estimating the cost of health care: va costs paul barnett may 16, 2007

Estimating the Cost of Estimating the Cost of Health Care: VA CostsHealth Care: VA Costs

Paul BarnettPaul BarnettMay 16, 2007May 16, 2007

22Health Economics Resource CenterHealth Economics Resource Center

Overview of Cost PresentationsOverview of Cost Presentations

Cost of InterventionCost of Intervention Session 2 weeks agoSession 2 weeks ago

Cost of VA provided Cost of VA provided carecare

Today’s session Today’s session

Cost incurred outside Cost incurred outside VAVA

Session in two weeksSession in two weeksPatient incurred costPatient incurred cost


Specific Learning ObjectivesSpecific Learning Objectives

Understand VA data sources for Understand VA data sources for patient and encounter costspatient and encounter costs

Be familiar with their methods of Be familiar with their methods of cost determinationcost determination

Be able to choose between data Be able to choose between data sourcessources

Know how to access the dataKnow how to access the data


VA Cost Data SetsVA Cost Data Sets Two possible sources:Two possible sources: HERC average cost estimatesHERC average cost estimates

– Non-VA data on relative values adjusted for Non-VA data on relative values adjusted for VA expendituresVA expenditures

DSS cost estimatesDSS cost estimates– Activity based cost allocation systemActivity based cost allocation system


Which cost data for my study?Which cost data for my study?

Randomized trial comparing two types of Randomized trial comparing two types of Cardiac Artery Bypass Graph (CABG) Cardiac Artery Bypass Graph (CABG) surgery surgery – Graphs using saphenous vein vs. radial Graphs using saphenous vein vs. radial

arteryartery What cost data should be used to estimate What cost data should be used to estimate

costs during the 2-year follow-up period?costs during the 2-year follow-up period?


HERC Average Cost DatasetsHERC Average Cost Datasets


HERC method of distributing costs HERC method of distributing costs to hospital stays and outpatient to hospital stays and outpatient

visitsvisits Acute medical surgical stays Acute medical surgical stays – Estimate of what stay would have cost in a Estimate of what stay would have cost in a

Medicare hospital, based on a regression modelMedicare hospital, based on a regression model Other inpatient careOther inpatient care

– Length of stayLength of stay Outpatient careOutpatient care

– Hypothetical Medicare payment based on Hypothetical Medicare payment based on procedure codes assigned to visitprocedure codes assigned to visit


Cost data used to build HERC Cost data used to build HERC average cost datasetsaverage cost datasets

Cost incurred at each medical center in Cost incurred at each medical center in each category of careeach category of care– FY98-03 FY98-03 Cost Distribution Cost Distribution

ReportReport

– FY04-present FY04-present Tabulation of DSS Tabulation of DSS datadata


HERC Method: Acute HERC Method: Acute Medical/Surgical HospitalizationsMedical/Surgical Hospitalizations Cost regression estimated using Cost regression estimated using

Medicare dataMedicare data– Length of stayLength of stay

– Days of intensive careDays of intensive care

– Diagnosis Related Group (DRG)Diagnosis Related Group (DRG) Stay is assigned to one of 511 groups based Stay is assigned to one of 511 groups based

on diagnosis and procedureson diagnosis and procedures Medicare relative value weights for DRGMedicare relative value weights for DRG


HERC Method: Acute HERC Method: Acute Medical/Surgical Stays (cont).Medical/Surgical Stays (cont).

– HERC identifies acute medical surgical HERC identifies acute medical surgical components of stays in the VA Patient components of stays in the VA Patient Treatment File (PTF)Treatment File (PTF) Consistent with non-VA hospital definitionConsistent with non-VA hospital definition Contiguous medical-surgical bed section Contiguous medical-surgical bed section

segmentssegments


HERC Method: Acute HERC Method: Acute Medical/Surgical Stays (cont).Medical/Surgical Stays (cont).

