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Kinds of Payers Terms modified by Payers Selected AbstractsEfficiency and Economic Benefits of a Payer-based Electronic Health Record in an Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 8 2010Gregory W. Daniel PhD ACADEMIC EMERGENCY MEDICINE 2010; 17:824,833 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The objective was to evaluate the use of a payer-based electronic health record (P-EHR), which is a clinical summary of a patient's medical and pharmacy claims history, in an emergency department (ED) on length of stay (LOS) and plan payments. Methods:, A large urban ED partnered with the dominant health plan in the region and implemented P-EHR technology in September 2005 for widespread use for health plan members presenting to the ED. A retrospective observational study design was used to evaluate this previously implemented P-EHR. Health plan and electronic hospital data were used to identify 2,288 ED encounters. Encounters with P-EHR use (n = 779) were identified between September 1, 2005, and February 17, 2006; encounters from the same health plan (n = 1,509) between November 1, 2004, and March 31, 2005, were compared. Outcomes were ED LOS and plan payment for the ED encounter. Analyses evaluated the effect of using the P-EHR in the ED setting on study outcomes using multivariate regressions and the nonparametric bootstrap. Results:, After covariate adjustment, among visits resulting in discharge (ED-only), P-EHR visits were 19 minutes shorter (95% confidence interval [CI] = 5 to 33 minutes) than non-P-EHR visits. Among visits resulting in hospitalization, the P-EHR was associated with an average 77-minute shorter ED LOS (95% CI = 28 to 126 minutes), compared to non,P-EHR visits. The P-EHR was associated with an average of $1,560 (95% CI = $43 to $2,910) lower total plan expenditures for hospitalized visits. No significant difference in total payments was observed among discharged visits. Conclusions:, In the study ED, the P-EHR was associated with a significant reduction in ED LOS overall and was associated with lower plan payments for visits that resulted in hospitalization. [source] Optimal drug pricing, limited use conditions and stratified net benefits for Markov models of disease progressionHEALTH ECONOMICS, Issue 11 2008Gregory S. Zaric Abstract Limited use conditions (LUCs) are a method of directing treatment with new drugs to those populations where they will be most cost effective. In this paper we investigate how a drug manufacturer could determine pricing and LUCs to maximize profits. We assume that the payer makes formulary decisions on the basis of net monetary benefits, that the disease can be modeled using a Markov model of disease progression, and that the drug reduces the probability of progression between states of the Markov model. LUCs are expressed as a range of probabilities of disease progression over which patients would have access to the new drug. We assume that the manufacturer determines the price and LUCs in order to maximize profits. We show that an explicit trade-off exists between the drug's price and the use conditions, that there is an upper bound on the drug price, that the proportion of the population targeted by the LUC does not depend on quality of life or costs in each health state or the payer's willingness to pay, and that high drug prices do not always correspond with high profits. Copyright © 2008 John Wiley & Sons, Ltd. [source] Medical Expenditures during the Last Year of Life: Findings from the 1992,1996 Medicare Current Beneficiary SurveyHEALTH SERVICES RESEARCH, Issue 6 2002Donald R Hoover Objective. To compare medical expenditures for the elderly (65 years old) over the last year of life with those for nonterminal years. Data Source. From the 1992,1996 Medicare Current Beneficiary Survey (MCBS) data from about ten thousand elderly persons each year. Study Design. Medical expenditures for the last year of life and nonterminal years by source of payment and type of care were estimated using robust covariance linear model approaches applied to MCBS data. Data Collection. The MCBS is a panel survey of a complex weighted multilevel random sample of Medicare beneficiaries. A structured questionnaire is administered at four-month intervals to collect all medical costs by payer and service. Medicare costs are validated by claims records. Principal Findings. From 1992 to 1996, mean annual medical expenditures (1996 dollars) for persons aged 65 and older were $37,581 during the last year of life versus $7,365 for nonterminal years. Mean total last-year-of-life expenditures did not differ greatly by age at death. However, non-Medicare last-year-of-life expenditures were higher and Medicare last-year-of-life expenditures were lower for those dying at older ages. Last-year-of-life expenses constituted 22 percent of all medical, 26 percent of Medicare, 18 percent of all non-Medicare expenditures, and 25 percent of Medicaid expenditures. Conclusions. While health services delivered near the end of life will continue to consume large portions of medical dollars, the portion paid by non-Medicare sources will likely rise as the population ages. Policies promoting improved allocation of resources for end-of-life care may not affect non-Medicare expenditures, which disproportionately support chronic and custodial care. [source] The epidemiologic, health-related quality of life, and economic burden of gastrointestinal stromal tumoursJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2007P. Reddy PharmD Summary Background and objectives:, Gastrointestinal stromal tumours (GIST) are uncommon tumours believed to arise from interstitial cells of Cajal or their precursors in the gastrointestinal (GI) tract, accounting for a small percentage of GI neoplasms and sarcomas. Given the recent recognition of GIST as a distinct cancer, as well as new treatment options available today, a review of the epidemiologic, health-related quality of life (HRQL), and economic burden of GIST is timely from a payer, provider and patient perspective and may provide guidance for treatment decision making and reimbursement. Methods:, A systematic literature review of PubMed and five scientific meeting databases, was conducted to identify published studies and abstracts describing the epidemiologic, HRQL and economic impact of GIST. Publications deemed worthy of further review, based