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3.
J Med Econ ; 24(1): 308-317, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33555956

RESUMEN

OBJECTIVE: The aims of this study were to evaluate health outcomes and the economic burden of hospitalized COVID-19 patients in the United States. METHODS: Hospitalized patients with a primary or secondary discharge diagnosis code for COVID-19 (ICD-10 code U07.1) from 1 April to 31 October 2020 were identified in the Premier Healthcare COVID-19 Database. Patient demographics, hospitalization characteristics, and concomitant medical conditions were assessed. Hospital length of stay (LOS), in-hospital mortality, hospital charges, and hospital costs were evaluated overall and stratified by age groups, insurance types, and 4 COVID-19 disease progression states based on intensive care unit (ICU) and invasive mechanical ventilation (IMV) usage. RESULTS: Of the 173,942 hospitalized COVID-19 patients, the median age was 63 years, 51.0% were male, and 48.5% were covered by Medicare. The most prevalent concomitant medical conditions were cardiovascular disease (73.5%), hypertension (64.8%), diabetes (40.7%), obesity (27.0%), and chronic kidney disease (24.2%). Approximately one-fifth (21.9%) of the hospitalized COVID-19 patients were admitted to the ICU and 16.9% received IMV; most patients (73.6%) did not require ICU admission or IMV, and 12.4% required both. The median hospital LOS was 5 days, in-hospital mortality was 13.6%, median hospital charges were $43,986, and median hospital costs were $12,046. Hospital LOS and in-hospital mortality increased with ICU and/or IMV usage and age; hospital charges and costs increased with ICU and/or IMV usage. Patients with both ICU and IMV usage had the longest median hospital LOS (15 days), highest in-hospital mortality (53.8%), and highest hospital charges ($198,394) and hospital costs ($54,402). LIMITATIONS: This retrospective administrative database analysis relied on coding accuracy and a subset of admissions with validated/reconciled hospital costs. CONCLUSIONS: This study summarizes the severe health outcomes and substantial hospital costs of hospitalized COVID-19 patients in the US. The findings support the urgent need for rapid implementation of effective interventions, including safe and efficacious vaccines.


Asunto(s)
/economía , Precios de Hospital/estadística & datos numéricos , Hospitalización/economía , Evaluación de Resultado en la Atención de Salud , Anciano , Anciano de 80 o más Años , /mortalidad , Costo de Enfermedad , Progresión de la Enfermedad , Femenino , Mortalidad Hospitalaria , Humanos , Cobertura del Seguro/economía , Unidades de Cuidados Intensivos/economía , Tiempo de Internación/economía , Masculino , Persona de Mediana Edad , Respiración Artificial/economía , Estudios Retrospectivos , Estados Unidos/epidemiología
4.
Dtsch Med Wochenschr ; 146(3): 198-204, 2021 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-33395708

RESUMEN

The COVID-19 illness can occur as an occupational disease or work-related accident. According to the German list of occupational diseases, recognition as an occupational disease 3101 requires occupational exposure of an insured person who has been exposed to an increased risk of infection compared to the general population as a result of their occupational activity in one of the four areas: (1) health service or (2) social welfare sector, (3) laboratory or (4) during activities with increased risk of infection comparable to (1) to (3). The insurance cover covers employees, self-employed people - if not exempted from insurance cover - and honorary workers. The COVID-19 disease is subject to legal notification, mostly in conjunction with a contemporary SARS-CoV-2 virus detection. Regarding insured people who are not included within the aforementioned areas (1) to (4), the COVID-19 illness can be acknowledged as an occupational accident if the intense and direct contact with infected people - not intended as in the case of occupational disease 3101 - but otherwise situationally results from the insured activity itself.


Asunto(s)
/economía , Cobertura del Seguro , Enfermedades Profesionales/economía , Enfermedades Profesionales/etiología , /aislamiento & purificación , Notificación de Enfermedades/legislación & jurisprudencia , Notificación de Enfermedades/normas , Alemania , Empleos en Salud , Humanos , Cobertura del Seguro/economía , Cobertura del Seguro/normas , Laboratorios , Exposición Profesional , Factores de Riesgo , Bienestar Social , Voluntarios
5.
JAMA Netw Open ; 4(1): e2032669, 2021 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-33399859

