The relationship between the markets for health insurance and medical malpractice insurance

This article evaluates the interdependence of medical malpractice insurance markets and health insurance markets. Prior research has addressed the performance of these markets, individually, without specifically quantifying the extent to which they are linked. Increasing levels of health insurance losses could increase the scale of potential malpractice claims, boosting medical malpractice losses, or could embody an improvement in medical care quality, which will reduce malpractice losses. Our results for a state panel data set from 2002 to 2009 demonstrate that health insurance losses are negatively related to medical malpractice insurance losses. An additional dollar of health insurance losses is associated with a $0.01–$0.05 reduction in medical malpractice losses. These findings have potentially important implications for assessments of the net cost of health insurance policies.     

Courts,scheduled damages,and medical malpractice insurance

We study how the functioning of the judicial system affects the availability and affordability of medical liability insurance, as proxied by the number of insurers and the premiums paid. We use two unique datasets collected in Italy from 2000 to 2010. Using the first dataset—insurance contracts for hospitals—we estimate the average treatment effect of schedules on insurers and premiums paid, conditional on judicial efficiency and proxied by different measures. Our identification rests on the partial overlap between healthcare districts and judicial districts, meaning that the caseload of a court and malpractice events at the healthcare provider level are not perfectly correlated. On average, the adoption of schedules does not produce any significant effect on insurers or on premiums paid. However, adopting schedules has a robust and significant effect on the number of insurers, but only in inefficient courts. We further investigate these findings using a second dataset comprising 17,578 malpractice insurance claims. We find evidence of a composition effect among claims that is triggered by higher levels of judicial inefficiency: As a court’s inefficiency increases, the likelihood for a case to not be decided on the merits decreases and the levels of reserve and recovery per claim decrease.     

The importance of level 1 trauma services in U.S. hospitals

In this quantitative research study, the organizational characteristics, market factors, and profitability of U.S. acute care hospitals that provide the highest intensity of trauma services are assessed. Results indicate these hospitals are larger, have a higher occupancy rate, higher expenses per discharge, and a lower length of stay. Hospitals with Level 1 trauma centers have a positive return on assets. The study has managerial implications associated with individual hospital performance and policy implications on resource allocation.     

The impact of private hospital insurance on the utilization of hospital care in Australia

We use the Australian National Health Survey to estimate the impact of private hospital insurance on the propensity for hospitalization as a private patient. We account for the potential endogeneity of supplementary private hospital insurance purchases and calculate moral hazard based on a difference-of-means estimator. We decompose the moral hazard estimate into a diversion component that is due to an insurance-induced substitution away from public patient care towards private patient care, and an expansion component that measures a pure insurance-induced increase in the propensity to seek private patient care. Our results suggest that on average, private hospital insurance causes a sizable and significant increase in the likelihood of hospital admission as a private patient. However, there is little evidence of an expansion effect; the treatment effect of private hospital insurance on private patient care is driven almost entirely by the substitution away from public patient care towards private patient care. We discuss the implications for policies that aim to expand supplementary private insurance coverage for the purpose of reducing excess demand on the public healthcare system.     

The effect of telehealth insurance mandates on health-care utilization and outcomes

This paper uses panel data techniques to investigate the impact of state mandates to cover telehealth services on private insurance premiums and enrollment, health-care utilization, and health outcomes. There is evidence that telehealth insurance mandates are associated with an increase in primary care, but no significant changes in overall health outcomes. However, there is evidence of a reduction of secondary care and improvement in health outcomes in non-metropolitan areas. The results provide useful information regarding the potential of telehealth to reduce health-care costs as well as to reduce disparities in access to health care and in health outcomes.     

Impact of treatment with liposomal bupivacaine on hospital costs,length of stay,and discharge status in patients undergoing total knee arthroplasty at high-use institutions

Aims: Post-surgical pain experienced by patients undergoing total knee arthroplasty (TKA) can be severe. Enhanced recovery after surgery programs incorporating multimodal analgesic regimens have evolved in an attempt to improve patient care while lowering overall costs. This study examined clinical and economic outcomes in hospitals using liposomal bupivacaine (LB) for pain control following TKA.

Methods: This retrospective observational study utilized hospital chargemaster data from the Premier Healthcare Database from January 2011 through April 2017 for the 10 hospitals with the highest number of primary TKA procedures using LB. Within these hospitals, patients undergoing TKA who received LB were propensity-score matched in a 1:1 ratio to a control group not receiving LB. Outcomes included hospital length of stay (LOS), discharge status, 30-day same-hospital readmissions, total hospitalization costs, and opioid consumption; only patients with Medicare or commercial insurance as the primary payer for TKA were considered.

Results: The study population included 20,907 Medicare-insured patients (LB?=?10,411; control =10,496) and 12,505 patients with commercial insurance (LB?=?6,242; control?=?6,263). Overall, LOS was 0.6?days shorter with LB (p?p?P?p?p?Limitations: Costs were estimated using Premier charge-to-cost ratios and limited to goods and services recorded in the chargemaster. Findings from these 10 hospitals may not be representative of other US hospitals.

Conclusions: In a sub-set of 10?US hospitals with the highest use of LB for TKA, LB use was associated with shorter hospital LOS, increased home discharge, lower total hospitalization costs, and decreased opioid use after TKA.     

A two-stage translog marginal cost pricing approach for Floridian hospital outputs

Since the passage of the Affordable Care Act (ACA) of 2010, issues still remain regarding the mandated purchase of insurance to ensure more universal coverage. One such issue is the pricing of these insurance packages and whether or not the reimbursements will cover necessary services. Therefore, policy concerns exist that increasing the number of insured individuals may not curtail costs. Conversely, providers may not wish to treat patients covered by excessively frugal plans such as Medicaid; hence the trade-offs between access and cost control. In this article, we present findings from a cost function and a productivity approach to determine the marginal cost of providing inpatient hospital care for hospitals operating in Florida during 2005. Using these methodological approaches, we are able to use the marginal rate of transformation to determine the relative marginal costs while controlling for hospital technical and allocative inefficiency. Our work differs from earlier articles as we avoid the Greene problem for cross-sectional models through a two-step approach. By including both reimbursement rates under conditions of hospital efficiency, we can ascertain payment schemes that should, at least in theory, cover necessary costs for patient care without leading to excessive input usage.     

Profiling hospital utilization in a mixed public–private system

While there is an extensive body of literature on the demand for hospital services, little is known about the interaction between public and private hospitals in a mixed system. In this article, we (1) apply latent class analysis to identify distinct subgroups of patients who use the hospital market differently, (2) characterize each patient type by their personal characteristics and (3) link the patient type to future hospital admissions. We apply our analysis to individual-level longitudinal patient data from Australia, focusing on three popular procedures that are performed in both public and private hospitals. We find 4–5 patient types. The most common types use either a public or a private hospital almost exclusively and absorb a moderate level of hospital resources. The severe types represent 13–17% of patients. The type which uses both sectors makes up 10–20% and tends to have private health insurance coverage. The patient types are predictive of prospective utilizations as we find that patients tend to be admitted to the sector they have used in the past. By revealing how patients use coexisting public and private hospitals, our results have direct implications on health resource financing and allocations.     

Resolving the impasse on hospital scale economics: a new approach

The existence of scale economies in hospitals in important for both public and managerial policy, yet production and cost function studies have found conflicting evidence. More recently, more sophisticated studies have typically found scale diseconomies, which is inconsistent with the views of industry participants and observers. In the early 1980s. California deregulated both private and public health insurance (Medical), which provides a natural laboratory for examining hospital efficiency. Using Stigler's original and multivariate survivor analysis, we resolve the conflict in favour of scale economies, and reconcile the controversy. The survivorship methodology in simple to apply, and a useful tool in conjunction with statistical cost and production studies.     

