The impact of lifestyle health risk on the bottom line: a case study

As the Lifestyle Advantage study continues, HPS expects to follow the utilization trends for a consistent group of participants and nonparticipants, maintaining full confidentiality. Several key issues will be addressed in the process: As the participation rate increases, will the claims payment gap between participants and nonparticipants be reduced? Can a company hope to see a return on an investment in a health promotion program? If so, over what period of time? Finding answers to these questions will contribute to the larger issues of long-term health care cost containment and health care reform.     

Health effects and optimal environmental taxes

The literature on environmental taxation in the presence of pre-existing distortionary taxes has shown that interactions with these distortions tend to raise the cost of an environmental tax, and thus that the optimal environmental tax is less than marginal environmental damages. A recent paper by Schwartz and Repetto (2000) challenges this finding, arguing that the health benefits from reduced pollution will also interact with pre-existing taxes, and may cause the optimal environmental tax to exceed marginal damages.Schwartz and Repetto’s analysis represented health effects implicitly in the utility function. In contrast, the present paper explicitly represents health effects in an analytically tractable general equilibrium model. This model shows that interactions with health effects from pollution actually will tend to reduce the optimal environmental tax, contradicting, Schwartz and Repetto’s conclusion. This demonstrates the usefulness of explicitly modeling health effects, and it reinforces the general notion that tax-interactions tend to raise the costs of an environmental tax.     

Fiscal implications of AIDS in South Africa

The number of people living with HIV is alarmingly large. In addition to the incomprehensible human suffering of those directly affected, AIDS also has large, negative economic effects. In this paper, I study the fiscal implications of the HIV/AIDS epidemic in South Africa in a standard neo-classical growth model. I find that an antiretroviral program is to a large extent self financing. Improvement in dependency ratios and health care cost savings would pay for Rand 144 billion of a full epidemiological intervention. The indirect effect through the changing demographic structure will be more important than the direct health care cost saving effect. I also explore different taxation policies. The households would be willing to sacrifice an amount equal to 12% of GDP in the first period to be subject to an optimal (Ramsey) fiscal policy rather than an alternative fixed debt to GDP policy. The optimal policy implies an increase in government debt during the peak of the epidemic.     

从不同决策主体角度对药品不良反应相关成本的分析

药品不良反应是当前比较严重的公共卫生问题之一,为避免药品不良反应的发生和处理不良反应引起的后果需要消耗大量的社会资源。根据当前的制度环境,从不同决策主体角度分析与其相关的不良反应成本,为决策者提供参考依据,提高决策水平,优化资源的配置。     

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.     

Bivariate risk attitudes,informal care and saving

The article examines choices of saving and caregiving for informal caregivers who will face uncertainty in health status of elderly parents. The caregivers have a general form of utility with two attributes: wealth and parental health. Informal care will substitute for future need of formal care when parents are in good health. The article first studies the optimal levels of saving and of caregiving and the link between them. Comparative statics results depending on partial risk aversion or correlation attitude are then presented. These results concern the effects of changes in the opportunity cost of caregiving, the share of expected bequest, the health status and the interest rate. The analysis is also extended to investigate the role of cross-prudence/imprudence in wealth when a background health risk is introduced.     

Staff nurse financial management committees--the nurse manager's guide to effective financial performance

As Cohen states (1991, p. 25), "The future role that nursing will play in the health care delivery system is one of many major issues faced by contemporary nursing...Nursing must be able to determine realistically the cost of and evaluate the effectiveness of nursing care provided to its patients." A unit-based financial management committee is one very effective way of teaching the skills needed for the professional nurse to advance the practice in financial management. This will help nursing gain the professional status that they have always worked for. But beyond these very lofty ideals, a staff nurse managed financial management committee can make the nurse manager's life much easier. Staff nurses need to understand and accept the importance of managing the financial as well as the quality side of patient care. When this happens, the budget becomes theirs. Nurses develop a sense of ownership of the budget and learn how to effectively manage the unit's finances. Much staff nurse brain power is not used. Systems must be developed to access nurses' effective ideas for financial management--first in a financial management committee and then on the unit. Not only will this develop the professional status that nurses need and deserve, but it will also impact the cost of health care. In a society where the cost of an appendectomy requires Dayton Hudson to sell 39,000 Ninja Turtle action figures, Atlantic Richfield to sell 192,000 gallons of gas a day, Anheuser-Busch to sell 11,627 6-packs of 12 oz.(ABSTRACT TRUNCATED AT 250 WORDS)     

