increase in total per capita food spending (independent variable). Linear regressions run separately for each permutation of gender and marital status (never married, married, divorced/separated). Proportionate per capita household expenditure on commercially prepared food was found to vary by marital status and gender. Households headed by unmarried men (both divorced/separated and never married) spent a significantly greater proportion of their food budget on commercially prepared food than their married male peers (38% and 60% higher, respectively). Regardless of marital status, households headed by women were found to spend approximately one-third of their total food budget on commercially prepared foods outside the home. Households headed by never married men spent 63% more per capita than those headed by never married women and households headed by divorced or separated men spent 37% more than those headed by divorced or separated women. Marital status is significantly related to the dietary patterns of households headed by men. In light of the high rates of divorce, separation, and delay of marriage, marriage cannot be considered an inclusive or permanent solution to changing male eating patterns. It is important that nutrition educators learn more about the dietary patterns of households headed by males outside the institution of marriage.

Social Welfare Expenditures and Infant Mortality.

PubMed

Shim, Joyce

2015-01-01

This study examines the effects of social welfare expenditures on infant mortality (deaths younger than age 1 per 1,000 live births) across 19 Organisation for Economic Co-operation and Development (OECD) countries from 1980 to 2010. Data are obtained from various sources including the OECD, World Health Organization, and World Bank. The findings indicate that among three social welfare expenditure measures for families, the expenditures on family cash allowances are predicted to reduce infant mortality. However, the other two measures-the expenditures on parental and maternity leave and expenditures on family services-have no significant effects on infant mortality.

11 CFR 110.20 - Prohibition on contributions, donations, expenditures, independent expenditures, and...

Code of Federal Regulations, 2011 CFR

2011-01-01

... 11 Federal Elections 1 2011-01-01 2011-01-01 false Prohibition on contributions, donations... EXPENDITURE LIMITATIONS AND PROHIBITIONS § 110.20 Prohibition on contributions, donations, expenditures... meaning as in 11 CFR 300.2(d). (2) Donation has the same meaning as in 11 CFR 300.2(e). (3) Foreign...

11 CFR 110.20 - Prohibition on contributions, donations, expenditures, independent expenditures, and...

Code of Federal Regulations, 2013 CFR

2013-01-01

... 11 Federal Elections 1 2013-01-01 2012-01-01 true Prohibition on contributions, donations... EXPENDITURE LIMITATIONS AND PROHIBITIONS § 110.20 Prohibition on contributions, donations, expenditures... meaning as in 11 CFR 300.2(d). (2) Donation has the same meaning as in 11 CFR 300.2(e). (3) Foreign...

11 CFR 110.20 - Prohibition on contributions, donations, expenditures, independent expenditures, and...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 11 Federal Elections 1 2014-01-01 2014-01-01 false Prohibition on contributions, donations... EXPENDITURE LIMITATIONS AND PROHIBITIONS § 110.20 Prohibition on contributions, donations, expenditures... meaning as in 11 CFR 300.2(d). (2) Donation has the same meaning as in 11 CFR 300.2(e). (3) Foreign...

11 CFR 110.20 - Prohibition on contributions, donations, expenditures, independent expenditures, and...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 11 Federal Elections 1 2012-01-01 2012-01-01 false Prohibition on contributions, donations... EXPENDITURE LIMITATIONS AND PROHIBITIONS § 110.20 Prohibition on contributions, donations, expenditures... meaning as in 11 CFR 300.2(d). (2) Donation has the same meaning as in 11 CFR 300.2(e). (3) Foreign...

Health care utilization in the elderly Mexican population: expenditures and determinants.

