RESUMO
OBJECTIVE: We identify economic costs associated with communicable disease (CD) monitoring/surveillance in Colorado local public health agencies and identify possible economies of scale. DATA SOURCES/STUDY SETTING: Data were collected via a survey of local public health employees engaged in CD work. Survey respondents logged time spent on CD surveillance for 2-week periods in the spring of 2014 and fall of 2014. Forty-three of the 54 local public health agencies in Colorado participated. STUDY DESIGN: We used a microcosting approach. We estimated a statistical cost function using cost as a function of the number of reported investigable diseases during the matched 2-week period. We also controlled for other independent variables, including case mix, characteristics of the agency, the community, and services provided. DATA COLLECTION/EXTRACTION METHODS: Data were collected from a microcosting survey using time logs. PRINCIPAL FINDINGS: Costs increased at a decreasing rate as cases increased, with both cases (ß = 431.5, p < .001) and cases squared (ß = -3.62, p = .05) statistically significant. CONCLUSIONS AND IMPLICATIONS: The results of the model suggest economies of scale. Cost per unit is estimated to be one-third lower for high-volume agencies as compared to low-volume agencies. Cost savings could potentially be achieved if smaller agencies shared services.
Assuntos
Doenças Transmissíveis/economia , Doenças Transmissíveis/epidemiologia , Administração em Saúde Pública/economia , Vigilância em Saúde Pública , Colorado , Comunicação , Custos e Análise de Custo , Notificação de Doenças/economia , Humanos , Modelos Econométricos , Fatores de TempoRESUMO
OBJECTIVE: Patients in the ICU are at the greatest risk of contracting healthcare-associated infections like methicillin-resistant Staphylococcus aureus. This study calculates the cost-effectiveness of methicillin-resistant S aureus prevention strategies and recommends specific strategies based on screening test implementation. DESIGN: A cost-effectiveness analysis using a Markov model from the hospital perspective was conducted to determine if the implementation costs of methicillin-resistant S aureus prevention strategies are justified by associated reductions in methicillin-resistant S aureus infections and improvements in quality-adjusted life years. Univariate and probabilistic sensitivity analyses determined the influence of input variation on the cost-effectiveness. SETTING: ICU. PATIENTS: Hypothetical cohort of adults admitted to the ICU. INTERVENTIONS: Three prevention strategies were evaluated, including universal decolonization, targeted decolonization, and screening and isolation. Because prevention strategies have a screening component, the screening test in the model was varied to reflect commonly used screening test categories, including conventional culture, chromogenic agar, and polymerase chain reaction. MEASUREMENTS AND MAIN RESULTS: Universal and targeted decolonization are less costly and more effective than screening and isolation. This is consistent for all screening tests. When compared with targeted decolonization, universal decolonization is cost-saving to cost-effective, with maximum cost savings occurring when a hospital uses more expensive screening tests like polymerase chain reaction. Results were robust to sensitivity analyses. CONCLUSIONS: As compared with screening and isolation, the current standard practice in ICUs, targeted decolonization, and universal decolonization are less costly and more effective. This supports updating the standard practice to a decolonization approach.
