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Sirur AJN, Pillai K R. Pricing of hospital services: evidence from a thematic review. HEALTH ECONOMICS, POLICY, AND LAW 2024; 19:234-252. [PMID: 38314528 DOI: 10.1017/s1744133123000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
The management implications of pricing healthcare services, especially hospitals, have received insufficient scholarly attention. Additionally, disciplinary overlaps have led to scattered academic efforts in this domain. This study performs a thematic synthesis of the literature and applies retrospective analysis to hospital service pricing articles to address these issues. The study's inputs were sourced from well-known online repositories, using a structured search string and PRISMA flow chart to select the pertinent documents. Our thematic analysis of pricing literature encompasses: (a) comprehension of hospital service pricing nature; (b) pricing objectives, strategies and practices differentiation; (c) presentation of factors impacting hospital service pricing. We observe that hospital pricing is an intricate and unclear matter. The terms 'pricing strategies' and 'pricing practices' are often used interchangeably in academic literature. Hospital service pricing is influenced by costs, demand and supply factors, market structure, pricing regulation and third-party reimbursements. The study's findings provide policy implications for service pricing in hospitals, in addition to suggesting avenues for future research on hospital pricing.
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Affiliation(s)
- Andria J N Sirur
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rajasekharan Pillai K
- Manipal Institute of Management, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Zitek T, Alexander JS, Bui J, Gonzalez N, Scheppke E, Obiorah S, Wong C, Farcy DA. Cash critical care time prices vary substantially by region and hospital ownership: A cross-sectional study. Am J Emerg Med 2024; 77:66-71. [PMID: 38104385 DOI: 10.1016/j.ajem.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES Emergency department (ED) patients may be billed for critical care time (current procedural terminology codes 99291 and 99292) if they receive at least 30 min of critical care services. We sought to determine the median cash (self-pay) prices for critical care time performed in the ED in the United States and assess for associations between hospital characteristics and prices. METHODS We performed a cross-sectional analysis of hospital cash prices for critical care time performed in the ED using the first 25 alphabetical states. For each hospital, we recorded hospital characteristics including state, control (nonprofit, governmental, or for-profit), size, teaching status, and system. We then searched for each hospital's cash prices for 99291 and 99292 using Turquoise and hospital websites. We determined the median price for 99291 nationally, regionally, and for large hospital systems. We performed multivariable quantile regression to assess for associations between hospital characteristics and prices for 99291. RESULTS Of the 2629 eligible hospitals, 2245 (85.4%) and 1893 (72.0%) reported cash prices for 99291 and 99292, respectively. For 99291, the cash price ranged from $45 to $84,775 with a median of $1816 (IQR: $1039-3237). For 99292, the median price was $567 (IQR: $298-1008). On multivariable analysis, hospitals had higher cash prices for 99291 if they were located in the West, for-profit, or part of a large system. In particular, hospitals owned by Tenet Healthcare charged the most for 99291 (median $28,244). CONCLUSION The cash prices for critical care time vary substantially based on hospital characteristics. In particular, for-profit hospitals and those in the West tend to charge the most. Given that patients who require critical care are unlikely to be able to choose the hospital to which they present, standardization of critical care time fees should be considered.
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Affiliation(s)
- Tony Zitek
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA; Herbert Wertheim College of Medicine at Florida International University, Miami, FL, USA.
| | - Jacob S Alexander
- Department of Surgery, University of Toledo Medical Center, Toledo, OH, USA
| | - Joseph Bui
- Herbert Wertheim College of Medicine at Florida International University, Miami, FL, USA
| | - Nicole Gonzalez
- Herbert Wertheim College of Medicine at Florida International University, Miami, FL, USA
| | - Eric Scheppke
- Edward Via College of Osteopathic Medicine, Auburn, AL, USA
| | - Samanthalee Obiorah
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Christopher Wong
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - David A Farcy
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA; Herbert Wertheim College of Medicine at Florida International University, Miami, FL, USA
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Cho LD, Hruby GW, Illescas AH, Sanderson M, Memtsoudis SG, Poeran J, Weber E. Inconsistent Surgical Implant Documentation: A Case Study in Total Knee and Hip Arthroplasty. Health Serv Insights 2023; 16:11786329231163008. [PMID: 37008409 PMCID: PMC10064159 DOI: 10.1177/11786329231163008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/23/2023] [Indexed: 04/04/2023] Open
Abstract
Value-based care initiatives require accurate quantification of resource utilization. This study explores hospital resource documentation performance for total knee and hip arthroplasty (TKA, THA) implants and how this may differ between hospitals. This retrospective study utilized the Premier discharge database, years 2006 to 2020. TKA/THA cases were categorized into 5 tiers based upon the completeness of implant component documentation: Platinum, Gold, Silver, Bronze, Poor. Correlation between TKA and THA documentation performance (per-hospital percentage of Platinum cases) was assessed. Logistic regression analyses measured the association between hospital characteristics (region, teaching status, bed size, urban/rural) and satisfactory documentation. TKA/THA implant documentation performance was compared to documentation for endovascular stent procedures. Individual hospitals tended to have very complete (Platinum) or very incomplete (Poor) documentation for both TKA and THA. TKA and THA documentation performance were correlated (correlation coefficient = .70). Teaching hospitals were less likely to have satisfactory documentation for both TKA (P = .002) and THA (P = .029). Documentation for endovascular stent procedures was superior compared to TKA/THA. Hospitals' TKA and THA-related implant documentation performance is generally either very proficient or very poor, in contrast with often well-documented endovascular stent procedures. Hospital characteristics, other than teaching status, do not appear to impact TKA/THA documentation completeness.
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Affiliation(s)
- Logan D Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gregory W Hruby
- Department of Analytics, Value Institute, New York-Presbyterian Hospital, New York, NY, USA
| | | | | | - Stavros G Memtsoudis
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg
| | - Jashvant Poeran
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ellerie Weber
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Ellerie Weber, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY 10029, USA.
