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BACKGROUND: Previously published epidemiological outcome studies of nonsurgical root canal therapy (NSRCT) in the United States utilize data only from a single, private dental insurer for adult populations. AIM: This study aimed to investigate the outcomes of initial NSRCT, performed on permanent teeth, in a publicly insured paediatric population. DESIGN: New York State Medicaid administrative claims were used to follow 77 741 endodontic procedures in 51 545 patients aged 6-18, from the time of initial NSRCT until the occurrence of an untoward event (retreatment, apicoectomy, and extraction). The initial treatment and untoward events were identified by Current Dental Terminology codes. The Kaplan-Meier survival estimates were calculated at 1, 3, and 5 years. Hazard ratios for time to permanent restoration and restoration type were calculated using the Cox proportional hazards model. RESULTS: The median follow-up time was 44 months [range: 12-158 months]. Procedural, NSRCT, survival was 98% at 1 year, 93% at 3 years, and 88% at 5 years. Extraction was the most common untoward event. Teeth permanently restored with cuspal coverage had the most favorable treatment outcomes. CONCLUSIONS: Overall, 89% of teeth were retained and remained functional over a minimum follow-up time of 5 years. These results elucidate the expected outcomes of NSRCT in permanent teeth for paediatric patients with public-payer dental benefits.
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Medicaid , Tratamiento del Conducto Radicular , Adulto , Niño , Humanos , Retratamiento , Tratamiento del Conducto Radicular/métodos , Resultado del TratamientoRESUMEN
Medicare provides essential health coverage for older and disabled adults, yet it does not limit out-of-pocket costs for covered benefits and excludes dental, hearing, and longer-term care. The resulting out-of-pocket costs can add up to a substantial share of income. Based on U.S. Census surveys, nearly a quarter of Medicare beneficiaries (11.5 million) were underinsured in 201314, meaning they spent a high share of their income on health care. Adding premiums to medical care expenses, we find that 16 percent of beneficiaries (8 million) spent 20 percent or more of their income on insurance plus care. At the state level, the proportion of beneficiaries underinsured ranged from 16 percent to 32 percent, while the proportion with a high total cost burden ranged from 11 percent to 26 percent. Low-income beneficiaries were most at risk. The findings underscore the need to assess beneficiary impacts of any proposal to redesign Medicare.
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Financiación Personal/estadística & datos numéricos , Pacientes no Asegurados/estadística & datos numéricos , Medicare/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Humanos , Pobreza , Riesgo , Gobierno Estatal , Estados UnidosRESUMEN
One important benefit gained by the millions of Americans with health insurance through the Affordable Care Act (ACA) is protection from high out-of-pocket health spending. While Medicaid unambiguously reduces out-of-pocket premium and medical costs for low-income people, it is less certain that marketplace coverage and other types of insurance purchased to comply with the law's individual mandate also protect from high health spending. Goal: To compare out-of-pocket spending in 2014 to spending in 2013; assess how this spending changed in states where many people enrolled in the marketplaces relative to states where few people enrolled; and project the decline in the percentage of people paying high amounts out-of-pocket. Methods: Linear regression models were used to estimate whether people under age 65 spent above certain thresholds. Key findings and conclusions: The probability of incurring high out-of-pocket costs and premium expenses declined as marketplace enrollment increased. The percentage reductions were greatest among those with incomes between 250 percent and 399 percent of poverty, those who were eligible for premium subsidies, and those who previously were uninsured or had very limited nongroup coverage. These effects appear largely attributable to marketplace enrollment rather than to other ACA provisions or to economic trends.
