Association of medicaid expansion of the Affordable Care Act with the stage at diagnosis and treatment of papillary thyroid cancer: A difference-in-differences analysis.

BACKGROUND: The Affordable Care Act's (ACA) Medicaid expansion has increased insurance coverage and improved various cancer outcomes. Its impact in papillary thyroid cancer (PTC) remains unclear. METHODS: Non-elderly patients (40-64 years-old) with PTC living in low-income areas either in a 2014 expansion, or a non-expansion state were identified from the National Cancer Database between 2010 and 2016. Insurance coverage, stage at diagnosis, and RAI administration were analyzed using a difference-in-differences analysis. RESULTS: 10,644 patients were included. Compared with non-expansion states, the percentage of uninsured patients (adjusted-DD -2.6% [95%-CI -4.3to-0.8%],p = 0.004) and patients with private insurance decreased, and those with Medicaid coverage increased (adjusted-DD 9.7% [95%-CI 6.9-12.5%],p < 0.001) in expansion states after ACA implementation. The percentage of patients with pT1 did not differ between expansion and non-expansion states; neither did the use of RAI. CONCLUSIONS: Medicaid expansion has resulted in a smaller uninsured population in PTC patients, but without earlier disease presentation nor change in RAI treatment.

"Now that you've got that coverage": Promoting use of a regular source of primary care among homeless persons.

BACKGROUND: The growing number of homeless persons in the United States demonstrates greater morbidity and mortality than the population as a whole. Homeless persons are often without a regular source of primary care. Homeless persons use emergency departments and are hospitalized at higher rates than nonhomeless persons. In 2010, the enactment of the Affordable Care Act expanded access to primary care services. Nurse practitioners were at the forefront of its subsequent implementation. PURPOSE: The purpose of this qualitative study was to explore the factors that influence establishing and maintaining a regular source of primary care among homeless persons. METHODOLOGICAL ORIENTATION: In 2017, semistructured interviews were conducted in a federally qualified health center that serves predominately homeless persons. SAMPLE: A purposive convenience sample included adult health center users (N = 20). The majority of participants were insured (90%), African American (70%), and male (65%). CONCLUSIONS: Thematic analysis revealed five facilitators: sense of community, mutual patient-provider respect, financial assurance, integrated health services, and patient care teams. To establish and maintain use of a regular primary care source, homeless persons desire to experience a sense of community, feel respected by their provider/staff, and have certainty that costs will not exceed their capacity to pay. Integrated care models that leverage a multidisciplinary team approach support the use of a regular primary care source. IMPLICATIONS FOR PRACTICE: Actualizing achievable strategies that promote the consistent use of a regular primary care source can reduce use of avoidable emergency and hospital-based services, thereby improving health outcomes among homeless persons.

News media's framing of health policy and its implications for government communication: A text mining analysis of news coverage on a policy to expand health insurance coverage in South Korea.

On August 9, 2017, South Korea announced a new measure to expand National Health Insurance (NHI) coverage, which was nicknamed "Mooncare." At the early stage of its implementation, the interpretation of a policy by social actors influences its success and the formation of social conflicts around it. This study sought to identify the strategies for interpreting Mooncare in newspapers and government documents and examine the conflicts between them. Therefore, this study used text mining methods that are well-suited to processing large amounts of natural language data. Findings revealed that, while the conservative newspaper The Chosun Ilbo tended to highlight the financial feasibility of Mooncare, the liberal newspaper The Hankyoreh emphasized the change in rationality of government from the previous administration implied by Mooncare. Additionally, medical newspapers tended to adopt the perspective of healthcare providers and to focus on the changes in the medical system that may threaten them. In contrast, general newspapers tended to adopt the perspective of Mooncare's beneficiaries. Finally, government documents were found to focus on simply introducing the benefits of Mooncare, not responding to the framings of various media. This study identified how various social actors interpreted Mooncare. The results suggest that the government should assume a more active role in the meaning making of the policy.

[Experiences with price competition of biosimilar drugs in Hungary]. / A biohasonló gyógyszerek árversenyének tapasztalatai Magyarországon.

