RESUMEN
INTRODUCTION: Alveolar bone grafting (ABG) delay can lead to suboptimal outcomes. This study seeks to categorize reasons patients with cleft lip and palate have no record of ABG or who underwent later than typical ABG (≥13 years). METHODS: At a single tertiary care center, a retrospective review was performed of all patients with unilateral, complete cleft lip and palate, born 1998-2005. Database query identified which patients had timely, late, or no record of ABG. The retrospective cohort study was performed to categorize ABG delay or absence of recorded ABG. RESULTS: Of 135 participants, 82 (61%) had timely, 8 (6%) had late, and 45 (33%) had no record of ABG. The primary factor for late ABG was noncompliance or refusal (n = 5 of 8, 63%), comorbidity or medical complexity (n = 1 of 8, 13%), orthodontic unpreparedness (n = 1 of 8, 13%), or inaccurate prior assessment of alveolar sufficiency (n = 1 of 8, 13%). The primary factor for ABG record absence was loss to follow-up (n = 40 of 45, 89%), noncompliance or refusal (n = 3 of 45, 7%), comorbidity or medical complexity (n = 1 of 45, 2%), or orthodontic unpreparedness (n = 1 of 45, 2%). Racial majority (White, Asian) patients received preferred care (timely ABG or medically appropriate absence or delay) at a significantly higher rate (67%) than underrepresented minorities (African American, Hispanic, Native American, other) (35%, P = 0.016). Families with private insurance and those who were self-pay received preferred care at a significantly higher rate (77%) than families with Medicaid (42%) (P <0.001). CONCLUSIONS: The high number of patients lost to follow-up highlights the impact of poor retention on ABG completion. Possible health disparities based on race and insurance status warrant clinical focus.
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Injerto de Hueso Alveolar , Labio Leporino , Fisura del Paladar , Trasplante Óseo , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Estudios de Cohortes , Humanos , Cobertura del Seguro , Seguro de Salud/clasificación , Cooperación del Paciente , Factores Raciales , Estudios Retrospectivos , Centros de Atención Terciaria , Negativa del Paciente al TratamientoRESUMEN
Importance: Rehospitalization after major surgery is common and represents a significant cost to the health care system. Little is known regarding the causes of these readmissions and the degree to which they may be preventable. Objective: To evaluate the degree to which readmissions after major surgery are potentially preventable. Design, Setting, and Participants: This retrospective cohort study used a weighted sample of 1â¯937â¯354 patients from the 2017 National Readmissions Database to evaluate all adult inpatient hospitalizations for 1 of 7 common major surgical procedures. Statistical analysis was performed from January 14 to November 30, 2020. Main Outcomes and Measures: The study calculated 90-day readmission rates as well as rates of readmissions that were considered potentially preventable. Potentially preventable readmissions (PPRs) were defined as those with a primary diagnosis code for superficial surgical site infection, acute kidney injury, aspiration pneumonitis, or any of the Agency for Healthcare Research and Quality-defined ambulatory care sensitive conditions. Multivariable logistic regression was used to identify factors associated with PPRs. Results: A total weighted sample of 1â¯937â¯354 patients (1â¯048â¯046 women [54.1%]; mean age, 66.1 years [95% CI, 66.0-66.3 years]) underwent surgical procedures; 164â¯755 (8.5%) experienced a readmission within 90 days. Potentially preventable readmissions accounted for 29â¯321 (17.8%) of all 90-day readmissions, for an estimated total cost to the US health care system of approximately $296 million. The most common reasons for PPRs were congestive heart failure exacerbation (34.6%), pneumonia (12.0%), and acute kidney injury (22.5%). In a multivariable model of adults aged 18 to 64 years, patients with public health insurance (Medicare or Medicaid) had more than twice the odds of PPR compared with those with private insurance (adjusted odds ratio, 2.09; 95% CI, 1.94-2.25). Among patients aged 65 years or older, patients with private insured had 18% lower odds of PPR compared with patients with Medicare as the primary payer (adjusted odds ratio, 0.82; 95% CI, 0.74-0.90). Conclusions and Relevance: This study suggests that nearly 1 in 5 readmissions after surgery are potentially preventable and account for nearly $300 million in costs. In addition to better inpatient care, improved access to ambulatory care may represent an opportunity to reduce costly readmissions among surgical patients.
