Changes in Regional Variation of Medicare Home Health Care Utilization and Service Mix for Patients Undergoing Major Orthopedic Procedures in Response to Changes in Reimbursement Policy

Background. Significant variation in regional utilization of home health (HH) services has been documented. Under Medicare's Home Health Interim and Prospective Payment Systems, reimbursement policies designed to curb expenditure growth and reduce regional variation were instituted.
Objective. To examine the impact of Medicare reimbursement policy on regional variation in HH care utilization and type of HH services delivered.
Research Design. We postulated that the reimbursement changes would reduce regional variation in HH services and that HH agencies would respond by reducing less skilled HH aide visits disproportionately compared with physical therapy or nursing visits. An interrupted time-series analysis was conducted to examine regional variation in the month-to-month probability of HH selection, and the number of and type of visits among HH users.
Subjects. A 100 percent sample of all Medicare recipients undergoing either elective joint replacement (1.6 million hospital discharges) or surgical management of hip fracture (1.2 million hospital discharges) between January 1996 and December 2001 was selected.
Results. Before the reimbursement changes, there was great variability in the probability of HH selection and the number of HH visits provided across regions. In response to the reimbursement changes, though there was little change in the variation of probability of HH utilization, there were marked reductions in the number and variation of HH visits, with greatest reductions in regions with highest baseline utilization. HH aide visits were the source of the baseline variation and accounted for the majority of the reductions in utilization after implementation.
Conclusions. The HH interim and prospective payment policies were effective in reducing regional variation in HH utilization.     

Evaluation of the Effect of a Consumer-Driven Health Plan on Medical Care Expenditures and Utilization

Objective. To compare medical care costs and utilization in a consumer-driven health plan (CDHP) to other health insurance plans.
Study Design. We examine claims and employee demographic data from one large employer that adopted a CDHP in 2001. A quasi-experimental pre–post design is used to assign employees to three cohorts: (1) enrolled in a health maintenance organization (HMO) from 2000 to 2002, (2) enrolled in a preferred provider organization (PPO) from 2000 to 2002, or (3) enrolled in a CDHP in 2001 and 2002, after previously enrolling in either an HMO or PPO in 2000. Using this approach we estimate a difference-in-difference regression model for expenditure and utilization measures to identify the impact of CDHP.
Principal Findings. By 2002, the CDHP cohort experienced lower total expenditures than the PPO cohort but higher expenditures than the HMO cohort. Physician visits and pharmaceutical use and costs were lower in the CDHP cohort compared to the other groups. Hospital costs and admission rates for CDHP enrollees, as well as total physician expenditures, were significantly higher than for enrollees in the HMO and PPO plans.
Conclusions. An early evaluation of CDHP expenditures and utilization reveals that the new health plan is a viable alternative to existing health plan designs. Enrollees in the CDHP have lower total expenditures than PPO enrollees, but higher utilization of resource-intensive hospital admissions after an initially favorable selection.     

1999年中国卫生总费用测算报告

这是国家卫生部卫生经济研究所公开发布的全国卫生总费用系列报告。它通过卫生总费用测算结果所提供的卫生资源筹集和分配使用的各种数据信息,从宏观上反映了1999年中国卫生事业发展所取得的新成就和卫生改革目标的实现,同时,也反映了中国在卫生筹资结构和医疗保障水平等方面存在的问题。     

Regional variations in the use of postnatal care in Nigeria: a spatial analysis

ABSTRACT

Maternal health outcomes vary considerably in Nigeria, with maternal mortality ratio ranging from 165 per 100,000 live births in the South-west to 1549 per 100,000 live births in the North-east. One important maternal health indicator is an adequate use of postnatal care (PNC); however, the evidence is sparse on its spatial distribution across regions in Nigeria. This paper thus examined the spatial distribution of uptake of postnatal care in Nigeria using data from the 2013 Nigeria Demographic and Health Survey, with a sample of 12,127 women aged 15–49 years. The Bayesian-structured additive regression of the logit model was used to examine the spatial relationships. The results revealed a north-south divide in the use of postnatal care, with higher PNC uptake established in the latter. Interestingly, results showed significant intra-region residual spatial variations with higher PNC use in Yobe and Bauchi in North-east Nigeria compared to other states within the region. The findings indicate the need for policymakers to develop state- and region-specific health policy and intervention programs to address the inequity in postnatal care coverage and usage across regions in Nigeria.     

