Prediction of the economic cost of individual long-term care in the Spanish population

Pensions together with savings and investments during active life are key elements of retirement planning. Motivation for personal choices about the standard of living, bequest and the replacement ratio of pension with respect to last salary income must be considered. This research contributes to the financial planning by helping to quantify long-term care economic needs. We estimate life expectancy from retirement age onwards. The economic cost of care per unit of service is linked to the expected time of needed care and the intensity of required services. The expected individual cost of long-term care from an onset of dependence is estimated separately for men and women. Assumptions on the mortality of the dependent people compared to the general population are introduced. Parameters defining eligibility for various forms of coverage by the universal public social care of the welfare system are addressed. The impact of the intensity of social services on individual predictions is assessed, and a partial coverage by standard private insurance products is also explored. Data were collected by the Spanish Institute of Statistics in two surveys conducted on the general Spanish population in 1999 and in 2008. Official mortality records and life table trends were used to create realistic scenarios for longevity. We find empirical evidence that the public long-term care system in Spain effectively mitigates the risk of incurring huge lifetime costs. We also find that the most vulnerable categories are citizens with moderate disabilities that do not qualify to obtain public social care support. In the Spanish case, the trends between 1999 and 2008 need to be further explored.

Au sortir de l'hôpital, comment renforcer la continuité de la prise en charge médicale [Discharge from hospital: how to improve continuity of medical care?].

Early readmission is the major success indicator of the transition between hospital and home. Patients admitted with heart failure reach a 20% rate. Potentially avoidable readmissions, defined as unpredictable and related to a known condition during index hospitalization, represent the improvement margin. For these latter, implementation of specific interventions can be effective. Complex interventions on transition, including several modalities and seeking to encourage patient autonomy seem more effective than others. We describe two models: a pragmatic one developed in a regional hospital, and a more complex one developed in a university hospital during the LEAR-HF study. In both cases, it is imperative to work on "medical liability": should it extend beyond discharge up to the threshold of the private practice?

Opioid poisoning and availability of specialized medical care in Ontario, 2002-2006

The prescription of opioid analgesics has risen sharply in North America over the past two decades. This increase has been accompanied by a rise in overdoses. The present study draws on administrative data collected from emergency department contacts to describe the epidemiology of opioid overdose in Ontario b~tween 2002 and 2006 and to examine the role of regional variation in availability of specialist care. The number of poisonings increased from 1250 (10.9 per 100,000) in FY2002 to 1816 (15.2 per 100,000) in FY2005. Local concentration of specialist physicians was significantly associated with the incidence of opioid overdose, inversely at most levels of availability, but positively at very high levels. Regional variation in incidence was also associated with demographics, median family income, and the rate of other drug poisonings. Policy options for limiting opioid-related harms are limited, but improvements in monitoring and clinical management may prove valuable.

Small-area variation in health care affecting the choice of cesarean delivery: the case of a Colombian health insurer

In the midst of health care reform, Colombia has succeeded in increasing health insurance coverage and the quality of health care. In spite of this, efficiency continues to be a matter of concern, and small-area variations in health care are one of the plausible causes of such inefficiencies. In order to understand this issue, we use individual data of all births from a Contributory-Regimen insurer in Colombia. We perform two different specifications of a multilevel logistic regression model. Our results reveal that hospitals account for 20% of variation on the probability of performing cesarean sections. Geographic area only explains 1/3 of the variance attributable to the hospital. Furthermore, some variables from both demand and supply sides are found to be also relevant on the probability of undergoing cesarean sections. This paper contributes to previous research by using a hierarchical model and by defining hospitals as cluster. Moreover, we also include clinical and supply induced demand variables.

Social citizenship, housing wealth and the cost of social care: is the Care Act 2014 'Fair'?

This article assesses the extent to which it is ‘fair’ for the government to require owner-occupiers to draw on the equity accumulated in their home to fund their social care costs. The question is stimulated by the report of the Commission on Funding of Care and Support, Fairer Care Funding (the Dilnot Commission) and the subsequent Care Act 2014. The enquiry is located within the framework of social citizenship and the new social contract. It argues that the individualistic, contractarian approach, exemplified by the Dilnot Commission and reflected in the Act, raises questions when considered from the perspective of intergenerational fairness. We argue that our concerns with the Act could be addressed by inculcating an expectation of drawing on housing wealth to fund older age: a policy of asset-based welfare.