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Seguro de Salud/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Anciano , Estudios de Casos y Controles , Estudios Transversales , Bases de Datos Factuales , Femenino , Accesibilidad a los Servicios de Salud/normas , Humanos , Seguro de Salud/clasificación , Masculino , Medicaid , Readmisión del Paciente/economía , Estudios Retrospectivos , Procedimientos Quirúrgicos Operativos/efectos adversos , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: Patients with head and neck cancer with Medicaid or no insurance present at a more advanced stage and have lower survival. This study is one of the first to examine the relationship between specific insurance types and overall survival for laryngeal squamous cell carcinoma patients. STUDY DESIGN: Retrospective chart review. SETTING: Henry Ford Cancer Institute. SUBJECTS AND METHODS: A retrospective database review was performed using the Henry Ford Virtual Data Warehouse Tumor Registry. Six hundred and fifty patients diagnosed with laryngeal squamous cell carcinoma were identified. Insurance groups analyzed were fee for service, health maintenance organization, Henry Ford Medical Group - a managed care type insurance, Medicare and Medicaid/uninsured. Cox proportional hazards and Kaplan-Meier curves were generated to analyze overall survival and display survival differences respectively. RESULTS: The uninsured group had the lowest median survival time of 29.8 months (95% CI: 20.3-44.8) and the highest HR of 1.85 (95% CI 1.16-2.93) as compared to the HMO group at p < 0.001. Patients with fee for service insurance had longer overall survival compared to the other insurance types. Patients with fee for service insurance also had a high proportion of patients with advanced stage disease, but a younger mean age. Henry Ford Medical Group had a higher mean age and no statistically significant difference in survival when compared to fee for service. (p = 0.999) After controlling for socioeconomic status, insurance type remains a significant predictor of overall survival. CONCLUSIONS: Fee for service had the highest overall survival of the different insurance types, but it was only statistically significant when compared to the Medicaid/uninsured group.
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Carcinoma de Células Escamosas/mortalidad , Seguro de Salud/clasificación , Neoplasias Laríngeas/mortalidad , Factores de Edad , Anciano , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Bases de Datos Factuales , Planes de Aranceles por Servicios , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/terapia , Masculino , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Calidad de la Atención de Salud , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
BACKGROUND: In the era of personalized medicine, cancer care is subject to major changes and innovations. It is unclear, however, to what extent implementation of such innovations and their impact on patient outcomes differ by health insurance type. This study compared provision of treatment and survival outcomes among patients with colorectal cancer (CRC) who had statutory health insurance (SHI) versus private health insurance (PHI) in Germany. METHODS: We analyzed patterns of CRC treatment (surgery, chemotherapy/radiotherapy, and targeted therapy) and survival in a large cohort of patients who were diagnosed with CRC in 2003 through 2014 and were observed for an average of 6 years. Associations of type of health insurance with treatment administration and with overall, CRC-specific, and recurrence-free survival were investigated using multivariable logistic and Cox proportional hazards models, respectively. RESULTS: Of 3,977 patients with CRC, 427 (11%) had PHI. Although type of health insurance was not associated with treatment administration in patients with stage I-III disease, those with stage IV disease with PHI more often received targeted therapy (65% vs 40%; odds ratio, 2.43; 95% CI, 1.20-4.91), with differences decreasing over time because of catch-up of uptake rates in patients with SHI. Median overall survival was longer in patients with PHI than in those with SHI (137.0 vs 114.9 months; P=.010), but survival advantages were explained to a large extent by differences in sociodemographic factors. In patients with stage IV disease, survival advantages of PHI were nonsignificant and were restricted to the early years after diagnosis. CONCLUSIONS: We observed major differences in uptake of targeted therapy between patients with PHI and those with SHI but no differences in patient survival after adjusting for relevant sociodemographic, clinical, and tumor characteristics. Further studies are needed on factors associated with the uptake of therapeutic innovations and their impact on patient survival by health insurance type.
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Neoplasias Colorrectales , Seguro de Salud/clasificación , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/terapia , Alemania , Humanos , Tasa de SupervivenciaRESUMEN
We examined the incidence of toxic shock syndrome in the United States during 2006-2018 among persons <21 years old with commercial or Medicaid-insurance using administrative data. There were 1008 commercially-insured and 481 Medicaid-insured toxic shock syndrome cases. The annual rate was 1 per 100,000 and stable over time. Rates were even lower in children <5 years old and stable over time.
