Impact of drug coverage on medical expenditures among the elderly

Our study compares expenditures for Medicare covered medical services among enrollees in three State pharmacy assistance programs with spending among low-income residents eligible or near-eligible for, but not enrolled in such State-sponsored programs after controlling for between-group differences in demographic, socioeconomic, health status, and insurance status characteristics. We estimate a two-part model in total and by type of service (inpatient, outpatient, and professional) and chronic condition (hypertension, heart disease, and arthritis). We find that drug coverage has no discernible effect on the use and cost of inpatient services, but is associated with a statistically significant increase in Medicare spending for physician services.     

Impact of drug coverage on medical expenditures among the elderly

Our study compares expenditures for Medicare covered medical services among enrollees in three State pharmacy assistance programs with spending among low-income residents eligible or near-eligible for, but not enrolled in such State-sponsored programs after controlling for between-group differences in demographic, socioeconomic, health status, and insurance status characteristics. We estimate a two-part model in total and by type of service (inpatient, outpatient, and professional) and chronic condition (hypertension, heart disease, and arthritis). We find that drug coverage has no discernible effect on the use and cost of inpatient services, but is associated with a statistically significant increase in Medicare spending for physician services.     

Laboratory-based influenza surveillance in New Caledonia, 1999-2003

We aimed to evaluate the annual incidence of influenza in New Caledonia and to identify the circulating viral types and subtypes in order to gather information for the local vaccination programme and regional influenza surveillance. A surveillance network was set up in 1999; it included sentinel practitioners in Noumea and the virology department of the Pasteur Institute. Influenza circulated in New Caledonia every year, regularly during the southern hemisphere winter and occasionally during March-May. Isolates were generally consistent with world surveillance, except in 1999, when a new A/H1N1 variant was identified. This study emphasises the need for regular influenza surveillance, even when performed on a limited scale. Importantly the optimal time for local vaccination was found to be in December or January each year.     

Changes in distribution of Medicare expenditures among aged enrollees, 1969-82.

In this article, we examined the concentration of Medicare expenditures among the aged for 1969, 1975, and 1982 to determine if expenditures have become more concentrated among a few heavy users of service over time. Despite an increase in reimbursements for the aged from $6.0 billion in 1969 to $41.8 billion in 1982, the distribution of those expenses remained remarkably stable, with a slight lessening in the concentration of reimbursements in 1982. Patterns were similar for both Part A (hospital insurance) and Part B (supplementary medical insurance) services. The concentration of expenditures was much greater among survivors than among people who died in both 1975 and 1982, with little change in the distribution of expenditures within either group.     

Impact of physical activity on medical expenditures among adults downhearted and blue

OBJECTIVE: To examine inactivity-associated medical expenditures in adults, controlling for frequency of feeling downhearted/blue. METHODS: Using the 1987 National Medical Expenditure Survey (N=12,250), expenditures were analyzed by comparison and multivariate models. Expenditures were updated to 2003 dollars. RESULTS: Medical expenditure was 354 dollars (t=3.80, P<0.01) lower for active than inactive persons: 6.1% of the expenditure (133 dollars in 1987, 429 dollars in 2003) was inactivity associated. The total inactivity-associated expenditure was near 12 billion dollars in 1987 (38 billion dollars in 2003). CONCLUSIONS: Medical expenditure increased with frequency of feeling downhearted/blue and was higher for inactive than active people.     

Managed care and medical expenditures of Medicare beneficiaries

This paper investigates the impact of Medicare HMO penetration on the medical care expenditures incurred by Medicare fee-for-service (FFS) enrollees. We find that increasing penetration leads to reduced spending on FFS beneficiaries. In particular, our estimates suggest that the increase in HMO penetration during our study period led to approximately a 7% decline in spending per FFS beneficiary. Similar models for various measures of health care utilization find penetration-induced reductions consistent with our spending estimates. Finally, we present evidence that suggests our estimated spending reductions are driven by beneficiaries who have at least one chronic condition.     

Sunscreen use among US high school students, 1999-2003

The purpose of this paper was to examine sunscreen use among US high school students. Data were derived from the Centers for Disease Control and Prevention's 1999, 2001, and 2003 national Youth Risk Behavior Surveys, which are cross-sectional surveys of health risk behaviors among high school students in the United States. In 2003, 1 in 7 (14.2%) high school students reported routine sunscreen or sunblock use, and this behavior varied by sex, race/ethnicity, grade in school, and geographic region. The use of sunscreen or sunblock with a sun protection factor of 15 or higher when outside for more than 1 hour on a sunny day did not change from 1999 to 2003. Parent and child education about the importance of skin cancer prevention practices, including sunscreen use, and a school environment supportive of sun-safe practices are necessary to help reduce risk for skin cancer.     

Homicides among children and young adults--Puerto Rico, 1999-2003

Interpersonal violence causes substantial morbidity and mortality worldwide and poses a considerable economic burden, equivalent to 4%-5% of the gross national product in certain countries. The Commonwealth of Puerto Rico is a U.S. territory with a 2004 population of approximately 3.9 million. In Puerto Rico, homicides were the 12th leading cause of death overall in 2003, ranking fifth among males and 15th among females. This report summarizes an analysis of death certificate data on violent deaths of children and young adults in Puerto Rico during 1999-2003, which determined that 93% of homicide victims aged <30 years were young males, the most common method of homicide was assault by firearm discharge, and the rate of homicide among males aged 25-29 years increased during the period. To address this problem, the Puerto Rican government has initiated a comprehensive strategy that includes enhancing an integrated surveillance system for fatal and nonfatal assault, supporting research on interpersonal violence, and establishing local prevention programs (e.g., violence prevention curricula in selected schools).     

