Health care spending growth: How different is the United States from the rest of the OECD?
ABSTRACT This paper compares the long-term (1970-2002) rates of real growth in health spending per capita in the United States and a group of high-income countries in the Organization for Economic Cooperation and Development (OECD). Real health spending growth is decomposed into population aging, overall economic growth, and excess growth. Although rates of aging and overall economic growth were similar, annual excess growth was much higher in the United States (2.0 percent) versus the OECD countries studied (1.1 percent). That difference, which is of an economically important magnitude, suggests that country-specific institutional factors might contribute to long-term health spending trends.
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ABSTRACT: The aims of this paper are to explore the experiences of budget holders within the English National Health Service (NHS), in their attempts to implement programmes of disinvestment, and to consider factors which influence the success (or otherwise) of this activity. Between 24 January and 15 March 2011 semi-structured, telephone interviews were conducted with representatives of 12 Primary Care Trusts in England. Interviews focussed on: understanding of the term "disinvestment"; current activities, and perceived determinants of successful disinvestment decision making and implementation. Data were organised into themes according to standard qualitative data coding practices. Findings indicate that experiences of disinvestment are varied and that organisations are currently adopting a range of approaches. There are a number of apparently influential determinants of disinvestment which relate to both health system features and organisational characteristics. According to the experiences of the interviewees, many of the easier disinvestment options have now been taken and more ambitious plans, which require wider engagement and more thorough project management, will be required in the future. Findings from the research suggest that issues around understanding and usage of disinvestment terminology should be addressed and that a more in-depth and ethnographic research agenda will be of most value in moving forward both the theory and practice of disinvestment. This research suggests that, in the English NHS at least, there is a disjuncture between common usage of the term "disinvestment" and the way that it has previously been understood by the wider research community. In addition to this, the research also highlights a broader range of potential determinants of disinvestment than are considered in the extant literature.Journal of Health Organisation and Management 01/2013; 27(6):762-80. DOI:10.1108/JHOM-11-2012-0225 · 0.36 Impact Factor
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ABSTRACT: Ambient and pervasive technologies provide several ways to assist people with special needs in smart environments. However, the system's complexity and the size of the contextual information of these environments lead to several difficulties in deploying and providing the assistance services. A service provision mechanism which is aware of the environment context can simplify the deployment of assistance services on environment devices, by taking care of the decision processes. Moreover, the integration of the interaction modalities in the decision processes of such mechanisms allows deliveries of services to users based on their capabilities and preferences. In this paper, we present a context-aware service provision system for smart environment, which takes into account a whole set of contextual information: user profiles, device profiles, software profiles and environment topology. In regards to our previous work, this paper focuses on the modeling of the user interaction capabilities, built around the notion of interaction modalities. We also detail the integration of the model to the service provision reasoning process, as well as its implementation. Finally, we demonstrate the functionalities of this system through technical validations and scenarios carried out in a real smart apartment.Journal of Ambient Intelligence and Smart Environments 01/2013; 5(1):47-64. DOI:10.3233/AIS-120190 · 1.08 Impact Factor
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ABSTRACT: To assess differences in medical care expenditures and informal care received for adults and children by individuals' self-reported epilepsy status and to estimate the total economic impact of epilepsy in the United States. Pooled medical expenditure panel survey data from 1996-2004 were used. Children's regression analyses were adjusted for race, sex, general self-reported health status, family size, and age. Adults' analyses were also adjusted for income and education. The national annual economic impact was estimated by multiplying the average individual differences by previously published national prevalence data. The results of regressions appropriately weighted to account for study design indicate excess medical expenditures for those with epilepsy of $4,523 [95% confidence interval: $3,184-$5,862]. Excess expenditures were similar for adults and children. Adults with epilepsy received 1.2 extra days of informal care [95% confidence interval: 0.2-2.3]. The national impact included $9.6 billion of medical expenditures and informal care. Epilepsy has significant impact on individual medical expenditure and generates a national impact in the billions of dollar.Epilepsia 07/2009; 50(10):2186-91. DOI:10.1111/j.1528-1167.2009.02159.x · 4.58 Impact Factor