The influence of providing publicly subsidized MI-E devices on health care utilization, expenses, and survival trajectory was investigated. The researchers conducted a retrospective pre/post cohort research that quantifies results by integrating data from prospectively recruited participants who used MI-E to health administrative databases. The study group compared the yearly health care usage of 106 participants (8 < 15 years old) before and after the device. There was no difference in the rates of visits to the emergency department (ED) or hospital admissions. Participants required fewer hospital days after MI-E approval (median [interquartile range] [IQR] 0 [0–9] vs 0 [0–4], P=.03). Physician specialty visits were similarly on the decline (median IQR 7 [4–11] vs 4 [2–7], P<.001). Home care nursing and homemaking/personal support visits, on the other hand, increased. Total costs were lower for 59.4%, similar for 13.2%, and higher for 27.4% after MI-E. The cost of physician billing has fallen while the cost of home care has climbed. Pre-MI-E expenses were the most important predictor of costs after approval by regression modeling. At the 12-month mark, 23 (21.7%) of the participants had died. Those who used more medical equipment in the house had an increased risk of death (hazard ratio 1.12, [95% CI 1.02–1.22]). The use of publicly financed MI-E devices did not affect the number of ED visits or hospital admissions. Still, it shifted health care consumption and expenses from acute to community care. Although the cost reductions from physician billings were offset by higher community costs, data indicated cost savings from fewer hospital days and specialist visits. Individuals who required numerous medical technologies had the highest risk of dying.
Source –rc.rcjournal.com/content/67/2/191