PubMed

González-González, César; Sánchez-García, Sergio; Juárez-Cedillo, Teresa; Rosas-Carrasco, Oscar; Gutiérrez-Robledo, Luis M; García-Peña, Carmen

2011-03-29

Worldwide population aging has been considered one of the most important demographic phenomena, and is frequently referred as a determinant of health costs and expenditures. These costs are an effect either of the aging process itself (social) or because of the increase that comes with older age (individual). To analyze health expenditures and its determinants in a sample of Mexican population, for three dimensions acute morbidity, ambulatory care and hospitalization focusing on different age groups, particularly the elderly. A secondary analysis of the Mexican National Health and Nutrition Survey (ENSANUT), 2006 was conducted. A descriptive analysis was performed to establish a health profile by socio-demographic characteristics. Logistic regression models were estimated to determine the relation between acute morbidity, ambulatory care, hospitalization and age group; to establish the determinants of hospitalization among the population 60 years and older; and to determine hospitalization expenditures by age. Higher proportion of elderly reporting health problems was found. Average expenditures of hospitalization in households were $240.6 am dlls, whereas in households exclusively with elderly the expenditure was $308.9 am dlls, the highest among the considered age groups. The multivariate analysis showed higher probability of being hospitalized among the elderly, but not for risks for acute morbidity and ambulatory care. Among the elderly, older age, being male or living in a city or in a metro area implied a higher probability of hospitalization during the last year, with chronic diseases playing a key role in hospitalization. The conditions associated with age, such as chronic diseases, have higher weight than age itself; therefore, they are responsible for the higher expenditures reported. Conclusions point towards a differentiated use and intensity of health services depending on age. The projected increase in hospitalization and health care needs for this

76 FR 50887 - Elections Regarding Start-Up Expenditures, Corporation Organizational Expenditures, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-17

... begins an active trade or business, an amount equal to the lesser of (1) the amount of the start-up... begins. All start-up expenditures that relate to the active trade or business are considered in... active trade or business to which the expenditures relate begins. The election either to amortize start...

Annual Medical Expenditure and Productivity Loss Among Colorectal, Female Breast, and Prostate Cancer Survivors in the United States

PubMed Central

Yabroff, K. Robin; Guy, Gery P.; Han, Xuesong; Li, Chunyu; Banegas, Matthew P.; Ekwueme, Donatus U.; Jemal, Ahmedin

2016-01-01

Background: There are limited nationally representative estimates of the annual economic burden among survivors of the three most prevalent cancers (colorectal, female breast, and prostate) in both nonelderly and elderly populations in the United States. Methods: The 2008 to 2012 Medical Expenditure Panel Survey data were used to identify colorectal (n = 540), female breast (n = 1568), and prostate (n = 1170) cancer survivors and individuals without a cancer history (n = 109 423). Excess economic burden attributable to cancer included per-person excess annual medical expenditures and productivity losses (employment disability, missed work days, and days stayed in bed). All analyses were stratified by cancer site and age (nonelderly: 18–64 years vs elderly: ≥65 years). Multivariable analyses controlled for age, sex, race/ethnicity, marital status, education, number of comorbidities, and geographic region. All statistical tests were two-sided. Results: Compared with individuals without a cancer history, cancer survivors experienced annual excess medical expenditures (for the nonelderly population, colorectal: $8647, 95% confidence interval [CI] = $4932 to $13 974, P < .001; breast: $5119, 95% CI = $3439 to $7158, P < .001; prostate: $3586, 95% CI = $1792 to $6076, P < .001; for the elderly population, colorectal: $4913, 95% CI = $2768 to $7470, P < .001; breast: $2288, 95% CI = $814 to $3995, P = .002; prostate: $3524, 95% CI = $1539 to $5909, P < .001). Nonelderly colorectal and breast cancer survivors experienced statistically significant annual excess employment disability (13.6%, P < .001, and 4.8%, P = .001) and productivity loss at work (7.2 days, P < .001, and 3.3 days, P = .002) and at home (4.5 days, P < .001, and 3.3 days, P = .003). In contrast, elderly survivors of all three cancer sites had comparable productivity losses as those without a cancer history. Conclusions: Colorectal, breast, and prostate cancer survivors experienced statistically

Surveying predictors of late-life longitudinal change in daily activity energy expenditure.

