Direct nonmedical costs

Direct costs include both medical and nonmedical expenditures for the detection, treatment, and prevention of disease. Direct medical costs reflect resources consumed in the "production" of health care, such as pharmaceutical products and services, physician visits, and hospital care. Direct nonmedical costs reflect expenditures for products and services that are not directly related to disease treatment but are still related to patient care. Examples of direct nonmedical costs include transportation to a pharmacy or physician s office and housekeeping during the illness period. Indirect costs account for changes in productivity of an individual because of illness. The monetary value of lost or altered productivity is typically used as a measure of indirect costs. Intangible costs and consequences are nonmonetary in nature and reflect the impact of disease and its treatment on the individual s social and emotional functioning and quality of life. Table 12.2 provides examples of these types of costs and consequences. 

Monetary transactions undertaken as a result of illness or health care to detect, prevent, or treat disease are not limited to direct medical costs. There is another type of cost that often is overlooked - direct nonmedical costs. These costs are incurred because of illness or the need to seek medical care. They include the cost of transportation to the hospital or physician s office, the cost of special clothing needed because of the illness, the cost of accommodations for receiving medical treatment at a distant medical facility, and the cost of special housing (e.g., the cost of modification of a home to accommodate an ill individual). Direct nonmedical costs, which are generally paid out of pocket by patients and their families, are just as much direct medical costs as are expenses that are more usually covered by third-party insurance plans. 

Costs are often separated into direct and indirect costs. Direct costs typically consist of hospitalization costs, physician fees, laboratory fees, and costs of medical treatments/medications. Direct nonmedical costs can include costs of using transportation to and from the medical facility. Thus far, only direct costs have been estimated. Indirect/opportunity costs incurred with the death of a patient or while the individual is undergoing treatment are often expressed as days lost from work and reduced productivity. The so-called intangible costs are the monetary values of the results of pain and suffering. 

Direct costs are the resources consumed in the prevention, detection, or treatment of a disease or illness. These costs can be divided into direct medical and direct nonmedical costs. Direct medical costs are specific monetary transactions associated with paying for medical care, such as hospitalizations, drugs, medical supplies, and physician visits. Direct nonmedical costs involve monetary transactions for required items or services that do not involve purchase of medical care. Examples include transportation to medical facilities, special foods, and the time that family members miss work to care for others. 

Direct Medical Costs Direct Nonmedical Costs... 

Direct nonmedical costs Transportation Food Family care Home aides... 

Direct nonmedical costs are any costs for nonmedical services that are results of illness or disease but do not involve purchasing medical services. These costs are consumed to purchase services other than medical care and include resources spent by patients for transportation to and from health care facihties, extra trips to the emergency department, child or family care expenses, special diets, and various other out-of-pocket expenses. 

Bloom, in 1995, gathered economic data in a single, blind, randomized controlled trial comparing omeprazole, 20 mg each day, to ranitidine, 150 mg each day, plus metoclopramide, 10 mg four times daily, in 184 patients with erosive esophagitis. Esophagitis was verified by endoscopy before entry into the trial. Healing was confirmed by endoscopy at the end of 4 weeks and, if necessary, at the end of 8 weeks of treatment. Patients kept a daily symptom diary and also recorded the numbers and types of medical services used outside those required by the protocol and direct nonmedical costs, such as meals... 

There are different ways to look at outcomes. One method, the ECHO model, purports three basic types of outcomes economic, clinical, and humanistic (Kozma et al., 1993). Economic outcomes include direct costs and consequences, both medical and nonmedical, and indirect costs and consequences. For example, when assessing outcomes from a patient perspective, a medication copayment would be a direct medication cost, whereas gas money to pick up the medication from the pharmacy would represent a nonmedical direct cost. Lost wages from missed work could be regarded as an indirect cost. 

When determining which method of economic analysis she should use, she eliminated cost-minimization analysis because the treatment alternatives (service versus no service) will not result in equivalent outcomes. A cost-effectiveness analysis would not be appropriate because she is only interested in one particular program. A cost-utility analysis is also not appropriate because quality of life, while included in the project, is not the focus of her project. A cost-benefit analysis could be appropriate. A cost-benefit analysis requires that both the interventions and outcomes be valued in monetary units. She can determine the direct medical and/or nonmedical costs for each patient from data captured by her HMO. The HMO is very interested in costs, both those to implement the service and those it may save as a result. Cynthia decides that the most understandable analysis to present to the HMO is a cost-benefit analysis. 

List the direct and indirect and medical and nonmedical costs and outcome measures related to Alan Brouchard s diabetes education clinic and Carols lipid management program ... 

Health care costs can be categorized as direct medical, direct nonmedical, indirect nonmedical, intangible, opportunity, and incremental costs. 

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