Medicare

Endophthalmitis, an ophthalmic condition characterized by an inflammation of the intraocular cavity, can have substantial implications for vision. However, little is known about the cost of treatment. The objective of this study was to estimate the direct medical cost of treatment for endophthalmitis in the United States. Retrospective data analysis using the 1997 through 2001 Medicare Beneficiary Encrypted Files. Beneficiaries who underwent cataract surgery were identified; baseline and clinical characteristics at the time of diagnosis were determined. Analyses stratified patients based on development of endophthalmitis in the year after surgery. Claims and reimbursements for cases (patients undergoing cataract extraction in whom endophthalmitis developed) and controls (patients who did not experience endophthalmitis) were determined and rates of resource use and costs were calculated from the perspective of Medicare. Annual Medicare payments and claims. A total of 417 beneficiaries with endophthalmitis occurring after cataract surgery were found; 139 558 had cataract surgery without subsequent endophthalmitis. Three fifths of beneficiaries were female and 89% were white. Ophthalmic claims and reimbursements were more than 1.45 times greater for cases than controls ($12 578 in higher claims and $3464 in higher reimbursements; P<0.0001). These findings demonstrate a substantial cost associated with endophthalmitis. With recent studies suggesting that prophylaxis is effective in preventing endophthalmitis, there is potential that inexpensive prophylaxis could result in cost and resource savings to Medicare.

The association of short-term readmissions after percutaneous coronary intervention (PCI) on healthcare costs has not been well studied. The Healthcare Cost and Utilization Project National Readmission Database encompassing 722 US hospitals was used to identify index PCI cases in patients ≥18 years old. Hierarchical regression analyses were used to examine the factors associated with risk of 30-day readmission and higher cumulative costs. We evaluated 206 869 hospitalized patients who survived to discharge after PCI from January through November 2013 and analyzed readmissions over 30 days after discharge. A total of 24 889 patients (12%) were readmitted within 30 days, with rates ranging from 6% to 17% across hospitals. Among the readmitted patients, 13% had PCI, 2% had coronary artery bypass surgery, and 3% died during the readmission. The most common reasons for readmission included nonspecific chest pain/angina (24%) and heart failure (11%). Mean cumulative costs were higher for ...

To compare the cost of substitutive Hospital at Home care versus traditional inpatient care for older patients with community-acquired pneumonia, exacerbation of chronic obstructive pulmonary disease, exacerbation of congestive heart failure, or cellulitis. Prospective nonrandomized clinical trial involving 455 community-dwelling older patients in 3 Medicare managed care health systems and at a Department of Veterans Affairs medical center. Costs were analyzed across all patients, within each of the separate health systems, and by condition. Generalized linear models controlling for confounders and using a log link and gamma family specification were used to make inferences about the statistical significance of cost differences. t Tests were used to make inferences regarding differences in follow-up utilization. The costs of the Hospital at Home intervention were significantly lower than those of usual acute hospital care (mean [SD], $5081 [$4427] vs $7480 [$8113]; P <.001). Labo...

To evaluate whether attending diabetes group visits (GVs) leads to lower medical care charges for inadequately insured patients with type 2 diabetes mellitus (DM). Randomized controlled clinical trial. Data were abstracted from financial records for 186 patients with uncontrolled type 2 DM randomized to receive care in GVs or usual care for 12 months. Mann-Whitney tests for differences of means for outpatient visits (primary and specialty care), emergency department (ED) visits, and inpatient stays were performed. Separate charge models were developed for primary and specialty outpatient visits. Because GV adherence is potentially dependent on unobserved patient characteristics, treatment effect models of outpatient charges and specialty care visits were estimated using maximum likelihood methods. Mann-Whitney test results indicated that GV patients had reduced ED and total charges but more outpatient charges than usual care patients. Ordinary least squares estimations confirmed tha...

Consumers need information to compare alternatives for markets to function efficiently. Recognizing this, public policies often pair competition with easy access to comparative information. The implicit assumption is that comparison friction—the wedge between the availability of comparative information and consumers’ use of it—is inconsequential because information is readily available and consumers will access this information and make effective choices. We

This article explores what globalization means for the relationship between Medicare and Canadian identity. Typical accounts of this relationship explain it as either the result of deep-seated Canadian values, or as the result of government action in the postwar era. Starting from where the second group leaves off, this article explores how the Medicare identity was the result of very specific capitalist property relations that are now fading. The article begins with an analysis of the origins of modern national identities, linking them to the transformation of property relations that characterized the transition to capitalism. It then focuses on the rise of social rights and how these were used to craft social solidarity among disparate individuals and groups in Canada. The next section focuses on globalization and the shift to neoliberalism. The article concludes with a reflection on what the demise of Medicare might mean for Canadian identity.

Nearly 8,000 people reside in Rhode Island's (RI's) 84 nursing homes at any single point in time. Many of these people are highly vulnerable because of illness or frailty. In this article, we describe the reasons that RI residents seek care from nursing homes, the associated costs (with a focus on Medicare and Medicaid payment), and different ways to assess nursing home quality. We also describe the home- and community-based services that can help people remain in the community. A resource list provides additional information for those seeking to better understand RI nursing homes and long-term care supports and services.

Purpose: In 2030, the United States will face a caregiver deficit. Currently, family members are taking on the role of unpaid caregiver as a key component to the American Healthcare system. Many family members take on this role out of love and familial obligation. As families assume this daunting task, they also take on a level of intense caregiver burden that causes stress on the caregiver in multiple aspects of their life. The purpose of this research is to explore and describe how caregivers use social media forums to address the financial, physical, mental, and relationship stresses of caregiving. By examining social media forums, this research describes the issues of the current caregiving environment. As the need for more caregivers’ increases with the retirement and health decline of the Baby Boomer generation, the public policy implications increase as well. The American Healthcare System, public policy, and senior care public programs are behooved to reform as caregiver burdens and resources become limited.
Methodology: The literature identified the categories of caregiver burden: relationship burden, financial burden, and health concerns. These three categories were used to explore social media forum Aging.com Caregiver Forum. The forum is used by caregivers where they connect, seek advice, and relate about their caregiving experiences. The framework developed from the literature divides caregiver questions and responses into the three categories included in this research. The subcategories included under the relationship burden, financial burden, and health concerns are displayed in the results data, where the question, answers, and number of likes and comments were analyzed.
Findings: Caregivers used Aging.com Caregiver Forum to ask each questions and gather recommendations. Many caregivers utilized this social media outlet as a support group. The topics and subcategories were divided to show where caregivers are experiencing the most burdens. Financial and Relationship burdens were clearly identified in this research. This explains the challenges caregivers face with the family dynamics, as well as the financial constraints and stress in the caregiving experience. As the Baby Boomer Generation increases in age and declines in health, public policy and programs will need to adapt to this growing scarcity of unpaid informal family caregivers.

The Indian Health Service (IHS), an agency within the U.S. Department of Health and Human Services, was responsible for providing federal health services to 1.51 million American Indian and Alaska Natives in 2000. Several opportunities related to health care exist for the IHS: potential public and private collaborations, continuation of the Clinton Administration's legacy of meaningful tribal consultation, and increasing the numbers of American Indian physicians, nurses, and other health related professionals. Modifications in federal programs such as Medicare and Medicaid pose a serious threat to the IHS because the IHS relies on these programs to offset the overall lack of funding. This article provides a framework for identifying the ways in which the external environment affects and determines the IHS' strategic responses to ensure competitiveness within the U.S. health care market. Value chain analysis will be used to evaluate the competitive advantages and disadvantages of the current IHS internal environment.