scholarly journals The Economic Consequences of Hospital Admissions

2018 ◽  
Vol 108 (2) ◽  
pp. 308-352 ◽  
Author(s):  
Carlos Dobkin ◽  
Amy Finkelstein ◽  
Raymond Kluender ◽  
Matthew J. Notowidigdo
Keyword(s):  
Hospital Admissions ◽  
Economic Consequences ◽  
Retirement Income ◽  
Elderly Adults ◽  
Access To Credit ◽  
Study Approach ◽  
Medical Spending ◽  
Consumer Borrowing ◽  
Medical Bills ◽  
Retirement Study

We use an event study approach to examine the economic consequences of hospital admissions for adults in two datasets: survey data from the Health and Retirement Study, and hospitalization data linked to credit reports. For non-elderly adults with health insurance, hospital admissions increase out-of-pocket medical spending, unpaid medical bills, and bankruptcy, and reduce earnings, income, access to credit, and consumer borrowing. The earnings decline is substantial compared to the out-of-pocket spending increase, and is minimally insured prior to age-eligibility for Social Security Retirement Income. Relative to the insured non-elderly, the uninsured non-elderly experience much larger increases in unpaid medical bills and bankruptcy rates following a hospital admission. Hospital admissions trigger fewer than 5 percent of all bankruptcies in our sample. (JEL D14, G22, I11, I13)

scholarly journals The Economic Consequences of Gray Divorce for Women and Men

2020 ◽  
Author(s):  
I-Fen Lin ◽  
Susan L Brown
Keyword(s):  
Gender Gap ◽  
Divorce Rate ◽  
Well Being ◽  
Economic Consequences ◽  
Standard Of Living ◽  
Economic Disadvantage ◽  
Economic Costs ◽  
Random Effects Models ◽  
Retirement Study ◽  
Economic Well Being

Abstract Objectives Gray divorce, which describes divorce among persons aged 50 and older, is increasingly common reflecting the doubling of the gray divorce rate since 1990. Yet, surprisingly little is known about the consequences of gray divorce and in particular how women and men fare economically during the aftermath. Method Using longitudinal data from the 2004–2014 Health and Retirement Study, we estimated hybrid fixed/random-effects models comparing women’s and men’s economic well-being prior to, during, and following gray divorce and subsequent repartnering. Results Women experienced a 45% decline in their standard of living (measured by an income-to-needs ratio), whereas men’s dropped by just 21%. These declines persisted over time for men, and only reversed for women following repartnering, which essentially offset women’s losses associated with gray divorce. No gender gap emerged for changes in wealth following divorce with both women and men experiencing roughly a 50% drop. Similarly, repartnering was ameliorative only for women’s wealth. Discussion Gray divorce is often financially devastating, especially for women. Although repartnering seems to reverse most of the economic costs of gray divorce for women, few form new co-residential unions after divorce. This study offers a cautionary tale about the financial aftermath of gray divorce, which is likely to contribute to growing economic disadvantage among older adults.

Clinician assessment of potentially avoidable hospitalization in patients with cancer.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 4-4
Author(s):  
Gabriel Brooks ◽  
Hajime Uno ◽  
Joseph O. Jacobson ◽  
Deborah Schrag
Keyword(s):  
Patient Care ◽  
Primary Outcome ◽  
Hospital Admissions ◽  
Physician Assistant ◽  
Metastatic Cancer ◽  
Patients With Cancer ◽  
Avoidable Hospitalizations ◽  
Medical Spending ◽  
Common Cancer ◽  
Clinician Assessment

4 Background: In patients with advanced cancer, acute hospitalization accounts for nearly half of all medical spending. Prior research has suggested that many hospitalizations in cancer patients are potentially avoidable, however the perspectives of clinicians directly involved in patient care are not known. Methods: We studied hospital admissions to an inpatient medical oncology service among patients with solid tumor malignancies. For each hospitalization, we interviewed three clinicians from the medical team: the outpatient medical oncologist, the inpatient attending oncologist, and the inpatient resident physician or physician assistant. Respondents were asked to identify whether or not each hospitalization was potentially avoidable (‘probably’ or ‘definitely’ avoidable vs. ‘definitely not’ or ‘probably not’ avoidable). The primary outcome was the proportion of hospitalizations identified as potentially avoidable by two or more of the three clinicians. Results: Complete clinician interview data were collected for 103 of 132 eligible hospitalizations (78%). The median age at hospitalization was 64 years, and 79% of hospitalized patients had metastatic cancer. The most common cancer sites were the lung, breast, and colorectum. 18% of hospitalizations were rated as potentially avoidable by the outpatient oncologist, 28% by the inpatient oncologist, and 30% by the inpatient resident or physician assistant. 24 hospitalizations (23%) were identified as potentially avoidable by two or more clinicians, but only 2% were identified as potentially avoidable by all three clinicians. Hospitalizations were more likely to be perceived as potentially avoidable when psychosocial factors contributed to the reason for hospital admission (OR 2.9, 95% CI 1.2-7.3). Median length of stay was shorter for potentially avoidable hospitalizations (2 vs. 4 days), but rates of death and readmission within 90 days did not significantly differ following potentially avoidable vs. other hospitalizations. Conclusions: A substantial proportion of hospitalizations in patients with cancer are perceived as potentially avoidable by clinicians who are directly involved in patient care.

scholarly journals Implementation of Medicare Part D and Nondrug Medical Spending for Elderly Adults With Limited Prior Drug Coverage

