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.     

Complex home care: Part 2- family annual income, insurance premium, and out-of-pocket expenses

Annual costs paid by families for intravenous infusion of home parenteral nutrition (HPN) health insurance premiums, deductibles, co-payments for health services, and the wide range of out-of-pocket home health care expenses are significant. The costs of managing complex chronic care at home cannot be completely understood until all out-of-pocket costs have been defined, described, and tabulated. Non-reimbursed and out-of-pocket costs paid by families over years for complex chronic care negatively impact the financial stability of families. National health care reform must take into account the long-term financial burdens of families caring for those with complex home care. Any changes that may increase the out-of-pocket costs or health insurance costs to these families can also have a negative long-term impact on society when greater numbers of patients declare bankruptcy or qualify for medical disability.     

Plan design innovations to control health care costs

Southern California Edison has achieved measurable success in health care cost management. Dr. Sokolov observes that the essence of SCE's problem-solving approach can be transferred to almost any organization.     

A nurse-run business to improve health care for nursing home residents

The costs of health care for the rapidly growing segment of our population over age 75 are staggering. EverCare is a nurse-run business that seeks to improve cost-effectiveness and quality of health care for nursing home residents enrolled in a health maintenance organization.     

Willingness and ability of Bulgarian consumers to pay for improved public health care services

An application of the contingent valuation method to the willingness and ability of Bulgarian consumers to pay for public health care services is presented. The study uses data from a household survey conducted in May–June 2000. The willingness and ability to pay for outpatient, inpatient and dental services is investigated. A combination of interval checklist and open-ended questions are used to elicit the willingness-to-pay amounts. The impact of the sociodemographic characteristics on the responses is examined by a generalized Tobit regression. Based on the regression equation, the welfare effects of various fee levels are simulated.     

Applying a nine cell financial analysis model to home health care

A nine-cell financial analysis model is used to evaluate the effectiveness of strategies on the economic performance of a home health care agency. Strategies associated with the drivers of economic performance are discussed: volume, unit price, unit costs of resources applied, and quantity of resources applied.     

Restructuring: specifics for home health

The current reimbursement climate, job characteristics, and health care personnel shortages challenge home health nurses in providing quality patient care. Through relatively simple restructuring efforts, home health nursing can become more satisfying and productive.     

Population aging,the costs of health care for the elderly and growth

Employing an overlapping-generations model with endogenous growth in which altruistic young agents take care of the health level of their aged parents at risk of illness, this paper examines how population aging influences the long-run growth rate of the economy. We show that life expectancy, when relatively low (high), positively (negatively) affects economic growth. This paper also investigates public policy on long-term care and demonstrates the existence of an intergenerational conflict between current and future generations. We also point out that population aging may mitigate the extent of this conflict.     

Estimating an hedonic translog cost function for the home health care industry

Medicare home health care plays an important role in providing cost effective care for the chronically ill and elderly. Long seen as a cost effective substitute for nursing home care, home care has become even more important with expenditures increasing by 31.4% from 1990 to 1996. The purpose of this paper is to provide a short run cost analysis of a sample of home health care providers to gain insight into the efficient provision of home health care services. This paper is a significant improvement over previous studies in that it uses a nationwide database to more accurately represent the multiproduct nature of the industry and uses an hedonic translog cost estimation with desirable economic properties.     

HMO plans,self-selection and utilization of health care services

This study examines the effect of health maintenance organizations (HMOs) on the use of health care services among the privately insured, nonelderly population. To consider jointly the possible self-selection bias and high frequency of zero observations in the applied utilization measures, we accommodate the endogeneity of health plan choice decisions in the censored regression model. Using data from the 2000 Medical Expenditure Panel Survey, we find strong evidence for favourable self-selection into HMO plans. Health maintenance organization enrollment is found to encourage greater use of office-based and hospital outpatient services. Overall satisfaction with the quality of care among HMO members is relatively low compared to that among nonHMO members. These findings suggest that more effort is needed to develop management strategies in HMOs in order to contain the moral hazard in utilization and assure the quality of service provided within the network of HMO providers.     

Flexible customer willingness to pay for bundled smart home energy products and services

Energy markets are rapidly changing with smarter, connected, more reliable infrastructure and cleaner generation on the supply side, and more choice, greater control and enhanced flexibility for customers. This paper examines willingness to pay for bundled smart home energy products and information services, using data from a set of two discrete choice experiments that were part of a survey by the regional energy provider of upstate New York. To let the data reveal how preferences are distributed in the population, a logit-mixed logit model in willingness-to-pay space and a combination of observed and unobserved preference heterogeneity was specified and fitted. Results show that residents of Tompkins County are willing to pay more than in other counties for residential storage, and that for home energy management there is an important generational divide with millennials being much more likely to perceive the economic value in the smart energy technologies. The flexible logit-mixed logit estimates provide evidence of important heterogeneity in preferences: whereas most of the population has a positive—albeit rather low—valuation of smart energy products and services, there is a considerable percentage of customers with negative perceptions.     

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.