PubMed

Valiani, Vincenzo; Sourdet, Sandrine; Schoeller, Dale A; Mackey, Dawn C; Bauer, Douglas C; Glynn, Nancy W; Yamada, Yosuke; Harris, Tamara B; Manini, Todd M

2017-01-01

Total daily energy expenditure (TEE) is composed of resting metabolic rate (RMR), post-prandial thermogenesis and activity energy expenditure (AEE). Higher AEE is strongly associated with lower mortality and physical limitations among older adults, but factors that predict changes in AEE in septu and octogenarians are not clearly understood. To identify factors associated with late-life longitudinal change in AEE. Energy expenditure was re-assessed in 83 participants (average age at baseline, 74.4±3.2 years)-an average of 7.5±0.54 years since the baseline measure. RMR was measured using indirect calorimetry and the thermic effect of meals was estimated at 10% of TEE. AEE was calculated as: TEE(0.9)-RMR. Participants were categorized into two groups according to the estimated day-to-day precision of the doubly-labeled water technique. Those who were within 10% or increased relative to their initial AEE measurement were categorized as having preserved AEE. Participants who declined greater than 10% of their initial measurement were categorized as having reduced AEE. A variety of socio-demographic, functional and mental factors, body composition, community and personal behaviors, blood measurements and health conditions were evaluated between groups at baseline and changes during follow-up. Daily AEE declined 106.61±293.25 kcal, which equated to a 14.63±40.57 kcal/d decrease per year. Fifty-nine percent (n = 49) preserved their AEE and 41% (n = 34) declined. Those who demonstrated a decline in AEE were older, had lower walking speed at baseline and showed a higher lean mass loss during follow up. Otherwise, groups were similar for socio-demographic characteristics, body composition, mental and physical function, health conditions and community and personal behaviors at baseline and change in these factors during follow-up. This study demonstrates that AEE declines through the 8th decade of life and is associated with age, lower walking speed at baseline and lean

Fabrication of prepackaged superalloy honeycomb Thermal Protection System (TPS) panels

NASA Technical Reports Server (NTRS)

Blair, W.; Meaney, J. E.; Rosenthal, H. A.

1985-01-01

High temperature materials were surveyed, and Inconel 617 and titanium were selected for application to a honeycomb TPS configuration designed to withstand 2000 F. The configuration was analyzed both thermally and structurally. Component and full-sized panels were fabricated and tested to obtain data for comparison with analysis. Results verified the panel design. Twenty five panels were delivered to NASA Langley Research Center for additional evaluation.

Associations Between Sedentary Behavior, Physical Activity, and Out-of-Pocket Health Care Expenditure: Evidence From Chinese Older Adults.

PubMed

Yu, Hongjun; Schwingel, Andiara

2018-06-12

This study examined the associations between sedentary behavior, physical activity, and health care expenditures among Chinese older adults. We conducted a survey on 4,165 older men and women living in major cities in China. Sedentary behavior and physical activity were measured by the Physical Activity Scale for the Elderly (PASE) questionnaire. Healthcare costs were assessed by self-reported out-of-pocket health care expenditures across outpatient care, inpatient care, medication, and formal caregiver expenses. Sedentary behavior was associated with an increase in annual out-of-pocket health care expenditures by approximately USD$37 for each additional sedentary hour (p < 0.001). Physical activity was associated with a decrease in annual health care expenditures by approximately USD$1.2 for each 1 PASE score (p < 0.001). Physical activity was a less salient indicator of health care expenditure for men than women. Reducing sedentary behavior among older men and women and promoting physical activity, especially among men, may be important strategies to reduce out-of-pocket health care expenditures in China.

[Influence of income on food expenditures away from home among Brazilian families, 2002-2003].

PubMed

Claro, Rafael Moreira; Levy, Renata Bertazzi; Bandoni, Daniel Henrique

2009-11-01

This study describes and evaluates the influence of income on the percentage of food expenditures away from home for Brazilian families. Food acquisition data from the National Household Budget Survey conducted from 2002 to 2003 (POF 2002/2003) by the Brazilian Institute of Geography and Statistics (IBGE) or National Census Bureau was used in the analysis. Information on food-and-drink expenditures away from home was analyzed. The influence of income on the share of food purchased away from home in the household budget, adjusted for socio-demographic variables, was analyzed through elasticity coefficients estimated in multiple linear regression. Food purchased away from home accounted for 21% of total food expenditures by Brazilian households. A 10% increase in income increased the share of food purchased away from home by 3%. Income elasticity was high, especially for the lowest income families. The results demonstrate an important influence of income on food expenditures away from home, and higher income is associated with a greater share of food purchased away from home.

