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1.
Am J Manag Care ; 30(3): e65-e72, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38457824

RESUMO

OBJECTIVES: To assess the national prevalence and cost of inappropriate MRI in patients with wrist pain prior to and following American College of Radiology (ACR) guideline publication. STUDY DESIGN: We used administrative claims from the IBM MarketScan Research Databases to evaluate the appropriateness of wrist MRI in a national cohort of patients with commercial insurance or Medicare Advantage. METHODS: Adult patients with a diagnosis of wrist pain between 2016 and 2019 were included and followed for 1 year. We made assessments of appropriateness based on ACR guidelines for specific wrist pain etiologies. We tabulated the total costs and out-of-pocket expenses associated with inappropriate MRI studies using weighted mean payments for facility and professional fees. We performed segmented logistic regression on interrupted time series data to identify predictors of receiving inappropriate imaging and the impact of guideline publication on MRI use. RESULTS: The study cohort consisted of 867,119 individuals. Of these, 40,164 individuals (4.6%) had MRI, of whom 52.6% received an inappropriate study. Inappropriate studies accounted for $44,493,234 in total payments and $8,307,540 in out-of-pocket expenses. The interrupted time series found an approximately 1% monthly decrease in the odds of receiving an inappropriate study after guideline dissemination. CONCLUSIONS: MRI as a diagnostic tool for wrist pain is often inappropriate and expensive. Our findings support interventions to increase guideline adherence, such as integrated clinical decision support tools.


Assuntos
Seguro , Punho , Idoso , Adulto , Humanos , Estados Unidos , Punho/diagnóstico por imagem , Medicare , Imageamento por Ressonância Magnética , Dor , Estudos Retrospectivos
3.
Addict Sci Clin Pract ; 19(1): 17, 2024 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-38493109

RESUMO

BACKGROUND: Potential differences in buprenorphine treatment outcomes across various treatment settings are poorly characterized in multi-state administrative data. We thus evaluated the association of opioid use disorder (OUD) treatment setting and insurance type with risk of buprenorphine discontinuation among commercial insurance and Medicaid enrollees initiated on buprenorphine. METHODS: In this observational, retrospective cohort study using the Merative MarketScan databases (2006-2016), we analyzed buprenorphine retention in 58,200 US adults with OUD. Predictor variables included insurance status (Medicaid vs commercial) and treatment setting, operationalized as substance use disorder (SUD) specialty treatment facility versus outpatient primary care physicians (PCPs) versus outpatient psychiatry, ascertained by linking physician visit codes to buprenorphine prescriptions. Treatment setting was inferred based on timing of prescriber visit claims preceding prescription fills. We estimated time to buprenorphine discontinuation using multivariable cox regression. RESULTS: Among enrollees with OUD receiving buprenorphine, 26,168 (45.0%) had prescriptions from SUD facilities without outpatient buprenorphine treatment, with the remaining treated by outpatient PCPs (n = 23,899, 41.1%) and psychiatrists (n = 8133, 13.9%). Overall, 50.6% and 73.3% discontinued treatment at 180 and 365 days respectively. Buprenorphine discontinuation was higher among enrollees receiving prescriptions from SUD facilities (aHR = 1.03[1.01-1.06]) and PCPs (aHR = 1.07[1.05-1.10]). Medicaid enrollees had lower buprenorphine retention than those with commercial insurance, particularly those receiving buprenorphine from SUD facilities and PCPs (aHR = 1.24[1.20-1.29] and aHR = 1.39[1.34-1.45] respectively, relative to comparator group of commercial insurance enrollees receiving buprenorphine from outpatient psychiatry). CONCLUSION: Buprenorphine discontinuation is high across outpatient PCP, psychiatry, and SUD treatment facility settings, with potentially lower treatment retention among Medicaid enrollees receiving care from SUD facilities and PCPs.


