Methods for Analyzing Health Care Utilization and Costs

Diehr, Paula; Yanez, David; Ash, Arlene S.; Hornbrook, Mark C.; Lin, Danyu

doi:10.1146/annurev.publhealth.20.1.125

Cited by 583 publications

(450 citation statements)

References 23 publications

(17 reference statements)

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“…18 In the first part of the model, we used logistic regression to predict the probability of incurring any healthcare expenditure in 2000. For the second part, we used the algorithm of Manning and Mullahy 19 to identify the most appropriate model specifications to predict health expenditures for adults who incurred any healthcare expenditures in 2000.…”

Section: Methodsmentioning

confidence: 99%

“…Heteroskedasticity was not evident, so expenditures were retransformed using the Duan nonparametric procedure to obtain predictions expressed in dollars. 18,19 We calculated overall annual per capita expenditures by multiplying each individual's probability of incurring any expense by his or her predicted expenditure. Using these same methods, we also calculated annual per capita expenditures for office-based visits, outpatient hospital visits, in-patient hospital visits, and prescription drugs.…”

Section: Methodsmentioning

confidence: 99%

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Impact of morbid obesity on medical expenditures in adults

2005

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CONTEXT: Morbid obesity (body mass index (BMI) Z40 kg/m 2 ) is associated with substantially increased morbidity and mortality from chronic health conditions and with poorer health-related quality of life; however, less is known about the impact of morbid obesity on healthcare expenditures. OBJECTIVE: To examine the impact of morbid obesity on healthcare expenditures using a nationally representative sample of US adults. DESIGN, SETTING, AND PARTICIPANTS: We performed a cross-sectional analysis of 16 262 adults from the 2000 Medical Expenditure Panel Survey, a nationally representative survey of the noninstitutionalized civilian population of the United States. Per capita healthcare expenditures were calculated for National Institutes of Health BMI categories, based on self-reported height and weight, using a two-part, multivariable model adjusted for age, gender, race, income, education level, type of health insurance, marital status, and smoking status. MAIN OUTCOME MEASURES: Odds of incurring any healthcare expenditure and per capita healthcare expenditures associated with morbid obesity in 2000. RESULTS: When compared with normal-weight adults, the odds of incurring any healthcare expenditure in 2000 were two-fold greater among adults with morbid obesity. Per capita healthcare expenditures for morbidly obese adults were 81% (95% confidence interval (CI): 48-121%) greater than normal-weight adults, 65% (95% CI: 37-110%) greater than overweight adults, and 47% (95% CI: 11-96%) greater than adults with class I obesity. Excess costs among morbidly obese adults resulted from greater expenditures for office-based visits, outpatient hospital care, in-patient care, and prescription drugs. Aggregate US healthcare expenditures associated with excess body weight among morbidly obese US adults exceeded $11 billion in 2000. CONCLUSIONS: The economic burden of morbid obesity among US adults is substantial. Further research is needed to identify interventions to reduce the incidence and prevalence of morbid obesity and improve the health and economic outcomes of morbidly obese adults.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Impact of morbid obesity on medical expenditures in adults

2005

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“…This method incorporates the likelihood of an individual incurring costs as well as the average estimate of the individual's costs based on their characteristics employing the survey weighting in incremental dollar changes. 25 The regression model dependent variable was costs in 2011 $US.…”

Section: Discussionmentioning

confidence: 99%

Association of increased emergency rooms costs for patients without access to necessary medications

Watanabe

Ney

2015

Research in Social and Administrative Pharmacy

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Background: Prescription medications are an important component of chronic disease management. They are vital in preventing unnecessary ER visits. However, few studies have examined the association between patients' self-reported inability to receive necessary medications and emergency room costs. Objectives: The study objectives were to: 1) determine differences in ER costs based on self-reported ability to obtain necessary medications. 2) identify differences in ER costs based on self-reported ability to obtain necessary medications among medication users. The association was also examined by insurance category. Methods: Respondent data from 10 years (2002-2011) of the U.S. Medical Expenditure Panel Survey was analyzed. The models employed estimated the association of respondents reporting being 'unable to receive necessary medications' on ER expenditures. Secondarily, the relationship was assessed by insurance category: private, public, and uninsured. Two-part cost regression models with bootstrapped estimates to produce 95% confidence intervals of cost differences were applied for these analyses. Significance was set at a ¼ 0.05. Analyses were completed using SAS 9.4 (Cary, NC) and Stata 13 (College Station, TX). Estimates were in 2011 US dollars. Results: People unable to receive necessary medications experienced increased average annual ER costs of $46.62 with 95% a confidence interval [CI] of 34.76-58.49) compared to patients able to receive necessary medications. By insurance category, respondents unable to receive necessary medications experienced increased ER costs ), for Publically Insured, Privately Insured, and Uninsured, respectively. Findings were similar for those already using medications. Conclusions: Inability to obtain necessary medications is associated with increased emergency room costs. Those with public insurance have a larger increase in ER costs if they are without necessary medications compared to those insured privately or without insurance.

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“…We used a two-part model to estimate inpatient expenditures because a large proportion of individuals had no inpatient admissions and, for those with admissions, expenditures were positively skewed [25]. In the first part of the two-part model, we used logistic regression to estimate the probability that a person with diabetes would have inpatient expenditures, and in the second part, we used a generalized linear model with log link and gamma distribution to estimate the inpatient expenditures for those who had such expenditures.…”

Section: Discussionmentioning

confidence: 99%

Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008

Shrestha

Zhang

et al. 2013

Diabetes Research and Clinical Practice

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Aim-We aimed at estimating excess medical expenditures associated with major depressive disorder (MDD) among working-age adults diagnosed with diabetes, disaggregated by treatment mode: insulin-treated diabetes (ITDM) or non-insulin-treated diabetes (NITDM).Methods-We analyzed data for over 500,000 individuals with diagnosed diabetes from the 2008 U.S. MarketScan claims database. We grouped diabetic patients first by treatment mode (ITDM or NITDM), then by MDD status (with or without MDD), and finally by whether those with MDD used antidepressant medication. We estimated annual mean excess outpatient, inpatient, prescription drug, and total expenditures using regression models, controlling for demographics, types of health coverage, and comorbidities.Results-Among persons having ITDM, the estimated annual total mean expenditure for those with no MDD (the comparison group) was $19,625. For those with MDD, the expenditures were $12,406 (63%) larger if using antidepressant medication and $7322 (37%) larger if not using antidepressant medication. Among persons having NITDM, the corresponding estimated expenditure for the comparison group was $10,746, the excess expenditures were $10,432 (97%) larger if using antidepressant medication and $5579 (52%) larger if not using antidepressant medication, respectively. Inpatient excess expenditures were the largest of total excess expenditure for those with ITDM and MDD treated with antidepressant medication; for all others with diabetes and MDD, outpatient expenditures were the largest excess expenditure.Conclusions-Among working-age adults with diabetes, MDD was associated with substantial excess medical expenditures. Implementing the effective interventions demonstrated in clinical trials and treatment guidelines recommended by professional organizations might reduce the economic burden of MDD in this population.

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Methods for Analyzing Health Care Utilization and Costs

Cited by 583 publications

References 23 publications

Impact of morbid obesity on medical expenditures in adults

Impact of morbid obesity on medical expenditures in adults

Association of increased emergency rooms costs for patients without access to necessary medications

Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008

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