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Thompson S, Lewis L, Takiar V. Hospital Price Transparency Rule Exposes Muddied Costs for Head and Neck Radiotherapy in One State. Am J Clin Oncol 2022; 45:268-272. [PMID: 35588227 DOI: 10.1097/coc.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Financial toxicity due to cancer treatment is a significant concern for patients. To increase transparency related to treatment costs, the Hospital Price Transparency Final Rule (HPTFR) was passed on January 1, 2021. We used hospital pricing documentation to explore the costs of head and neck cancer (HNC) radiotherapy in Ohio, hypothesizing a large variance in cost based on geography. MATERIALS AND METHODS Radiation oncology facilities were identified using the Ohio Hospital Association (OHA) website. The reported technical charges for Current Procedural Terminology (CPT) codes commonly billed in the definitive management of HNC with radiotherapy were recorded, and total treatment costs (TTCs) were calculated. RESULTS Of 254 OHA-listed hospitals, 102 had radiation oncology facilities. Seven facilities were excluded due to a lack of pricing data, leaving 95 facilities in 40 of 88 counties. Median TTC was $176,496. Average TTC was $184,831 (SD: $83,982). The 22 rural hospitals charged less compared with nonrural hospitals, with a difference in medians of $72,084.38 (P<0.001). No difference was found between the TTCs of nonprofit and public hospitals (P=0.348) nor between academically affiliated and nonacademically affiliated hospitals (P=0.247). There is no correlation between county median household income and TTC (R2=0.0007). Rather, TTCs varied drastically across counties, regardless of income levels. CONCLUSIONS There is a wide range of treatment costs for HNC patients receiving definitive radiotherapy in Ohio, and no variables fully explain this variance. Further policies are needed to improve the quality, quantity, and accessibility of health care data to address financial toxicity.
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Affiliation(s)
- Samuel Thompson
- Medical Sciences Baccalaureate Program, University of Cincinnati College of Medicine
| | - Luke Lewis
- Department of Radiation Oncology, University of Cincinnati
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati
- Cincinnati VA Medical Center, Cincinnati, OH
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Szewczyk Z, Weaver N, Rollo M, Deeming S, Holliday E, Reeves P, Collins C. Maternal Diet Quality, Body Mass Index and Resource Use in the Perinatal Period: An Observational Study. Nutrients 2020; 12:nu12113532. [PMID: 33213030 PMCID: PMC7698580 DOI: 10.3390/nu12113532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/16/2022] Open
Abstract
The impact of pre-pregnancy obesity and maternal diet quality on the use of healthcare resources during the perinatal period is underexplored. We assessed the effects of body mass index (BMI) and diet quality on the use of healthcare resources, to identify whether maternal diet quality may be effectively targeted to reduce antenatal heath care resource use, independent of women’s BMI. Cross-sectional data and inpatient medical records were gathered from pregnant women attending publicly funded antenatal outpatient clinics in Newcastle, Australia. Dietary intake was self-reported, using the Australian Eating Survey (AES) food frequency questionnaire, and diet quality was quantified from the AES subscale, the Australian Recommended Food Score (ARFS). Mean pre-pregnancy BMI was 28.8 kg/m2 (range: 14.7 kg/m2–64 kg/m2). Mean ARFS was 28.8 (SD = 13.1). Higher BMI was associated with increased odds of caesarean delivery; women in obese class II (35.0–39.9 kg/m2) had significantly higher odds of caesarean delivery compared to women of normal weight, (OR = 2.13, 95% CI 1.03 to 4.39; p = 0.04). Using Australian Refined Diagnosis Related Group categories for birth admission, the average cost of the birth admission was $1348 more for women in the obese class II, and $1952 more for women in the obese class III, compared to women in a normal BMI weight class. Higher ARFS was associated with a small statistically significant reduction in maternal length of stay (RR = 1.24, 95% CI 1.00, 1.54; p = 0.05). There was no evidence of an association between ARFS and mode of delivery or “midwifery-in-the-home-visits”.
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Affiliation(s)
- Zoe Szewczyk
- Hunter Medical Research Institute (HMRI) Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; (N.W.); (S.D.); (E.H.); (P.R.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Correspondence: (Z.S.); (C.C.)
| | - Natasha Weaver
- Hunter Medical Research Institute (HMRI) Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; (N.W.); (S.D.); (E.H.); (P.R.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Megan Rollo
- School of Health Sciences, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia;
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Simon Deeming
- Hunter Medical Research Institute (HMRI) Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; (N.W.); (S.D.); (E.H.); (P.R.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Elizabeth Holliday
- Hunter Medical Research Institute (HMRI) Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; (N.W.); (S.D.); (E.H.); (P.R.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Penny Reeves
- Hunter Medical Research Institute (HMRI) Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; (N.W.); (S.D.); (E.H.); (P.R.)
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Clare Collins
- School of Health Sciences, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia;
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Correspondence: (Z.S.); (C.C.)
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Akobirshoev I, Mitra M, Parish SL, Valentine A, Simas TAM. Racial and Ethnic Disparities in Birth Outcomes and Labor and Delivery Charges Among Massachusetts Women With Intellectual and Developmental Disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 58:126-138. [PMID: 32240049 DOI: 10.1352/1934-9556-58.2.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Understanding the pregnancy experiences of racial and ethnic minority women with intellectual and developmental disabilities (IDD) is critical to ensuring that policies can effectively support these women. This research analyzed data from the 1998-2013 Massachusetts Pregnancy to Early Life Longitudinal (PELL) data system to examine the racial and ethnic disparities in birth outcomes and labor and delivery charges of U.S. women with IDD. There was significant preterm birth disparity among non-Hispanic Black women with IDD compared to their non-Hispanic White peers. There were also significant racial and ethnic differences in associated labor and delivery-related charges. Further research, examining potential mechanisms behind the observed racial and ethnic differences in labor and delivery-related charges in Massachusetts' women with IDD is needed.