Universal Health Care and the Economics of Responsibility

In the American health care system the cost of health insurance is underwritten by all three sectors of the economy: 1) households; 2) employers; and 3) government. However, while costs are shared, responsibility is not. The retreat of private firms and government from assuming a substantial share of the burden of health care costs is based on the presumption that health care is an individual’s responsibility, while the contributions of government and the private sector are basically optional - a matter of benevolence rather than responsibility. The outcome of the current debates over health care reform will depend on this issue of responsibility. Who should pay for health care? Is it a collective responsibility or an individual one? In this paper, we explore the economics of responsibility as it applies to health care. In the institutionalist framework, any reallocation of costs must be driven by an underlying philosophy of shared responsibility.     

History and structure of business groups on health

In summary, business groups on health, given the strong financial and political support of key business decision makers, have shown that the competitive model can be used to encourage cost efficiencies in the health care system. It remains yet to be seen whether the growth of such organizations can produce needed change within a time frame that will make other approaches, such as national health insurance, unnecessary.     

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.     

Distress financing of out‐of‐pocket health expenditure in India

In the absence of a universal health insurance mechanism, the increasing burden of out‐of‐pocket (OOP) health expenditure has become a growing concern in India. To cope with the cost of illness, people use either their savings and income, or they have to rely upon distress means of finance such as depletion of household assets, borrowings from banks and moneylenders, and contributions from family and friends. This paper analyses the changes that have taken place in the incidence and covariates of distress financing in India by using data from National Sample Survey Organisation for the years 2004 and 2014. Results indicate that during this period the incidence of distress sources as a means to finance OOP health expenditure has hovered around 50%. Further, the results reveal a significant socioeconomic gradient in the incidence of distress financing. Socioeconomic and health‐related covariates significantly impact the likelihood of distress financing as a means to cope with OOP health expenditure. The results indicate the need for government action to formulate a comprehensive plan through an increase in public spending on health care that will improve the quantity and quality of the public health‐care system and enhance the scope of health insurance in India.     

The Impact of Access to Water on Child Health in Senegal

This paper addresses the impact of access to water on child health in Senegal by using multinomial propensity score matching to estimate the impact of five water sources on the incidence of diarrhea in children. This information will facilitate a more informed cost‐benefit analysis when implementing water projects. Much research categorizes water sources into a binary variable: “improved” or “unimproved”. According to the findings of this paper, this is an erroneous restriction, as I find heterogeneous impacts of water sources on child health. In fact, water sources that are generally believed to be superior are not significantly different, and some are significantly less effective in decreasing incidence of diarrhea.     

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.     

从人口、资源与环境的视点看中美食品贸易

食品贸易不仅仅是保障各国食品安全,利用不同国家比较优势获得经济利益的经济活动,也是与人类健康与安全、生态环境保护和生物资源可持续利用紧密相关的一个全球性社会问题。本文从人口、资源与环境的视点,利用国际贸易的比较优势理论分析了中美食品贸易的意义,得出以下主要结论：首先,应充分利用中国的人力资源成本优势和美国的机械费用优势,发展食品贸易,提高两国人民的福利;其次,为老龄人提供营养丰富的健康食品应成为中美食品贸易发展的机会之一;再次,应充分发挥两国的自然资源禀赋优势,发展食品贸易;最后,中国将成为美国食品贸易的巨大市场,但两国间对食品质量问题有较大的认识差距,因此应在食品贸易的过程中,不断培育绿色食品理念,加强政府间交流与沟通,构建食品安全控制机制。     

THE VALUE OF CLEANER AIR: AN INTEGRATED APPROACH

Policymakers in the legislative and regulatory arenas face increasing public expectations that authorities will both promulgate and implement strict environmental programs. At the same time, the aggregate cost of such programs is rising and is impacting economic sectors previously untouched. In this context, a major study used an integrated interdisciplinary perspective to determine what economic benefits would result from air pollution controls. Specifically, the study developed estimates for the health benefits of reducing ozone and fine particulate matter concentrations in the nation's most polluted region—the South Coast Air Basin centering on Los Angeles. This paper presents the economic methodologies and results of that study. It also discusses how health and atmospheric sciences informed the economic assessment.     

