Medicare beneficiaries' costs of care in the last year of life.

This paper profiles Medicare beneficiaries' costs for care in the last year of life. About one-quarter of Medicare outlays are for the last year of life, unchanged from twenty years ago. Costs reflect care for multiple severe illnesses typically present near death. Thirty-eight percent of beneficiaries have some nursing home stay in the year of their death; hospice is now used by half of Medicare cancer decedents and 19 percent of Medicare decedents overall. African Americans have much higher end-of-life costs than others have, an unexpected finding in light of their generally lower health care spending.     

Health care expenditure in the last months of life

In OECD countries, a considerable share of health care expenditure (HCE) is spent for the care of the terminally ill. This paper derives the demand for HCE in the last 2 years of life from a model that accounts for age, mortality risk and wealth. The empirical tests are based on data of deceased members of a major Swiss sick fund. The empirical evidence confirms most of the hypotheses derived from the model, i.e., (i) HCE increases with closeness to death, (ii) for retired individuals, HCE decreases with age, and (iii) low-income individuals, as compared to high-income individuals, incur lower HCE in the last months of life.     

Expenditures on health care in the last year of life.

18-26% of public expenditure on health care is devoted to care of patients in their last year of life. 60% of this expenditure is on patients in somatic nursing homes. The figures do not tell directly whether too much or too little money in Norwegian health care is spent on people in the end stage of life. In order to answer this question, one must look at the quality of terminal care and assess the share of patients having a reasonable benefit of the care they receive.     

Health for all--the last progress assessment before the year 2000

Zusammenfassung Im Zusammenhang mit dem alle drei Jahre an die WHO zu erstattenden Bericht über die zur Verwirklichung von Gesundheit für alle erzielten Fortschritte, wird der spezifischen Frage des Ausgleichs gesundheitlicher Ungleichheit nachgegangen. Unterschiede des Gesundheitszustands als Funktion des soziopolitischen Kontexts sind ein wesentlicher Aspekt dieser Fragestellung und von besonderem Interesse in einem föderalistischen Staat. Der Gesundheitszustand wird anhand von Mortalitäts-(Haupttodesursachen) und Morbiditätsindikatoren (Invalidität) für die 0-bis 64jährige Bevölkerung beschrieben. Zusätzlich zum Vergleich von Mortalitäts-und Morbiditätsraten zwischen den Kantonen wird ein Dissimilaritätsindex (Dl) verwendet. Für alle Kriterien werden die Trends über einen Zeitraum von 10–12 Jahren ermittelt. Die Ergebnisse weisen auf eine abnehmende Sterblichkeit, sowohl insgesamt, als auch bei den Haupttodesursachen hin. Während bei den Männern nicht nur die Gesamtsterblichkeit, sondern auch die Dissimilarität zwischen den Kantonen abnimmt, nehmen bei den Frauen die Sterblichkeitsunterschiede zwischen den Kantonen zu. Ähnlich verhält es sich bei den Morbidität Bei einer für beide Geschlechter zunehmenden Rate der Invalidenrentner, nimmt der entsprechende Dl-Wert bei den Männern ab, bei den Frauen jedoch zu. Die Befunde werden auf dem Hintergrund sozioökonomischer Unterschiede zwischen den fraglichen Kantonen (z.B. Arbeitslosigkeit) diskutiert.

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Health for all — the last evaluation of progress before the year 2000

Summary In the framework of the tri-annual report to WHO of progress towards Health for all the specific question concerning reduction of inequity in health is addressed. Regional variations in health status represent an important aspect of that question which is of particular interest in a federal country where major public health competencies are located at the regional level (cantons in Switzerland). Health status is described by both mortality measures (main causes of death) in the population aged 0–64 years and morbidity indicators (rates of disability pensioners) in the same age group. In addition to the comparison of mortality and morbidity rates between cantons an index of dissimilarity (Dl) was used. For both criteria, changes over a time period of 10 to 12 years were considered. Results show decreasing trends of mortality from all and main causes of death in both sexes. While this tendency goes along with decreasing dissimilarity as to male overall mortality, the corresponding female Dl increases, indicating an increase in inequity between the cantons. A similar pattern is observed as to morbidity: although rates of disability pensioners went up for both sexes, this increase resulted in a lower Dl-value for men but a higher one for women. The results are discussed against the background of socioeconomic differences (e.g. unemployment) between the cantons studied.

