Hips and hearts: The variation in incentive effects of insurance across hospital procedures

Doiron, Denise; Fiebig, Denzil G.; Suziedelyte, Agne

doi:10.1016/j.jhealeco.2014.06.006

Cited by 33 publications

(9 citation statements)

References 39 publications

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“…Secondary end points were the level of adherence with the eTG for the management of severe pyelonephritis/urosepsis and the appropriateness of gentamicin use in this sample population. Adherence to standard treatment guidelines was evaluated based on recommendations in the eTG 23 , where first line treatment is stated (for the complete study period) as gentamicin IV 4–6 mg/kg given as an immediate single dose with amoxicillin/ampicillin IV 2 g given every 6 hours [24,25]. For patients hypersensitive to penicillin, gentamicin alone can be used for initial therapy.…”

Section: Methodsmentioning

confidence: 99%

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The use of initial dosing of gentamicin in the management of pyelonephritis/urosepsis: A retrospective study

et al. 2019

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ObjectiveThe primary objective was to determine if initial empirical intravenous dosing of gentamicin improved patient's outcomes in pyelonephritis/urosepsis compared with alternative IV antibiotic management.DesignRetrospective cross-sectional descriptive study.SettingPublic TertiaryTeaching Hospital serving adults in an urban centre.ParticipantsAll adult patient records with a recorded diagnosis of any of pyelonephritis/urosepsis, urinary tract infection, UTI, complicated urinary tract infection, bacteriuria, symptomatic bacteriuria and asymptomatic bacteriuria from 2nd February 2012 to 10th May 2014 were reviewed. Only patients treated with an empirical regimen of one or more IV antibiotics were included in the study.Main outcomesThe primary outcomes were: duration of IV antibiotic treatment, time to resolution of symptoms and length of hospital stay (LOS). Secondary end points were: compliance with Therapeutic Guidelines: Antibiotic (electronic version) (eTG) for severe pyelonephritis/urosepsis and appropriateness of gentamicin use.Data analysisUnivariate and multivariable associations between baseline and demographic variables and the main outcomes were performed using Chi-square tests and a General Linear Model using the SAS version 9.2 software.ResultsOf 295 patients reviewed 152 were prescribed one or more IV antibiotics and included in the study. Approximately half of the patients (n = 73, 48%) were prescribed IV piperacillin/tazobactam (Tazocin), while gentamicin was prescribed for 66 patients (43.4%). Of the 152 patients evaluated, 49 (32%) were given gentamicin first. Multivariable regression analysis showed that duration of IV treatment was shorter for those aged over 70 (40.2 hours vs 85.5 hours for those aged up to 70; p = 0.0074), and those who received gentamicin as first line treatment (41.3 hours vs 89.8 hours for those not receiving any gentamicin; p = 0.0312). After adjustment for age and gentamicin administration, there appeared to be no significant difference in duration of IV treatment for any other independent variables. No significant associations between the independent variables (gentamicin, age, gender, comorbidities, and eTG compliance) and either time to resolution of symptoms (median: 68 hours) or hospital LOS (median: 5 days) were observed.ConclusionsNeither time to resolution of abnormal symptoms nor length of stay were significantly influenced by an initial dose of gentamicin when the data were subjected to multivariable analysis. The age of the patient and pattern of gentamicin treatment were the dominant factors associated with duration of IV antibiotics. Piperacillin/tazobactam is not recommended in treatment guidelines for pyelonephritis/urosepsis but was the most commonly prescribed IV antibiotic. This requires review by the appropriate hospital clinicians.

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Section: Methodsmentioning

confidence: 99%

“…coli , Klebsiella pneumoniae and Pseudomonas aeruginosa [21, 22]. In Australia, the Therapeutic Guidelines: Antibiotic (electronic version) (eTG) [23], recommend gentamicin IV 4–6 mg/kg as a single dose with amoxicillin/ampicillin IV 2 g 6 hourly as first line empirical therapy in urosepsis [24, 25].…”

Section: Introductionmentioning

confidence: 99%

The use of initial dosing of gentamicin in the management of pyelonephritis/urosepsis: A retrospective study

et al. 2019

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“…Although we control for an extensive set of variables measuring objective and subjective health status and preference heterogeneity, we cannot fully rule out the possibility of biases resulting from omitted variables. To gauge how large the remaining biases in the estimated effects of marital status would be, we examine how sensitive the estimates are to the exclusions of observed controls, following the literature (Altonji, Elder, & Taber, 2005; Doiron, Fiebig, & Suziedelyte, 2014). Specifically, we delete a particular set of control variables from the specification with full sets of controls each time and re‐estimate these alternative specifications.…”

Section: Empirical Strategymentioning

confidence: 99%

Marital status and hospital use in older adults

Hall

2022

Australian Economic Papers

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The proportion of single person households is increasing with population ageing. At older ages living in a single person household is more likely to be due to bereavement or separation than at younger ages. We examine the association between marital status and the likelihood and the length of hospitalisations, with particular emphasis on whether and how this association varies by different types of hospitalisations with a distinct nature of care. Using a large survey linked to multiple years of detailed administrative records enables us to better control for individual heterogeneity and allows us to conduct a finer classification of hospitalisations. A two‐part model is used for estimation. We also investigate the relationship between marital status and the presentations to emergency department. The results show singles have an increased probability of hospitalisation and length of stay, with a substantial heterogeneity revealed in the association between marital status and different types of hospitalisations. The findings are consistent with the lesser availability of informal care for those being single and point to the need to develop appropriate and targeted strategies to reduce hospitalisation in this group.

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“…Among studies of the latter, many consider the effects of PHI on hospital utilization, including Holly et al (1998), Harmon and Nolan (2001), Savage and Wright (2003), Doiron, Fiebig and Suziedelyte (2014) and Eldridge, Onur and Velamuri (2017). However, fewer consider moral hazard in extras treatments such as dental services, vision care or allied health services, not least in Australia.…”

Section: Related Studiesmentioning

confidence: 99%

Moral hazard in Australian private health insurance: the case of dental care services and extras cover

Nguyen

Worthington

2021

Geneva Pap Risk Insur Issues Pract

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We assess ex post moral hazard in Australian private health insurance (PHI) relating to dental care services (so-called extras cover) using the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) Survey. Cross-sectional probit regressions specify dental care use as a function of dental care demand and endogenous PHI policy holding, including selfassessed health condition, health risk factors and socioeconomic controls including age, income, education, family structure and welfare status. We find that ex post moral hazard results in the additional use of dental care services by PHI holders. Further, dynamic analysis indicates that PHI, no matter how sporadic, is always associated with significantly more likely use of dental care services, increasing when continuously held, suggesting strong persistence in moral hazard.Keywords Private health insurance ⋅ moral hazard ⋅ dental care services ⋅ Australia

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Hips and hearts: The variation in incentive effects of insurance across hospital procedures

Cited by 33 publications

References 39 publications

The use of initial dosing of gentamicin in the management of pyelonephritis/urosepsis: A retrospective study

The use of initial dosing of gentamicin in the management of pyelonephritis/urosepsis: A retrospective study

Marital status and hospital use in older adults

Moral hazard in Australian private health insurance: the case of dental care services and extras cover

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