Consequences of Increasing Copayments for Ambulatory Care
Key point: Even small increases in cost-sharing were associated with fewer outpatient visits and more inpatient admissions among elders.
Citation: Trivedi AN, Moloo H, Mor V. Increased ambulatory care copayments and hospitalizations among the elderly. N Engl J Med. 2010; 62: 320-328.
Recently, many health plans have increased copayments for outpatient visits. Although the rationale, presumably, is to minimize unnecessary ambulatory care, the strategy could backfire if higher copayments dissuade patients from obtaining necessary clinical services.
To examine this issue, researchers analyzed data from 36 Medicare managed care plans with nearly 1 million enrollees. In 18 plans, mean copayments for outpatient visits increased during the study period (2001-2006), from a mean of $7 to $14 for primary care visits and from $13 to $22 for specialist visits.
During the year after outpatient copayments increased, 20 fewer outpatient visits occurred per 100 enrollees (compared with plans that did not charge copayments). However, annual inpatient admissions increased by two per 100 enrollees and inpatient days increased by 13 per 100 enrollees after copayments increased. Annual outpatient expenditures fell by an estimated $7,150 per 100 enrollees, but this savings was negated by inpatient expenditures, which increased by an estimated $24,000 per 100 enrollees annually.
[Published in J Watch General Med, January 28, 2010 – Allan S. Brett, MD.]
Errors Found in Pediatric Deaths Due to Severe Bacterial Infection
Key point: Most cases of death secondary to severe bacterial infection were those where management was suboptimal.
Citation: Launay E, Gras-Le Guen C, Martinot A, et al. Suboptimal care in the initial management of children who died from severe bacterial infection: A population-based confidential inquiry. Pediatr Crit Care Med. 2010; Jan 9. [Epub ahead of print]
The retrospective study analyzed all deaths from severe bacterial infection in pediatric patients at least 3-months-old in a geographic zone of France from 2000 through 2006. Of 23 deaths from severe bacterial infection, 21 could be analyzed; management was considered suboptimal in 75%.
The types of errors identified included:
- parental delay in seeking medical care
- physician’s delay in administering appropriate treatment (antibiotic therapy in the case of purpura)
- insufficient doses of or failure to repeat fluid resuscitation
- overall underestimation of disease severity
This study found a high frequency of suboptimal care in the initial management of children who died of severe bacterial infection, with four separate types of errors. Other studies as needed to access the potential avoidability of this type of death.
Effect of Pneumococcal Conjugate Vaccine of Incidence of Empyema
Key point: The annual empyema-associated hospitalization rates increased almost 70% between 1997 and 2006.
Citation: Li ST, Tancredi DJ. Empyema hospitalization increased in U.S. children despite pneumococcal conjugate vaccine. Pediatrics. 2010; 125(1): 26-33.
The purpose of this study was to determine if the incidence of empyema among children in the United States has changed since the introduction of the pneumococcal conjugate vaccine in 2000.
During 2006, an estimated total of 2,898 hospitalizations of children ≤18 years of age in the United States were associated with empyema.
The empyema-associated hospitalization rate was estimated at 3.7 per 100,000 children, an increase of almost 70% from the 1997 empyema hospitalization rate of 2.2 per 100,000.
The rate of complicated pneumonia (empyema, pleural effusion, or bacterial pneumonia requiring a chest tube or decortication) increased 44%, to 5.5 per 100,000.
Among children ≤18 years of age, the annual empyema-associated hospitalization rates increased almost 70% between 1997 and 2006, despite decreases in the bacterial pneumonia and invasive pneumococcal disease rates.