JAMA ◽  
2011 ◽  
Vol 306 (4) ◽  
pp. 402 ◽  
Author(s):  
J. Michael McWilliams ◽  
Alan M. Zaslavsky ◽  
Haiden A. Huskamp
Keyword(s):  
Medicare Part D ◽  
Drug Coverage ◽  
Medicare Part ◽  
Elderly Adults ◽  
Part D ◽  
Medical Spending

scholarly journals Economic Evaluation Applied to Health Policy in New Zealand

2021 ◽  
Author(s):  
◽  
William Guy Scott
Keyword(s):  
Health Policy ◽  
Hospital Admissions ◽  
Disease Incidence ◽  
Incidence Rates ◽  
Data Set ◽  
Aggregated Data ◽  
Study Approach ◽  
Incidence Data ◽  
Additional Information ◽  
First Case

<p>Data available in the public domain are frequently aggregated to preserve confidentiality and to reduce a database to a manageable size. Drawing conclusions from such data may lead to inappropriate policy advice. The aims of this paper are to show how the aggregation of data to form rates may obscure important information and lead to misinterpretation of results. Suggestions are offered on ways in which this problem may be addressed. We also highlight the need to seek additional information in order to clarify findings. We used a case study approach by drawing on illustrative examples to highlight some problems encountered when using aggregated data about population. The focus is on health policy. Two types of problem were discussed in the cases chosen, but a common resolution was appropriate. In the first case policies based on the assumption that hospital admissions equate with disease incidence would be different from policies framed on actual incidence data. In the second, incidence rates changed when they were disaggregated to gender and age-specific rates. Policies formulated from analysis of aggregated data would be different form those based on disaggregated data. In the cases studied, the variables of gender, age and ethnicity influence incidence rates and must not be ignored. Researchers are recommended to study the data-set in the most disaggregated form available, and to check how data have been defined, collected and recorded, before preparing summary tables and graphs. Additional research or data from another source may be needed to clarify findings.</p>

scholarly journals Economic Evaluation Applied to Health Policy in New Zealand

2021 ◽  
Author(s):  
◽  
William Guy Scott
Keyword(s):  
Health Policy ◽  
Hospital Admissions ◽  
Disease Incidence ◽  
Incidence Rates ◽  
Data Set ◽  
Aggregated Data ◽  
Study Approach ◽  
Incidence Data ◽  
Additional Information ◽  
First Case

<p>Data available in the public domain are frequently aggregated to preserve confidentiality and to reduce a database to a manageable size. Drawing conclusions from such data may lead to inappropriate policy advice. The aims of this paper are to show how the aggregation of data to form rates may obscure important information and lead to misinterpretation of results. Suggestions are offered on ways in which this problem may be addressed. We also highlight the need to seek additional information in order to clarify findings. We used a case study approach by drawing on illustrative examples to highlight some problems encountered when using aggregated data about population. The focus is on health policy. Two types of problem were discussed in the cases chosen, but a common resolution was appropriate. In the first case policies based on the assumption that hospital admissions equate with disease incidence would be different from policies framed on actual incidence data. In the second, incidence rates changed when they were disaggregated to gender and age-specific rates. Policies formulated from analysis of aggregated data would be different form those based on disaggregated data. In the cases studied, the variables of gender, age and ethnicity influence incidence rates and must not be ignored. Researchers are recommended to study the data-set in the most disaggregated form available, and to check how data have been defined, collected and recorded, before preparing summary tables and graphs. Additional research or data from another source may be needed to clarify findings.</p>

Racial disparities in financial outcome among older adults with cancer: Analysis of the Health and Retirement Study.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 3-3
Author(s):  
Emily Castellanos
Keyword(s):  
Racial Disparities ◽  
Cancer Patients ◽  
Financial Hardship ◽  
Net Worth ◽  
Black And White ◽  
Medical Spending ◽  
Medicaid Enrollment ◽  
Medical Burden ◽  
Financial Outcome ◽  
Retirement Study

3 Background: Financial hardship from cancer is often attributed to high costs of care, but the relationship of out-of-pocket (OOP) medical burden to racial disparities seen in financially distressed cancer patients is underexplored. Using the Health and Retirement Study, a national longitudinal survey of U.S. households from 1992-2012, we examined the effect of a cancer diagnosis on financial hardship and OOP medical spending among black and white adults age-eligible for Medicare insurance. Methods: Analyses were restricted to adults 65 years or older to reduce heterogeneity in employment and insurance. Financial hardship was defined as new financial insolvency, > 50% decline in net worth, acquisition of debt, or high medical burden (OOP medical spending > 20% of income). The proportions of black and white cancer patients reporting financial hardship, as well as OOP medical spending, household debt, income, net worth, and insurance status by racial group were determined. Statistical comparisons using a t-test for proportions or Wilcoxon rank-sum testing were performed. Results: A total of 2158 white and 322 black cancer patients were identified. Black cancer patients were more likely than white cancer patients to report new financial insolvency (6.8% vs 1.6%; p < 0.0001), loss of > 50% of net worth (26.7% vs 15.3%; p < 0.0001), or new debt (27.6% vs 14.9%); p < 0.0001). OOP medical spending, median household income, and net worth were significantly lower in black vs white cancer patients. The rate of high medical burden was similar between black vs white patients (22.1% vs 21.6%, respectively). Dual Medicare/Medicaid enrollment was higher among black vs white cancer patients, at 23.1% and 7.4%. Conclusions: Significant racial disparities in the prevalence of financial hardship were seen among older adult cancer patients, despite lower OOP medical spending and increased dual Medicare/Medicaid enrollment by black vs white cancer patients. Interventions aimed at alleviating disparities in financial outcome among cancer patients should account for pre-existing differences in socioeconomic status in addition to direct medical costs.

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