Effect of Pediatric Influenza on Caregivers’ Burden—A Literature Review

Influenza, or the flu, is a common and potentially serious infection that disproportionally affects children with more than 20,000 yearly hospitalizations in children under the age of 5. A literature review of the caregiver burden associated with pediatric influenza was conducted. Two main types of burdens were identified: economic and noneconomic. Flu treatment costs $3,990 for pediatric inpatients services and $730 for emergency department (ED) pediatric patients. Caregivers may also face out-of-pocket costs ($178 for inpatients, $125 for ED patients, and $52 for outpatients) or those not covered by health insurance. Caregivers can also face indirect costs while caring for their children with the flu. Indirect costs were common, and 75% of pediatric caregivers reported these costs when caring for a sick child. Missed work is the most common indirect cost and is estimated as high as 73 work hours ($1,456) missed while caring for a sick child. Other costs associated with pediatric influenza included noneconomic burden: sudden changes in daily life, loss of leisure time, social disruption, and psychological impact or stress. Noneconomic burdens were also found to be significant and lowered the quality of life of caregivers even after the child’s illness. Socioeconomic status is an important predictor of influenza rates. Residents in high-poverty areas are three times more likely to have hospitalizations due to pediatric influenza than those in low-poverty areas. From the literature it is evident that pediatric influenza has demonstrated a considerable impact on caregivers’ lives both financially and in other aspects.     

Pediatric Chronic Illness Management: A Qualitative Dyadic Analysis of Adolescent Patient and Parent Illness Narratives

In pediatric chronic illness, little is known about the relational interactions between adolescent patients, parents, and illnesses and how they influence self-management of illness. We conducted interviews with 32 individuals (16 dyads) representing adolescents diagnosed with a chronic illness and their primary parent who had been referred to a psychosocial treatment program for challenges with illness management. Interviews were conducted individually and analyzed dyadically using grounded theory to better understand the relational processes that may be contributing to illness management difficulties. Results include a theory of patient–parent illness responses and how parental illness meanings play a role in adolescent self-management. Results can be used to better understand and treat family relational patterns that may be influencing pediatric illness management challenges.     

The cost of implementing a jail diversion program for people with mental illness in San Antonio,Texas

Jail diversion programs for people with mental illness are designed to redirect offenders with mental illness into community treatment. Although much has been published about program models and their successes, little detail is available to policy makers and community stakeholders on the resources required to start and implement a jail diversion program and which agencies bear how much of the burden. The current study used data on a model jail diversion program in San Antonio, Texas, to address this research gap. Data on staff costs, client contacts, planning, and implementation were collected for three types of diversion: pre-booking police, post-booking bond, and post-booking docket. An activity-based costing algorithm was developed to which parameter values were applied. The start-up cost for the program was $556,638.69. Pre-booking diversion cost $370 per person; 90% of costs were incurred by community mental health agencies for short-term monitoring and screening (>80% of activities). Post-booking bond and docket diversion cost $238 and $205 per person, respectively; the majority of costs were incurred by the courts for court decisions. Developing a multiple-intercept jail diversion program requires significant up-front investment. The share of costs varies greatly depending on the type of diversion.     

Expensive Children in Poor Families: Out‐of‐Pocket Expenditures for the Care of Disabled and Chronically Ill Children in Welfare Families

A significant minority of poor families care for children with disabilities and chronic illnesses. This study is among the first to explore private costs resulting from children's disabilities among low‐income families. We find that almost half of the sample of California AFDC families with special‐needs children incurred some direct, out‐of‐pocket expenses in the preceding month, and about 20% incurred total costs exceeding $100. We also estimate lost employment income among low‐income mothers caring for children with disabilities. We conclude that both out‐of‐pocket expenses and foregone earnings represent a substantial burden for many low‐income families with special‐needs children, and we discuss the policy implications of these findings.     

