Escalating health care costs: costs of litigation

Fifty children with head injury were evaluated in an attempt to establish a correlation between post-traumatic hyperglycaemia and long-term outcome. In all the patients, the blood glucose level was measured on admission and on the days following the trauma (threshold of normal value set at 150 mg/dl). Hyperglycaemia was seen more frequently in children with severe head injury than in those with mild and moderate head injury. It was present in 87.5% of the patients with a Glasgow Coma Score (GCS) < or =8 (the average blood glucose level on admission was 237.8+/-92 mg/dl), in 60% of the patients with a GCS of 9-12 (178+/-78.7 mg/dl) and only in 25% of those with a GCS of 13-15 (131.5+/-39 mg/dl). A close correlation was also seen between the outcome and the blood glucose level. In fact, the blood glucose on admission was higher in the patients with a poor outcome, i.e. in those having a Glasgow Outcome Score (GOS) of 2 or 3 and in those who died (GOS 1), than in the patients with a good outcome (GOS of 4 or 5). Finally, hyperglycaemia persisted beyond the first 24 h after trauma in all the children who died or who survived with a poor outcome. Hyperglycaemia, and especially its persistence over time, appears to be an important negative prognostic factor in children with head injury.     

Complementary medicine--health policy and health care costs

Complementary medical methods are increasingly offered by physicians as well as other members of the health services and numerous therapists and they are sought and used by a majority of the population. From the point of view of health care authorities the question of acceptance or admission of methods and offering persons is raised. Unfortunately Switzerland lacks an uniform federal curriculum for practitioners of natural cures of other therapists in complementary medicine. Therefore, in order to control the steadily increasing wild growth of complementary medical offerings, several states (Kantone) have introduced examinations for the registration of such paramedical practitioners. Whether complementary (paramedical) medicine will really reduce costs of health care remains unproven so far. According to several surveys most alternative methods are used in addition to "school medicine" (academic medicine). Health insurance companies should subject reimbursement of costs to the fulfillment of standards regarding efficacy, appropriateness and economy equal to all other medications and therapies.     

The effects of preferred provider organizations on health care use and costs

Preferred provider organizations (PPOs) now account for half the enrollment in managed care plans. There are more than 1,000 PPOs, and over 20% of the insured population in the United States are enrolled in this type of plan. Still, there have been few investigations of use and cost of health services in these plans. This paper presents an analysis of a convenience sample of 1,977 companies, most of them mid-sized, from 1988 to 1990. On average, PPOs were associated with cost savings of 12% per covered life (95% confidence interval, 7.2% to 16.9%) as compared to traditional plans with utilization review. The source of cost savings was primarily through lower utilization rates, including a 9.7% lower rate of physician office visits (5.2% to 14.3%) and a 9.3% lower rate of hospital admissions (4.1% to 14.5%). Cost savings were found in seven individual PPOs and a group of small PPOs in the study. Two PPOs were associated with added costs and results were indeterminate for four others. While PPOs may not achieve the level of savings reported by some health maintenance organizations, they may provide a means to achieve some degree of managed care savings for some employer groups.     

The effects of social support and education on health care costs after three years

This study reports on the results of a randomized controlled trial that evaluated a caregiver-based intervention program for children with autism in community day-care centers. Thirty-five preschool children with a DSM III-R diagnosis of autism or pervasive developmental disorder were randomized to an experimental or control group. Children in the experimental group were enrolled in day care and their parents and child care workers received a 12-week intervention consisting of lectures and on-site consultations to day-care centers. In addition, supportive work was undertaken with families. Control subjects received day care alone. In the experimental group, there were greater gains in language abilities, significant increases in caregivers' knowledge about autism, greater perception of control on the part of mothers, and greater parent satisfaction. We conclude that this research design demonstrated that the intervention was significantly superior to day care alone.     

Reduced substance-abuse-related health care costs among voluntary participants in Alcoholics Anonymous

OBJECTIVE: This study examined differences in outcomes, alcoholism treatment utilization, and costs between alcoholic individuals with no previous treatment history who chose to attend Alcoholics Anonymous (AA) or to seek help from a professional outpatient alcoholism treatment provider. METHODS: Participants in this three-year prospective study were recruited at alcoholism information and referral services and at detoxification units in the San Francisco Bay Area. Chi square and t tests and repeated-measures analyses of variance were used to examine data gathered from interviews with 201 participants at baseline and at one and three years. RESULTS: At baseline, participants who chose to attend AA meetings (N = 135) were not significantly different from those who chose professional outpatient treatment (N = 66) in sex, marital status, employment, race, and symptoms of alcohol dependence and depression. However, AA attendees had lower incomes and less education and experienced more adverse consequences of drinking at baseline than did those who sought outpatient care, suggesting somewhat worse prognoses for the AA group. Over the three-year study, per-person treatment costs for the AA group were 45 percent (or $1,826) lower than costs for the outpatient treatment group. Despite the lower costs, outcomes for the AA group at both one and three years were similar to those of the outpatient treatment group. CONCLUSIONS: Voluntary AA participation may significantly reduce professional treatment costs. Clinicians, researchers, and policymakers should recognize the potential health care cost offsets offered by AA and other self-help organizations.     

Influencing the rising costs of health care: a staff nurse's perspective

In the current atmosphere of rising health costs and increasing hospital expenditures, nurses must take an active role in seeking solutions to these problems. The staff nurse can positively influence the events that occur when a person is admitted into the hospital and can play a major role in the functioning of the organization as a whole, which in turn affects the larger domains of society.     

Choice-sensitive health costs

Gemcitabine, a cytidine nucleoside analogue, has schedule-dependent antitumor activity in vitro and in vivo. Gemcitabine also has dose- and time-dependent radiosensitization properties in vitro. Thus it may have therapeutic application in combination with radiation. The aims of this study were to investigate whether gemcitabine could enhance radiation-induced tumor regrowth delay in a human squamous carcinoma (FaDu) xenograft in nude mice and to examine the effect of gemcitabine on radiation-induced apoptosis in in vivo tumors. Radiation was given locally to the tumors twice daily in 2 Gy fractions over 2 weeks for 5 days/week. Significant regrowth delay enhancement was observed which was dependent on gemcitabine schedule. Effective schedules using maximum tolerated gemcitabine doses were twice weekly and once weekly, but not daily. Significant toxicity occurred with radiation plus twice weekly gemcitabine, but enhancement was seen using gemcitabine doses well below the maximum tolerated dose. Both gemcitabine and radiation led to apoptotic cell death, but this was not increased when both treatments were combined. These results indicate that gemcitabine may be of therapeutic value as a radiation enhancer in the treatment of human cancers. Preliminary studies suggest that increased apoptotic cell death is not a mechanism leading to this enhancement.