优化卫生资源配置 控制医疗费用过快增长

目前,在我国迫切需要加强卫生资源宏观管理,提高医疗机构微观效率,增加财政补助,控制医院收入增长,对药品实行统一集中采购。通过这些措施,控制医疗费用。只有在低费用的基础上,我们才能建立以个人责任为基础、具有较强费用控制机制的医疗保障制度;只有这些措施互相配合,综合作用,才能降低医疗费用;只有提供基本、低价、有效的医疗服务,才能真正实现医疗保障的“低水平、广覆盖”。     

The Impacts of China's Urban Employee Basic Medical Insurance on Healthcare Expenditures and Health Outcomes

At the end of 1998, China launched a government‐run mandatory insurance program, the urban employee basic medical insurance (UEBMI), to replace the previous medical insurance system. Using the UEBMI reform in China as a natural experiment, this study identifies variations in patient cost sharing that were imposed by the UEBMI reform and examines their effects on the demand for healthcare services. Using data from the 1991–2006 waves of the China Health and Nutrition Survey, we find that increased cost sharing is associated with decreased outpatient medical care utilization and expenditures but not with decreased inpatient care utilization and expenditures. Patients from low‐income and middle‐income households or with less severe medical conditions are more sensitive to prices. We observe little impact on patient's health, as measured by self‐reported health status. Copyright © 2015 John Wiley & Sons, Ltd.     

中国卫生总费用历史回顾和发展预测

为了配合国务院有关部门开展中国卫生筹资发展研究,中国卫生总费用核算小组组织人力进行《中国卫生总费用历史回顾和发展预测》。我们的研究工作包括以下４个部分：１．对历史上积累的数据按照目前的计算口径作出调整和修匀;２．利用历史数据从卫生服务需求和卫生筹资提供能力两个角度进行时间序列影响因素分析;３．利用从各方面收集到的数据和科学判断,按照供求两组时间序列经济模型对１９９９￣２００２年和２０１０年卫生总费     

The Impact of Poverty,Chronic Illnesses,and Health Insurance Status on Out-of-Pocket Health Care Expenditures in Later Life

This study aims to examine poverty, chronic illnesses, health insurance, and health care expenditures, within the context of a political economy of aging perspective. Subsamples of 1,773 older adults from the Medical Expenditure Panel Survey were selected for analyses. The results showed that chronic illnesses influenced out-of-pocket health care costs. Older persons with more than one health insurance spent less on out-of-pocket health care costs. The results have implications for health care social workers concerned with the growing costs of chronic illnesses, implementing integrated care, and advocating for extending public health insurance coverage especially for our most impoverished older adults.     

The Sisyphus Syndrome in Health Revisited

Health care may be similar to Sisyphus work: When the task is about to be completed, work has to start all over again. To see the analogy, consider an initial decision to allocate more resources to health. The likely consequence is an increased number of survivors, who will exert additional demand for health care. With more resources allocated to health, the cycle starts over again. The objective of this paper is to improve on earlier research that failed to find evidence of a Sisyphus syndrome in industrialized countries. This time, there are signs of such a cycle, which however seems to have faded away recently.JEL classification: I10, J10     