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Choque Séptico/epidemiología , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Seguro de Salud/clasificación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND: High-deductible health plans (HDHPs) are increasing in prevalence as a cost control device for slowing health care cost growth by reducing nonessential medical service utilization. High cost-sharing associated with HDHPs can lead to significant financial distress and worse disease outcomes. We hypothesize that chronic disease patients are delaying or foregoing necessary medical care due to health care costs. METHODS: A retrospective cohort analysis of IBD patients at risk for high medical service utilization with continuous enrollment in either an HDHP or THP from 2009 to 2016 were identified using the MarketScan database. Health care costs were compared between insurance plan groups by Kruskal-Wallis test. Temporal trends in office visits, colonoscopies, emergency department (ED) visits, and hospitalizations were evaluated using additive decomposition time series analysis. RESULTS: Of 605,862 patients with a diagnosis of IBD, we identified 13,052 eligible patients. Annual out-of-pocket costs were higher in the HDHP group (n = 524) than the THP group (n = 12,458) ($2870 vs $1,864; P < 0.001) without any difference in total health care expenses ($23,029 vs $23,794; P = 0.583). Enrollment in an HDHP influenced colonoscopy, ED visit, and hospitalization utilization timing. Colonoscopies peaked in the fourth quarter, ED visits peaked in the first quarter, and hospitalizations peaked in the third and fourth quarter. CONCLUSIONS: High-deductible health plan enrollment does not change the cost of care; however, it shifts health care costs onto patients and changes the timing of the care they receive. High-deductible health plans are incentivizing delays in obtaining health care with a potential to cause worse disease outcomes and financial distress. Further evaluation is warranted.
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Deducibles y Coseguros , Enfermedades Inflamatorias del Intestino , Seguro de Salud/clasificación , Aceptación de la Atención de Salud , Enfermedad Crónica , Humanos , Enfermedades Inflamatorias del Intestino/terapia , Estudios RetrospectivosRESUMEN
OBJECTIVE: The characteristics of surgical patients were examined according to type of health insurance to determine whether differences existed between these groups. METHODS: We evaluated the characteristics of cases in the UPR General Surgery Department's database (entered from January 1, 2018 through December 31, 2018) by insurance type. The variables examined included age, gender, inpatient/outpatient status, wound classification, type of surgery, American Society of Anesthesiology (ASA) scores and whether a given patient had diabetes, was a smoker, or suffered from hypertension. This database had no trauma cases. RESULTS: Information was available for 5,097 cases during the study period. The mean age of the group was 51 (±22) years. The gender distribution indicated that 56% were women and 44% were men. The insurance types were distributed as follows: government/no insurance, 40%; Medicare, 12%; and private insurance, 48%. The government-insured/uninsured patients were younger (mean age, 41 ±24) and had had emergency surgery more frequently (18%) than had privately insured patients (10%). Medicare patients were significantly older (mean age, 72 ±12), and had had higher incidences of diabetes (46%) and hypertension (81%), presenting with ASA scores greater than or equal to 3 in 73% of cases. More privately insured individuals than those in other groups had had elective surgery (90%); 48% had been outpatients when they had their surgery, 58% had had clean wounds, and 61% of the patients having elective surgery were women. CONCLUSION: There were significant differences (P<.05) in the characteristics of patients with different types of health insurance. The frequency of emergency surgery was found to be significantly higher in the government-insured/uninsured group than in the privately insured group.
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Seguro de Salud/clasificación , Adulto , Factores de Edad , Anciano , Bases de Datos Factuales/estadística & datos numéricos , Diabetes Mellitus/epidemiología , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Urgencias Médicas/epidemiología , Femenino , Hospitales Universitarios , Humanos , Hipertensión/epidemiología , Seguro de Salud/estadística & datos numéricos , Masculino , Pacientes no Asegurados/estadística & datos numéricos , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Sector Privado/estadística & datos numéricos , Sector Público/estadística & datos numéricos , Puerto Rico/epidemiología , Factores Sexuales , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Estados UnidosRESUMEN
INTRODUCTION: Patient-reported outcome measures (PROMs) are used to assess performance and value. The type of health insurance coverage may influence outcomes scores. The goal of this study was to determine if the type of insurance coverage is associated with the trends in PROMs within an orthopaedic cohort. METHODS: We reviewed the electronic medical records of 10,745 adult foot and ankle patients who completed PROMs questionnaires from 2015 to 2017. Patients completed the Foot and Ankle Ability Measure, PROMIS Global-Mental, PROMIS Global-Physical, and PROMIS Physical Function Short Form 10a. Descriptive analyses, analysis of variance, and Tukey HSD (honest significant difference) post hoc analyses were conducted. RESULTS: Patients with commercial insurance consistently had the highest outcomes scores, whereas those with Workers Comp/Motor Vehicle and Medicaid had the lowest. PROMs of patients with commercial insurance were statistically significantly higher than the pooled scores of all other patients. Markedly poorer scores were also seen for Workers Comp/Motor Vehicle and Medicaid. In addition, these differences in PROMs for Workers Comp/Motor Vehicle and Medicaid exceeded the minimal clinically important differences. Patients with Medicare or Free Care had generally lower scores than the pooled averages, but these results were not statistically significant. DISCUSSION: PROMs scores vary between the patients with different insurance types in an orthopaedic foot and ankle cohort. These data suggest that patient insurance type may affect patient-reported outcomes. LEVEL OF EVIDENCE: Level III, Retrospective Cohort.
