NEWS BRIEFS
NEWS BRIEFS
Warfarin still underused in high-risk stroke patients
It costs about $15,000 to prevent a stroke, and the average total cost of caring for a 65-year-old stroke patient in this country is $100,000. Despite its cost-effectiveness, warfarin is used in only half of eligible patients, according to a new report.1
Among study participants not prescribed warfarin at discharge, 62% also were not prescribed aspirin. Elderly patients with an ischemic stroke associated with atrial fibrillation are at especially high risk for recurrent stroke, and the annual rate of recurrent stroke is higher than 10%. Warfarin has been shown to be highly effective in reducing this risk by two-thirds. The report’s authors say there may be several reasons why warfarin is underused, including the misperception of hemorrhagic risk. To address the issue of underutilization of anticoagulation, the researchers suggest:
• integration of data from many different sources, including the results of new clinical trials and management guidelines;
• the use of simple, individualized reminders to change physician behavior — telephone or written follow-up;
• computer-based alerts to improve compliance with treatment guidelines.
Reference
1. Brass LM, Krumholz HM, Scinto JD, et al. Warfarin use following ischemic stroke among Medicare patients with atrial fibrillation. Arch Intern Med 1998; 158:2,093-2,100.
Health care spending shows slowest increase in 40 years
Health care spending in the United States rose only 4.8% in 1997, the slowest increase in almost 40 years, according to a new report released by the Health Care Financing Admini stration (HCFA). HCFA reports that health care spending in 1997 totaled $1.1 trillion, with per-person spending, on average, at just under $4,000.
Longer-term HCFA estimates, however, predict that health care spending will grow more rapidly in the coming years.
The report by HCFA analysts shows that the gap between health spending paid for by public and private sources narrowed slightly in 1997, continuing a trend that began in 1990. Private funding paid for 53.6% of health care in 1997 ($585.3 billion), down from 59.5% in 1990, while public programs, including Medicare and Medicaid, paid for 46.4% of health care in 1997, up from 40.5% in 1990.
The overall slowdown in health care spending has been driven largely by rapidly falling growth in private spending, which reached an all-time low growth rate of 2.3% in 1994. In addition, since 1994, the rate of spending from public funding sources — primarily Medicare and Medicaid — has slowed, contributing to lower overall spending growth.
Total Medicaid spending increased only 3.8% in 1997, to $159.9 billion, the slowest growth since Medicaid's inception nearly 30 years ago. Preliminary data suggest the slowdown can be attributed to decreases in Medicaid enrollment in 1995, 1996, and 1997, as well as reductions in the rate of spending growth per enrollee.
Expenditures for hospital care accounted for 38% of personal health care spending and were the slowest-growing service, increasing only 2.9% to $371 billion in 1997. Spending for physician services increased 4.4% in 1997, continuing a trend of single-digit growth started in 1992.
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