An Empirical Analysis of Rural-Urban Differences in Out-Of-Pocket Health Expenditures in a Low-Income Society of China.

PubMed

Wang, Lidan; Wang, Anjue; Zhou, Detong; FitzGerald, Gerry; Ye, Dongqing; Jiang, Qicheng

2016-01-01

The paper examines whether out-of-pocket health care expenditure also has regional discrepancies, comparing to the equity between urban and rural areas, and across households. Sampled data were derived from Urban Household Survey and Rural Household Survey data for 2011/2012 for Anhui Province, and 11049 households were included in this study. The study compared differences in out-of-pocket expenditure on health care between regions (urban vs. rural areas) and years (2011 vs. 2012) using two-sample t-test, and also investigated the degree of inequality using Lorenz and concentration curves. Approximately 5% and 8% of total household consumption expenditure was spent on health care for urban and rural populations, respectively. In 2012, the wealthiest 20% of urban and rural population contributed 49.7% and 55.8% of urban and rural total health expenditure respectively, while the poorest 20% took only 4.7% and 4.4%. The concentration curve for out-of-pocket expenditure in 2012 fell below the corresponding concentration curve for 2011 for both urban and rural areas, and the difference between curves for rural areas was greater than that for urban areas. A substantial and increasing gap in health care expenditures existed between urban and rural areas in Anhui. The health care financing inequality merits ample attention, with need for policymaking to focus on improving the accessibility to essential health care services, particularly for rural and poor residents. This study may provide useful information on low income areas of China.

26 CFR 1.528-6 - Expenditure test.

Code of Federal Regulations, 2013 CFR

2013-04-01

.... Qualifying expenditures are expenditures by an organization for the acquisition, construction, management..., construction, management, maintenance or care of association property, shall constitute qualifying expenditures...

26 CFR 1.528-6 - Expenditure test.

Code of Federal Regulations, 2012 CFR

2012-04-01

.... Qualifying expenditures are expenditures by an organization for the acquisition, construction, management..., construction, management, maintenance or care of association property, shall constitute qualifying expenditures...

26 CFR 1.528-6 - Expenditure test.

Code of Federal Regulations, 2011 CFR

2011-04-01

.... Qualifying expenditures are expenditures by an organization for the acquisition, construction, management..., construction, management, maintenance or care of association property, shall constitute qualifying expenditures...

Development of a Web-Based Survey for Monitoring Daily Health and its Application in an Epidemiological Survey

PubMed Central

Ohkusa, Yasushi; Akahane, Manabu; Sano, Tomomi; Okabe, Nobuhiko; Imamura, Tomoaki

2011-01-01

Background Early detection of symptoms arising from exposure to pathogens, harmful substances, or environmental changes is required for timely intervention. The administration of Web-based questionnaires is a potential method for collecting information from a sample population. Objective The objective of our study was to develop a Web-based daily questionnaire for health (WDQH) for symptomatic surveillance. Methods We adopted two different survey methods to develop the WDQH: an Internet panel survey, which included participants already registered with an Internet survey company, and the Tokyo Consumers’ Co-operative Union (TCCU) Internet survey, in cooperation with the Japanese Consumers’ Co-operative Union, which recruited participants by website advertising. The Internet panel survey participants were given a fee every day for providing answers, and the survey was repeated twice with modified surveys and collection methods: Internet Panel Survey I was conducted every day, and Internet Panel Survey II was conducted every 3 days to reduce costs. We examined whether the survey remained valid by reporting health conditions on day 1 over a 3-day period, and whether the response rate would vary among groups with different incentives. In the TCCU survey, participants were given a fee only for initially registering, and health information was provided in return for survey completion. The WDQH included the demographic details of participants and prompted them to answer questions about the presence of various symptoms by email. Health information collected by the WDQH was then used for the syndromic surveillance of infection. Results Response rates averaged 47.3% for Internet Panel Survey I, 42.7% for Internet Panel Survey II, and 40.1% for the TCCU survey. During a seasonal influenza epidemic, the WDQH detected a rapid increase in the number of participants with fever through the early aberration reporting system. Conclusions We developed a health observation method