– HERC applies regression parameters to VA HERC applies regression parameters to VA stays to estimate what stay would have cost stays to estimate what stay would have cost in a Medicare hospitalin a Medicare hospital

– Estimates adjusted to reflect actual VA Estimates adjusted to reflect actual VA expendituresexpenditures


HERC Method: Other staysHERC Method: Other stays Costs assumed to be proportional to length of stayCosts assumed to be proportional to length of stay

– RehabilitationRehabilitation– Blind rehabilitationBlind rehabilitation– Spinal cord injurySpinal cord injury– PsychiatryPsychiatry– Substance abuse Substance abuse – Intermediate medicineIntermediate medicine– DomiciliaryDomiciliary– Psychosocial residential rehabilitationPsychosocial residential rehabilitation– Long-Term CareLong-Term Care


HERC Cost File: HERC Cost File: Inpatient Discharge DataInpatient Discharge Data

Cost of each VA hospital discharge Cost of each VA hospital discharge reported in Patient Treatment File reported in Patient Treatment File (PTF)(PTF)

Stays ending in discharge in Fiscal YearStays ending in discharge in Fiscal Year Excludes stays that began before FY98Excludes stays that began before FY98

– Length of stay, costs at national and local Length of stay, costs at national and local ratesrates


HERC Cost File: HERC Cost File: Inpatient Discharge Data (cont.)Inpatient Discharge Data (cont.)

Subtotals of days and costs in 10 categories:Subtotals of days and costs in 10 categories:Medicine and surgery Medicine and surgery RehabilitationRehabilitation

Blind rehabilitation Blind rehabilitation Spinal cord Spinal cord injuryinjury

Psychiatry Psychiatry Substance Substance abuse abuse

Intermediate medicine Intermediate medicine DomiciliaryDomiciliary

Psych. residential rehab. Psych. residential rehab. Nursing homeNursing home


HERC Cost File: Bed Section Data HERC Cost File: Bed Section Data

Most studies don’t need this data set Most studies don’t need this data set Used to build HERC discharge dataUsed to build HERC discharge data Stays that occurred in year, regardless of Stays that occurred in year, regardless of

dischargedischarge Days and costs by PTF bed section Days and costs by PTF bed section

segment (or group of acute medical segment (or group of acute medical surgical bed section segments)surgical bed section segments)


HERC Method: Outpatient costsHERC Method: Outpatient costs

HERC assigns hypothetical payment HERC assigns hypothetical payment – based on Current Procedure Terminology based on Current Procedure Terminology

(CPT) and HCPCS codes, up to 20 per visit(CPT) and HCPCS codes, up to 20 per visit– Physician reimbursement rates from Medicare Physician reimbursement rates from Medicare

and other payersand other payers– Facility reimbursement rates from MedicareFacility reimbursement rates from Medicare

Adjusted to reflect expenditures in the Adjusted to reflect expenditures in the category of outpatient care, defined using category of outpatient care, defined using clinic stop (DSS identifier)clinic stop (DSS identifier)


HERC Cost File: HERC Cost File: Outpatient Cost Data SetOutpatient Cost Data Set

Cost of each VA outpatient record in the Cost of each VA outpatient record in the National Patient Care Database outpatient National Patient Care Database outpatient events file (SE)events file (SE)

National and local costsNational and local costs Hypothetical Medicare paymentHypothetical Medicare payment


HERC Cost File: HERC Cost File: Person-Level Annual Cost Person-Level Annual Cost

One person per recordOne person per record FY1998-FY2004FY1998-FY2004 Total VA cost and costs of five inpatient and Total VA cost and costs of five inpatient and

five outpatient categories, LOS for inpatient five outpatient categories, LOS for inpatient carecare

Includes DSS outpatient pharmacyIncludes DSS outpatient pharmacy Stays that cross fiscal years are assigned cost Stays that cross fiscal years are assigned cost

in proportion to the days in fiscal year.in proportion to the days in fiscal year.

DSS National Data DSS National Data ExtractsExtracts


DSS determines cost of productsDSS determines cost of products

Cost assigned to cost centerCost assigned to cost center– Staff activities reports and financial dataStaff activities reports and financial data

Cost of overhead departments distributed Cost of overhead departments distributed Products of each department tabulatedProducts of each department tabulated Relative values assigned to products Relative values assigned to products Unit cost of each product determinedUnit cost of each product determined


DSS assigns cost to encountersDSS assigns cost to encounters

Unit cost of each

intermediate product

WorkloadCount of each

intermediate product used in encounter

Total cost of encounter

(Visit or stay)

=

X


Where do DSS data come from?Where do DSS data come from?

