scholarly journals Healthcare utilization and costs among high-need and frail Mexican American Medicare beneficiaries

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262079
Author(s):  
Maricruz Rivera-Hernandez ◽  
Amit Kumar ◽  
Lin-Na Chou ◽  
Tamra Keeney ◽  
Nasim Ferdows ◽  
...  
Keyword(s):  
Health Care ◽  
Mexican Americans ◽  
Epidemiologic Study ◽  
Nursing Home Care ◽  
Care Utilization ◽  
Health Care Spending ◽  
Social Risk ◽  
Social Risk Factors ◽  
Cost Category ◽  
Medicare Spending

Objectives To examine Medicare health care spending and health services utilization among high-need population segments in older Mexican Americans, and to examine the association of frailty on health care spending and utilization. Methods Retrospective cohort study of the innovative linkage of Medicare data with the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) were used. There were 863 participants, which contributed 1,629 person years of information. Frailty, cognition, and social risk factors were identified from the H-EPESE, and chronic conditions were identified from the Medicare file. The Cost and Use file was used to calculate four categories of Medicare spending on: hospital services, physician services, post-acute care services, and other services. Generalized estimating equations (GEE) with a log link gamma distribution and first order autoregressive, correlation matrix was used to estimate cost ratios (CR) of population segments, and GEE with a logit link binomial distribution was applied to estimate odds ratios (OR) of healthcare use. Results Participants in the major complex chronic illness segment who were also pre-frail or frail had higher total costs and utilization compared to the healthy segment. The CR for total Medicare spending was 3.05 (95% CI, 2.48–3.75). Similarly, this group had higher odds of being classified in the high-cost category 5.86 (95% CI, 3.35–10.25), nursing home care utilization 11.32 (95% CI, 3.88–33.02), hospitalizations 4.12 (95% CI, 2.88–5.90) and emergency room admissions 4.24 (95% CI, 3.04–5.91). Discussion Our findings highlight that frailty assessment is an important consideration when identifying high-need and high-cost patients.

scholarly journals REDUCING HEALTH DISPARITIES IN THE ERA OF VALUE-BASED CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S562-S563
Author(s):  
Amit Kumar ◽  
Elham Mahmoudi ◽  
Maricruz Rivera-Hernandez
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Puerto Rico ◽  
Mortality Rates ◽  
Minority Populations ◽  
Social Risk ◽  
Social Risk Factors ◽  
Physician Visits ◽  
The Us ◽  
The Impact

Abstract The US health care system is at a critical moment of transformation. The implementation of value-based models has made significant progress towards improving care quality and coordination, continuity of care and reducing cost. However, concerns have been raised regarding “cherry-picking” healthier people that may negatively impact patients with more complex needs and minority populations. Given that the US is becoming more diverse, there is a need for understanding the impact of social risk factors including ethnicity, immigration status, income and geography on health outcomes and issues of health care disparities. This panel brings together four studies that examine these phenomena in minority populations. These studies will provide novel insight regarding 1) healthcare utilization in Mexican-American Medicare beneficiaries and showing that social determinants of health are associated with a higher risk of hospitalization, emergency room admissions, and outpatient visits. 2) Mortality rates and predialysis care among Hispanics in the US, Hispanics in Puerto Rico, and Whites in the US demonstrating substantial disparities in access to recommended nephrology care for Hispanics in Puerto Rico; 3) Trends in age-adjusted mortality rates and supply of physicians in states with different nurse-practitioners regulation. 4) The impact of social risk factors on disenrollment from Fee-For-Service and enrollment in a Medicare Advantage plan in older Mexican-Americans. 5) Racial disparities in access to physician visits, prescription drugs, and healthcare spending among older adults with cognitive limitation. Studies in this panel will also discuss the effects of changes in care delivery and payment innovations in improving health equity.

scholarly journals Sickness Presence among Health Care Professionals: A Cross Sectional Study of Health Care Professionals in Slovenia

2020 ◽  
Vol 17 (1) ◽  
pp. 367 ◽  
Author(s):  
Alenka Skerjanc ◽  
Metoda Dodic Fikfak
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Sick Leave ◽  
Health Care Professionals ◽  
Cross Sectional Study ◽  
Social Risk ◽  
Sectional Study ◽  
Social Risk Factors ◽  
Cross Sectional ◽  
Sickness Presence

Background and objectives: Presenteeism is a relatively new phenomenon that people, despite complaints and ill health that should prompt them to rest and take sick leave, go to work in any case. The highest sickness presence is largely to be found in the care and welfare and educational sectors. The aim of the study is to investigate the relations between different factors and sickness presence among health care professionals. Materials and Methods: A cross-sectional study was conducted at the largest hospital in Slovenia involving 5865 health care professionals employed at the University Medical Centre Ljubljana in the period between 1 January 2010 and 31 December 2010. Logistic regression methods were used to assess the associations between risk factors and their interactions and sickness presence. Results: Besides high odds for sickness presence in multivariate modelling for acute (OR = 359.7; 95%CI = 89.1–1452.8) and chronic disease (OR = 722.5; 95%CI = 178.5–2924.5) the highest odds were calculated for poor self-related health (OR = 3.0; 95%CI = 1.9–4.8), no possibility of replacement (OR = 1.9; 95%CI = 1.5–2.3), sickness absence > two times a year (OR = 1.6; 95%CI = 1.2–2.1), disabled workers (OR = 1.6; 95%CI = 1.0–2.5), and lower salary when on sick leave (OR = 1.5; 95%CI = 120–1.9). Risk factors interactions were not found to be associated with sickness presence among health care workers. Conclusions: The pre-requisite for higher sickness presence is workers’ bad health. The results indicate that sickness presence was associated with psycho social risk factors at work and their economic consequences. Continued sickness presence might have negative rather than positive consequences on work and health care professionals’ health in the future. Sickness presence needs to be taken into account for health care organizers.

