Nursing home costs and quality of care outcomes

The relationship between cost and quality of care in nursing homes was examined using quality indicator measures of resident outcomes. While each individual quality measure makes only small contributions to costs, when considered across the facility, quality could have a substantial financial impact on the operations of the home.     

Home care reimbursement,long-term care utilization,and health outcomes

Using a substantial change in Medicare reimbursement policy to study the market for home health care, I find that the introduction of tightly binding average per-patient reimbursement caps led to a large drop in the provision of home care, particularly to the least healthy beneficiaries. This decline in home health utilization was not offset by increases in institutional long-term care or other medical care and there were no associated adverse health consequences. However, approximately one-quarter of the decline in Medicare spending was offset by increases in out-of-pocket expenditures for home health care, with the offset concentrated in higher income populations.     

Non-cognitive child outcomes and universal high quality child care

Exploiting a rich panel data child survey merged with administrative records along with a pseudo-experiment generating variation in the take-up of preschool across municipalities, we provide evidence of the effects on non-cognitive child outcomes of participating in large scale publicly provided universal preschool programs and family day care vis-à-vis home care. We find that, compared to home care, being enrolled in preschool at age three does not lead to significant differences in child outcomes at age seven no matter the gender or the mother's level of education. Family day care, on the other hand, seems to significantly deteriorate outcomes for boys whose mothers have a lower level of education. Finally, longer hours in non-parental care lead to poorer child outcomes.     

Cost-effective care a phone call away: a nurse-managed telephonic program for patients with chronic heart failure

Health care providers and health care systems are challenged to find cost-effective ways to address the costs associated with heart failure. A multidisciplinary team of nurses, physicians, pharmacists, and dieticians was assembled at New Hanover Regional Medical Center (Wilmington, NC) to develop strategies to decrease the readmission rate without compromising patient care. The team developed a disease management program that included comprehensive inpatient education, as well as an outpatient telephonic program to reinforce education after discharge. Goals were to reduce readmissions of patients with heart failure, to decrease the cost per case of each patient with chronic heart failure, and to reduce the length of stay for patients who were readmitted. The CHF Telephonic Program was extremely successful in meeting patient-focused and organizational goals related to readmissions, length of stay, and cost of care.     

Cost of hospital care for elderly at risk of falling

The variables that relate to cost of hospital care for a large sample of elderly patients at risk for falling are examined. The chief predictors of cost of hospitalization were medical, pharmacy, and nursing interventions. Use of nursing interventions, on average, raised the median hospital cost less than use of medical or pharmacy interventions. Using a standardized nursing language with the hospital's information system can provide nurses with information that demonstrates the cost effectiveness of their interventions.     

Employer initiatives to examine cost and quality in health care

Actions by private sector employers as well as moves by federal and state agencies have begun the process of integrating cost and quality in health care decision making.     

Cost of care for new versus recurrent acute coronary syndrome patients

Abstract

Introduction: The economic burden of acute coronary syndrome (ACS) continues long after the acute event has resolved. This study compared ACS-related costs between new and recurrent ACS patients using retrospective claims data from a large US health plan.

Methods: Patients with ACS were identified using ICD-9 codes between the 1st January 2001 and the 30th June 2003. The first diagnosis was defined as the index event. Patient claims were examined 1 year before, and up to 1 year after, the index event. Hospitalisations, revascularisations and costs for new and recurrent cohorts were compared. Multivariate regression was used to examine cost predictors.

Results: In total, 15,508 patients were identified, 82% had new ACS. The new ACS cohort was more likely to have myocardial infarction and be hospitalised for the index event, leading to higher index event costs. However, the recurrent ACS cohort had more re-hospitalisations, longer lengths of inpatient stay and a higher probability of revascularisation during follow-up. The index event cost per patient and per patient-month was higher for new ACS patients. After adjusting for confounding factors, multivariate cost models revealed annualised follow-up medical costs were 9.9% higher (p=0.017) and annualised follow-up pharmacy costs were 8.3% higher (p≤0.0001) for the new ACS cohort.

Conclusion: Newly diagnosed ACS patients had significantly higher adjusted costs in the year following the index event, but recurrent ACS patients still experienced high medical costs. More emphasis by providers and patients on adherence to treatment guidelines may be one step to improving patient outcomes.

*This paper was presented in part at the Academy of Managed Care Pharmacy Annual Meeting, 7th April 2006.     

The impact of horizontal mergers and acquisitions on cost and quality in health care

Mergers and acquisitions among HMOs, hospitals and other health care providers can be disconcerting to benefits staff and employees, but they can be successfully managed. They may offer an employer the opportunity to improve the quality of care provided and to do so at reduced costs.     