Assuntos
Buprenorfina , Seguro , Transtornos Relacionados ao Uso de Opioides , Adulto , Estados Unidos , Humanos , Buprenorfina/uso terapêutico , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Tratamento de Substituição de Opiáceos , Analgésicos Opioides/uso terapêutico
4.
Accid Anal Prev ; 199: 107519, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38458008

RESUMO

BACKGROUND: Road traffic deaths are increasing globally, and preventable driving behaviours are a significant cause of these deaths. In-vehicle telematics has been seen as technology that can improve driving behaviour. The technology has been adopted by many insurance companies to track the behaviours of their consumers. This systematic review presents a summary of the ways that in-vehicle telematics has been modelled and analysed. METHODOLOGY: Electronic searches were conducted on Scopus and Web of Science. Studies were only included if they had a sample size of 10 or more participants, collected their data over at least multiple days, and were published during or after 2010. 45 relevant papers were included in the review. 27 of these articles received a rating of "good" in the quality assessment. RESULTS: We found a divide in the literature regarding the use of in-vehicle telematics. Some articles were interested in the utility of in-vehicle telematics for insurance purposes, while others were interested in determining the influence that in-vehicle telematics has on driving behaviour. Machine learning analyses were the most common forms of analysis seen throughout the review, being especially common in articles with insurance-based outcomes. Acceleration, braking, and speed were the most common variables identified in the review. CONCLUSION: We recommend that future studies provide the demographical information of their sample so that the influence of in-vehicle telematics on the driving behaviours of different groups can be understood. It is also recommended that future studies use multi-level models to account for the hierarchical structure of the telematics data. This hierarchical structure refers to the individual trips for each driver.


Assuntos
Condução de Veículo , Seguro , Humanos , Acidentes de Trânsito/prevenção & controle , Tecnologia , Aceleração
5.
AIDS ; 38(4): 610-612, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38416555

RESUMO

In a cross-sectional analysis of HIV preexposure prophylaxis (PrEP) utilization by commercially insured patients from 2019 to 2021, most prescriptions were for branded formulations of PrEP despite the availability of a generic version. Accounting for the modest relative clinical benefit of branded TAF/FTC (tenofovir alafenamide fumarate/emtricitabine) PrEP over generic TDF/FTC (tenofovir disoproxil fumarate/emtricitabine) PrEP, use of generic TDF/FTC PrEP would have reduced commercial insurers' spending by 33%.


Assuntos
Infecções por HIV , Seguro , Humanos , Estudos Transversais , Infecções por HIV/prevenção & controle , Adenina , Emtricitabina , Tenofovir
6.
Oecologia ; 204(2): 279-288, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38366067

RESUMO

In temperate lakes, eutrophication and warm temperatures can promote cyanobacteria blooms that reduce water quality and impair food-chain support. Although parasitic chytrids of phytoplankton might compete with zooplankton, they also indirectly support zooplankton populations through the "mycoloop", which helps move energy and essential dietary molecules from inedible phytoplankton to zooplankton. Here, we consider how the mycoloop might fit into the biodiversity-ecosystem functioning (BEF) framework. BEF considers how more diverse communities can benefit ecosystem functions like zooplankton production. Chytrids are themselves part of pelagic food webs and they directly contribute to zooplankton diets through spore production and by increasing host edibility. The additional way that chytrids might support BEF is if they engage in "kill-the-winner" dynamics. In contrast to grazers, which result in "eat-the-edible" dynamics, kill-the-winner dynamics can occur for host-specific infectious diseases that control the abundance of dominant (in this case inedible) hosts and thus limit the competitive exclusion of poorer (in this case edible) competitors. Thus, if phytoplankton diversity provides functions, and chytrids support algal diversity, chytrids could indirectly favour edible phytoplankton. All three mechanisms are linked to diversity and therefore provide some "insurance" for zooplankton production against the impacts of eutrophication and warming. In our perspective piece, we explore evidence for the chytrid insurance hypothesis, identify exceptions and knowledge gaps, and outline future research directions.


Assuntos
Ecossistema , Seguro , Animais , Zooplâncton , Fitoplâncton , Biodiversidade , Dinâmica Populacional
8.
J Dermatolog Treat ; 35(1): 2299598, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38317525

