ABSTRACT
OBJECTIVE: To examine infertility-related fund-raising campaigns on a popular crowdfunding website and to compare campaign characteristics across states with and without legislative mandates for insurance coverage for infertility-related care. DESIGN: Retrospective cohort study. SETTING: Online crowdfunding platform (GoFundMe) between 2010 and 2020. PATIENT(S): GoFundMe campaigns in the United States containing the keywords "fertility" and "infertility." INTERVENTION(S): State insurance mandates for infertility treatment coverage. MAIN OUTCOME MEASURE(S): Primary outcomes included fund-raising goals, funds raised, campaign location, and campaigns per capita. RESULT(S): Of the 3,332 infertility-related campaigns analyzed, a total goal of $52.6 million was requested, with $22.5 million (42.8%) successfully raised. The average goal was $18,639 (standard deviation [SD] $32,904), and the average amount raised was $6,759 (SD $14,270). States with insurance mandates for infertility coverage had fewer crowdfunding campaigns per capita (0.75 vs. 1.15 campaigns per 100,000 population than states without insurance mandates. CONCLUSION(S): We found a large number of campaigns requesting financial assistance for costs associated with infertility care, indicating a substantial unmet financial burden. States with insurance mandates had fewer campaigns per capita, suggesting that mandates are effective in mitigating this financial burden. These data can inform future health policy legislation on the state and federal levels to assist with the financial burden of infertility.
Subject(s)
Crowdsourcing/economics , Health Care Costs , Health Expenditures , Infertility/economics , Infertility/therapy , Insurance Coverage/economics , Insurance, Health/economics , Reproductive Techniques, Assisted/economics , State Health Plans/economics , Crowdsourcing/legislation & jurisprudence , Eligibility Determination/economics , Female , Government Regulation , Health Care Costs/legislation & jurisprudence , Health Expenditures/legislation & jurisprudence , Health Services Needs and Demand/economics , Humans , Infertility/diagnosis , Insurance Coverage/legislation & jurisprudence , Insurance, Health/legislation & jurisprudence , Male , Needs Assessment/economics , Reproductive Techniques, Assisted/legislation & jurisprudence , Retrospective Studies , State Health Plans/legislation & jurisprudence , United StatesSubject(s)
Centers for Medicare and Medicaid Services, U.S./legislation & jurisprudence , Commerce/legislation & jurisprudence , Health Care Costs/legislation & jurisprudence , Health Policy/economics , Orthopedic Procedures/economics , Humans , Orthopedic Procedures/legislation & jurisprudence , United StatesSubject(s)
Cost Control/legislation & jurisprudence , Government Regulation , Health Care Costs/legislation & jurisprudence , Hospital Charges/legislation & jurisprudence , Insurance Carriers/legislation & jurisprudence , Insurance, Health/economics , Health Expenditures/statistics & numerical data , Health Policy , Insurance Carriers/economics , Insurance, Health/legislation & jurisprudence , Patient Protection and Affordable Care Act , United StatesSubject(s)
Cost Control/legislation & jurisprudence , Delivery of Health Care/economics , Health Care Costs/legislation & jurisprudence , Delivery of Health Care/legislation & jurisprudence , Delivery of Health Care/organization & administration , Humans , Medical Overuse/economics , Prescription Fees/legislation & jurisprudence , United StatesSubject(s)
Health Care Costs/legislation & jurisprudence , Health Policy/legislation & jurisprudence , Orthopedics/legislation & jurisprudence , Politics , Value-Based Health Insurance , Value-Based Purchasing/legislation & jurisprudence , Cost Savings , Cost-Benefit Analysis , Government Regulation , Health Policy/economics , Health Services Accessibility/economics , Health Services Accessibility/legislation & jurisprudence , Humans , Orthopedic Procedures/economics , Orthopedic Procedures/legislation & jurisprudence , Orthopedics/economics , Policy Making , Value-Based Health Insurance/economics , Value-Based Purchasing/economicsSubject(s)
Fees and Charges/legislation & jurisprudence , Health Policy/legislation & jurisprudence , Insurance, Health/legislation & jurisprudence , Benchmarking , Delivery of Health Care/economics , Federal Government , Health Care Costs/legislation & jurisprudence , Health Facility Merger/economics , Health Policy/economics , Insurance, Health/economics , Negotiating , State Government , United StatesABSTRACT
The year 2020 marks the 10th anniversary of the signing of the Affordable Care Act (ACA). Perhaps the greatest overhaul of the US health care system in the past 50 y, the ACA sought to expand access to care, improve quality, and reduce health care costs. Over the past decade, there have been a number of challenges and changes to the law, which remains in evolution. While the ACA's policies were not intended to specifically target surgical care, surgical patients, surgeons, and the health systems within which they function have all been greatly affected. This article aims to provide a brief overview of the impact of the ACA on surgical patients in reference to its tripartite aim of improving access, improving quality, and reducing costs.