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Cobertura del Seguro , Seguro de Salud/clasificación , Enfermedades Musculoesqueléticas/cirugía , Evaluación del Resultado de la Atención al Paciente , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
OBJECTIVES: to analyze lawsuits brought by beneficiaries of health insurance operators. METHODS: this was a cross-sectional descriptive study carried out in a large-capacity private health insurance operator using data collected by the company from 2012 to 2015. RESULTS: ninety-six lawsuits were brought by 86 beneficiaries regarding medical procedures (38.5%), treatments (26.1%), examinations (14.6%), medications (9.4%), home care (6.2%), and other types of hospitalization (5.2%). The procedures with the highest number of lawsuits were percutaneous rhizotomy; chemotherapy; treatment-related positron-emission tomography scans; and for medications relative to antineoplastic and Hepatitis C treatment. CONCLUSIONS: the lawsuits were filed because of the operators' refusal to comply with items not established in contracts or not regulated and authorized by the Brazilian National Regulatory Agency for Private Health Insurance and Plans, refusals considered unfounded.
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Cobertura del Seguro/normas , Seguro de Salud/normas , Responsabilidad Legal , Brasil , Estudios Transversales , Humanos , Seguro de Salud/clasificación , Jurisprudencia , Sector Privado/normas , Sector Privado/tendenciasRESUMEN
OBJECTIVES: Proton beam therapy (PBT) is a type of radiation therapy (RT) used for certain cancer types because it minimizes collateral tissue damage. The high cost and limited availability of PBT have constrained its utilization. This study examined patterns and determinants of PBT use in California. STUDY DESIGN: Persons with diagnoses of all cancer types from 2003 to 2016 inclusive who had any type of RT were identified in the California Cancer Registry in this retrospective analysis. METHODS: Cross-tabulations were performed to summarize the demographic characteristics of the study population, both for individuals who received PBT and for those who received other RT modalities. PBT use patterns over time were assessed. Multivariate logistic regression models assessed the effects of demographics and health insurance type on receipt of PBT. RESULTS: Of the 2,499,510 people with a cancer diagnosis during the study period, 578,632 (23%) received some type of RT, and of these, 8609 received PBT (1.5%). PBT was most often used to treat cancers of the prostate (41.3%), breast (14.0%), eye (11.7%), lung (6.1%), and brain (6.0%). PBT use was highest in 2003-2004 and then declined over time. PBT use was significantly associated with being white or male, younger age, higher socioeconomic status, Medicare or dual Medicare-Medicaid insurance, uninsured/self-pay status, and proximity to treatment. CONCLUSIONS: Significant differences exist in PBT use by demographics and health insurance type. The identified racial and socioeconomic disparities merit further investigation. More granular studies on both use patterns and effectiveness of PBT for specific cancers are needed to draw stronger conclusions about its cost-benefit ratio.