RESUMO

BACKGROUND: With advent of newer treatments for psoriasis, real-world use of biologics in Japan is evolving. METHODS: This retrospective study utilized data from patients with ≥1 psoriasis-related biologic claims record between January 2016 and December 2020 in Japan to evaluate treatment patterns, healthcare resource utilization (HCRU), and associated costs. Data were analyzed using descriptive statistics. RESULTS: Of 1,614 eligible patients, 72.5% were male, 29.2% had comorbid hypertension and 26.6% had comorbid cardiovascular disease. Interleukin (IL)-17 and tumor necrosis factor alpha (TNFα) inhibitors were commonly prescribed across lines of treatment, while IL-23 inhibitors were most considered for switches (92% of switches were from IL-12/23/IL-17/TNFα inhibitors). The overall mean adherence rate for all classes was 80.1%, but adherence varied across biologics. Infliximab and IL-23 inhibitor users exhibited optimal medical possession ratios, reflecting the best adherence rates. Overall HCRU (visits/patient-year) was 9.05 for outpatient visits, 0.09 for inpatient hospitalization, and 0.5 for psoriasis-related phototherapy. HCRU associated with hospitalization was slightly higher for bio-experienced patients and so was the overall costs per patient-year relative to bio-naïve patients. CONCLUSION: Variable adherence rates observed suggest the need for improvement in treatment management with different biologics. Bio-experienced patients burdened by disease progression and treatment switches may result in increased HCRU.


Assuntos
Produtos Biológicos , Seguro , Psoríase , Humanos , Masculino , Feminino , Estudos Retrospectivos , Fator de Necrose Tumoral alfa , Japão , Psoríase/tratamento farmacológico , Atenção à Saúde , Interleucina-23 , Custos de Cuidados de Saúde
9.
Sci Rep ; 14(1): 3239, 2024 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-38331964

RESUMO

In most of the United States, insurance companies may use gender to determine car insurance rates. In addition, several studies have shown that women over the age of 25 generally pay more than men for car insurance. Then, we investigate whether the distributions of claims for women and men differ in location, scale and shape by means of the GAMLSS regression framework, using microdata provided by U.S. and Australian insurance companies, to use this evidence to support policy makers' decisions. We also develop a parametric-bootstrap test to investigate the tail behavior of the distributions. When covariates are not considered, the distribution of claims does not appear to differ by gender. When covariates are included, the regressions provide mixed evidence for the location parameter. However, for female claimants, the spread of the distribution is lower. Our research suggests that, at least for the contexts analyzed, there is no clear statistical reason for charging higher rates to women. While providing evidence to support unisex insurance pricing policies, given the limitations represented by the use of country-specific data, this paper aims to promote further research on this topic with different datasets to corroborate our findings and draw more general conclusions.


Assuntos
Seguro , Masculino , Humanos , Feminino , Estados Unidos , Austrália , Custos e Análise de Custo , Políticas
10.
Artigo em Inglês | MEDLINE | ID: mdl-38397706

RESUMO

Evidence for acute or long-term coronavirus disease 2019 (COVID-19) infection is relatively limited. We aimed to evaluate the impact of COVID-19 infection on health-related quality of life (HRQoL) in the Japanese population. Eligible study participants were 13,365 employees and their dependents who answered questionnaires at baseline and 18 months later and who had at least 6 months of continuous enrolment before and after baseline. Of the 711 study participants who developed COVID-19 infection, 29.0% reported a decline in HRQoL, whereas 25.2% of uninfected participants reported a decline. The adjusted odds ratios (95% confidence intervals) for the association between COVID-19 infection and declines in HRQoL in the age categories of less than 30 years, 30s, 40s, 50s, and 60 years or higher were 0.54 (0.15-1.92), 1.70 (1.03-2.81), 1.14 (0.82-1.57), 1.05 (0.77-1.42), and 0.87 (0.46-1.64), respectively. This study demonstrates a differential association between COVID-19 infection and declines in HRQoL by age group. A 1.7-fold increase in the odds of negative changes in HRQoL was observed in only those in their 30s. Further studies are needed to elucidate differences in the impact of COVID-19 infection on HRQoL between younger people such as those in their 30s and the older population.


Assuntos
COVID-19 , Seguro , Humanos , Adulto , Qualidade de Vida , COVID-19/epidemiologia , Japão/epidemiologia , Inquéritos e Questionários
11.
Epidemiol Psychiatr Sci ; 33: e5, 2024 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-38314538