on the information available in the abstract, were retrieved in full text. Results and discussion:, Thirty-four publications met the review criteria: 29 provided data on GIST epidemiology, one provided cost data, three reported HRQL outcomes, and one reported cost and HRQL outcomes. The annual incidence of GIST (cases per million) ranged from 6·8 in the USA to 14·5 in Sweden, with an estimated 5-year survival rate of 45,64%. On the Functional Illness of Chronic Therapy-fatigue instrument, GIST patients scored 40·0 compared with 37·6 in anaemic cancer patients (0 = worst; 52 = least fatigue). Total costs over 10 years for managing GIST patients with molecularly targeted treatment was estimated at £47 521,£56 146 per patient compared with £4047,£4230 per patient with best supportive care. Conclusions:, The incidence of GIST appears to be similar by country; the lower estimate in one country could be explained by differences in method of case ascertainment. Data suggest that the HRQL burden of GIST is similar to that with other cancers although this requires further exploration. The value of new therapies in GIST needs to consider not only cost but also anticipated benefits and the unmet medical need in this condition. [source] Public and Private Provision of Health CareJOURNAL OF ECONOMICS & MANAGEMENT STRATEGY, Issue 1 2002Pedro Pita Barros One of the mechanisms that are implemented in the cost containment movement in the health care sectors in western countries is the definition, by the third-party payer, of a set of preferred providers. The insured patients have different access rules to such providers when ill. The rules specify the copayments patients must pay when using an out-of-plan care provider. This paper studies the competitive process among providers in terms of both prices and qualities. Competition is influenced by the status of providers as in-plan or out-of-plan care providers. Also, there is a moral hazard of provider choice related to the trade-off between freedom to choose and the need to hold down costs. It is possible to achieve the first-best allocation by an appropriate definition of the reimbursement scheme when decisions on prices and qualities are taken simultaneously (as in primary health care sectors). In contrast, some type of regulation is needed to achieve the optimal solution when decisions are sequential (as in specialized health care sectors). We also derive normative conclusions on how price controls should be implemented in some European Union member states. [source] The development of dentist practice profiles and managementJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2009Chinho Lin PhD Abstract Rationale and objectives, With the current large computerized payment systems and increase in the number of claims, unusual dental practice patterns to cover up fraud are becoming widespread and sophisticated. Clustering the characteristic of dental practice patterns is an essential task for improving the quality of care and cost containment. This study aims at providing an easy, efficient and practical alternative approach to developing patterns of dental practice profiles. This will help the third-party payer to recognize and describe novel or unusual patterns of dental practice and thus adopt various strategies in order to prevent fraudulent claims and overcharges. Methodology, Knowledge discovery (or data mining) was used to cluster the dentists' profiles by carrying out clustering techniques based on the features of service rates. It is a hybrid of the knowledge discovery, statistical and artificial neural network methodologies that extracts knowledge from the dental claim database. Results, The results of clustering highlight characteristics related to dentists' practice patterns, and the detailed managerial guidance is illustrated to support the third-party payer in the management of various patterns of dentist practice. Conclusion, This study integrates the development of dentists' practice patterns with the knowledge discovery process. These findings will help the third-party payer to discriminate the patterns of practice, and also shed more light on the suspicious claims and practice patterns among dentists. [source] Medical Error and Patient Safety: Understanding Cultures in ConflictLAW & POLICY, Issue 2 2002Joanna Weinberg Evidence documenting the high rate of medical errors to patients has taken a prominent place on the health care radar screen. The injuries and deaths associated with medical errors represent a major public health problem with significant economic costs and erosion of trust in the health care system. Between 44,000 and 98,000 deaths due to preventable medical errors are estimated to occur each year, making medical errors the eighth leading cause of death in the United States. However, the recent prominence of the issue of safety or error does not reflect a new phenomenon or sudden rift in the quality of health care (although it is a system fraying at the edges). Rather, the prominence of the issue reflects a radical change in the culture of health care, and in how relationships within the health care system are structured and perceived. In this paper, I discuss the multiple factors responsible for the change in the culture of health care. First, the culture has shifted from a clinician cantered system, in which decision making is one,sided, to a shared system of negotiated care between clinician and patient, and, often, between administrator or payer. Second, the nature of quality in health care has changed due to the geometric increase in the availability of technological and pharmaceutical enhancements to patient care. Third, the health care culture continues to rely on outdated models of conflict resolution. Finally, the regulatory structure of health system oversight was set in place when fee,for,service care governed physician,patient relationships and where few external technologies were available. In the current health care culture, that structure seems inadequate and diffuse, with multiple and overlapping federal and state regulatory structures that make implementation of patient safety systems difficult. [source] Systematic review: patient-centred endpoints in economic evaluations of gastro-oesophageal reflux diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2002N. Vakil Summary Aim : To perform a systematic review of the economic literature on gastro-oesophageal reflux