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Affiliation(s)
- Ilhom Akobirshoev
- Ilhom Akobirshoev and Monika Mitra, Brandeis University; Susan L. Parish, Virginia Commonwealth University; Anne Valentine, Brandeis University; and Tiffany A. Moore Simas, University of Massachusetts Medical School
| | - Monika Mitra
- Ilhom Akobirshoev and Monika Mitra, Brandeis University; Susan L. Parish, Virginia Commonwealth University; Anne Valentine, Brandeis University; and Tiffany A. Moore Simas, University of Massachusetts Medical School
| | - Susan L Parish
- Ilhom Akobirshoev and Monika Mitra, Brandeis University; Susan L. Parish, Virginia Commonwealth University; Anne Valentine, Brandeis University; and Tiffany A. Moore Simas, University of Massachusetts Medical School
| | - Anne Valentine
- Ilhom Akobirshoev and Monika Mitra, Brandeis University; Susan L. Parish, Virginia Commonwealth University; Anne Valentine, Brandeis University; and Tiffany A. Moore Simas, University of Massachusetts Medical School
| | - Tiffany A Moore Simas
- Ilhom Akobirshoev and Monika Mitra, Brandeis University; Susan L. Parish, Virginia Commonwealth University; Anne Valentine, Brandeis University; and Tiffany A. Moore Simas, University of Massachusetts Medical School
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Galvani AP, Parpia AS, Foster EM, Singer BH, Fitzpatrick MC. Improving the prognosis of health care in the USA. Lancet 2020; 395:524-533. [PMID: 32061298 PMCID: PMC8572548 DOI: 10.1016/s0140-6736(19)33019-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 11/12/2019] [Accepted: 11/22/2019] [Indexed: 01/22/2023]
Abstract
Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.
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Affiliation(s)
- Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA.
| | - Alyssa S Parpia
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA
| | - Eric M Foster
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Meagan C Fitzpatrick
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Schultz B, Fogel N, Finlay A, Collinge C, Githens MF, Higgins T, Mehta S, O'Toole RV, Summers H, Bishop JA, Gardner MJ. Orthopedic Surgeons Have Inadequate Knowledge of the Cost of Trauma-Related Imaging Studies. Orthopedics 2019; 42:e454-e459. [PMID: 31269218 DOI: 10.3928/01477447-20190627-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/16/2018] [Indexed: 02/03/2023]
Abstract
Radiographic imaging is integral to the diagnosis and treatment of orthopedic injuries. Previous studies have shown that orthopedists consistently underestimate the price of implants, but their knowledge of imaging charges is unknown. This study evaluated whether orthopedic residents and faculty could accurately estimate charges of imaging modalities at their respective institutions. A survey with 10 common imaging studies was sent to 8 academic level I trauma centers. Participants estimated the total charge of each imaging modality. This was compared with the actual charge at their institution. Seven centers produced 162 responders: 74 faculty and 88 residents. The differences between the estimated cost and the billing charge were calculated and broken down by training level and imaging modality. Overall, imaging charges were underestimated by 31% (P<.001), with 19.4% of estimates being within 20% of actual charges (95% confidence interval, 19.1-19.9). There was no difference between training levels (P=.69). There was greater than 1000% variation in charges between institutions. Orthopedists across training levels underestimate hospital charges associated with common imaging studies, and there is a large variation in charges between centers. Awareness of charges is important because charges affect clinical decision making and are relevant to practicing both cost-conscious and clinically sound medicine. [Orthopedics. 2019; 42(5):e454-e459.].
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Krishnaswami J, del C. Colon-Gonzalez M. Reforming Women's Health Care: A Call to Action for Lifestyle Medicine Practitioners to Save Lives of Mothers and Infants. Am J Lifestyle Med 2019; 13:495-504. [PMID: 31523215 PMCID: PMC6732876 DOI: 10.1177/1559827619838461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/21/2019] [Indexed: 12/16/2022] Open
Abstract
Maternal and infant mortality are fundamental indicators of a society's health and wellness. These measures depict a health crisis in the United States. Compared with other rich countries, women in the United States more frequently die from pregnancy or childbirth, and infants are less likely to survive to their first birthday. Most of these deaths are preventable; disproportionately affect diverse, low-income groups; and are perpetuated by social and health care inequities and subpar preventive care. Lifestyle medicine (LM) is uniquely positioned to ameliorate this growing crisis. The article presents key prescriptions for LM practitioners to build health and health equity for women. These prescriptions, summarized by the acronym PURER, include action in the areas of (1) practice, (2) understanding/empathy, (3) reform, (4) empowerment, and (5) relationship health. The PURER approach focuses on partnering with diverse female patients to promote resilience, promoting social connection and engagement, facilitating optimal family planning and advocating for culturally responsive, equitable health care systems. Through PURER, LM practitioners can help women and partners resiliently overcome the harmful challenges of discrimination and stress characterizing present-day American life. Over time, the equitable and collective practice of LM can help ameliorate the health care barriers undermining the health of women, families, and society.
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Affiliation(s)
- Janani Krishnaswami
- Internal Medicine / Preventive Medicine, University
of Texas Rio Grande Valley. Texas (MDCCG)
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Whaley CM. Provider responses to online price transparency. JOURNAL OF HEALTH ECONOMICS 2019; 66:241-259. [PMID: 31299558 DOI: 10.1016/j.jhealeco.2019.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/03/2019] [Accepted: 06/03/2019] [Indexed: 06/10/2023]
Abstract
Price transparency initiatives have recently emerged as a solution to the lack of health care price information available to consumers. This paper uses the staggered and nationwide diffusion of a leading internet-based price transparency platform to estimate the effects of price transparency on provider prices. I find a 1-4% reduction in provider prices for homogenous services, laboratory tests, but find no price response for differentiated services, office visits. Price responses are driven by active consumer use of price information. This paper demonstrates how reducing consumer search costs can spur limited firm price competition in health care markets.