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Neoplasias/radioterapia , Terapia de Protones/tendencias , Adulto , Anciano , California/epidemiología , Femenino , Humanos , Cobertura del Seguro/clasificación , Seguro de Salud/clasificación , Masculino , Persona de Mediana Edad , Sistema de Registros , Estudios Retrospectivos , Factores SocioeconómicosRESUMEN
BACKGROUND: The influenza virus caused 48.8 million people to fall ill and 79 400 deaths during the 2017-2018 influenza season, yet less than 50% of US adults receive an annual flu vaccination (AFV). Having health insurance coverage influences whether individuals receive an AFV. The current study aims to determine if an association exists between an individual's health plan type (HPT) and their receipt of an AFV. METHODS: Data from the 2017 Behavioral Risk Factor Surveillance System and the optional 'Health Care Access' module were used for this study. The final study sample size was 35 684. Multivariable weighted and adjusted logistic regression models were conducted to investigate the association between HPT and AFV. RESULTS: Medicare coverage was significantly associated with an increase in AFV for both men (adjusted OR (AOR) 1.62 (95% CI 1.28 to 2.06)) and women (AOR 1.28 (95% CI 1.00 to 1.53)). For men, other sources of coverage were also significantly positively associated with AFV (AOR 1.67 (95% CI 1.27 to 2.19)), while for women obtaining coverage on their own was significantly negatively associated with AFV (AOR 0.75 (95% CI 0.59 to 0.97)). CONCLUSION: These findings are of interest to health policy makers as these show there are HPTs which are effective at improving vaccination rates. Adopting methods used by these HPTs could help the USA reach its Healthy People 2020 AFV coverage goal of 70%.
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Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Medicare/estadística & datos numéricos , Adulto , Anciano , Sistema de Vigilancia de Factor de Riesgo Conductual , Femenino , Humanos , Vacunas contra la Influenza/economía , Seguro de Salud/clasificación , Seguro de Salud/economía , Masculino , Persona de Mediana Edad , Estados Unidos , Vacunación/estadística & datos numéricos , Cobertura de Vacunación , Adulto JovenRESUMEN
ABSTRACT Objectives: to analyze lawsuits brought by beneficiaries of health insurance operators. Methods: this was a cross-sectional descriptive study carried out in a large-capacity private health insurance operator using data collected by the company from 2012 to 2015. Results: ninety-six lawsuits were brought by 86 beneficiaries regarding medical procedures (38.5%), treatments (26.1%), examinations (14.6%), medications (9.4%), home care (6.2%), and other types of hospitalization (5.2%). The procedures with the highest number of lawsuits were percutaneous rhizotomy; chemotherapy; treatment-related positron-emission tomography scans; and for medications relative to antineoplastic and Hepatitis C treatment. Conclusions: the lawsuits were filed because of the operators' refusal to comply with items not established in contracts or not regulated and authorized by the Brazilian National Regulatory Agency for Private Health Insurance and Plans, refusals considered unfounded.
RESUMEN Objetivos: analizar las acciones judiciales iniciadas por beneficiarios de planes de salud de prepago. Métodos: estudio descriptivo, transversal, desarrollado en importante operadora de planes de salud de prepago, utilizando datos recopilados por la empresa entre 2015 y 2015. Resultados: fueron impulsadas 96 acciones judiciales por parte de 86 beneficiarios, referentes a procedimientos médicos (38,5%), tratamientos (26,1%), estudios (14,6%), medicación (9,4%), Home Care (6,2%) y 5,2% por otros tipos de internación. La mayoría de acciones por procedimientos correspondió a rizotomía percutánea; en tratamientos, a quimioterapia; en estudios, a tomografía por emisión de positrones; en medicamentos, a antineoplásicos y para tratar la hepatitis C. Conclusiones: motivaron las acciones judiciales interpuestas la negativa de la operadora de planes de salud a cubrir prestaciones no incluidas en el alcance del plan contratado por el beneficiario, así como asuntos no reglados y autorizados por la Agencia Nacional de Salud Complementaria, considerándose, en consecuencia, improcedentes.
RESUMO Objetivos: analisar as ações judiciais demandadas por beneficiários de uma operadora de plano de saúde. Métodos: estudo descritivo de corte transversal desenvolvido em uma operadora de plano privado de saúde de grande porte, utilizando dados compilados pela empresa no período de 2012 a 2015. Resultados: foram movidas 96 ações judiciais por 86 beneficiários, referentes a procedimentos médicos (38,5%), tratamentos (26,1%), exames (14,6%), medicamentos (9,4%), Home Care (6,2%) e 5,2% a outros tipos de internações. O maior número de ações dentre os procedimentos foi rizotomia percutânea; para tratamentos, a quimioterapia; exames solicitados de tomografia por emissão de pósitrons; para medicamentos, os antineoplásicos e para tratamento de Hepatite C. Conclusões: a razão para as demandas judiciais impetradas foi a negativa da operadora em atender os itens não pertencentes ao escopo do que foi contratado pelo beneficiário ou itens não regulamentados e autorizados pela Agência Nacional de Saúde Suplementar, portanto sendo consideradas improcedentes.