The lifetime economic and social costs of child maltreatment in Australia

A cost of illness (COI) study was undertaken to estimate the magnitude and range of lifetime effects associated with child maltreatment in Australia, using an incidence-based approach. Costs were primarily estimated through calculation of population attributable fractions (PAFs) to determine the marginal effects of child maltreatment on a range of outcomes. PAFs were then applied to estimates of expenditure, inflated to 2014–15 Australian dollars, projected over the life course, according to a baseline age of incident cases for child maltreatment in 2012–13, and discounted at 7% per annum. Sensitivity analysis was conducted using a best and lower bound estimate of incidence of child abuse. The best estimate of the total estimated lifetime financial costs for incident cases of child maltreatment in 2012–13 was $9.3 billion (a cost per child maltreated of $176,437), with a lower bound of $5.8 billion. The best estimate of lifetime costs associated with reduced quality of life and premature mortality (non-financial costs) for all incident cases of child maltreatment in 2012–13 was $17.4 billion, or $328,757 per child maltreated. The considerable lifetime costs associated with child maltreatment warrants an expansion of existing investment in primary and secondary prevention and targeted support services for children and families at risk.     

The social costs of child abuse in Japan

The present study calculates the social costs of child abuse in Japan. The items calculated included the direct costs of dealing with abuse and the indirect costs related to long-term damage from abuse during the fiscal year 2012 (April 1, 2012, to March 31, 2013). Based on previous studies on the social costs of child abuse and peripheral matters conducted in other countries, the present study created items for the estimable direct costs and indirect costs of child abuse, and calculated the cost of each item. Among indirect costs, future losses owing to child abuse were calculated using extra costs with a discount rate of 3%. The social cost of child abuse in Japan in the fiscal year 2012 was at least ¥1.6 trillion ($16 billion). The direct costs totaled ¥99 billion ($1 billion), and the indirect costs totaled ¥1.5 trillion ($15 billion). This sum of ¥1.6 trillion for only the year 2012 is almost equal to the total amount of damages of ¥1.9 trillion caused by the 2011 Tohoku Earthquake and Tsunami in Fukushima Prefecture. Moreover, abuse is a serious problem that occurs every year and has recurring costs, unlike a natural calamity. However, Japan has no system for calculating the long-term effects of abuse. Therefore, owing to the scarcity of data, the calculations in the present study may underestimate the true costs.     

Chronic illness and social network bridging in later life

Chronic disease has profound impacts on the structural features of individuals’ interpersonal connections such as bridging — ties to people who are otherwise poorly connected to each other. Prior research has documented competing arguments regarding the benefits of network bridging, but less is known about how chronic illness influences bridging and its underlying mechanisms. Using data on 1555 older adults from the National Social Life, Health, and Aging Project (NSHAP), I find that older adults diagnosed with chronic illness tend to have lower bridging potential in their networks, particularly between kin and non-kin members. They also report more frequent interactions with close ties but fewer neighbors, friends, and colleagues in their networks, which mediates the association between chronic illness and social network bridging. These findings illuminate both direct and indirect pathways through which chronic illness affects network bridging and highlight the context-specific implications for social networks in later life.     

Workplace accommodations: evidence based outcomes

One central component to meaningful employment for people with disabilities is the ADA's workplace accommodation provision that allows qualified individuals to perform essential job functions. Little empirical evidence is available to evaluate the costs, benefits, and effectiveness of accommodations. Previous research has focused on direct costs. This article advocates an inclusive accommodation cost/benefit analysis to include direct and indirect costs and benefits and to differentiate disability-related accommodation costs from typical employee costs. The inclusive cost/benefit analysis is applied to preliminary data from interviews with employers who contacted the Job Accommodation Network (JAN). Results suggest that accommodations are low cost, beneficial and effective.     