A Monte Carlo simulation estimating US hospital cost reductions associated with hypotension control in septic ICU patients

Objective: This economic analysis extends upon a recent epidemiological study to estimate the association between hypotension control and hospital costs for septic patients in US intensive care units (ICUs).

Methods: A Monte Carlo simulation decision analytic model was developed that accounted for the probability of complications—acute kidney injury and mortality—in septic ICU patients and the cost of each health outcome from the hospital perspective. Probabilities of complications were calculated based on observational data from 110?US hospitals for septic ICU patients (n?=?8,782) with various levels of hypotension exposure as measured by mean arterial pressure (MAP, units: mmHg). Costs for acute kidney injury (AKI) and mortality were derived from published literature. Each simulation calculated mean hospital cost reduction and 95% confidence intervals based on 10,000 trials.

Results: In the base-case analysis hospital costs for a hypothetical “control” cohort (MAP of 65?mmHg) were $699 less per hospitalization (95% CI: $342–$1,116) relative to a “case” cohort (MAP of 60?mmHg). In the most extreme case considered (45?mmHg vs 65?mmHg), the associated cost reduction was $4,450 (95% CI: $2,020–$7,581). More than 99% of the simulated trials resulted in cost reductions. A conservative institution-level analysis for a hypothetical hospital (which assumes no benefit for increasing MAP above 65?mmHg) estimated a cost decline of $417 for a 5?mmHg increase in MAP per ICU septic patient. These results are applicable to the US only.

Conclusions: Hypotension control (via MAP increases) for patients with sepsis in the ICU is associated with lower hospitalization cost.     

An estimation of the demand and supply for physician services using a panel data

Using the single-equation and simultaneous equations methods, demand and supply for physician services at medical practices are estimated with panel data, which is primarily based on American Medical Association divisional surveys. Fixed effects and no-effects models are employed for estimation of the parameters of the simultaneous equations and their elasticities. The results suggest that the demand is highly income inelastic. However, private insurance and Medicaid raise the rate of utilization. The adverse effect of uninsured is also evident, though it is not as high as private insurance. Evidence also supports the demand inducement hypothesis and points to the rising demand for health care as the U.S. population is aging. The supply function parameters generally demonstrate their expected pattern. It is notable that the malpractice liability premiums exhibit a negligible effect on the supply of office visits.     

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.     

非理性就医对医保费用管理的挑战及应对策略

目的分析参保患者非理性就医现象,积极探索应对策略,为控制不合理增长的医疗费用提供参考。方法结合我院医保工作中对医保基金正确合理使用的管理及参保患者的就医情况,分析近年来参保患者非理性就医的现象、原因及结果,探索应对策略,总结规范化管理的措施。结果小病大治、大病贵治、无病保养等是非理性就医的主要表现,严重影响医保费用的管理,助推了过度医疗和医疗费用的不合理增长。结论应落实国家医药卫生体制改革,完善配套的医疗保险政策,深化医院医保费用管理,科学控制基本医疗付费总额,控制医疗费用不合理增长,从而保障医保基金的安全使用。     

Characteristics,comorbidities, and use of healthcare resources of patients with phenylketonuria: a population-based study

Abstract

Background: Phenylketonuria is a well-known disease, yet the characteristics of the affected population and their use of healthcare resources have not been comprehensively evaluated. Patient characteristics and use of resources are subjects of interest for most governments, especially for a disease included in newborn screening programs.

Objective: The aim of this study was to determine characteristics and use of healthcare resources of patients with phenylketonuria in the region of Catalonia.

Methods: Records of 289 patients admitted with phenylketonuria between 2007 and 2017 were extracted from the PADRIS database that includes admission data from primary care centers, hospitals (inpatient and outpatient care), extended care facilities, and mental health centers.

Results: The patient population was composed of 140 male patients and 149 female patients, and 102 patients were registered via newborn screening during the study period. Patients were admitted on average 2.19 times per year, mostly into primary care centers which concentrated the largest portion of direct medical expenses. Similar percentages of urgent and scheduled admissions were registered both in primary care and hospitals. Annual direct medical cost of treating patients with phenylketonuria was €667 per patient. Finally, 66.80% of the patients suffered from chronic conditions affecting two or more systems, likely to correspond to a wide variety of conditions.