disease to evaluate (a) the use of patient-centred effectiveness end-points, or (b) the use of patient-centred economic end-points, and the influence of these end-points on the outcome of the model. Methods : Three electronic databases (EMBASE, BIOSIS and Medline) were used, together with a manual search of meeting abstracts for relevant articles. The quality of the studies was determined by the Drummond criteria. Results : Our initial search identified 179 articles and a manual search revealed 78 abstracts and articles. A total of 47 studies (36 fully published articles and 11 abstracts) met the seven Drummond criteria for inclusion in our evaluation. Conclusions : This systematic review demonstrates that many of the published economic evaluations available today take the perspective of the third-party payer and focus on pharmaceutical costs relevant to the third-party payer. Our study also demonstrates that there are a number of costs of illness determinations, such that pharmaceutical costs account for only a small proportion of the total costs of managing gastro-oesophageal reflux disease. Future economic analyses should consider an evaluation of the patient's desire for complete symptom relief by including cost,utility assessments or willingness to pay data. [source] Complementary and alternative medicine use in Gilles de la Tourette syndromeMOVEMENT DISORDERS, Issue 13 2009Katie Kompoliti MD Abstract The aim of this study was to describe the use of complementary and alternative medicine (CAM) in patients with Tourette syndrome (TS) and explore associations with CAM use. In recent years CAM use has increased, but rates of CAM use in TS patients are not reported. Consecutive TS patients or their parent(s), seen in an academic movement disorder center, completed a questionnaire regarding their use of CAM. One hundred TS patients or parents completed the questionnaire, mean age 21.5 ± 13.5, 76 males, 87 Caucasians. Sixty four patients had used at least one CAM modality. CAM treatments used were prayer (28), vitamins (21), massage (19), dietary supplements (15), chiropractic manipulations (12), meditation (10), diet alterations (nine), yoga (nine), acupuncture (eight), hypnosis (seven), homeopathy (six), and EEG biofeedback (six). Fifty six percent of patients using CAM reported some improvement. Users paid out of pocket for 47% of treatments pursued, and 19% of these payers received partial reimbursement by third party payer. Users and non-users did not differ in age, gender, race, income, educational level, general health, tic severity, medication use for TS, current satisfaction from medications or experience of side effects from medications. CAM use was associated with the presence of affective disorder (P = 0.004), but not with either ADHD or OCD. Among CAM users, 80% initiated CAM without informing their doctor. CAM is commonly used in children and adults with TS, and often without the neurologist's knowledge. Physicians should inquire about CAM to understand the spectrum of interventions that patients with TS use. © 2009 Movement Disorder Society [source] Surgical Excision of Acoustic Neuroma: Patient Outcome and Provider CaseloadTHE LARYNGOSCOPE, Issue 8 2003Fred G. Barker II Abstract Objectives/Hypothesis For many complex surgical procedures, larger hospital or surgeon caseload is associated with better patient outcome. We examined the volume,outcome relationship for surgical excision of acoustic neuromas. Study Design Retrospective cohort study. Methods The Nationwide Inpatient Sample (1996 to 2000) was used. Multivariate regression analyses were adjusted for age, sex, race, payer, geographic region, procedure timing, admission type and source, medical comorbidities, and neurofibromatosis status. Results At 265 hospitals, 2643 operations were performed by 352 identified primary surgeons. Outcome was measured on a four-level scale at hospital discharge: death (0.5%) and discharge to long-term care (1.2%), to short-term rehabilitation (4.4%), and directly to home (94%). Outcomes were significantly better after surgery at higher-volume hospitals (OR 0.47 for fivefold-larger caseload, P <.001) or by higher-volume surgeons (OR 0.46, P <.001). Of patients who had surgery at lowest-volume-quartile hospitals, 12.3% were not discharged directly home, compared with 4.1% at highest-volume-quartile hospitals. There was a trend toward lower mortality for higher-volume hospitals (P = .1) and surgeons (P = .06). Of patients who had surgery at lowest-caseload-quartile hospitals, 1.1% died, compared with 0.6% at highest-volume-quartile hospitals. Postoperative complications (including neurological complications, mechanical ventilation, facial palsy, and transfusion) were less likely with high-volume hospitals and surgeons. Length of stay was significantly shorter with high-volume hospitals (P = .01) and surgeons (P = .009). Hospital charges were lower for high-volume hospitals (by 6% [P = .006]) and surgeons (by 6% [P = .09]). Conclusion For acoustic neuroma excision, higher-volume hospitals and surgeons provided superior short-term outcomes with shorter lengths of stay and lower charges. [source] Predictive Ability of Pretransplant Comorbidities to Predict Long-Term Graft Loss and DeathAMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2009G. Machnicki Whether to include additional comorbidities beyond diabetes in future kidney allocation schemes is controversial. We investigated the predictive ability of multiple pretransplant comorbidities for graft and patient survival. We included first-kidney transplant deceased donor recipients if Medicare was the primary payer for at least one year pretransplant. We extracted pretransplant comorbidities from Medicare claims with the Clinical Classifications Software (CCS), Charlson and Elixhauser comorbidities and used Cox regressions for graft loss, death with function (DWF) and death. Four models were compared: (1) Organ Procurement Transplant Network (OPTN) recipient and donor factors, (2) OPTN + CCS, (3) OPTN + Charlson and (4) OPTN + Elixhauser. Patients were censored at 9 years or loss to follow-up. Predictive performance was evaluated with the c-statistic. We examined 25 270 transplants between 1995 and 2002. For graft loss, the predictive value of all models was statistically and practically similar (Model 1: 0.61 [0.60 0.62], Model 2: 0.63 [0.62 0.64], Models 3 and 4: 0.62 [0.61 0.63]). For DWF and