Continued escalation in health care expenditures in the United States has led to an unsustainable model that consumes almost 20% of GDP. Policymakers have recognized the need for industry reform and have taken action through the passage of the Affordable Care Act (ACA). The purpose of this quantitative, longitudinal study was to examine the relationship between the type of health insurance and health care costs. Mechanism theory and game theory provided the theoretical framework. The analysis of secondary data from the Healthcare Cost and Utilization Project included a sample of 1,956,790-inpatient hospital stays from 2007 to 2014. Results of one-way ANOVAs indicated that between 2% and 9% of health care costs could be attributed to type of health insurance, a statistically significant finding. Results also supported the effectiveness of the ACA in stabilizing health care costs. The average annual rate of health care cost increase was 38.6% from 2007 until 2010, decreasing to an average annual increase of 4.3% from 2011 until 2014. Results provide important information to generate positive social change for consumers, providers, and policymakers. This includes improving decisions related to health care costs, improved understanding of the costs of health care services, increased transparency, increased patient engagement, maximizing consumer utility, facilitation of reduction of waste within the industry, and increased understanding of the impact of health policy on health care costs and efficiencies within newly created health policies. Results may also improve transparency of health care costs, which allows consumers, providers, and policymakers to take specific action to reduce health care costs, resulting in a more just and sustainable health care model.

Diss. (sammanfattning) Stockholm Karol. inst., 2002. / Härtill 7 uppsatser.