Assuntos
Infecção Hospitalar/prevenção & controle , Controle de Infecções/organização & administração , Unidades de Terapia Intensiva/organização & administração , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/prevenção & controle , Portador Sadio/diagnóstico , Análise Custo-Benefício , Humanos , Controle de Infecções/economia , Unidades de Terapia Intensiva/economia , Cadeias de Markov , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Modelos Econométricos , Anos de Vida Ajustados por Qualidade de Vida , Infecções Estafilocócicas/diagnósticoRESUMO
OBJECTIVE: To evaluate the effect of the Oregon and New Mexico Health Insurance Flexibility and Accountability (HIFA) demonstrations. HIFA is an optional state Medicaid expansion targeted at adults and children with incomes below 200 percent of the federal poverty level (FPL). The study has five research questions: What type of health insurance do HIFA enrollees self report in surveys? What are the demographic characteristics of these enrollees? What type of health insurance coverage, if any, did HIFA enrollees have just prior to enrollment in the HIFA program? Among those with prior coverage, what prompted participation in the HIFA program? What type of health insurance, if any, would HIFA enrollees have in the absence of HIFA? METHODS: Data were collected via telephone interviews with a total of 406 enrollees from Oregon and 409 enrollees from New Mexico. The survey was conducted between July 7 and September 20, 2009, for both states. The sample frame for the survey was based on administrative records of adults enrolled in June 2009. After completion of the survey, active enrollment status as of the date the telephone interview was confirmed. Respondents no longer enrolled at the time of the survey (7 cases in NM and 14 in OR) were excluded from the analysis. The final sample size was 794 verified HIFA enrollees. RESULTS: HIFA enrollees tended to be middle-aged, male, and relatively unhealthy. Employment status varied tremendously from the self-employed to retired to unable to work. HIFA enrollees were reasonably well educated with 80 percent having at least a high school education. Most HIFA enrollees (90 percent) reported being uninsured just prior to participation in HIFA. Of those who were uninsured, most reported having been uninsured for an extended time-a year or more. Most enrollees joined HIFA because they lacked access to health insurance or could not afford insurance on the private market. The overwhelming majority (76 percent) of respondents believed that they would be uninsured in the absence of HIFA, with few considering either an employer plan or private purchase to be a viable option. Over 90 percent of enrollees correctly indicated they had insurance coverage. However, characterization of the type of coverage was problematic, particularly in the absence of the program-specific name. CONCLUSIONS: HIFA enrolled a relatively sick, male, middle-aged population that tended to have been long-term uninsured--the kind of enrollees for which the programs were designed--with little apparent crowd-out of private insurance. The reported health status coupled with low incomes suggests that individual purchase is unlikely, a sentiment echoed by the respondents. In the absence of HIFA, most enrollees believed they would rejoin the ranks of the uninsured from where they came.
Assuntos
Nível de Saúde , Medicaid/estatística & dados numéricos , Adulto , Distribuição por Idade , Definição da Elegibilidade , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Saúde Mental , Pessoa de Meia-Idade , New Mexico , Oregon , Distribuição por Sexo , Fatores Socioeconômicos , Estados UnidosRESUMO
OBJECTIVE: The Patient Protection and Affordable Care Act (ACA) increases Medicaid physician fees for preventive care up to Medicare rates for 2013 and 2014. The purpose of this paper was to model the relationship between Medicaid preventive care payment rates and the use of U.S. Preventive Services Task Force (USPSTF)-recommended preventive care use among Medicaid enrollees. DATA SOURCES/STUDY SESSION: We used data from the 2003 and 2008 Medical Expenditure Panel Survey (MEPS), a national probability sample of the U.S. civilian, noninstitutionalized population, linked to Kaiser state Medicaid benefits data, including the state Medicaid-to-Medicare physician fee ratio in 2003 and 2008. STUDY DESIGN: Probit models were used to estimate the probability that eligible individuals received one of five USPSF-recommended preventive services. A difference-in-difference model was used to separate out the effect of changes in the Medicaid payment rate and other factors. DATA COLLECTION/EXTRACTION METHODS: Data were linked using state identifiers. PRINCIPAL FINDINGS: Although Medicaid enrollees had a lower rate of use of the five preventive services in univariate analysis, neither Medicaid enrollment nor changes in Medicaid payment rates had statistically significant effects on meeting screening recommendations for the five screenings. The results were robust to a number of different sensitivity tests. Individual and state characteristics were significant. CONCLUSIONS: Our results suggest that although temporary changes in primary care provider payments for preventive services for Medicaid enrollees may have other desirable effects, they are unlikely to substantially increase the use of these selected USPSTF-recommended preventive care services among Medicaid enrollees.