VISTA workload, clinical, & financial data

National Data Extracts of DSS

(SAS Files at Austin)

Time allocation Relative values

DSS VISN Level Production Databases

(at Austin but limited access)


DSS National Data ExtractsDSS National Data Extracts Inpatient filesInpatient files

– Treating specialty fileTreating specialty file– Discharge fileDischarge file

Outpatient Encounter FilesOutpatient Encounter Files Pharmacy filesPharmacy files Intermediate Product Department filesIntermediate Product Department files Clinical FilesClinical Files


DSS Cost File: DSS Cost File: Inpatient Discharge FileInpatient Discharge File

Care of patients discharged in fiscal yearCare of patients discharged in fiscal year Record represents one discharge (even if Record represents one discharge (even if

stay involves multiple bed sections)stay involves multiple bed sections) Includes cost incurred in prior fiscal yearsIncludes cost incurred in prior fiscal years May exclude stays that began before DSS May exclude stays that began before DSS

implementationimplementation


DSS Cost File: DSS Cost File: Inpatient Treating Specialty FileInpatient Treating Specialty File

Treating specialty is synonymous with Treating specialty is synonymous with bed sectionbed section

File includes:File includes:– Care provided during fiscal yearCare provided during fiscal year

– Stays not yet over Stays not yet over

– One record per bed section (treating One record per bed section (treating specialty) per monthspecialty) per month


DSS Cost Files: Outpatient filesDSS Cost Files: Outpatient files

One record per patient per day per clinic One record per patient per day per clinic stopstop– NPCD events file allows more than 1 record NPCD events file allows more than 1 record

per clinic stop per dayper clinic stop per day

– DSS includes care not in NPCD events file, DSS includes care not in NPCD events file, e.g., prostheticse.g., prosthetics

Four regional files ~100 million records Four regional files ~100 million records per yearper year


DSS Cost Files: Pharmacy filesDSS Cost Files: Pharmacy files

Daily outpatient pharmacy cost filesDaily outpatient pharmacy cost files– One record per dayOne record per day

– Cost but not names of drugs dispensed Cost but not names of drugs dispensed Prescription level filesPrescription level files

– One record per dispensed prescriptionOne record per dispensed prescription

– Includes drug, cost, quantity, doseIncludes drug, cost, quantity, dose

– Includes file with inpatient prescriptions Includes file with inpatient prescriptions


DSS Cost Files: Intermediate DSS Cost Files: Intermediate Product Department FilesProduct Department Files

Both inpatient and outpatient filesBoth inpatient and outpatient files One record with costs incurred in each One record with costs incurred in each

intermediate product department in intermediate product department in stay/visitstay/visit

Not yet documentedNot yet documented


Clinical DSS National Data FilesClinical DSS National Data Files Laboratory TestsLaboratory Tests

– All tests, inpatient and outpatientAll tests, inpatient and outpatient RadiologyRadiology

– Cost of each procedureCost of each procedure Laboratory Results Laboratory Results

– 59 laboratory tests59 laboratory tests

Which data to use: Which data to use: HERC or DSS?HERC or DSS?


Criteria:Criteria:

Is costing method consistent with study goals?Is costing method consistent with study goals? What is study time frame?What is study time frame? Are pharmacy or contract care costs needed?Are pharmacy or contract care costs needed? Are data needed on characteristics of care?Are data needed on characteristics of care? Are cost-subtotals needed?Are cost-subtotals needed? Which data are more accurate?Which data are more accurate?


Is costing method consistent with Is costing method consistent with study goals?study goals?

Study to determine cost-effectiveness for U.S. health Study to determine cost-effectiveness for U.S. health care systemcare system– HERC uses non-VA relative values, HERC costs more like HERC uses non-VA relative values, HERC costs more like

costs typical of non-VA health care settingscosts typical of non-VA health care settings Study to determine efficiency of different VA Study to determine efficiency of different VA

providersproviders– DSS costs estimate reflect differences in productivity, DSS costs estimate reflect differences in productivity,

efficiencies, economies of scale, etc.efficiencies, economies of scale, etc.– Strong assumptions make HERC estimates inappropriate Strong assumptions make HERC estimates inappropriate

for this type of study for this type of study


Time FrameTime Frame

HERC begins with FY98. HERC has HERC begins with FY98. HERC has documented how to estimate cost of documented how to estimate cost of earlier yearsearlier years

DSS begins same year, but early years of DSS begins same year, but early years of uncertain accuracyuncertain accuracy


Outpatient Pharmacy CostOutpatient Pharmacy Cost

DSS has pharmacy data, HERC does notDSS has pharmacy data, HERC does not Pharmacy data also available from Pharmacy Pharmacy data also available from Pharmacy

