Does younger children's social health insurance alleviate household impoverishment due to illness?

BACKGROUND: The ambitious expansion of social health insurance in China has played a crucial role in preventing and alleviating poverty caused by illness. However, there is no government-sponsored health insurance program specifically for younger children and inequities are more pronounced in healthcare utilization, medical expenditure, and satisfaction in some households with severely ill children. This study assessed the effectiveness of child health insurance in terms of alleviating poverty caused by illness. METHODS: Data were collected from two rounds of follow-up surveys using the China Family Panel Studies 2016 and 2018 child questionnaires to investigate the relationship between child health insurance and household medical impoverishment (MI). Impoverishing health expenditure (IHE) and catastrophic health expenditure (CHE) were measured to quantify "poverty due to illness" in terms of absolute and relative poverty, respectively. Propensity score matching with the difference-in-differences (PSM-DID) method, robustness tests, and heterogeneity analysis were conducted to address endogeneity issues. RESULTS: Social health insurance for children significantly reduced household impoverishment due to illness. Under the shock of illness, the incidences of IHE and CHE were significantly lower in households with insured children. The poverty alleviation mechanism transmitted by children enrolled in social health insurance was primarily driven by hospitalization reimbursements and the proportion of out-of-pocket medical payments among the total medical expenditure for children. CONCLUSIONS: Children's possession of social health insurance significantly reduced the likelihood of household poverty due to illness. The poverty-reducing effect of social medical insurance is most significant in rural areas, low-income families, no-left-behind children, and infants. Targeted poverty alleviation strategies for marginalized groups and areas would ensure the equity and efficiency of health system reforms, contributing to the goal of universal health insurance coverage in China.

Access to healthcare services and factors associated with unmet needs among migrants in Phuket Province, Thailand, 2023: a cross-sectional mixed-method study.

BACKGROUND: Phuket Province is a major tourist destination with a migrant workforce accounting for 10% of its population. Despite governmental efforts to adjust health insurance policies, migrants face healthcare access challenges. This study examines the current healthcare access situation and factors associated with unmet needs among migrants in Phuket Province. METHODS: We used a cross-sectional mixed-methods approach, recruiting participants through snowball sampling from the Migrant Health Volunteer Network. Quantitative data were gathered using self-administered questionnaires, with unmet need defined as desired outpatient or recommended inpatient services not received at government hospitals. Multivariable logistic regression identified unmet need predictors, and we assessed the mediating effect of health insurance status. Qualitative data from three focus groups on healthcare access provided context and enriched the quantitative findings. RESULTS: This study includes 296 migrants mainly from Myanmar. The overall unmet need prevalence was 14.86%, mainly attributed to having undocumented status (34.09%), affordability issues (20.45%), and language barriers (18.18%). Working in the fishery industry significantly increased unmet needs risk (aOR 2.68, 95% CI 1.08-6.62). Undocumented status contributed a marginal total effect of 4.86 (95% CI 1.62-14.54), with a natural indirect effect through uninsured status of only 1.16 (95% CI 0.88-1.52). Focus group participants used various medical resources, with insured individuals preferring hospital care, but faced obstacles due to undocumented status and language barriers. CONCLUSION: Valid legal documents, including work permits and visas, are crucial for healthcare access. Attention to fishery industry practices is needed. We recommend stakeholder discussions to streamline the process of obtaining and maintaining these documents for migrant workers. These improvements could enhance health insurance acquisition and ultimately improve healthcare affordability for this population. These insights could be applied to migrant workers in other urban and suburban area of Thailand regarding access to government healthcare facilities.

Estimating diabetes mellitus incidence using health insurance claims data: A database-driven cohort study.

Type II diabetes mellitus is a global public health challenge, necessitating robust epidemiological investigations. The majority of evidence reports prevalence as estimations of incidence requiring longitudinal cohort studies that are challenging to conduct. However, this has been addressed by the secondary use of existing health insurance claims data. The current study aimed to examine the incidence of type II diabetes mellitus using existing claims and ledger data. The National Health Insurance and medical care system databases were used to extract type II diabetes mellitus (defined as ICD10 codes E11$-14$) claims data over a period of 5 years for individuals over 40 years old living in one city in Japan. Prevalence was calculated, and insured individuals whose data could be tracked over the entire study period were included in the subsequent analyses. Therefore, annual incidence was calculated by estimating differences in prevalence by year. Data analyses were stratified by sex and age group, and a model analysis was conducted to account for these variables. Overall, the prevalence, diabetes medication usage, and insulin usage were 26.3%, 12.1%, and 2.0%, respectively. Annual incidence of type II diabetes mellitus ranged between 1.2% and 4.6%. Both prevalence and incidence tended to be higher in males and peaked around 60-80 years old. The overall annual incidence was estimated at 3.03% (95% CI: 2.21%-3.85%). The annual incidence was not always associated with a low risk, indicating a consistent risk from middle age onward, although the level of risk varied with age. The current study successfully integrated existing claims and ledger data to explore incidence, and this methodology could be applied to a range of injuries and illnesses in the future.

Risk Factors for Adults with Chronic Obstructive Pulmonary Disease in the United States, Utilizing State-Based Surveillance.

Chronic Obstructive Pulmonary Disease (COPD) is a complex and heterogeneous condition. Exposure to tobacco smoke and air pollutants are key risk factors for COPD development; however, other risk factors include race/ethnicity, sex of adults, a history of asthma, occupational exposures, and chronic respiratory infections. Data for the current study were from the 2022 Behavioral Risk Factor Surveillance Survey. Chi-squares and multinomial logistic regression analyses, adjusted with the survey's sampling weight, were used to examine how critical health indicators impacted a COPD diagnosis. Participants (N = 311,175) were adults aged 45 years and older. Adjusted multinomial regression analyses showed adults who reported asthma, current and former smoking, poor physical health, depression, less physical activity, and fatigue were more likely to report COPD. Those with COPD were more likely to be male than female. Moreover, those with COPD reported higher rates of health insurance coverage, and yet had lower income and more financial difficulty affording a doctor for health services. In a follow up regression analysis, examining racial differences in COPD for participants, American Indian adults had a higher odds of reporting COPD than the "other" race groups. Because COPD remains a leading cause of death and disability in the U.S., and racial disparities persist in respiratory outcomes, continuing to identify risk factors for vulnerable groups could assist health program planners with development of successful health messaging.

Analysis of hospitalization expenditures and influencing factors for inpatients with chronic bronchitis based on SHA2011 in a central Province of China.

This study compared the hospitalization expenses of patients with chronic bronchitis in a central province (Province A) in China to estimate the direct medical cost of the family. Our data included hospitalization records of 30,341 patients with chronic bronchitis from five urban general hospitals in Province A. Using descriptive statistics and regression analysis, we explored the relevant factors affecting hospitalization expenses. Our study results have indicated that from 2016 to 2020, the medical expenditure of patients with chronic bronchitis increased annually, with an average annual growth rate of 22.65%. Among all kinds of expenses, the hospitalization expenses, drug cost, bed cost, test cost and other cost of UEMI (Urban Employee Medical Insurance) are higher than that of other types of medical insurance. The check-up fees of CMI (Commercial Insurance) are lower than that of other types of insurance. Between 2016 and 2019, the average medical expenses per patient with chronic bronchitis increased by 44%, which is the highest average medical expenses among patients aged 60-70. And the highest average medical expenditure emerged when the number of service days is between 5 and 10 days. The increase in expenditure could be attributed to the rapid development of medical technology and the increasing medical demand of the people. Overall, the results of our study implied a significant increase in medical expenses for patients with chronic bronchitis from 2015 to 2020, indicating that chronic bronchitis could bring heavy economic pressures to patients, their families and society.

Differential impact of SARS-CoV-2 infection during different outbreak periods on incident diabetes in Japan: a matched cohort study utilizing health insurance claims.

BACKGROUND: An increased risk of diabetes after COVID-19 exposure has been reported in Caucasians during the early phase of the pandemic, but the effects across viral variants and in non-Caucasians have not been evaluated. METHODS: To address this gap, survival analyses were performed for five outbreak periods. From an anonymized health insurance database REZULT for the employees and their dependents of large companies or government agencies in Japan, 5 matched cohorts were generated based on age, sex, area of residence (47 prefectures), and 7 ranges of medical bills (COVID-19 exposed:unexposed = 1:4). Observation of each matching group began on the same day. Incident diabetes type 1 (T1D) and type 2 (T2D) were defined as the first claim during the target period, including at least 1 year before the start of observation. RESULTS: T1D accounted for 0.8% of incident diabetes after the first COVID-19 exposure, similar to the non-exposed cohort. Most T2D in the COVID-19 cohort was observed within a few weeks. After further adjustment for the number of days from the start of observation to hospitalization (a time-dependent variable), the hazard ratio for incident T2D ranged from 14.1 to 20.0, with 95% confidence intervals (95%CI) of 8.7 to 32.0, during the 2-month follow-ups from the original strain outbreak to the Delta variant outbreak (by September 2021), and decreased to 2.0, with a 95%CI of 1.6 to 2.5, during the Omicron outbreak (by March 2022). No association was found during the BA.4/5 outbreak (until September 2022). Males had a higher risk, and the trend toward higher risk in older age groups was inconsistent across the periods. CONCLUSIONS: Our large dataset, covering 2019-2023, reports for the first time the impact of COVID-19 on incident diabetes in non-Caucasians. The risk intensity and attributes of post-COVID-19 T2D were inconsistent across outbreak periods, suggesting diverse biological effects of different SARS-CoV-2 variants.