death, performance improved to 0.70 and was slightly better with the CCS. Pretransplant comorbidities derived from administrative claims did not identify factors not collected on OPTN that had a significant impact on graft outcome predictions. This has important implications for the revisions to the kidney allocation scheme. [source] Effect of Comorbidity Adjustment on CMS Criteria for Kidney Transplant Center PerformanceAMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2009E. D. Weinhandl The Centers for Medicare & Medicaid Services (CMS) uses kidney transplant outcomes, unadjusted for standard comorbidity, to identify centers with sufficiently higher than expected rates of graft failure or patient death (underperforming centers) that they may be denied Medicare participation. To examine whether comorbidity adjustment would affect this determination, we identified centers that would have failed to meet 1-year graft survival criteria, 1992,2005, with and without adjustment using the Elixhauser Comorbidity Index. Adjustment was performed for each U.S. center for 24 consecutive (overlapping) 30-month intervals, including 102 176 adult deceased-donor and living-donor kidney transplant patients with Medicare as primary payer 6 months pretransplant. For each interval, we determined percent positive agreement (PPA) (number of centers underperforming both before and after adjustment, divided by number underperforming either before or after adjustment). Overall PPA was 80.8%, with no evidence of a trend over time. Among deceased-donor recipients, 10 of 31 comorbid conditions were predictors of graft failure in at least half of the intervals, as were six conditions among living-donor recipients. Lack of comorbidity adjustment may disadvantage centers willing to accept higher risk patients. Risk of jeopardizing Medicare funding may give centers incentive to deny transplantation to higher risk patients. [source] Efficiency and Economic Benefits of a Payer-based Electronic Health Record in an Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 8 2010Gregory W. Daniel PhD ACADEMIC EMERGENCY MEDICINE 2010; 17:824,833 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The objective was to evaluate the use of a payer-based electronic health record (P-EHR), which is a clinical summary of a patient's medical and pharmacy claims history, in an emergency department (ED) on length of stay (LOS) and plan payments. Methods:, A large urban ED partnered with the dominant health plan in the region and implemented P-EHR technology in September 2005 for widespread use for health plan members presenting to the ED. A retrospective observational study design was used to evaluate this previously implemented P-EHR. Health plan and electronic hospital data were used to identify 2,288 ED encounters. Encounters with P-EHR use (n = 779) were identified between September 1, 2005, and February 17, 2006; encounters from the same health plan (n = 1,509) between November 1, 2004, and March 31, 2005, were compared. Outcomes were ED LOS and plan payment for the ED encounter. Analyses evaluated the effect of using the P-EHR in the ED setting on study outcomes using multivariate regressions and the nonparametric bootstrap. Results:, After covariate adjustment, among visits resulting in discharge (ED-only), P-EHR visits were 19 minutes shorter (95% confidence interval [CI] = 5 to 33 minutes) than non-P-EHR visits. Among visits resulting in hospitalization, the P-EHR was associated with an average 77-minute shorter ED LOS (95% CI = 28 to 126 minutes), compared to non,P-EHR visits. The P-EHR was associated with an average of $1,560 (95% CI = $43 to $2,910) lower total plan expenditures for hospitalized visits. No significant difference in total payments was observed among discharged visits. Conclusions:, In the study ED, the P-EHR was associated with a significant reduction in ED LOS overall and was associated with lower plan payments for visits that resulted in hospitalization. [source] Consumer Response to Information about a Functional Food Product: Apples Enriched with AntioxidantsCANADIAN JOURNAL OF AGRICULTURAL ECONOMICS, Issue 3 2009Armenak Markosyan Interest in functional foods has been growing as consumers become increasingly concerned with diet and nutrition. This article measures consumers' responses to apples enriched with an antioxidant coating. Antioxidant-enriched apples are believed to provide additional health benefits reducing the risk of cancer and heart diseases. We discuss the consumer's benefit-risk trade-offs. Although functional food products provide health benefits beyond basic nutrition, some consumers may reject them because they utilize new technology. Face-to-face consumer surveys with contingent valuation questions were conducted in Seattle and Spokane, Washington in 2006. Consumers who choose where to shop based on organic availability are less likely to pay a premium for apples enriched with antioxidants. Also, there is evidence that consumers in Spokane are more likely to pay a premium for the product than consumers in supermarkets in Seattle. Information regarding the potential health benefits of antioxidants has a positive significant effect on consumers' willingness to pay (WTP). The estimated mean WTP suggests that there is a small premium associated with this product in the mind of an average consumer. L'intérêt pour les aliments fonctionnels ne cesse de croître étant donné que les consommateurs s'intéressent de plus en plus au régime alimentaire et à la nutrition. Le présent article évalue la réaction des consommateurs à la vente de pommes enrobées d'antioxydants. On croit que les pommes enrichies d'antioxydants procureraient des bienfaits supplémentaires pour la santé en diminuant le risque de cancer et de cardiopathies. Nous avons examiné les avantages et les risques pour le consommateur. Bien que les aliments fonctionnels apportent des bienfaits pour la santé en plus d'une nutrition de base, certains consommateurs peuvent les refuser parce qu'ils ont nécessité l'utilisation de nouvelles technologies. En 2006, nous avons effectué, à Seattle et à Spokane dans l'État de Washington, des sondages en personne à l'aide de l'approche des préférences exprimées. Les consommateurs qui choisissaient un magasin d'alimentation en fonction de la disponibilité de produits biologiques étaient moins enclins à payer une prime pour obtenir des pommes enrichies d'antioxydants. Les