Average charges for a radical prostatectomy and a transurethral resection of the prostate (TURP): geographic variations, 1994.
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Fees, Medical↗
Biomedical subjects
M Mushinski
Publications and source records attributed to M Mushinski.
Environmental factors in cancer of the larynx: a second look.
During a retrospective case-control study of recent laryngeal cancer patients, several associated factors were studied to determine possible changes in the epidemiology of laryngeal cancer between 1956 and 1974. The large sex difference noted in the early survey (male: female ratio of 14.9:1) diminished considerably in the present sample (4.6:1) because more women are cigarette smokers in the cancer age group today than was the case 20 years ago. Laryngeal cancer patients tended to be less educated than the controls and included a smaller proportion of Jews and more Catholics than the control group. The risk for developing laryngeal cnacer was considerably lower for exsmokers and long-term (10+ years) filter cigarette smokers as compared with non-filter smokers. At each level of alcohol consumption, the risk increased as exposure to tobacco increased. Occupations associated with wood exposure were found to affect the development of laryngeal cancer, independently of smoking status. Future studies should include an extensive study of nutritional deficiencies associated with alcoholism to determine if a correlation exists between such deficiencies, socioeconomic status, and an increased risk of laryngeal cnacer.
Adult↗
International mortality rates and life expectancy: selected countries.
The total U.S. mortality rate for men and women, all causes combined, continues to decrease, but remains less favorable than that in many other developed countries. The 1995 age-adjusted rate for men was ranked 9th among 15 selected industrialized countries and that for women 11th. In 1996 the U.S. age-adjusted rate dropped to a record low of 491.6 per 100,000 population. Since 1990 this rate decreased substantially more among U.S. nonwhites than whites. The rates dropped 11 and 6 percent for nonwhite men and women, respectively, and 8 and 2 percent for their white counterparts. Thus, the gender gap continues to narrow as do the racial differentials in U.S. life expectancy and mortality. International mortality data for 1995 indicate that Iceland had the best recorded age-adjusted rate for men (487.4 per 100,000 population)--just ahead of Japan which has had the lowest mortality rate for more than 20 years. Age-adjusted death rates among U.S. nonwhite men and for men in Scotland were ranked the lowest, while among women, the worst mortality rates were evident among the Danish and Scottish women. Although life expectancy values are improving in all 15 countries, U.S. longevity continues to fare poorly in comparison to other developed countries. The U.S. life expectancy for men was ranked 13th for the 1990-1995 period and 11th for women. Longevity was the highest for men in Japan and Iceland, 76.4 and 76.3 years, respectively, and the lowest for men in Finland (72.0 years). For women, longevity was the best in Japan at 82.4 years, and the worst in Denmark (77.8 years). Life expectancies for men during 1995-2000 are projected to improve from 1.6 years in New Zealand to 0.4 years in Japan. For women, life expectancy will remain at 80.8 years in Sweden while increasing 0.8 years in the United States, Germany, the United Kingdom and New Zealand.
Adolescent↗
Laparoscopic and open appendectomies--average charges, 1997.
During 1997 the average total charge for an open appendectomy (OA) was $9,670 while that for a laparoscopic appendectomy (LA) was $11,290. The 20 study states (those with 50 or more OAs) accounted for 77 percent of the 2,979 OA procedures investigated. The total charges ranged from $12,800 in California to $6,540 in Oklahoma. The hospital charges were more than 30 percent higher than the U.S. norm in California and Florida and more than 30 percent below it in Oklahoma and Washington. New York and New Jersey reported the highest physicians' fees while the Michigan doctors' charges were 35 percent below the average. Length of stay for an open appendectomy averaged 2.92 days across the country and ranged from 3.33 days in New York to 2.33 days in Colorado. The hospital plus physicians' charges for LAs ranged from $14,350 in California (27 percent above the norm) to $9,210 in Colorado (18 percent below). California and Florida reported the highest hospital charges whereas those in New York were the lowest. The physicians' fees ranged from $4,280 in New York to $1,830 in Colorado. The patients with LAs remained in the hospital, on average, 2.22 days. The length of stay ranged from almost three days in Ohio to 1.62 days in Colorado.
