OBJECTIVE -To compare the odds of major depression among Medicare claimants with and without diabetes and to test whether annual medical payments are greater for those with both diabetes and major depression than for those with diabetes alone. RESEARCH DESIGN AND METHODS-This retrospective analysis relies on claims data from the 1997 Medicare 5% Standard Analytic Files. Using these data, we statistically determined whether the odds of major depression are greater among elderly claimants with diabetes after controlling for age, race/ethnicity, and sex. We then used regression analysis on a sample of over 220,000 elderly claimants with diabetes to test whether payments for non-mental health-related services are greater for those with both diabetes and major depression (n ϭ 4,203) than for those with diabetes alone. RESULTS -Our findings indicate that the odds of major depression are significantly greater among elderly Medicare claimants with diabetes than among those without diabetes (OR 1.58 Ϯ 0.05). We also found that elderly claimants with both diabetes and major depression seek treatment for more services and spend more time in inpatient facilities, and as a result incur higher medical costs than claimants with diabetes but without major depression. These results hold even after excluding services related to mental health treatment.CONCLUSIONS -This analysis suggests that treatment for major depression among claimants with diabetes may reduce total medical costs if treatment results in a decrease in utilization for general medical services in the future. Diabetes Care 26:415-420, 2003
Over the past twenty-five years, the average ratio of hospital charges for services (gross revenues) to payments received (net revenues) has grown from 1.1 to 2.6. This reflects a transition from predominantly cost-and charge-based payment systems to regulated and negotiated fixed payments. Hospitals have been able to squeeze additional revenues from remaining charge-based payers and services by sharply increasing charges, negatively affecting the uninsured. Although protection of the uninsured seems warranted, it might be difficult to regulate hospital pricing systems in isolation from other controversial issues, such as the acceptability of cross-subsidies and the role of market forces. [Health Affairs 25, no. 1 (2006): 45-56] O c c a s i o na l n e ws s to r i e s have "exposed" inexplicable prices for products and services provided by hospitals, such as a five-dollar aspirin pill. During the past twenty-five years, hospital charges have gone from tracking fairly closely with production costs to exceeding them many times over. Are hospitals aggressive price-setters that are brazenly taking advantage of patients at their most vulnerable moments? Or have powerful payers lowered hospital payments to levels that force hospitals to seek additional funding from a limited number of other payer groups?This paper attempts to shed light on the forces that have generated the gap between billed charges and underlying costs by tracing the history of setting charges for hospital services and examining the role and implications of the chargemaster (catalog of retail list prices) for hospitals, purchasers, and patients. Data were obtained from a literature review and interviews with a small convenience sample of senior executives and other professionals working in the hospital industry in different parts of the country, including for-profit and not-for-profit settings.
Narcotics and other prescription drugs play a significant and legitimate role in medical practice. The illicit use of prescribed medicines, however, remains a major problem. This paper examines the effectiveness of two drug diversion control programs, multiple copy prescriptions programs (MCPP) and electronic data transfer (EDT) systems, and their impact on medical practice. Current evidence demonstrates that these programs decrease prescription drug use, with much of the decrease due to declines in inappropriate use. MCPPs appear more effective than EDT in preventing diversion. More research is needed. however, to assess their effects on medical practice, particularly patient quality of care.
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