consommateurs de Spokane ont semblé plus enclins à payer une prime pour ce produit que les consommateurs qui fréquentaient les supermarchés de Seattle. L'information sur les bienfaits potentiels des antioxydants sur la santé a des répercussions positives considérables sur la volonté de payer des consommateurs. La volonté de payer moyenne estimative laisse supposer que, dans l'esprit du consommateur moyen, ce produit procure un certain avantage. [source] An Examination of the Disparity Between Hypothetical and Actual Willingness to Pay Using the Contingent Valuation Method: The Case of Red Kite Conservation in the United KingdomCANADIAN JOURNAL OF AGRICULTURAL ECONOMICS, Issue 2 2007Michael Christie This paper reports the findings of a field experiment that explores the criterion validity of the contingent valuation (CV) method. The empirical experiment examined the disparity between hypothetical and actual willingness to pay (WTP) bids for Red Kite conservation in Wales. Hypothetical WTP was elicited using an open-ended CV instrument, while the actual WTP value was determined from actual donations to the Welsh Kite Trust,a charity set up to aid the conservation of Red Kites in Wales. The survey results indicate that hypothetical WTP was three times greater than the mean value of actual donations; this finding is consistent with a number of other criterion validity experiments. However, we also demonstrate equality of hypothetical and actual WTP among those who actually express a payment amount. Further investigations identify that an underlying cause of this disparity stems from the respondents of the CV survey overstating their intention of pay. This observation has potentially significant implication for CV design in that it suggests that the emphasis in design should be placed much more fully on initially determining whether people would actually pay at all. Le présent article présente les résultats d'une expérience sur le terrain qui a exploré la validité de critère de la méthode d'évaluation contingente (CV). L'expérience empirique a examiné l'écart entre la volonté de payer (VDP) hypothétique et réelle pour la conservation du milan royal dans le pays de Galles. La VDP hypothétique a été obtenue en utilisant un questionnaire ouvert pour effectuer l'évaluation contingente (CV), tandis que la valeur de la VDP réelle a été déterminée d'après les dons réels versés àThe Welsh Kite Trust, organisation caritative créée pour la conservation du milan royal au pays de Galles. Les résultats du sondage ont indiqué que la VDP hypothétique était trois fois supérieures à la valeur moyenne des dons réels; ce résultat rejoint ceux d'autres expériences sur la validité de critère. Cependant, nous avons aussi démontré une égalité entre la VDP hypothétique et réelle des personnes qui ont exprimé le montant du don. Des sondages ultérieurs ont montré qu'une des causes sous-jacentes de cet écart venait du fait que les répondants avaient exagéré leur intention de payer. Cette observation a une implication potentielle importante pour la conception d'évaluation contingente puisqu'elle laisse supposer que l'accent mis sur la conception devrait plutôt être mis sur la détermination initiale de l'intention des personnes à payer ou non. [source] Producer Willingness to Pay for Precision Application Technology: Implications for Government and the Technology IndustryCANADIAN JOURNAL OF AGRICULTURAL ECONOMICS, Issue 1 2003Darren Hudson This paper focuses on the willingness to pay (WTP) for precision application/site-specific management technologies on the part of agricultural producers. We use a contingent valuation survey to elicit WTP for a package of technologies and examine the impact of government subsidies on potential demand. Results suggest that producer WTP is significantly lower than current technology prices, necessitating a 60% government subsidy to induce adoption, on average. Agronomic factors such as soil characteristic variability and soil quality are important determinants of WTP. In addition, how well the technology integrates into current farming practices and equipment also appears important. Les auteurs s'intéressent à la volonté des agriculteurs de payer pour des applications de précision ou des technologies de gestion adaptées à l'exploitation. Ils recourent à une étude d'évaluation des contingences pour jauger la volonté de payer un ensemble de technologies et pour préciser l'incidence des subventions gouvernementales sur la demande potentielle. Les résultats laissent croire que la volonté de payer est sensiblement plus faible que le coût actuel de la technologie, de sorte que l'adoption d'une technologie requiert une subvention publique de 60 %, en moyenne. Les paramètres agronomiques comme la variabilité des propriétés et la qualité du sol jouent un rôle important dans la volonté de payer. Enfin, la manière dont une technologie s'intègre aux pratiques agricoles et au matériel existants paraît aussi avoir son importance en la matière. [source] Cancer treatment cost in the United States,,CANCER, Issue 14 2010Has the burden shifted over time? Abstract BACKGROUND: There has not been a comprehensive analysis of how aggregate cancer costs have changed over time. The authors present 1) updated estimates of the prevalence and total cost of cancer for select payers and how these have changed over the past 2 decades; and 2) for each payer, the distribution of payments by type of service over time to assess whether there have been shifts in cancer treatment settings. METHODS: Pooled data from the 2001 through 2005 Medical Expenditure Panel Survey and the 1987 National Medical Care Expenditure Survey were used for the analysis. The authors used an econometric approach to estimate cancer-attributable medical expenditures by payer and type of service. RESULTS: In 1987, the total medical cost of cancer (in 2007 US dollars) was $24.7 billion. Private payers financed the largest share of the total (42%), followed by Medicare (33%), out of pocket (17%), other public (7%), and Medicaid (1%). Between 1987 and the 2001 to 2005 period, the total medical cost of cancer increased to $48.1 billion. In 2001 to 2005, the shares of cancer costs were: private insurance (50%), Medicare (34%), out of pocket (8%), other public (5%), and Medicaid (3%). The share of total cancer costs that resulted from inpatient admissions fell from 64.4% in 1987 to 27.5% in 2001 to 2005. CONCLUSIONS: