Reconciling medical expenditure estimates from the MEPS and the NHA, 1996

This article compares 1996 estimates of national medical care expenditures from the Medical Expenditure Panel Survey (MEPS) and the National Health Accounts (NHA). The MEPS estimate for total expenditures in 1996 was $548 billion; whereas, the NHA estimate for personal health care (PHC) in 1996 was $912 billion. Much of this apparent difference, however, arises from differences in scope between MEPS and NHA--rather than from differences in estimates for comparably-defined expenditures. We adjusted the NHA for differences in included populations and types of services covered, finding a much smaller difference between MEPS and a comparably-defined NHA.     

A Preliminary analysis of medical expenditures among active and sedentary US adults with mental disorders

OBJECTIVE: To determine whether leisure-time physical activity is associated with lower direct annual medical expenditures among a sample of adults with mental disorders. METHODS: Using the 1995 National Health Interview Survey and 1996 Medical Expenditure Panel Survey, differences between medical expenditures for sedentary and active persons were analyzed using t-tests. RESULTS: The per capita annual direct medical expenditure was US 2785 dollars higher for sedentary than for active persons (P<0.05). The total expenditure associated with sedentary behavior was US 31.7 billion dollars (US 19.1 billion dollars in men; US 12.6 billion dollars in women). CONCLUSIONS: Physical activity is associated with a reduced economic burden among people with mental disorders.     

The Disease and Economic Burdens of Esophageal Cancer in China from 2013 to 2030: Dynamic Cohort Modeling Study

BackgroundEsophageal cancer (EC) is the sixth leading cause of tumor-related deaths worldwide. Estimates of the EC burden are necessary and could offer evidence-based suggestions for local cancer control.ObjectiveThe aim of this study was to predict the disease burden of EC in China through the estimation of disability-adjusted life years (DALYs) and direct medical expenditure by sex from 2013 to 2030.MethodsA dynamic cohort Markov model was developed to simulate EC prevalence, DALYs, and direct medical expenditure by sex. Input data were collected from the China Statistical Yearbooks, Statistical Report of China Children’s Development, World Population Prospects 2019, and published papers. The JoinPoint Regression Program was used to calculate the average annual percentage change (AAPC) of DALY rates, whereas the average annual growth rate (AAGR) was applied to analyze the changing direct medical expenditure trend over time.ResultsFrom 2013 to 2030, the predicted EC prevalence is projected to increase from 61.0 to 64.5 per 100,000 people, with annual EC cases increasing by 11.5% (from 835,600 to 931,800). The DALYs will increase by 21.3% (from 30,034,000 to 36,444,000), and the years of life lost (YLL) will account for over 90% of the DALYs. The DALY rates per 100,000 people will increase from 219.2 to 252.3; however, there was a difference between sexes, with an increase from 302.9 to 384.3 in males and a decline from 131.2 to 115.9 in females. The AAPC was 0.8% (95% CI 0.8% to 0.9%), 1.4% (95% CI 1.3% to 1.5%), and –0.7% (95% CI –0.8% to –0.7%) for both sexes, males, and females, respectively. The direct medical expenditure will increase by 128.7% (from US $33.4 to US $76.4 billion), with an AAGR of 5.0%. The direct medical expenditure is 2-3 times higher in males than in females.ConclusionsEC still causes severe disease and economic burdens. YLL are responsible for the majority of DALYs, which highlights an urgent need to establish a beneficial policy to reduce the EC burden.     

Medical expenditures for disability and disabling comorbidity.

Disability and disabling comorbidity place a disproportionately large burden on the health care system. National Medical Care Utilization and Expenditure Survey data show that medical care expenditures for noninstitutionalized persons amounted to $154 billion ($691 per capita) in 1980. The medical expenditure per capita for people reporting two or more disabling chronic conditions ($2456) was 5 times the amount incurred by those with no limiting conditions ($486) and more than 1.5 times the amount incurred by those with one limiting condition.     

