title: Medication costs in different provider settings.
abstract: Comparison was made of the cost of medications between Shared Health Facilities (SHFs) or Medicaid Mills and a Neighborhood Health Center (NHC) for nine conditions in fields of adult medicine, pediatrics, and gynecology. A total of 10 cases from SHF reviews were matched by diagnosis, age, and length of time under care with those in the NHC. For otitis media and pharyngitis in children and questionable urinary tract infection and vaginitis in adult women, the average costs were significantly higher in the SHFs. Average costs for family planning services and vaginal bleeding were higher in the SHFs but not significantly so. Medication costs for children with asthma and adults with bronchitis and hypertension were approximately the same in both settings. The reasons for higher costs included greater use of more expensive antibiotics, concurrent use of decongestants and antihistamines for infectious conditions of childhood, and dispensing of medications on "shot-gun" basis without adequate diagnostic studies. The most striking difference was the additional average cost of $798 for hospitalization of the SHF patients with vaginal bleeding when D & C and surgery were performed. The NHC women had no hospitalizations as the recommended procedure of endocervical biopsy in the office was Center policy. Other quality inferences noted in the NHC, but not in SHFs, were routine performance of throat cultures for pharyngitis, wet smears for vaginitis, and deferral of treatment until cultures were received for urinary tract infection. The small number of cases for each condition and the large intersample variability were limiting factors in this study, but the findings do suggest that higher standards of care contribute to lower therapy costs.
authors.forename: M A
authors.initials: MA
authors.lastname: Morehead
authors.forename: K
authors.initials: K
authors.lastname: Lobach
authors.forename: J
authors.initials: J
authors.lastname: Lee
mesh_terms: D000328:Adult; D001249:Asthma / Q000188:drug therapy / Q000191:economics; D001991:Bronchitis / Q000188:drug therapy / Q000191:economics; D002675:Child, Preschool; D003151:Community Health Centers / Q000191:economics*; D003276:Contraceptives, Oral; D016527:Drug Costs / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000191:economics; D007223:Infant; D008484:Medicaid / Q000706:statistics & numerical data*; D009519:New York City; D010033:Otitis Media / Q000188:drug therapy / Q000191:economics; D010612:Pharyngitis / Q000188:drug therapy / Q000191:economics; D011331:Private Practice / Q000191:economics*; D014481:United States; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000191:economics; D014592:Uterine Hemorrhage / Q000188:drug therapy / Q000191:economics; D014627:Vaginitis / Q000188:drug therapy / Q000191:economics
chemical_list: D003276:Contraceptives, Oral