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Showing posts with label costs. Show all posts
Showing posts with label costs. Show all posts

Wednesday, May 23, 2012

paywalled: Confidence in receiving medical care when seriously ill: a seven-country comparison of the impact of cost barriers - Health Expectations



Confidence in receiving medical care when seriously ill: a seven-country comparison of the impact of cost barriers - Wendt - 2011 - Health Expectations

Abstract

Objective  This paper examines how negative experiences with the health-care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States.
Methods  The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country-wise multivariate logistic regression models.
Results  Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In the Netherlands and UK, cost barriers are only a marginal phenomenon.
Conclusions  The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co-payments, have a negative effect on overall public support and therefore on the legitimacy of health-care systems.

Thursday, April 05, 2012

abstract: Eligibility criteria in private and public coverage policies for BRCA genetic testing and genetic counseling.



Eligibility criteria in private and public coverage policies for BRCA genetic testing and genetic counseling

Genet Med. 2011 Dec;13(12):1045-50. doi: 10.1097/GIM.0b013e31822a8113.

Abstract

PURPOSE:

Coverage policies for genetic services for hereditary cancers are of interest because the services influence cancer risk reduction for both persons with cancer and their family members. We compared coverage policies for BRCA genetic testing and genetic counseling among selected payers in the United States to illuminate eligibility criteria variation that may explain differential access by insurance type. We compared these policies with policies for breast cancer screening with magnetic resonance imaging to consider whether payers apply a unique policy approach to genetic services.

METHODS:

We conducted a case study of large private and public payers selected on number of covered lives. We examined coverage policies for BRCA genetic testing, genetic counseling, and screening with magnetic resonance imaging and the eligibility criteria for each. We compared eligibility criteria against National Comprehensive Cancer Network guidelines.

RESULTS:

Eligibility criteria for BRCA testing were related to personal history and family history of cancer. Although private payers covered BRCA testing for persons with and without cancer, the local Medicare carrier in our study only covered testing for persons with cancer. In contrast, Arizona's Medicaid program did not cover BRCA testing. Few payers had detailed eligibility criteria for genetic counseling. Private payers have more detailed coverage policies for both genetic services and screening with magnetic resonance imaging in comparison with public payers.

CONCLUSION:

Despite clinical guidelines establishing standards for BRCA testing, we found differences in coverage policies particularly between private and public payers. Future research and policy discussions can consider how differences in private and public payer policies influence access to genetic technologies and health outcomes.

Saturday, March 17, 2012

WSJ to Biotech: "You're All Going To Die." Thanks - Now Let's Keep Fighting. - Forbes (worth reading)



WSJ to Biotech: "You're All Going To Die." Thanks - Now Let's Keep Fighting. - Forbes

"Friday’s WSJ features a brutally – I mean brutally — frank article about the dismal state of biotech financing.  There are few revelations (certainly not for those readers of this column who I know follow the space closely), and unfortunately, few patches of sunlight.   This clip from Play It Again, Sam pretty much captures the tone.
The crisis in financing is having a chilling effect on biomedical innovation.  As discussed in my last column, the main problem in our industry is that the sheer cost of drug development has become almost prohibitively expensive, effectively pricing almost everyone but the largest companies out of the market............"

"..........In the land of digital health, I also worry that there are a lot of developers who I don’t think really understand the gravitas of illness and disease.  For many of these folks, wellness is best envisioned as a fun and entertaining diversion, one that should be pursued with enthusiasm and characterized by delight.  Yet this whole idea of “gamefication” – while obviously both popular and fundable – doesn’t really connect with so much of what I’ve seen as a physician (and you don’t have to be a physician to understand the distinction – clearly, Jamie Heywood is an it-getter).
Perhaps when you’re 22, wellness is a game, but for most of the patients I recall in internal medicine, it really was anything but; patients have very serious, often existential concerns about their health, and about their ability to work and to provide.  What these patients want, expect, and deserve is serious engagement – and not some dipshit app........."

Tuesday, March 13, 2012

YouTube: Interview with Dr Stukel, Author of Hospital Spending Intensity and Patient Outcomes




Also, planning a comparison study with London School of Economics and Havard

open access: Association of Hospital Spending Intensity With Mortality and Readmission Rates in Ontario (Canada) Hospitals, March 14, 2012 — JAMA



 Blogger's Note: universal healthcare system, this study included colorectal cancer patients, comparisons between Canadian/U.S. systems, note authors' affiliations

Association of Hospital Spending Intensity With Mortality and Readmission Rates in Ontario Hospitals, March 14, 2012

"Our objective was to assess whether acute care patients admitted to Canadian hospitals that treat patients more intensively (and at higher cost) have lower mortality and readmissions and higher quality of care.......We studied 4 common conditions that have moderate to high incidence and mortality, that can be validly ascertained using health administrative data, and for which treatment follows relatively standard protocols. "

