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As in Davidoff et al. , health insurance premiums are not included because these do not directly relate to medical care use. To accommodate potential nonlinear age effects, we use categorical age bands (65–74 (ref.), 75–84, 85+). Separate binary markers are constructed to indicate female, non-white, married, high school graduate, had two or more living children, and lived with others in household. Separate indicator variables are also constructed for whether covered by Medicaid, private health insurance, and private long-term care insurance. Functional status measures include count of instrumental activities of daily living limitations (0 (ref.), 1–3, and 4–5), and count of activities of daily living disabilities (0 (ref.), 1–2, and 3+). Self-rated health is a categorical variable (excellent (ref.), very good, good, and fair/poor), while cognitive score is a continuous variable (range from 0–7).
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This has led to worry of widespread fraud (and a few highly-publicized cases of fraudulent PPP loan applications), and it has forced numerous federal agencies to turn their attention to combatting PPP loan fraud. The Care.com Safety Center has many resources and tools to assist you in verifying and evaluating potential care providers. The Care.com Safety Centerhas many resources and tools to assist you in verifying and evaluating potential care providers. Federal authorities are aggressively targeting individuals and companies for PPP loan fraud.
Additionally, costs of hospitalization care and/or overnight nursing home use also contributes significantly to the high costs of care for community-dwelling older adults with CVD. For the fourth costliest chronic condition–cancer–the key driver of increased spending is non-inpatient services , which accounts for 48% of the total excess spending. Noncommunicable diseases are among the most prevalent and costly health conditions in the United States. As of 2013, two out of every three older Americans have two or more chronic health conditions . Older adults have higher prevalence of chronic diseases than younger adults. According to nationwide statistics from the American Heart Association , about 85% of Americans aged 65+ have cardiovascular diseases as compared to 50% for those aged 45–64.
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Interventions to strengthen early detection and timely treatment of the more costly diseases, for example, can reduce the need for more expensive treatment and excessive OOP spending downstream. The HRS collects information on a set of doctor-diagnosed chronic health problems, including heart disease, stroke, cancer, diabetes, chronic lung disease, hypertension, arthritis, and major psychiatric problems. Respondents are asked, “Has a doctor ever told you that you have had a ? We construct a dichotomous variable for each chronic disease coded as , where 1 indicates ever having the condition and 0 otherwise. We combine responses for heart disease and stroke to create a CVD dummy.
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Home Health Agency
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For three of the four costliest conditions , prescription drug spending is singularly the most important driver of additional expenses. These findings are consistent with other recently published studies [38–39], and likely due to the extensive use of prescription drugs in disease management, e.g. oral agents or insulin therapy consumed by diabetes patients. A key conclusion is that service drivers of increased spending may be heterogeneous across disease types. Decomposition analysis can thus help health administrators and policymakers target interventions.
Hospice Care
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We find that prescription medication is a major component of the increased OOP spending for Medicare beneficiaries with CVD, diabetes and hypertension in 2014. Pharmaceuticals account for about 90% of the higher spending among beneficiaries with diabetes and hypertension. 67% of the excess OOP expenditure attributable to CVD stems from prescription drugs spending.
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A final limitation is that our analyses are cross-sectional and do not take into account dynamic changes in OOP expenditure over time. To put these dollar estimates in context, we also evaluate the spending difference in percentage terms. That is, we divide increased spending by the predicted average spending for persons without that disease . Our results suggest that Medicare beneficiaries with CVD spend 30.5% more than those without CVD.
Standard specification tests conducted support the use of the log link and the gamma distribution [29–30]. A series of goodness-of-fit tests further confirm that the fitted models do not have significant specification errors. For each outcome variable, we combine the results of the first and second parts to estimate average spending across different disease types. To ensure generalizability of the study findings to the U.S. population, we take into account the complex sample design of the HRS via individual-level sampling weights in all regressions. Statistical analyses are performed using STATA version 14.0 (STATA Corp., TX, USA).
For instance, lowering pharmaceutical costs for diabetes through volume purchasing or provider incentives. Value-based insurance design plans, which align individuals’ OOP costs with the value of the health services they receive, can also promote more cost efficient healthcare services and consumer choices . In this study we modeled the effect of various types of chronic diseases on OOP healthcare expenditure among non-institutionalized older adults. Our multivariate two-part analyses revealed that CVD, diabetes, hypertension and cancer, trigger significantly higher spending needs than other diseases such as arthritis. Our results are robust to variations in sample and how spending differences are assessed. The costly nature of CVD is perhaps least surprising because stroke and heart failure are currently among the most expensive chronic conditions in the Medicare fee-for-service program .
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