Subject(s)
Health Care Costs/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Patient Protection and Affordable Care Act/statistics & numerical data , Quality Improvement/statistics & numerical data , Surgical Procedures, Operative/statistics & numerical data , Health Care Costs/legislation & jurisprudence , Health Care Costs/trends , Health Services Accessibility/history , Health Services Accessibility/legislation & jurisprudence , Health Services Accessibility/trends , History, 21st Century , Patient Protection and Affordable Care Act/economics , Patient Protection and Affordable Care Act/legislation & jurisprudence , Patient Protection and Affordable Care Act/trends , Quality Improvement/economics , Quality Improvement/legislation & jurisprudence , Quality Improvement/trends , Surgical Procedures, Operative/economics , Uncertainty , United StatesABSTRACT
ABSTRACT: Lawmakers suggest Certificate of Need (CON) laws' main goals are increasing access to healthcare, increasing quality of healthcare, and decreasing healthcare costs. This retrospective database study aims to evaluate the effectiveness of CON through analysis of total knee, hip, and shoulder arthroplasty (TKA, THA, and TSA, respectively). A review was performed using the Humana Insurance PearlDiver national database from 2007 to 2015. Access to care was approximated by the rates of total joint arthroplasty (TJA) in patients diagnosed with arthritis to the corresponding joint. The quality of care was assessed using complication rates after TJA. The total cost of TJA was approximated from average reimbursement to the healthcare facility per procedure. Patients in states without CON programs received TKA, THA, and TSA more frequently (p < .0001, p = .250, p = .019). No significant difference was found in studied complication rates between CON and non-CON states. Similarly, there was no trend found when comparing the cost of each procedure in CON versus non-CON states. These findings are consistent with other recent studies detailing the impact of CON regulation on THA and TKA. The apparent nonsuperiority of CON states in achieving their purported goals may call into question the effectiveness of additional bureaucracy and regulation, suggesting a need for further examination.
Subject(s)
Arthroplasty, Replacement, Hip/economics , Arthroplasty, Replacement, Hip/legislation & jurisprudence , Arthroplasty, Replacement, Knee/economics , Arthroplasty, Replacement, Knee/legislation & jurisprudence , Certificate of Need/legislation & jurisprudence , Health Care Costs/legislation & jurisprudence , Health Policy/legislation & jurisprudence , Adult , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/statistics & numerical data , Arthroplasty, Replacement, Knee/statistics & numerical data , Female , Health Care Costs/statistics & numerical data , Humans , Male , Middle Aged , Retrospective Studies , United StatesABSTRACT
In an effort to curb excessive health care spending and incentivize high-quality care, many payers have implemented value-based payment reforms designed to pay for the quality rather than the quantity of health care services. Medicare, the largest payer in the United States, has implemented numerous value-based payment policies over the past decade, many of which affect cardiovascular care. In this review, we discuss some of these major nationwide value-based payment reforms as they relate to cardiovascular care and what we may expect in the future from cardiovascular value-based policies.