RESUMEN

Importance: There has been little rigorous evidence to date comparing public vs private health insurance. With policy makers considering a range of policies to expand coverage, understanding the trade-offs between these coverage types is critical. Objective: To compare months of coverage, utilization, quality, and costs between low-income adults with Medicaid vs those with subsidized private (Marketplace) insurance. Design, Setting, and Participants: This cross-sectional study used a propensity score-matched sample of adults enrolled in either Medicaid or Marketplace plans at any point between January 1, 2014, and December 31, 2015. The sample was restricted to individuals with incomes narrowly above and below 138% of the federal poverty level (FPL), which represented the eligibility cutoff between the programs. Data were obtained from 3 state agencies merging comprehensive insurance claims with income eligibility data for Colorado Medicaid expansion and Marketplace enrollees. Income data were linked with an all-payer claims database, and generalized linear models were used to adjust for clinical and demographic confounders. Participants included 8182 low-income nonpregnant adults aged 19 to 64 years enrolled in Medicaid or Marketplace coverage during the 2014 to 2015 period, with incomes between 134% and 143% of the FPL. Exposures: Health insurance through Colorado Medicaid or Colorado's state-based Marketplace. Main Outcomes and Measures: The primary analytical approach was a multivariate regression analysis of the propensity score-matched sample. Primary outcomes were months of coverage in Medicaid or Marketplace insurance, office and emergency department (ED) visits, ambulatory care-sensitive hospitalizations, and total costs. For secondary quality outcomes, the propensity score-matched sample was widened to 129% to 148% of the FPL to ensure adequate sample size. Secondary outcomes included prescription drug utilization, types of ED visits, hospitalizations, out-of-pocket costs, and clinical quality measures. Primary data analysis was between September 2018 to July 2019, with revisions finalized in November 2020. Results: The propensity score-matched narrow-income sample included a total of 8182 participants (4091 Medicaid eligible [50%]: mean [SD] age, 42.8 [13.6] years; 2230 women [54.5%]; 4091 Marketplace eligible [50%]: mean [SD] age, 42.7 [13.9] years; 2229 women [54.5%]). Demographic differences across the 2 groups were well balanced, with all standardized mean differences less than 0.10. Marketplace coverage was associated with fewer ED visits (mean, 0.36 [95% CI, 0.32-0.40] visits vs 0.56 [95% CI, 0.50-0.62] visits; P < .001) and more office (outpatient) visits than Medicaid (mean, 2.22 [95% CI, 2.11-2.32] visits vs 1.73 [95% CI, 1.64-1.81] visits; P < .001). No differences in ambulatory care-sensitive hospitalizations were found (0.004 [95% CI, 0.001-0.006] vs 0.007 [95% CI, 0.002-0.011]; P = .15). Total costs were 83% higher in Marketplace coverage (mean, $4553 [95% CI, $3368-$5738] vs $2484 [95% CI, $1760-$3209]; P < .001) owing almost entirely to higher prices, and out-of-pocket costs were 10 times higher (mean, $569 [95% CI, $337-$801] vs $45 [95% CI, $26-$65]; P < .001). Five of 12 secondary quality measures favored private insurance, and 1 favored Medicaid. Conclusions and Relevance: In this cross-sectional propensity score-matched study, Medicaid and Marketplace coverage differed in important ways. Public coverage through Medicaid was associated with more ED visits and fewer office visits than private Marketplace coverage, which may reflect barriers to outpatient care or lower cost-sharing barriers to ED care in Medicaid. Results suggest that Medicaid coverage was substantially less costly to beneficiaries and society than private coverage, with mixed results on health care quality.


Asunto(s)
Cobertura del Seguro/economía , Seguro de Salud/economía , Medicaid/economía , Pobreza , Adulto , Anciano , Colorado , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Estados Unidos
6.
Health Aff (Millwood) ; 40(1): 105-112, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33400569