Submitted by MONIQUE YNDAWE CASTANHO ARAUJO null (mo_castanho@hotmail.com) on 2016-05-17T15:06:15Z No. of bitstreams: 1 dissertação MYCA 13-05-signed.pdf: 1845562 bytes, checksum: 09cb69365609868915483407107f50dd (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-05-19T13:19:49Z (GMT) No. of bitstreams: 1 araujo_myc_me_prud.pdf: 1845562 bytes, checksum: 09cb69365609868915483407107f50dd (MD5) / Made available in DSpace on 2016-05-19T13:19:49Z (GMT). No. of bitstreams: 1 araujo_myc_me_prud.pdf: 1845562 bytes, checksum: 09cb69365609868915483407107f50dd (MD5) Previous issue date: 2016-04-29 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O aumento da expectativa de vida vem acompanhado de conseqüências econômicas e sociais, onde destaca-se o aumento das doenças crônicas e dos gastos com saúde. As doenças crônicas não transmissíveis são as principais causas de morte no mundo e estão presentes de forma mais intensa na população idosa, tendo como alguns de seus fatores de risco o tabagismo, uso de álcool, inatividade física e obesidade. Dessa forma, o objetivo da presente pesquisa foi analisar associação entre agregação de fatores/comportamentos de risco à saúde e perda de produtividade laboral e aumento dos custos com saúde em adultos atendidos no Sistema Único de Saúde. Para tanto, 342 pacientes foram convidados a fazer parte da pesquisa e foram avaliados quanto a associação dos custos com tratamento na atenção primária e perda de produtividade com fatores/comportamentos de risco como adiposidade corporal, nível de atividade física, consumo de álcool e tabagismo e com variáveis de desfecho das doenças crônicas como os distúrbios do sono e dor lombar, e ainda, às variáveis sexo e idade de aposentadoria. Os fatores/comportamentos de risco foram agregados para constituir uma única variável de risco, assim, a amostra foi subdividida em três grupos: (i) nenhum comportamento/fator de risco, (ii) 1 comportamento/fator de risco, (iii) 2 ou mais comportamentos/fatores de risco, e o grau de influência de cada fator de risco nos custos com perda de produtividade foi verificado isoladamente e agregado a outros fatores de risco. A análise estatística foi composta pelos testes de Kolmogorov-Smirnov, Levene, Kruskal Wallis para comparação de três ou mais grupos (Mann Whitney, como post-hoc quando necessário) e Mann Whitney para comparação de dois grupos, qui-quadrado, regressão logística binária e Hosmer-Lemeshow, os procedimentos foram realizados no programa BioEstat 5.0 com significância adotada em 5%. Verificou-se que não houve associação entre agregação dos fatores/comportamentos de risco e gastos na atenção primária, no entanto maiores gastos foram encontrados para as variáveis distúrbios do sono, dor lombar, idade de aposentadoria e sexo. Para os fatores de risco e as varáveis de desfecho, observou-se que tabagismo (p-valor= 0,023) e distúrbios do sono (p-valor= 0,027) se associam aos gastos com perda de produtividade por absenteísmo. Gastos com perda de produtividade por aposentadoria por invalidez foram maiores para pacientes com distúrbios de sono (p-valor= 0,004) e dor lombar (p-valor= 0,001). A agregação dos fatores de risco obesidade, sedentarismo, uso de álcool e tabagismo, esteve associada a gastos com perda de produtividade por aposentadoria por invalidez (p-valor= 0,036), e ainda, observou-se que obesidade situa o paciente no maior quartil de perda de produtividade por aposentadoria por invalidez OR= 2.47 [95%IC= 1.20 – 5.06]. Conclui-se que fatores e comportamentos de risco às doenças crônicas não transmissíveis, bem como, suas variáveis de desfecho estão associados a gastos com saúde e perda de produtividade laboral em adultos atendidos na atenção básica do sistema de saúde da cidade de Presidente Prudente/SP. / The increase in life expectancy is accompanied by economic and social consequences, which highlights the increase in chronic diseases and health spending. Noncommunicable chronic diseases are the leading causes of death worldwide and are present more intensely in the elderly, having as some of its risk factors, smoking, alcohol use, physical inactivity and obesity. Thus, the objective of this study was to analyze the association between the aggregation of factors / risk behaviors to health and productivity loss and the raise on health care costs in adults treated at the Health System. Therefore, 342 patients were invited to join the study and were evaluated concerning the association of treatment costs in public primary health care services and productivity loss with factors / risk behaviors such as body fat, physical activity level, alcohol consumption and smoking, with outcome variables of chronic diseases such as sleep disorders and back pain; moreover, the gender and age of retirement. The factors / risk behaviors were aggregated to constitute a single risk variable, so the sample was subdivided into three groups: (i) no behavior / risk factor, (ii) one behavior / risk factor, (iii) 2 or more behaviors / risk factors and the degree of influence of each risk factor in productivity loss costs was checked separately and added to other risk factors. Statistical analysis was made by the Kolmogorov-Smirnov, Levene, Kruskal Wallis tests for comparison of three or more groups (Mann Whitney as post-hoc where necessary) and Mann Whitney test for comparison of two groups, chi-square test, binary logistic regression and HosmerLemeshow, the procedures were performed at 5.0 BioEstat program at 5% significance adopted. It was found that there was no association between aggregation of factors / risk behavior and expenses in public primary health care services but higher expenses were found for the variable sleep disorders, back pain, retirement age and sex. For risk factors and outcome variables it was observed that smoking (p = 0.023) and sleep disorders (p = 0.027) are associated with expenses on productivity loss by absenteeism. Costs on productivity loss by disability retirement were higher for patients with sleep disorders (p = 0.004) and low back pain (p = 0.001). The aggregation of risk factors such as, obesity, physical inactivity, alcohol consumption and smoking was associated with expenses on productivity loss disability retirement _ (p-value = 0.036) and it was observed that obesity places the patient in the highest quartile of productivity loss due to disability retirement OR = 2.47 [95% CI = 1:20 to 5:06]. It is concluded that factors and risk behaviors for noncommunicable chronic diseases as well as their outcome variables are associated with health expenses and loss of labor productivity in adults seen in the public primary health care service in the health system of the city of Presidente Prudente / SP. / FAPESP: 2014/09645-7

The master thesis deals with the health care systems of Spain and Portugal. The theoretical part of the thesis describes the general types of health care systems and the way they compare. In the next part the health systems of both countries are introduced with a focus on the financing, provision of services and health care reforms. The practical part of the thesis aims to analyse the relation between health expenditures and selected indicators of quality of health care in Spain and Portugal. For this purpose is used the correlation coefficient and the cost effectiveness analysis, which provides a comparison of the two countries with selected OECD countries.

