ABSTRACT
BACKGROUND: Recent CMS billing changes have raised concerns about insurance coverage for deep inferior epigastric perforator (DIEP) flap breast reconstruction. This study compared the costs and utilization of transverse rectus abdominis myocutaneous (TRAM), DIEP, and latissimus dorsi (LD) flaps in breast reconstruction. METHOD: The study utilized the National Inpatient Sample database to identify female patients who underwent DIEP, TRAM, and LD flap procedures from 2016 to 2019. Key data such as patient demographics, length of stay, complications, and costs (adjusted to 2021 USD) were analyzed, focusing on differences across the flap types. RESULTS: A total of 17,770 weighted patient encounters were identified, with the median age being 51. The majority underwent DIEP flaps (73.5%), followed by TRAM (14.2%) and LD (12.1%) flaps. The findings revealed that DIEP and TRAM flaps had a similar length of stay (LOS), while LD flaps typically had a shorter LOS. The total hospital charges to costs using cost-to-charge ratio were also comparable between DIEP and TRAM flaps, whereas LD flaps were significantly less expensive. Factors such as income quartile, primary payer of hospitalization, and geographic region significantly influenced flap choice. CONCLUSION: The study's results appear to contradict the prevailing notion that TRAM flaps are more cost-effective than DIEP flaps. The total hospital charges to costs using cost-to-charge ratio and hospital stays associated with TRAM and DIEP flaps were found to be similar. These findings suggest that changes in the insurance landscape, which may limit the use of DIEP flaps, could undermine patient autonomy while not necessarily reducing healthcare costs. Such policy shifts could favor less costly options like the LD flap, potentially altering the landscape of microvascular breast reconstruction.
Subject(s)
Mammaplasty , Perforator Flap , Humans , Mammaplasty/economics , Mammaplasty/methods , Female , Perforator Flap/blood supply , Perforator Flap/economics , Perforator Flap/transplantation , Middle Aged , United States , Rectus Abdominis/transplantation , Rectus Abdominis/blood supply , Adult , Length of Stay/economics , Length of Stay/statistics & numerical data , Epigastric Arteries/surgery , Epigastric Arteries/transplantation , Breast Neoplasms/surgery , Breast Neoplasms/economics , Myocutaneous Flap/transplantation , Myocutaneous Flap/economics , Myocutaneous Flap/blood supply , Retrospective Studies , Microsurgery/economics , Superficial Back Muscles/transplantation , Insurance Coverage/economics , AgedABSTRACT
This cross-sectional study evaluates the association between Medicare coverage and patient out-of-pocket costs for cardiovascular-kidney-metabolic medications.
Subject(s)
Health Expenditures , Medicare , Humans , United States , Medicare/economics , Health Expenditures/statistics & numerical data , Male , Female , Aged , Cardiovascular Diseases/economics , Cardiovascular Diseases/drug therapy , Insurance Coverage/economics , Insurance Coverage/statistics & numerical data , Cardiovascular Agents/economics , Cardiovascular Agents/therapeutic useABSTRACT
This Viewpoint discusses the proliferation of Medicare Advantage plans targeting specific groups of individuals and whether these plans will improve quality of care for beneficiaries.
Subject(s)
Insurance Benefits , Medicare Part C , Quality of Health Care , Fee-for-Service Plans , Medicare Part C/economics , Medicare Part C/statistics & numerical data , Medicare Part C/trends , Quality Indicators, Health Care , Quality of Health Care/economics , Quality of Health Care/standards , United States/epidemiology , Insurance Coverage/economics , Insurance Coverage/statistics & numerical data , Insurance Coverage/trends , Insurance Benefits/economics , Insurance Benefits/statistics & numerical data , Insurance Benefits/trendsABSTRACT
This study examines state Medicaid coverage policies for antiobesity medications and their trends in Medicaid reimbursement from 2011 to 2022.