Benefits Management systemBenefits Management system– No direct access, must file request and wait for it No direct access, must file request and wait for it

to be fulfilledto be fulfilled– PBM costs include only drug cost (not dispensing PBM costs include only drug cost (not dispensing

or overhead cost)or overhead cost)– PBM data are available for years before DSS PBM data are available for years before DSS


VA Contract CareVA Contract Care VA purchases about 4% of care from non-VA VA purchases about 4% of care from non-VA

providersproviders DSS data on contract careDSS data on contract care

– Community nursing home costs in DSS Community nursing home costs in DSS outpatientoutpatient filefile

– Increasing effort to include contract care in DSSIncreasing effort to include contract care in DSS HERC excludes contract careHERC excludes contract care See VA fee basis files for cost of this careSee VA fee basis files for cost of this care

– Fee basis files are also incomplete!Fee basis files are also incomplete!


Data Needed on Care Data Needed on Care Characteristics?Characteristics?

Cost data sets have limited information on Cost data sets have limited information on patient, stay, or encounterpatient, stay, or encounter– These data must be obtained from PTF or NPCD These data must be obtained from PTF or NPCD

outpatient care filesoutpatient care files– HERC or DSS inpatient discharge data easily HERC or DSS inpatient discharge data easily

mergedmerged– HERC outpatient data more easily merged to HERC outpatient data more easily merged to

NPCD NPCD HERC average cost data are easier to useHERC average cost data are easier to use


easy

Med/surg

Rehab, mental health, long term care, etc.

PTF Bed section files

hard

DischargePTF Discharge fileseasy

OutpatientOutpatient NPCDeasy

VA Utilization Data HERC Cost Data

Ease of merging HERC files with Ease of merging HERC files with utilization filesutilization files


Treating specialtyPTF Bed section filesvery hard

DischargePTF Discharge fileseasy

OutpatientNPCD Outpatient Files

moderate

VA Utilization Data DSS Cost Data

Ease of merging DSS NPCD with Ease of merging DSS NPCD with utilization filesutilization files


Are cost subtotals needed?Are cost subtotals needed?

HERC inpatient discharge datasetHERC inpatient discharge dataset– 10 sub-total fields10 sub-total fields

HERC outpatient datasetHERC outpatient dataset– Category of care (CAT) can be used to Category of care (CAT) can be used to

generate cost sub-totalsgenerate cost sub-totals


Are cost-subtotals needed?Are cost-subtotals needed? DSS inpatient dischargeDSS inpatient discharge

– No totals by type of care (e.g., medical-surgical vs. No totals by type of care (e.g., medical-surgical vs. long term carelong term care

– Must be done using treating specialty, but hard to Must be done using treating specialty, but hard to aggregate treating specialty records when stay aggregate treating specialty records when stay crosses a fiscal yearcrosses a fiscal year HERC plans to create file with cost subtotalsHERC plans to create file with cost subtotals

DSS outpatientDSS outpatient– User must define categories based on clinic stopUser must define categories based on clinic stop

HERC average cost data are easier to use.HERC average cost data are easier to use.


Which cost data are more Which cost data are more accurate: DSS or HERC accurate: DSS or HERC

average costs?average costs?


Costing MethodsCosting Methods

Direct measurement

Pseudo-bill

Reduced list costing

Clinical cost function

Average cost per visit

More precise Less precise

InpatientHERCMed/Surg

OutpatientHERC AC Costs

Inpt. Rehab, HERC MH, LTC

DSS


Potential errors in HERC methodsPotential errors in HERC methods Inpatient costs:Inpatient costs:

– Regression may not do a good job of estimating Regression may not do a good job of estimating cost of acute medical surgical stays costs that are at cost of acute medical surgical stays costs that are at the extremesthe extremes

Outpatient costs estimates depend CPT codes Outpatient costs estimates depend CPT codes – Codes may be used inappropriatelyCodes may be used inappropriately

E.g.. At one site methadone visits ($10) coded as E.g.. At one site methadone visits ($10) coded as medical care ($150)medical care ($150)

– CPT modifiers not used CPT modifiers not used Not possible to tell if medical equipment code Not possible to tell if medical equipment code

represents one time purchase or daily rentalrepresents one time purchase or daily rental


Potential errors in DSS methodsPotential errors in DSS methods

Outlier costs Outlier costs – Mismatch of cost and utilization can result in unit Mismatch of cost and utilization can result in unit

costs that are very high cost, or negativecosts that are very high cost, or negative DSS quality assurance effortsDSS quality assurance efforts