The cost of implementing a 2-1-1 call center-based cancer control navigator program

ObjectivesDetermine the cost of implementing a call center-based cancer screening navigator program.MethodsSocial service call centers in Houston and Weslaco, TX, assessed cancer risks and implemented cancer screening promotion and navigation. Micro costing was used to estimate the program costs. Staff logs and call records tracked personnel time and material costs, including a standard 30% overhead rate. Sensitivity analysis examined the effect of varying uncertain cost parameters. Scale effects were simulated for larger population coverage.ResultsThe total cost to recruit and navigate 732 persons, out of 2933 individuals who called the center was $215,847. The participant time cost was $19,503, and the personnel cost was $116,523. The cost per navigated participant was $295 (95% CI, $290.56–$298.07). The average cost per participant for recruitment and referral only, was $36 (95% CI, $34.9–$36.9). Average cost declines to $34 for recruitment and referral, and to $225 for recruitment, referral, and navigation when the number of participants increases to 15,000 individuals.ConclusionsExpanding 2-1-1 referral services with opportunistic cancer screening promotion takes advantage of existing infrastructure but requires substantial additional staff time, participant time, and budget. Cost estimation is the first step in a full economic evaluation and informs program planners and decision-makers on the resource and budgetary requirements of this innovative strategy for increasing cancer screening in low income communities.     

Pediatrics: The emerging psychosocial challenges of the AIDS epidemic

HIV has a pervasive and profound effect on the psychological, social and neuropsychological functioning of infected infants, children and their families. This article discusses direct and indirect psychological manifestations of HIV in children. Direct effects are the outcome of the virus acting on the central nervous system and can result in compromised cognitive, language, motor, socio-emotional and motivational functioning. Indirect effects involve psychological responses to the stress of living with a life threatening illness, the social ostracism, disruption in life goals and undergoing frequent invasive and protracted medical procedures. A major focus of this article is to outline and describe a model comprehensive psychosocial support system developed within the Pediatric Branch of the National Cancer Institute. This includes early intervention issues and strategies for working with families during the introductory phase of the treatment program that also provides the framework for a care management approach, salient mental health problems that frequently occur in this group, and appropriate interventions for individuals and families. Attention is also given to dealing with anticipatory loss and bereavement, implementing traditional innovative intervention techniques, and for providing advocacy services concerning possible legal, financial, housing, and educational issues.     

Costs of colorectal cancer screening provision in CDC’s Colorectal Cancer Control Program: Comparisons of colonoscopy and FOBT/FIT based screening

We assess annual costs of screening provision activities implemented by 23 of the Centers for Disease Control and Prevention’s Colorectal Cancer Control Program (CRCCP) grantees and report differences in costs between colonoscopy and FOBT/FIT-based screening programs. We analysed annual cost data for the first three years of the CRCCP (July 2009–June 2011) for each screening provision activity and categorized them into clinical and non-clinical screening provision activities. The largest cost components for both colonoscopy and FOBT/FIT-based programs were screening and diagnostic services, program management, and data collection and tracking. During the first 3 years of the CRCCP, the average annual clinical cost for screening and diagnostic services per person served was $1150 for colonoscopy programs, compared to $304 for FIT/FOBT-based programs. Overall, FOBT/FIT-based programs appear to have slightly higher non-clinical costs per person served (average $1018; median $838) than colonoscopy programs (average $980; median $686). Colonoscopy-based CRCCP programs have higher clinical costs than FOBT/FIT-based programs during the 3-year study timeframe (translating into fewer people screened). Non-clinical costs for both approaches are similar and substantial. Future studies of the cost-effectiveness of colorectal cancer screening initiatives should consider both clinical and non-clinical costs.     