Geographic Variation in Public Health Spending: Correlates and Consequences

Objectives. To examine the extent of variation in public health agency spending levels across communities and over time, and to identify institutional and community correlates of this variation.
Data Sources and Setting. Three cross-sectional surveys of the nation's 2,900 local public health agencies conducted by the National Association of County and City Health Officials in 1993, 1997, and 2005, linked with contemporaneous information on population demographics, socioeconomic characteristics, and health resources.
Study Design. A longitudinal cohort design was used to analyze community-level variation and change in per-capita public health agency spending between 1993 and 2005. Multivariate regression models for panel data were used to estimate associations between spending, institutional characteristics, health resources, and population characteristics.
Principal Findings. The top 20 percent of communities had public health agency spending levels >13 times higher than communities in the lowest quintile, and most of this variation persisted after adjusting for differences in demographics and service mix. Local boards of health and decentralized state-local administrative structures were associated with higher spending levels and lower risks of spending reductions. Local public health agency spending was inversely associated with local-area medical spending.
Conclusions. The mechanisms that determine funding flows to local agencies may place some communities at a disadvantage in securing resources for public health activities.     

Determinants of expenditure variation in health care and care of the elderly among finnish municipalities

In Finland, municipal health care expenditure varies from FIM 3 800 per capita to FIM 7 800 per capita. The objective of this study was to estimate the impact of different economic, structural and demographic factors on the per capita costs of health services and care of the elderly. Using regression analysis we attempted to explain observed differences in expenditure by determining separately the effects of allocative and productive inefficiency and the effects of factors influencing the demand for services. We found income level of local population, generosity of central government matching grant, allocative efficiency (the mix of care between institutional and non-institutional care), productive efficiency of service providers, and factors associated with the need of services (age structure, morbidity) to be the most important determinants of health care expenditure. Our results reveal that municipalities have the means at their disposal (by shifting resources to outpatient care and increasing productivity) to significantly reduce expenditure on health services and care of the elderly.     

Analysis and Implications of the Determinants of Healthcare Expenditure in African Countries

The income elasticity of health care spending in the OECD countries tends toward luxury good values. Similar studies, based on more recent data, and capable of informing macroeconomic health policies of the African countries, do not currently exist. How the health care expenditure in Africa responds to changes in the Gross Domestic Products (GDP), Official Development Assistance (ODA), and other determinants, is also relevant for health policy because health care is a necessity in the ‘basic needs’ theory of economic development. This paper presents econometric model findings of the determinants of per-capita health expenditure (in PPPs) for 26 African countries, using the flexible Box-Cox model regression methods and 1995 cross-sectional data (sources: WRI, UNEP, UNDP, The World Bank). The economic and other determinants, capturing 74 percent of the variations in health expenditures, include per-capita GDP (in PPPs), ODA (US$), Gini income inequality index, population dependency ratio, internal conflicts, and the percentage of births attended by trained medical workers. Income inequality dampens, while the ODA and population per health personnel raise health care expenditure. The GDP elasticity of about 0.6 signals the tendency for health care to behave like a technical ‘necessity.’ Implications for sustainable basic health development policies are discussed.     

安徽省阜阳市卫生总费用测算报告

中国卫生总费用核算体系,应该包括地市级卫生总费用核算。以安徽省阜阳市为试点,讨论如何在现有方法的基础上,克服部分资料来源的困难,探索一种适合地市级卫生总费用测算的方法,并提供阜阳市卫生总费用的初步测算结果,为当地卫生部门服务。     

从医药消费量的时序变化看医疗改革效果

文章使用经价格指数调整后的医疗保健支出作为医药消费量的代理变量,以城镇居民医药消费量的时序变化为评价指标,建立计量模型,采用最小二乘法,对1997—2005年30个省的相关数据进行回归分析,得出医药消费量的时序变化。发现在保证其他因素不变后,居民人均医药消费量在大部分年度不但没有增加反而下降的事实,证明医疗体制改革没有达到预期效果。最后本文建议医疗体制改革设计要从根本入手,要考虑到具体措施的可操作性。