Conclusions: Altogether, phenylketonuria patient demographics and direct medical costs in Catalonia have been revised. Patients diagnosed with phenylketonuria appeared 1.3-times more likely to suffer from chronic conditions in distinct organ systems, which is expected to have an effect on their use of healthcare resources. These results support the need to adapt and improve the healthcare system, taking multimorbidity into consideration in an effort to control the medical expenses derived.     

Cost estimation of neonatal intensive care in Greece: the case of Athens maternity hospitals

Summary

This study aimed to estimate the hospitalisation costs for neonatal intensive care and to investigate any discrepancies with reimbursement by the social funds in Greece.

The study was based on a prospective selection of neonates admitted to the intensive care unit of two hospitals within a 3-month period in 2004. Data were collected and classified with respect to birthweight and gestational age. Microcosting recording of data was used. A National Health System hospital perspective was applied.

The study sample consisted of 99 neonates with mean cost per infant reaching €5,845 in contrast to the €3,952 reimbursed by the social security funds, showing a discrepancy between actual and nominal costs. Cost per infant was found to have an inverse relationship both with birthweight and gestational age. Personnel costs accounted for 59.9% of all resources consumed followed by enteral/parenteral feeding for 16.1% and pharmaceuticals expenses for 11.1%. The remaining covers the costs of consumables, diagnostic test and overheads (12.9%).     

Medical costs in patients with heart failure after acute heart failure events: one-year follow-up study

Aims: This study investigated annual medical costs using real-world data focusing on acute heart failure.

Methods: The data were retrospectively collected from six tertiary hospitals in South Korea. Overall, 330 patients who were hospitalized for acute heart failure between January 2011 and July 2012 were selected. Data were collected on their follow-up medical visits for 1 year, including medical costs incurred toward treatment. Those who died within the observational period or who had no records of follow-up visits were excluded. Annual per patient medical costs were estimated according to the type of medical services, and factors contributing to the costs using Gamma Generalized Linear Models (GLM) with log link were analyzed.

Results: On average, total annual medical costs for each patient were USD 6,199 (±9,675), with hospitalization accounting for 95% of the total expenses. Hospitalization cost USD 5,904 (±9,666) per patient. Those who are re-admitted have 88.5% higher medical expenditure than those who have not been re-admitted in 1 year, and patients using intensive care units have 19.6% higher expenditure than those who do not. When the number of hospital days increased by 1?day, medical expenses increased by 6.7%.

Limitations: Outpatient drug costs were not included. There is a possibility that medical expenses for AHF may have been under-estimated.

Conclusion: It was found that hospitalization resulted in substantial costs for treatment of heart failure in South Korea, especially in patients with an acute heart failure event. Prevention strategies and appropriate management programs that would reduce both frequency of hospitalization and length of stay for patients with the underlying risk of heart failure are needed.     

临床药师参与住院医保病史监管的情况与分析

目的分析综合性医院临床药师对住院医保患者在诊疗过程中的不合理情况,提出对策。方法抽取本院2013年1至10月住院医保患者的病史资料,对住院过程中的不合理情况及类别进行调查总结。结果不合理类别中,不合理用药居首。结论临床药师参与不合理用药监管可控制医保医疗费用的快速增长。     

Endogenous hospital regulation and its effects on hospital and non-hospital expenditures

Past studies of hospital rate setting regulation conclude that mature programs have been effective in constraining hospital expenditures. However, if rate regulation is influenced by higher hospital expenditures the relationship between expenditures and rate setting is confounded. This study assesses the impact of rate setting on hospital and non-hospital expenditures using a simultaneous-equation model which separates the effects of hospital expenditures on the decision to regulate from the effects of regulation on expenditures. The simultaneous-equation results indicate that mature rate setting is associated with lower per capita health care expenditures, including hospital and non-hospital expenditures.