Individual and Social Costs of Divorce in Utah

This preliminary report provides an overview of the economic consequences of divorce for couples experiencing divorce in Utah. The economic impact on the divorcing individuals, the surrounding communities in which they live, and the state and federal governments were assessed. The data collected in Utah reveals that the federal government absorbs the most substantial costs, including a host of expenditures related to welfare assistance and medical costs. The 9,735 divorces in Utah during 2001 cost the state and federal government nearly $300 million in direct and indirect costs. Extrapolation from these estimates reveals that divorce and its direct and indirect economic consequences cost the United States $33.3 billion annually. Implications for social policy and strengthening marriages are provided.A longer version of this paper, including a cost analysis breakdown for each state, is available from the author. This paper was originally written while the author was at Utah State University. This report is based on initial research findings by Dr. Steven L. Nock and Dr. David B. Larson. I would like to thank Dr. Brent A. Barlow, Brigham Young University, and Drs. Kathleen W. Piercy and James P. Marshall, Utah State University, for their valuable assistance in this research. A special thanks also goes to the reviewers for their invaluable comments on earlier versions of this article.David G. Schramm, Department of Human Development and Family Studies, Auburn University, 203 Spidle Hall, Auburn, AL 36849; e-mail: schradg@auburn.edu.     

Taming predators through photography

In this article we examine an innovative application of visual communication and social science methods, moving the study of indigenous media from the purely academic realm into pediatric health research. Through Video Intervention/Prevention Assessment (VIA), children and adolescents who share a medical condition create visual narratives of their lives with chronic disease to show and tell their illness experiences to health care providers. Clinicians routinely plan medical management with limited knowledge of how patients interact with disease in their “real life” physical, psychological, and social environments. VIA asks young patients to teach clinicians the realities of day‐to‐day life with illness, yielding unique insights that can guide the development of more realistic, more humane, and ultimately more effective medical care. We describe the VIA methodology, a pilot study of asthma, and the illness experiences shown and told by VIA Asthma participants. Not only did VIA generate useful research findings, it also produced visual documents of the child's illness experience that can serve as tools for influencing policy, advocating for patients, and educating health care providers, patients, and their families.     

America's Conservation Reserve Program: Rural planning or just another subsidy?

The Conservation Reserve Program was created by Congress in 1985 to remove highly erodible cropland from production and thus reduce soil erosion and crop surpluses. The program is aimed at enrolling 40–45 million acres out of an estimated 118 million acres of highly erodible cropland. As of November 1987, 23 million acres had been placed in the Conservation Reserve. The program is strictly voluntary. Landowners may receive an annual rental payment and half the cost of approved conservation measures. In return, landowners must retire highly erodible cropland from production for ten years. Over 200,000 landowners have each enrolled an average of 110 acres at a cost to the U.S. Treasury of more than $50,000 per landowner. The total cost of the Conservation Reserve Program currently exceeds $12 billion. Whether the long-term benefits of the program can justify the cost remains in doubt. The program has an effective life of only ten years. A more direct and effective long-term means of reducing soil erosion and crop surpluses might be to have the federal government purchase farmland to create a national strategic cropland reserve.     

Family Intervention and Health Care Costs for Kansas Medicaid Patients with Schizophrenia

Despite a number of studies investigating the effect of pharmacotherapy on treatment costs for schizophrenia patients, there has been little attention given to the effect of family intervention. In this study, data from the Kansas Medicaid system were used to analyze healthcare costs for 164 schizophrenia patients who had participated in family intervention. Structural equation modeling was used to test two competing views of the role of family intervention in treatment. The results showed that a model including direct and indirect effects of family intervention provided a better fit to the data. Family intervention had a significant indirect effect on general medical costs (through other psychological treatment) that showed a savings of $586 for each unit increase in the provision of these services. In addition, the total indirect effects for family intervention showed a $580 savings for general medical costs and $796 for hospitalization costs (for each unit increase).     

Costs,Benefits, and Management Considerations of a Prepaid Student Dental Health Plan

Abstract

The Student Dental Health Program (SDHP) is an open panel, prepaid dental insurance plan at the University of Alabama in Birmingham. The program was developed primarily to provide optimal dental health service; however the SDHP also serves educational and research functions that are consistent with the objectives of the university. The student bodies of the Schools of Dentistry, Medicine, Nursing, and Optometry constitute the enrollee population.