A model to optimize investments in health technologies,quality of care and research

Funds for health technologies compete with funds for implementing health technologies as well as funds for conducting research to reduce uncertainty around treatment and implementation cost-effectiveness. No study has yet shown how to allocate a combined budget for health technologies, implementation and research. The purpose of this work was to present an allocation model with the goal to maximize health. Based on a constrained optimization formulation, we show that considering opportunities to invest in implementation and research may justify considerable disinvestment in health technologies. This may reduce the willingness to pay for new health technologies significantly.     

Changing health care, one phone call at a time

Demand management is an approach to providing health care benefits that is designed to help beneficiaries receive the appropriate level of care at the appropriate time. When this is accomplished, health care expenditures are reduced. This case study shows how a large union health plan implemented a demand management program that has been well received by its members and has been effective in helping to control plan costs.     

Patient as center of the health care universe: a closer look at patient-centered care

We need to consider how the health care system should revolve around the patient, rather than the patient rotating around the hospital. Considering a patient-centric point of view when implementing and optimizing the use of health information technology (HIT) provides new perspectives on the meaning of "integrated" health care. ot only do we need to give patients the opportunities to participate as true partners in their health care, we must convince them why this partnership makes sense. We should not be naive and believe all patients want this involvement in their care today and are ready to do all their health care transactions electronically. But considering and using these practices are important steps in the health care reform journey to improve quality and decrease cost. Many patients will benefit by our working with them to demystify the health care experience through patient-centric practices and the use of HIT.     

Complex home care: part III--economic impact on family caregiver quality of life and patients' clinical outcomes

Family caregivers perform a significant role in the care of patients with chronic illnesses and prescribed life-long complex home care treatments. Both quantitative and qualitative data from this study suggest the mental health burdens and financial costs of home parenteral nutrition (HPN) caregiving are extensive. In this study, the variability in HPN out-of-pocket expenses and the uncertainty of incurring such extensive costs created additional financial worries within already stressed families. Based on these data, interventions to improve caregivers' sleepiness, depression, and physical health could be hypothesized to improve both patients' and caregivers' quality of life and reduce the frequency of patients' catheter-related infections. These specific nursing interventions also could improve caregiver health and subsequently reduce the costs of caregivers' health care.     

University quality and labour market outcomes

This paper uses proxies for university quality derived from the Research Assessment Exercise and the Teaching Quality Assurance Agency to assess the impact of university quality on the labour market outcomes of a cohort of UK graduates. The impacts on job quality and earnings were mainly limited to graduates in particular disciplines or those obtaining ‘poor’ degrees from ‘good’ universities. The results suggest that, after controlling for pre-entry qualifications, labour market outcomes for most graduates depended more on the subject studied and degree classification awarded than on the university attended.     

Income-related inequalities of health and health care utilization

By utilizing the China Health and Nutrition Survey (CHNS) data, this paper examines the extent of deviations in terms of horizontal equity in the field of China’s health and medical community, i.e., that those in equal demand ought to be treated equally, and computes the contribution of income in health inequality and utilization inequality of health care. The main conclusions are: There is pro-rich inequality in health and utilization of health care; income contribution to inequality of health care utilization accounts for 0.13–0.2; insurance also enlarges the inequality of health care utilization; health inequality in rural area is larger than that of in urban area; and both rural and urban health inequality are increasing. From 1991 to 2006, income changes in urban districts and rural area account for 7.08% and 13.38% respectively of raising inequality of rural and urban health.     

Prenatal care: Mechanisms and impacts on infant health and health care utilization

We estimate that prenatal care has positive impacts on health measured at birth, shifts the distribution of future health care utilization away from inpatient care, and find that some of these impacts likely come from an informational mechanism. We also find well child visits are used in a complementary fashion with emergency department care in the production of infant health, suggesting that factors beyond barriers to access may drive the demand for emergency care. Finally, we find differential impacts of prenatal care across racial groups with evidence that the information mechanism may be particularly important for black mothers.     

Public financing of health expenditures,insurance, and health outcomes

The effects of public financing of health expenditures, insurance coverage and other factors on health outcomes are examined within health production models estimated using 1960–1992 data across 20 OECD countries. Mortality rates are found to depend on the mix of health care expenditures and the type of health insurance coverage. Increases in the publicly financed share of health expenditures are associated with increases in mortality rates. Increases in inpatient and ambulatory insurance coverage are associated with reduced mortality. The effects of GDP, health expenditures and age structure on mortality are similar to those in previous studies. Tobacco use, alcohol use, fat consumption, female labour force participation, and education levels are also significantly related to overall mortality rates. Increases in income inequality are associated with lower mortality rates, suggesting that the negative relationship between inequality and health outcomes suggested by some previous studies does not remain when a more complete model is estimated. The result that increases in public financing increase mortality rates is robust to a number of changes in specifications and samples. Thus, as countries increase the level of their health expenditures, they may want to avoid increasing the proportion of their expenditures that are publicly financed.