Subject(s)
Anti-Obesity Agents , Glucagon-Like Peptide-1 Receptor Agonists , Insurance Coverage , Insurance, Health, Reimbursement , Medicaid , Humans , Anti-Obesity Agents/economics , Anti-Obesity Agents/therapeutic use , Glucagon-Like Peptide-1 Receptor Agonists/economics , Glucagon-Like Peptide-1 Receptor Agonists/therapeutic use , Insurance Coverage/economics , Insurance Coverage/statistics & numerical data , Insurance Coverage/trends , Insurance, Health, Reimbursement/economics , Insurance, Health, Reimbursement/statistics & numerical data , Insurance, Health, Reimbursement/trends , Medicaid/economics , Medicaid/statistics & numerical data , Medicaid/trends , State Government , United States/epidemiologyABSTRACT
BACKGROUND: Access to medicines is a serious problem globally and in Chile. Despite the creation of coverage policies, part of the population with chronic conditions of high prevalence, still does not have access to the medicines it requires and disease control continues to be low. The objective of the study was to estimate the medication use and effective coverage for diabetes, dyslipidemia and hypertension in Chile, analyzing them according to sociodemographic variables and social determinants of health. METHODS: Cross-sectional analytical study with information from the 2016-2017 National Health Survey (sample = 6,233 people aged 15 years or older, expanded = 14,518,969). Descriptive analyses of medication use and effective coverage for hypertension, diabetes and dyslipidemia were carried out, and multivariate logistic regression models were developed to analyze possible associations with variables of interest. RESULTS: 60% of people with hypertension or diabetes use medications and only 27.7% in dyslipidemia. While 54.2% of those with diabetes have their glycemia controlled, in hypertension and dyslipidemia the effective coverage drops to 33.3% and 6.6%, respectively. There are no differences in use by health system, but there are differences in the control of hypertension and diabetes, favoring beneficiaries of the private subsystem. Effective coverage of dyslipidemia and hypertension also increases in those using medications. The drugs coincide with the established protocols, although beneficiaries of the private sector report greater use of innovative drugs. CONCLUSION: A significant proportion of Chileans with hypertension, diabetes or dyslipidemia still do not use the required medications and do not control their conditions.
Subject(s)
Diabetes Mellitus , Dyslipidemias , Hypertension , Insurance Coverage , Insurance, Health , Prescription Drugs , Humans , Chile/epidemiology , Chronic Disease , Cross-Sectional Studies , Diabetes Mellitus/drug therapy , Diabetes Mellitus/economics , Diabetes Mellitus/epidemiology , Dyslipidemias/drug therapy , Dyslipidemias/economics , Dyslipidemias/epidemiology , Hypertension/drug therapy , Hypertension/economics , Hypertension/epidemiology , Prescription Drugs/economics , Prescription Drugs/therapeutic use , Prevalence , South American People , Insurance Coverage/economics , Insurance Coverage/statistics & numerical data , Insurance, Health/economicsSubject(s)
Chronic Disease , Medicare Part C , Aged , Humans , Chronic Disease/economics , Chronic Disease/epidemiology , Health Expenditures , Medicare Part C/economics , Medicare Part C/statistics & numerical data , United States/epidemiology , Insurance Coverage/economics , Insurance Coverage/statistics & numerical dataSubject(s)
Chronic Disease , Medicare Part C , Aged , Humans , Chronic Disease/economics , Chronic Disease/epidemiology , Health Expenditures/statistics & numerical data , Medicare Part C/economics , Medicare Part C/statistics & numerical data , United States/epidemiology , Insurance Coverage/economics , Insurance Coverage/statistics & numerical dataSubject(s)
Biomedical Technology , Device Approval , Health Services Accessibility , Insurance Coverage , Humans , Device Approval/legislation & jurisprudence , Health Services Accessibility/economics , Health Services Accessibility/legislation & jurisprudence , Insurance Coverage/economics , United States , United States Food and Drug Administration/legislation & jurisprudence , Biomedical Technology/economics , Biomedical Technology/legislation & jurisprudenceSubject(s)
Health Services Accessibility , Insurance Coverage , Medicaid , Humans , Health Services Accessibility/economics , Health Services Accessibility/legislation & jurisprudence , Health Services Accessibility/statistics & numerical data , Insurance Coverage/economics , Insurance Coverage/legislation & jurisprudence , Insurance Coverage/statistics & numerical data , Insurance, Health/economics , Insurance, Health/legislation & jurisprudence , Insurance, Health/statistics & numerical data , Medicaid/economics , Medicaid/legislation & jurisprudence , Medicaid/statistics & numerical data , Preliminary Data , United States/epidemiologyABSTRACT
This study reviewed public comments for all Medicare National Coverage Determinations between June 2019 and 2022 on select pulmonary and cardiac devices to determine whether financial conflicts of interest were disclosed.