archives@tulane.edu / 1 / Kimberly Michelle Koporc

Many children in developing countries forgo education due to the direct or opportunity costs of attending school. To help defray the direct costs of secondary schooling, the Ghanaian government launched its free secondary school initiative in 2017, which sought to make tuition and all educational-related expenses free for every Ghanaian child who passed the Basic Education Certificate Examination (BECE). The first objective of this study is to examine to what extent the association between household income and school enrollment decreased in strength over time due to Ghana’s 2017 policy reform using the Ghana socio-economic panel survey (GSPS) and difference-in-differences estimation technique. Our results show that household assets (a proxy for income) had a significant and positive association with school enrollment before the policy change; however, household assets have no significant association with enrollment after the policy change, thus suggesting that family resources do not matter for child enrollment after the policy change. Our results also imply that the 2017 policy reform effectively reduced the hurdles facing lower-income families in paying for secondary school education. The second objective of this study is to examine the effects of this government policy on household labor market outcomes in Ghana. Using the Ghana Socio-Economic Panel Survey (GSPS) and the difference-in-differences estimation technique, we found an increase in labor supply and wages for households with SHS kids before the policy change; however, after policy reform, both labor supply and wages of SHS households decreased suggesting that the free SHS policy did eliminates the direct cost of schooling. These results also indicate that the free SHS policy has significant implications for human capital development and household welfare and health since the policy eliminates the direct cost of schooling. The third chapter examines the impact of environmental tax revenues on domestic healthcare expenditures using panel data of 96 developing and developed countries from 2000 to 2018 and the fixed effect estimation technique. We find a positive and statistically significant association between total environmental tax revenue and government health expenditures; however, this finding is primarily driven by low-income countries. In addition, we find a positive effect of all kinds of environmental tax revenues on government health expenditures; however, the largest and strongest effect arises with pollution tax and transport tax respectively. Our empirical results confirm the validity of the double dividend hypothesis, thus suggesting that environmental tax revenues have significant implications for public health expenditures.

Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0967. Adviser: Luisa Franzini. Includes bibliographical references.

Submitted by EDUARDO PEREIRA DA SILVA (eduardoplug@gmail.com) on 2018-04-19T20:54:46Z No. of bitstreams: 1 Dissertação-Eduardo Versão Final.pdf: 1402968 bytes, checksum: 9ac0f4e0cb292ed83f576b710fe5d154 (MD5) / Approved for entry into archive by Claudia Adriana Spindola null (claudia@fct.unesp.br) on 2018-04-20T11:34:33Z (GMT) No. of bitstreams: 1 silva_ep_me_prud.pdf: 1402968 bytes, checksum: 9ac0f4e0cb292ed83f576b710fe5d154 (MD5) / Made available in DSpace on 2018-04-20T11:34:33Z (GMT). No. of bitstreams: 1 silva_ep_me_prud.pdf: 1402968 bytes, checksum: 9ac0f4e0cb292ed83f576b710fe5d154 (MD5) Previous issue date: 2018-03-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A qualidade do sono tem sido apontada como importante variável associada à manutenção da saúde e redução de despesas com serviços de saúde. No entanto, pouco se sabe sobre a relação entre qualidade do sono, alterações metabólicas e efeito da prática de atividades físicas, bem como o impacto desses fatores para os custos com saúde no âmbito do Sistema Único de Saúde (SUS). Objetivos: Analisar a relação entre qualidade do sono e gasto com saúde de pacientes do SUS, bem como identificar se estas relações ocorrem independentemente da prática de atividades físicas e fatores associados. Métodos: A amostra foi composta por 168 adultos de ambos os sexos (52 homens [31%] e 116 mulheres [69%]) com média de idade de 63,8 ± 8,6 anos, atendidos por duas unidades básicas de saúde da cidade de Presidente Prudente/SP. A variável dependente analisada foi os gastos em saúde. Como variáveis independentes foram analisados: i) indicadores de adiposidade corporal: percentil de gordura, circunferência de cintura e índice de massa corporal; ii) variáveis hemodinâmicas: pressão arterial sistólica e diastólica, glicemia, colesterol total, lipoproteínas de alta e baixa densidade, e triglicérides; iii) qualidade do sono e iv) a prática de atividade física. Adicionalmente, foram consideradas as variáveis de ajuste: sexo, idade e condição econômica. As análises estatísticas foram realizadas com testes de Kruskal-Wallis, Mann-Whitney e Spearman. Resultados: Alterações nos padrões do sono foram positivamente correlacionados com gastos com medicamentos r= 0,213 [95%IC= 0,052- 0,363] e negativamente com gastos com exames r= -0,166 [95%IC= -0,313- -0,012] (p-valor= -0,152), mesmo após ajuste por fatores de confusão. Além disso, os gastos com serviços de saúde também foram correlacionados ao escore de atividade física (p-valor= 0,162), pressão arterial (p-valor= -0,164), e variáveis bioquímicas. Conclusão: A qualidade do sono está correlacionada com os gastos de cuidados em saúde no Sistema Único de Saúde, mesmo após ajuste do modelo por variáveis de confusão, com destaque para gastos com medicamentos e exames. / Sleep quality has been identified as an important variable related to the maintenance of health and reduction of expenses with health services. However, little is known about the relationship between sleep quality, metabolic changes and the effect of physical activity practice, as well as the impact of these factors on health costs within the Unified Health System (UHS). Objectives: To analyze the relationship between sleep quality and health expenditure of UHS patients, as well as their activities related to the practice of associated physical and physical activities. Methods: The test was performed by 168 adults of both sexes (52 men [31%] and 116 women [69%]) with mean age of 63.8 ± 8.6 years, attended by two basic health units city of Presidente Prudente/SP. A dependent variable analyzed was health spending. The measures of confidence were: i) indicators of body adiposity: fat percentile, waist circumference and body mass index; ii) hemodynamic variables: systemic and diastolic arterial hypertension, glycemia, total cholesterol, high and low density lipoproteins, and triglycerides; iii) quality of sleep and iv) a practice of physical activity. Additionally, adjustment variables were found: gender, age and economic matrix. The analyzes consist of Kruskal-Wallis, MannWhitney and Spearman tests. Results: changes in the patterns were positively correlated with drug expenditures r = 0.213 [95% CI = 0.052-0.363] and with the negative shift with exams r = -0.166 [95% CI = -0.313-0.012] (p = value = -0.152), even if adjusted for confounding factors. In addition, health expenditures were correlated to the physical activity score (p-value = 0.162), arterial measure (p-value = -0.164), and biochemical variables. Conclusion: Sleep quality correlates with health care expenditures in the Unified Health System, even with the change in the model of basic variables, with emphasis on drug and testing expenditures.