Household expenditure on leprosy outpatient services in the Indian health system: A comparative study

PubMed Central

Suryawanshi, Pramilesh; Raikwar, Akash; Arif, Mohammad; Richardus, Jan Hendrik

2018-01-01

Background Leprosy is a major public health problem in many low and middle income countries, especially in India, and contributes considerably to the global burden of the disease. Leprosy and poverty are closely associated, and therefore the economic burden of leprosy is a concern. However, evidence on patient’s expenditure is scarce. In this study, we estimate the expenditure in primary care (outpatient) by leprosy households in two different public health settings. Methodology/Principal findings We performed a cross-sectional study, comparing the Union Territory of Dadra and Nagar Haveli with the Umbergaon block of Valsad, Gujrat, India. A household (HH) survey was conducted between May and October, 2016. We calculated direct and indirect expenditure by zero inflated negative binomial and negative binomial regression. The sampled households were comparable on socioeconomic indicators. The mean direct expenditure was USD 6.5 (95% CI: 2.4–17.9) in Dadra and Nagar Haveli and USD 5.4 (95% CI: 3.8–7.9) per visit in Umbergaon. The mean indirect expenditure was USD 8.7 (95% CI: 7.2–10.6) in Dadra and Nagar Haveli and USD 12.4 (95% CI: 7.0–21.9) in Umbergaon. The age of the leprosy patients and type of health facilities were the major predictors of total expenditure on leprosy primary care. The higher the age, the higher the expenditure at both sites. The private facilities are more expensive than the government facilities at both sites. If the public health system is enhanced, government facilities are the first preference for patients. Conclusions/Significance An enhanced public health system reduces the patient’s expenditure and improves the health seeking behaviour. We recommend investing in health system strengthening to reduce the economic burden of leprosy. PMID:29300747

Examining geographic and socio-economic differences in outpatient and inpatient consumer expenditures for treating HIV/AIDS in Nigeria

PubMed Central

Onwujekwe, Obinna E; Ibe, Ogochukwu; Torpey, Kwasi; Dada, Stephanie; Uzochukwu, Benjamin; Sanwo, Olusola

2016-01-01

Introduction The expenditures on treatment of HIV/AIDS to households were examined to quantify the magnitude of the economic burden of HIV/AIDS to different population groups in Nigeria. The information will also provide a basis for increased action towards a reduction of the economic burden on many households when accessing antiretroviral therapy (ART). Methods A household survey was administered in three states, Adamawa, Akwa Ibom and Anambra, from the South-East, North-East and South-South zones of Nigeria, respectively. A pretested interviewer-administered questionnaire was used to collect data from a minimum sample of 1200 people living with HIV/AIDS (PLHIV). Data were collected on the medical and non-medical expenditures that patients incurred to treat HIV/AIDS for their last treatment episode within three months of the interview date. The expenditures were for outpatient visits (OPV) and inpatient stays (IPS). The incidence of catastrophic health expenditure (CHE) on ART treatment services was computed for OPV and IPS. Data were disaggregated by socio-economic status (SES) and geographic location of the households. Results The average OPV expenditures incurred by patients per OPV for HIV/AIDS treatment was US$6.1 with variations across SES and urban-rural residence. More than 95% of the surveyed households spent money on transportation to a treatment facility and over 70% spent money on food for OPV. For medical expenditures, the urbanites paid more than rural dwellers. Many patients incurred CHE during outpatient and inpatient visits. Compared to urban dwellers, rural dwellers incurred more CHE for outpatient (p=0.02) and inpatient visits (p=0.002). Conclusions Treatment expenditures were quite high, inequitable and catastrophic in some instances, hence further jeopardizing the welfare of the households and the PLHIV. Strategically locating fully functional treatment centres to make them more accessible to PLHIV will largely reduce expenditures for travel

Intersystem return on investment in public mental health: Positive externality of public mental health expenditure for the jail system in the U.S.

