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PubMedDate not supplied

[Health-economic considerations for the use of BMP-2 for spinal surgery in Germany].

INTRODUCTION: BMP-2 can replace autogenous bone grafting in lumbar one-level anterior lumbar interbody fusions (ALIF). The current G-DRG system does not reimburse the upfront price of 2,970 euro per BMP-2 application for hospitals in Germany. The purpose of the current study was to create a health economic model to evaluate the financial savings for health care providers (hospitals) and health care payers (health care insurance) that can be achieved by the use of BMP-2 in spine surgery. METHODS: A previously published pooled data analysis was used in which BMP-2 showed significant improvements in the treatment after ALIF surgery compared to autogenous bone grafting, including earlier return to work time and reduced revision rates. These medical findings were transformed into economic data based on the regulations of the German health system of 2005. RESULTS: The significantly shorter return to work time under BMP-2 treatment generates important financial savings for health care insurances offsetting the upfront prize of 2,970 euro for BMP-2. Savings for hospitals are mainly related to shorter surgery time due to the absence of the bone grafting procedure and faster discharge of the patient. CONCLUSIONS: The combination of improved medical outcome by BMP-2 treatment for the patient and net savings for the entire health care system in Germany represents a "dominant" strategy from a health economic perspective. This implicates that BMP-2 in ALIF procedures is to be recommended from a health economic point of view for the German health care system.

Bone Morphogenetic Protein 2↗
PubMed2026

The Childhood Cancer and Leukemia International Consortium (CLIC): Expanding global collaboration in pediatric cancer etiology research.

Childhood cancers are rare, but incidence has risen modestly in countries with robust registration, partly reflecting improved diagnosis. In high-income countries, cancer is the leading cause of disease-related death in children. Marked inequities in incidence, survival, and research capacity underscore the need for large-scale collaboration to identify environmental, genetic, and contextual determinants of risk. The Childhood Cancer and Leukemia International Consortium (CLIC) was established in 2007 to study the etiology of childhood leukemia and later expanded in 2019 to include other childhood cancers, principally solid tumors. CLIC pools harmonized, individual-level data from case-control and cohort studies, obtained through interviews, record linkage (insurance claims, registries), or geographic information systems, and integrates germline genomic data where available. Membership has grown from 13 studies in 9 countries to 57 studies in 21 countries; recruitment spans the early 1960s to the present and encompasses approximately 150,000 cases across all tumor types and 300,000 controls with clinical, demographic, and exposure data, centralized via harmonized data dictionaries at the Data Coordination Center, established in 2014 at the International Agency for Research on Cancer, and supported by a secure analysis platform. Pooled analyses across diverse populations have implicated parental age, prenatal vitamin or folic acid use, mode of delivery, fetal growth, selected congenital anomalies, occupational or household exposures (e.g., pesticides), paternal smoking, and markers of early-life immune modulation (e.g., breastfeeding, daycare attendance) in leukemia risk, informing carcinogen evaluation and prevention. The integration of genetic ancestry and germline susceptibility data is clarifying ancestry-related differences in leukemia biology and outcomes, while confirming risk loci with population-specific effects. CLIC is now adding polygenic risk scores and exposomic data to refine etiologic subtyping and identify modifiable pathways, while broadening representation from underserved regions through partnership-building and capacity-strengthening.

Humans↗
PubMed2001

Stand-alone health insurance tax credits aren't enough.

Using health insurance tax credits to help reduce the ranks of the nearly 43 million uninsured Americans has attracted broad bipartisan support in Congress. But tax credits alone will not help many sick or older people obtain affordable coverage, according to an expert panel at an April 10, 2001, conference sponsored by the Center for Studying Health System Change (HSC). To make tax credits a viable option for eligible people, the individual insurance market would need significant reforms or a better way to spread risk-similar to large employers-over a large and varied population. This Issue Brief highlights critical issues policy makers should consider when crafting tax credit proposals, including the use of purchasing pools.

Age Factors↗
PubMed1995

Strategic responses by hospitals to increased financial risk in the 1980s.