Design Overview

We undertook a longitudinal cohort study of patients hospitalized with selected acute clinical conditions in Ontario, Canada, and assessed the content, quality, and outcomes with respect to “exposure” to the index hospital's medical spending intensity. Medical intensity is defined as the quantity of medical care provided overall to similarly ill patients and is a marker of a hospital's propensity to treat similarly ill patients more (or less) intensively. It reflects the component of spending variation attributable to practice style rather than to differences in illness or price.
Because sicker patients use more services, higher-spending hospitals may appear to have worse outcomes, in part because patients are more severely ill. We used several techniques to remove this potential “reverse causality,” as in previous work.1,2​,3,4

 COMMENT

We found that higher hospital spending intensity was associated with better survival, lower readmission rates, and better quality of care for seriously ill, hospitalized patients in Ontario in a universal health care system with more selective access to medical technology. Higher-spending hospitals were higher-volume teaching or community hospitals with high-volume or specialist attending physicians and having specialized programs, such as regional cancer centers, and specialized services, such as on-site cardiac catheterization, cardiac surgery, and diagnostic imaging facilities. The study also points to plausible mechanisms through which higher spending may be associated with better outcomes. 

Benefits appeared early, suggesting an acute-phase hospital effect. For acute conditions, timely access to preoperative and in-hospital specialist care, skilled nursing staff, rapid response teams, cardiac high-technology services, and regional cancer centers, all found in the higher-spending systems, are related to better outcomes.21​,27,34​,35,36​,37,38​,39 These systems also provided consistently, but not strikingly, higher levels of evidence-based care and collaborative ambulatory care, both shown to improve care.22​,23,40 Higher spending on evidence-based services delivered in the acute phase of care for severely ill hospitalized patients—by far the largest component of spending for our cohorts—is indeed likely to be beneficial. 

It would be facile to interpret this study as demonstrating that higher spending is causally related to better outcomes and that providing more money to lower-spending hospitals would necessarily improve their outcomes. Higher-spending hospitals differed in many ways, such as greater use of evidence-based care, skilled nursing and critical care staff, more intensive inpatient specialist services, and high technology, all of which are more expensive. 

To place the study in context, the United States has a 3- to 4-times higher per capita supply of specialized technology, such as computed tomography and magnetic resonance imaging scanners, but a similar supply of acute care beds and nurses.41 Ontario 2001 population rates of cardiac testing and revascularization lagged behind corresponding 1992 US rates and paralleled the supply of cardiologists and catheterization facilities.42​,43,44 It is therefore possible that Canadian hospitals, with fewer specialized resources, selective access to medical technology, and global budgets, are using these resources more efficiently, especially during the inpatient episode for care-sensitive conditions.45,46 Canada's health care expenditures per capita are about 57% of those in the United States.47 At this spending level, there might still be a positive association between spending and outcomes. For example, the same-day PCI rate for patients with AMI in low-intensity hospitals in 2008 was 3.5%, leaving room for improvement. This pattern is consistent with studies in the United States showing a positive association between spending and outcomes among low-intensity hospitals or regions but no association at average or higher intensity levels.5​,6

Strengths of the study include the population-based, longitudinal cohort design; the consistency of findings across cardiac, cancer, medical, and surgical patients; the examination of plausible clinical mechanisms whereby higher intensity may be associated with better outcomes; and the examination of readmissions. The “look-back” (EOL-EI) and “look-forward” (AC-EI) measures of spending intensity were highly correlated and produced similar findings, as in US studies.2
 ​
Several limitations should be considered. Because the design precludes strong inferences about causation, we cannot know which components of care may have led to better outcomes. In observational studies, comparisons of exposure groups may be biased because of unobserved selection bias.13 It is unlikely that the findings are the result of unmeasured case mix, because patients in higher-spending hospitals had similar or higher illness severity at admission, which would, if anything, bias toward finding worse outcomes. We cannot rule out the possibility that higher-intensity hospitals coded more aggressively, but there is less incentive to do so in a system with global hospital budgets. Although admission severity would be determined more accurately using clinical detail from medical charts, previous work has shown high concordance between risk-adjusted hospital outcomes using chart and administrative data.48​,49 Canadian data distinguish between comorbidities present at admission and complications, leading to improved admission severity coding. The EOL-EI has been critiqued for the purpose of estimating hospital efficiency50​,51 but is used here simply to distinguish high- and low-intensity hospitals, as in other US studies.1​,2,3​,4 The findings may not generalize to chronic conditions, for which avoiding exacerbations of disease that lead to hospitalization through coordinated ambulatory care is key. The findings also may not generalize to jurisdictions in which hospital resources are more abundant and are used in cost-effective as well as cost-ineffective ways, leading to inefficiency.45​,46

This study shows that in Ontario, a province with global hospital budgets and fewer specialized health care resources than the United States, outcomes following an acute hospitalization are positively associated with higher hospital spending intensity. Higher spending intensity, in turn, is associated with greater use of specialists, better patient care, and more use of advanced procedures. These results suggest that it is critical to understand not simply how much money is spent but whether it is spent on effective procedures and services. 

pdf file: 

http://jama.ama-assn.org/content/307/10/1037.full.pdf




Monday, June 13, 2011

abstract: Consolidation paclitaxel is more cost-effective than bevacizumab following upfront treatment of advanced epithelial ovarian cancer (taxol/avastin)



Introduction


Randomized trials have demonstrated significant improvements in progression-free survival (PFS) with consolidation paclitaxel (P) and bevacizumab (B) following cytoreduction and adjuvant carboplatin/paclitaxel (CP) for advanced epithelial ovarian cancer (EOC). We sought to evaluate the cost-effectiveness (C/E) of these consolidation strategies.

Conclusions


In this model, B consolidation for advanced EOC was associated with a modest improvement in effectiveness that is less than that with P consolidation and more costly. A statistically significant improvement in survival may improve the value of B consolidation.

Research highlights


► Paclitaxel is a more cost-effective consolidation option in advanced ovarian cancer.
► Consolidation Bevacizumab is not cost-effective for advanced ovarian cancer.

abstract - Gynecologic Oncology : The revolving door: Hospital readmissions of gynecologic oncology patients



Conclusions

Hospital readmissions affect the cost of care, but also the quality of care delivered to our patients. When extrapolated across institutions and across the country, unplanned readmissions are a costly expenditure to patients and the health system, deserving of attention.

Research highlights

► Readmissions to the Gynecologic Oncology service affected 13.2% of the population.
► Total cost of readmissions in 5 years at a single academic institution: $6,421,733.
► Unplanned readmissions: 72.6% of the cost for ovarian/uterine/cervical cancer.

Friday, June 10, 2011

Cancer patients struggle as drug costs soar - Michigan News



Blogger's Note: decisions eg "buy groceries or not" is not new to cancer patients/families and is a rather old comment which seemingly has not made an impact (on instititional decision makers)

"Overall, this study provides a patient-centered view of a reality of modern day cancer care -- something that we call 'financial toxicity,'" senior author Dr. Amy Abernethy, an associate professor in Duke's medical oncology division, said in a Duke news release.
"We used to think about chemotherapy toxicity in terms of bad side effects like vomiting, nerve pain, confusion and risk of fatal infection. Now we are starting to think in terms of how treatment choices impact real aspects of daily living such as the ability to buy groceries or not," she added."

Friday, January 14, 2011

Annual Costs of Cancer Care | Cancer Prevalence and Cost of Care Projections - female/male cancer sites (ncluding ovarian)



Chart:  Average Annual Costs of Care

Annualized Mean Net Costs of Care by Age, Gender and Phase of Care (Per Patient). Costs in 2010 US Dollars.

Monday, December 06, 2010

Canada - Fraser Institute:The Dollar Cost of Medicare | Fraser Institute



The Dollar Cost of Medicare

Appeared in the New Brunswick Telegraph Journal
Authors:
Release Date: November 16, 2010
The true cost of Medicare for individuals and families in Canada is often misunderstood, with many people thinking it’s either free or covered by our provincial health insurance premiums....cont\d

Tuesday, September 07, 2010

Canadian Doctors for Medicare | False Alarm on Health Care



"....the tiresome insistence on using faulty logic to justify alarmist views on health care.

Three pieces of real data ought to put this debate to rest.

First, increases in the cost of health care are not a result of our public system. They are common to systems around the world, all facing new and expensive technologies and ever-increasing demand.

Second, Canada's medicare system is actually quite reasonably priced. It is the increasing cost of drugs, which are mostly privately funded, that is increasing health-care costs.

Third, user fees and privatization would increase health-care costs overall by downloading them from governments onto citizens. Furthermore, experience with user fees demonstrates that they cause people to delay necessary care, which leads to more profound and expensive illnesses when care is eventually sought....."cont'd

Wednesday, July 21, 2010

Comparative effectiveness of screening and prevention strategies among BRCA1/2-affected mutation carriers



Conclusion: Our analysis suggested that among BRCA1/2 mutation carriers, prophylactic surgery would dominate or be cost effective compared to chemoprevention and screening. Annual screening with MRI and mammography was the most effective strategy because it was associated with the longest quality-adjusted survival, but it was also very expensive.

Thursday, July 08, 2010

U.S. - States Requiring Coverage of Clinical Trial Costs - National Cancer Institute



A growing number of states have passed legislation or instituted special agreements requiring health plans to pay the cost of routine medical care you receive as a participant in a clinical trial......
.......updated with information about Florida, Iowa, and South Carolina.

As of July 1, 2010, these states have implemented legislation or voluntary agreements requiring health plans to pay the cost of routine medical care for participants in certain clinical trials. More than 30 states now require such coverage through legislation or special voluntary agreements. View website…
Links on this page

* Use this map or this alphabetical list.
* Overview of the issue.
* Other resources.

Monday, May 17, 2010

amednews: Hospitals exchange of cost data clears antitrust hurdle :: May 17, 2010 ... American Medical News



"Quality-adjusted pricing also should be taken into account, he said. "From an antitrust perspective, when dealing with a service industry ... just looking at cost may say very little."