scholarly journals Assessment of Social Risk Factors and Interest in Receiving Health Care–Based Social Assistance Among Adult Patients and Adult Caregivers of Pediatric Patients

2020 ◽  
Vol 3 (10) ◽  
pp. e2021201
Author(s):  
Emilia H. De Marchis ◽  
Danielle Hessler ◽  
Caroline Fichtenberg ◽  
Eric W. Fleegler ◽  
Amy G. Huebschmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Pediatric Patients ◽  
Social Assistance ◽  
Adult Patients ◽  
Social Risk ◽  
Social Risk Factors ◽  
Adult Caregivers

scholarly journals Defining ‘actionable’ high- costhealth care use: results using the Canadian Institute for Health Information population grouping methodology

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Maureen Anderson ◽  
Crawford W. Revie ◽  
Henrik Stryhn ◽  
Cordell Neudorf ◽  
Yvonne Rosehart ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Information ◽  
Economic Status ◽  
Health Care Use ◽  
Care Utilization ◽  
Health Care Spending ◽  
Health Profile ◽  
Socio Economic Status ◽  
Canadian Institute

Abstract Background A small proportion of the population consumes the majority of health care resources. High-cost health care users are a heterogeneous group. We aim to segment a provincial population into relevant homogenous sub-groups to provide actionable information on risk factors associated with high-cost health care use within sub-populations. Methods The Canadian Institute for Health Information (CIHI) Population Grouping methodology was used to define mutually exclusive and clinically relevant health profile sub-groups. High-cost users (> = 90th percentile of health care spending) were defined within each sub-group. Univariate analyses explored demographic, socio-economic status, health status and health care utilization variables associated with high-cost use. Multivariable logistic regression models were constructed for the costliest health profile groups. Results From 2015 to 2017, 1,175,147 individuals were identified for study. High-cost users consumed 41% of total health care resources. Average annual health care spending for individuals not high-cost were $642; high-cost users were $16,316. The costliest health profile groups were ‘long-term care’, ‘palliative’, ‘major acute’, ‘major chronic’, ‘major cancer’, ‘major newborn’, ‘major mental health’ and ‘moderate chronic’. Both ‘major acute’ and ‘major cancer’ health profile groups were largely explained by measures of health care utilization and multi-morbidity. In the remaining costliest health profile groups modelled, ‘major chronic’, ‘moderate chronic’, ‘major newborn’ and ‘other mental health’, a measure of socio-economic status, low neighbourhood income, was statistically significantly associated with high-cost use. Interpretation Model results point to specific, actionable information within clinically meaningful subgroups to reduce high-cost health care use. Health equity, specifically low socio-economic status, was statistically significantly associated with high-cost use in the majority of health profile sub-groups. Population segmentation methods, and more specifically, the CIHI Population Grouping Methodology, provide specificity to high-cost health care use; informing interventions aimed at reducing health care costs and improving population health.

Trends in U.S. Health Care Spending on Inflammatory Bowel Diseases, 1996-2016

2021 ◽  
Author(s):  
Siddharth Singh ◽  
Alexander S Qian ◽  
Nghia H Nguyen ◽  
Stephanie K M Ho ◽  
Jiyu Luo ◽  
...  
Keyword(s):  
Health Care ◽  
Confidence Interval ◽  
Inflammatory Bowel Diseases ◽  
Temporal Trends ◽  
Age Groups ◽  
Care Utilization ◽  
Health Care Spending ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Global Burden Of Diseases

Abstract Background Inflammatory bowel diseases (IBD) are rising in prevalence and are associated with high health care costs. We estimated trends in U.S. health care spending in patients with IBD between 1996 and 2016. Methods We used data on national health care spending developed by the Institute for Health Metrics and Evaluations for the Disease Expenditure Project. We estimated corresponding U.S. age-specific prevalence of IBD from the Global Burden of Diseases Study. From these 2 sources, we estimated prevalence-adjusted, temporal trends in U.S. health care spending in patients with IBD, stratified by age groups (<20 years, 20-44 years, 45-64 years, ≥65 years) and by type of care (ambulatory, inpatient, emergency department [ED], pharmaceutical prescriptions, and nursing care), using joinpoint regression, expressed as an annual percentage change (APC) with 95% confidence intervals. Results Overall, annual U.S. health care spending on IBD increased from $6.4 billion (95% confidence interval, 5.7-7.4) in 1996 to $25.4 billion (95% confidence interval, 22.4-28.7) in 2016, corresponding to a per patient increase in annual spending from $5714 to $14,033. Substantial increases in per patient spending on IBD were observed in patients aged ≥45 years. Between 2011 and 2016, inpatient and ED care accounted for 55.8% of total spending and pharmaceuticals accounted for 19.9%, with variation across age groups (inpatient/ED vs pharmaceuticals: ages ≥65 years, 57.6% vs 11.2%; ages 45-64 years, 49.5% vs 26.9%; ages 20-44 years, 59.2% vs 23.6%). Conclusions Even after adjusting for rising prevalence, U.S. health care spending on IBD continues to progressively increase, primarily in middle-aged and older adults, with unplanned health care utilization accounting for the majority of costs.

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