Kanika Kapur

Does an Exercise and Incontinence Intervention Save Healthcare Costs in a Nursing Home Population

OBJECTIVES: To determine whether an intervention that combines low‐intensity exercise and incontinence care offsets some of its costs by reducing the incidence of selected health conditions in nursing home residents.

The Impact of Health on Job Mobility: A Measure of Job Lock

The author analyzes data from the National Medical Expenditure Survey of 1987 to measure the importance of “job lock”—the reduction in job mobility due to the non-portability of employer-provided health insurance. Refining the approach commonly used by other researchers investigating the same question, the author finds insignificant estimates of job lock; moreover, the confidence intervals of these estimates exclude large levels of job lock. A replication of an influential previous study that used the same data source shows large and significant job lock, as did that study, but when methodological problems are corrected and improved data are used to construct the job lock variables, job lock is found to be small and statistically insignificant.

The Roles of Government and Nonprofit Suppliers in Mixed Industries

In what ways, if any, does the behavior of government and nonprofit organizations differ? This article examines evidence from two industries-nursing homes and mentally handicapped facilities-to determine whether government and nonprofit organization behavior differs in identifiable dimensions and, if it does, why the differences occur. Behavior is studied in terms of consumer access, as measured by the use of waiting lists, and output quality, as measured by consumer satisfaction. Considerable differential behavior is found across the two institutional forms, even though both governmental and nonprofit organizations are subject to the nondistribution constraint. By contrast with private firms, both types of organizations may not lawfully distribute profit or surplus to owners, managers, or trustees. The behavioral differences found are consistent with varied models, one of which is that government and nonprofit providers have different objective functions, trading off quality and consumer access differently as government pursues a supplier-of-last-resort objective function.

The Role of Health Insurance in Joint Retirement among Married Couples

Because the near-elderly have high expected medical expenditures, availability of health insurance is an important factor in their retirement decisions. Using Health and Retirement Study data collected in 1992–2002, the authors of this study investigate whether access to employer-provided retiree health insurance enabled dual working couples to time their retirement together—a behavior called “joint retirement.” They find that when wives had employer-provided retiree health insurance, the likelihood of joint retirement more than doubled. The effect of retiree health insurance on overall employment patterns, in contrast, was modest: estimates indicate that a hypothetical change from universal availability of such insurance to its universal unavailability would have increased employment levels by only two percentage points.

Do patients bypass rural hospitals? Determinants of inpatient hospital choice in rural California

Rural hospitals play a crucial role in providing health care to rural Americans, a vulnerable and underserved population; however, rural hospitals have faced threats to their financial viability and many have closed as a result. This paper examines the hospital characteristics that are associated with patients choosing rural hospitals, and sheds light on the types of patients who depend on rural hospitals for care and, hence, may be the most harmed by the closure of rural hospitals. Using data from California hospitals, the paper shows that patients were more likely to choose nearby hospitals, larger hospitals, and hospitals that offered more services and technologies. However, even after adjusting for these factors, patients had a propensity to bypass rural hospitals in favor of large urban hospitals. Offering additional services and technologies would increase the share of rural residents choosing rural hospitals only slightly.

Inter-relationships between the economic and emotional consequences of colorectal cancer for patients and their families: a qualitative study

BackgroundWhile the evidence-base concerning the economic impact of cancer for patients and their families/carers has grown in recent years, there is little known about how emotional responses to cancer influence this economic impact. We investigated the economic costs of cancer in the context of patients’ emotions and how these both shaped the patient and family burden.MethodsHealth professionals from six hospitals invited patients diagnosed with colorectal cancer (ICD10 C18-C20) within the previous year to take part in the study. Semi-structured face-to-face interviews were conducted with patients and, where available, a family member. Interviews covered medical and non-medical costs incurred as a result of cancer and the impact of these on the lives of the patient and their family. Interviews were audio-recorded. Recordings were transcribed verbatim and these data were analysed qualitatively using thematic content analysis.ResultsTwenty-two patients with colorectal cancer (17 colon and 5 rectal; 14 women and 8 men) were interviewed; 6 were accompanied by a family member. Important cancer-related financial outlays included: travel and parking associated with hospital appointments; costs of procedures; increased household bills; and new clothing. Cancer impacted on employed individuals’ ability to work and depressed their income. The opportunity cost of informal care for carers/family members, especially immediately post-diagnosis, was a strong theme. All patients spoke of the emotional burden of colorectal cancer and described how this burden could lead to further costs for themselves and their families by limiting work and hindering their ability to efficiently manage their expenses. Some patients also spoke of how economic and emotional burdens could interact with each other. Support from employers, family/carers and the state/health services and patients’ own attitudes influenced this inter-relationship.ConclusionsThe economic impact of colorectal cancer on patients and their families is complex. This study suggests that the economic costs and the emotional impact of cancer are often related and can exacerbate each other, but that various factors can meditate this inter-relationship.

Expenditures for Physician Services under Alternative Models of Managed Care

This study compares expenditures for physician services in a closed panel gatekeeper health maintenance organization (HMO) and an open panel point of service HMO that share the same physician network. The study uses administrative files of the two study HMOs for 1994-1995 to assess differences in spending for primary care physicians’ (PCPs’) services, specialists’ services, and total physician services. When the copayments for PCP visits and PCP-referred specialist visits were

Work-related Productivity Losses in an Era of Ageing Populations: The Case of Colorectal Cancer

0, total physician expenditures were 4 percent higher in the gatekeeper HMO than in the point of service plan (p < .05). When the copayments for PCP visits and PCP-referred specialist visits were

Labor Market Implications of State Small Group Health Insurance Reform

10, total physician expenditures ranged from equal in both HMOs to 7 percent higher in the gatekeeper HMO (p < .01), depending on the copayment for self-referred visits. Expenditures for specialists’services were not higher in the point of service plan. The authors conclude that direct patient access to specialists does not necessarily result in higher physician or specialist expenditures in HMOs.

Cost comparisons and methodological heterogeneity in cost-of-illness studies: the example of colorectal cancer.

Objective: We investigated patterns and costs of lost productivity due to colorectal cancer in Ireland and examined how rising pension ages affect these costs. Methods: Data from a postal survey of colorectal cancer survivors (6 to 30 months after diagnosis; n = 159), taken from March 2010 to January 2011, were combined with population-level survival estimates and national wage data to calculate temporary and permanent disability, and premature mortality, costs using the human capital approach. Results: Almost 40% of respondents left the workforce permanently after diagnosis and 90% took temporary time off work. Total costs of lost productivity per person were &OV0556;205,847 in 2008 assuming retirement at the age of 65. When the retirement age was raised to 70, productivity costs increased by almost a half. Conclusions: Our study demonstrated the considerable productivity costs associated with colorectal cancer and highlighted the effect of rising retirement ages on costs.