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Akobirshoev I, Mitra M, Parish SL, Moore Simas TA, Dembo R, Ncube CN. Racial and ethnic disparities in birth outcomes and labour and delivery-related charges among women with intellectual and developmental disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:313-326. [PMID: 30576027 PMCID: PMC7271252 DOI: 10.1111/jir.12577] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/12/2018] [Accepted: 11/16/2018] [Indexed: 06/02/2023]
Abstract
BACKGROUND Women with intellectual and developmental disabilities (IDD) in the USA are bearing children at increasing rates. However, very little is known whether racial and ethnic disparities in birth outcomes and labour and delivery-related charges exist in this population. This study investigated racial and ethnic disparities in birth outcomes and labour and delivery-related charges among women with IDD. METHODS The study employed secondary analysis of the 2004-2011 Healthcare Cost and Utilization Project National Inpatient Sample, the largest all-payer, publicly available US inpatient healthcare database. Hierarchical mixed-effect logistic and linear regression models were used to compare the study outcomes. RESULTS We identified 2110 delivery-associated hospitalisations among women with IDD including 1275 among non-Hispanic White women, 527 among non-Hispanic Black women and 308 among Hispanic women. We found significant disparities in stillbirth among non-Hispanic Black and Hispanic women with IDD compared with their non-Hispanic White peers [odds ratio = 2.50, 95% confidence interval (CI): 1.16-5.28, P < 0.01 and odds ratio = 2.53, 95% CI: 1.08-5.92, P < 0.01, respectively]. There were no racial and ethnic disparities in caesarean delivery, preterm birth and small-for-gestational-age neonates among women with IDD. The average labour and delivery-related charges for non-Hispanic Black and Hispanic Women with IDD ($18 889 and $22 481, respectively) exceeded those for non-Hispanic White women with IDD ($14 886) by $4003 and $7595 or by 27% and 51%, respectively. The significant racial and ethnic differences in charges persisted even after controlling for a range of individual-level and institutional-level characteristics and were 6% (ln(β) = 0.06, 95% CI: 0.01-0.11, P < 0.05) and 9% (ln(β) = 0.09, 95% CI: 0.03-0.14, P < 0.01) higher for non-Hispanic Black and Hispanic Women with IDD compared with non-Hispanic White women with IDD. CONCLUSIONS Our findings highlight the need for an integrated approach to the delivery of comprehensive perinatal services for racial and ethnic minority women with IDD to reduce their risk of having a stillbirth. Additionally, further research is needed to examine the causes of racial and ethnic disparities in hospital charges for labour and delivery admission among women with IDD and ascertain whether price discrimination exists based on patients' racial or ethnic identities.
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Affiliation(s)
- I Akobirshoev
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - M Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - S L Parish
- Bouvé College of Health Science, Northeastern University, Boston, MA, USA
| | - T A Moore Simas
- Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, USA
| | - R Dembo
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - C N Ncube
- Bouvé College of Health Science, Northeastern University, Boston, MA, USA
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Out-of-pocket expenditure and correlates of caesarean births in public and private health centres in India. Soc Sci Med 2019; 224:45-57. [DOI: 10.1016/j.socscimed.2019.01.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/15/2018] [Accepted: 01/28/2019] [Indexed: 01/20/2023]
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Schiman C, Liu L, Shih YCT, Zhao L, Daviglus ML, Liu K, Fries J, Garside DB, Vu THT, Stamler J, Lloyd-Jones DM, Allen NB. Cardiovascular health in young and middle adulthood and medical care utilization and costs at older age - The Chicago Heart Association Detection Project Industry (CHA). Prev Med 2019; 119:87-98. [PMID: 30594534 PMCID: PMC6434936 DOI: 10.1016/j.ypmed.2018.12.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 12/20/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022]
Abstract
It is unclear how long-term medical utilization and costs from diverse care settings and their age-related patterns may differ by cardiovascular health (CVH) status earlier in adulthood. We followed 17,195 participants of the Chicago Heart Association Detection Project Industry (1967-1973) with linked Medicare claims (1992 to 2010). Baseline CVH is a composite measure of blood pressure, body mass index, diabetes, cholesterol, and smoking and includes four mutually exclusive strata: all factors were favorable (5.5%), one or more factors were elevated but none high (20.3%), one factor was high (40.9%), and two or more factors were high (33.2%). We assessed differences in the quantities (using negative binomial models) of and costs (using quantile regressions) for inpatient admissions, ambulatory care, home health care, and others between less favorable and all favorable CVH. All analyses adjusted for baseline age, race, sex, education, age at follow-up, year, state of residence, and death. We found that all favorable CVH in earlier adulthood was associated with lower long-term utilization and costs in all settings and the gap widened with age. Compared to all favorable CVH, the annual number of acute inpatient admissions per person was 79% greater (p-value < 0.001) for poor CVH, the median annual Medicare payment per person was $640 greater (41%, p-value < 0.001), and the mean was $4628 greater (67%, p-value < 0.001). The cost differences were greatest for acute inpatient, followed by ambulatory, post-acute inpatient, home health, and other. Early prevention efforts may potentially result in compressed all-cause morbidity in later years of age, along with reductions in resource use and health care costs for associated conditions.
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Affiliation(s)
- Cuiping Schiman
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States of America.
| | - Lei Liu
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States of America.
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States of America.
| | - Martha L Daviglus
- Institute of Minority Health Research, University of Illinois College of Medicine, Chicago, IL, United States of America.
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States of America.
| | - James Fries
- Department of Medicine, Stanford School of Medicine, Stanford, CA, United States of America.
| | - Daniel B Garside
- Institute of Minority Health Research, University of Illinois College of Medicine, Chicago, IL, United States of America.
| | - Thanh-Huyen T Vu
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States of America.
| | - Jeremiah Stamler
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States of America.
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States of America.
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States of America.
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15
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MOHAMMADSHAHI M, HEMATYAR H, NAJAFI M, ALIPOURI SAKHA M, POURREZA A. Caesarean Section vs. Normal Vaginal Delivery: A Game Theory Discussion in Reimbursement Interventions. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:1709-1716. [PMID: 30581788 PMCID: PMC6294862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The rate of caesarean section (C-section) in Iran is too high, so having a plan to control it is crucial. Since one of the most important reasons for inclination of providers to do C-section is financial issues, the purpose of this study was offering financial solutions for increasing normal vaginal delivery (NVD) and decreasing non-indicated C-section. METHODS This analytical-descriptive research, used game theory for offering financial mechanisms. The game was a dynamic one in which the backward induction was used to obtain a Nash equilibrium. Financial structure and the mean number of NVD and C-section in a certain period of time in comparison with standards were as the main influential factors on financial dimensions and were included in the model. RESULTS The effect of financial structure was shown through a specified insurance for childbirth, existence of a monitoring department and tariffs. CONCLUSION The main solution for controlling C-section in designed game was taxes and fines for physician or hospital in non- indicated cases and giving reward otherwise.
