Home About us Contact
|
Home About us Contact | ||
|
|
||
Medical Expenses (medical + expense)
Selected AbstractsAssessing Treatment Effects of Inhaled Corticosteroids on Medical Expenses and Exacerbations among COPD Patients: Longitudinal Analysis of Managed Care ClaimsHEALTH SERVICES RESEARCH, Issue 6 2008Manabu Akazawa Objective. To assess costs, effectiveness, and cost-effectiveness of inhaled corticosteroids (ICS) augmenting bronchodilator treatment for chronic obstructive pulmonary disease (COPD). Data Sources. Claims between 1997 and 2005 from a large managed care database. Study Design. Individual-level, fixed-effects regression models estimated the effects of initiating ICS on medical expenses and likelihood of severe exacerbation. Bootstrapping provided estimates of the incremental cost per severe exacerbation avoided. Data Extraction Methods. COPD patients aged 40 or older with ,15 months of continuous eligibility were identified. Monthly observations for 1 year before and up to 2 years following initiation of bronchodilators were constructed. Principal Findings. ICS treatment reduced monthly risk of severe exacerbation by 25 percent. Total costs with ICS increased for 16 months, but declined thereafter. ICS use was cost saving 46 percent of the time, with an incremental cost-effectiveness ratio of $2,973 per exacerbation avoided; for patients ,50 years old, ICS was cost saving 57 percent of time. Conclusions. ICS treatment reduces exacerbations, with an increase in total costs initially for the full sample. Compared with younger patients with COPD, patients aged 50 or older have reduced costs and improved outcomes. The estimated cost per severe exacerbation avoided, however, may be high for either group because of uncertainty as reflected by the large standard errors of the parameter estimates. [source] Dental Service Utilization among Urban and Rural Older Adults in China , A Brief CommunicationJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2007Bei Wu PhD Abstract Objectives: China's health care system is bifurcated in nature between rural and urban areas. In addition, there is a huge gap in socioeconomic status between rural and urban residents. The purpose of the study was to examine the factors related to dental visits among elders in rural and urban areas of Shanghai, China. Methods: Using a stratified random sampling method, a cross-sectional, face-to-face survey was conducted among elders aged 60 years and above in Shanghai during 2003-04. A total of 1,044 older respondents were included in the sample. Results: There was a significant urban and rural difference in dental visit rates over the 12-month period of the study. Results from the logistic regression analysis suggested that residing in urban areas was a significant positive factor related to dental visits. In addition, being younger, being able to pay out-of-pocket medical expenses, having had regular medical checkups, having a higher number of limitations because of chronic conditions, and being more concerned about eating a healthy diet were associated with increased odds of dental visits. Conclusions: Results suggest that urban,rural differences, as reflected in the socioeconomic status gap, disparity in medical insurance coverage, and access to dental care, have a significant impact on the use of dental services by Chinese elders. Individual sociodemographic characteristics, health status, and health attitude are important explanatory variables. [source] The Workers' Compensation System: Worker friend or foe?AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 4 2004Lee Strunin PhD Abstract Background The workers' compensation system was designed to help injured workers who have substantial medical expenses and perhaps have lost a great deal of income. This study determines both similarities and differences in how workers experience their interactions with the workers' compensation systems in Florida and Wisconsin. Methods Ethnographic open-ended interviews with 204 workers from Florida and 198 workers in Wisconsin were conducted. All the workers had back injuries in 1990 and were either paid workers' compensation temporary disability benefits for at least 4 weeks or received permanent disability benefits or compromise settlements. Results Some interactions with the workers' compensation system were positive. However, the majority of respondents in both states experienced their encounters with the workers' compensation system as cumbersome, frustrating, and demeaning. Conclusions Mistrust, stigmatization, payment delays, and refusal of insurer personnel to pay benefits contribute to workers' negative experiences with the workers' compensation system. These insurer behaviors raise the costs to injured workers of workers' compensation benefits and thus may reduce the propensity of eligible workers to apply for benefits. Am. J. Ind. Med. 45:338,345, 2004. © 2004 Wiley-Liss, Inc. [source] | ||||||||||