Medical expenditures attributable to injuries--United States, 2000

In the United States, injuries (i.e., unintentional and intentional) are the leading cause of death among persons aged <35 years and the fourth leading cause of death among persons of all ages. Injuries create a substantial burden on society in terms of medical resources used for treating and rehabilitating injured persons, productivity losses caused by morbidity and premature mortality, and pain and suffering of injured persons and their caregivers. To estimate annual injury-attributable medical expenditures in the United States, CDC analyzed data on injury prevalence and costs from the 2000 Medical Expenditure Panel Survey (MEPS) and the National Health Accounts (NHA). This report summarizes the results of that analysis, which indicated that injury-attributable medical expenditures cost as much as 117 billion dollars in 2000, approximately 10% of total U.S. medical expenditures. This finding underscores the need for innovative and effective interventions to prevent injuries.     

Economic Measurement of Medical Errors Using a Hospital Claims Database

ObjectiveThe primary objective of this study was to estimate the occurrence and costs of medical errors from the hospital perspective.MethodsMethods from a recent actuarial study of medical errors were used to identify medical injuries. A visit qualified as an injury visit if at least 1 of 97 injury groupings occurred at that visit, and the percentage of injuries caused by medical error was estimated. Visits with more than four injuries were removed from the population to avoid overestimation of cost. Population estimates were extrapolated from the Premier hospital database to all US acute care hospitals.ResultsThere were an estimated 161,655 medical errors in 2008 and 170,201 medical errors in 2009. Extrapolated to the entire US population, there were more than 4 million unique injury visits containing more than 1 million unique medical errors each year. This analysis estimated that the total annual cost of measurable medical errors in the United States was $985 million in 2008 and just over $1 billion in 2009. The median cost per error to hospitals was $892 for 2008 and rose to $939 in 2009. Nearly one third of all medical injuries were due to error in each year.ConclusionsMedical errors directly impact patient outcomes and hospitals’ profitability, especially since 2008 when Medicare stopped reimbursing hospitals for care related to certain preventable medical errors. Hospitals must rigorously analyze causes of medical errors and implement comprehensive preventative programs to reduce their occurrence as the financial burden of medical errors shifts to hospitals.     

Medical Expenditures Associated with Nonfatal Occupational Injuries among Immigrant and U.S.-born Workers

ABSTRACT: 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 of nonfatal occupational injuries than U.S.-born workers. There was no significant difference in seeking medical treatment and in the mean expenditures per injured worker between the two groups. The proportion of total expenditures paid by workers' compensation was smaller (marginally significant) for immigrant workers than for U.S.-born workers.     

Examining the bidirectional relationship between food insecurity and healthcare spending

ObjectiveTo improve food insecurity interventions, we sought to better understand the hypothesized bidirectional relationship between food insecurity and health care expenditures.Data SourceNationally representative sample of the civilian noninstitutionalized population of the United States (2016‐2017 Medical Expenditure Panel Survey [MEPS]).Study DesignIn a retrospective longitudinal cohort, we conducted two sets of analyses: (a) two‐part models to examine the association between food insecurity in 2016 and health care expenditures in 2017; and (b) logistic regression models to examine the association between health care expenditures in 2016 and food insecurity in 2017. We adjusted for demographic and socioeconomic variables as well as 2016 health care expenditures and food insecurity.Data CollectionHealth care expenditures, food insecurity, and medical condition data from 10 886 adults who were included in 2016‐2017 MEPS.Principal FindingsFood insecurity in 2016, compared with being food secure, was associated with both a higher odds of having any health care expenditures in 2017 (OR 1.29, 95% CI: 1.04 to 1.60) and greater total expenditures ($1738.88 greater, 95% CI: $354.10 to $3123.57), which represents approximately 25% greater expenditures. Greater 2016 health care expenditures were associated with slightly higher odds of being food insecure in 2017 (OR 1.007 per $1000 in expenditures, 95% CI: 1.002 to 1.012, P =0.01). Exploratory analyses suggested that poor health status may underlie the relationship between food insecurity and health care expenditures.ConclusionsA bidirectional relationship exists between food insecurity and health care expenditures, but the strength of either direction appears unequal. Higher health care expenditures are associated with a slightly greater risk of being food insecure (adjusted for baseline food insecurity status) but being food insecure is associated with substantially greater subsequent health care expenditures (adjusted for baseline health care expenditures). Interventions to address food insecurity and poor health may be helpful to break this cycle.     