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Santé pour tous — la dernière évaluation des progrès avant l'an 2000

Résumé Dans le cadre du rapport triannuel à l'intention de l'OMS sur les progrès accomplis dans la réalisation de la Santé pour tous, la question spécifique relative à la réduction de l'inéquité face à la santé est étudiée, les variations régionales de l'état de santé représentent un aspect important de cette question surtout dans un Etat fédéral qui concède d'importan tes compétences en matière de santé publique à l'échelon cantonal. L'état de santé est décrit en utilisant des indicateurs de mortalité (globale et due aux causes de décès principales) et de morbidité (invalidité) dans la population âgée de 0 à 64 ans. Outre la comparaison des taux demortalité. et de morbidité entre cantons, un indice de dissimilarité (ID), est utilisé. Pour tous ces critères, l'observation porte sur une période de 10 à 12 ans. Les résultats montrent une diminution de la morfalité (toutes causes confondues et causes principales) pour les deux sexes. Alors que cette tendance est associée à une réduction de l'ID relatif à la mortalité masculine (toutes causes confondues), la valeur correspondante de l'ID des femmes augmente, indiquant dès lors un renforcenent de l'inéquité entre les cantons. Une tendance similaire peut être observée en ce qui concerne la morbidité: bien que les taux des rentiers de l'assurance invalidité augmentent pour les deux sexes, cetter augmentation va de pair avec une diminution de la valeur de l'ID des hommes et une augmentation de celle des femmes. Ces rêsultats sont discutés dans le contexte des différences socio-économiques (p. ex. chômage) entre les cantons étudiés.

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Dieser Artikel ist Teil eines Auftrags des Bundesamtes für Gesundheit zur periodischen Evaluation der GFA-Strategie zu Handen der Weltge-sundheitsorganisation.     

The Dutch experience with Health Impact Assessment of disasters

Over the past decade, the Dutch government has learned thata crisis/disaster is not over when the fire has been extinguished,chemical spills have been contained or affected livestock hasbeen cleared. Examples are as follows:

• The crash of an El Alairplane in a residential area in Amsterdam(1992, 39 fatalities),where a disaster Health Impact Assessment(HIA) amongst 7300victims was initiated after 8 years underpolitical and societalpressure.1
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Health care costs: the other point of view

Health care delivery in America is not efficient. Hospitals are not efficient and many are still wasteful. Some of the most blatant wastes in hospitals are staffing patterns that developed during the years of cost reports. Spending patterns become the norm, rather than excess, when they continue unabated for years. There are many reasons for cost increases in health care and specifically in hospitals. However, it is difficult to make these reasons add up to the total cost increase. No one has the answers; observation can only be made of what has been occurring and what continues to occur. Whatever the reason for the increase in health care costs, the consumer will bear the burden because of the circular flow of income and expenditures between the business sector and the household sector. Increased health care costs are passed on to the consumer in the form of increased expenditures for household goods and services or taxes. Ford Motor Company President Mr. Peterson says that $1,500 of every new automobile represents employee health care costs. The American consumer created the demand for health care services, and only the consumer can control the demand. One solution would be to let the consumer bear health care costs directly and remove the inefficiencies created by third party insurance carriers. This hypothesizes that the health care consumer is the most efficient shopper for health care services, and that third party insurance carriers are an important source of inefficiency in the health care delivery system. Many other solutions have been proposed by the government and by the insurance and health care industries, but most have only increased the cost of health care. Perhaps some day the health care industry will learn how to control the dynamics of this four-party purchasing decision. Until then, costs will continue to grow dramatically, and the executives of the industries who compete in the two-party purchasing system will wonder why the process is so complicated.     

Health care costs of physical inactivity in Canadian adults

The purpose of this study was to provide a contemporary estimate of the health care cost of physical inactivity in Canadian adults. The health care cost was estimated using a prevalence-based approach. The estimated direct, indirect, and total health care costs of physical inactivity in Canada in 2009 were $2.4 billion, $4.3 billion, and $6.8 billion, respectively. These values represented 3.8%, 3.6%, and 3.7% of the overall health care costs.     

Health care costs of medical patients at an urban care center

Many cost containment strategies advocate that physicians should use fewer or less costly resources. In order to place these strategies in perspective, components of charges (costs) for medical patients at an urban center were examined to ascertain their contribution to the total health care bill. Contributions to total costs by location of service were: inpatient, 77.9%; outpatient, 17.1%; emergency room, 5.0%. Contributions by cost category were: facility charge, 52.8%; tests, 25.6%; pharmaceuticals, 11.0%. A goal to reduce total costs by 5% would require reducing pharmaceuticals by 45.4% or tests by 19.5%. In contrast, the same goal could be accomplished by reducing hospitalization by only 6.4%. If a strategy increased ambulatory costs by 5%, but resulted in a 7.5% decrease in hospitalization, the total health care costs would still decrease by 5%. Thus, rather than using fewer and less costly resources, physicians are encouraged to use more resources in ambulatory care to prevent morbidity requiring hospitalization.