RESUMO

AIMS: Prior research, largely focused on US male veterans, indicates an increased risk of cardiovascular disease among individuals with post-traumatic stress disorder (PTSD). Data from other settings and populations are scarce. The objective of this study is to examine PTSD as a risk factor for incident major adverse cardiovascular events (MACEs) in South Africa. METHODS: We analysed reimbursement claims (2011-2020) of a cohort of South African medical insurance scheme beneficiaries aged 18 years or older. We calculated adjusted hazard ratios (aHRs) for associations between PTSD and MACEs using Cox proportional hazard models and calculated the effect of PTSD on MACEs using longitudinal targeted maximum likelihood estimation. RESULTS: We followed 1,009,113 beneficiaries over a median of 3.0 years (IQR 1.1-6.0). During follow-up, 12,662 (1.3%) persons were diagnosed with PTSD and 39,255 (3.9%) had a MACE. After adjustment for sex, HIV status, age, population group, substance use disorders, psychotic disorders, major depressive disorder, sleep disorders and the use of antipsychotic medication, PTSD was associated with a 16% increase in the risk of MACEs (aHR 1.16, 95% confidence interval (CI) 1.05-1.28). The risk ratio for the effect of PTSD on MACEs decreased from 1.59 (95% CI 1.49-1.68) after 1 year of follow-up to 1.14 (95% CI 1.11-1.16) after 8 years of follow-up. CONCLUSION: Our study provides empirical support for an increased risk of MACEs in males and females with PTSD from a general population sample in South Africa. These findings highlight the importance of monitoring cardiovascular risk among individuals diagnosed with PTSD.


Assuntos
Doenças Cardiovasculares , Transtorno Depressivo Maior , Seguro , Transtornos de Estresse Pós-Traumáticos , Feminino , Humanos , Masculino , Estudos de Coortes , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , África do Sul/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Fatores de Risco , Doenças Cardiovasculares/epidemiologia
12.
Front Public Health ; 12: 1323359, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38371234

RESUMO

An important way to reduce urban-rural disparity lies in encouraging migrant workers to return to their hometowns for entrepreneurship. This paper examines the effect of the Integrated Medical Insurance System on the return-to-hometown entrepreneurship among migrant workers. Using microdata from the China Household Finance Survey (CHFS) spanning from 2013 to 2019, we find that the Integrated Medical Insurance System (IMIS) significantly increases the likelihood of migrant workers returning to their hometowns for entrepreneurship by 0.44%. This result remains stable after a series of robustness checks. Heterogeneity results indicate that this "pullback effect" is more pronounced for those who are male and with lower educational levels, higher income, larger social networks, and lower risk preferences. Finally, the interaction between the Mass Entrepreneurship and Innovation policy (MEI) and IMIS can create a more significant combined effect in promoting the return of migrant workers to their hometowns for entrepreneurial activities.


Assuntos
Seguro , Migrantes , Masculino , Humanos , Feminino , Empreendedorismo , Renda , China
13.
Health Informatics J ; 30(1): 14604582241230384, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38301111

RESUMO

The objective of this study was to apply the Knowledge Discovery in Databases process to find out if beneficiaries of a private healthcare insurance would belong, at least once, to the 'very high cost' and 'complex cases' groups throughout the 12 months after the month when algorithms were applied. Datasets were built containing information on beneficiaries' effective use of their health plan, as well as their characteristics. Five machine learning algorithms were used, namely Random forest, Extra tree, Xgboost, Naive bayes and K-nearest neighbor. The K-nearest neighbor algorithm had a recall rate of 81.12%, 83.77% precision and an Area Under the Curve (AUC) value of 0.9045. The study also revealed that categorization occurs, on average, 8.11 months before a beneficiary entering, for the first time, a high-risk group, considering the dataset classification from January 2019 to June 2020.


Assuntos
Algoritmos , Seguro , Humanos , Teorema de Bayes , Aprendizado de Máquina , Bases de Dados Factuais
14.
Epilepsy Res ; 201: 107313, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38417192