PubMed

Yoon, Jangho; Luck, Jeff

2016-12-01

This study examines the extent to which increased public mental health expenditures lead to a reduction in jail populations and computes the associated intersystem return on investment (ROI). We analyze unique panel data on 44 U.S. states and D.C. for years 2001-2009. To isolate the intersystem spillover effect, we exploit variations across states and over time within states in per capita public mental health expenditures and average daily jail inmates. Regression models control for a comprehensive set of determinants of jail incarcerations as well as unobserved determinants specific to state and year. Findings show a positive spillover benefit of increased public mental health spending on the jail system: a 10% increase in per capita public inpatient mental health expenditure on average leads to a 1.5% reduction in jail inmates. We also find that the positive intersystem externality of increased public inpatient mental health expenditure is greater when the level of community mental health spending is lower. Similarly, the intersystem spillover effect of community mental health expenditure is larger when inpatient mental health spending is lower. We compute that overall an extra dollar in public inpatient mental health expenditure by a state would yield an intersystem ROI of a quarter dollar for the jail system. There is significant cross-state variation in the intersystem ROI in both public inpatient and community mental health expenditures, and the ROI overall is greater for inpatient mental health spending than for community mental health spending. Copyright © 2016. Published by Elsevier Ltd.

Trends in Educational Expenditure.

ERIC Educational Resources Information Center

Burke, Gerald

This study provides an overview of expenditures for education and training by educational institutions in Australia, 1991-2001. The study used newly available data from the Australian Bureau of Statistics (ABS) and administrative data from the main sectors' reports on the size and trends in public and private education expenditures. It analyzed…

Passing by the girls? Remittance allocation for educational expenditures and social inequality in Nepal's households 2003–2004.

PubMed

Vogel, Ann; Korinek, Kim

2012-01-01

We examine the utilization of remittances for expenditures associated with development, specifically children's education. We use household-level data from the Nepal Living Standards Survey (NLSS II, 2003–04) to separate remittance effects from general household income effects to demonstrate the migration–development relationship reflected in child schooling investment. We find that family-household remittances are spent on education of children, but the expenditures are disproportionately for boys' schooling. Only when girls are members of higher-income households do greater schooling expenditures go to them. This gender-discriminating pattern at the household level contrasts with the call for universal and gender-equal education.

26 CFR 1.501(h)-1 - Application of the expenditure test to expenditures to influence legislation; introduction.

Code of Federal Regulations, 2010 CFR

2010-04-01

... expenditures to influence legislation; introduction. 1.501(h)-1 Section 1.501(h)-1 Internal Revenue INTERNAL...) Exempt Organizations § 1.501(h)-1 Application of the expenditure test to expenditures to influence... attempting to influence legislation, (except as otherwise provided in subsection (h)).” This requirement is...

Health seeking behaviour and the related household out-of-pocket expenditure for chronic non-communicable diseases in rural Malawi.

PubMed

Wang, Qun; Brenner, Stephan; Leppert, Gerald; Banda, Thomas Hastings; Kalmus, Olivier; De Allegri, Manuela

2015-03-01

Malawi is facing a rising chronic non-communicable disease (CNCD) epidemic. This study explored health seeking behaviour and related expenditure on CNCDs in rural Malawi, with specific focus on detecting potential differences across population groups. We used data from the first round of a panel household health survey conducted in rural Malawi between August and October 2012 on a sample of 1199 households. Multinomial logistic regression was used to analyse factors associated with health seeking choices for CNCDs, distinguishing between no care, informal care and formal care. Descriptive statistics (mean, standard deviation and median) were used to describe related household out-of-pocket expenditure. There were 475 individuals (equivalent to 8.4% of all respondents) reporting at least one CNCD. Among them, 37.3% did not seek any care, 42.5% sought formal care (facility-based care), and 20.2% opted for informal care (traditional or home treatment). Regression analysis showed that illness severity and duration, socio-economic status, being a household head, and the proportion of household members living with a CNCD were significantly associated with health care utilization. Among those seeking care, 65.8% incurred out-of-pocket expenditure with an average of USD 1.49 spent on medical treatment and an additional USD 0.50 spent on transport. Further qualitative inquiry is needed to understand the reasons for low service utilization and to explore the potential role of supply-side factors. To increase access to care for people suffering from CNCDs, the provision of a free Essential Health Package in Malawi ought to be strengthened through the integration of system-wide screening, risk factor modification and continuity of care options for people suffering from CNCDs. This would ensure affordable services to modulate health seeking behaviour of patients at risk of major chronic illnesses. Published by Oxford University Press in association with The London School of

