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1.
Am J Manag Care ; 30(3): 107-108, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38457817

RESUMO

Out-of-pocket costs of diabetes medications other than insulin can be quite high for individuals with employer-sponsored health insurance.


Assuntos
Diabetes Mellitus , Planos de Assistência de Saúde para Empregados , Humanos , Estados Unidos , Gastos em Saúde , Custos e Análise de Custo , Diabetes Mellitus/tratamento farmacológico , Insulina/uso terapêutico , Seguro Saúde
3.
J Cancer Res Clin Oncol ; 150(3): 113, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38436796

RESUMO

PURPOSE: This study aims to estimate changes in the value of oncology drugs over time from initial data of the reimbursement decisions to subsequent publications in Korea, using two value frameworks. METHODS: We retrieved primary publications assessed for reimbursement between 2007 and July 2021 from the decision documents of Health Insurance Review and Assessment and subsequent publications made available following reimbursement decision from ClinicalTrials.Gov and PubMed databases. Changes in the clinical benefit scores were assessed using the American Society of Clinical Oncology Value Framework (ASCO-VF) and the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). A paired t test was performed to test whether there was a difference in the scores between primary and subsequent publications. RESULTS: Of 73 anticancer product/indication pairs, 45 (61.6%) had subsequent publications, of which 62.5% were released within 1 year of reimbursement decision. The mean ESMO-MCBS and ASCO-VF Net Health Benefit scores increased from primary to subsequent publications, although the differences were not significant. The mean ASCO-VF bonus score significantly increased from 15.91 to 19.09 (p = 0.05). The ESMO-MCBS and bonus scores increased by 0.25 and 0.21, respectively, and the bonus score had a greater impact on the ESMO-MCBS score than the preliminary score did. CONCLUSION: The value of drugs demonstrated in subsequent publications varies considerably among oncology drugs, depending on uncertainty associated with the initial evidence and the availability of updated evidence. As decision-making in the face of uncertainty becomes more prevalent, the value frameworks can serve as simple screening tools for re-evaluation in these cases.


Assuntos
Seguro Saúde , Oncologia , Humanos , Bases de Dados Factuais , Qualidade da Assistência à Saúde
5.
Front Public Health ; 12: 1357114, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38500728

RESUMO

Objective: The implementation of the outpatient pooling scheme in China has substantially elevated the compensation levels for outpatient expenses. This study aims to assess whether socioeconomically disadvantaged enrollees benefit proportionally compared to their non-disadvantaged counterparts. Method: A cohort comprising 14,581 Urban and Rural Resident Basic Medical Insurance (URRBMI) enrollees and 830 Urban Employee Basic Medical Insurance (UEBMI) enrollees was derived from the China Health and Retirement Longitudinal Study 2018. Outpatient pooling scheme benefits were evaluated based on two metrics: the probability of obtaining benefits and the magnitude of benefits (reimbursement amounts and ratios). Two-part models were employed to adjust outpatient benefits for healthcare needs. Inequality in benefit distribution was assessed using the concentration curve and concentration index (CI). Results: Following adjustments for healthcare needs, the CI for the probability of receiving outpatient benefits for URRBMI and UEBMI enrollees were - 0.0760 and - 0.0514, respectively, indicating an evident pro-poor pattern under the outpatient pooling scheme. However, the CIs of reimbursement amounts (0.0708) and ratio (0.0761) for URRBMI recipients were positive, signifying a discernible pro-rich inequality in the degree of benefits. Conversely, socioeconomically disadvantaged UEBMI enrollees received higher reimbursement amounts and ratios. Conclusion: Despite a higher likelihood of socioeconomically disadvantaged groups receiving outpatient benefits, a pro-rich inequality persists in the degree of benefits under the outpatient pooling scheme in China. Comprehensive strategies, including expanding outpatient financial benefits, adopting distinct reimbursement standards, and enhancing the accessibility of outpatient care, need to be implemented to achieve equity in benefits distribution.


Assuntos
Seguro Saúde , Pacientes Ambulatoriais , Humanos , Estudos Longitudinais , Assistência Ambulatorial , China
6.
J Health Econ ; 94: 102868, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38447245

RESUMO

This paper shows that selection incentives in downstream markets distort upstream prices. It is possible for inputs to be priced above the value that the good has for final consumers. We apply this idea to pharmaceutical companies selling drugs to a health insurance market with selection problems. We specify the conditions under which drugs are sold at prices exceeding treatment value. Another feature of the model is an excessive private incentive to reduce market size, e.g. in the form of personalized medicine.