RESUMEN

The return of a Democratic administration to the White House, coupled with coronavirus disease 2019 (COVID-19) pandemic-induced contractions of job-based insurance, may reignite debate over public coverage expansion and its costs. Decades of research demonstrate that uninsured people and people with copays and deductibles use less care than people with first-dollar coverage. Hence, most economic analyses of Medicare for All proposals and other coverage expansions project increased utilization and associated costs. We review the utilization surges that such analyses have predicted and contrast them with the more modest utilization increments observed after past coverage expansions in the US and other affluent nations. The discrepancy between predicted and observed utilization changes suggests that analysts underestimate the role of supply-side constraints-for example, the finite number of physicians and hospital beds. Our review of the utilization effects of past coverage expansions suggests that a first-dollar universal coverage expansion would increase ambulatory visits by 7-10 percent and hospital use by 0-3 percent. Modest administrative savings could offset the costs of such increases.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Costos y Análisis de Costo/economía , Cobertura del Seguro/economía , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención de Salud Universal , Humanos , Medicaid/economía , Pacientes no Asegurados , Medicare/economía , Patient Protection and Affordable Care Act/economía , Estados Unidos
7.
J Urol ; 205(1): 115-121, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32658588

RESUMEN

PURPOSE: Optimal treatment of intermediate risk prostate cancer remains unclear. National Comprehensive Cancer Network® guidelines recommend active surveillance, prostatectomy or radiotherapy. Recent trials demonstrated no difference in prostate cancer specific mortality for men undergoing active surveillance for low risk prostate cancer compared to prostatectomy or radiotherapy. The use of active surveillance for intermediate risk prostate cancer is less clear. In this study we characterize U.S. national trends for demographic, clinical and socioeconomic factors associated with active surveillance for men with intermediate risk prostate cancer. MATERIALS AND METHODS: This retrospective cohort study examined 176,122 men diagnosed with intermediate risk prostate cancer from 2010 to 2016 in the National Cancer Database. Temporal trends in demographic, clinical and socioeconomic factors among men with intermediate risk prostate cancer and association with the use of active surveillance were characterized. The analysis was performed in April 2020. RESULTS: In total, 176,122 men were identified with intermediate risk prostate cancer from 2010 to 2016. Of these men 57.3% underwent prostatectomy, 36.4% underwent radiotherapy and 3.2% underwent active surveillance. Active surveillance nearly tripled from 1.6% in 2010 to 4.6% in 2016 (p <0.001). On multivariate analysis use of active surveillance was associated with older age, diagnosis in recent years, lower Gleason score and tumor stage, type of insurance, treatment at an academic center and proximity to facility, and attaining higher education (p <0.05). Race and comorbidities were not associated with active surveillance. CONCLUSIONS: Our findings highlight increasing active surveillance use for men with intermediate risk prostate cancer demonstrating clinical and socioeconomic disparities. Prospective data and improved risk stratification are needed to guide optimal treatment for men with intermediate risk prostate cancer.


Asunto(s)
Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Neoplasias de la Próstata/terapia , Espera Vigilante/estadística & datos numéricos , Factores de Edad , Anciano , Anciano de 80 o más Años , Disparidades en Atención de Salud/economía , Humanos , Cobertura del Seguro/economía , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/economía , Seguro de Salud/estadística & datos numéricos , Calicreínas/sangre , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Próstata/patología , Antígeno Prostático Específico/sangre , Prostatectomía/economía , Prostatectomía/estadística & datos numéricos , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/patología , Radioterapia/economía , Radioterapia/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Factores Socioeconómicos , Espera Vigilante/economía
8.
J Urol ; 205(1): 257-263, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32716676

RESUMEN

PURPOSE: Among some populations access to neonatal circumcision has become increasingly limited despite evidence of its benefits. This study examines national neonatal circumcision trends before and after the 2012 American Academy of Pediatrics recommendation for neonatal circumcision reimbursement. MATERIALS AND METHODS: A retrospective cohort study of boys aged 28 days or less was conducted using data from the Kids' Inpatient Database (2003 to 2016). Boys who underwent neonatal circumcision prior to discharge were compared to boys who did not. Boys with coagulopathies, penile anomalies or a history of prematurity were excluded. RESULTS: An estimated 8,038,289 boys comprised the final cohort. Boys were primarily White (53.7%), privately insured (49.1%) and cared for at large (60.8%) teaching (49.4%) hospitals in metropolitan areas (84.1%). While 55.0% underwent circumcision prior to discharge, neonatal circumcision rates decreased significantly over time (p <0.0001). Black (68.0%) or White (66.0%) boys, boys in the highest income quartile (60.7%) and Midwestern boys (75.0%) were most likely to be circumcised. Neonatal circumcision was significantly more common among privately (64.9%) than publicly (44.6%) insured boys after controlling for demographics, region, hospital characteristics and year (p <0.0001). The odds of circumcision over time were not significantly different in the years before vs after 2012 (p=0.28). CONCLUSIONS: Among approximately 8 million boys sampled over a 13-year period 55.0% underwent neonatal circumcision. The rate of neonatal circumcision varied widely by region, race and socioeconomic status. The finding that boys with public insurance have lower circumcision rates in all years may be related to lack of circumcision access for boys with public insurance.