中国1993－2008年脑血管病直接经济负担研究

目的 评价1993－2008年中国脑血管病直接经济负担状况及其变化趋势。方法 利用1993、1998、2003和2008年4次国家卫生服务调查数据,采用二步模型法推算中国1993－2008年≥30岁人群脑血管病直接经济负担及其变化情况,包括脑血管病直接门诊费用和直接住院费用。结果 1993－2008年中国≥30岁人群脑血管病直接经济负担明显上升,从1993年的84.73亿元上升至2008年的1 031.25亿元,去除物价影响后,实际增长了5.3倍,年均增速为13.1%,高于同期卫生总费用和GDP的增长速度,其中2003－2008年直接经济负担的增长速度最快,年均增速为19.8%。结论 中国≥30岁人群脑血管病疾病负担给个人和社会造成的影响已相当严峻,应加强对脑血管病相关领域的理论和实践研究。     

中国12个地区乙型肝炎相关疾病住院患者经济负担调查

目的 中国缺少全国性乙型肝炎（乙肝）相关疾病经济负担研究,本病的社会经济危害未能阐明,乙肝防治经济学评价缺乏关键参数;本研究旨在获得我国不同地区乙肝相关疾病患者住院期间及年均直接、间接和无形费用。方法 选取中国12个地区的传染病专科医院和综合性医院,采用时间阶段连续病例整群抽样法,对住院治疗的乙肝相关疾病患者进行调查。直接费用包括直接医疗和直接非医疗费用;间接费用采用人力资本法,分地区按城镇和农村人口计算患者和陪护人误工费;无形费用采用支付意愿法。多元线性逐步回归分析直接和间接费用的影响因素。结果 全国12个地区共调查医院27所,有效调查样本4 718例,总应答率为77.7%。按住院期间计算,平均住院29.2（27~34）d,例均费用16 832.80元,药费（10 365.10元）占比（61.2%）最高;直接和间接费用分别为18 336.10元和4 759.60元,二者之比3.85：1,直接和间接费用高低与乙肝严重程度相一致。直接医疗费用为17 434.70元,高于直接非医疗费用（901.40元）;直接医疗费用中,住院费高于门诊费和自购药费;直接非医疗费用中,旅费最高。间接费用中,患者误工费（3 832.50元）高于陪护人误工费（927.20元）。直接和间接费用合计高低依次为肝移植、重型乙肝、原发性肝癌和失代偿期肝硬化,而急性乙肝、代偿期肝硬化和慢性乙肝（CHB）较低。直接和间接费用共同影响因素为医院级别高、乙肝相关疾病严重、城市户籍、使用抗病毒治疗、住院天数多、家庭收入高。按1年计算,年均门诊和住院3.74次和1.51次,年均直接、间接和无形费用分别为30 135.30元、6 253.80元和44 729.90元,合计总费用为81 119.00元;直接、间接和无形费用的构成比分别为37.3%、7.7%和55.0%。年均直接费用中,住院直接费用（26 074.20元）高于年均门诊费（4 061.10元）,年均直接医疗费用（28 402.80元）远高于年均直接非医疗费用（1 732.50元）。年均间接费用中,门诊和住院间接费用分别为763.60元和5 490.10元。年均无形费用以肝癌最高,肝硬化和CHB次之,重型乙肝和肝移植均较低,急性乙肝最低。结论 乙肝相关疾病给中国带来了沉重经济负担,患者更多的依赖医疗服务,非医疗服务费用较少;采取有效治疗策略,遏制乙肝相关疾病的恶化,将会收到显著的经济效益;乙肝相关疾病对人群心理健康的影响,可用无形费用给出经济学表述。     

Cost of tax-exempt health benefits in 1998

The tax expenditure for health benefits is the amount of revenues that the federal government forgoes by exempting the following from the federal income and Social Security taxes: (1) employer health benefits contribution, (2) health spending under flexible spending plans, and (3) the tax deduction for health expenses. The health tax expenditure was $111.2 billion in 1998. This figure varied from $2,357 per family among those with annual incomes of $100,000 or more to $71 per family among those with annual incomes of less than $15,000. Families with incomes of $100,000 or more (10 percent of the population) accounted for 23.6 percent of all tax expenditures.     