Assuntos
Custos de Medicamentos , Seguro Saúde , Humanos , Custos e Análise de Custo
7.
PLoS One ; 19(3): e0296695, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38483859

RESUMO

Based on the unbalanced panel data of Chinese professional health insurance companies from 2011 to 2021, the paper constructs "PW+PCSE" model to empirically investigate the main factors affecting the commercial health insurance surrender in China from the company level. The results show that asset-liability ratio has a significant positive effect on health insurance surrender rate. The value preservation and appreciation rate of capital and R&D expenditure rate both have significant negative effects on health insurance surrender rate. These studies bring important enlightenment for domestic health insurance companies to avoid surrender risk.


Assuntos
Seguro Saúde , Seguro de Responsabilidade Civil , Gastos em Saúde , China
8.
RMD Open ; 10(1)2024 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-38485454

RESUMO

OBJECTIVE: To assess the risk of serious infection associated with different targeted therapies for psoriatic arthritis (PsA) in real-world settings. METHODS: This nationwide cohort study used the administrative healthcare database of the French health insurance scheme linked to the hospital discharge database to identify all adults with PsA who were new users of targeted therapies (adalimumab, etanercept, golimumab, certolizumab pegol, infliximab, secukinumab, ixekizumab, ustekinumab, and tofacitinib) from 1 January 2015 to 30 June 2021. The primary outcome was a serious infection (ie, requiring hospitalisation), in a time-to-event analysis using propensity score-weighted Cox models, with adalimumab as the comparator, estimating weighted HRs (wHRs) and their 95% CIs. RESULTS: A total of 12 071 patients were included (mean age 48.7±12.7 years; 6965 (57.7%) women). We identified 367 serious infections (3.0% of patients), with a crude incidence rate of 17.0 per 1000 person-years (95% CI, 15.2 to 18.7). After inverse propensity score weighting and adjustment for time-dependent covariates and calendar year, risk of serious infection was significantly lower for new users of etanercept (wHR 0.72; 95% CI, 0.53 to 0.97) or ustekinumab (wHR, 0.57; 95% CI, 0.35 to 0.93) than adalimumab new users. This risk was not statistically modified with the other targeted therapies. CONCLUSIONS: The incidence of serious infection was low for PsA patients who were new users of targeted therapies in real-world settings. Relative to adalimumab new users, this risk was lower among new users of etanercept and ustekinumab and unmodified for the other molecules.


Assuntos
Artrite Psoriásica , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Artrite Psoriásica/tratamento farmacológico , Artrite Psoriásica/epidemiologia , Adalimumab/efeitos adversos , Etanercepte , Ustekinumab , Estudos de Coortes , Seguro Saúde
9.
Int J Equity Health ; 23(1): 58, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38491541

RESUMO

BACKGROUND: The Government of North Macedonia's Primary Health Care reform is committed to leaving no one behind on the path to Universal health Coverage (UHC). During mid-2022 to March 2023, the World Health Organization (WHO) collaborated with the Government and other national stakeholders for an assessment of barriers to effective coverage with health services experienced by adult citizens, with a specific focus on rural areas and subpopulations in situations of vulnerability. METHODS: This study constituted the piloting of a draft forthcoming WHO handbook on assessing barriers for health services, grounded in the Tanahashi framework for effective coverage with health services. In North Macedonia, the convergent parallel mixed methods study involved four sources. These were: a nationally representative Computer Assisted Telephone Interview Survey (1,139 respondents); 24 key informant interviews with representatives from government, professional associations, non-governmental and civil society organizations, and development partners; 12 focus groups in four regions with adults from vulnerable/high risk groups in rural areas and small urban settlements and an additional focus group with persons with disabilities; and a literature review. Instrument design was underpinned by the Tanahashi framework, which also orientated data triangulation and deductive analysis. The research team synergistically incorporated emerging themes in an inductive way. A key component of the assessment was participatory design of the study protocol with inputs from national stakeholders as well as participatory deliberation of the results and the ways forward. RESULTS: Despite considerable progress towards UHC in North Macedonia, the assessment elucidated remaining challenges. These included: insufficient numbers of health workers, in general and particularly in the more disadvantaged regions of the country; inadequate number of outpatient medicines covered by health insurance; distance and transportation obstacles, including indirect travel costs, particularly in rural areas; adverse gender norms and relations for both women and men inhibiting timely treatment seeking; perceived discrimination by providers on multiple grounds; bottlenecks including waiting times to get appointments for specialist referrals; and lack of patient adherence, due several factors including costs of medicines and health products. CONCLUSIONS: The outputs from this study of barriers to effective coverage with health services for adult citizens of North Macedonia are feeding into the ongoing Primary Health Care reform, and provide evidence for equity-related actions in the forthcoming National Development Strategy.