Characteristics of Spinal Cord Injury Presenting to Tertiary Care Center in Gandaki province of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Spinal cord injury is one of the common injury which causes damage to the spinal cord due to trauma, diseases or degenerations leading to disability and decreasing life expectancy. The study aims to find the characteristics of spinal cord injury presenting at a tertiary care centre. METHODS: A Descriptive hospital based cross-sectional study was conducted at Pokhara, Gandaki Province, from 28th March to 25th September, 2023. 139 participants were interviewed for the study. Structured interview schedule and validated questionnaires were used for data collection. Ethical approval was taken for the study (Reference number: 151/079). RESULTS: A total of 139 cases were observed; most common affected age group was between 25-55 years with a mean age of 48.68 years. Most (66.9%) of the spinal cord injury patients were not enrolled in health insurance program. Most 107 (77.0%) common cause for spinal cord injury was falls from height. Age, gender, occupation and duration of stay in the hospital were statistically significant with mode of treatment. CONCLUSIONS: Spinal cord injury mostly traumatic commonly due to fall from height affecting mainly male population residing in rural areas at their fourth decade of life who are mainly involve in manual work and agriculture. Spinal cord injury is a major health problem at global and local level causing major morbidity.

Sociodemographic Differences in Nonfinancial Access Barriers to Health Care Among Adults: United States, 2022.

Objective: Nonfinancial access barriers to care describe various reasons why adults may delay or not get medical care, beyond cost. This report focuses on five access barriers to care and describes the percentage of U.S. adults who delayed or did not get medical care in the past 12 months because of 1) being too busy with work or other commitments; 2) an appointment not being available when needed; 3) not being able to get to the doctor's office or clinic when open; 4) difficulty finding a doctor, clinic, or hospital that would accept their health insurance; and 5) it taking too long to get to the doctor's office or clinic from their house or work. Methods: Data from the 2022 National Health Interview Survey were used to produce estimates of the percentage of adults who delayed or did not get medical care in the past 12 months because of those access barriers to care, overall and by selected sociodemographic characteristics. Results: Among U.S. adults in 2022, 12.5% delayed or did not get medical care in the past 12 months because they were too busy to go to a provider, 10.6% could not find an available appointment when needed, 4.6% were unable to get to a provider when open, 4.4% had difficulty finding a doctor compatible with their health insurance, and 2.4% responded that it takes too long to get to a provider. Percentages varied by sociodemographic characteristics. Conclusion: This study provides nationally representative estimates of selected nonfinancial access barriers to medical care, both overall and for selected sociodemographic groups. Findings suggest that nonfinancial access barriers to care are widespread in the United States, and ongoing monitoring may help to address inequities in access to care.

High-Deductible Health Insurance May Exacerbate Racial And Ethnic Wealth Disparities.

This study examined the equity implications of high-deductible health plans within the context of racial and ethnic wealth disparities. Using restricted data from the Medical Expenditure Panel Survey, we evaluated the net worth (in 2011-18) and financial assets (in 2011-16) of families with private insurance and those in high-deductible health plans with and without an associated health savings account. Our results represent, to our knowledge, the first estimates of racial and ethnic wealth disparities within these populations. Results show that White households consistently held significantly more wealth than did Black and Hispanic households across income levels. In the lowest income quartile, White privately insured families had more than 350 percent more in financial assets than their Black counterparts. Low-income Black and Hispanic families with high-deductible health plans but no savings accounts had median financial assets ($2,200 and $2,000, respectively) that were well below the average family coverage deductible. Study findings highlight the role of systemic racial wealth disparities, beyond that of income, to establish a unique pathway whereby high deductibles can exacerbate health care inequities.

Implementation Of New Mexico's 'No Behavioral Health Cost Sharing' Law: A Qualitative Study.