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16
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Norum J, Svee TE. Caesarean Section Rates and Activity-Based Funding in Northern Norway: A Model-Based Study Using the World Health Organization's Recommendation. Obstet Gynecol Int 2018; 2018:6764258. [PMID: 30116268 PMCID: PMC6079324 DOI: 10.1155/2018/6764258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 06/07/2018] [Accepted: 06/26/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Caesarean section (CS) rates vary significantly worldwide. The World Health Organization (WHO) has recommended a maximum CS rate of 15%. Norwegian hospitals are paid per CS (activity-based funding), employing the diagnosis-related group (DRG) system. We aimed to document how financial incentives can be affected by reduced CS rates, according to the WHO's recommendation. METHODS We employed a model-based analysis and included the 2016 data from the Norwegian Patient Registry (NPR) and the Medical Birth Registry of Norway (MBRN). The vaginal birth rate and CS rates of each hospital trust in Northern Norway were analyzed. RESULTS There were 4,860 deliveries and a 17.5% CS rate (range 13.9-20.3%). The total funding of the deliveries was €16,351,335 (CS: €6,389,323; vaginal births: €9,962,012). The CS rate varied significantly and was lower in the southern region (P < 0.002). Consequently, the introduction of a cutoff at a 15% CS rate would gain the two southern hospital trusts by a budget increase of 0.2%. The two northern ones would experience 6.4% less resources. A total of €644,655 could be allocated to further quality and safety initiatives in obstetrics. CONCLUSION The economic consequences of the model-based financial incentive were low, but probably sufficient to get the necessary attention and influence on the CS rate. RECOMMENDATIONS A financial incentive for the reduction of CS rates should be tested as a supplement to other instruments.
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Affiliation(s)
- Jan Norum
- Department of Surgery, Hammerfest Hospital, Hammerfest, Norway
- Department of Clinical Medicine, Faculty of Health Science, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Tove Elisabeth Svee
- Department of Obstetrics, University Hospital of North Norway, Harstad, Norway
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17
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Xu X, Lee HC, Lin H, Lundsberg LS, Pettker CM, Lipkind HS, Illuzzi JL. Hospital variation in cost of childbirth and contributing factors: a cross-sectional study. BJOG 2017; 125:829-839. [PMID: 29090498 DOI: 10.1111/1471-0528.15007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine hospital variation in cost of childbirth hospitalisations and identify factors that contribute to the variation. DESIGN Cross-sectional analysis of linked birth certificate and hospital discharge data. SETTING Two hundred and twenty hospitals in California delivering ≥ 100 births per year. POPULATION A total of 405 908 nulliparous term singleton vertex births during 2010-2012. METHODS Cost of childbirth hospitalisations was compared across hospitals after accounting for differences in patient clinical risk factors. Relative contributions of patient sociodemographic, obstetric intervention, birth attendant and institutional characteristics to variation in cost were assessed by further adjusting for these factors in hierarchical generalised linear models. MAIN OUTCOME MEASURES Cost of childbirth hospitalisation. RESULTS Median risk-standardised cost of childbirth was $7149 among the hospitals (10th -90th percentile range: $4760-$10,644). Maternal sociodemographic characteristics and type of birth attendant did not explain hospital variation in cost. Adjustment for obstetric interventions overall reduced within-hospital variance by 15.8% (P < 0.001), while adjusting for caesarean delivery alone reduced within-hospital variance by 14.4% (P < 0.001). However, obstetric interventions did not explain between-hospital variation in cost. In contrast, adjustment for institutional characteristics reduced between-hospital variance by 30.3% (P = 0.002). Hospital type of ownership, teaching/urban-rural status, neonatal care capacity and geographic region were most impactful. Risk-standardised cost was positively correlated with risk-standardised rate of severe newborn morbidities (correlation coefficient 0.22, P = 0.001), but not associated with risk-standardised rate of severe maternal morbidities. CONCLUSIONS Cost of childbirth hospitalisations varied widely among hospitals in California. Institutional characteristics significantly contributed to this variation. Higher-cost hospitals did not have better outcomes, suggesting potential opportunities to enhance value in care. TWEETABLE ABSTRACT Hospitals vary in cost of childbirth. Institutional characteristics significantly contribute to the variation.
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Affiliation(s)
- X Xu
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - H C Lee
- Department of Pediatrics, Division of Neonatal & Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - H Lin
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - L S Lundsberg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - C M Pettker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - H S Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - J L Illuzzi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
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18
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Law A, Yu J, Lin W, Lynen R, Lin J. Evaluation of hospitalization costs and associated factors among maternity stays involving low-risk and moderate- to high-risk childbirths in the United States. Hosp Pract (1995) 2017; 45:230-237. [PMID: 28990811 DOI: 10.1080/21548331.2017.1386066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aimed to assess the costs of childbirth and to identify factors associated with such hospital costs for low- and moderate/high-risk childbirth groups. METHODS All hospitalizations for childbirth between 2010-2014 in the Premier Perspective Hospital Database were identified. Risk category for each birth was defined by the age of the subject and/or presence of specific maternal comorbidities and obstetric risk factors. Hospital childbirth costs were determined and stratified by risk groups. Factors associated with costs for each risk group were evaluated by multiple regression. RESULTS Among 2,367,195 hospitalizations for childbirth, vaginal birth was the most common delivery method (n = 1,596,757; 68%). Among women characterized as moderate/high-risk, 42% (n = 642,495) had C-sections, while 11% (n = 90,211) of women categorized as low-risk had C-sections. The proportion of women with serious maternal morbidity among moderate/high-risk vs. low-risk women was 2% (n = 29,496) vs. 0.3% (n = 2749), respectively. The mean costs for moderate/high-risk vs. low-risk hospitalizations were $6145 (median = $5760) and $5397 (median = $5001), respectively (p < 0.0001). Factors significantly associated with costs for moderate/high-risk hospitalizations included delivery type (C-section vs. vaginal birth), LOS, urban/rural hospital status, geographic regions, calendar year of hospitalization, teaching status, payer types and serious maternal morbidity. Similar factors were found to impact costs among low-risk hospitalizations. CONCLUSIONS Characteristics such as delivery type, LOS, geographical region, teaching status, serious maternal morbidity and hospital urban/rural status were shown to impact hospital costs of childbirth. Screening and prevention strategies of factors that negatively impact costs may aid in reducing the hospitalization costs associated with childbirths.
