Cost Control in a Parallel Universe: Medicare Spending in the United States and Canada

Himmelstein, David U.; Woolhandler, Steffie

doi:10.1001/2013.jamainternmed.272

Cited by 17 publications

(6 citation statements)

References 3 publications

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“…16 The trend is also consistent with the more rapid increase in inflation-adjusted overall Medicare spending after 1999. 17 Third, Sharma et al 18 reported that the proportion of Medicare patients experiencing comanagement was relatively unchanged from 1996 to 2000 and then increased sharply. They found that “the increase was entirely attributable to a surge in comanagement by generalist physicians.” 18 (p363) Although cataract surgery is performed on an outpatient basis, it is possible that generalists’ increased involvement with perioperative care extends to outpatient surgery.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Consultations for Medicare Patients Undergoing Cataract Surgery

et al. 2014

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IMPORTANCE Low-risk elective surgical procedures are common, but there are no clear guidelines for when preoperative consultations are required. Such consultations may therefore represent a substantial discretionary service.OBJECTIVE To assess temporal trends, explanatory factors, and geographic variation for preoperative consultation in Medicare beneficiaries undergoing cataract surgery, a common low-risk elective procedure. DESIGN, SETTING, AND PARTICIPANTS Cohort study using a 5% national random sample of Medicare part B claims data including a cohort of 556 637 patients 66 years or older who underwent cataract surgery from 1995 to 2006. Temporal trends in consultations were evaluated within this entire cohort, whereas explanatory factors and geographic variation were evaluated within the 89 817 individuals who underwent surgery from 2005 to 2006. MAIN OUTCOMES AND MEASURES Separately billed preoperative consultations (performed by family practitioners, general internists, pulmonologists, endocrinologists, cardiologists, nurse practitioners, or anesthesiologists) within 42 days before index surgery. RESULTS The frequency of preoperative consultations increased from 11.3% in 1998 to 18.4% in 2006. Among individuals who underwent surgery in 2005 to 2006, hierarchical logistic regression modeling found several factors to be associated with preoperative consultation, including increased age (75-84 years vs 66-74 years: adjusted odds ratio [AOR], 1.09 [95% CI, 1.04-1.13]), race (African American race vs other: AOR, 0.71 [95% CI, 0.65-0.78]), urban residence (urban residence vs isolated rural town: AOR, 1.64 [95% CI, 1.49-1.81]), facility type (outpatient hospital vs ambulatory surgical facility: AOR, 1.10 [95% CI, 1.05-1.15]), anesthesia provider (anesthesiologist vs non-medically directed nurse anesthetist: AOR, 1.16 [95% CI, 1.10-1.24), and geographic region (Northeast vs South: AOR, 3.09 [95% CI,). The burden of comorbidity was associated with consultation, but the effect size was small (<10%). Variation in frequency of consultation across hospital referral regions was substantial (median [range], 12% [0-69%]), even after accounting for differences in patient-level, anesthesia provider-level, and facility-level characteristics. Between 1995 and 2006, the frequency of preoperative consultation for cataract surgery increased substantially. Referrals for consultation seem to be primarily driven by nonmedical factors, with substantial geographic variation. CONCLUSIONS AND RELEVANCE

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Section: Discussionmentioning

confidence: 99%

Preoperative Consultations for Medicare Patients Undergoing Cataract Surgery

et al. 2014

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“…Health care reforms were enacted in some countries to bend the rising health care cost curve [ 36 , 37 ]. In Canada, several features of its program helped constrain cost [ 38 ]. Canadian hospitals received prospectively determined global operating budgets, in which capital costs were not involved but distributed separately, eliminating incentives to overprovide lucrative services.…”

Section: Discussionmentioning

confidence: 99%

Trends and Factors Affecting Hospitalization Costs in Patients with Inflammatory Bowel Disease: A Two-Center Study over the Past Decade

Tang

Shen

2013

Gastroenterology Research and Practice

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With the growing number of patients with inflammatory bowel disease (IBD) and hospitalization cases, the overall medical care cost elevates significantly in consequence. A total of 2458 hospitalizations, involving 1401 patients with IBD, were included from two large medical centers. Hospitalization costs and factors impacting cost changes were determined. Patients with IBD and frequency of hospitalizations increased significantly from 2003 to 2011 (P < 0.001). The annual hospitalization cost per patient, cost per hospitalization, and daily cost during hospitalization increased significantly in the past decade (all P < 0.001). However, length of stay decreased significantly (P < 0.001). Infliximab was the most significant factor associated with higher hospitalization cost (OR = 44380.09, P < 0.001). Length of stay (OR = 1.29, P < 0.001), no medical insurance (OR = 1.31, P = 0.017), CD (OR = 3.55, P < 0.001), inflammatory bowel disease unclassified (IBDU) (OR = 4.30, P < 0.0001), poor prognosis (OR = 6.78, P < 0.001), surgery (OR = 3.16, P < 0.001), and endoscopy (OR = 2.44, P < 0.001) were found to be predictors of higher hospitalization costs. Patients with IBD and frequency of hospitalizations increased over the past decade. CD patients displayed a special one peak for age at diagnosis, which was different from UC patients. The increased hospitalization costs of IBD patients may be associated with infliximab, length of stay, medical insurance, subtypes of IBD, prognosis, surgery, and endoscopy.

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“…13 This increased expenditure does not add demonstrable benefit to US patients. 14 At the other extreme are more modest prices in the Middle East, Africa, Latin America, and other emerging nations, where only a minority of patients can afford, as individuals or through government subsidies, to access the CML drugs. In many emerging nations where governments cannot afford to budget for such drugs, CML experts are advocating frontline allogeneic stem cell transplantation because it costs an average of $30 000 to $80 000 as a one-time procedure.…”

mentioning

confidence: 99%

The price of drugs for chronic myeloid leukemia (CML) is a reflection of the unsustainable prices of cancer drugs: from the perspective of a large group of CML experts

2013

Blood

533

144

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As a group of more than 100 experts in chronic myeloid leukemia (CML), we draw attention to the high prices of cancer drugs, with the particular focus on the prices of approved tyrosine kinase inhibitors for the treatment of CML. This editorial addresses the multiple factors involved in cancer drug pricing and their impact on individual patients and health care policies, and argues for the need to (1) lower the prices of cancer drugs to allow more patients to afford them and (2) maintain sound long-term health care policies.

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Cost Control in a Parallel Universe: Medicare Spending in the United States and Canada

Cited by 17 publications

References 3 publications

Preoperative Consultations for Medicare Patients Undergoing Cataract Surgery

Preoperative Consultations for Medicare Patients Undergoing Cataract Surgery

Trends and Factors Affecting Hospitalization Costs in Patients with Inflammatory Bowel Disease: A Two-Center Study over the Past Decade

The price of drugs for chronic myeloid leukemia (CML) is a reflection of the unsustainable prices of cancer drugs: from the perspective of a large group of CML experts

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