RESUMO

Epilepsy is a severe chronic neurological disease affecting 60 million people worldwide. Primary treatment is with anti-seizure medicines (ASMs), but many patients continue to experience seizures. We used retrospective insurance claims data on 280,587 patients with uncontrolled epilepsy (UE), defined as status epilepticus, need for a rescue medicine, or admission or emergency visit for an epilepsy code. We conducted a computational risk ratio analysis between pairs of ASMs using a causal inference method, in order to match 1034 clinical factors and simulate randomization. Data was extracted from the MarketScan insurance claims Research Database records from 2011 to 2015. The cohort consisted of individuals over 18 years old with a diagnosis of epilepsy who took one of eight ASMs and had more than a year of history prior to the filling of the drug prescription. Seven ASM exposures were analyzed: topiramate, phenytoin, levetiracetam, gabapentin, lamotrigine, valproate, and carbamazepine or oxcarbazepine (treated as the same exposure). We calculated the risk ratio of UE between pairs of ASM after controlling for bias with inverse propensity weighting applied to 1034 factors, such as demographics, confounding illnesses, non-epileptic conditions treated by ASMs, etc. All ASMs exhibited a significant reduction in the prevalence of UE, but three drugs showed pair-wise differences compared to other ASMs. Topiramate consistently was associated with a lower risk of UE, with a mean risk ratio range of 0.68-0.93 (average 0.82, CI: 0.56-1.08). Phenytoin and levetiracetam were consistently associated with a higher risk of UE with mean risk ratio ranges of 1.11 to 1.47 (average 1.13, CI 0.98-1.65) and 1.15 to 1.43 (average 1.2, CI 0.72-1.69), respectively. Large-scale retrospective insurance claims data - combined with causal inference analysis - provides an opportunity to compare the effect of treatments in real-world data in populations 1,000-fold larger than those in typical randomized trials. Our causal analysis identified the clinically unexpected finding of topiramate as being associated with a lower risk of UE; and phenytoin and levetiracetam as associated with a higher risk of UE (compared to other studied drugs, not to baseline). However, we note that our data set for this study only used insurance claims events, which does not comprise actual seizure frequencies, nor a clear picture of side effects. Our results do not advocate for any change in practice but demonstrate that conclusions from large databases may differ from and supplement those of randomized trials and clinical practice and therefore may guide further investigation.


Assuntos
Epilepsia , Seguro , Humanos , Adolescente , Topiramato/uso terapêutico , Levetiracetam/uso terapêutico , Fenitoína/uso terapêutico , Estudos Retrospectivos , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Epilepsia/induzido quimicamente
15.
Arch Dermatol Res ; 316(2): 65, 2024 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-38175227

RESUMO

Information on the population-based incidence of psoriasis vulgaris was limited. This study was to provide a comprehensive understanding of the age-specific and sex-specific incidence of psoriasis vulgaris in Germany. The data were obtained in the context of a morbidity-based risk adjustment by statutory health insurance companies in Germany, comprising information regarding 65 million population. Psoriasis vulgaris diagnoses were made and coded according to the 10th edition of the International Statistical Classification of Diseases and Related Health Problems. Age-specific and sex-specific incidences were calculated using data from 2009 to 2011. There was a rise in the age- and sex-specific incidences of psoriasis vulgaris through midlife, reaching a peak at the age of 60 and subsequently declining for both genders. The peak incidence for men, at 130 cases per 100,000 person-years, slightly exceeded the peak incidence for women of 117 per 100,000 person-years. An increase in the overall incidence rate can also be observed over the course of the three-year period covered by the data. Considerable variations in the age- and sex-specific incidences of psoriasis vulgaris can be seen across the lifespan. Nevertheless, the overall age-standardized incidence for the German population was low compared to other European countries.


Assuntos
Seguro , Feminino , Humanos , Masculino , Incidência , Alemanha/epidemiologia , Europa (Continente)
16.
Gesundheitswesen ; 86(3): 182-191, 2024 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-38242157

RESUMO

BACKGROUND: The age-standardized application rate for medical rehabilitation services of the German Pension Insurance Association has been declining since 2009. Two of the most frequent reasons for applying for rehabilitation services represent musculoskeletal disorders and mental disorders. The aim of this analysis was to identify factors influencing the utilization of rehabilitation services in the federal states of Berlin and Brandenburg. METHODS: The explorative time series analysis is based on a research dataset of the German Pension Insurance Federation. Insured persons of the German Pension Insurance Federation from the federal states of Berlin and Brandenburg with a diagnosis of musculoskeletal disorders or mental disorders were included. Descriptive differences in targeted and prognostic parameters were calculated using chi-square and t-test statistics. Predictive parameters for the utilization of medical rehabilitation services were calculated using binary, logistic regression analyses. RESULTS: A total of 11,257 insured cases were examined. For the population of insured persons from Berlin, the use of medical rehabilitation services showed significant prognostic variables for gender, age at retirement, marital status, level of education, occupational requirement level, total accumulated earning points, gross pension level, status of a temporary pension, health insurance status, and diagnosis group. For Brandenburg, significant prognostic variables were found for age at retirement, marital status, nationality, education level, occupational requirement level, total accumulated earning points, status of a temporary pension, occupational sector, and diagnosis group. CONCLUSION: In Berlin and Brandenburg mental disorders and sociodemographic parameters are associated with an increased probability of not claiming medical rehabilitation services before the onset of reduced earning capacity. It remains to be investigated which mechanisms cause people with mental disorders to make no use of medical rehabilitation services. Future analyses should examine isolated interaction mechanisms for the utilization of medical rehabilitation services, especially in the case of existing F-diagnoses. In addition, explanations for different influencing variables between states remain to be explored.