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Seguro de Costos Compartidos/economía , Financiación Personal/economía , Intercambios de Seguro Médico/economía , Cobertura del Seguro/economía , Seguro de Salud/economía , Patient Protection and Affordable Care Act/economía , Adulto , Seguro de Costos Compartidos/estadística & datos numéricos , Seguro de Costos Compartidos/tendencias , Financiación Personal/estadística & datos numéricos , Financiación Personal/tendencias , Predicción , Intercambios de Seguro Médico/estadística & datos numéricos , Intercambios de Seguro Médico/tendencias , Humanos , Renta , Cobertura del Seguro/estadística & datos numéricos , Cobertura del Seguro/tendencias , Seguro de Salud/estadística & datos numéricos , Persona de Mediana Edad , Patient Protection and Affordable Care Act/estadística & datos numéricos , Patient Protection and Affordable Care Act/tendencias , Estados UnidosRESUMEN
The Congressional Budget Office (CBO), a nonpartisan agency of Congress, made official projections of the Affordable Care Act's impact on insurance coverage rates and the costs of providing subsidies to consumers purchasing health plans in the insurance marketplaces. This analysis finds that the CBO overestimated marketplace enrollment by 30 percent and marketplace costs by 28 percent, while it underestimated Medicaid enrollment by about 14 percent. Nonetheless, the CBO's projections were closer to realized experience than were those of many other prominent forecasters. Moreover, had the CBO correctly anticipated income levels and health care prices in 2014, its estimate of marketplace enrollment would have been within 18 percent of actual experience. Given the likelihood of additional reforms to national health policy in future years, it is reassuring that, despite the many unforeseen factors surrounding the law's rollout and participation in its reforms, the CBO's forecast was reasonably accurate.
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Predicción/métodos , Agencias Gubernamentales , Reforma de la Atención de Salud/legislación & jurisprudencia , Intercambios de Seguro Médico/legislación & jurisprudencia , Política de Salud/legislación & jurisprudencia , Cobertura del Seguro/legislación & jurisprudencia , Seguro de Salud/legislación & jurisprudencia , Medicaid/legislación & jurisprudencia , Patient Protection and Affordable Care Act , Intercambios de Seguro Médico/economía , Intercambios de Seguro Médico/estadística & datos numéricos , Intercambios de Seguro Médico/tendencias , Política de Salud/tendencias , Humanos , Cobertura del Seguro/economía , Cobertura del Seguro/estadística & datos numéricos , Cobertura del Seguro/tendencias , Seguro de Salud/economía , Seguro de Salud/estadística & datos numéricos , Seguro de Salud/tendencias , Medicaid/economía , Medicaid/estadística & datos numéricos , Medicaid/tendencias , Pacientes no Asegurados , Modelos Teóricos , Estados UnidosRESUMEN
The Affordable Care Act's employer mandate requires large firms to pay penalties unless they offer affordable health insurance coverage to full-time employees, raising concerns that employers might lay off workers or reduce hours. In this brief, we estimate the number of workers potentially at risk of losing their jobs or having hours reduced. Most workers near the thresholds--those in firms with around 50 full-time-equivalent employees or those working near 30 hours per week--are already insured or have been offered coverage. There are 100,000 full-time workers at the firm-size threshold and 296,000 at the hourly threshold who are uninsured. Fewer than 10 percent, less than 0.03 percent of the U.S. labor force, might see reductions in employment or hours in the short run. Over time, employment patterns might change, leading to fewer firm sizes and work schedules near the thresholds, potentially affecting up to 0.5 percent of the workforce.
