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A comparison of dental care expenditures and office-based medical care expenditures, 1987

JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 1999年第5期130卷 659-666页

作者： Manski, RJ Moeller, JF Maas, WR Univ Maryland Sch Dent Dept Oral Hlth Care Delivery Baltimore MD 21201 USA US Dept HHS Agcy Hlth Care Policy & Res Rockville MD 20852 USA

Background. This article compares national estimates of utilization of and expenditures for dental care and office-based medical care. The comparison includes respondents in several socioeconomic and demographic categories. Methods. The focus of the analyses is on dental care and office-based medical care utilization during 1987. Specifically, the authors provide national estimates for numbers of dental and office-based medical visits made, expenditures for and sources of payment for each of several socioeconomic and demographic categories using household survey data from the 1987 National Medical Expenditure Survey, or NMES. Results. Data show that out-of-pocket expenditures are greater for dental care than for office-based medical care;that few Medicaid dollars are spent on dental care;that insurance is an important component of dental and office-based medical care;and that dentists provide greater amounts of unreimbursed care than do their office-based physician counterparts. Conclusions. NMES data show that dental care expenditures are considerable, almost as large as expenditures for office-based medical care, and are a significant component of all nonhospital health care expenditures for noninstitutionalized Americans. Practice Implications. U.S. dentists provide a significant amount of care. By understanding these analyses, practitioners will be better positioned to provide care and to better meet the dental needs of all Americans.

关键词：数据收集牙科保健服务/经济学牙科保健服务/统计学和数值数据卫生经费支出/统计学和数值数据诊室就医/经济学诊室就医/统计学和数值数据偿还途径/经济学偿还途径/统计学和数值数据社会经济因素美国青少年成年人女(雌)性人类男(雄)性中年人

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Office based wire-guided open breast biopsy under local anesthesia is accurate and cost effective

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AMERICAN JOURNAL OF SURGERY 2000年第5期179卷 422-425页

作者： Morris, KT Pommier, RF Vetto, JT Oregon Hlth Sci Univ Dept Surg Sect Surg Oncol Portland OR 97201 USA

BACKGROUND: Mammographic abnormalities found to be malignant by stereotactic biopsy still require a wire-guided biopsy (WGB) in most cases. We have previously described a simplified method of WGB that allows the procedure to be done with a minimum of dissection and under local anesthesia in the office setting. We hypothesized that this procedure can be used to produce cost-effective, office-based breast preservation therapy (BPT). METHODS: We reviewed our recent experience with this WGB method to determine applicability and accuracy in the office setting. A cost-effectiveness analysis was also performed to determine potential charge reductions when this method is used to avoid operating room (OR) usage for either lumpectomy or lumpectomy plus sentinel lymph node biopsy (SLNB). RESULTS: Of the 164 biopsies reviewed, 114 (70%) were performed in the office setting under local anesthesia and 50 (30%) were performed in the OR. The most common reasons for choosing the OR setting included performance of biopsy during an unrelated procedure requiring the OR (16 cases), patient preference (12), deep lesions (6), and the inability of the patient to cooperate with local anesthesia (5). The complication rates were similar between the two settings (7% for office-based and 4% for OR;P = 0.697), and in neither setting were any lesions missed. A cost-effectiveness analysis using our Current Procedure Terminology (CPT)-based charges revealed a potential per-case charge reduction of $4,632 for office-based lumpectomy and $4306 for office-based lumpectomy/SLNB, using our method of WGB and local anesthesia, compared with the OR setting. CONCLUSIONS: Office-based WGB using our previously described method is accurate and can be applied to at least 70% of patients. Based on the favorable results of our cost analysis and rising support for SLNB, we anticipate increased utilization of the clinic setting and local anesthesia for BPT in the future, (C) 2000 by Excerpta Medica, Inc.

