PharmacoEconomics & Outcomes News 315 - 2 Jun 2001

Is the US getting value for itshealthcare dollar?

A recent analysis by investigators from the USNational Center for Health Statistics indicates that theUS population has been getting more healthcareservices for its healthcare dollar over the 15 years to1998.

The analysis, which used data from the NationalHealth Care Survey and other surveys, showed that theUS population has been receiving more ambulatorysurgery, more cardiac procedures, morepharmaceuticals, more therapies in nursing homes andmore home healthcare over time.

Major trend: more care for the elderlyOverall, there has been a 30% reduction in hospital

length of stay since 1970, report the investigators. Inparticular, their analysis showed that the number ofhospital discharges decreased from 148 per 1000population in 1985 to 116 per 1000 population in1997/1998. Concomitantly, an increase in the numberof ambulatory procedures was observed. And althoughthe number of procedures performed in hospitalsdeclined steadily over the 15-year period, the number ofcardiovascular procedures performed more thandoubled (increasing 108%); there was an even largerincrease in the elderly, note the investigators. Notably,the rates of angioplasty among the elderly increased by218% between 1990 and 1998. Also, the rate of nursing-home discharges per 1000 persons increasedsignificantly (from 38 in 1985 to 63 in 1997/1998).Furthermore, the number of elderly receiving homehealthcare increased from 29 per 1000 in 1990/1992 to38 per 1000 in 1997/1998. The analysis also showedthat the number of medications prescribed increasedfrom 109 per 100 visits in 1985 to 137 per 100 visits in1997/1998.

Effect of payment policy?The investigators comment that it is important to

examine the duration and content of medical encountersover time. For example, although rates of hospitaldischarge declined over the 15-year period, remaininghospital stays were more resource intensive and costlythan in the past. The investigators also comment thatdata must be analysed within the context of changes inpayment policy, although ‘one would hope thatutilization would be more strongly correlated with needthan with payment policy’, they comment.Bernstein AB, et al. Trend data on medical encounters: tracking a moving target.Health Affairs 20: 58-72, Mar-Apr 2001 800817556

1

PharmacoEconomics & Outcomes News 2 Jun 2001 No. 3151173-5503/10/0315-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved