Bisma Ali Sayed

Successful/Productive Aging, Responsibility, and Reflection

Successful aging is a central piece of the “new gerontology,” an effort by scholars and others to view aging in a fresh, positive light (Holstein and Minkler 2003; Moody 2005). This new approach must be viewed within its historical and contradictory cultural context (Moody 2002). In the twentieth century, improvements to the public health and social welfare infrastructures, coupled with advances in biomedicine, engendered shifts in the goals of modern medicine. With the increase in life expectancy, chronic health conditions supplanted acute health conditions as the primary threats to health and well-being. To accommodate this shift, healthcare efforts in the twenty-first century were increasingly targeted toward managing quality of life through long-term disease management. The increased prevalence of chronic conditions and the aging of the population are seen as creating tremendous pressure on the healthcare system and society. Indeed, many argue that our social welfare and healthcare infrastructures are not equipped to efficiently handle the burdens of chronic diseases and an aging population (Kovner and Knickman 2011). Recent research suggests that elders consume a relatively large share of healthcare, although they comprise only 13 % of the population in the United States (Stanton 2006). This is in part because they are victim to multiple chronic conditions that are expensive to treat and also because of the medicalization of normal aging processes (Illich 2000; Stanton 2006). Accordingly, curbing healthcare costs of elders is a key focus in the battle for efficient healthcare service delivery.

Monetary conversion factors for economic evaluations of substance use disorders

AIMS Estimating the economic consequences of substance use disorders (SUDs) is important for evaluating existing programs and new interventions. Policy makers in particular must weigh program effectiveness with scalability and sustainability considerations in deciding which programs to fund with limited resources. This study provides a comprehensive list of monetary conversion factors for a broad range of consequences, services, and outcomes, which can be used in economic evaluations of SUD interventions (primarily in the United States), including common co-occurring conditions such as HCV and HIV. METHODS Economic measures were selected from standardized clinical assessment instruments that are used in randomized clinical trials and other research studies (e.g., quasi-experimental community-based projects) to evaluate the impact of SUD interventions. National datasets were also reviewed for additional SUD-related consequences, services, and outcomes. Monetary conversion factors were identified through a comprehensive literature review of published articles as well as targeted searches of other sources such as government reports. RESULTS Eight service/consequence/outcome domains were identified containing more than sixty monetizable measures of medical and behavioral health services, laboratory services, SUD treatment, social services, productivity outcomes, disability outcomes, criminal activity and criminal justice services, and infectious diseases consequences. Unit-specific monetary conversion factors are reported, along with upper and lower bound estimates, whenever possible. CONCLUSIONS Having an updated and standardized source of monetary conversion factors will facilitate and improve future economic evaluations of interventions targeting SUDs and other risky behaviors. This exercise should be repeated periodically as new sources of data become available to maintain the timeliness, comprehensiveness, and quality of these estimates.

The Economic Cost of Substance Abuse Treatment in the State of Florida

Objective: Public and private stakeholders of substance abuse treatment services require economic cost data to guide program evaluations and funding decisions. Background: Rigorous cost assessments have been conducted for several treatment programs across the United States, but a systematic and comprehensive evaluation of programs in a particular state has never been attempted. Research Design: The present study recruited all publicly funded treatment programs in the State of Florida and administered the Brief Drug Abuse Treatment Cost Analysis Program. Subjects: A total of 175 programs participated in the study, representing a 71% response rate. Measures: Annual, weekly, and episode costs are estimated by modality. Conclusion: The study procedures and empirical findings from this research can be used by program evaluators and government officials in Florida and other states as they develop service reimbursement algorithms and initiate more extensive evaluations of publicly funded substance abuse treatment programs.