关键词：算法麻醉局部/经济学麻醉局部/方法活组织检查/经济学活组织检查/方法乳腺肿瘤/病理学乳腺肿瘤/放射摄影术费用效益分析可行性研究乳房X线摄影术/经济学乳房X线摄影术/方法乳房切除术区段/经济学乳房切除术区段/方法诊室就医/经济学手术室/经济学病人遴选放射摄影术介入性/经济学放射摄影术介入性/方法可重复性结果治疗结果成年人老年人老年人 80以上女(雌)性人类中年人

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Influence of the unit of analysis on the studies of the factors of primary care resource utilization

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Gaceta sanitaria / S.E.S.P.A.S 1999年第1期13卷 53-61页

作者： Juncosa, S. Bolíbar, B. Roset, M. Martínez, C. Unitat d'Investigació Centre Institut Català de la Salut Terrassa España. Barcelona 08027 Spain

OBJECTIVE: To identify the characteristics of the patient that influence a different cost of his care, specifically, the different behaviour of these factors depending on the unit considered: encounter, episode or patient. METHODS: Observational study with the voluntary participation of 13 physicians (9 general practitioners and 4 paediatricians) and nursing staff. During 7 months all diagnoses and interventions to a sample of attended patients were gathered. The cost of care was calculated and aggregated depending on the three units, and four models of multiple lineal regression were built with the following explanatory variables: age, gender, morbidity (ambulatory diagnosis groups), comorbidity and psychosocial conditions. RESULTS: 1,868 adult patients (more than 14 years) made 11.146 consults which belong to 4,772 episodes. The 895 paediatric patients made 6,254 consults that belonged to 3,416 episodes. Morbidity is the variable that shows a major increase in all units. Overall, the capacity to explain cost variations are: 0.03 for the encounter, 0.14 for the episode and 0.44 for the patient. CONCLUSIONS: The patients variables considered in the study explain very little the resource utilization of the encounter, more the episode, and rather more the patient. Those results indicate that the assessment or comparison of the effectiveness, efficiency, or quality of the encounters will be very difficult considering only the commonly used variables to control the patient factors. The patient classification systems that group with a similar complexity that use the visits as the unit, should, consequently, consider additional variables of the process of care in contrast with the others units. This have implications in the collection and availability of the information.

关键词：门诊医疗/经济学门诊医疗/利用共病现象数据收集/方法诊断相关患者组家庭医学/统计学和数值数据卫生保健费用/统计学和数值数据卫生资源/经济学卫生资源/利用模型理论年患病率/发展趋势多元分析诊室就医/经济学诊室就医/利用病人/分类病人/心理学儿科学/统计学和数值数据初级卫生保健/经济学初级卫生保健/利用回归分析研究设计社会经济因素西班牙/流行病学青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性中年人

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Two-part pricing and the mark-ups charged by primary care physicians for new and established patient visits

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Journal of Health Economics 1990年第4期8卷 399-417页

作者： Hoerger, Thomas J. Vanderbilt University Nashville TN 37235 United States

Patients learn something when they visit a physician for the first time. Primary care physicians may exploit this information by using a two-part pricing strategy to price discriminate between new and established patients. The price of established patient visits will exceed marginal cost;because physicians maximize their profits from the entire relationship with a patient, competition drives new patient prices below marginal cost. Empirical tests indicate that general and family practitioners and obstetricians and gynecologists charge higher mark-ups on established patient visits than on new patient visits. Internists charge similar mark-ups on both types of visit. © 1990.

关键词：选择行为经济竞争家庭医学/经济学费用医疗/统计学和数值数据妇科学/经济学内科学/经济学模型统计学产科学/经济学诊室就医/经济学病人接受卫生保健的程度初级卫生保健/经济学相对价值表美国人类

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WILLINGNESS TO PAY FOR ANTIHYPERTENSIVE THERAPY - RESULTS OF A SWEDISH PILOT-STUDY

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JOURNAL OF HEALTH ECONOMICS 1991年第4期10卷 461-474页

作者： JOHANNESSON, M JONSSON, B BORGQUIST, L UNIV LUND INST ECON RESS-22101 LUNDSWEDEN

In this methodological study the results of a Swedish pilot study about willingness to pay for antihypertensive therapy are presented. The aim of the study was to test the feasibility of the contingent valuation (CV) method in this area. Open-ended and discrete CV questions were compared in a mail questionnaire. The open-ended CV question did not work well. The answers to the discrete question, analysed by logistic regression analysis, indicated a willingness to pay in the range SEK 2500-5000 per year for antihypertensive therapy. Further studies should be undertaken to explore the reliability and the validity of the CV method.

