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      The Effect of Usual Source of Care on the Association of Annual Healthcare Expenditure with Patients’ Age and Chronic Disease Duration

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          Abstract

          Along with rapid population aging, the importance of chronic disease management increases with high growth of national healthcare expenditures, and efficient spending on healthcare is required to reduce unnecessary utilizations. For that reason, this study examined the association of annual healthcare expenditure with age and disease duration of chronic patients. Furthermore, the study investigated the effect of usual source of care (USOC) to suggest directions for preventive management of chronic disease. Using Korean Health Panel Study data, this study selected 1481 outpatients, who had out-of-pocket costs for hypertension or diabetes, and their total healthcare and chronic disease management (CDM) costs were examined. With patient aging, CDM cost decreased while the total healthcare cost increased, but longer duration of hypertension or diabetes resulted in increases in both CDM and total healthcare costs. In addition, the moderating effect of USOC indicated that elderly patients had increased CDM costs when they had a regular site for healthcare. In contrast, patients with longer duration had reductions in both CDM and total healthcare costs while having a regular doctor increased CDM cost. The results of this study could be an evidence for future policies to suggest proper preventive management plans for specific subjects.

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          Most cited references26

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          A comparison of multivariable regression models to analyse cost data.

          Analysis of cost data is important in providing reliable information to aid budgeting decisions. Certain features of cost data, such as its typically highly skewed distribution and the need to estimate arithmetic mean costs in order to allow inferences to be made on total costs, make it difficult to analyse. Multivariable regression analysis is useful for estimating the influence of explanatory variables on cost in order to predict costs of future patients and allows for the control of variables which influence cost but whose distributions differ between comparison groups. This is especially important in the case of observational studies, where there may be no control over the balance of characteristics between the comparison groups. This paper compares the appropriateness of various multivariable models of cost data by examining regression diagnostics, using as an example data collected on costs incurred in the treatment of inflammatory bowel disease. The models compared are normal and bootstrapped multiple linear regression, median regression, gamma model with the log link and normal linear regression (NLR) of log costs. Gamma modelling with the log link was found to be the most suitable model. Bootstrapping was found to make very little difference to conclusions from the NLR model.
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            Usual source of care in preventive service use: a regular doctor versus a regular site.

            M Xu (2002)
            To compare the effects of having a regular doctor and having a regular site on five preventive services, controlling for the endogeneity of having a usual source of care. The Medical Expenditure Panel Survey 1996 conducted by the Agency for Healthcare Research and Quality and the National Center for Health Statistics. Mammograms, pap smears, blood pressure checkups, cholesterol level checkups, and flu shots were examined. A modified behavioral model framework was presented, which controlled for the endogeneity of having a usual source of care. Based on this framework, a two-equation empirical model was established to predict the probabilities of having a regular doctor and having a regular site, and use of each type of preventive service. Having a regular doctor was found to have a greater impact than having a regular site on discretional preventive services, such as blood pressure and cholesterol level checkups. No statistically significant differences were found between the effects a having a regular doctor and having a regular site on the use of flu shots, pap smears, and mammograms. Among the five preventive services, having a usual source of care had the greatest impact on cholesterol level checkups and pap smears. Promoting a stable physician-patient relationship can improve patients' timely receipt of clinical prevention. For certain preventive services, having a regular doctor is more effective than having a regular site.
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              Better continuity of care reduces costs for diabetic patients.

              To examine the effects of continuity of care on healthcare utilization and expenses for patients with diabetes mellitus.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                27 August 2018
                September 2018
                : 15
                : 9
                : 1844
                Affiliations
                [1 ]Department of Public Health Sciences, Graduate School of Korea University, Seoul 02841, Korea; msjess0329@ 123456hotmail.com
                [2 ]BK21PLUS Program in Embodiment: Health-Society Interaction, Korea University, Seoul 02841, Korea
                Author notes
                [* ]Correspondence: mkchoi@ 123456korea.ac.kr
                Article
                ijerph-15-01844
                10.3390/ijerph15091844
                6165154
                30150530
                89952fb2-d049-4fe7-93fb-a15b688835ae
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 05 August 2018
                : 25 August 2018
                Categories
                Article

                Public health
                chronic disease,healthcare expenditure,usual source of care
                Public health
                chronic disease, healthcare expenditure, usual source of care

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