The authors identified 3 trends in the total costs of cancer: 1) the medical costs of cancer have nearly doubled; 2) cancer costs have shifted away from the inpatient setting; and 3) the share of these costs paid for by private insurance and Medicaid have increased. Cancer 2010. Published 2010 by American Cancer Society. [source] International Diabetes Federation: a consensus on Type 2 diabetes preventionDIABETIC MEDICINE, Issue 5 2007K. G. M. M. Alberti Abstract Aims, Early intervention and avoidance or delay of progression to Type 2 diabetes is of enormous benefit to patients in terms of increasing life expectancy and quality of life, and potentially in economic terms for society and health-care payers. To address the growing impact of Type 2 diabetes the International Diabetes Federation (IDF) Taskforce on Prevention and Epidemiology convened a consensus workshop in 2006. The primary goal of the workshop and this document was the prevention of Type 2 diabetes in both the developed and developing world. A second aim was to reduce the risk of cardiovascular disease in people who are identified as being at a higher risk of Type 2 diabetes. The IDF plan for prevention of Type 2 diabetes is based on controlling modifiable risk factors and can be divided into two target groups: ,,People at high risk of developing Type 2 diabetes ,,The entire population. Conclusions, In planning national measures for the prevention of Type 2 diabetes, both groups should be targeted simultaneously with lifestyle modification the primary goal through a stepwise approach. In addition, it is important that all activities are tailored to the specific local situation. Further information on the prevention of diabetes can be found on the IDF website: http://www.idf.org/prevention. [source] The Emergency Medical Treatment and Labor Act as a Federal Health Care Safety Net ProgramACADEMIC EMERGENCY MEDICINE, Issue 11 2001W. Wesley Fields MD Abstract Despite the greatest economic expansion in history during the 1990s, the number of uninsured U.S. residents surpassed 44 million in 1998. Although this number declined for the first time in recent years in 1999, to 42.6 million, the current economic slow-down threatens once again to increase the ranks of the uninsured. Many uninsured patients use hospital emergency departments as a vital portal of entry into an access-improverished health care system. In 1986, Congress mandated access to emergency care when it passed the Emergency Medical Treatment and Labor Act (EMTALA). The EMTALA statute has prevented the unethical denial of emergency care based on inability to pay; however, the financial implications of EMTALA have not yet been adequately appreciated or addressed by Congress or the American public. Cuts in payments from public and private payers, as well as increasing demands from a larger uninsured population, have placed unprecedented financial strains on safety net providers. This paper reviews the financial implications of EMTALA, illustrating how the statute has evolved into a federal health care safety net program. Future actions are proposed, including the pressing need for greater public safety net funding and additional actions to preserve health care access for vulnerable populations. [source] Prior Payment Status and the Likelihood to Pay Dividends: International EvidenceFINANCIAL REVIEW, Issue 3 2010Mia Twu G32; G35 Abstract By using the signaling model and the life-cycle theory, I examine the importance of prior payment status in determining the likelihood to pay dividends. I categorize firms into those that paid dividends previously and those that did not. My results show that strong dividend stickiness exists and the determinants to pay differ significantly for the two groups of firms. High growth and low insider holdings make prior payers more likely to pay but prior nonpayers less likely to pay. Furthermore, prior payers are more sensitive to profitability and earned/contributed equity mix, while prior nonpayers are more sensitive to risk and dividend premiums. Finally, taking the prior payment status into account eliminates the problem of overestimating the portion of payers put forth by previous studies. [source] DISAPPEARING DIVIDENDS: CHANGING FIRM CHARACTERISTICS OR LOWER PROPENSITY TO PAY?JOURNAL OF APPLIED CORPORATE FINANCE, Issue 1 2001Eugene F. Fama The proportion of U.S. firms paying dividends drops sharply during the 1980s and 1990s. Among NYSE, AMEX, and Nasdaq firms, the proportion of dividend payers falls from 66.5% in 1978 to only 20.8% in 1999. The decline is due in part to an avalanche of new listings that tilts the population of publicly traded firms toward small firms with low profitability and strong growth opportunities,the timeworn characteristics of firms that typically do not pay dividends. But this is not the whole story. The authors' more striking finding is that, no matter what their characteristics, firms in general have become less likely to pay dividends. The authors use two different methods to disentangle the effects of changing firm characteristics and changing propensity to pay on the percent of dividend payers. They find that, of the total decline in the proportion of dividend payers since 1978, roughly one-third is due to the changing characteristics of publicly traded firms and two-thirds is due to a reduced propensity to pay dividends. This lower propensity to pay is quite general,dividends have become less common among even large, profitable firms. Share repurchases jump in the 1980s, and the authors investigate whether repurchases contribute to the declining incidence of dividend payments. It turns out that repurchases are mainly the province of dividend payers, thus leaving the decline in the percent of payers largely unexplained. Instead, the primary effect of repurchases is to increase the already high payouts of cash dividend payers. [source] Billing effectively with the new health and behavior current procedural terminology codes in primary care and specialty clinicsJOURNAL OF CLINICAL PSYCHOLOGY, Issue 10 2006Robin E. S. Miyamoto The health and behavior current procedural terminology (CPT) codes introduced in 2003 have gained nationwide acceptance through Medicare and limited acceptance through third party payers. The codes facilitate accurate description and quantification of behavioral medicine services within a primary care or specialty clinic setting. The author reviews