Out-of-pocket spending is a long-standing challenge for privately insured people. New Mexico passed the first US law prohibiting private insurers from applying cost sharing to behavioral health treatment, effective January 1, 2022. We examined the perceptions of key informants, including clinicians, insurers, and state officials, about implementing the No Behavioral Health Cost Sharing law to explore how it might affect downstream outcomes such as spending and access. The law was viewed favorably and implemented without much difficulty. Clinicians noted widespread positive impacts, particularly for those needing intensive treatment. However, they worried about workforce capacity and the exclusion of people covered under self-insured employer plans, which are exempt from state regulation under the Employee Retirement Income Security Act (ERISA) of 1974. Insurers found the law to be in alignment with their organizational goals, but they expressed concern about the administrative burden caused by increased reviews of claims, and some were monitoring for unintended consequences (for example, waste and fraud) that could lead to increased premiums. Engagement strategies were needed to inform eligible members and facilitate enrollment in eligible plans. The law provides a potential model for states to improve access to behavioral health care, but impacts may be limited by factors such as workforce, awareness, and federal ERISA constraints.

Relationship Between Insurance Status and Receipt of Cardiac Tests and Procedures During Hospitalization: A Cross-Sectional Study.

BACKGROUND: Prior analyses of the relationship between insurance status and receipt of tests and procedures have yielded conflicting findings and have focused on outpatient care. We sought to characterize the relationship between primary payer and diagnostic and procedural intensity, comparing rates of cardiac tests and procedures in matched hospitalized Medicaid and commercially insured patients. METHODS AND RESULTS: We created a propensity score-matched sample of Medicaid and commercially insured adults hospitalized at all acute care hospitals in Kentucky, Maryland, New Jersey, and North Carolina from 2016 to 2018. The main outcome was receipt of a cardiac test or procedure: echocardiogram, stress test, cardiac catheterization (elective, in acute coronary syndrome, in ST-segment-elevation myocardial infarction), and pacemaker and subcutaneous cardiac rhythm monitor implantation. Generalized linear models with a hospital-specific indicator variable were estimated to calculate the adjusted odds of a commercially insured patient receiving a given test or procedure relative to a Medicaid patient. Models controlled for race, ethnicity, and zip code income quartile. Commercially insured patients were more likely to receive each cardiac test or procedure, with adjusted odds ratios ranging from 1.16 (95% CI, 1.00-1.34) for cardiac catheterization in ST-segment-elevation myocardial infarction to 1.40 (95% CI, 1.27-1.54) for pacemaker implantation. CONCLUSIONS: Hospitalized commercially insured patients were more likely to undergo a range of cardiac tests and procedures, some of which may represent low-value care. This may be driven by a combination of physician and patient preference, financial incentives, and social determinants of health. Our findings support the need for hospital payment models focused on increasing value and reducing inequities.

The equity road ahead for financing non-national immunization program vaccines in China: challenges and opportunities from a qualitative study.

BACKGROUND: In China, national immunization program (NIP) vaccines benefit from robust financial support and have achieved high coverage. Non-NIP vaccines rely on fragmented funding sources, mostly out-of-pocket payment, and face sub-optimal and inequitable coverage. Sustainable financing needs to be secured for addressing equity in non-NIP vaccine delivery. However, discussion and understanding of this issue remain limited. This study aims to analyze the current situation, comprehensively identify challenges and opportunities in non-NIP vaccine financing, and offer suggestions to enhance vaccine uptake and improve public health. METHODS: Between July and December 2023, we conducted a series of semi-structured, in-person interviews with 55 stakeholders from the Health Bureau, Centers for Disease Control and Prevention, Medical Insurance Bureau, and Finance Bureau across five provinces in China. Participants were selected through stratified sampling, and the interviews mainly included their involvement in non-NIP vaccine financing, challenges faced, and strategies for improvement to enhance financing performance. Informed consent was obtained, and thematic analysis was used to analyze the data. RESULTS: Non-NIP vaccine financing sources include out-of-pocket payments, government fiscal, health insurance and other external funds. These four channels differ in vaccine types covered, costs, and target populations, each with unique challenges and opportunities. High out-of-pocket costs remain a significant barrier to equitable vaccine uptake, while market competition has lowered the vaccine price and improved accessibility. Local fiscal support for free vaccination programs faces challenges related to sustainability and regional disparity, though governmental commitment to vaccination is growing. Nevertheless, centralized procurement organized by the government has lowered the price and reduced the financial burden. Despite legal restrictions on using basic health insurance for vaccinations and limited commercial insurance options, private medical savings accounts and mutual-aid mechanisms present new opportunities. Although the scope and impact of external support are limited, it has successfully increased awareness and social attention to vaccination. CONCLUSION: Relying on individual payments as the main financing channel for non-NIP vaccines is unsustainable and inadequate for ensuring universal vaccine access. A concerted and synergistic approach is essential to ensure sufficient, sustainable resources and enhance public financial management to improve equity in the non-NIP vaccines.