Appendectomy↗
Average charges for hip replacement surgeries: United States, 1997.
Hip replacement surgeries continue to increase in both number and rates in the United States. In 1996 around 140,000 total hip arthroplasties (THAs) were performed across the country. In addition, 103,000 revision surgeries and 30,000 partial hip replacements were performed. More women than men have these procedures and almost seven out of ten are performed on patients over age 64. The 1997 charges for these surgeries varied extensively between geographic areas and states. The THA total charge averaged $20,290 across the United States, with California reporting an average 56 percent above this and Pennsylvania with a charge 29 percent below. Per diem charges totaled $4,110 and the length of stay was 4.94 days. THA revision surgeries cost $24,530 on average with the charge in California the highest of the study states, 42 percent above the U.S. norm and more than twice that in Indiana. Per diem charges were $4,370 and average hospitalization lasted 5.61 days. Partial hip replacement charges averaged $15,890 across the United States, with an average length of stay of 7.07 days.
Aged↗
U.S. cancer incidence, mortality and survival: 1973-1996.
Earlier predictions of morbidity and mortality improvements for the four leading sites of cancer are beginning to occur. After decades of increases, incidence and mortality rates for all cancers combined have declined since 1992. Between 1990 and 1996 the age-adjusted death rates for all cancers had dropped 3.7 percent to 166.9 per 100,000 and incidence rates had decreased 2.8 percent to 388.6. The overall decreases were greater among men than women; male mortality rates dropped 6.2 percent and incidence dropped 5.2 percent for men versus 1.8 and 1.9 percent, respectively, for women. Lung cancer incidence among men continued its more than 10-year decline in age-adjusted rates and mortality rates dropped for a fifth consecutive year to 68.2 per 100,000 population. Among women, lung cancer incidence rates began to plateau in the mid-1990s similar to the pattern experienced by men a decade earlier. The rates of prostate cancer have begun to decrease but remain 65 to 75 percent higher among black men than white. Mortality rates dropped 9.5 percent among white men but only 2.0 percent among blacks since 1990. By 1996 even breast cancer death rates were declining ahead of the predicted decrease by the end of the century. Mortality rates for all women combined was 24.3 per 100,000 population, 24.0 for white women and 30.8 for blacks, 11.3, 12.1 and 2.5 percent, respectively lower than in 1990. The previously noted decreases in colorectal cancer mortality and incidence continue with age-adjusted rates dropping to 16.8 and 42.7 per 100,000 population, respectively, in 1996.
Age Distribution↗
Costs of alcohol and drug abuse in the United States, 1992. Alcohol/Drugs COI Study Team.
In a study of the economic costs to society of alcohol and drug abuse, the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health estimate the cost to be $246 billion in 1992, the most recent year for which sufficient data were available. This estimate represents $965 for every man, woman and child living in the United States in 1992. Alcohol abuse and alcoholism generated about 60 percent of the estimated costs ($148 billion), while drug abuse and dependence accounted for the remaining 40 percent ($98 billion). Prior to this study, the most recent comprehensive estimates of these costs were based on data for 1985. The need to update earlier estimates was driven primarily by the changing culture of substance abuse and the changing nature, extent and treatment of the problem. Over 80 percent of the increase in estimated costs of alcohol abuse can be attributed to changes in data and methodology employed in the new study, suggesting that the previous study significantly underestimated the costs of alcohol abuse. In contrast, over 80 percent of the increase in estimated costs of drug abuse is due to real changes in drug-related emergency room episodes, criminal justice expenditures and service delivery patterns. Estimated costs for alcohol and drug abuse in 1995 were also calculated and were projected to be $276 billion. After adjusting for population growth and inflation, this estimate represents a 12.5 percent increase over the 1992 estimates.
Adolescent↗
Prostate surgeries: average charges throughout the United States, 1997.
During 1997 hospital claims for 2,149 radical (open) prostatectomies among selected group policy insureds averaged $16,990 and for 2,192 transurethral resections of the prostate (TURPs), $6,620. There was marked geographic variation in both the distribution and charges for these two procedures. The Pacific region reported the highest average total charges for both procedures, driven by the high charges in California. The California average total charges were 39 percent above the norm for an open procedure and 54 percent above for a TURP. Illinois and Florida each reported open prostatectomy charges over $20,000, 20 and 18 percent, respectively, above the norm. For a TURP, however, Minnesota and Arizona reported the second and third highest charges, each over $8,000, and around 30 percent above the average. Washington state reported the lowest average charge for an open procedure ($12,020, 29 percent below the norm and about half that in California); Pennsylvania had the lowest TURP total charge ($3,860, 42 percent below the norm and 62 percent lower than the California charge). Among study states, charges 15 percent or more below average for an open procedure were also recorded in Pennsylvania, Indiana, Maryland and North Carolina. Similarly low charges for a TURP were recorded in Ohio. Michigan and North Carolina (each more than 15 percent below the norm). The hospital charges comprised 63 percent of the total for an open procedure and 68 percent for a TURP. The California average was the highest for both surgeries. 58 and 69 percent, respectively, above the norm and 129 percent above the low charge in Maryland for an open procedure and 193 percent above the low charge in Pennsylvania for a TURP. Physicians' charges averaged $6,370 for an open prostatectomy and $2,130 for a TURP. For both surgeries, these charges were the highest in New Jersey and New York (between 20 and 30 percent above the norm) and the lowest in Pennsylvania where they averaged 28 percent lower than the norm for an open procedure and 40 percent lower for a TURP. The length of stay averaged 3.75 days for a radical prostatectomy and 2.80 days for a TURP. These days ranged from 4.20 days in New Jersey to 3.11 days in Minnesota for an open procedure and 3.51 days in New Jersey to 2.14 days in Minnesota for a TURP.
Aged↗
Cardiac catheterizations: average inpatient charges, 1998.
In 1998 the average change for an impatient cardiac catheterization (CC)was $12,450 among 13,922 group health insured over age 30. Among the 29 states in which at least 150,CCs were performed, the average total charge ranged from $24,000 in California, which was 93 percent above the U.S. norm, to just over one-third of this total in Iowa ($8,810). The second highest average charge was reported in Texas ($20,140, 62 percent above the norm) and the second lowest was in Maryland ($11,420, 8 percent below). On average, the hospital proportion of the total CC charges accounted for 80 percent but ranged from 86 percent in California to 71 percent in Maryland. Physician fees averaged $2,450 across the country and ranged from $3,830 in Texas (56 percent above in average) to $2,140 in Iowa (13 percent below the norm). Length to stay averaged 3.2 days, with patients in Iowa remaining in the hospital for 5.6 days and those in Washington 2.9 days. Per diem costs averaged $3,850 and were the highest in California, $6,470 (68 percent above the average) and $1,570 in Iowa (59 percent below).
Cardiac Catheterization↗
The Social Security system: benefit differences among racial/ethnic groups.
Based on published and unpublished data from the Bureau of the Census and the Social Security Administration, an assessment is presented of how major racial/ethnic groups in the United States fare under Social Security. The Social Security Act was signed into law in 1935 to provide economic security to U.S. workers. Today, there are some 44.5 million Social Security beneficiaries in this country. The majority of these beneficiaries are retired workers (62.3 percent) with survivors of deceased workers comprising another 11.6 percent. Several aspects of the Social Security system are particularly important to minority groups. The data indicate that minorities rely more on Social Security benefits in retirement than do whites. In comparison with only 16 percent of white elderly beneficiaries, one-third of elderly blacks and one-third of elderly Hispanics depend on Social Security payments for 100 percent of their retirement income. Minorities also have less retirement income from other sources, such as pensions and assets, than do whites. Both blacks and Hispanics tend to have lower earnings than whites and, thus, benefit from the progressive benefit formula of the Social Security system. Further, blacks, with shorter life expectancies, benefit more from the disability and survivors benefits than do whites. Social Security has a major impact on poverty rates, particularly for minorities. Without Social Security benefits and no other changes in savings or pensions, poverty rates would be around 60 percent for blacks, Native Americans and Hispanics versus 24, 12 and 20 percent, respectively, with Social Security benefits. The U.S. minority population will continue to grow in both numbers and proportions. By 2050, almost half (47 percent) of the total U.S. population will be minorities due principally to growth in Hispanic, black and Asian populations. The increasingly diverse population will change the composition of the nation's workforce as well as the size and makeup of its elderly population. These demographic changes will be important to consider when evaluating the future role that Social Security will play in the lives of these changing populations.
Aged↗
Average charges for three types of hysterectomy procedures: United States, 1998.
The average charges associated with three forms of hysterectomies (abdominal-laparotomy) vaginal and laparoscopically-assisted vaginal hysterectomy (LAVH) in 1998 were investigated by geographic area and individual states. Considerable variation in the rates of and charges for these three procedures was reported. Based on data from more than 400,000 women insured under group health contracts, the average charges for these three gynecological surgeries were calculated for the study group of 14,184. The majority of the surgeries were laparotomies (64 percent) with LAVH accounting for only 10 percent; the largest proportion of the procedures were performed in the West South Central and South Atlantic regions of the country and the highest average charge was associated with the LAVH procedures. In 1998, the average charge for an abdominal hysterectomy in the United States was $12,500: that for a vaginal hysterectomy was $10,380; and that for a laparoscopically-assisted vaginal hysterectomy was $14,500. The Pacific area registered the highest average charges for all three (between 19 and 21 percent higher than the U.S. norm) while the lowest geographic area charges were reported in West North Central states (between 18 and 21 percent lower than the U.S. average). The charges in California were the highest of all study states for each of the surgeries, ranging from 38 to 43 percent higher than the average, whereas the charges in Iowa were the lowest for the laparotomies and vaginal hysterectomies (42 and 36 percent, respectively below the norm) and in Kansas for the LAVHs (34 percent lower than the U.S. average). Physicians fees were the highest in New York for each procedure ranging from 33 percent higher than the norm for a vaginal hysterectomy, 50 percent higher for an LAVH and 72 percent higher for a laparotomy. The lowest physician charges were reported in Iowa for the vaginal and abdominal surgeries and in Minnesota for the LAVHs. The average length of stay was 3.10 days for the laparotomy procedures, 2.20 days for the vaginal hysterectomies and 1.99 days for the LAVH patients, with substantial variation between states for each procedure.
Adult↗
Average hospital charges for percutaneous transluminal coronary angioplasty, 1993: geographic variations.
Claims to Metropolitan Life Insurance Company by group health insured and their dependents for a percutaneous transluminal coronary angioplasty (PTCA) averaged $21,760 in 1993. The charges varied by as much as 68 percent among the 22 states in which at least 50 PTCAs were performed. The highest average total charges were reported in Colorado and California, where they were 29 and 26 percent, respectively, above the average for the United States as a whole. The lowest average total charge was reported in Ohio, where the PTCA cost $16,770-23 percent lower than the national average. An average of 4.3 days of hospitalization was required for a PTCA. Hospital charges (room and board and ancillary fees) accounted for 78 percent of the total PTCA charges to insurance. The charges for the operating room, laboratory, blood bank, respiratory therapy and other ancillary fees together accounted for 80 percent of the total hospital bill and averaged $13,550 for the country as a whole. Physicians' fees averaged $4,740 across the United States and ranged from a high of $5,930 in Connecticut to a low of $3,730 in Michigan. These PTCA total charges were close to half the charge reported for a coronary artery bypass graft (CABG) in 1992 and the length of stay was also about half that for a CABG.
