Showing posts with label finance. Show all posts
Showing posts with label finance. Show all posts

Wednesday, October 14, 2015

A Costly, Complex Year: Examining Healthcare Cost And End of Life Care

By: Joann Schulte  DO, MPH; Editorial Board Member 

      Almost two-thirds of bankruptcy filings have a medical cause and 14.6% of those interviewed for bankruptcy in 2007 had anill child1with a complex medical condition. An estimated 2.8 to 3.3 million individuals with vast medical bills file for bankruptcy each year2.  If the percentage of filers with children has remained constant, it means between 408,800 and 481,800 people seeking bankruptcy protection each year have children with complex illnesses severe enough to prompt the filings.
      Work published this early relased recently in Pediatrics from  (doi: 10.1542/peds.2015-0260) will help provide needed information for children’s medical care and costs in the last year of life.  A group of researchers from Boston and Philadelphia used data from the forty-one free-standing children’s hospitals to describe illness and costs for such children.  The hospitals submitted data to the Pediatric Health Information System database, an administrative database that contains inpatient utilization and cost data. Children are assigned a unique identifier to track them across multiple admissions. The researchers used the data to characterize the admissions and costs incurred among a cohort of 1,252 children who were admitted and died in calendar year 2012.  Infants less than a year of age were excluded to ensure a complete one-year review.
      Those children had complex medical conditions in nine organ systems:  cardiovascular, congenital/genetic, gastrointestinal, hematologic/immunologic, malignancy, metabolic, neuromuscular, renal and respiratory. The authors converted charges to costs, using an existing ratio for each hospital and they adjusted for inflation by using the Consumer Price Index.
The authors found that the children in their last year of life had medians of two admissions, twenty-seven hospital days and $142,562 in hospital costs. Total hospital costs were $392 million, of which 58% occurred in the final admission for these children to the hospital($228 million).
      In a multivariate analysis, children diagnosed with hematological/immunologic conditions have the greatest impact on hospital resource use.  Compared to children with other complex conditions, children with hematologic/immunologic conditions spend 45 more days in the hospital and accumulated $326,844 more in hospital costs.  The vast majority of children (987, 79%) spent time in the intensive care unit and most were mechanically ventilated (946, 76 %) during their last admissions.
      These 1,252 children had an unhappy outcome, but information about their hospitalizations is an important step in painting a detailed picture about terminal pediatric illnesses.  Having such information may help economists and pediatric providers both provide needed care and figure out how to do so without bankrupting families.  


1. Himmelstein DU, Thorne D, Warren E, Woolhandler S.  Medical bankruptcy in the United States, 2007:  Results of a national study.  American Journal of Medicine  2009; 122 (8):741-746.

2. Himmelstein DU, Warren E, Thorne D, Woolhandler S.  Market Watch: Illness and injury as contributors to bankruptcy.  http://content.healthaffairs

Thursday, June 19, 2014

Abusive Head Trauma Medical Costs

Pediatrics Editorial Board Member Joann Schulte, DO, MPH, shares her expert perspective on a new article from our July issue. To learn more about Dr. Schulte and her work in general pediatrics and preventive medicine, check out her bio on our Contributors page.

By: Joann Schulte, DO, MPH

Photo by COD Newsroom via Flickr
When infants and children are abused, the long-term consequences are serious. Shaken baby syndrome or abusive head trauma can shape children’s futures negatively, and two-thirds of such children are left with significant disability, often requiring more medical care. Those children also incur significant medical expenses according to research published early released from the July issue of Pediatrics.

Using a case-control methodology, Cora Peterson and her co-authors (doi: 10.1542/ peds.2014-0117) estimated that a child who suffered abusive head trauma incurred medical expenses totaling $47,952 in the four years after the injury. For children covered by commercial insurance, estimated expenses were $38,321. Estimated expenses were higher for Medicaid patients at $56,691. Those estimated expenses did not include non-medical costs related to special education or disability.

The authors studied children aged 0 to 4 years and used regression modeling to simulate the direct medical costs. The cases and controls (five controls for each abused child) were identified in the Truven Health MarketScan database, which reports paid insurance claims and patient encounters, for the period of 2003 through 2011. Their modeling of direct medical costs was based on payments made for medical care.

Their study of the economic costs during a four-year period after abusive head trauma is a sobering analysis of the devastating consequences of what child abuse can produce.

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Friday, March 7, 2014

The Economics of Childhood Immunizations: What a Bargain!

Photo by Douglas Demaio via Flickr
If I were to ask what you think is the leading contributor to improving child health in this country, near or at the top of the list would have to be immunizations. But do the economics support the health outcomes of vaccinating an entire population against serious bacterial and viral diseases? How do the costs of lives saved through population-based immunization compare to the huge cost of the vaccines and their administration?

Zhou et al. (doi: 10.1542/peds.2013-0698) used a decision analysis methodology to look at the direct and societal costs of vaccines, their administration, vaccine adverse events as well as parent travel and work time lost to determine the net savings and benefit-cost ratios of routine childhood immunization. The savings are impressive as are the benefit-cost ratios but take a shot at reviewing the data yourself to learn more.

When one is concerned at the rising costs of health care, don’t point the finger at vaccines—instead point a syringe at a child so as to prevent serious infectious diseases and save lives in this country and around the world.

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Monday, February 24, 2014

Pediatricians Take Their Best Shot at Vaccine Financing or Lack Thereof

Photo by James Gathany, Centers for Disease Control & Prevention
While we certainly celebrate patients having easy access through our offices to safe and effective vaccines, insurance coverage and reimbursement for
the cost and administration of
these immunizations has become more and more variable. What does this mean for the primary care pediatrician?

O’Leary et al. (doi: 10.1542/peds.2013-2367) address this question via a descriptive study of data from a national survey of private pediatricians and family physicians. The results may not surprise you if you are working in primary care, but are nonetheless concerning given the level of dissatisfaction reported in payment from payors. What does this mean for assuring children have access to these critical vaccines?

Dr. Joseph Hagan, co-editor in chief of Bright Futures and a practicing pediatrician himself injects his opinion on this study and its ramifications for children in an accompanying commentary (doi: 10.1542/peds.2013-4023).

Both articles offer some sharp tips and strategies for dealing with the financial risks of buying and administering vaccines in your office. Read both and learn more.

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