Projecting the Influence of Sugar-Sweetened Beverage Warning Labels and Restaurant Menu Labeling Regulations on Energy Intake,Weight Status,and Health Care Expenditures in US Adults: A Microsimulation

BackgroundAccurate, readily accessible, and easy-to-understand nutrition labeling is a promising policy strategy to address poor diet quality and prevent obesity.ObjectiveThis study projected the influence of nationwide implementation of sugar-sweetened beverage (SSB) warning labels and restaurant menu labeling regulations.DesignA stochastic microsimulation model was built to estimate the influences of SSB warning labels and menu labeling regulations on daily energy intake, body weight, body mass index, and health care expenditures among US adults.Participants/settingThe model used individual-level data from the National Health and Nutrition Examination Survey, Medical Expenditure Panel Survey, and other validated sources.Statistical analyses performedThe model was simulated using the bootstrapped samples, and the means and associated 95% CIs of the policy effects were estimated.ResultsSSB warning labels and restaurant menu labeling regulations were estimated to reduce daily energy intake by 19.13 kcal (95% CI 18.83 to 19.43 kcal) and 33.09 kcal (95% CI 32.39 to 33.80 kcal), body weight by 0.92 kg (95% CI 0.90 to 0.93 kg) and 1.57 kg (95% CI 1.54 to 1.60 kg), body mass index by 0.32 (95% CI 0.31 to 0.33) and 0.55 (95% CI =0.54 to 0.56), and per-capita health care expenditures by $26.97 (95% CI $26.56 to $27.38) and $45.47 (95% CI $44.54 to $46.40) over 10 years, respectively. The reduced per-capita health care expenditures translated into an annual total medical cost saving of $0.69 billion for SSB warning labels and $1.16 billion for menu labeling regulations. No discernable policy effect on all-cause mortality was identified. The policy effects could be heterogeneous across population subgroups, with larger effects in men, non-Hispanic Black adults, and younger adults.ConclusionsSSB warning labels and menu labeling regulations could be effective policy leverage to prevent weight gains and reduce medical expenses attributable to adiposity.     

Effect of the Arizona tobacco control program on cigarette consumption and healthcare expenditures

This research investigates the relationship between per capita tobacco control expenditures, cigarette consumption, and healthcare expenditures in the state of Arizona. Arizona's tobacco control program, which was established in 1994, concentrates on youth uptake of smoking and avoids public policy and commentary on the tobacco industry. We use a cointegrating time series analysis using aggregate data on healthcare and tobacco control expenditures, cigarette consumption and prices and other data. We find there is a strong association between per capita healthcare expenditure and per capita cigarette consumption. In the long run, a marginal increase in annual cigarette consumption of one pack per capita increases per capita healthcare expenditure by $19.5 (SE $5.45) in Arizona. A cumulative increase of $1.00 in the difference between control state and Arizona per capita tobacco control expenditures increases the difference in cigarette consumption by 0.190 (SE 0.0780) packs per capita. Between 1996 and 2004, Arizona's tobacco control program was associated with a cumulative reduction in cigarette consumption of 200 million packs (95% CI 39.0 million packs, 364 million packs) worth $500 million (95% CI: $99 million, $896 million) in pre-tax cigarette sales to the tobacco industry. The cumulative healthcare savings was $2.33 billion (95% CI $0.37 billion, $5.00 billion) and the cumulative reduction in cigarette. Arizona's tobacco control expenditures are associated with reduced cigarette consumption and healthcare expenditures, amounting to about 10 times the cost of the program through 2004. This return on investment, while large, was less than the more aggressive California program, which did not limit its focus to youth and included tobacco industry denomalization messages.     