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Humanos , Responsabilidad Legal , Cobertura del Seguro/normas , Seguro de Salud/normas , Brasil , Estudios Transversales , Sector Privado/normas , Sector Privado/tendencias , Seguro de Salud/clasificación , JurisprudenciaRESUMEN
OBJECTIVE: To investigate the association between insurance provider and reported assistive technology (AT) use to access computers and electronic devices 1 year after sustaining tetraplegia. DESIGN: Multicenter cross-sectional study. SETTING: Participants enrolled in the Spinal Cord Injury Model Systems (SCIMS) National Database. INTERVENTIONS: Not applicable. PARTICIPANTS: Men and women with tetraplegia (N=498) enrolled in the SCIMS National Database were included in the analysis. MAIN OUTCOME MEASURES: The primary study outcome was the use of AT when operating a computer or other mobile electronic device. The primary predictor was the subject's principal health insurance provider, which was grouped into the 3 categories: government (Medicare, Medicaid, and other government), private (private insurance, private funds, and other), and workers' compensation. RESULTS: Overall, 34.7% of participants reported using AT to access computers and electronic devices. Results of logistic regression analysis revealed sex, injury level, injury completeness, self-perceived health status, and 12-month history of pressure ulcer were all significantly associated with AT use. After adjusting for these factors, participants with workers' compensation were more likely to report AT use than individuals with either government or private insurance. CONCLUSIONS: Despite significant technological advances, AT is not readily available to the people who might benefit most from its use. Findings from the present study are the first to shed light on AT funding sources and reveal that individuals with workers' compensation are more likely use AT than individuals with either government or private insurance. Additional work focused on AT use and functional outcomes is needed to assess the effect of barriers to use. Collectively, this work may inform insurers of the importance of having AT available for this unique population to potentially improve quality of life and participation.
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Computadores/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Cuadriplejía/rehabilitación , Dispositivos de Autoayuda/estadística & datos numéricos , Traumatismos de la Médula Espinal/rehabilitación , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Bases de Datos Factuales , Femenino , Humanos , Seguro de Salud/clasificación , Masculino , Asistencia Médica/estadística & datos numéricos , Persona de Mediana Edad , Cuadriplejía/etiología , Calidad de Vida , Factores Sexuales , Traumatismos de la Médula Espinal/complicaciones , Índices de Gravedad del Trauma , Estados Unidos , Indemnización para Trabajadores/estadística & datos numéricos , Adulto JovenRESUMEN
ObjectivesãThe goal of this study was to determine whether experiencing Japan's specific medical checkup is associated with a health promotion lifestyle, health literacy (HL), and social capital (SC) by type of healthcare coverage.MethodsãThe subjects were 1,048 residents of A City aged 40 through 74 years. Individuals who had experienced more than one medical checkup during the past two years were categorized as "Consultation." Individuals without that experience were categorized as "No consultation." Data were collected via an anonymous self-administered mail questionnaire survey. Health promotion lifestyles were assessed using a Japanese version of the Health-Promoting Lifestyle Profile (HPLP II). HL was measured with the 14-item Health Literacy Scale. The SC was measured following Hanibuchi's six-item scale.ResultsãThe response rates were 34.4% for males and 39.6% for females. Of the males covered by National Health Insurance (NHI), 68.8% were Consultation. Of the females covered by NHI, 79.4% were Consultation. Of the males covered by social insurance, 91.7% were Consultation, and 72.6% of the females covered by social insurance were Consultation. The consultation ratio of males covered by NHI was significantly lower among those without a co-residential spouse than among those living with a spouse. The physical activity score (a HPLP II subscale) of the females covered by NHI was significantly lower among those without compared to those with consultation. Among the males covered by social insurance, the nutrition score (a HPLP II subscale) was significantly higher among those without compared to those with consultation, and the number of neighbors providing companionship (an item in the SC scale) was larger. Among the females covered by social insurance, the health responsibility score (a HPLP II subscale) was significantly lower among those without than among those with consultation.ConclusionãThere were significant relationships between experiencing more than one medical checkup during the past two years and health promotion lifestyles and between that experience and social capital, except for males covered by NHI. Policies based on these results are encouraged to increase participation in medical checkups. Regarding males covered by NHI, support of their participation in medical checkups by people close to them would be an effective way to increase participation.