Subject(s)
Conflict of Interest , Equipment and Supplies , Insurance Coverage , Medicare , Aged , Humans , Conflict of Interest/economics , Equipment and Supplies/economics , Medicare/economics , Medicare/ethics , United States , Insurance Coverage/economics , Insurance Coverage/ethicsABSTRACT
This Viewpoint discusses the maternal mortality crisis in the US, the need for an extension of Medicaid postpartum coverage, and the residual challenges across the US related to maternal health.
Subject(s)
Insurance Coverage , Maternal Mortality , Medicaid , Postnatal Care , Female , Humans , Medicaid/economics , United States/epidemiology , Postpartum Period , Postnatal Care/economics , Insurance Coverage/economicsABSTRACT
This study examines whether Medicare Advantage (MA) enrollees with more chronic conditions were more likely to disenroll when MA enrollment grew rapidly from 2009 to 2019.
Subject(s)
Insurance Coverage , Medicare Part C , Multiple Chronic Conditions , Aged , Humans , Fee-for-Service Plans , Medicare Part C/economics , Medicare Part C/statistics & numerical data , Multiple Chronic Conditions/economics , Multiple Chronic Conditions/epidemiology , Multiple Chronic Conditions/therapy , United States/epidemiology , Insurance Coverage/economics , Insurance Coverage/statistics & numerical data , Insurance Coverage/trendsSubject(s)
Health Equity , Insurance Coverage , Insurance, Health , Sex Reassignment Surgery , California , Insurance Coverage/economics , Insurance Coverage/legislation & jurisprudence , Insurance, Health/economics , Insurance, Health/legislation & jurisprudence , Sex Reassignment Surgery/economics , Sex Reassignment Surgery/legislation & jurisprudence , United States , Health Equity/economics , Health Equity/legislation & jurisprudenceSubject(s)
Health Equity , Insurance Coverage , Insurance, Health , Sex Reassignment Surgery , California , Insurance Coverage/economics , Insurance Coverage/legislation & jurisprudence , Insurance, Health/economics , Insurance, Health/legislation & jurisprudence , Sex Reassignment Surgery/economics , Sex Reassignment Surgery/legislation & jurisprudence , United States , Health Equity/economics , Health Equity/legislation & jurisprudenceABSTRACT
This RCD discusses the recent development in Lange v Houston County. In this case, the United States District Court for The Middle District Of Georgia Macon Division found that an Exclusion Policy, prohibiting health insurance coverage of gender-affirming surgery for an employee, Anna Lange, violated Title VII of the Civil Rights Act. On appeal, the Defendants argued that the District Court erred in its decision and relied on the cost burden of gender-affirming surgery as one of their defenses. This RCD highlights that cost is a common defense tactic used by defendants in these cases. However, the author argues that these concerns are unfounded and meritless given the cost-effectiveness of including gender-affirming surgeries in health insurance plans, as highlighted in the RCD.