Objective Objective of this study was to investigate the impact of the recent economic crisis of 2007/2008 on the subjective well-being and health status in thirteen European countries. Methods The European Social Survey (ESS) database was searched for individual health and wellbeing indicators and the database of the European Commission Eurostat for economic indicators. Data representing social determinants like education, housing and employment status and others before, during and after the crisis were retrieved. Eurostat data were used to analyse economic indicators and health outcomes on country level. Descriptive statistics were used to describe the changes in the different parameters over time. Regression analysis was performed to demonstrate relations between subjective well-being and different social determinants. Results Between 2006 and 2012 all countries experienced changes in their populations' subjective well-being. From 2006 to 2010 (crisis) the number of people with good or very good subjective well-being increased in France, Ireland, Belgium and Portugal by 0.6%, 1.0%, 1.2% and 6.5%, respectively. In Denmark and Spain this number remained basically stable. In Sweden, the United Kingdom, Finland and Germany the percentage of the population with good or very good subjective well-being decreased by 1.1%, 2.7%, 1.7% and 2.8%, respectively. Regression analysis demonstrated a significant relation between good and very good subjective well-being and level of education, main activity during the last 7 days, satisfaction with life, satisfaction with household income, main source of household income, gender and age. This relation differed for various factors and countries. In none of the countries satisfaction with national health services and satisfaction with current state of economy within the country was found significantly related to subjective well-being. The main amendable determinant correlating with a higher degree of subjective well-being is good education. The correlation between education and subjective well-being got stronger after the crisis than before or during the crisis. Conclusion Economic development does not have a uniform impact on subjective well-being. Education is a major amendable determinant influencing individual well-being. We could not find evidence for any significant impact of the organization of the healthcare services or social system on the subjective well-being.

With the passage of the Affordable Care Act, states were given the option to expand their Medicaid programs. Since then, thirty-eight states and Washington, D.C., have done so. Previous work has identified the widespread effects of expansion on enrollment and the financial implications for individuals, hospitals, and the federal government, yet administrative expenditures have not been considered. Using data from all fifty states for the period 2007-17, our study estimated the effects of Medicaid expansion overall, as well as differing effects by the size and nature of the expansions. Using a quasi-experimental approach, we found no overall effect of expansion on administrative spending. However, the size of the expansion may have produced differing effects. States with small expansions experienced some increases in administrative spending, whereas states with large expansions experienced some decreases in administrative spending, including a $77 reduction in per enrollee administrative spending compared with nonexpansion states. As more states consider expanding their Medicaid programs, our findings provide evidence of potential effects.