Assuntos
Reforma dos Serviços de Saúde , Serviços de Saúde , Masculino , Adulto , Humanos , Feminino , República da Macedônia do Norte , Seguro Saúde , Grupos Focais
10.
BMC Public Health ; 24(1): 864, 2024 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-38509510

RESUMO

BACKGROUND: Cost-related medication nonadherence (CRN) is associated with poor prognosis among patients with chronic obstructive pulmonary disease (COPD), a population that requires long-term treatment for secondary prevention. In this study, we aimed to estimate the prevalence and sociodemographic characteristics of CRN in individuals with COPD in the US. METHODS: In a nationally representative survey of US adults in the National Health Interview Survey (2013-2020), we identified individuals aged ≥18 years with a self-reported history of COPD. Cross-sectional study. RESULTS: Of the 15,928 surveyed individuals, a weighted 18.56% (2.39 million) reported experiencing CRN, including 12.50% (1.61 million) missing doses, 13.30% (1.72 million) taking lower than prescribed doses, and 15.74% (2.03 million) delaying filling prescriptions to save costs. Factors including age < 65 years, female sex, low family income, lack of health insurance, and multimorbidity were associated with CRN. CONCLUSIONS: In the US, one in six adults with COPD reported CRN. The influencing factors of CRN are multifaceted and necessitating more rigorous research. Targeted interventions based on the identified influencing factors in this study are recommended to enhance medication adherence among COPD patients.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Adulto , Humanos , Feminino , Estados Unidos/epidemiologia , Adolescente , Idoso , Estudos Transversais , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Inquéritos e Questionários , Seguro Saúde , Adesão à Medicação
11.
BMC Public Health ; 24(1): 767, 2024 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-38475807

RESUMO

BACKGROUND: The study uncovers micro and macro socioeconomic disparities in terms of health behavior, disease perception, and reception of information. Furthermore, findings shed light on the possible role of health insurance on access to information, disease perception and the adoption of preventive behaviors in the context of a public health emergency such as the COVID-19 pandemic. METHODS: This study employed a cross-sectional design using the Philippine Demographic and Health Survey (DHS). With a total of 29,809 respondents, it evaluated the individual or household and systemwide socioeconomic determinants of four different outcomes: receipt of information, disease perception, uptake of free preventive services, and treatment-seeking behavior. In addition to logistic regression models with the socioeconomic variables as the independent variables, models for the evaluation of the moderating effect of insurance ownership were fitted. Predicted probabilities were reported for the analysis of moderating effects. RESULTS: Findings show that individual and householdsocioeconomic determinants affected health-behavior and access to or receipt of information pertinent to the COVID-19 pandemic. Both education and wealth affected the receipt of information such that individuals in more advantaged socioeconomic positions were at least 30% more likely to have received information on COVID-19. Wealth was also associated to treatment-seeking behavior. Regional differences were seen across all dependent variables. Moreover, the study provides evidence that ownership of insurance can close education-based gaps in the uptake of free vaccination and COVID-19 testing. CONCLUSION: It is imperative that targeted efforts be maximized by utilizing existing strategies and mechanisms to reach the marginalized and disadvantaged segments of the population. Health insurance may give off added benefits that increase proficiency in navigating through the healthcare system. Further research may focus on examining pathways by which health insurance or social policies may be used to leverage responses to public health or environmental emergencies.


Assuntos
COVID-19 , Revelação , Humanos , Estudos Transversais , Filipinas , Teste para COVID-19 , Pandemias , Fatores Socioeconômicos , Seguro Saúde , Comportamentos Relacionados com a Saúde
12.
Medicine (Baltimore) ; 103(11): e37488, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38489736

RESUMO

Surgical access remains a pressing public health concern in African nations, with a substantial portion of the population facing challenges in obtaining safe, timely, and affordable surgical care. This paper delves into the impact of health insurance schemes on surgical accessibility in Africa, exploring the barriers, challenges, and future directions. It highlights how high out-of-pocket costs, reliance on traditional healing practices, and inadequate surgical infrastructure hinder surgical utilization. Financing mechanisms often need to be more effective, and health insurance programs face resistance within the informal sector. Additionally, coverage of the poor remains a fundamental challenge, with geographical and accessibility barriers compounding the issue. Government policies, often marked by inconsistency and insufficient allocation of resources, create further obstacles. However, strategic purchasing and fund integration offer avenues for improving the efficiency of health insurance programs. The paper concludes by offering policy recommendations, emphasizing the importance of inclusive policies, streamlined financing mechanisms, coverage expansion, and enhanced strategic purchasing to bridge the surgical access gap in Africa. Decoupling entitlement from the payment of contributions, broadening the scope of coverage for outpatient medicines and related expenses, and enhancing safeguards against overall costs and charges, especially for individuals with lower incomes. Ultimately, by addressing these challenges and harnessing the potential of health insurance schemes, the continent can move closer to achieving universal surgical care and improving the well-being of its people.