– Audit that costs in DSS agree with general ledger Audit that costs in DSS agree with general ledger – Extreme high outliers are filtered out when DSS Extreme high outliers are filtered out when DSS

national data extracts (NDE) are builtnational data extracts (NDE) are built


Which is more accurate?Which is more accurate? HERC cost estimatesHERC cost estimates

– based on strong assumptionsbased on strong assumptions– reflect relative resource use in non-VA settingsreflect relative resource use in non-VA settings

DSS cost estimates DSS cost estimates – reflect actual VA experiencereflect actual VA experience– have more variancehave more variance– may be more prone to inappropriate outliersmay be more prone to inappropriate outliers

Both data sets rely on DSS distribution of Both data sets rely on DSS distribution of costs to departmentscosts to departments


Data validation Data validation


Which stay has been assigned Which stay has been assigned inappropriate costs?inappropriate costs?

Cost of stay Cost of stay (dollars)(dollars)

AA 97,30997,309

BB 190,202190,202

CC 183,732183,732

DD 50,12050,120

EE 129,209129,209

FF 2,391,2192,391,219


What do you want to know about What do you want to know about the stay to know if costs were the stay to know if costs were inappropriately high or low?inappropriately high or low?


Type of CareType of Care

CostCost Type of CareType of Care

AA 97,30997,309 Acute Medical-SurgicalAcute Medical-Surgical

BB 190,202190,202 Acute Medical-SurgicalAcute Medical-Surgical

CC 183,732183,732 RehabilitationRehabilitation

CC 50,12050,120 PsychiatricPsychiatric

DD 129,209129,209 PsychiatricPsychiatric

EE 2,391,2192,391,219 Nursing Home with Acute Nursing Home with Acute Medical-SurgicalMedical-Surgical


Length of StayLength of StayCostCost Type of CareType of Care DaysDays Cost/DayCost/Day

AA 97,30997,309 Med-SurgMed-Surg 77 13,90113,901

BB 190,202190,202 Med-SurgMed-Surg 44 47,55147,551

CC 183,732183,732 RehabRehab 262262 701701

DD 50,12050,120 PsychiatricPsychiatric 271271 185185

EE 129,209129,209 PsychiatricPsychiatric 161161 803803

FF 2,391,2192,391,219 LTC & LTC &

Med-Surg Med-Surg

2,4982,498 957957


DRG Weight DRG Weight

DRG weights predict costs of Acute Medical Surgical DRG weights predict costs of Acute Medical Surgical Stays, but not other types of hospital careStays, but not other types of hospital care

CostCost DaysDays Cost/DayCost/Day DRG DRG WeightWeight

Cost per day per Cost per day per DRG WeightDRG Weight

AA 97,30997,309 77 13,90113,901 2.122.12 6,5576,557

BB 190,202190,202 44 47,55147,551 0.820.82 57,98857,988


Why would there be a VA Why would there be a VA outpatient visit with a cost of outpatient visit with a cost of

$20,000?$20,000?


Validation of data and handling of Validation of data and handling of outliersoutliers

No easy solutionNo easy solution Compare to clinical characteristics, e.g., Compare to clinical characteristics, e.g.,

DRG, procedure codeDRG, procedure code Compare to other VA cost data setCompare to other VA cost data set Avoid routine trimming of dataAvoid routine trimming of data

Data Access and Data Access and DocumentationDocumentation


HERC Data at AustinHERC Data at Austin

Please register with HERC to accessPlease register with HERC to accesshttp://www.herc.research.va.gov/resources/register_data.asp


DSS DataDSS Data

See HERC guide on DSSSee HERC guide on DSS VISN Support Services Center Web Site (KLF VISN Support Services Center Web Site (KLF

Menu)Menu)– Summaries of DSS dataSummaries of DSS data– Documentation of DSS and new DSS datasetsDocumentation of DSS and new DSS datasets

DSS Program Office Web SiteDSS Program Office Web Site See HERC intranet web site for linksSee HERC intranet web site for links


HERC GuidebooksHERC Guidebooks

Research Guide to Decision Support System Research Guide to Decision Support System National Cost Extracts 1998-2004 National Cost Extracts 1998-2004

HERC’s Average Cost Datasets for VA HERC’s Average Cost Datasets for VA Inpatient Care 1998 - 2005 Inpatient Care 1998 - 2005

HERC's Annual Person Level Cost Dataset HERC's Annual Person Level Cost Dataset User Guide: Fiscal Years 1998-2003 User Guide: Fiscal Years 1998-2003