their appropriate utilization to enhance reimbursement and facilitate development of self-sustaining behavioral medicine programs. Information is provided on increased use and reimbursement of codes within psychology. Future directions for continued advocacy, increased acceptance, training, and research are discussed. © 2006 Wiley Periodicals, Inc. J Clin Psychol 62: 1221,1229, 2006. [source] Trade implications of price discrimination in a domestic marketAGRIBUSINESS : AN INTERNATIONAL JOURNAL, Issue 1 2010Nobunori Kuga This study examines how domestic price discrimination between fluid and manufacturing milk influences dairy trade. Two types of dairy models are used for the study. The first one is a stylized mathematical model which is used to explore the relative trade effects of domestic price discrimination accompanied with revenue pooling mechanism versus border measures in dairy product markets. The second one is a partial equilibrium, multiple-region model of dairy policy and trade, which is used to see the empirical implication of domestic price discrimination for six major dairy producers. The analytical results identify the trading status as the key to determine the relative trade effects. While domestic price discrimination is always less trade distorting than border measures in a net-importer case, the relative trade distortiveness depends on the export volume in a net exporter case. The theoretical possibility that domestic price discrimination is more trade distorting than border measures is found when the ratio of dairy export to domestic manufacturing milk consumption is very high. The results also indicate that while the both support measures increase dairy export, domestic price discrimination may place greater economic burden on fluid milk consumers and less economic burden on tax payers than border measures. In addition, the results imply that domestic price discrimination schemes can be effective trade protective measures for Canada, Japan and the United States, where the schemes are currently being implemented. © 2010 Wiley Periodicals, Inc. [source] Assessing Cost-Effectiveness of Sealant Placement in ChildrenJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 2 2005Rocio B. Quiñonez DMD Abstract Objective: The lack of cost-effectiveness information regarding sealant placement strategies is thought to have influenced reimbursement policies and subsequent sealant utilization in dental practice. This study compared three strategies for managing the occlusal surfaces of first permanent molars: seal all (SA), risk-based (RBS), and seal none (SN). Methods: A decision tree was developed for various possible outcomes following each of the above strategies. Due to the complexity of the decision tree, a Markov model was used to allow for the construction of a chain of events representing the natural history of sealant retention, caries formation, and their associated health states. The outcome measures were the incremental cost per month gained in a cavity-free state over a ten-year period. Results: Our theoretical model showed that RBS strategy improved clinical outcomes, in the form of cavity-free months, and saved money over SN. The strategy of sealing both high and low risk teeth (SA) further improved outcomes but at an additional cost compared to RBS. However, the cost was small, $08 for each additional cavity-free month gained per tooth. Further, minor changes in the baseline assumptions resulted in the SA strategy being the dominant strategy. Conclusion: This study provides evidence that sealing children's first permanent molars can improve outcomes and save money by delaying or avoiding invasive treatment and the destructive cycle of caries. In a time of limited funds for dental services, these results can assist payers in establishing more rational sealant reimbursement policies. [source] Barriers to the optimal rehabilitation of surgical cancer patients in the managed care environment: An administrator's perspectiveJOURNAL OF SURGICAL ONCOLOGY, Issue 5 2007Pamela Germain MBA Abstract Ensuring that surgical cancer patients obtain optimal rehabilitation care (defined here as all care provided post-operatively following cancer surgery) can be challenging because of the fragmented nature of the U.S. healthcare delivery and payment systems. In the managed care environment, surgical cancer patients' access to rehabilitation care is likely to vary by type of health insurance plan, by setting, by type of provider, and by whether care is provided in-network or out-of-network. The author of this article, who negotiates managed care contracts for the Roswell Park Cancer Institute (RPCI), gives examples of strategies used with some success by RPCI to collaborate with local payers to ensure that surgical cancer patients get optimal rehabilitation care, especially as they make the transition from hospital to outpatient care. She suggests that further collaborations of healthcare providers, payers, consumers, and policymakers are needed to help ensure optimal rehabilitation care for surgical cancer patients. J. Surg. Oncol. 95:386,392. © 2007 Wiley-Liss, Inc. [source] Complementary and alternative medicine use in Gilles de la Tourette syndromeMOVEMENT DISORDERS, Issue 13 2009Katie Kompoliti MD Abstract The aim of this study was to describe the use of complementary and alternative medicine (CAM) in patients with Tourette syndrome (TS) and explore associations with CAM use. In recent years CAM use has increased, but rates of CAM use in TS patients are not reported. Consecutive TS patients or their parent(s), seen in an academic movement disorder center, completed a questionnaire regarding their use of CAM. One hundred TS patients or parents completed the questionnaire, mean age 21.5 ± 13.5, 76 males, 87 Caucasians. Sixty four patients had used at least one CAM modality. CAM treatments used were prayer (28), vitamins (21), massage (19), dietary supplements (15), chiropractic manipulations (12), meditation (10), diet alterations (nine), yoga (nine), acupuncture (eight), hypnosis (seven), homeopathy (six), and EEG biofeedback (six). Fifty six percent of patients using CAM reported some improvement. Users paid out of pocket for 47% of treatments pursued, and 19% of these payers received partial reimbursement by third party payer. Users and non-users did not differ in age, gender, race, income, educational level, general health, tic severity, medication