Assuntos
Seguro Saúde , Cobertura Universal do Seguro de Saúde , Humanos , África , Renda , Governo
13.
BMC Health Serv Res ; 24(1): 273, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38438924

RESUMO

BACKGROUND: Despite sophisticated risk equalization, insurers in regulated health insurance markets still face incentives to attract healthy people and avoid the chronically ill because of predictable differences in profitability between these groups. The traditional approach to mitigate such incentives for risk selection is to improve the risk-equalization model by adding or refining risk adjusters. However, not all potential risk adjusters are appropriate. One example are risk adjusters based on health survey information. Despite its predictiveness of future healthcare spending, such information is generally considered inappropriate for risk equalization, due to feasibility challenges and a potential lack of representativeness. METHODS: We study the effects of high-risk pooling (HRP) as a strategy for mitigating risk selection incentives in the presence of sophisticated- though imperfect- risk equalization. We simulate a HRP modality in which insurers can ex-ante assign predictably unprofitable individuals to a 'high risk pool' using information from a health survey. We evaluate the effect of five alternative pool sizes based on predicted residual spending post risk equalization on insurers' incentives for risk selection and cost control, and compare this to the situation without HRP. RESULTS: The results show that HRP based on health survey information can substantially reduce risk selection incentives. For example, eliminating the undercompensation for the top-1% with the highest predicted residual spending reduces selection incentives against the total group with a chronic disease (60% of the population) by approximately 25%. Overall, the selection incentives gradually decrease with a larger pool size. The largest marginal reduction is found moving from no high-risk pool to HRP for the top 1% individuals with the highest predicted residual spending. CONCLUSION: Our main conclusion is that HRP has the potential to considerably reduce remaining risk selection incentives at the expense of a relatively small reduction of incentives for cost control. The extent to which this can be achieved, however, depends on the design of the high-risk pool.


Assuntos
Seguro Saúde , Motivação , Humanos , Inquéritos Epidemiológicos , Controle de Custos , Instalações de Saúde
14.
Future Oncol ; 20(5): 269-282, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38440864

RESUMO

Aims: To describe nursing practices for financial toxicity management based on nurses' perceptions. Materials & methods: A survey was conducted with 615 oncology nurses in Japan, focusing on nurses' perspectives on the importance of financial toxicity, nursing practices to manage financial toxicity and factors inhibiting its management. Results: A total of 521 participated, of whom 266 respondents (51.1%) considered nurses' role important, and they engaged in a significantly higher proportion of nursing practices. Participants with greater perceptions of their role included certified or specialized nurses and nurses responsible for outpatient care. Conclusion: Interventions leveraging the expertise of certified or specialized nurses and nurses involved in outpatient care could help to spread proactive nurse practices addressing financial toxicity.


Assuntos
Assistência Ambulatorial , Estresse Financeiro , Humanos , Certificação , Japão , Seguro Saúde
15.
NPJ Prim Care Respir Med ; 34(1): 1, 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38453930

RESUMO

Medication adherence is vital for patients suffering from Chronic Obstructive Pulmonary Disease (COPD) to mitigate long-term consequences. The impact of poor medication adherence on inferior outcomes like exacerbations leading to hospital admissions is yet to be studied using real-world data. Using Swiss claims data from 2015-2020, we group patients into five categories according to their medication possession ratio. By employing a logistic regression, we quantify each category's average treatment effect of the medication possession ratio on hospitalized exacerbations. 13,557 COPD patients are included in the analysis. Patients with high medication adherence (daily medication reserve of 80% to 100%) are 51% less likely to incur exacerbation following a hospital stay than patients with the lowest medication adherence (daily medication reserve of 0% to 20%). The study shows that medication adherence varies strongly among Swiss COPD patients. Furthermore, high medication adherence immensely decreases the risk of hospitalized exacerbations.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Humanos , Suíça , Estudos Retrospectivos , Hospitalização , Adesão à Medicação , Seguro Saúde , Progressão da Doença
16.
Am J Public Health ; 114(4): 407-414, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38478867