Asunto(s)
Circuncisión Masculina/tendencias , Accesibilidad a los Servicios de Salud/economía , Disparidades en Atención de Salud/economía , Afroamericanos/estadística & datos numéricos , Circuncisión Masculina/economía , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Geografía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/tendencias , Disparidades en Atención de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/tendencias , Humanos , Recién Nacido , Cobertura del Seguro/economía , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/economía , Seguro de Salud/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Clase Social , Estados Unidos
9.
J Urol ; 205(1): 213-218, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32856985

RESUMEN

PURPOSE: Neurogenic lower urinary tract dysfunction is a significant source of morbidity for individuals with spinal cord injury and is managed with a range of treatment options that differ in efficacy, tolerability and cost. The effect of insurance coverage on bladder management, symptoms and quality of life is not known. We hypothesized that private insurance is associated with fewer bladder symptoms and better quality of life. MATERIALS AND METHODS: This is a cross-sectional, retrospective analysis of 1,226 surveys collected as part of the prospective Neurogenic Bladder Research Group SCI Registry. We included patients with complete insurance information, which was classified as private or public insurance. The relationship between insurance and bladder management, bladder symptoms and quality of life was modeled using multinomial logistic regression analysis. Spinal cord injury quality of life was measured by the Neurogenic Bladder Symptom Score. RESULTS: We identified 654 privately insured and 572 publicly insured individuals. The demographics of these groups differed by race, education, prevalence of chronic pain and bladder management. Publicly insured patients were more likely to be treated with indwelling catheters or spontaneous voiding and less likely to take bladder medication compared to those with private insurance. On multivariate analysis insurance type was not associated with differences in bladder symptoms (total Neurogenic Bladder Symptom Score) or in urinary quality of life. CONCLUSIONS: There is an association between insurance coverage and the type of bladder management used following spinal cord injury, as publicly insured patients are more likely to be treated with indwelling catheters. However, insurance status, controlling for bladder management, did not impact bladder symptoms or quality of life.


Asunto(s)
Disparidades en Atención de Salud/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Traumatismos de la Médula Espinal/complicaciones , Vejiga Urinaria Neurogénica/terapia , Adulto , Catéteres de Permanencia/economía , Catéteres de Permanencia/estadística & datos numéricos , Estudios Transversales , Femenino , Disparidades en Atención de Salud/economía , Humanos , Cobertura del Seguro/economía , Seguro de Salud/economía , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Satisfacción del Paciente/economía , Estudios Prospectivos , Calidad de Vida , Estudios Retrospectivos , Traumatismos de la Médula Espinal/economía , Traumatismos de la Médula Espinal/terapia , Resultado del Tratamiento , Vejiga Urinaria/inervación , Vejiga Urinaria/fisiopatología , Vejiga Urinaria Neurogénica/diagnóstico , Vejiga Urinaria Neurogénica/economía , Vejiga Urinaria Neurogénica/etiología , Cateterismo Urinario/economía , Cateterismo Urinario/estadística & datos numéricos
11.
PLoS Med ; 17(8): e1003247, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32764761