THE VALUE OF CLEANER AIR: AN INTEGRATED APPROACH

Policymakers in the legislative and regulatory arenas face increasing public expectations that authorities will both promulgate and implement strict environmental programs. At the same time, the aggregate cost of such programs is rising and is impacting economic sectors previously untouched. In this context, a major study used an integrated interdisciplinary perspective to determine what economic benefits would result from air pollution controls. Specifically, the study developed estimates for the health benefits of reducing ozone and fine particulate matter concentrations in the nation's most polluted region—the South Coast Air Basin centering on Los Angeles. This paper presents the economic methodologies and results of that study. It also discusses how health and atmospheric sciences informed the economic assessment.     

Moving towards an Improved Microsimulation Model of the Australian Pharmaceutical Benefits Scheme

Finding ways of curbing government expenditure on the Pharmaceutical Benefits Scheme (PBS) while maintaining social equity and access to ‘essential’ medicines is at the centre of ongoing public debate. This article describes a microsimulation model of the PBS that simulates current and future use and costs of PBS medicines under existing and different PBS policy settings, and estimates the distributional effects of policy changes. The article outlines future developments that will extend the current model to include health outcomes. Adding health outcomes will enable the debate on PBS sustainability to be advanced beyond the prevailing cost‐containment mentality to consider not only the costs of pharmaceutical use but also the benefits that result from the use of these medicines.     

基于政策导向的医用耗材管理

《关于深化医药卫生体制改革的意见》和《全国医疗服务价格项目规范（试行）》两政策对医院来说,都是更大的挑战。基于这些政策导向,就必须加强医用耗材管理,规范医用耗材的使用。为此,应控制高端产品的适用范围;引进ERP系统,同时对高值耗材实行条码化管理,确保医用耗材的实耗实销。将政策导向贯彻到医用耗材管理中,实现账物相符,收支平衡,杜绝内耗,在保证医护质量的情况下,合理使用医用耗材,保证患者费用合理,控制医疗费用的不合理增长,确保医院成本效益合理。     

The impact of frailty on the economic evaluation of geriatric surgery: hospital costs and opportunity costs based on meta-analysis

Abstract

Objectives: We used a systematic review and meta-analysis to analyze the difference in costs between surgery for frail and non-frail elderly patients. The opportunity cost of frailty in geriatric surgery is estimated using the results.

Methodology: Two literature reviews were carried out between 2000 and 2019: (1) studies comparing total hospital costs of frail and non-frail surgical patients; (2) studies evaluating the length of hospital stay and cost for surgical geriatric patients. We performed a meta-analysis of the items selected in the first review. We subsequently calculated the opportunity cost of frail patients, based on the design of a cost/time variable.

Results: Twelve articles in the first review were selected (272,717 non-frail and 16,461 frail). Fourteen articles were selected from the second review. Frail patients had higher hospital costs than non-frail patients (22,282.541 € and 16,388.844, p?<?.001) and a longer hospital stay (10.16 days and 8.4 (p?<?.001)). The estimated opportunity cost in frail patients is 1,019.56 € (cost/time unit factor of 579.30 €/day).

Conclusions: Frail surgical geriatric patients generate a higher total hospital cost, and an opportunity cost arising from not operating in the best possible state of health. Preoperatively treating the frailty of elderly patients will improve the use of health resources     

Immigration and health care reform: shared struggles

The connection between health care and immigration share overlaping key areas in policy reform. General concern, anger, and fear about immigration has been spreading nationwide. While illegal immigrants' use of expensive emergency department services does add to the cost for uncompensated care, this expenditure is not a primary cost driver but more a symptom of little or no access to preventative or primary health care. As a result of federal inaction, more state politicians are redefining how America copes with illegal residents including how or whether they have access to health care. The overlap of immigration and health care reform offers an opportunity for us to enter the next round of debate from a more informed vantage point.