RESUMO

Objectives. To produce a database of private insurance hearing aid mandates in the United States and quantify the share of privately insured individuals covered by a mandate. Methods. We used health-related policy surveillance methods to create a database of private insurance hearing aid mandates through January 2023. We coded salient features of mandates and combined policy data with American Community Survey and Medicare Expenditure Panel Survey-Insurance Component data to estimate the share of privately insured US residents covered by a mandate from 2008 to 2022. Results. A total of 26 states and 1 territory had private insurance hearing aid mandates. We found variability for mandate exceptions, maximum age eligibility, allowable frequency of benefit use, and coverage amounts. Between 2008 and 2022 the proportion of privately insured youths (aged ≤ 18 years) living where there was a private insurance hearing aid mandate increased from 3.4% to 18.7% and the proportion of privately insured adults (19-64 years) increased from 0.3% to 4.6%. Conclusions. Hearing aid mandates cover a small share of US residents. Mandate exceptions in several states limit coverage, particularly for adults. Public Health Implications. A federal mandate would improve hearing aid access. States can also improve access by adopting exception-free mandates with limited utilization management and no age restrictions. (Am J Public Health. 2024;114(4):407-414. https://doi.org/10.2105/AJPH.2023.307551).


Assuntos
Auxiliares de Audição , Cobertura do Seguro , Adulto , Adolescente , Humanos , Estados Unidos , Idoso , Epidemiologia Legal , Medicare , Política de Saúde , Seguro Saúde
17.
Int J Equity Health ; 23(1): 49, 2024 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-38468302

RESUMO

BACKGROUND: Improving the accessibility of public services for migrants is an important endeavor to promote equity in economic and social development. As a response to the large-scale movement of migrants and the fragmentation of China's health insurance system, the Chinese Government has launched a policy of trans-provincial immediate reimbursement for healthcare expenses. The present study hopes to examine the effect of immediate reimbursement policy on the utilization of healthcare services for migrants in China. METHODS: This study used two waves of data from the China Migrants Dynamic Survey (CMDS) collected in 2013 and 2017, with the sample comprising 13,540 individuals. We constructed a difference-in-differences (DID) model to investigate the impact of the policy on the utilization of healthcare services for migrants. Meanwhile, we also analyzed the heterogeneity of the policy effect by grouping the samples by industry, gender, income, and education level. RESULTS: The results found that the trans-provincial immediate reimbursement significantly promoted the probability of migrants' utilization of quality healthcare services (average treatment effect on the treated = 0.072, p < 0.05). Heterogeneity analyses revealed that the policy effect was more pronounced among higher-income and better-educated migrants. In addition, the policy effect was more significant for female migrants, and the benefits were more marked for migrants in high-risk industries. CONCLUSIONS: The trans-provincial immediate reimbursement policy has improved the inequity of healthcare services utilization among migrants as a whole; however, within the migrants, inequity still exists. More attention should also be paid to low-income or low-education groups in future policy design.


Assuntos
Migrantes , Humanos , Feminino , Atenção à Saúde , Pobreza , Renda , Seguro Saúde , China
18.
Front Public Health ; 12: 1286549, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38476487

RESUMO

Background: China has made remarkable achievements in alleviating poverty under its current poverty standards. Despite these immense successes, the challenge of consolidating these achievements remains. In reality, health risks are among the significant factors causing rural households to fall into poverty, and medical insurance is the significant factor mitigating household vulnerability to poverty. Therefore, alleviating or guarding against households falling into poverty is essential. Methods: This paper establishes a multi-equilibrium model that incorporates heterogeneous health risks and medical insurance. Through parameter calibration and value function iteration, numerical solutions are derived. Results: Heterogeneous health risks significantly increase poverty vulnerability and wealth inequality in rural households. Medical insurance, through its investment incentives and loss compensation effects, efficiently mitigates these issues, especially benefiting those in poorer health. Furthermore, the dual-slanted compensation policy efficiently mitigates the adverse effects of "reverse redistribution." Conclusion: Medical insurance effectively mitigates household vulnerability to poverty and wealth inequality. Government departments must establish health records for residents. By recognizing variations in health conditions, these departments can provide households with poorer health conditions with a higher medical expense compensation ratio. In addition, the government should further focus medical expense reimbursements toward households on the cusp of escaping poverty to ensure that they are not plunged back (or further) into poverty due to medical expenses.


Assuntos
Gastos em Saúde , Seguro Saúde , Humanos , Pobreza , Características da Família , China
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