ABSTRACT From August 1, 1999, ¡§Co-payment For the Frequent-Visit Outpatients¡¨ has gone into effect. Frequent visit outpatients have to pay more medical expenses out of their own pocket. How did the new co-payment scheme affect the medical expenditure and utilization of the outpatients, especially frequent-visit outpatients? Can this new co-payment scheme work efficiently and reach its goal: reduce the unnecessary waste of the medical resources? At Taiwan, Central Healthcare and Medical Service (CHMS) has a large outpatient database, which contains the basic information of the outpatients. This study chose the database about the ¡§Frequent Outpatients¡¨ from August-December 1998, and August-December, 1999 as population. Such data included the 157,613 cases from 1998 and 160,870 cases from 1999. By analyzing the 1998 and 1999 data provided by the Central Healthcare and Medical Service, this study found the followings have been changed since new scheme took effect: 1. Co-payment had broad and deep effect on the patients¡¦ medical care utilization. Due to the additional High Medical Utilization Co-payment Fee, NT 50 or NT 100, outpatients would be more cautious before they go to see the doctors. At the same time, trying to get more for what they pay, outpatients would rather go to the major regional hospitals or centers in the medical system than small hospitals or clinics. As for the prescribed drug, outpatients were inclined to ask doctors for prescription drugs that can be taken for more days, so they can reduce their visits and therefore save some co-payment fees. This study also found prescribed drug expenses per patient dramatically increase when the average drug expenses per day decrease. Apparently, the increased drug expenses were form the more prescribed-drug days per visit. With the drug expenditures going up, average outpatient expenses per visit increased and the detailed and combination of medical bill varies. 2. Male and female had different responses to this new co-payment scheme. The gender-oriental differences were found in the following areas: ¡]1¡^Regional hospitals (centers) or small clinics. ¡]2¡^The average prescribed-drug days for each visit. ¡]3¡^Drug expenditure per day per patient.¡]4¡^Total expenses per outpatient visit. ¡]5¡^The detailed breakdown of each outpatient visit¡¦s expenses. 3. No effect on the following outpatient age segments:¡¨ age 6-14 teenager¡¨,¡¨ age 15-24 young people¡¨, and ¡§age 25-44 adults¡¨. The new co-payment system had no effect on the above-mentioned age groups, but it did have big and deep influence on the ¡§age 45-64 mid-age adult¡¨ and ¡§age 65 + elderly¡¨, especially on the elderly. The elderly were the major medical service user, and a lot of them lived on their retire and lived on their pensions, so they got hit badly by the high co-payment. 4. In general the higher co-payment had big effect on following three groups: ¡]1¡^¡§Media-utilization Outpatient Group¡¨, ¡]2¡^¡§High- utilization Outpatient Group¡¨ ¡]3¡^¡§Extremely- utilization Outpatient Group¡¨ To save money, outpatients, whatever group they belong to, would reduce their doctor visit. After analyzing all of the above-mentioned aspects, impacts, differences, changes and effects this high co-payment have had on the different age and gender groups since August 1999, this study concluded that the new co-payment regulation had significantly reduced the medical service demands, especially from female or male age 45+.

Older adults with infectious and chronic diseases, such as cardiovascular disease and human immunodeficiency virus (HIV), are at high risk for associated chronic comorbidities, which are associated with increased medical expenditures to cover treatment costs. The purpose of this study was to investigate (a) whether adults 65 or older with either HIV or cardiovascular disease were predisposed to increased medical expenditures versus adults 64 and younger, and (b) the impact of race and type of health service used on total direct medical expenditures incurred among adults with HIV or cardiovascular disease. A quantitative, deductive, retrospective cross-sectional design was used, and the behavioral model of health services use and the socioecological model were chosen as the study’s theoretical foundations. Analyses were conducted using binary logistic regression. Controlling for confounding variables of education and region of residence, the key findings were that adults ≥ 65 years had higher odds of incurring higher expenditures overall. White patients had higher odds of incurring higher expenditures for medication (OR 1.251), office-based visits (OR 1.433), inpatient visits (OR 1.245), and outpatient visits (OR 1.451) when compared to other races. Older adults with HIV had higher expenditures for medication and home health (OR 1.850); and older adults with cardiovascular disease had higher outpatient (OR 1.235), inpatient (OR 2.142), and emergency room expenditures (OR 1.063). These findings might promote social change because assessing the influences of cost disparities on infectious and chronic diseases can help address variations in health care costs and can initiate the development of tailored evidence-based practice guidelines that can help older adults.

Objective: To estimate the national prevalence and direct incremental expenditures of musculoskeletal disorders (MSD's) using the 2007 Medical Expenditure Panel Survey data. <br>Methods: A retrospective database analysis was conducted and individuals with MSD's (ICD-9-CM codes 274.00; 710.00-738.00) were identified. Dependent variables were total health care and other service category expenditures. The study utilized descriptive and regression analyses. <br>Results: In 2007, the national prevalence of MSD's was 33 million with incremental costs of $886.49 per person. The inpatient expenditures ($33,461.85) were the highest cost component in MSD's and the predictors of total health care expenditures were age, marital status, and presence of the disease condition. <br>Conclusion: The systematic assessment of MSD's and their associated incremental costs to the society is essential in increasing the awareness of decision makers to implement intervention strategies that are effective in lowering the disease incidence and in reducing the overall cost of disease management. / Mylan School of Pharmacy and the Graduate School of Pharmaceutical Sciences / Pharmacy Administration / MS / Thesis