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Affiliation(s)
- Amy Law
- a Medical Affairs , Bayer HealthCare Pharmaceuticals Inc , Whippany , NJ , USA
| | - Justin Yu
- a Medical Affairs , Bayer HealthCare Pharmaceuticals Inc , Whippany , NJ , USA
| | - Wenlong Lin
- a Medical Affairs , Bayer HealthCare Pharmaceuticals Inc , Whippany , NJ , USA
| | - Richard Lynen
- a Medical Affairs , Bayer HealthCare Pharmaceuticals Inc , Whippany , NJ , USA
| | - Jay Lin
- b HEOR , Novosys Health , Green Brook , NJ , USA
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19
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Miller GE, Culhane J, Grobman W, Simhan H, Williamson D, Adam EK, Buss C, Entringer S, Kim KY, Garcia-Espana JF, Keenan-Devlin L, McDade TW, Wadhwa PD, Borders A. Mothers' childhood hardship forecasts adverse pregnancy outcomes: Role of inflammatory, lifestyle, and psychosocial pathways. Brain Behav Immun 2017; 65:11-19. [PMID: 28450221 PMCID: PMC5537016 DOI: 10.1016/j.bbi.2017.04.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/28/2017] [Accepted: 04/23/2017] [Indexed: 12/23/2022] Open
Abstract
Research suggests the health consequences of economic hardship can be transmitted across generations. Some of these disparities are thought to be passed to offspring during gestation. But this hypothesis has not been tested in contemporary American samples, and the mechanisms of transmission have not been characterized. Accordingly, this study had two goals: first, to determine if women exposed to economic hardship during childhood showed higher rates of adverse birth outcomes; and second, to evaluate the contribution of inflammation, psychosocial, lifestyle, and obstetric characteristics to this phenomenon. This prospective study enrolled 744 women with singleton pregnancies (59.1% White; 16.3% Black; 18.7% Latina; 5.9% Other). Childhood economic hardship was measured by self-report. Birth outcomes included length of gestation and incidence of preterm birth; birth weight percentile and small for gestational age; length of hospital stay and admission to Special Care Nursery. Analyses revealed that mothers' childhood economic hardship was independently associated with multiple adverse birth outcomes, even following adjustment for demographics, maternal education, and obstetrical confounders. Women raised in economically disadvantaged conditions had shorter gestation length and higher preterm delivery rates. Their babies had lower birth weights, were more likely to be small for gestational age, stayed in the hospital longer, and had more Special Care Nursery admissions. Mediation analyses suggested these associations arose through multiple pathways, and highlighted roles for inflammation, education, adiposity, and obstetric complications. Collectively, these findings suggest that childhood economic hardship predisposes women to adverse birth outcomes, and highlights likely behavioral and biological mechanisms.
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Affiliation(s)
- Gregory E. Miller
- Department of Psychology, Northwestern University,Institute for Policy Research, Northwestern University
| | - Jennifer Culhane
- Children’s Hospital of Philadelphia, Division of Adolescent Medicine,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine
| | - William Grobman
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine
| | - Hyagriv Simhan
- Division of Maternal-Fetal Medicine, University of Pittsburgh School of Medicine,Division of Obstetrical Services, Magee Women’s Hospital
| | | | - Emma K. Adam
- Institute for Policy Research, Northwestern University,School of Education and Social Policy, Northwestern University
| | - Claudia Buss
- Development, Health and Disease Research Program, University of California, Irvine,Institute of Medical Psychology, Charite University of Medicine, Berlin, Germany
| | - Sonja Entringer
- Development, Health and Disease Research Program, University of California, Irvine,Institute of Medical Psychology, Charite University of Medicine, Berlin, Germany
| | - Kwang-Youn Kim
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | | | - Lauren Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University Health System, University of Chicago Pritzker School of Medicine
| | - Thomas W. McDade
- Institute for Policy Research, Northwestern University,Department of Anthropology, Northwestern University
| | - Pathik D. Wadhwa
- Development, Health and Disease Research Program, University of California, Irvine
| | - Ann Borders
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine,Department of Obstetrics and Gynecology, NorthShore University Health System, University of Chicago Pritzker School of Medicine,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
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20
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Hoxha I, Syrogiannouli L, Braha M, Goodman DC, da Costa BR, Jüni P. Caesarean sections and private insurance: systematic review and meta-analysis. BMJ Open 2017; 7:e016600. [PMID: 28827257 PMCID: PMC5629699 DOI: 10.1136/bmjopen-2017-016600] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Financial incentives associated with private insurance may encourage healthcare providers to perform more caesarean sections. We therefore sought to determine the association of private insurance and odds of caesarean section. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase and The Cochrane Library from the first year of records through August 2016. ELIGIBILITY CRITERIA We included studies that reported data to allow the calculation of OR of caesarean section of privately insured as compared with publicly insured women. OUTCOMES The prespecified primary outcome was the adjusted OR of births delivered by caesarean section of women covered with private insurance as compared with women covered with public insurance. The prespecified secondary outcome was the crude OR of births delivered by caesarean section of women covered with private insurance as compared with women covered with public insurance. RESULTS Eighteen articles describing 21 separate studies in 12.9 million women were included in this study. In a meta-analysis of 13 studies, the adjusted odds of delivery by caesarean section was 1.13 higher among privately insured women as compared with women with public insurance coverage (95% CI 1.07 to 1.18) with no relevant heterogeneity between studies (τ2=0.006). The meta-analysis of crude estimates from 12 studies revealed a somewhat more pronounced association (pooled OR 1.35, 95% CI 1.27 to 1.44) with no relevant heterogeneity between studies (τ2=0.011). CONCLUSIONS Caesarean sections are more likely to be performed in privately insured women as compared with women using public health insurance coverage. Although this effect is small on average and variable in its magnitude, it is present in all analyses we performed.
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Affiliation(s)
- Ilir Hoxha
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | | | - Medina Braha
- Department of Management and Marketing, International Business College Mitrovica, Mitrovica, Kosovo
| | - David C Goodman
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - Bruno R da Costa
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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21
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Garbens A, Goldenberg M, Wallis CJD, Tricco A, Grantcharov TP. The cost of intraoperative adverse events in abdominal and pelvic surgery: A systematic review. Am J Surg 2017; 215:163-170. [PMID: 28709625 DOI: 10.1016/j.amjsurg.2017.06.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/30/2017] [Accepted: 06/13/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The assessment of intra-operative adverse events (iAEs) is a vastly under researched area with the potential to provide new methods on how to improve patient outcomes and hospital costs. Our objective was to determine the relationship between iAEs and total hospital costs in abdominal and pelvic surgery. DATA SOURCES We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Embase, MEDLINE and EBM Reviews online databases were searched to identify all studies that reported iAE rates and total hospital costs. We then analyzed the costing approach used in each article using the Drummond tool and evaluated articles quality using the GRADE method. CONCLUSIONS In total, 1709 unique references were identified through our literature search. After review, 23 were included. All studies that reported iAE rates and cost as the primary outcome found that iAEs significantly increased total hospital costs. We identified a relationship between iAEs and increased hospital costs. Future studies need to be performed to further evaluate the relationship between iAEs and cost as current studies are of low quality.