OBJECTIVE: This research addresses the following types of responses by hospitals to increased financial risk: (a) increases in prices to privately insured patients (testing separately the effects of risk from the effects of "cost-shifting" that depends on level of Medicare payment in relation to case mix-adjusted cost); (b) changes in service mix offered and selectivity in acceptance of patients to reduce risk; and (c) efforts to reduce variation in resource use for those patients admitted. DATA SOURCES: The database includes a national panel of over 400 hospitals providing information from patient discharge abstracts, hospital financial reports, and county level information over the period 1980-1987. STUDY DESIGN: Econometric methods suitable to panel data are implemented, with tests for pooling, hospital-specific fixed effects, and possible problems of selection bias. PRINCIPAL FINDINGS: The prices paid by private insurers to a particular hospital were affected by the changes in risk imposed by Medicare prospective payment, the generosity of Medicare payment, state rate regulation, and ability of the hospital to bear risk. The risk-weighted measure of case mix did not respond to changes in payment policy, but other variables reflecting the management of care after admission to reduce risk did change in the predicted directions. CONCLUSIONS: Some of the findings in this article are relevant to current Medicare policies that involve risk-sharing, for instance, special allowances for "outlier" patients with unusually high cost, and for sole community hospitals. The first type of allowance appears successful in preserving access to care, while the second type is not well justified by the findings. State rate regulation programs were associated not only with lower hospital prices but also with less risk reduction behavior by hospitals. The design of regulation as a sort of risk-pooling arrangement across payers and hospitals may be attractive to hospitals and help explain their support for regulation is some states.

Cost Allocation↗
PubMed1987

Pooling the AIDS risk.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1995

A contemporary perspective on capitated reimbursement for imaging services.

Capitation ensures predictability of healthcare costs, requires acceptance of a premium in return for providing all required medical services and defines the actual dollar amount paid to a physician or hospital on a per member per month basis for a service or group of services. Capitation is expected to dramatically affect the marketplace in the near future, as private enterprise demands lower, more stable healthcare costs. Capitation requires detailed quantitative and financial data, including: eligibility and benefits determination, encounter processing, referral management, claims processing, case management, physician compensation, insurance management functions, outcomes reporting, performance management and cost accounting. It is important to understand actuarial risk and capitation marketing when considering a capitation contract. Also, capitated payment methodologies may vary to include modified fee-for-service, incentive pay, risk pool redistributions, merit, or a combination. Risk is directly related to the ability to predict utilization and unit cost of imaging services provided to a specific insured population. In capitated environments, radiologists will have even less control over referrals than they have today and will serve many more "covered lives"; long-term relationships with referring physicians will continue to evaporate; and services will be provided under exclusive, multi-year contracts. In addition to intensified use of technology for image transfer, telecommunications and sophisticated data processing and tracking systems, imaging departments must continue to provide the greatest amount of appropriate diagnostic information in a timely fashion at the lowest feasible cost and risk to the patient.

Capitation Fee↗
PubMedDate not supplied

Doctor Dean's prescription for health care reform.

One of the nation's smallest states is taking big steps to ensure universal access to health care for all of its citizens. Vermont will create a purchasing pool of public employees, individuals, and businesses who will enroll in a consolidated community-rated insurance plan. A new dispute resolution system will try to remove malpractice suits from the courtroom. Vermont's efforts are needed to show that states can and should develop universal systems of care, so that when a national system is produced states will be the only logical choice to run it.

Cost Control↗
PubMed2006

Access to care and utilization among children: estimating the effects of public and private coverage.

OBJECTIVES: We examine the relationship between health insurance coverage and children's access to and utilization of medical care. Access measures we study are having a usual source of care (USC) and lacking a USC for financial or insurance reasons. We also examine indicators for ambulatory visits, well-child visits, dental visits, emergency room use, and inpatient hospital stays. METHODS: We pool data from the first 7 years of the Medical Expenditure Panel Survey (MEPS), 1996 to 2002. Pooling yields a large sample of children, enabling us to analyze access and utilization using simple descriptive statistics, multivariate analysis, and instrumental variables estimation (IV). IV estimation is of particular interest given the possibility of bias caused by confounding factors (such as child health or parent attitudes) and measurement error in insurance coverage. We also compare estimates from IV linear probability models to estimates from IV probit with residual inclusion. RESULTS: As previous studies have found, public and private coverage are both associated with large increases in access and utilization. Simple mean comparisons suggest that private coverage has a larger effect than does public coverage. Differences between public and private coverage are reduced (and often reversed) when we control for other characteristics of children and their families. IV coverage effect estimates from both linear probability and residual inclusion probit models are substantially greater than conventional estimates across a wide range of access and utilization measures. CONCLUSIONS: Despite concerns that conventional estimates overstate the impact of coverage on access and use, our results suggest that the reverse may be true. One explanation may be that conventional estimates are biased toward zero due to error in the reporting of insurance coverage. The magnitude of the coverage effects we find highlights the importance of reducing uninsurance among children.

Aid to Families with Dependent Children↗
PubMed1991

An intergenerational policy proposal for the 1990s: applying the temporary disability insurance model to family caregiving.

This paper proposes a new policy initiative to assist family caregivers at a time when major demographic shifts in both the family and the workplace have taken place. Women especially are in the position of having to balance both work and family responsibilities without proper assistance. The initiative is based on an expansion of the Temporary Disability Insurance (TDI) model, to include care of family members of all ages by providing an adequate wage replacement. The shifting dependency ratio, resulting in a shrinking caregiver pool, is discussed as well as existing policies and their short-comings. For example, no current policies provide paid leave. The evolution of TDI, including resistance to it, is examined. Finally, Massachusetts' abortive attempt at a comprehensive plan for employment-leave insurance is discussed in detail and policy recommendations are outlined.

