Parkinson's disease (PD), following Alzheimer's disease, is the second-most common neurodegenerative disorder in the United States. A lack of treatment options for changing the trajectory of disease progression, in combination with an increasing elderly population, portends a rising economic burden on patients and payers. This study combined information from nationally representative surveys to create a burden of PD model. The model estimates disease prevalence, excess healthcare use and medical costs, and nonmedical costs for each demographic group defined by age and sex. Estimated prevalence rates and costs were applied to the U.S. Census Bureau's 2010 to 2050 population data to estimate current and projected burden based on changing demographics. We estimate that approximately 630,000 people in the United States had diagnosed PD in 2010, with diagnosed prevalence likely to double by 2040. The national economic burden of PD exceeds $14.4 billion in 2010 (approximately $22,800 per patient). The population with PD incurred medical expenses of approximately $14 billion in 2010, $8.1 billion higher ($12,800 per capita) than expected for a similar population without PD. Indirect costs (e.g., reduced employment) are conservatively estimated at $6.3 billion (or close to $10,000 per person with PD). The burden of chronic conditions such as PD is projected to grow substantially over the next few decades as the size of the elderly population grows. Such projections give impetus to the need for innovative new treatments to prevent, delay onset, or alleviate symptoms of PD and other similar diseases.

Objective: This study estimates current and projects future neurologist supply and demand under alternative scenarios nationally and by state from 2012 through 2025. Conclusions: In the absence of efforts to increase the number of neurology professionals and retain the existing workforce, current national and geographic shortfalls of neurologists are likely to worsen, exacerbating long wait times and reducing access to care for Medicaid beneficiaries. Current geographic differences in adequacy of supply likely will persist into the future. Methods:

BackgroundThe Centers for Disease Control and Prevention estimates that 28.9 million adults had diabetes in 2012 in the US, though many patients are undiagnosed or not managing their condition. This study provides US national and state estimates of insured adults with type 2 diabetes who are diagnosed, receiving exams and medication, managing glycemic levels, with diabetes complications, and their health expenditures. Such information can be used for benchmarking and to identify gaps in diabetes detection and management.MethodsThe study combines analysis of survey data with medical claims analysis for the commercially insured, Medicare, and Medicaid populations to estimate the number of adults with diagnosed type 2 diabetes and undiagnosed diabetes by insurance type, age, and sex. Medical claims analysis used the 2012 de-identified Normative Health Information database covering a nationally representative commercially insured population, the 2011 Medicare 5% Sample, and the 2008 Medicaid Mini-Max.ResultsAmong insured adults in 2012, approximately 16.9 million had diagnosed type 2 diabetes, 1.45 million had diagnosed type 1 diabetes, and 6.9 million had undiagnosed diabetes. Of those with diagnosed type 2, approximately 13.0 million (77%) received diabetes medication-ranging from 70% in New Jersey to 82% in Utah. Suboptimal percentages had claims indicating recommended exams were performed. Of those receiving diabetes medication, 43% (5.6 million) had medical claims indicating poorly controlled diabetes-ranging from 29% with poor control in Minnesota and Iowa to 53% in Texas. Poor control was correlated with higher prevalence of neurological complications (+14%), renal complications (+14%), and peripheral vascular disease (+11%). Patients with poor control averaged $4,860 higher average annual health care expenditures-ranging from $6,680 for commercially insured patients to $4,360 for Medicaid and $3,430 for Medicare patients.ConclusionsThis study highlights the large number of insured adults with undiagnosed type 2 diabetes by insurance type and state. Furthermore, this study sheds light on other gaps in diabetes care quality among patients with diagnosed diabetes and corresponding poorly controlled diabetes. These findings underscore the need for improvements in data collection and diabetes screening and management, along with policies that support these improvements.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-016-0110-4) contains supplementary material, which is available to authorized users.

Objective: To estimate the demand for women's health care by 2020 using today's national utilization standards. Methods: This descriptive study incorporated the most current national data resources to design a simulation model to create a health and economic profile for a representative sample of women from each state. Demand was determined utilizing equations about projected use of obstetrics-gynecology (ob-gyn) services. Applying patient profile and health care demand equations, we estimated the demand for providers in 2010 in each state for comparison with supply based on the 2010 American Medical Association Masterfile. U.S. Census Bureau population projections were used to project women's health care demands in 2020. Results: The national demand for women's health care is forecast to grow by 6% by 2020. Most (81%) ob-gyn related services will be for women of reproductive age (18-44 years old). Growth in demand is forecast to be highest in states with the greatest population growth (Texas, Florida), where supply is currently less than adequate (western United States), and among Hispanic women. This increase in demand by 2020 will translate into a need for physicians or nonphysician clinicians, which is clinically equivalent to 2,090 full-time ob-gyns. Conclusion: Using today's national norms of ob-gyn related services, a modest growth in women's health care demands is estimated by 2020 that will require a larger provider workforce.

Objective The aim of this study was to assess the current and future adequacy of physiatrist supply in the United States. Design A 2019 online survey of board-certified physiatrists (n = 616 completed, 30.1% response) collected information about demographics, practice characteristics, hours worked, and retirement intentions. Microsimulation models projected future physiatrist supply and demand using data from the American Board of Physical Medicine and Rehabilitation, national and state population projections, American Community Survey, Behavioral Risk Factor Surveillance System, Medical Expenditure Panel Survey, and other sources. Results Approximately 37% of 8853 active physiatrists indicate that their workload exceeds capacity, 59% indicate that workload is at capacity, and 4% indicate under capacity. These findings suggest a national shortfall of 940 (10.6%) physiatrists in 2017, with substantial geographic variation in supply adequacy. Projected growth in physiatrist supply from 2017 to 2030 approximately equals demand growth (2250 vs. 2390), suggesting that without changes in care delivery, the shortfall of physiatrists will persist, with a 1080 (9.7%) physiatrist shortfall in 2030. Conclusion Without an increase in physiatry residency positions, the current national shortfall of physiatrists is projected to persist. Although a projected increase in physiatrists’ use of advanced practice providers may help preserve access to comprehensive physiatry care, it is not expected to eliminate the shortfall.