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Affiliation(s)
- A Garbens
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
| | - M Goldenberg
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
| | - C J D Wallis
- Division of Urology, Department of Surgery, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - A Tricco
- Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, ON, Canada.
| | - T P Grantcharov
- Division of General Surgery, Department of Surgery, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada.
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22
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Shaw D, Guise JM, Shah N, Gemzell-Danielsson K, Joseph KS, Levy B, Wong F, Woodd S, Main EK. Drivers of maternity care in high-income countries: can health systems support woman-centred care? Lancet 2016; 388:2282-2295. [PMID: 27642026 DOI: 10.1016/s0140-6736(16)31527-6] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/24/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
In high-income countries, medical interventions to address the known risks associated with pregnancy and birth have been largely successful and have resulted in very low levels of maternal and neonatal mortality. In this Series paper, we present the main care delivery models, with case studies of the USA and Sweden, and examine the main drivers of these models. Although nearly all births are attended by a skilled birth attendant and are in an institution, practice, cadre, facility size, and place of birth vary widely; for example, births occur in homes, birth centres, midwifery-led birthing units in hospitals, and in high intervention hospital birthing facilities. Not all care is evidenced-based, and some care provision may be harmful. Fear prevails among subsets of women and providers. In some settings, medical liability costs are enormous, human resource shortages are common, and costs of providing care can be very high. New challenges linked to alteration of epidemiology, such as obesity and older age during pregnancy, are also present. Data are often not readily available to inform policy and practice in a timely way and surveillance requires greater attention and investment. Outcomes are not equitable, and disadvantaged segments of the population face access issues and substantially elevated risks. At the same time, examples of excellence and progress exist, from clinical interventions to models of care and practice. Labourists (who provide care for all the facility's women for labour and delivery) are discussed as a potential solution. Quality and safety factors are informed by women's experiences, as well as medical evidence. Progress requires the ability to normalise birth for most women, with integrated services available if complications develop. We also discuss mechanisms to improve quality of care and highlight areas where research can address knowledge gaps with potential for impact. Evaluation of models that provide woman-centred care and the best outcomes without high costs is required to provide an impetus for change.
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Affiliation(s)
- Dorothy Shaw
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada; BC Women's Hospital and Health Centre, Vancouver, BC, Canada.
| | - Jeanne-Marie Guise
- Departments of Obstetrics and Gynecology, Medical Informatics and Clinical Epidemiology, Public Health and Preventive Medicine, and Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Neel Shah
- Beth Israel Deaconess Medical Center, Harvard T H Chan School of Public Health, Cambridge, MA, USA
| | - Kristina Gemzell-Danielsson
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - K S Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; The Children's and Women's Hospital of British Columbia, BC, Canada
| | - Barbara Levy
- George Washington University School of Medicine, Washington, DC, USA; Uniformed Services University of the Health Sciences, Washington, DC, USA
| | - Fontayne Wong
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Susannah Woodd
- London School of Hygiene & Tropical Medicine, London, UK
| | - Elliott K Main
- California Maternal Quality Care Collaborative, San Francisco, CA, USA
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23
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Preussler JM, Mau LW, Majhail NS, Meyer CL, Denzen EM, Edsall KC, Farnia SH, Silver A, Saber W, Burns LJ, Vanness DJ. Administrative Claims Data for Economic Analyses in Hematopoietic Cell Transplantation: Challenges and Opportunities. Biol Blood Marrow Transplant 2016; 22:1738-1746. [PMID: 27184624 PMCID: PMC5600540 DOI: 10.1016/j.bbmt.2016.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/03/2016] [Indexed: 01/17/2023]
Abstract
There is an increasing need for the development of approaches to measure quality, costs, and resource utilization patterns among allogeneic hematopoietic cell transplantation (HCT) patients. Administrative claims data provide an opportunity to examine service utilization and costs, particularly from the payer's perspective. However, because administrative claims data are primarily designed for reimbursement purposes, challenges arise when using it for research. We use a case study with data derived from the 2007 to 2011 Truven Health MarketScan Research database to discuss opportunities and challenges for the use of administrative claims data to examine the costs and service utilization of allogeneic HCT and chemotherapy alone for patients with acute myeloid leukemia (AML). Starting with a cohort of 29,915 potentially eligible patients with a diagnosis of AML, we were able to identify 211 patients treated with HCT and 774 treated with chemotherapy alone where we were sufficiently confident of the diagnosis and treatment path to allow analysis. Administrative claims data provide an avenue to meet the need for health care costs, resource utilization, and outcome information. However, when using these data, a balance between clinical knowledge and applied methods is critical to identifying a valid study cohort and accurate measures of costs and resource utilization.
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Affiliation(s)
| | - Lih-Wen Mau
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota.
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | - Christa L Meyer
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Ellen M Denzen
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Kristen C Edsall
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | | | - Alicia Silver
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Linda J Burns
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
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24
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Common and Costly Hospitalizations Among Insured Young Adults Since the Affordable Care Act. J Adolesc Health 2016; 59:61-7. [PMID: 27158097 DOI: 10.1016/j.jadohealth.2016.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/15/2016] [Accepted: 03/15/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the most prevalent and costly inpatient hospitalizations in a national cohort of privately insured young adults since the Affordable Care Act. METHODS Cross-sectional study of a national administrative data set of privately insured young adult (18-30 years) beneficiaries hospitalized from January 2012 to June 2013. The most prevalent diagnosis categories for young adult hospitalizations are presented as percentages of all young adult hospitalizations by gender and age group (18-21, 22-25, and 26-30 years). Mean and median out-of-pocket costs by diagnosis category and gender are calculated based on deductible, copay and coinsurance payments. RESULTS We analyzed 158,777 hospitalizations among 4.7 million young adult beneficiaries; young adults accounted for 18.3% of privately insured hospitalizations across all ages. Top diagnoses for young adult female hospitalizations were pregnancy related (71.9%) and mental illness (8.9%). Top diagnoses for young adult male hospitalizations were mental illness (39.3%) and injuries and poisoning (14.0%). Mean and median total out-of-pocket costs for any young adult hospitalization were $1,034 and $700, respectively (mean deductible payment = $411). The most expensive out-of-pocket hospitalizations were for dermatologic diseases (e.g., skin infections) with means of $1,306 for females and $1,287 for males. CONCLUSIONS This study establishes a baseline for the ongoing assessment of the most common and costly hospitalizations among privately insured young adults in the United States under the Affordable Care Act. The substantial burden of potentially avoidable hospitalizations (e.g., mental health, injury, and poisonings) supports resource allocation to improve outpatient services, mental health access, and public health prevention strategies for young adults.
