Estimating medical costs from a transition model

Nonparametric estimators of the mean total cost have been proposed in a variety of settings. In clinical trials it is generally impractical to follow up patients until all have responded, and therefore censoring of patient outcomes and total cost will occur in practice. We describe a general longitudinal framework in which costs emanate from two streams, during sojourn in health states and in transition from one health state to another. We consider estimation of net present value for expenditures incurred over a finite time horizon from medical cost data that might be incompletely ascertained in some patients. Because patient specific demographic and clinical characteristics would influence total cost, we use a regression model to incorporate covariates. We discuss similarities and differences between our net present value estimator and other widely used estimators of total medical costs. Our model can accommodate heteroscedasticity, skewness and censoring in cost data and provides a flexible approach to analyses of health care cost.Comment: Published in at http://dx.doi.org/10.1214/193940307000000266 the IMS Collections (http://www.imstat.org/publications/imscollections.htm) by the Institute of Mathematical Statistics (http://www.imstat.org

Current and Future Medical Costs of Childhood Obesity in Alaska

This study examines the medical costs of childhood obesity in Alaska, today and in the future. We estimate that 15.2% of those ages 2 to 19 in Alaska are obese. Using parameters from published reports and studies, we estimate that the total excess medical costs due to obesity for both adults and children in Alaska in 2012 were $226 million, with medical costs of obese children and adolescents accounting for about$7 million of that total. And those medical costs will get much higher over time, as today’s children transition into adulthood. Aside from the 15.2% currently obese, another estimated 20% of children who aren’t currently obese will become obese as adults, if current national patterns continue. We estimate that the 20-year medical costs—discounted to present value—of obesity among the current cohort of Alaska children and adolescents will be $624 million in today’s dollars. But those future costs could be decreased if Alaskans found ways to reduce obesity. We consider how reducing obesity in several ways could reduce future medical costs: reducing current rates of childhood obesity, rates of obese children who become obese adults, or rates of non-obese children and adolescents who become obese adults. We undertake modest reductions to showcase the potential cost savings associated with each of these channels. Clearly the financial\ savings are a direct function of the obesity reductions and therefore the magnitude of the realized savings will vary accordingly. Also keep in mind that these figures are only for the current cohort of children and adolescents; over time more generations of Alaskans will grow from children into adults, repeating the same cycle unless rates of obesity decline. And finally, remember that medical costs are only part of the broader range of social and economic costs obesity creates.Alaska Department of Health and Social Services Section of Chronic Disease Prevention and Health Promotion Sectio

Bacterial Foodborne Disease: Medical Costs and Productivity Losses

Microbial pathogens in food cause an estimated 6.5-33 million cases of human illness and up to 9,000 deaths in the United States each year. Over 40 different foodborne microbial pathogens, including fungi, viruses, parasites, and bacteria, are believed to cause human illnesses. For six bacterial pathogens, the costs of human illness are estimated to be $9.3-$12.9 billion annually. Of these costs, $2.9-$6.7 billion are attributed to foodborne bacteria. These estimates were developed to provide analytical support for USDA's Hazard Analysis and Critical Control Point (HACCP) systems rule for meat and poultry. (Note that the parasite Toxoplasma gondii is not included in this report.) To estimate medical costs and productivity losses, ERS uses four severity categories for acute illnesses: those who did not visit a physician, visited a physician, were hospitalized, or died prematurely. The lifetime consequences of chronic disease are included in the cost estimates for E. coli O157:H7 and fetal listeriosis.cost-of-illness, foodborne pathogens, lost productivity, medical costs, Food Consumption/Nutrition/Food Safety, Health Economics and Policy,

Health Care Cost Containment and Coverage Expansion

Examines the relationship between expanding insurance coverage and controlling medical costs. Analyzes combinations of cost containment options and coverage expansion models for their compatibility and implications for the feasibility of proposed reforms

Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families: Findings From the Commonwealth Fund Biennial Health Insurance Surveys, 2001-2007

Highlights declining health coverage and rising deductibles for American adults and the implications for medical costs, debt burdens, and access to health care. Examines socioeconomic and demographic characteristics of the uninsured and underinsured

Louisiana's Proposed Section 1115 Medicaid Demonstration Project: Estimating the Numbers of Uninsured and Projected Medicaid Costs

Analyzes the composition and medical costs of the uninsured in Louisiana after Hurricane Katrina, based on a detailed analysis of who the uninsured are in Louisiana, their current medical spending, and what their spending might be under Medicaid

Pembiayaan Pasien Skizofrenia Paranoid

This study aims to determine the burden of direct medical costs on paranoid patients at Tombulilato Regional Hospital and the factors influencing direct medical costs. The method used in this research was retrospective, using medical record data and details of direct medical costs. The results of this research are that the total direct medical costs of inpatient schizophrenia patients are IDR. 523,028,500, with the most significant accommodation cost being the room cost of Rp. 184,190,000 because the patient's length of stay is very strongly related to direct medical costs. The conclusion is that the total direct medical costs incurred amounted to Rp. 523,028,500 with the relationship between the length of hospital stay and direct medical expenses.   Keywords: Direct medical costs, influencing factors, schizophreni

Workers' compensation in the United States: high costs, low benefits

Studies suggest that income replacement is low for many workers with serious occupational injuries and illnesses. This review discusses three areas that hold promise for raising benefits to workers while reducing workers' compensation costs to employers: improving safety, containing medical costs, and reducing litigation. In theory, workers' compensation increases the costs to employers of injuries and so provides incentives to improve safety. Yet, taken as a whole, research does not provide convincing evidence that workers' compensation reduces injury rates. Moreover, unlike safety and health regulation, workers' compensation focuses the attention of employers on individual workers. High costs may lead employers to discourage claims and litigate when claims are filed. Controlling medical costs can reduce workers' compensation costs. Most studies, however, have focused on costs and have not addressed the effectiveness of medical care or patient satisfaction. Research also has shown that workers' compensation systems can reduce the need for litigation. Without litigation, benefits can be delivered more quickly and at lower costs

Microbial Foodborne Disease: Hospitalizations, Medical Costs and Potential Demand for Safer Food

Food Consumption/Nutrition/Food Safety, Health Economics and Policy,

Non-Medical Financial Burden in Tuberculosis Care: a Cross-Sectional Survey in Rural China

Background: Treatment of tuberculosis (TB) in China is partially covered by national programs and health insurance schemes, though TB patients often face considerable medical expenditures. For some, especially those from poorer households, non-medical costs, such as transport, accommodation, and nutritional supplementation may be a substantial additional burden. In this article we aim to evaluate these non-medical costs induced by seeking TB care using data from a large scale cross-sectional survey. Methods: A total of 797 TB cases from three cities were randomly selected using a stratified cluster sampling design. Inpatient medical costs, outpatient medical costs, and direct non-medical costs related to TB treatment were collected using in-person interviews by trained interviewers. Mean and median non-medical costs for different sub-groups were calculated and compared using Kruskal-Wallis and Mann–Whitney U tests. Regression analysis was conducted to assess the influence of different patient characteristics on total non-medical cost. Results: The median non-medical cost was RMB 1429, with interquartile range RMB 424–2793. The median non-medical costs relating to inpatient treatment, outpatient treatment, and additional nutrition supplementation were RMB 540, 91, and 900, respectively. Of the 797 cases, 20 % reported catastrophic expenditure on non-medical costs. Statistically significant differences were detected between different cities, age groups, geographical locations, inpatient/outpatient care, education levels and family income groups. Conclusions: Non-medical costs relating to TB treatment are a serious financial burden for many TB patients. Financial assistance that can limit this burden is urgently needed during the treatment period, especially for the poor