Analysis of Dental Prosthetic Treatment in Patients with Cancer Aged 65 Years and Older after Expanded Health Insurance Coverage: A Retrospective Clinical Study.

Background and Objectives: With increases in cancer incidence and the number of cancer survivors, the demand for cancer management is growing. However, studies on dental prosthetic treatment for patients with cancer are rare. We aim to investigate the dental prosthetic treatment in patients with cancer aged ≥65 years after expanded health insurance coverage. Materials and Methods: This retrospective study included patients who were treated with implants and removable dentures at Ulsan University Hospital in South Korea between June 2015 and June 2023. Data on age, sex, cancer location, comorbid systemic diseases, number of remaining teeth, dental prosthetic treatment history, type of dental prosthetic treatment, and insurance coverage status were extracted from patient medical records and panoramic radiographs. The influence of multiple variables on dental prosthetic treatment was analyzed using the Chi-square and Fisher's exact tests. Results: The study included 61 patients with cancer (32 men, 29 women; average age: 70.9 years). Among them, 56 (91.8%) had insurance coverage benefits, and 34 (55.7%) received treatments such as implants, removable partial dentures, or complete dentures for the first time. Treatment types included 37 (60.7%) cases of implant prostheses and 24 (39.3%) conventional removable dentures. No statistical differences were observed in the type of dental prosthetic treatment according to sex, age, cancer location, number of systemic diseases, and dental prosthetic treatment history (p > 0.05). Patients with <10 remaining teeth received treatment with conventional removable dentures, which was statistically significant (p < 0.001). Conclusions: Of the 61 patients, 56 (91.8%) received insurance benefits, and 34 (55.7%) underwent dental prosthetic treatment for the first time. Within the limitations of this retrospective study, the expanded health insurance coverage alleviated the unmet demand for dental prosthetic treatment. As cancer prevalence continues to increase, expanding customized health insurance coverage is crucial to meet this demand.

Equity in Heart Failure Care: A Get With the Guidelines Analysis of Between- and Within-Hospital Differences in Care by Sex, Race, Ethnicity, and Insurance.

BACKGROUND: Disparities in guideline-based quality measures likely contribute to differences in heart failure (HF) outcomes. We evaluated between- and within-hospital differences in the quality of care across sex, race, ethnicity, and insurance for patients hospitalized for HF. METHODS: This retrospective analysis included patients hospitalized for HF across 596 hospitals in the Get With the Guidelines-HF registry between 2016 and 2021. We evaluated performance across 7 measures stratified by patient sex, race, ethnicity, and insurance. We evaluated differences in performance with and without adjustment for the treating hospital. We also measured variation in hospital-specific disparities. RESULTS: Among 685 227 patients, the median patient age was 72 (interquartile range, 61-82) and 47.2% were women. Measure performance was significantly lower (worse) for women compared with men for all 7 measures before adjustment. For 4 of 7 measures, there were no significant sex-related differences after patient-level adjustment. For 20 of 25 other comparisons, racial and ethnic minorities and Medicaid/uninsured patients had similar or higher (better) adjusted measure performance compared with White and Medicare/privately insured patients, respectively. Angiotensin receptor neprilysin inhibitor measure performance was significantly lower for Asian, Hispanic, and Medicaid/uninsured patients, and cardiac resynchronization therapy implant/prescription was lower among women and Black patients after hospital adjustment, indicating within-hospital differences. There was hospital-level variation in these differences. For cardiac resynchronization therapy implantation/prescription, 278 hospitals (46.6%) had ≥2% lower implant/prescription for Black versus White patients compared with 109 hospitals (18.3%) with the same or higher cardiac resynchronization therapy implantation/prescription for Black patients. CONCLUSIONS: HF quality measure performance was equitable for most measures. There were within-hospital differences in angiotensin receptor neprilysin inhibitor and cardiac resynchronization therapy implant/prescription for historically marginalized groups. The magnitude of hospital-specific disparities varied across hospitals.

Understanding Variation in Negotiated Rates Using Novel Health Plan Price Transparency Data.

This study uses health plan price transparency data to examine how negotiated rates for the same service vary within and across US payers and hospitals.