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Cram P. CORR Insights(®): Time-driven Activity-based Costing More Accurately Reflects Costs in Arthroplasty Surgery. Clin Orthop Relat Res 2016; 474:16-8. [PMID: 26013146 PMCID: PMC4686495 DOI: 10.1007/s11999-015-4295-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/02/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Peter Cram
- Division of General Internal Medicine, Toronto General Hospital, 200 Elizabeth Street, Eaton 14th Floor, Toronto, ON, M5G 2C4, Canada.
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Park JD, Kim E, Werner RM. Inpatient Hospital Charge Variability of U.S. Hospitals. J Gen Intern Med 2015; 30:1627-32. [PMID: 25931006 PMCID: PMC4617932 DOI: 10.1007/s11606-015-3352-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 03/03/2015] [Accepted: 03/30/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND The range of hospital charges for similar diagnoses show tremendous variability across U.S. hospitals. This charge variability remains unexplained. OBJECTIVE We aimed to describe hospital charge variability in the U.S. and examine its relationship to local health factors. DESIGN This was a descriptive study of the 2011 Medicare Inpatient Charge data summarizing inpatient hospital charges billed to Medicare. This data was evaluated using 29 county-level measures of health status, health behavior, clinical access and quality, built environment, and socioeconomic status in a clustered, multivariate linear regression. PARTICIPANTS 2871 U.S. hospitals registered with Medicare and with at least ten discharges for diagnosis-related groups (DRGs) of six common inpatient conditions. MAIN MEASURE Inpatient hospital charges were assessed. KEY RESULTS No community health measures were associated with hospital charges. The one notable exception associated with higher charges was higher rates of uninsured status ($344.84 higher charges for every one-percentage point increase in prevalence (p < 0.001)). One variable was associated with lower hospital charges: the percentage of children living in poverty [$309.30 lower charges for every one-percentage point increase in prevalence (p < 0.001)]. CONCLUSIONS Overall, hospital charges lacked an association with population health measures, and their variability remains largely unexplained. However, the association of higher charges with uninsured status raises concerns about hospitals' price-setting strategies, such as price discrimination and cost-shifting strategies that expose vulnerable populations to great financial risks.
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Affiliation(s)
- James D Park
- Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Edward Kim
- Department of Computer Science, The College of New Jersey, Ewing, NJ, USA.,Department of Computing Sciences, Villanova University, Villanova, PA, USA
| | - Rachel M Werner
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Xu X, Gariepy A, Lundsberg LS, Sheth SS, Pettker CM, Krumholz HM, Illuzzi JL. Wide Variation Found In Hospital Facility Costs For Maternity Stays Involving Low-Risk Childbirth. Health Aff (Millwood) 2015; 34:1212-9. [DOI: 10.1377/hlthaff.2014.1088] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Xiao Xu
- Xiao Xu is an assistant professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, in New Haven, Connecticut
| | - Aileen Gariepy
- Aileen Gariepy is an assistant professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine
| | - Lisbet S. Lundsberg
- Lisbet S. Lundsberg is an associate research scientist in the Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine
| | - Sangini S. Sheth
- Sangini S. Sheth is an assistant professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine
| | - Christian M. Pettker
- Christian M. Pettker is an associate professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine
| | - Harlan M. Krumholz
- Harlan M. Krumholz is the Harold H. Hines Jr. Professor of Medicine and Epidemiology and Public Health at the Yale School of Medicine
| | - Jessica L. Illuzzi
- Jessica L. Illuzzi is an associate professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine
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Friedman AM, Ananth CV, Chen L, D'Alton ME, Wright JD. An economic analysis of trial of labor after cesarean delivery. J Matern Fetal Neonatal Med 2015; 29:1030-5. [PMID: 25865742 DOI: 10.3109/14767058.2015.1035250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Given that cesarean delivery is one of the most commonly performed surgical procedures in the United States and an important contributor to obstetric care costs, this analysis sought to examine maternal hospital costs associated with trial of labor after cesarean delivery (TOLAC) versus repeat cesarean delivery (RCD). METHODS A national sample was used to identify women with singleton pregnancy who underwent either TOLAC or RCD from 2006 to 2012. Women with diagnoses that could confound cost via extended hospital length of stay prior to delivery were excluded. Other medical and obstetric covariates that could influence cost were included in an adjusted model. RESULTS A total of 485,247 women were identified, including 365,596 (75.3%) cesarean deliveries without labor, 41,988 (8.6%) successful and 77,663 (16.0%) unsuccessful TOLAC deliveries. The inflation-adjusted median costs in this cohort were $5512 for cesarean without labor, $4175 for successful TOLAC, $5166 for all TOLAC attempts, and $5759 for failed TOLAC. In a multivariable model, hospital region was a major predictor of median cost as were demographic variables and medical comorbidities. CONCLUSION TOLAC is associated with modest reductions of cost for maternal hospitalizations. However, other medical, demographic and hospital factors appear to be more important factors.
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Affiliation(s)
- Alexander M Friedman
- a Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , NY , USA and
| | - Cande V Ananth
- a Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , NY , USA and.,b Department of Epidemiology , Joseph L. Mailman School of Public Health, Columbia University , New York , NY , USA
| | - Ling Chen
- a Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , NY , USA and
| | - Mary E D'Alton
- a Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , NY , USA and
| | - Jason D Wright
- a Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , NY , USA and
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Abstract
In an analysis of all Ohio newborn infants discharged home alive between 2007 and 2012, the authors identified that significant variation in hospital charges (among Medicare Severity Diagnostic Related Group categorizations), previously identified nationally, persists at the state and local levels among term and preterm infants (p <.0001). Additionally, the authors identified variation in length of stay among infants with extreme immaturity or respiratory distress syndrome (p <.0001). Charge data remain the best available proxy for closely guarded hospital cost figures; increased pricing transparency would further support comparison of hospital newborn care costs.
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