Total cost rose from $18,418 in 1969–70 with 862 enrollees, to $70,930 in 1975–76 with 1,618 enrollees. During the same period the number of procedures completed increased from 2,868 to 6,796, with the average cost per procedure increasing from $6.42 to $10.44. The number of restorative services declined and preventive services increased. In 1976–77 benefits per student treated were estimated at $80 as compared to the annual fee of $48. The value of unmet needs upon entrance to the program averaged $59 per enrollee in 1974–75. By 1976–77 this figure was reduced to $26 due to implementation of an initial screening. The program is self-supporting due to a variety of cost containment measures. On balance, the program can be considered successful and beneficial to all parties concerned.     

Making Child Care "Affordable" in the United States

Two alternative federally financed plans are presented as modelsfor a program which would make child care of acceptable quality"affordable" for millions of American families. Taking a cuefrom currently operating state programs, care is defined as"affordable" if it costs parents no more than 30 percent ofthe amount by which their income exceeds the poverty line. Thefirst plan would cost the government $25 billion per year andwould concentrate help on families with incomes up to twicethe poverty line. The second would cost $39 billion per year,would provide higher quality care, and would allow all UnitedStates families to have access to care that was "affordable"by our definition. Costs of these magnitudes preclude financingof any significant part by employers or philanthropies. Whilesome government savings might result from the beneficial effectsof these programs, the main rationale for them rests, not onthe calculation that they will save the government money (althoughthey might), but on the fact that they will prevent considerablemisery to children and their families. Making quality childcare affordable to all families would result in safer, moreeducational, and more enjoyable care for children, and wouldgive a financial boost to families pitifully short of resourcesin a non-stigmatizing way. It would reduce child poverty andreduce enrollment in welfare-type programs. It would also giveparents a chance to particiopate in the world of work and toachieve the gains in resources and status that such a participationwould alllow.     

Reframing the benefits and beneficiaries of public benefits programs

This article uses current research to demonstrate that in addition to the direct benefits received by recipients of four main types of public benefit programs—cash assistance, public health insurance, food assistance, and public housing—non-recipients receive a variety of indirect economic and noneconomic benefits. Non-recipients include individuals, families, organizations, businesses, neighborhoods, and the general public. The review indicates that public benefits programs can indirectly benefit non-recipients economically by increasing economic security; stimulating local, state, and national economies; increasing employment and other measures of economic well-being; generating tax revenues; and providing cost savings. In addition, we determined two main types of indirect noneconomic benefits: enhancing neighborhood quality and the intrinsic rewards gained from fulfilling humanitarian and related values. We then summarize the results of these studies and make suggestions for future research. Finally, based on the reviewed research, we identify methods to reframe negative perceptions of government spending on public benefits programs. By reframing the benefits and beneficiaries of these programs, social workers, professional organizations, lobbyists, politicians, and elected officials can increase societal and political support for public benefits programs.     

CONSUMPTION BENEFITS OF NATIONAL HOCKEY LEAGUE GAME TRIPS ESTIMATED FROM REVEALED AND STATED PREFERENCE DEMAND DATA

This paper examines the demand for hockey game trips among metropolitan and nonmetropolitan residents of Alberta, Canada. Using data on both revealed and stated preference game‐trip behavior from a telephone survey conducted throughout Alberta, we estimate the effect of ticket prices, team quality, arena amenities, and capacity on the latent demand for National Hockey League hockey games. We find that lower ticket prices, higher team quality, and additional capacity encourage attendance. In the status quo scenario, consumer surplus per game is $50 for those who had attended hockey games and about 50% less for those who had not attended games. Exploiting the stated preference data, we develop a number of other consumer surplus estimates. We also include travel costs in the estimation of the demand function and estimate the full value of the game trip considering both ticket prices and travel costs. Sold‐out arenas in Calgary and Edmonton generate annual consumption benefits of $40 and $35 million when only ticket prices are used to calculate consumer surplus (i.e., excluding travel costs). Considering the full‐price consumer surplus for the Calgary Flames of $103 per game trip, the annual consumption benefits may be as high as $82 million. (JEL R22, L83, D61)