Assuntos
Pessoas com Deficiência , Seguro , Doenças Musculoesqueléticas , Humanos , Berlim , Fatores de Tempo , Alemanha/epidemiologia , Pessoas com Deficiência/reabilitação , Pensões
17.
J Environ Manage ; 352: 120075, 2024 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-38232593

RESUMO

This paper presents a regression model that quantifies the causal relationship between flood risk factors and the flood insurance payout in the U.S. The flood risk factors that have been considered in this research are flood exposure, infrastructure vulnerability, social vulnerability, and the number of mobile homes. Historical data for the annual flood insurance payout, flood risk factors, and other control variables were collected for six years between 2016 and 2021 and used in a Mixed Effects Regression model to derive the empirical relationships. The regression model expressed the natural logarithm of the annual flood insurance payout in a county based on the flood risk factors and control variables. The paper presents the regression coefficients that quantify the causal influence. It has been found that all four flood risk factors have statistically significant positive influence on the flood insurance payout in a county. However, the extent of the influence is different for different flood risk factors. Among them, flood exposure has the highest influence on the flood insurance payout, which is followed by the number of mobile homes, infrastructure vulnerability, and social vulnerability. Since the federal flood insurance program in the U.S. has a large debt to the U.S. treasury, the government should plan for effective risk reduction that can reduce the flood insurance payout in future to keep the program solvent. The outcomes of this research are expected to facilitate that decision-making process by providing the empirical relationship between flood risk factors and flood insurance payout.


Assuntos
Inundações , Seguro , Fatores de Risco , Previsões , Comportamento de Redução do Risco
18.
PLoS One ; 19(1): e0283252, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38181030

RESUMO

OBJECTIVE: The objective of this study was to evaluate the relationship between three distinct spinal manipulative therapy dose groups and escalated spine care by analyzing insurance claims from a cohort of patients with low back pain. METHODS: We compared three distinct spinal manipulative therapy dose groups (low = 1 SMT visits, moderate = 2-12 SMT visits, high = 13+ SMT visits), to a control group (no spinal manipulative therapy) regarding the outcome of escalated spine care. Escalated spine care procedures include imaging studies, injection procedures, emergency department visits, surgery, and opioid medication use. Propensity score matching was performed to address treatment selection bias. Modified Poisson regression modeling was used to estimate the relative risk of spine care escalation among three spinal manipulative therapy doses, adjusting for age, sex, retrospective risk score and claim count. RESULTS: 83,025 claims were categorized into 11,114 unique low back pain episodes; 8,137 claims had 0 spinal manipulative therapy visits, with the remaining episodes classified as low dose (n = 404), moderate dose (n = 1,763) or high dose (n = 810). After propensity score matching, 5,348 episodes remained; 2,454 had 0 spinal manipulative therapy visits with the remaining episodes classified as low dose (n = 404), moderate dose (n = 1,761), or high dose (n = 729). The estimated relative risk (vs no spinal manipulative therapy) for any escalated spine care was 0.45 (95% confidence interval 0.38, 0.55, p <0.001), 0.58 (95% confidence interval 0.53, 0.63, p <0.001), and 1.03 (95% confidence interval 0.95, 1.13, p = 0.461) for low, moderate, and high dose spinal manipulative therapy groups, respectively. CONCLUSIONS: For claims associated with initial episodes of low back pain, low and moderate dose spinal manipulative therapy groups were associated with a 55% and 42% reduction, respectively, in the relative risk of any escalated spine care.