RESUMEN

BACKGROUND: Patients with opioid use disorder (OUD) who are hospitalized for serious infections requiring prolonged intravenous antibiotics may face barriers to discharge, which could prolong hospital length of stay (LOS) and increase financial burden. We investigated differences in LOS, discharge disposition, and charges between hospitalizations for serious infections in patients with and without OUD. METHODS AND FINDINGS: We utilized the 2016 National Inpatient Sample-a nationally representative database of all discharges from US acute care hospitals. The population of interest was all hospitalizations for infective endocarditis, epidural abscess, septic arthritis, or osteomyelitis. The exposure was OUD, and the primary outcome was LOS until discharge, assessed by using a competing risks analysis to estimate adjusted hazard ratios (aHRs). Adjusted odds ratio (aOR) of discharge disposition and adjusted differences in hospital charges were also reported. Of 95,470 estimated hospitalizations for serious infections (infective endocarditis, epidural abscess, septic arthritis, and osteomyelitis), the mean age was 49 years and 35% were female. 46% had Medicare (government-based insurance coverage for people age 65+ years), and 70% were non-Hispanic white. After adjustment for potential confounders, OUD was associated with a lower probability of discharge at any given LOS (aHR 0.61; 95% CI 0.59-0.63; p < 0.001). OUD was also associated with lower odds of discharge to home (aOR 0.38; 95% CI 0.33-0.43; p < 0.001) and higher odds of discharge to a post-acute care facility (aOR 1.85; 95% CI 1.57-2.17; p < 0.001) or patient-directed discharge (also referred to as "discharge against medical advice") (aOR 3.47; 95% CI 2.80-4.29; p < 0.001). There was no significant difference in average total hospital charges, though daily hospital charges were significantly lower for patients with OUD. Limitations include the potential for unmeasured confounders and the use of billing codes to identify cohorts. CONCLUSIONS: Our findings suggest that among hospitalizations for some serious infections, those involving patients with OUD were associated with longer LOS, higher odds of discharge to post-acute care facilities or patient-directed discharge, and similar total hospital charges, despite lower daily charges. These findings highlight opportunities to improve care for patients with OUD hospitalized with serious infections, and to reduce the growing associated costs.


Asunto(s)
Disparidades en Atención de Salud/tendencias , Hospitalización/tendencias , Infecciones/epidemiología , Trastornos Relacionados con Opioides/epidemiología , Índice de Severidad de la Enfermedad , Adulto , Anciano , Estudios Transversales , Femenino , Disparidades en Atención de Salud/economía , Hospitalización/economía , Humanos , Infecciones/economía , Infecciones/terapia , Cobertura del Seguro/economía , Cobertura del Seguro/tendencias , Masculino , Medicare/economía , Medicare/tendencias , Persona de Mediana Edad , Trastornos Relacionados con Opioides/economía , Trastornos Relacionados con Opioides/terapia , Estados Unidos/epidemiología
12.
Plast Reconstr Surg ; 146(2): 127e-136e, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32740569

RESUMEN

BACKGROUND: Reduction mammaplasty is the standard of care for symptomatic macromastia. The process of requesting insurance coverage for reduction mammaplasty is cumbersome and potentially controversial, and insurance policies vary significantly. The goal of our analysis is to identify trends in insurance coverage rates, assess for the presence of disparities, and propose ways to increase chances of successful preauthorization. METHODS: The authors performed a retrospective review of preauthorizations for reduction mammaplasty at a single institution from 2012 to 2017. Insurance company names were deidentified. Preauthorization denial rates were assessed by year, insurance carrier, and reason for denial. Multiple regression analysis was performed to identify predictors for predetermination denial by insurance companies. RESULTS: Among 295 preauthorizations, 212 were approved (72 percent) and 83 were denied (28 percent), among which 18 were appealed, 13 successfully. Rates of insurance denials have been increasing steadily, from 18 percent to 41 percent. Medicaid had the lowest denial rates (9.3 percent), whereas private carriers denials ranged from 21.4 to 62.1 percent. In terms of reason for denial, 30 percent were because of contract exclusion, 39 percent were because of inadequate documentation or not meeting medical criteria, and 12 percent were because of inadequate predicted resection weight. Certain private insurance carriers were the only independent predictors of predetermination denial. CONCLUSIONS: Rate of preauthorization denials is high and has been increasing steadily. Insurance criteria remain arbitrary. A proper documentation and appeal process by the plastic surgeon may improve rates of insurance approval. Although resection weight does not correlate with symptom relief, predicted breast tissue resection weight continues to be critical for insurance approval.


Asunto(s)
Mama/anomalías , Hipertrofia/cirugía , Reembolso de Seguro de Salud/economía , Mamoplastia/economía , Garantía de la Calidad de Atención de Salud/normas , Adulto , Mama/cirugía , Femenino , Estudios de Seguimiento , Humanos , Cobertura del Seguro/economía , Mamoplastia/métodos , Estudios Retrospectivos , Estados Unidos
14.
PLoS One ; 15(8): e0238258, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32853228