关键词：健康态度费用效益分析药费支出评价研究(主题) 卫生服务研究/方法高血压/经济学高血压/治疗预期寿命 Logistic模型模型经济计量学诊室就医/经济学回归分析社会经济因素瑞典生命价值人类

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An economic evaluation comparing two schedules of antenatal visits

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Journal of Health Services Research and Policy 2000年第2期5卷 69-75页

作者： Henderson, J. Roberts, T. Sikorski, J. Wilson, J. Clement, S. Natl. Perinatal Epidemiol. Unit Institute of Health Sciences Oxford United Kingdom

Objectives: To conduct an economic evaluation comparing a traditional antenatal visiting schedule (traditional care) with a reduced schedule of visits (new style care) for women at low risk of complications. Methods: Economic evaluation using the results of a randomised controlled trial, the Antenatal Care Project. This took place between 1993 and 1994 in antenatal clinics in South East London and involved 2794 women at low risk of complications. Results: The estimated baseline costs to the UK National Health Service (NHS) for the traditional schedule were £544 per woman, of which £251 occurred antenatally, with a range of £327-1203 per woman. The estimated baseline costs to the NHS for the reduced visit schedule was £563 per woman, of which £225 occurred antenatally, with a range of £274-1741 per woman. Savings from new style care that arose antenatally were offset by the greater numbers of babies in this group who required special or intensive care. Sensitivity analyses based on possible variations in unit costs and resource use and modelled postnatal stay showed considerable variation and substantial overlap in costs. Conclusions: Patterns of antenatal care involving fewer routine visits for women at low risk of complications are unlikely to result in savings to the Health Service. In addition, women who had the reduced schedule of care reported greater dissatisfaction with their care and poorer psychosocial outcomes which argues against reducing numbers of antenatal visits. (C) The Royal Society of Medicine Press Ltd 2000.

关键词：费用效益分析大不列颠诊室就医/经济学诊室就医/统计学和数值数据产前保健/经济学产前保健/组织和管理敏感性与特异性公费医疗/经济学女(雌)性人类

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Costs analysis of ambulatory blood pressure monitoring in mild hypertension

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Gaceta sanitaria / S.E.S.P.A.S 1999年第5期13卷 384-390页

作者： Mar, J. Pastor, R. Abásolo, R. Servicio de Gestión Clínica Hospital Alto Deba Guipúzcoa España. Mondragón 20500 France

BACKGROUND: To contrast the costs of conventional and ambulatory blood pressure monitoring (ABPM) methods in the diagnosis, treatment and follow-up of mild hypertensive patients. METHODS: Among patients with conventional diagnosis of mild hypertension, the ABPM would discriminate patients with sustained hypertension, who would receive drug treatment, from patients with white coat hypertension (WCH), who would be only followed up. The diagnosis, treatment and control costs were obtained from 446 mild hypertensive patients from the Primary Health Care Center Aranbizkarra II (Vitoria, Spain) during 1996. For each gender, the overall costs per patient were estimated in both conventional and ABPM methods in terms of mean diagnosis age and WCH percentage. RESULTS: For 45 years old patients and 30% of WCH, the overall costs per patient among men were 414,999 and 371, 101 pesetas with conventional and ABPM methods, respectively. From 30 to 60 years old patients, the ABPM method turned up to be less expensive as long as the WCH percentage was higher than 6%. Similar results were obtained among women with mild hypertension. CONCLUSIONS: ABPM can be accepted as an useful clinical tool for the screening of patients with conventional diagnosis of mild hypertension. On the one hand, ABPM allows to select patients with low cardiovascular risk (WCH). On the other hand, the savings resulting from treatment reduction and fewer physician visits are higher than the additional costs of ABPM recordings.

关键词：抗高血压药/经济学抗高血压药/治疗应用血压测定/经济学血压测定/方法血压监测便携式/经济学费用控制成本及成本分析高血压/药物疗法高血压/经济学诊室就医/经济学危险西班牙老年人女(雌)性人类男(雄)性中年人

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