Subject(s)
Employer Health Costs , Health Benefit Plans, Employee , Insurance Coverage , Sex Reassignment Surgery , Humans , Cost-Benefit Analysis , Insurance Coverage/economics , Sex Reassignment Surgery/economics , Transgender Persons , United States , Male , Female , Employer Health Costs/statistics & numerical data , Health Benefit Plans, Employee/economicsSubject(s)
Health Services Accessibility , Insurance, Health , Medically Uninsured , Vaccination Coverage , Vaccines , Adult , Humans , Health Services Accessibility/economics , Health Services Accessibility/statistics & numerical data , Insurance Coverage/economics , Insurance Coverage/statistics & numerical data , Insurance, Health/economics , Insurance, Health/statistics & numerical data , Medically Uninsured/statistics & numerical data , United States/epidemiology , Vaccination/economics , Vaccination/statistics & numerical data , Vaccines/therapeutic use , Vaccination Coverage/economics , Vaccination Coverage/statistics & numerical dataABSTRACT
Financial toxicity is a growing problem in the delivery of cancer care and contributes to inequities in outcomes across the cancer care continuum. Racial/ethnic inequities in prostate cancer, the most common cancer diagnosed in men, are well described, and threaten to widen in the era of precision oncology given the numerous structural barriers to accessing novel diagnostic studies and treatments, particularly for Black men. Gaps in insurance coverage and cost sharing are 2 such structural barriers that can perpetuate inequities in screening, diagnostic workup, guideline-concordant treatment, symptom management, survivorship, and access to clinical trials. Mitigating these barriers will be key to achieving equity in prostate cancer care, and will require a multi-pronged approach from policymakers, health systems, and individual providers. This narrative review will describe the current state of financial toxicity in prostate cancer care and its role in perpetuating racial inequities in the era of precision oncology.
Subject(s)
Black or African American , Health Services Accessibility , Healthcare Disparities , Precision Medicine , Prostatic Neoplasms , Humans , Male , Black People , Health Services Accessibility/economics , Healthcare Disparities/economics , Healthcare Disparities/ethnology , Precision Medicine/economics , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/economics , Prostatic Neoplasms/ethnology , Prostatic Neoplasms/therapy , Racial Groups , Insurance Coverage/economics , Cost Sharing/economicsABSTRACT
Importance: Gender-affirming surgery is often beneficial for gender-diverse or -dysphoric patients. Access to gender-affirming surgery is often limited through restrictive legislation and insurance policies. Objective: To investigate the association between California's 2013 implementation of the Insurance Gender Nondiscrimination Act, which prohibits insurers and health plans from limiting benefits based on a patient's sex, gender, gender identity, or gender expression, and utilization of gender-affirming surgery among California residents. Design, Setting, and Participants: Population epidemiology study of transgender and gender-diverse patients undergoing gender-affirming surgery (facial, chest, and genital surgery) between 2005 and 2019. Utilization of gender-affirming surgery in California before and after implementation of the Insurance Gender Nondiscrimination Act in July 2013 was compared with utilization in Washington and Arizona, control states chosen because of geographic similarity and because they expanded Medicaid on the same date as California-January 1, 2014. The date of last follow-up was December 31, 2019. Exposures: California's Insurance Gender Nondiscrimination Act, implemented on July 9, 2013. Main Outcomes and Measures: Receipt of gender-affirming surgery, defined as undergoing at least 1 facial, chest, or genital procedure. Results: A total of 25â¯252 patients (California: n = 17â¯934 [71%]; control: n = 7328 [29%]) had a diagnosis of gender dysphoria. Median ages were 34.0 years in California (with or without gender-affirming surgery), 39 years (IQR, 28-49 years) among those undergoing gender-affirming surgery in control states, and 36 years (IQR, 22-56 years) among those not undergoing gender-affirming surgery in control states. Patients underwent at least 1 gender-affirming surgery within the study period in 2918 (11.6%) admissions-2715 (15.1%) in California vs 203 (2.8%) in control states. There was a statistically significant increase in gender-affirming surgery in the third quarter of July 2013 in California vs control states, coinciding with the timing of the Insurance Gender Nondiscrimination Act (P < .001). Implementation of the policy was associated with an absolute 12.1% (95% CI, 10.3%-13.9%; P < .001) increase in the probability of undergoing gender-affirming surgery in California vs control states observed in the subset of insured patients (13.4% [95% CI, 11.5%-15.4%]; P < .001) but not self-pay patients (-22.6% [95% CI, -32.8% to -12.5%]; P < .001). Conclusions and Relevance: Implementation in California of its Insurance Gender Nondiscrimination Act was associated with a significant increase in utilization of gender-affirming surgery in California compared with the control states Washington and Arizona. These data might inform state legislative efforts to craft policies preventing discrimination in health coverage for state residents, including transgender and gender-diverse patients.