HERC's outpatient average cost dataset for HERC's outpatient average cost dataset for VA care: fiscal years 2000-2004 VA care: fiscal years 2000-2004

http://www.herc.research.va.gov/publications/guidebooks.asp


HERC Technical ReportsHERC Technical Reports

#9. Reconciliation of DSS Encounter-Level #9. Reconciliation of DSS Encounter-Level National Data Extracts and the VA National National Data Extracts and the VA National Patient Care Database: FY2001-FY2002 Patient Care Database: FY2001-FY2002

#10. A Comparison for Inpatient Costs from the #10. A Comparison for Inpatient Costs from the HERC and DSS National Data Extract Datasets HERC and DSS National Data Extract Datasets

#13. Comparison Between DSS National Data #13. Comparison Between DSS National Data Extracts and HERC Average Costs: Aggregate and Extracts and HERC Average Costs: Aggregate and Person-Level Costs, FY2001Person-Level Costs, FY2001

http://www.herc.research.va.gov/publications/technical_reports.asp


VIREC DocumentationVIREC Documentation

VIReC Research User Guides VIReC Research User Guides – DSS Clinical National Data ExtractsDSS Clinical National Data Extracts

– DSS pharmacy dataDSS pharmacy data

– Medical SAS Datasets (PTF and NPCD)Medical SAS Datasets (PTF and NPCD)

www.virec.research.va.gov

http://www.virec.research.va.gov/References/RUG/RUG.htm


Useful Non-VA LinksUseful Non-VA Links

Medicare Public Use Files (Medicare Public Use Files (www.cms.hhs.govwww.cms.hhs.gov)) Physician Fee Schedule Payment Amount Physician Fee Schedule Payment Amount

File National/CarrierFile National/Carrier National Physician Fee Schedule Relative National Physician Fee Schedule Relative

Value FileValue File DRGs Relative Weight FileDRGs Relative Weight File Clinical Diagnostic Laboratory Fee Clinical Diagnostic Laboratory Fee

ScheduleSchedule


Non-VA Links (Cont.)Non-VA Links (Cont.)

Ingenix Ingenix

– Source of relative values for CPT codes Source of relative values for CPT codes that are not reimbursed by Medicare that are not reimbursed by Medicare (known as “gap codes): (known as “gap codes):

– www.ingenix.comwww.ingenix.com


Additional ReadingAdditional Reading

HERC 2003 Supplement in HERC 2003 Supplement in Medical Care Medical Care Research and ReviewResearch and Review

– Methods on average costsMethods on average costs

– Discussion of pharmacy dataDiscussion of pharmacy data

– Overview of VA cost optionsOverview of VA cost options http://http://www.herc.research.va.gov/publications/supplements.aspwww.herc.research.va.gov/publications/supplements.asp


Additional ViewingAdditional Viewing

HERC Course ArchivesHERC Course Archives

– More detail on each datasetMore detail on each datasethttp://www.herc.research.va.gov/resources/training_course_archives.asphttp://www.herc.research.va.gov/resources/training_course_archives.asp


Next ClassNext Class4/11/2007:4/11/2007: Overview of Economics Analysis with Experimental Overview of Economics Analysis with Experimental

DataData4/18/2007: 4/18/2007: Elements of a Complete Cost Effectiveness AnalysisElements of a Complete Cost Effectiveness Analysis5/2/2007: 5/2/2007: Estimating the Cost of the Intervention: Costing Estimating the Cost of the Intervention: Costing

MethodsMethods5/16/2007: 5/16/2007: Estimating the Cost of Health Care: VA CostsEstimating the Cost of Health Care: VA Costs5/30/2007: 5/30/2007: Estimating the Cost of Health Care: Non-VA CostsEstimating the Cost of Health Care: Non-VA Costs6/13/2007: 6/13/2007: Effectiveness, Patient Preferences and UtilitiesEffectiveness, Patient Preferences and Utilities6/20/2007: 6/20/2007: Introduction to Decision AnalysisIntroduction to Decision Analysis7/11/2007: 7/11/2007: Economic Analysis and Implementation ResearchEconomic Analysis and Implementation Research7/18/2007: 7/18/2007: CEA Alternatives: Lost Productivity, Willingness to CEA Alternatives: Lost Productivity, Willingness to

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estimating the cost of health care: va costs paul barnett may 16, 2007

Documents

cost of va

cost of health care

va cost data sets

medicare data cost regression

category of care cost

va data sources

methods of cost determination

cost allocation system