Causes of Medicaid expenditure growth

Expenditures for the Medicaid program grew at the alarming and unexpected average annual rate of nearly 20 percent from 1989 ($58 billion) to 1992 ($113 billion). These statistics raise a critical question: What caused spending to grow so dramatically? Using State-level data from 1984-92, this analysis examines the determinants of Medicaid expenditure growth. The results indicate that Medicaid enrollment, Federal Medicaid policy, and State policy are significantly related to Medicaid expenditure growth. The analysis also finds the prevalence of acquired immunodeficiency syndrome (AIDS) to be significantly related to Medicaid expenditures.     

Medical care expenditures for diabetes, its chronic complications, and its comorbidities.

BACKGROUND: Medical expenditures for diabetes are estimated, including expenditures for chronic complications of diabetes, unrelated conditions for which diabetics are at higher risk, and various comorbidities that raise the cost of medical care. METHODS: A variety of national data sources are used to disaggregate the Health Care Financing Administration's national health expenditures in 1995 by sex, age, and diagnosis. Expenditures for chronic complications and other unrelated conditions for which diabetics have higher rates of utilization are determined by analysis of attributable risks. Additional expenditures generated by extra hospital inpatient days and higher charges for nursing home and home health care for comorbidities are estimated by regression analyses. Sensitivity analysis is used to calculate a range of estimated expenditures. RESULTS: Total expenditures attributed to diabetes are $47.9 billion in 1995, including $18.8 billion for first listed diabetes, $18.7 billion for chronic complications, $8.5 billion for unrelated conditions, and $1.9 billion for comorbidities. The range of total expenditures is $34.3 to $63.7 billion. CONCLUSIONS: Comprehensive accounting of expenditures more accurately assesses the economic burden of diabetes and potential savings from prevention, especially of chronic complications. This analysis is illustrative for other chronic illnesses.     

Risking Life and Limb: Estimating a Measure of Medical Care Economic Risk and Considering its Implications

This paper considers the risk of incurring future medical expenditures in light of a family's resources available to pay for those expenditures as well as their choice of health insurance. We model non‐premium medical out‐of‐pocket expenditures and use the estimates from our model to develop a prospective measure of medical care economic risk estimating the proportion of families who are at risk of incurring high non‐premium out‐of‐pocket medical care expenses in relation to its resources. We further use the estimates from our model to compare the extent to which different types of insurance mitigate the risk of incurring non‐premium expenditures by providing for increased utilization of medical care. We find that while 21.3% of families lack the resources to pay for the median expenditures for their insurance type, 42.4% lack the resources to pay for the 99^th percentile of expenditures for their insurance type. We also find the mediating effect of insurance on non‐premium expenditures to outweigh the associated premium expense for expenditures above $1804 for employer‐sponsored insurance and $4337 for direct purchase insurance for those younger than age 65; and above $12 118 of expenditures for Medicare supplementary plans for those aged 65 or older. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.     

Peer Reviewed: State-Level Medicaid Expenditures Attributable to Smoking

Introduction

Medicaid recipients are disproportionately affected by tobacco-related disease because their smoking prevalence is approximately 53% greater than that of the overall US adult population. This study estimates state-level smoking-attributable Medicaid expenditures.

Methods

We used state-level and national data and a 4-part econometric model to estimate the fraction of each state''s Medicaid expenditures attributable to smoking. These fractions were multiplied by state-level Medicaid expenditure estimates obtained from the Centers for Medicare and Medicaid Services to estimate smoking-attributable expenditures.

Results

The smoking-attributable fraction for all states was 11.0% (95% confidence interval, 0.4%-17.0%). Medicaid smoking-attributable expenditures ranged from $40 million (Wyoming) to $3.3 billion (New York) in 2004 and totaled $22 billion nationwide.

Conclusion

Cigarette smoking accounts for a sizeable share of annual state Medicaid expenditures. To reduce smoking prevalence among recipients and the growth rate in smoking-attributable Medicaid expenditures, state health departments and state health plans such as Medicaid are encouraged to provide free or low-cost access to smoking cessation counseling and medication.