Health Services Use and Costs for Americans with Intellectual and Developmental Disabilities: A National Analysis

ERIC Educational Resources Information Center

Fujiura, Glenn T.; Li, Henan; Magaña, Sandy

2018-01-01

Health services and associated costs for adults with intellectual and developmental disabilities (IDD) were nationally profiled and the predictors of high expense users statistically modeled. Using linked data from the National Health Interview Survey and Medical Expenditure Panel Survey for the years 2002 through 2011, the study found a mixed…

Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance.

PubMed

Li, Ye; Wu, Qunhong; Xu, Ling; Legge, David; Hao, Yanhua; Gao, Lijun; Ning, Ning; Wan, Gang

2012-09-01

To assess the degree to which the Chinese people are protected from catastrophic household expenditure and impoverishment from medical expenses and to explore the health system and structural factors influencing the first of these outcomes. Data were derived from the Fourth National Health Service Survey. An analysis of catastrophic health expenditure and impoverishment from medical expenses was undertaken with a sample of 55 556 households of different characteristics and located in rural and urban settings in different parts of the country. Logistic regression was used to identify the determinants of catastrophic health expenditure. The rate of catastrophic health expenditure was 13.0%; that of impoverishment was 7.5%. Rates of catastrophic health expenditure were higher among households having members who were hospitalized, elderly, or chronically ill, as well as in households in rural or poorer regions. A combination of adverse factors increased the risk of catastrophic health expenditure. Families enrolled in the urban employee or resident insurance schemes had lower rates of catastrophic health expenditure than those enrolled in the new rural corporative scheme. The need for and use of health care, demographics, type of benefit package and type of provider payment method were the determinants of catastrophic health expenditure. Although China has greatly expanded health insurance coverage, financial protection remains insufficient. Policy-makers should focus on designing improved insurance plans by expanding the benefit package, redesigning cost sharing arrangements and provider payment methods and developing more effective expenditure control strategies.

Catastrophic Health Expenditure and Rural Household Impoverishment in China: What Role Does the New Cooperative Health Insurance Scheme Play?

PubMed Central

Wu, Qunhong; Liu, Chaojie; Jiao, Mingli; Liu, Guoxiang; Hao, Yanhua; Ning, Ning

2014-01-01

Objective To determine whether the New Cooperative Medical Insurance Scheme (NCMS) is associated with decreased levels of catastrophic health expenditure and reduced impoverishment due to medical expenses in rural households of China. Methods An analysis of a national representative sample of 38,945 rural households (129,635 people) from the 2008 National Health Service Survey was performed. Logistic regression models used binary indicator of catastrophic health expenditure as dependent variable, with household consumption, demographic characteristics, health insurance schemes, and chronic illness as independent variables. Results Higher percentage of households experiencing catastrophic health expenditure and medical impoverishment correlates to increased health care need. While the higher socio-economic status households had similar levels of catastrophic health expenditure as compared with the lowest. Households covered by the NCMS had similar levels of catastrophic health expenditure and medical impoverishment as those without health insurance. Conclusion Despite over 95% of coverage, the NCMS has failed to prevent catastrophic health expenditure and medical impoverishment. An upgrade of benefit packages is needed, and effective cost control mechanisms on the provider side needs to be considered. PMID:24714605

Heterogeneous effects of health insurance on out-of-pocket expenditure on medicines in Mexico.

PubMed

Wirtz, Veronika J; Santa-Ana-Tellez, Yared; Servan-Mori, Edson; Avila-Burgos, Leticia

2012-01-01