RESUMEN

This study aims to understand the difference in trauma patients' use of health services in Korea according to insurance type and the Injury Severity Score. Andersen's behavioral model of health service use is employed to identify the factors influencing their use. Claims data from January 1 to December 31, 2016 were extracted from both the Health Insurance Review and Assessment Service and the automobile insurance screening center for all the medical treatments identified with the Korean Triage and Acuity Scale and Injury Severity Score. Using the Health Insurance Review and Assessment Service's remote statistical analysis system, hierarchical regression and negative binomial analyses were conducted to determine the effect of predisposing, enabling, and need factors on health service use. The results demonstrate that the use of Korean health services is relatively equitable since medical expenses for trauma patients are greatly influenced by need factors. However, the length of time trauma patients stay in the hospital appears to differ according to insurance type. This study suggests that healthcare policies need to increase coverage benefits and improve medical billing for patients with severe trauma, as well as develop a more robust screening system for patients with mild to moderate impairments.


Asunto(s)
Servicios de Salud/economía , Seguro de Salud/economía , Heridas y Traumatismos/economía , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Puntaje de Gravedad del Traumatismo , Cobertura del Seguro/economía , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud , Calidad de la Atención de Salud/economía , República de Corea , Adulto Joven
15.
PLoS One ; 15(7): e0235262, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32716927

RESUMEN

OBJECTIVE: Public insurance (Medicaid) covered 42% of all U.S. births in 2018. This paper describes and analyzes the self-reported experiences of women with Medicaid versus commercial insurance relating to autonomy, control and respectful treatment in maternity care. METHODS: The sampling frame for the Listening to Mothers in California survey was drawn from 2016 California birth certificate files. The 30-minute survey had a 55% response rate. A secondary multivariable analysis of results from the survey included 2,318 women with commercial private insurance (1,087) or public (Medi-Cal) (1,231) coverage. Results were weighted and were representative of all births in 2016 in California. The multivariable analysis of variables related to maternal agency included engagement in decision making regarding interventions such as vaginal birth after cesarean and episiotomy, feeling pressured to have interventions and sense of fair treatment. We examined their relationship to insurance status adjusted for maternal age, race/ethnicity, education, nativity and attitude toward birth as well as type of prenatal provider, type of birth attendant and pregnancy complications. RESULTS: Women with Medi-Cal had a demographic profile distinct from those with commercial insurance. In multivariable analysis, women with Medi-Cal reported less control over their maternity care experience than women with commercial insurance, including less choice of prenatal provider (AOR 1.61 95%C.I. 1.20, 2.17), or a vaginal birth after cesarean (AOR 2.93 95%C.I. 1.49, 5.73). Mothers on Medi-Cal were also less likely to be consulted before experiencing an episiotomy (AOR 0.30 95%C.I. 0.09, 0.94). They were more likely to report feeling pressure to have a primary cesarean (AOR 2.54 95%C.I. 1.55, 4.16) and less likely to be encouraged by staff to make their own decisions (AOR 0.63 95%C.I. 0.47, 0.85). CONCLUSIONS: Childbearing women with public insurance in California clearly and consistently reported less opportunity to choose their care than women with private insurance. These inequities are a call to action for increased accountability and quality improvement relating to care of the many childbearing women with Medicaid coverage.


Asunto(s)
Disparidades en Atención de Salud/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Servicios de Salud Materna/estadística & datos numéricos , Relaciones Profesional-Paciente , Respeto , Adulto , California , Femenino , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/economía , Humanos , Cobertura del Seguro/economía , Edad Materna , Servicios de Salud Materna/economía , Medicaid/economía , Medicaid/estadística & datos numéricos , Embarazo , Autoinforme/estadística & datos numéricos , Factores Socioeconómicos , Estados Unidos , Adulto Joven
16.
Tex Med ; 116(5): 37-39, 2020 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-32645188

RESUMEN

From electronic health records to quality reporting, today's physicians deal with plenty of distractions from patient care. Starting in 2021, hospital-employed physicians may find themselves adding another one: explaining to patients the difference between their hospital's multiple published prices for the same service.