AIM: The aim of our study is to analyse the biosimilar bids of the Hungarian National Health Insurance Fund Administration in case of colony-stimulating factor and erythropoietin products. DATA AND METHODS: Data derived from the nationwide pharmaceutical database of Hungarian National Health Insurance Fund Administration. We analysed how the number of patients treated by colony-stimulating factor and erythropoietin products changed before (01.07.2011.-30.06.2012.) and after (01.07.2012.-30.06.2013.) the first biosimilar bid performed in March 2012 in Hungary. RESULTS: In the 12 months before biosimilar bid 4167 patients received erythropoietin treatment, while in the first 12 months after the bid 3647 patients, resulting in a 12.5 % decline. In the 12 months before biosimilar bid 13974 patients received colony-stimulating factor treatment, while in the first 12 months after the bid 13352 patients, resulting in a 4.5% decline. CONCLUSIONS: The analyses of the Hungarian price competition bid of biosimilar products showed a minimal decline in the number of patients under treatment by both colony-stimulating factor and erythropoietin products while the health insurance reimbursement of these drugs significantly decreased.

Recent health insurance trends for US families: children gain while parents lose.

In the past decade, political and economic changes in the United States (US) have affected health insurance coverage for children and their parents. Most likely these policies have differentially affected coverage patterns for children (versus parents) and for low-income (versus high-income) families. We aimed to examine--qualitatively and quantitatively--the impact of changing health insurance coverage on US families. Primary data from interviews with Oregon families (2008-2010) were analyzed using an iterative process. Qualitative findings guided quantitative analyses of secondary data from the nationally-representative Medical Expenditure Panel Survey (MEPS) (1998-2009); we used Joinpoint Regression to assess average annual percent changes (AAPC) in health insurance trends, examining child and parent status and type of coverage stratified by income. Interviewees reported that although children gained coverage, parents lost coverage. MEPS analyses confirmed this trend; the percentage of children uninsured all year decreased from 9.6 % in 1998 to 6.1 % in 2009; AAPC = -3.1 % (95 % confidence interval [CI] from -5.1 to -1.0), while the percentage of parents uninsured all year rose from 13.6 % in 1998 to 17.1 % in 2009, AAPC = 2.7 % (95 % CI 1.8-3.7). Low-income families experienced the most significant changes in coverage. Between 1998 and 2009, as US children gained health insurance, their parents lost coverage. Children's health is adversely affected when parents are uninsured. Investigation beyond children's coverage rates is needed to understand how health insurance policies and changing health insurance coverage trends are impacting children's health.

Acupuncture.

Worldwide, acupuncture is integral to everyday medical practice. In recent decades its practice has gained popularity in the United States. With increasing evidence of its clinical efficacy, acupuncture is now a widely practiced treatment modality in complementary and integrative medicine. According to the 2007 National Health Interview Survey, an estimated 3.1 million US adults and 150,000 children had acupuncture in the previous year. The National Health Interview Survey also estimated that between 2002 and 2007, acupuncture use among adults increased by approximately 1 million people. Patients want more information from their clinicians about the use of acupuncture and its safety and efficacy. Although many clinicians may recommend acupuncture, they often believe they are not sufficiently informed to discuss acupuncture with their patients. This article provides answers to the most frequently asked questions regarding acupuncture.

[Cardiac rehabilitation: current status and future challenges]. / Kardiologische Rehabilitation: Aktueller Stand und zukünftige Anforderungen.

The goal of cardiac rehabilitation is to support heart patients using a multidisciplinary team in order to obtain the best possible physical and mental health and achieve long-term social reintegration. In addition to improving physical fitness, cardiac rehabilitation restores self-confidence, thus better equipping patients to deal with mental illness and improving their social reintegration ("participation"). Once the causes of disease have been identified and treated as effectively as possible, drug and lifestyle changes form the focus of cardiac rehabilitation measures. In particular diseases, rehabilitation offers the opportunity for targeted educational courses for diabetics or drug dose escalation, as well as special training for heart failure patients. A nationwide network of outpatient heart groups is available for targeted follow-up. Cardiac patients predominantly rehabilitated in follow-up rehabilitation are older and have greater morbidity than in the past; moreover, they generally come out of acute clinical care earlier and are discharged from hospital more quickly. The proportion of severely ill and multimorbid patients presents a diagnostic and therapeutic challenge in cardiac rehabilitation, although cardiac rehabilitation was not initially conceived for this patient group. The benefit of cardiac rehabilitation has been a well documented reduction in morbidity and mortality. However, hurdles remain, partly due to the patients themselves, partly due to the health insurers. Some insurance providers still refuse rehabilitation for non-ST-segment elevation infarction. In principle rehabilitation can be carried out in an inpatient or an outpatient setting. Specific allocation criteria have not yet been established, but the structure and process quality of outpatient rehabilitation should correspond to that of the inpatient setting. The choice between the two settings should be based on pragmatic criteria. Both settings should be possible for an individual patient. Cardiac rehabilitation is already focusing on older, sicker and polymorbid patients; this will become ever more the case in the future. There is still a need for future clinical research for these patients.

