Medicare is challenged to maintain solvency as enrollment climbs because of the aging baby boomers and costs increase as a result of the substantial disease burden present among seniors. In the present study, an actuarial model was developed to determine the present cost (2008) of Medicare-covered benefits for elderly individuals, and to test the impact on cost of health risk reduction that may be possible through population health and wellness interventions. In the model, beneficiaries were categorized by risk according to health status using 3 different indices, and baseline per month and lifetime expenditures were estimated. Changes in morbidity were tested via scenarios of modified transition rates between the risk categories that might result from population health and wellness initiatives, including increases in the proportion of low-risk individuals entering Medicare, and delayed or reduced rates of upward risk transitions. The model showed that the discounted total lifetime cost of Medicare benefits was $174,018 per person, from age 65 until death. Each risk-reduction scenario was associated with both annual and lifetime cost savings, which accounted for increased longevity associated with decreased risk profiles. In conclusion, a model has been developed that can predict the impact on Medicare costs of varying levels of risk reduction in the senior population and, therefore, the potential financial benefit of population health and wellness policy initiatives directed at improving health prior to and during the years of Medicare. The model shows that there are substantial opportunities for savings through modest improvements to the health of the Medicare population.
The ?(15)N values of organisms are commonly used across diverse ecosystems to estimate trophic position and infer trophic connectivity. We undertook a novel cross-basin comparison of trophic position in two ecologically well-characterized and different groups of dominant mid-water fish consumers using amino acid nitrogen isotope compositions. We found that trophic positions estimated from the ?(15)N values of individual amino acids are nearly uniform within both families of these fishes across five global regions despite great variability in bulk tissue ?(15)N values. Regional differences in the ?(15)N values of phenylalanine confirmed that bulk tissue ?(15)N values reflect region-specific water mass biogeochemistry controlling ?(15)N values at the base of the food web. Trophic positions calculated from amino acid isotopic analyses (AA-TP) for lanternfishes (family Myctophidae) (AA-TP ?2.9) largely align with expectations from stomach content studies (TP ?3.2), while AA-TPs for dragonfishes (family Stomiidae) (AA-TP ?3.2) were lower than TPs derived from stomach content studies (TP?4.1). We demonstrate that amino acid nitrogen isotope analysis can overcome shortcomings of bulk tissue isotope analysis across biogeochemically distinct systems to provide globally comparative information regarding marine food web structure.
Related JoVE Video
Journal of Visualized Experiments
What is Visualize?
JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.
How does it work?
We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.
Video X seems to be unrelated to Abstract Y...
In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.