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Alfabetización en Salud/estadística & datos numéricos , Promoción de la Salud/estadística & datos numéricos , Estilo de Vida Saludable , Seguro de Salud , Examen Físico/estadística & datos numéricos , Capital Social , Adulto , Anciano , Concienciación , Femenino , Conductas Relacionadas con la Salud , Educación en Salud , Humanos , Seguro de Salud/clasificación , Japón/epidemiología , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
BACKGROUND: High patient out-of-pocket (OOP) spending for medical care is associated with medical debt, distress about household finances, and forgoing medical care because of cost in the USA. OBJECTIVE: To examine the national prevalence of medical financial hardship domains: (1) material conditions from increased OOP expenses (e.g., medical debt), (2) psychological responses (e.g., distress), and (3) coping behaviors (e.g., forgoing care); and factors associated with financial hardship. DESIGN AND PARTICIPANTS: We identified adults aged 18-64 years (N = 68,828) and ≥ 65 years (N = 24,614) from the 2015-2017 National Health Interview Survey. Multivariable analyses of nationally representative cross-sectional survey data were stratified by age group, 18-64 years and ≥ 65 years. MAIN MEASURES: Prevalence of material, psychological, and behavioral hardship and hardship intensity. KEY RESULTS: Approximately 137.1 million (95% CI 132.7-141.5) adults reported any medical financial hardship in the past year. Hardship is more common for material, psychological and behavioral domains in adults aged 18-64 years (28.9%, 46.9%, and 21.2%, respectively) than in adults aged ≥ 65 years (15.3%, 28.4%, and 12.7%, respectively; all p < .001). Lower educational attainment and more health conditions were strongly associated with hardship intensity in multivariable analyses in both age groups (p < .001). In the younger group, the uninsured were more likely to report multiple domains of hardship (52.8%), compared to those with some public (26.5%) or private insurance (23.2%) (p < .001). In the older group, individuals with Medicare only were more likely to report hardship in multiple domains (17.1%) compared to those with Medicare and public (12.1%) or Medicare and private coverage (10.1%) (p < .001). CONCLUSIONS: Medical financial hardship is common in the USA, especially in adults aged 18-64 years and those without health insurance coverage. With trends towards higher patient cost-sharing and increasing health care costs, risks of hardship may increase in the future.
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Gastos en Salud/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Adolescente , Adulto , Anciano , Enfermedad Crónica/economía , Enfermedad Crónica/epidemiología , Comorbilidad , Seguro de Costos Compartidos/economía , Seguro de Costos Compartidos/estadística & datos numéricos , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Cobertura del Seguro/economía , Seguro de Salud/clasificación , Seguro de Salud/estadística & datos numéricos , Masculino , Pacientes no Asegurados/psicología , Pacientes no Asegurados/estadística & datos numéricos , Persona de Mediana Edad , Pobreza/psicología , Estados Unidos/epidemiología , Adulto JovenRESUMEN
INTRODUCTION: The purpose of this study was to test the hypothesis that patients with Medicaid insurance or Medicaid-like coverage would have longer times to follow-up and be less likely to complete colonoscopy compared with patients with commercial insurance within the same healthcare systems. METHODS: A total of 35,009 patients aged 50-64years with a positive fecal immunochemical test were evaluated in Northern and Southern California Kaiser Permanente systems and in a North Texas safety-net system between 2011 and 2012. Kaplan-Meier estimation was used between 2016 and 2017 to calculate the probability of having follow-up colonoscopy by coverage type. Among Kaiser Permanente patients, Cox regression was used to estimate hazard ratios and 95% CIs for the association between coverage type and receipt of follow-up, adjusting for sociodemographics and health status. RESULTS: Even within the same integrated system with organized follow-up, patients with Medicaid were 24% less likely to complete follow-up as those with commercial insurance. Percentage receiving colonoscopy within 3 months after a positive fecal immunochemical test was 74.6% for commercial insurance, 63.10% for Medicaid only, and 37.5% for patients served by the integrated safety-net system. CONCLUSIONS: This study found that patients with Medicaid were less likely than those with commercial insurance to complete follow-up colonoscopy after a positive fecal immunochemical test and had longer average times to follow-up. With the future of coverage mechanisms uncertain, it is important and timely to assess influences of health insurance coverage on likelihood of follow-up colonoscopy and identify potential disparities in screening completion.