Assuntos
Seguro , Dor Lombar , Manipulação da Coluna , Transtornos Relacionados ao Uso de Opioides , Humanos , Dor Lombar/terapia , Estudos de Coortes , Estudos Retrospectivos , Manipulação da Coluna/efeitos adversos
19.
JAMA Netw Open ; 7(1): e2351644, 2024 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-38227313

RESUMO

Importance: Costs of employer-sponsored health care benefits have increased faster than workers' wages for several decades, with important implications for disparities in earnings and wage stagnation. Objective: To quantify how growth in employer-sponsored health insurance (ESI) premiums may have been associated with reduced annual wages, disparities in earnings by race and ethnicity and wage level, and wage stagnation among US families with ESI. Design, Setting, and Participants: In this economic evaluation, serial cross-sectional analyses were performed of US families receiving ESI from 1988 to 2019 based on data from the Consumer Expenditure Survey, Kaiser Employer Health Benefits Survey, US Census Bureau's Current Population Survey, and federal payroll taxation rates. Statistical analysis was conducted from February 2022 to July 2023. Main Outcomes and Measures: Percentage of annual compensation associated with health care premiums (after accounting for tax deductibility) and lost wages associated with growth in cost of premiums from 1989 to 2019 based on 1988 compensation. To assess disparities, analyses were stratified by race and ethnicity and wage level. Results: In 1988, 44.7 million individuals (head of household: mean [SD] age, 43.3 [13.1] years; 30.1% were female; and 2.4% identified as Asian, 6.2% as Hispanic, 8.6% as non-Hispanic Black, and 82.8% as non-Hispanic White) were covered by ESI family plans; this number remained similar in 2019 at 44.8 million individuals (head of household: mean [SD] age, 47.1 [12.9] years; 41.3% were female; and 1.3% identified as Asian, 9.9% as Hispanic, 9.9% as non-Hispanic Black, and 78.9% as non-Hispanic White). In 1988, the mean (SD) household size was 3.3 (1.3) people, and in 2019, it was 3.4 (1.3) people. If ESI costs had remained at the same proportion of the 1988 average compensation package, then in 2019, the median US family with ESI could have earned $8774 (95% CI, $8354-$9195) more in annual wages. During all 32 years, health care premiums as a percentage of compensation were greater for non-Hispanic Black and Hispanic families than for non-Hispanic White families. By 2019, 13.8% (95% CI, 13.5%-14.1%) of compensation among non-Hispanic White families with ESI went to premium costs compared with 19.2% (95% CI, 18.8%-19.7%) among non-Hispanic Black families and 19.8% (19.3%-20.3%) among Hispanic families with ESI. In 2019, health care premiums as a percentage of compensation at the 95th percentile of earnings for families with ESI were 3.9% (95% CI, 3.8%-4.0%) compared with 28.5% (95% CI, 27.8%-29.2%) at the 20th percentile of earnings. From 1988 to 2019, the mean cumulative lost earnings associated with growth in health care premiums for the median US family with ESI was $125 340 (95% CI, $120 155-$130 525) in 2019 dollars, 4.7% of earnings over the 32-year period. Conclusions and Relevance: This economic evaluation of US families receiving ESI suggests that 3 decades of increasing health care premiums were likely associated with reduced annual earnings and increased earnings inequality by race and ethnicity and wage level and were meaningfully associated with wage stagnation.


Assuntos
Custos e Análise de Custo , Renda , Seguro , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Transversais , Etnicidade , Seguro/economia , Grupos Raciais
20.
PLoS One ; 19(1): e0296899, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38236922

RESUMO

In the context of digitization, the insurance industry's value chain is undergoing significant shifts. However, the existing research on its comprehension and measurement remains relatively limited. This study constructs an index system for digital transformation in the insurance industry (DTII) on three components: digital infrastructure, digital platform, and digital applications. Utilizing data from 31 provinces in China, this study employs the entropy weight method, analytic hierarchy process method and minimum relative entropy method to measure the weights of indicators, empirically applying this index system. The results show that DTII in China experiences rapid advancement with an average annual growth rate of 20.46% from 2014 to 2020 and there exists strong regional convergence. In addition, the spatial agglomeration and spatial effects of DTII are mainly concentrated in the life insurance industry and the eastern region. This study provides an index system and empirical evidence for evaluating the DTII, providing policy insights for exploring the sustainable development path of the insurance industry in the digital era.


Assuntos
Processo de Hierarquia Analítica , Seguro , China , Entropia , Indústrias , Desenvolvimento Econômico
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