Current trends in the length of stay in neurological early rehabilitation.

BACKGROUND: Neurological early rehabilitation (phase B) is an integral component of the phase model of the German Federal Rehabilitation Council (Bundesarbeitsgemeinschaft für Rehabilitation, BAR). We studied the current trend in patients' length of stay. METHODS: This study included 2060 cases of the BDH-Klinik Hessisch Oldendorf (a neurological rehabilitation clinic) from 2005 to 2008 that fulfilled the structural characteristics of item 8-552 of the German coding system for operations and procedures (Operationen- und Prozedurenschlüssel, OPS), which codes for neurological and neurosurgical early rehabilitation. We studied the parameters age, sex, length of stay, type of discharge, diagnoses, and morbidity. 75.7% of the collective carried a diagnosis of cerebral ischemia, traumatic brain injury, or intracerebral hemorrhage. RESULTS: The mean length of stay over the entire period of the study was 44.6 days. A successive reduction of the mean length of stay from 2005 to 2008 was evident, from 46.8 days in 2005 to 37.5 in 2008 (p<0.001). The morbidity, too, declined over the period of the study. 76.4% of the cases analyzed stayed in hospital for at least the minimum of 8 weeks proposed by the BAR. 39.5% of the patients improved to such an extent in phase B that they were able to be transferred to a further rehabilitation facility, while about one patient in five was transferred from early rehabilitation to a nursing facility. The mortality was 0.9%. Although the early rehabilitation procedure was correctly coded, a total of 60 different diagnosis-related groups (DRGs) were applied. CONCLUSION: These data support the BAR's recommendation for a minimum length of stay of 8 weeks in phase B. The observed shortening of the length of stay was found to be primarily the result of a reduction in morbidity during early rehabilitation. This, in turn, may well be due to a selection effect of the early rehabilitation procedure code 8-552.

Medicaid and indigent care issue brief: Medicaid: eligibility: year end report-2003.

Medicaid provides health insurance coverage to low-income children, parents meeting specific income thresholds, pregnant women, the elderly and people with disabilities. In 1999, Medicaid provided health care insurance to approximately 32 million low-income Americans. However, in that same year, 42 million Americans had no health insurance at all. In order to reduce the number of people without health insurance, states have expanded or clarified their eligibility standards to allow more people to enroll in Medicaid and other medical assistance programs.

[Herbal drugs: luxury or basic therapy in federal insurance practice?]. / Pflanzliche Arzneimittel: Luxus- oder Basistherapie in der kassenärztlichen Praxis?

Over the past 6 years SHI-accredited prescriptions for herbal medicinal products have decreased in Germany by around 40% (Social Health Insurance). However, this has not reduced overall drug expenditure for the statutory health insurers; in fact costs have increased more sharply than before. This development was recently explained by "Modernisation of Pharmacotherapy" which picked out 5 groups as examples. The present paper examines one of these examples, i.e. modern antidepressant therapy, and compares it with the results of recent studies and meta-analyses of herbal and synthetic preparations. Above all, the comparison for this indication revealed that the medication itself, independent of which group it belongs to, contributes merely one third of the treatment results whereas the remaining two thirds are contributed by therapists and their surroundings. Experienced physicians achieve virtually the same treatment results with suitable St. John's wort preparations as they do with modern synthetic antidepressants. Hence, medically supervised therapy with herbal medicinal products for suitable indications could avoid billions in development and treatment costs for supposedly innovative drugs. These savings would then benefit broader basic therapy.