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Colonoscopía/estadística & datos numéricos , Detección Precoz del Cáncer/estadística & datos numéricos , Seguro de Salud/clasificación , Medicaid/estadística & datos numéricos , Tiempo de Tratamiento , California , Neoplasias Colorrectales/diagnóstico , Femenino , Humanos , Cobertura del Seguro/estadística & datos numéricos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Sangre Oculta , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Proveedores de Redes de Seguridad/estadística & datos numéricos , Texas , Estados UnidosRESUMEN
Affordability and geographic accessibility are key health care access characteristics. We used data from 481 youth and young adults (YYA) with diabetes (389 type 1, 92 type 2) to understand the association between health care access and glycemic control as measured by HbA1c values. In multivariate models, YYA with state or federal health insurance had HbA1c percentage values 0.68 higher (P = 0.0025) than the privately insured, and those without insurance 1.34 higher (P < 0.0001). Not having a routine diabetes care provider was associated with a 0.51 higher HbA1c (P = 0.048) compared to having specialist care, but HbA1c did not differ significantly (P = 0.069) between primary vs specialty care. Distance to utilized provider was not associated with HbA1c among YYA with a provider (P = 0.11). These findings underscore the central role of health insurance and indicate a need to better understand the root causes of poorer glycemic control in YYA with state/federal insurance.
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Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/epidemiología , Hemoglobina Glucada/metabolismo , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Adolescente , Adulto , Glucemia/análisis , Glucemia/metabolismo , Niño , Servicios de Salud del Niño/estadística & datos numéricos , Diabetes Mellitus Tipo 1/economía , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/terapia , Femenino , Hemoglobina Glucada/análisis , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/normas , Humanos , Cobertura del Seguro , Seguro de Salud/clasificación , Seguro de Salud/legislación & jurisprudencia , Seguro de Salud/estadística & datos numéricos , Masculino , Patient Protection and Affordable Care Act , South Carolina/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: This study examines individuals' choice of private health insurance in Spain. Private health insurance choices reveal the attributes of health care most highly valued by the population, and the perceived responsiveness of the public system in delivering those preferences. METHOD: The paper exploits the 2004, 2009 and 2014 waves of the national Health Barometer survey, examining the health insurance choice separately for the general population and a small but influential sector of elite public-sector employees who can opt out from the public health system (civil servants). RESULTS: Public healthcare is a highly regarded provider in terms of technology and doctor training, even by those who chose private health insurance, but falls short in terms of amenities such as comfort and speed of attendance. These findings confirm well-known strengths and criticisms of the public system. However, the study also finds that citizens are concerned about the performance of the public sector in key domains of health system responsiveness, such as personal contact and information and these concerns also influence their decision to opt for private provision. Finally, civil servants, even the minority who opted for public provision, tend to have a lower opinion of the public health service than non-civil servants, especially in terms of personal contact, information, primary care and specialist care. CONCLUSIONS: These perceptions and concerns of the public about the performance of the public health service will be of interest for policy makers and should be investigated further.
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Conducta de Elección , Comportamiento del Consumidor , Toma de Decisiones , Seguro de Salud , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Empleados de Gobierno , Encuestas de Atención de la Salud , Política de Salud , Humanos , Seguro de Salud/clasificación , Seguro de Salud/economía , Masculino , Persona de Mediana Edad , Sector Privado , Sector Público , Factores Socioeconómicos , España , Adulto JovenRESUMEN
BACKGROUND:: Although most children at end of life have commercial insurance, little is known about their demographic and clinical characteristics, what care they are receiving, and how much it costs. OBJECTIVES:: To describe commercially insured children who enrolled in hospice care during their last year of life and to examine differences across age-groups. METHODS:: A retrospective cohort study was conducted using 2005 to 2014 data from the MarketScan Commercial Claims and Encounters database from Truven Health Analytics. Variables were created for demographics, health, utilization, and spending. Analyses included χ2 and analysis of variance tests of differences. RESULTS:: Among the 17 062 children who utilized hospice, 49% had a preferred provider organization (PPO). Hospice length of stay averaged less than 5 days. Over 80% of children visited their primary care physician. Eight percent had hospital readmissions, and 38% had emergency department (ED) visits. Average expenditures were US$3686 per month or US$44 232 annually. The most common condition for children less than 1 year was cardiovascular (21.96%). Neuromuscular conditions were the most frequent (7.89%) in children aged 1 to 5 years, while malignancies (10.53% and 11.32%, respectively) were prevalent in ages 6 to 14 and 15 to 17. Children less than 1 year had the highest frequency of hospital readmissions (16.25%) with the lowest ED visits (28.67%) while incurring the highest expenses (US$11 211/month). CONCLUSIONS:: The findings suggest that commercially insured children, who enroll in hospice, have flexible coverage with a PPO. Hospital readmissions and ED visits were relatively low for a population who was seriously ill. There were significant age-group differences.