Variations Among Regions and Hospitals in Managing Chronic Illness: How Much Care Is Enough?

Classic epidemiology looks at what happens to people who live in a defined region over time. For example, birth rate, the number of births that occur among populations over a year, is a common statistics that we\u27re all familiar with. Since the early 1990s we have conducted research at Dartmouth Medical School to convert that classic epidemiologic perspective into looking at what is happening in terms of the health care system itself. We ask how much care people are getting in different regions of the country. We want to know the patterns of that care. And we want to get into the causes of so-called unwarranted variation, that is, differences that cannot be explained on the basis of patient illness, the dictates of scientific medicine, or the preferences of patients. Those three key words--illness, preference, and science--ultimately don\u27t explain very much of the variation we see. We began the Dartmouth Atlas Project in 1993 as a study of health care markets in the United States, measuring variations in health care resources and their utilization among geographic areas. In recent years, we have expanded our research agenda to include the resources and utilization among patients at specific hospitals. We use very large claims databases from the Medicare program and other sources to define where people go for medical care, what kind of care they receive, and whether increasing investments in health care resources and their use result in better health outcomes

Geographic Variation and Health Care Cost Growth: Research to Inform a Complex Diagnosis

Summarizes preliminary findings and discussions from RWJF's Changes in Health Care Financing Organization initiative about the drivers of healthcare costs across states, including sector-specific factors, technology, chronic illness, and waste

Supporting Cancer Prevention Strategies Using Geospatial Analysis on HRSA data

This paper uses develops a methodology to geospatially analyze factors associated with disparities in cancer rates

Finding Resources for Health Reform and Bending the Health Care Cost Curve

Examines policy options for slowing healthcare spending growth, improving outcomes, and financing comprehensive reform, including changes to Medicare Advantage and hospital pay-for-performance. Compares their estimated budget impact over ten years

The role and importance of economic evaluation of traditional herbal medicine use for chronic non-communicable diseases

Background: Non-communicable diseases (NCD) constitute major public health problems globally, with an impact on morbidity and mortality ranking high and second to HIV/AIDS. Existing studies conducted in South Africa have demonstrated that people living with NCD rely on traditional herbal medicine (THM) primarily or in combination with conventional drugs. The primary research focus has been on the clinical and experimental aspects of THM use for NCD, with limited data on the economic impact of health care delivery. Therefore, the purpose of this study will be to determine the cost and utilization of resources on THM in South Africa for NCD. Materials and methods: Study describes the methods toward incorporating cost estimations and economic evaluation illustrated with the Prospective Urban and rural Epidemiological (PURE) study in South Africa. The South African PURE cohort is investigating the geographic and socioeconomic influence of THM spending and utilization, variations in spending based on perceived health status, marital status, and whether spending patterns have any impact on hospitalizations and disability. Data collection and evaluation plan: Since the individual costs of THM are not regulated nor do they have a standardized price value, information obtained through this study can be utilized to assess differences and determine underlying factors contributing to spending. This insight into THM spending patterns can aid in the development and implementation of guidelines or standardized legislation governing THM use and distribution. An economic evaluation and cost estimation model has been proposed, while the data collection is still ongoing. Particularly, willingness to pay method measures how much participants are willing to pay for THM for perceived improvements in health. Resource-use and expenditures along with annual direct costs for households will be determined. Conclusion: Economic evaluations can provide insight for health care policy decision makers on the appropriate inclusion of THM to reduce the overall burden of health care costs in South Africa. Because of the increased prevalence of integrative medicine, it is crucial to consider potential implications and their use of comparative effectiveness research to incorporate complementary and alternative medicine in future. Keywords: complementary medicine, alternativ