Kathryn Whetten-Goldstein

A comprehensive assessment of the cost of multiple sclerosis in the United States

Comprehensive data on the costs of multiple sclerosis is sparse. We conducted a survey of 606 persons with MS who were members of the National Multiple Sclerosis Society to obtain data on their cost of personal health services, other services, equipment, and earnings. Compensation of such cost in the form of health insurance, income support, and other subsidies was measured. Survey data and data from several secondary sources was used to measure costs incurred by comparable persons without MS. Based on the 1994 data, the annual cost of MS was estimated at over

Hospital pharmacy decisions, cost containment, and the use of cost-effectiveness analysis

34 000 per person, translating into a conservative estimate of national annual cost of

Civil liability, criminal law, and other policies and alcohol-related motor vehicle fatalities in the United States: 1984–1995

6.8 billion, and a total lifetime cost per case of

The impact of ancillary services on primary care use and outcomes for HIV/AIDS patients with public insurance coverage

2.2 million. Major components of cost were earnings loss and informal care. Virtually all persons with MS had health insurance, mostly Medicare/Medicaid. Health insurance covered 51 per cent of costs for services, excluding informal care. On average, compensation for earnings loss was 27 per cent. MS is very costly to the individual, health care system, and society. Much of the cost (57 per cent) is in the form of burdens other than personal health care, including earnings loss, equipment and alternations, and formal and informal care. These costs often are not calculated.

Effects of the threat of medical malpractice litigation and other factors on birth outcomes.

The key hypothesis of the study was that hospital pharmacies under the pressure of managed care would be more likely to adopt process innovations to assure less costly and more cost-effective provision of care. We conducted a survey of 103 hospitals and analyzed secondary data on cost and staffing. Compared to the size of the reduction in length of stay, changes in the way that a day of care is delivered appear to be minor, even in areas with substantial managed care share. The vast majority of hospitals surveyed had implemented some form of therapeutic interchange and generic substitution. Most hospitals used some drug utilization guidelines, but as of mid 1995 these were not yet important management tools for hospital pharmacies. To our knowledge, ours was the first survey to investigate the link between hospital formularies and use of cost-effectiveness analysis. At most cost-effectiveness was a minor tool in pharmaceutical decision making in hospitals at present. We could determine no differences in use of such analyses by managed care market share in the hospitals market share. One impediment to the use of cost-effectiveness studies was the lack of timeliness of studies. Other stated reasons for not using cost-effectiveness analysis more often were: lack of information on hospitalized patients and hence on the potential cost offsets accruing to the hospital: lack of independent sponsorship, and inadequate expertise in economic evaluation.

The Road from Medical Injury to Claims Resolution: How No-Fault and Tort Differ

This study examines the associations between alcohol policies and motor vehicle fatality rates from 1984 to 1995 in the United States. State policies and state characteristics variables were merged with motor vehicle fatality rates over an 11 year period and analyzed using minimum logit chi-square method and fixed effects to create a quasi time-series analysis. Laws allowing individuals to sue bars for the drunken behavior of their patrons were the policies most strongly associated with lower minor and adult fatality rates. The mandatory first offense fine was associated with lower minor fatality rates but not adult fatality rates, while minor and adult rates fell after administrative per se license suspension and anti-consumption laws for all vehicle occupants. Many other public policies evaluated were not associated with lower fatality rates.

The influence of obstetric no-fault compensation on obstetricians’ practice patterns

To better understand the impact of ancillary services on access to primary care, utilization of health services, costs and health status of HIV/AIDS patients, we studied adult HIV/AIDS patients eligible for public insurance for low-income people (Medicaid) in eastern North Carolina. Using primary data from a 1997 survey of such patients linked to Medicaid claims, multivariate logit analysis was used to estimate the effect of receiving housing, legal services and substance abuse treatment and of self-reported failure to obtain transportation and child care services on: (a) adequacy and use of primary care; (b) CD-4 counts; (c) viral load; and (d) self-rated health status. Between two-thirds and four-fifths of patients needing ancillary services obtain them. Receipt of housing and legal services were found to have a positive relationship with access to primary care. Difficulties in obtaining transportation and receipt of substance abuse services had a negative relationship with receipt of adequate primary care. On balance, these findings provide some support for continued public funding for various ancillary services to improve patient access to needed primary care. At current funding levels, not all patients needing help appear able to obtain such services.

Financial Burden of Chronic Neurological Disorders to Patients and Their Families: What Providers Need to Know

Most major health reform proposals include reform of medical malpractice. A major objective of the current medical malpractice system is to improve quality of care. The authors examine the effect of variations in the threat of medical malpractice, measured by claims frequency and payments per exposure year, on various indicators of birth outcomes, fetal deaths, low Apgar score, death within 5 days of birth, infant death, and death or permanent impairment at 5 years of age. Data came from 2 sources: a Survey of Obstetrical Care of 963 women in Florida in 1992 who delivered 5 years previously; and a fetal death and a linked birth-death file obtained from Florida Vital Statistics for 1987. Among the outcomes considered, only fetal deaths decreased in response to an increased threat of being sued, and this relationship was only obtained from one of the data sets. Overall, no systematic improvement in birth outcomes in response to an increased threat of medical malpractice litigation was obtained.

Liability, Risk Perceptions, and Precautions at Bars

The no-fault system offers an alternative method to tort litigation of obtaining compensation for injuries. By eliminating negligence as a criterion for payment, the no-fault system aims to pay compensation more quickly and return a higher percentage of the liability dollar to those who have suffered harm, either to person or to property. The no-fault concept has been widely applied, especially to automobile accidents, in the United States and in other countries with mixed results. In the area of medical malpractice, no-fault has been of-

Malpractice, Patient Satisfaction, and Physician-Patient Communication-Reply

OBJECTIVES The objectives were to determine level of satisfaction among obstetricians with the no-fault insurance programs in Florida and Virginia and to study any reported practice patterns attributable to implementation of no-fault compensation. STUDY DESIGN Structured surveys were conducted with 119 obstetricians in Florida and Virginia. RESULTS More than 90% of obstetricians were enrolled in no-fault insurance programs, but only 13% reported having had a patient compensated by a no-fault program. Only 14% knew of a colleague with a patient who had been compensated. Despite no-fault compensation, threat of lawsuits was a factor in 39% of cases of physicians who quit practicing obstetrics. The no-fault programs did not cause obstetricians to report increases in their obstetric caseloads or in their fraction of patients at high risk. Overall, obstetricians were far more satisfied with the no-fault system than with the tort system. Still, more than half of the respondents expressed dissatisfaction with premiums assessed by no-fault insurance. CONCLUSION Obstetricians who knew about the no-fault programs were generally satisfied with their performance. However, the no-fault programs have not built a constituency with physicians, and the programs are relatively small in their scope of coverage. No-fault compensation thus has had minor impact on reported obstetric practice. To be effective in improving patient access, no-fault compensation must be broader in scope.