Medical care equity for older persons in Chile: the role of the insurance sector

Includes bibliography

Periocular basal cell carcinoma: cost of topical immunotherapy versus estimated cost of surgical treatment

Purpose: The objective of this study was to compare the estimated cost of clinical and surgical treatment for basl cell carcinoma of the eyelid. Methods: This was a pilot study of 12 patients with basal cell carcinoma receiving treatment with 5% imiquimod cream at the ocular plastic surgery center, medical school University of Sao Paulo (HC-FMUSP, Brazil). The cost of clinical treatment was estimated based on the time of treatment and amount of medication consumed by patients in the home setting. The cost of surgical treatment was estimated by ophthalmologists with experience in reconstructive plastic surgery based on analysis of images of the same patients. Surgeons responded to a questionnaire with four questions about surgical technique, surgical materials required, estimated duration of surgery and type of anesthesia. Results: Immunotherapy lasted from 8 to 12 weeks. All patients reported each cold-stored sachet with 5% imiquimod cream lasted 3 days. According to the institution, a box with 12 sachets costs BRL 480.00. Patients required 1.58-3.11 boxes for complete treatment, corresponding to a total cost of BRL 758.40-1,492.80. Based on image analysis, surgeons evaluated surgery would require 1-3 hours. The estimated cost of surgery room and staff was BRL 263.00, to which the cost of supplies was added. Thus, the total cost of surgical treatment was BRL 272.61-864.82. On the average, immunotherapy was 57,64% more costly than surgical treatment. Conclusions: Malignant eyelid tumors are a common finding in clinical ophthalmology. Surgery is still the treatment of choice at our institution, but immunotherapy with 5% imiquimod cream may be indicated for patients with multiple lesions or high surgical risk and for patients declining surgery for reasons of fear or esthetic concerns. The ability to estimate costs related to the treatment of malignant eyelid tumors is an important aid in the financial planning of health care institutions. Further studies should evaluate the possibility of institutions equating the cost of immunotherapy and surgical treatment by acquiring similar but less expensive medications.

A Reappraisal in Sao Paulo, Brazil (2008) of "The Ecology of Medical Care:" The "One Per Thousand's Rule"

BACKGROUND AND OBJECTIVES: Medical ecology is a conceptual framework introduced in 1961 to describe the relationship and utilization of health care services by a given population. We applied this conception to individuals enrolled in a private health maintenance organization (HMO) in Sao Paulo, Brazil, with the aim of describing the utilization of primary health care, verifying the frequency of various symptoms, and identifying the roles of different health care sources. METHODS: This was a cross-sectional telephone survey among a random sample of people enrolled in a private HMO. We interviewed a random sample of non-pregnant adults over age 18 using 10 questions about symptoms and health care use during the month prior to interview. RESULTS: The final sample consisted of 1,065 participants (mean age 68 years, 68% female). From this sample, 424 (39.8%) reported the presence of symptoms, 311 (29.2%) had a medical office consult, 104 (9.8%) went directly to an emergency medical department, 63 (5.9%) were hospitalized, 22 (2.1%) used complementary medicine resources, seven (0.7%) were referred to home care, and one (0.1%) was admitted to an academic hospital. CONCLUSIONS: The proportion of study participants referred to an academic care center was similar to that observed in previous "medical ecology" studies in different populations.

Cost of low back pain in Switzerland in 2005

Low back pain (LBP) is the most prevalent health problem in Switzerland and a leading cause of reduced work performance and disability. This study estimated the total cost of LBP in Switzerland in 2005 from a societal perspective using a bottom-up prevalence-based cost-of-illness approach. The study considers more cost categories than are typically investigated and includes the costs associated with a multitude of LBP sufferers who are not under medical care. The findings are based on a questionnaire completed by a sample of 2,507 German-speaking respondents, of whom 1,253 suffered from LBP in the last 4 weeks; 346 of them were receiving medical treatment for their LBP. Direct costs of LBP were estimated at 2.6 billion and direct medical costs at 6.1% of the total healthcare expenditure in Switzerland. Productivity losses were estimated at 4.1 billion with the human capital approach and 2.2 billion with the friction cost approach. Presenteeism was the single most prominent cost category. The total economic burden of LBP to Swiss society was between 1.6 and 2.3% of GDP.

Geographic variation in the cost of ambulatory care in Switzerland

Swiss health care is relatively costly. In order better to understand the drivers of spending, this study analyses geographic variation in per capita consultation costs for ambulatory care.

Competence of Long-Term Care Residence to Participate in Decisions About Their Medical Care: A Brief, Objective Assessment

Data from 50 residents of a long-term care facility were used to examine the extent to which performance on a brief, objective inventory could predict a clinical psychologist's evaluation of competence to participate in decisions about medical care. Results indicate that the competence to participate in medical decisions of two-thirds of the residents could be accurately assessed using scores on a mental status instrument and two vignette-based measures of medical decision-making. These procedures could enable nursing home staff to objectively assess the competence of residents to participate in important decisions about their medical care.

"Is there a doctor on board?" - legal aspects of medical care in emergency situations during spare time

Medical emergencies on international flights are not uncommon. In these situations the question often arises whether physicians are obliged to render first aid and whether omission leads to legal consequences. The general obligation to aid those in need applies to everyone, not only to physicians. Evading this duty makes liable to prosecution for omittance of defence of a third person in line with Art. 128 of the Swiss Penal Code, punishable by custodial sentence up to three years or an equivalent punitive fine. Vocational and professional law extend the duty to aid for physicians to urgent cases. Although resulting from the performance of a legal obligation, malpractice occurred in the course of first aid can lead to claims for compensation - even from foreign patients, and that according to their own domestic law.

A study of patient satisfaction with medical care services in Yanbu al-Sinaiya, Saudi Arabia

This study attempts to provide reliable scientific data that will enable the health services department of the Royal Commission of Yanbu Al Sinaiyah, Saudi Arabia to improve the quality of health care services provided in their facilities. Patient satisfaction and dissatisfaction were investigated along seven dimensions: General satisfaction scale, Communication, Technical quality, Art of care, Continuity of care, Time spent with the doctor, and Access/Convenience/ and availability. Patient satisfaction parameters were compared for Saudi vs. non-Saudi, males vs. females, and for patients seen in the hospital vs. those seen in Al-nawa and Radwa primary care centers. The information was obtained by using a self-administered questionnaire. The results indicate that patients seen in Al-nawa primary care center were more satisfied with care than patients seen in the hospital who in turn were more satisfied than those seen in Radwa primary care center. The non-Saudi patients were more satisfied than the Saudi patients across all three facilities and satisfaction scales. The female patients were more satisfied than the male patients across all three facilities and satisfaction scales. ^

Risk, outcomes, and cost of emergency center visits in cancer patients

Cancer is a chronic disease that often necessitates recurrent hospitalizations, a costly pattern of medical care utilization. In chronically ill patients, most readmissions are for treatment of the same condition that caused the preceding hospitalization. There is concern that rather than reducing costs, earlier discharge may shift costs from the initial hospitalization to emergency center visits. ^ This is the first descriptive study to measure the incidence of emergency center visits (ECVs) after hospitalization at The University of M. D. Anderson Cancer Center (UTMDACC), to identify the risk factors for and outcomes of these ECVs, and to compare 30-day all-cause mortality and costs for episodes of care with and without ECVs. ^ We identified all hospitalizations at UTMDACC with admission dates from September 1, 1993 through August 31, 1997 which met inclusion criteria. Data were electronically obtained primarily from UTMDACC's institutional database. Demographic factors, clinical factors, duration of the index hospitalization, method of payment for care, and year of hospitalization study were variables determined for each hospitalization. ^ The overall incidence of ECVs was 18%. Forty-five percent of ECVs resulted in hospital readmission (8% of all hospitalizations). In 1% of ECVs the patient died in the emergency center, and for the remaining 54% of ECVs the patient was discharged home. Risk factors for ECVs were marital status, type of index hospitalization, cancer type, and duration of the index hospitalization. The overall 30-day all-cause mortality rate was 8.6% for hospitalizations with an ECV and 5.3% for those without an ECV. In all subgroups, the 30-day all-cause mortality rate was higher for groups with ECVs than for those without ECVs. The most important factor increasing cost was having an ECV. In all patient subgroups, the cost per episode of care with an ECV was at least 1.9 times the cost per episode without an ECV. ^ The higher costs and poorer outcomes of episodes of care with ECVs and hospital readmissions suggest that interventions to avoid these ECVs or mitigate their costs are needed. Further research is needed to improve understanding of the methodological issues involved in relation to health care issues for cancer patients. ^