Sliding into poverty? Cross-national patterns of income source change and income decay in old age

In this article we examine the change in the mix of income and benefits that older adults receive as they age, with a focus on older women. Our study is a crossnational comparison of five OECD countries using the Luxemburg Income Study database. We investigate the change of private income and social benefits following synthetic cohorts for two decades. Our study reveals that older women rely heavily on socially provided benefits for a majority of their income, and these benefits are primarily responsible for whether older women find themselves in poverty or not. Older men and women in countries with relatively generous (or well targeted) social retirement and social transfer benefits have lower levels of poverty. A caveat of the study is a comparison of older adults who own their homes and those who rent. We find that older homeowners are less likely to be in poverty than renters. As the value of homes and homeownership increase, housing will become an especially important source of support in old age

Good Research Practices for Measuring Drug Costs in Cost-Effectiveness Analyses: A Managed Care Perspective: The ISPOR Drug Cost Task Force Report—Part III

AbstractObjectivesThe objective of this report is to provide guidance and recommendations on how drug costs should be measured for cost-effectiveness analyses conducted from the perspective of a managed care organization (MCO).MethodsThe International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force on Good Research Practices—Use of Drug Costs for Cost Effectiveness Analysis (DCTF) was appointed by the ISPOR Board of Directors. Members were experienced developers or users of CEA models. The DCTF met to develop core assumptions and an outline before preparing a draft report. They solicited comments on drafts from external reviewers and from the ISPOR membership at ISPOR meetings and via the ISPOR Web site.ResultsThe cost of a drug to an MCO equals the amount it pays to the dispenser for the drug's ingredient cost and dispensing fee minus the patient copay and any rebates paid by the drug's manufacturer. The amount that an MCO reimburses for each of these components can differ substantially across a number of factors that include type of drug (single vs. multisource), dispensing site (retail vs. mail order), and site of administration (self-administered vs. physician's office). Accurately estimating the value of cost components is difficult because they are determined by proprietary and confidential contracts.ConclusionEstimates of drug cost from the MCO perspective should include amounts paid for medication ingredients and dispensing fees, and net out copays, rebates, and other drug price reductions. Because of the evolving nature of drug pricing, ISPOR should publish a Web site where current DCTF costing recommendations are updated as new information becomes available

Poor People in Rich Nations: The United States in Comparative Perspective

Most examinations of United States domestic antipoverty policy are inherently parochial, for they are based on the experiences of only our nation in isolation from the others. However, cross-national comparisons can also teach lessons about antipoverty policy. While all nations value low poverty, high levels of economic self-reliance, and equality of opportunity for younger persons, they differ dramatically in the extent to which they reach these goals. Nations also exhibit differences in the extent to which working age adults mix economic self-reliance (earned incomes), family support, and government support to avoid poverty. We begin by reviewing international concepts and measures of poverty. The Luxembourg Income Study (LIS) database contains the information needed to construct comparable poverty measures for more than 30 nations. It allows comparisons of the level and trend of poverty and inequality across several nations, along with considerable detail on the sources of market incomes and public policies that shape these outcomes. We will highlight the different relationships between antipoverty policy and outcomes among several countries, and consider the implications of our analysis for research and for antipoverty policy in the United States. In doing so, we will draw on a growing body of evidence that evaluates antipoverty programs in a cross-national context. Many international bodies have publishes crossnational studies of the incidence of poverty in recent years, including the United Nations Children's Fund, the United Nations Human Development Report, the Organization for Economic Cooperation and Development, and the Luxembourg Income Study. A large subset of these studies is based on LIS data

Cross National Comparisons of Levels and Trends in Inequality

This article reviews the evidence on cross-national comparisons of earnings and income inequality in OECD countries. It begins with a series of stylized facts which are then examined and supported by recent studies in the field. Economic, demographic, institutional and policy-related influences on earnings and income distribution are reviewed. The paper concludes with a call for more work on empirically testable structural models of household income distribution. In contrast, British researchers such as Atkinson (1970) and Dutch researchers such as Pen 1 (1971) and their predecessors made key contributions to both inequality theory and measurement during the 1970s. I. Introduction Interest in the distribution of earnings and the distribution of household income was largely a parochial backwater of economic research in the United States until the early 1980s. This lack of interest reflected the view that both the functional and personal distributions of income in the United States s..

Excess comorbidity prevalence and cost associated with functional dyspepsia in an employed population

Background: Limited published data exist on the associated comorbid conditions with functional dyspepsia (FD). Aims: This study aimed to assess the prevalence, services, and costs related to comorbid conditions associated with FD and the risk of having FD for each comorbid condition. Methods: A retrospective database analysis was undertaken using payroll data and adjudicated claims from January 1, 2001, through December 31, 2004 among >300,000 employees. Employees with FD were compared to propensity-score-matched employees without FD (controls). Outcome measures included the prevalence, costs, and utilization of health services for comorbid conditions as defined by the Agency for Healthcare Research and Quality (AHRQ) and the odds ratios of having FD from a multivariate model. Results: FD employees (N = 1,669) and a 50:1 matched control cohort (N = 83,450) were compared. Compared to matched controls, FD employees were more likely to have all major diagnostic categories. Moreover, 199/261 of the AHRQ’s specific categories were more common in the FD cohort. Annual medical costs for the FD cohort were greater than for controls in 155/261 (59%) specific categories and significantly greater (P ≤ 0.05) in 76 categories (29%). Similarly, services were greater for 179/261 (69%) specific categories and significantly greater (P ≤ 0.05) in 110 categories (42%). In a multivariate model, esophageal disorders, gastritis and duodenitis, and abdominal pain were the most associated with having FD (odds ratios 3.8, 3.7, and 3.6, respectively). Only hypertension complications and disorders of the teeth and jaw were significantly negatively associated with FD.Conclusion: There is unexplained excess comorbidity associated with FD which may be a major determining factor for excess healthcare services and costs