Adult↗
PubMed1989

Physicians who have lost their malpractice insurance. Their demographic characteristics and the surplus-lines companies that insure them.

The present study analyzes demographic data on 920 physicians who lost their coverage and applied to a "surplus-lines" company that insures essentially all applicants. Our analysis reveals that (1) some specialties are heavily overrepresented in the surplus-lines pool, (2) physicians aged 45 to 54 years are also overrepresented, (3) board certification is seen as frequently in the surplus-lines group as in the US physician population, and (4) the percentage of foreign medical graduates in the surplus-lines pool is virtually the same as that in the US physician population. A model of the actuarial process by which claims data can lead to termination of standard coverage suggests that disproportionate representation of high-risk specialties is not simply a function of a high average claims rate. We also show that, in contrast to joint underwriting associations, surplus-lines companies impose high premiums, large deductibles, and restrictions on practice, all of which are likely to reduce the frequency of negligent behavior.

Actuarial Analysis↗
PubMed1993

The impact of clinical trial protocols on patient care in a community hospital.

Although clinical research is essential in cancer control, less than 5% of cancer cases in community hospitals are entered in clinical trials. Phase III studies comprise the bulk of clinical research at our community hospital. Potential research protocols are selected by the Community Clinical Oncology Program Therapeutic Investigations Committee for referral to affiliated institutional review boards. Selection criteria include assessments of the scientific validity, relevance, and importance of the research, the match between the proposed protocol and research interests and experience of the investigators, priorities of the research bases for patient accrual, and resource availability for conduct of the study. There are serious impediments to the performance of clinical trials in the multiethnic, multilingual urban community hospital setting. These include diminution of the potential patient pool for trial entry due to language barriers and other difficulties associated with patient accrual; escalating costs (insurance coverage from some carriers in not available for clinical trial participation, and some therapies may be excluded by third-party payers); underinsurance or lack of insurance in many segments of the potential patient population; declining financial support for clinical research and the variability of payments, with restrictions even for standard or conventional treatments; the widespread belief that investigational studies are too costly or are of unproven value; potential liabilities associated with withholding cancer therapy; the unresolved legal quagmire surrounding cancer care for patients just under 18 years of age; and the potential for scientific misconduct related to the performance of clinical trials.

Clinical Trials as Topic↗
PubMed2001

Gatekeepers and sentinels. Their consolidated effects on inpatient medical care.

Evaluations assessing precertification by nurse gatekeepers and onsite monitoring by nurse sentinels report inconclusive unique effects of these programs on the utilization, expense, and appropriateness of inpatient medical care. By applying the fixed- and random-effects paradigm of meta-analysis, this article consolidates the results of all relevant quasi-experiments conducted by an evaluation group of a large private insurer from 1986 to 1990. It determines the difference in effect between the target and comparison groups, reports this effect and its statistical range, and determines the pooled effect and its range. The random effects indicate that precertification will reduce admissions, and onsite, concurrent review will reduce length of stay, bed days, and inpatient ancillary expense. The precertification and onsite programs may reduce negative iatrogenic effects, thereby enhancing the patients' well-being. If applied to privately insured populations who are still served on a fee-for-service basis, the gatekeeper and sentinel effects of these programs may reduce utilization and expense; however, inference of these results to Medicare fee-for-service care remains problematical.

Concurrent Review↗
PubMed1995

Hospitalizations for near drowning in California: incidence and costs.

California hospital discharge data for 1991 were examined to describe persons hospitalized for near drownings (i.e., a submersion incident for which the victim was admitted to a hospital). Among residents with near-drowning injuries, there were 865 discharges, regardless of outcome (rate = 2.8/100,000); 785 persons survived the hospitalization, and 80 (9%) did not. Swimming pools were the most common submersion site (62%). Highest rates per 100,000 were found among males (3.6), Blacks (3.6), and children 1 through 5 years old (18.4). Charges for the initial hospitalization (excluding physicians' fees) amounted to $11.4 million. The state government's share of these charges was $5.4 million, with Medi-Cal expected to pay $4.1 million. Blacks, males, Medi-Cal recipients, and young children are most at risk and should be targeted for prevention programs.

Adolescent↗
PubMed1990

The CHAMPUS reform initiative and fiscal intermediary managed care.

Initiatives to maximize the purchasing power of DOD's health care dollars are critical to DOD's ability to function within an increasingly constrained federal budget and to provide a quality medical benefit for military family members. The CHAMPUS Reform Initiative and Fiscal Intermediary Managed Care, two leading edge programs, hold great promise in meeting this challenge.

Costs and Cost Analysis↗