Angioplasty, Balloon, Coronary↗
Average charges for uncomplicated cesarean and vaginal deliveries, United States, 1993.
During 1993, average charges for a cesarean birth among MetLife group health insureds and dependents was $11,000 in comparison to $6,430 for women who had an uncomplicated vaginal delivery. Among the 34 states with at least 50 uncomplicated cesarean births, the average total charge ranged from highs of $13,700 in New York and $13,480 in California to lows of $7,730 in Oklahoma and $8,270 in Ohio. Among the states with at least 100 vaginal births, New York again reported the highest average total charge ($8,840)--a charge 2.1 times the lowest reported charge in Arkansas ($4,190). The hospital charges (room and board plus ancillary fees) accounted for 63 percent of the total charges billed to MetLife for a cesarean delivery and 57 percent for a vaginal birth. Physician fees averaged $4,070 for a cesarean and $2,740 for a vaginal birth across the country; New York reported the highest charges for both types of deliveries, $6,680 and $4,710, respectively. Minnesota reported the lowest physician charges--$2,370 for a cesarean birth and $1,390 for an uncomplicated vaginal delivery. Hospital stays averaged 3.4 days for a cesarean delivery and 1.9 for a vaginal birth. Room and board charges accounted for 34 percent of the hospital charges associated with a cesarean birth and 37 percent for an uncomplicated vaginal birth.
Cesarean Section↗
Cancer incidence, mortality and survival: trends in four leading sites.
Cancer mortality rates in the United States have stabilized in the past few years after rising for more than 50 years. Incidence and mortality rates for all cancers tend to be higher among men than women, among blacks than whites and among those over age 65. In 1994 cancer of the lung, prostate, breast, and colon/rectum (colorectal) will account for an estimated 57 percent of all new cancer cases and 55 percent of cancer deaths. Analysis of incidence, mortality and survival rates of these four major cancers indicate some encouraging trends. That is, even though age-adjusted incidence rates continue to increase, it appears that educational and screening efforts are having a positive influence on mortality rates. Lung cancer incidence has declined in recent years following a decrease in smoking among men that began some 20 years ago; evidence also indicates a start of a declining trend in their mortality from this disease, as well. Lung cancer incidence and mortality rates among women, however, continue to rise. In 1986 lung cancer became the leading cause of cancer deaths among women. Increased use and improved techniques of cancer detection for prostate, breast and colorectal cancers are resulting in larger numbers of these cancers being detected at early stages when they are more readily treatable. It is hoped that such activities will ultimately reduce mortality for these three major cancer sites.
Black or African American↗
Trends in multiple births.
Since the early 1970s, the number and rate of multiple births have increased fairly steadily. Of the 4,110,907 babies born in the United States in 1991, 98,125 (2.4 percent) were twins, triplets or other higher order plural births. The 1991 rate of 23.9 multiple births per 1,000 live births--the highest recorded in this country in the last 50 years--was 1.3 percent higher than that in 1990, and 14 percent higher than the rate in 1985. The twins proportion of all multiple births has been slowly decreasing--97.6 percent in 1985, 96.9 percent in 1990 and 96.6 percent in 1991. Rates of multiple births continue to be higher among black women than white (2.8 and 2.3 per 1,000 live births, respectively, in 1991) and are more prevalent among older women. In 1991 the rates were higher through each age group to a high of 3.4 for white and 3.6 for black mothers aged 35-39 before dropping to 1.9 and 0.5, respectively, among 45- to 49-year-olds. Incidence of low birthweight (< 2,500 grams) and of very low birthweight (< 1,500 grams) babies were more frequent among multiple births than singletons and were more common among black than white infants. The median weight for white singleton births was 3,420 grams versus 2,260 grams for black plural births. The District of Columbia, Michigan and Massachusetts registered the highest percentage of multiple births in 1991 (2.9 to 2.7 percent) and the lowest rates were recorded in New Mexico and Wyoming (1.9 percent).