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Empleo/legislación & jurisprudencia , Planes de Asistencia Médica para Empleados/legislación & jurisprudencia , Intercambios de Seguro Médico/legislación & jurisprudencia , Programas Obligatorios/legislación & jurisprudencia , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Pequeña Empresa/legislación & jurisprudencia , Empleo/economía , Francia , Planes de Asistencia Médica para Empleados/economía , Reforma de la Atención de Salud/economía , Reforma de la Atención de Salud/legislación & jurisprudencia , Intercambios de Seguro Médico/economía , Humanos , Programas Obligatorios/economía , Patient Protection and Affordable Care Act/economía , Pequeña Empresa/economía , Estados UnidosRESUMEN
INTRODUCTION: This epidemiological analysis used procedure codes from dental insurance claims data to identify apexification cases and evaluate survival at the tooth-level. METHODS: Dental insurance claims data from New York State (2006-2019) and Massachusetts (2013-2018) were used in an observational, retrospective cohort study to evaluate the provision and treatment outcomes of apexification. Statistical analyses included Kaplan-Meier survival estimates and Cox proportional hazards regression. Cox proportional hazard regression was used to evaluate the hazard of adverse event occurrence by age, gender, tooth type, placement of permanent restoration, and dental provider type. A sensitivity analysis evaluated potential bias in the survival estimates and adjusted hazard ratios (aHRs) due to differential loss to follow-up. Robust standard errors were used to account for potential dependence between teeth within an individual. RESULTS: The analytic cohort of 575 individuals included 632 teeth, with an average follow-up time of 64 months. The survival rates of apexification procedures were 95% at 1 year; 93% at 2 years; 90% at 3 years; and 86% at 5 years. Tooth retention following apexification was 98% at 1 year; 96% at 2 years; 95% at 3 years; and 90% at 5 years. Tooth type and subsequent placement of a permanent restoration were significant predictors of survival after apexification. CONCLUSIONS: The procedural and tooth survival outcomes of apexification were high and comparable to studies that analyzed clinical data on tooth survival following apexification.
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Apexificación , Ápice del Diente , Humanos , Estados Unidos/epidemiología , Apexificación/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Modelos de Riesgos ProporcionalesRESUMEN
Objectives: This study investigated differences in the provision of root canal therapy and outcomes in a publicly insured cohort of children and adolescents. Methods: New York State Medicaid administrative claims from 2006 to 2018 were analyzed. Enrollees aged 6-18 were included in the study if they had initial non-surgical root canal therapy (NSRCT), in the permanent dentition, that allowed for at least 1 year of post-treatment follow-up. Descriptive analyses, multivariable logistic regression, and multivariable Cox proportional hazard models were used to examine the association between demographic variables (gender, age, race/ethnicity, and area-based factors) and dental treatment provision and outcomes. Results: Male gender was associated with having more than one initial NSRCT (adjusted odds ratio (aOR) = 1.06; 95% confidence interval (CI) = 1.02-1.10), as was rurality (aOR = 1.15; 95% CI = 1.06-1.24). Black/African American (AA) and Hispanic children were less likely than non-Hispanic white children to have multiple NSRCTs (aOR = 0.88; 95% CI = 0.83-0.93 and aOR = 0.78; 95% CI = 0.74-0.83). Being older or female conferred a lower hazard of an untoward event (aHR = 0.93; 95% CI = 0.92-0.94 and aHR = 0.86; 95% CI = 0.81-0.91). Compared to non-Hispanic white children, Hispanic and Black/AA children had a higher risk of untoward event (aHR = 1.31; 95% CI = 1.21-1.41 and aHR = 1.55; 95% CI = 1.43-1.67) while children of Asian descent had a lower incidence after initial NSRCT (aHR = 0.79; 95% CI = 0.71-0.88). Conclusion: Race/ethnicity was the strongest demographic predictor of provision of initial non-surgical root canal therapy, subsequent placement of a permanent restoration and the occurrence of an untoward event after NSRCT in this cohort.
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National health care expenditures constitute revenue to the health care system. However, little is known about how this revenue is distributed across sectors. This article calculates revenues and detailed expenditures for physicians' offices, hospitals, and outpatient care centers in 1997, 2002, 2007, and 2012, using a range of Census Bureau and Bureau of Labor Statistics sources. Between 1997 and 2012, spending on these three sectors rose by $580 billion, and employment rose by 1.7 million people. Just under half of all 2012 revenues were spent on labor compensation. The labor compensation share of spending declined slightly; within these sectors, the share of compensation paid to physicians and nurses increased. Although employment of nonprofessional labor grew during the study period, this group did not account for much of the sector's increased spending. The plurality of the 1997-2012 spending increase went to producers of purchased materials and services, which now account for more than one-third of payments.