Babesiosis among elderly Medicare beneficiaries, United States, 2006-2008

We used administrative databases to assess babesiosis among elderly persons in the United States by year, sex, age, race, state of residence, and diagnosis months during 2006-2008. The highest babesiosis rates were in Connecticut, Rhode Island, New York, and Massachusetts, and findings suggested babesiosis expansion to other states.     

Impact of new medical technologies on health expenditures in Israel 2000-07

OBJECTIVES: The aim of this study was to estimate the impact of new medical technologies on public healthcare expenditures in Israel over the period 2000-07. METHODS: For each year, government estimates for the costs of new technologies recommended as high-priority for public funding were summarized. The ratio of projected costs of these technologies to total public healthcare expenditures was calculated and compared with actual governmental budget allocations for new technologies. RESULTS: Funding all new high-priority medical technologies would have increased healthcare expenditures by 2.1 percent per year. Government allocations for new technologies raised expenditures by 1.0 percent per year. CONCLUSIONS: New medical technologies significantly increase healthcare expenditures in Israel. Budgetary constraints have reduced their actual impact by 52 percent. This study indicates the need for an annual addition of 2 percent to public healthcare budget for funding new high-priority technologies.     

Racial and ethnic differences in public and private medical care expenditures among aged Medicare beneficiaries

This study examines the current allocation of medical care expenditures among non-Hispanic white, non-Hispanic black, and Hispanic seniors who are Medicare beneficiaries. Analyses of both "need-based" and "demand-based" perspectives found that white, black, and Hispanic seniors in similar health had similar total annual expenditures for medical care. The groups did, however, differ substantially in the distribution of expenditures between public and private sources of payment. Notably, racial and ethnic differences in public and private expenditures all but vanished when socioeconomic variables and health insurance coverage were included in the analyses. The findings suggest that public sources of payment for medical care services, especially public supplementary coverage have helped to eliminate racial and ethnic gaps in expenditures.     

Heat-related deaths--United States, 1999-2003

Heat-related illnesses (e.g., heat cramps, heat exhaustion, heat syncope, or heatstroke) can occur when high ambient temperatures overcome the body's natural ability to dissipate heat. Older adults, young children, and persons with chronic medical conditions are particularly susceptible to these illnesses and are at high risk for heat-related mortality. Previous analyses of the risk factors associated with heat-related deaths have been based on the underlying cause entered on the death certificate and have not included decedents for whom hyperthermia was listed as a contributing factor but not the underlying cause of death. This report describes an analysis in which number of heat-related deaths were counted, including deaths in which hyperthermia was listed as a contributing factor on the death certificate. The analysis revealed that including these deaths increased the number of heat-related deaths by 54% and suggested that the number of heat-related deaths is underestimated.     

Medicare expenditures for physician and supplier services, 1970-88

The trend data in this article focus on Medicare expenditures and allowed charges for physician and supplier services rendered during the period from 1970 through 1988. A brief overview is presented on the provisions of the new Medicare physician payment system mandated by Congress and scheduled to be phased in starting January 1, 1992. The data provide one of the baselines that could be used for measuring and evaluating the impact of the new Medicare payment system for physician services.     

Assessment of the effectiveness of the 2003-04 influenza vaccine among children and adults--Colorado, 2003

The 2003-04 influenza season was characterized by the early onset of influenza activity, reports of severe illness, particularly in children, and predominant circulation of an influenza A (H3N2) virus strain that was antigenically different from the influenza A (H3N2) vaccine strain. In 2003, a retrospective cohort study among children and a case-control study among adults in Colorado were conducted to provide preliminary data on the effectiveness of the 2003-04 influenza vaccine. This report summarizes the results of those studies, which indicated vaccine effectiveness (VE) among both adults and children, differing from results of a previous study that did not indicate effectiveness among adults.     

Increasing evidence of immunity to varicella among children in Massachusetts, 1999-2003

BACKGROUND: Experiences with vaccine-preventable diseases have demonstrated the success of school-entry requirements in increasing vaccination coverage and decreasing disease incidence. This study examines the effect of early implementation of daycare and school-entry requirements for varicella vaccination on recorded varicella immunity of preschool and school-aged children in Massachusetts. METHODS: Immunization surveys were conducted in licensed child care centers and schools with kindergarten and/or 7th grades. Evidence of immunity to varicella was defined as having physician verified records of varicella vaccination or disease history from the 1999-2000 through 2003-2004 school years. RESULTS: During the 5-year study period, physician-certified reliable history of varicella disease decreased in each grade level while vaccination coverage increased. The increase in the number of children in each grade level receiving varicella vaccine led to an increase in the overall percentage of children with evidence of immunity to varicella: 85% to 97% for children aged 2 years or more in child care, 93% to 98% for children in kindergarten, and 88% to 92% for children in 7th grade. CONCLUSIONS: The implementation of daycare and school-entry requirements for varicella vaccination within 4 years of the start of the varicella vaccination program in Massachusetts was associated with high levels of vaccination coverage in the cohorts of children targeted by the requirements. Although evidence of immunity from varicella disease decreased during the study period, the increase in varicella vaccination coverage compensated for the decline in disease history, resulting in a higher proportion of young children with evidence of immunity to varicella.     

Vaccination without documentation: influenza immunization among medical residents at a tertiary-care medical center.

Sixty-four percent of medical residents unimmunized by the Occupational Health Service were immunized elsewhere. Those unvaccinated lacked time to comply. An immune staff is critical to prevent transmission to high-risk patients and limit absenteeism. The hospital is implementing a program to deliver medical care to the house staff.