Black or African American↗
Violence in America's public schools.
As part of MetLife's series of annual surveys of U.S. public school teachers, the latest survey examined the perceptions of teachers, students and law enforcement officials about violence in their respective schools during 1993. Members of each group recognized violence as a problem in their schools, but the perceived magnitude of the problem differed among the three survey populations. Students reported seeing and fearing violence more than the teachers. Although the majority of teachers and students reported feeling safe in school, 11 percent of teachers and 23 percent of students had been victims of violence. The level of violence reported by teachers and the proportions who reported that weapons were regularly brought to school increased as the perceived quality of the education provided in the school decreased, as the proportion of minority and/or low income students increased, and in urban versus rural/suburban schools. Lack of parental supervision at home and lack of family involvement in school were considered major factors contributing to school violence by at least two-thirds of the teachers and 83 percent or more of the law officers. Sixty-six percent of students reported that guns/knives were carried to school primarily to impress friends or to increase feelings of importance; 38 percent of teachers thought self-protection and/or attempts to impress friends explained why students carried weapons to school.
Adolescent↗
Average charges for a total knee replacement: United States, 1994.
Total knee replacements (TKRs) have increased more than fourfold since 1989. The charges for these surgeries have been increasing also, and in 1994 claims to MetLife for a TKR averaged $28,340. Three geographic areas reported average total charges above this norm and six below. The highest average total charge (including hospital and physician charges) was reported in New York and California, each with charges 27.1 percent above the U.S. average. These charges are contrasted with the low average charge reported in Ohio, 19.3 percent below the norm. About one-fourth of the total charges were for physician fees, which averaged $7,150 across the country. Among the 16 study states in which at least 15 TKRs were performed in 1994, the average totals ranged from $11,930 in New York to $6,290 in Colorado. On average, the patients remained hospitalized for 6.7 days, with major state variations noted. The longest stay was reported in New York (more than 11.5 days) and the shortest in Arizona (4.6 days). Per diem charges generally were inversely related to the hospital stays, averaging $4,230 and ranged from a high of $6,640 in Arizona to $3,110 in New York.
Aged↗
Hysterectomy charges: geographic variations United States, 1994.
During 1994 Metropolitan Life Insurance Company claims by group health insureds and their dependents for a vaginal hysterectomy averaged $10,500, for an abdominal hysterectomy (laparotomy), $12,440, and for a laparoscopically assisted vaginal hysterectomy (LAVH), $13,840. The distributions of the three surgeries varied by geographic area and state. The East South Central states had the lowest average total charge for each procedure whereas the highest charge for a laparotomy was reported in the Middle Atlantic states; the highest vaginal hysterectomy charge was in the Pacific area, and LAVH average total charge was the highest in New England. Of the three surgeries, the vaginal hysterectomy charges varied the most by state-the average charge in Florida was almost twice that in Oklahoma. Laparotomy charges differed by 59 percent between California and Tennessee, where they were 30 percent above and 19 percent below the U.S. norm, respectively. The total charge for the LAVHs varied by 42 percent and was the highest in California and lowest in North Carolina. Three study states, California, Florida and Illinois, were among the four states with the highest average total charges for each form of hysterectomy. Physicians' fees accounted for 41 percent of vaginal hysterectomy charges, 37 percent of the laparotomy total charges, and 34 percent of the LAVH charges. Of the laparotomies, the physicians' fees differed by 132 percent between the highest in New York and the lowest in Tennessee. For the country as a whole, the average length of stay was 2.17 days for the LAVHs, 2.54 days for a vaginal hysterectomy and 3.43 days for an abdominal hysterectomy.
Adult↗