use for TS, current satisfaction from medications or experience of side effects from medications. CAM use was associated with the presence of affective disorder (P = 0.004), but not with either ADHD or OCD. Among CAM users, 80% initiated CAM without informing their doctor. CAM is commonly used in children and adults with TS, and often without the neurologist's knowledge. Physicians should inquire about CAM to understand the spectrum of interventions that patients with TS use. © 2009 Movement Disorder Society [source] Economic burden associated with Parkinson's disease on elderly Medicare beneficiariesMOVEMENT DISORDERS, Issue 3 2006Katia Noyes PhD Abstract We evaluated medical utilization and economic burden of self-reported Parkinson's disease (PD) on patients and society. Using the 1992,2000 Medicare Current Beneficiary Survey, we compared health care utilization and expenditures (in 2002 U.S. dollars) of Medicare subscribers with and without PD, adjusting for sociodemographic characteristics and comorbidities. PD patients used significantly more health care services of all categories and paid significantly more out of pocket for their medical services than other elderly (mean ± SE, $5,532 ± $329 vs. $2,187 ± $38; P < 0.001). After adjusting for other factors, PD patients had higher annual health care expenses than beneficiaries without PD ($18,528 vs. $10,818; P < 0.001). PD patients were more likely to use medical care (OR = 3.77; 95% CI = 1.44,9.88), in particular for long-term care (OR = 3.80; 95% CI = 3.02,4.79) and home health care (OR = 2.08; 95% CI = 1.76,2.46). PD is associated with a significant economic burden to patients and society. Although more research is needed to understand the relationship between PD and medical expenditures and utilization, these findings have important implications for health care providers and payers that serve PD populations. © 2005 Movement Disorder Society [source] Charitable Donations and the Estate Tax: A Tale of Two HypothesesAMERICAN JOURNAL OF ECONOMICS AND SOCIOLOGY, Issue 3 2010William Beranek Regression studies have suggested that reducing estate-tax rates would lead to a net reduction in total charitable donations distributed at death. Not only is this notion counterintuitive, our empirical analysis yields the contrary conclusion: overall donations would increase. In rationalizing this donation-decline outcome, investigators have pointed to the tax deductibility of donations in assessing estate-tax liability. These efforts, we show, are dubious. The view that donations will decline is also shown to be inconsistent with axioms of generally accepted economic theory. Two distinct sets of indifference curves that imply these two antithetical views are suggested, their observable predictions derived and compared to the relevant evidence, showing that the increasing-donation hypothesis is confirmed, offering overall a clear challenge to the decline-in-donation position. Our empirical results suggest that most estate-tax payers possess indifference curves consistent with those that embody the increasing-donation hypothesis. [source] Ethical Issues for Psychologists in Pain ManagementPAIN MEDICINE, Issue 2 2001Mary Lou Taylor PhD Pain management is relatively young as a specialty. Although increasing attention is being paid to issues such as pain at the end of life and pain in underserved populations, only recently has an open discussion of ethical issues in chronic pain treatment come to the fore. Psychologists specializing in pain management are faced with a myriad of ethical issues. Although many of these problems are similar to those faced by general clinical psychologists or other health psychologists, they are often made more complex by the multidisciplinary nature of pain management and by the psychologists' relationships to third-party payers (health maintenance organizations, workers' compensation), attorneys, or other agencies. An open forum exploring ethical issues is needed. This article outlines major ethical considerations faced by pain management psychologists, including patient autonomy and informed consent, confidentiality, reimbursement and dual relationships, patient abandonment, assessment for medical procedures, clinical research, and the interface of psychology and medicine. American Psychological Association ethical principles and principles of biomedical ethics need to be considered in ethical decision making. Further exploration and discussion of ethics for pain management psychologists are recommended. [source] Cost and mortality associated with hospitalizations in patients with immune thrombocytopenic purpura,AMERICAN JOURNAL OF HEMATOLOGY, Issue 10 2009Mark D. Danese Immune thrombocytopenic purpura (ITP) is associated with low platelet counts and, consequently, a high risk of adverse events leading to hospitalization. However, there are few data on the clinical and economic burden of hospitalizations for ITP. The Nationwide Inpatient Sample (NIS) database of discharges, a stratified 20% sample of all United States (US) community hospitals across all payers, was used to evaluate discharges in ITP patients. We developed nationally representative numbers of discharges in ITP patients from 2003 to 2006 based on diagnosis codes. Using appropriate weights for each NIS discharge, we created national estimates of average cost, length of stay, and in-hospital mortality for specific groups of ITP-related hospitalizations. Approximately 129,000 discharges occurred between 2003 and 2006 in ITP patients. The average cost associated with all discharges in 2008 dollars was 16,476, with a 6.4-day length of stay and in-hospital mortality of 3.8%. In contrast, the average cost of all hospitalizations in the US population during the same period was 10,039, the average length of stay was 4.8 days, and in-hospital mortality was 2.5%. Mortality risk was higher for ITP patients than for the standard US population adjusted for age and gender, with a relative mortality ratio of 1.5 (95% CI: 1.4,1.6). On the basis of a nationally representative sample of US discharge records from 2003 to 2006, hospitalization with ITP represents an economically and clinically important event. ITP was associated with higher costs, longer stays, and more in-hospital deaths on average than all other hospitalized patients combined. Am. J. Hematol. 2009. © 2009 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||||||||