Asunto(s)
Economía Hospitalaria/legislación & jurisprudencia , Planes de Aranceles por Servicios/economía , Planes de Aranceles por Servicios/legislación & jurisprudencia , Costos de la Atención en Salud/legislación & jurisprudencia , Sistema de Pago Prospectivo/legislación & jurisprudencia , Registros Electrónicos de Salud , Humanos , Cobertura del Seguro/economía
17.
Medicine (Baltimore) ; 99(27): e21016, 2020 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-32629722

RESUMEN

We evaluated the statewide burden of obesity and its complications among government and state funded programs (Medicare and Medicaid) and commercial insurance.We calculated the prevalence of obesity and the prevalence of relevant comorbidities among different demographic groups and based on health insurance, among adults (18-65 years old) who visited a statewide health network in the state of Rhode Island, in 2017.The overall prevalence of obesity among 74,089 individuals was 38.88% [Asians 16.77%, Whites 37.49%, Hispanics 44.23%, and Blacks 48.44%]. Medicare or Medicaid beneficiaries were 26% and 27%, respectively, more likely to have obesity than those who had commercial insurance (Odds Ratio:1.26, 95% confidence interval [CI]:1.20-1.32; Odds Ratio:1.27, 95%CI:1.22-1.32). Moreover, Medicaid and Medicare beneficiaries with obesity had a higher prevalence of diabetes compared with privately insured with obesity (10.58% and 10.44% vs 4.45%). Medicare beneficiaries with obesity had a statistically higher prevalence of ischemic heart disease (4.34%, 95%CI: 3.77-4.91) than privately insured (3.21%, 95%CI: 2.94-3.47).Based on statewide data among 18 to 65 years old adults, Medicare and Medicaid provide health coverage to 40% of individuals with obesity and 46% of those with the obesity-related comorbidities and complications. State and federal health care programs need to support and expand obesity-related services and coverage.


Asunto(s)
Demografía/tendencias , Cobertura del Seguro/economía , Obesidad/economía , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Comorbilidad , Costo de Enfermedad , Estudios Transversales , Demografía/estadística & datos numéricos , Diabetes Mellitus/epidemiología , Femenino , Humanos , Masculino , Medicaid/economía , Medicare/economía , Persona de Mediana Edad , Isquemia Miocárdica/epidemiología , Obesidad/complicaciones , Obesidad/epidemiología , Obesidad/etnología , Prevalencia , Rhode Island/epidemiología , Estados Unidos , Adulto Joven
18.
Proc Natl Acad Sci U S A ; 117(32): 18939-18947, 2020 08 11.
Artículo en Inglés | MEDLINE | ID: mdl-32719129

RESUMEN

Changes in the way health insurers pay healthcare providers may not only directly affect the insurer's patients but may also affect patients covered by other insurers. We provide evidence of such spillovers in the context of a nationwide Medicare bundled payment reform that was implemented in some areas of the country but not in others, via random assignment. We estimate that the payment reform-which targeted traditional Medicare patients-had effects of similar magnitude on the healthcare experience of nontargeted, privately insured Medicare Advantage patients. We discuss the implications of these findings for estimates of the impact of healthcare payment reforms and more generally for the design of healthcare policy.


Asunto(s)
Reforma de la Atención de Salud/economía , Política de Salud/economía , Seguro de Salud/economía , Ensayos Clínicos Controlados Aleatorios como Asunto/economía , Humanos , Cobertura del Seguro/economía , Estados Unidos
20.
Int J Health Serv ; 50(4): 408-414, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32605414

RESUMEN

Four decades of neoliberal health policies have left the United States with a health care system that prioritizes the profits of large corporate actors, denies needed care to tens of millions, is extraordinarily fragmented and inefficient, and was ill prepared to address the COVID-19 pandemic. The payment system has long rewarded hospitals for providing elective surgical procedures to well-insured patients while penalizing those providing the most essential and urgent services, causing hospital revenues to plummet as elective procedures were cancelled during the pandemic. Before the recession caused by the pandemic, tens of millions of Americans were unable to afford care, compromising their physical and financial health; deep-pocketed corporate interests were increasingly dominating the hospital industry and taking over physicians' practices; and insurers' profits hit record levels. Meanwhile, yawning class-based and racial inequities in care and health outcomes remain and have even widened. Recent data highlight the failure of policy strategies based on market models and the need to shift to a nonprofit social insurance model.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud/organización & administración , Neumonía Viral/epidemiología , Betacoronavirus , Costos y Análisis de Costo , Prestación de Atención de Salud/economía , Accesibilidad a los Servicios de Salud/organización & administración , Disparidades en el Estado de Salud , Humanos , Cobertura del Seguro/economía , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/economía , Seguro de Salud/estadística & datos numéricos , Medicare/economía , Pandemias , Política , Factores Socioeconómicos , Estados Unidos/epidemiología
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