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1.
PLoS One ; 19(5): e0303897, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38771807

RESUMEN

China has experienced rapid development in the digital economy. Using data from 30 provinces in China between 2011 and 2017, this paper constructs a two-way fixed effects model to study the effects and mechanisms of the digital economy development on social insurance funds revenue. An increase of one unit in digital economy development led to a 0.56% increase in basic endowment insurance funds revenue and a 0.33% increase in basic health insurance funds revenue. The digital economy increased the social insurance funds revenue by promoting employment and increasing income. Furthermore, the effects of digital economic development on social insurance funds revenue were heterogeneous for different levels of economic development and urbanization. The conclusions stood after robustness tests by changing the method of weighting the digital economy indicators and using instrumental variables. This paper confirmed the positive role of the development of the digital economy in increasing the revenue of social insurance funds from the perspective of quantitative research and explored the mechanisms in depth. In order to increase social insurance funds revenue, it is essential to accelerate the development of the digital economy, especially in regions with lower economic development and urbanization, and to address the needs of the technically unemployed and those engaged in flexible employment.


Asunto(s)
Desarrollo Económico , China , Humanos , Renta , Empleo/economía , Seguridad Social/economía , Seguro de Salud/economía , Urbanización
2.
Front Public Health ; 12: 1323090, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38756872

RESUMEN

Background: It introduced an artefactual field experiment to analyze the influence of incentives from fee-for-service (FFS) and diagnosis-intervention package (DIP) payments on physicians' provision of medical services. Methods: This study recruited 32 physicians from a national pilot city in China and utilized an artefactual field experiment to examine medical services provided to patients with different health status. Results: In general, the average quantities of medical services provided by physicians under the FFS payment were higher than the optimal quantities, the difference was statistically significant. While the average quantities of medical services provided by physicians under the DIP payment were very close to the optimal quantities, the difference was not statistically significant. Physicians provided 24.49, 14.31 and 5.68% more medical services to patients with good, moderate and bad health status under the FFS payment than under the DIP payment. Patients with good, moderate and bad health status experienced corresponding losses of 5.70, 8.10 and 9.42% in benefits respectively under the DIP payment, the corresponding reductions in profits for physicians were 10.85, 20.85 and 35.51%. Conclusion: It found patients are overserved under the FFS payment, but patients in bad health status can receive more adequate treatment. Physicians' provision behavior can be regulated to a certain extent under the DIP payment and the DIP payment is suitable for the treatment of patients in relatively good health status. Doctors sometimes have violations under DIP payment, such as inadequate service and so on. Therefore, it is necessary to innovate the supervision of physicians' provision behavior under the DIP payment. It showed both medical insurance payment systems and patients with difference health status can influence physicians' provision behavior.


Asunto(s)
Planes de Aranceles por Servicios , Humanos , China , Planes de Aranceles por Servicios/economía , Masculino , Femenino , Seguro de Salud/estadística & datos numéricos , Seguro de Salud/economía , Médicos/economía , Médicos/estadística & datos numéricos , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Persona de Mediana Edad , Estado de Salud
3.
Inquiry ; 61: 469580241249092, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38742676

RESUMEN

Healthcare organizations increasingly engage in activities to identify and address social determinants of health (SDOH) among their patients to improve health outcomes and reduce costs. While several studies to date have focused on the evolving role of hospitals and physicians in these types of population health activities, much less is known about the role health insurers may play. We used data from the National Longitudinal Survey of Public Health Systems for the period 2006 to 2018 to examine trends in health insurer participation in population health activities and in the multi-sector collaborative networks that support these activities. We also used a difference-in-differences approach to examine the impact of Medicaid expansion on insurer participation in population health networks. Insurer participation increased in our study period both in the delivery of population health activities and in the integration into collaborative networks that support these activities. Insurers were most likely to participate in activities focusing on community health assessment and policy development. Results from our adjusted difference-in-differences models showed variation in association between insurer participation in population health networks and Medicaid expansion (Table 2). Population health networks in expansion states experienced significant increases insurer participation in assessment (4.48 percentage points, P < .05) and policy and planning (7.66 percentage points, P < .05) activities. Encouraging insurance coverage gains through policy mechanisms like Medicaid expansion may not only improve access to healthcare services but can also act as a driver of insurer integration into population health networks.


Asunto(s)
Aseguradoras , Seguro de Salud , Medicaid , Salud Poblacional , Humanos , Estados Unidos , Estudios Longitudinales , Seguro de Salud/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Aseguradoras/estadística & datos numéricos , Aseguradoras/tendencias , Determinantes Sociales de la Salud
4.
BMC Med Ethics ; 25(1): 56, 2024 May 16.
Artículo en Inglés | MEDLINE | ID: mdl-38755596

RESUMEN

In case of an emergency, health insurance in Germany provides easy access to medical care in emergency departments. Over 100,000 people do not have health insurance for various reasons. They are repeatedly refused treatment in emergency rooms as their right to care outside of regular insurance is often unknown or ignored.


Asunto(s)
Servicio de Urgencia en Hospital , Seguro de Salud , Negativa del Paciente al Tratamiento , Humanos , Alemania , Accesibilidad a los Servicios de Salud , Pacientes no Asegurados
5.
Support Care Cancer ; 32(6): 373, 2024 May 23.
Artículo en Inglés | MEDLINE | ID: mdl-38777864

RESUMEN

PURPOSE: Febrile neutropenia (FN) is a known side effect of chemotherapy, often requiring hospitalization. Economic burden increases with an FN episode and estimates of cost per episode should be updated from real-world data. METHODS: A retrospective claims analysis of FN episodes in patients with non-myeloid malignancies from 2014 to 2021 was performed in IQVIA PharMetrics® Plus database. FN episodes were defined as having same-day claims for neutropenia and fever or infection, plus antibiotic in outpatient settings, following a claim for chemotherapy; index date was defined as the first claim for neutropenia/fever/infection. Patients receiving bone marrow/stem cell transplant and CAR-T therapy were excluded, as were select hematologic malignancies or COVID-19. Healthcare utilization and costs were evaluated and described overall, by episode type (w/wo hospitalization), index year, malignancy type, NCI comorbidity score, and age group. RESULTS: 7,033 FN episodes were identified from 6,825 patients. Most episodes had a hospitalization (91.2%) and 86% of patients had ≥1 risk factor for FN. Overall, FN episodes had a mean (SD) FN-related cost of $25,176 ($39,943). Episodes with hospitalization had higher average FN-related costs versus those without hospitalization ($26,868 vs $7,738), and costs increased with comorbidity score (NCI=0: $23,095; NCI >0-2: $26,084; NCI ≥2: $26,851). CONCLUSIONS: FN continues to be associated with significant economic burden, and varied by cancer type, comorbidity burden, and age. In this analysis, most FN episodes were not preceded by GCSF prophylaxis. The results of this study highlight the opportunity to utilize GCSF in appropriate oncology scenarios.


Asunto(s)
Neutropenia Febril Inducida por Quimioterapia , Humanos , Estudios Retrospectivos , Masculino , Persona de Mediana Edad , Femenino , Estados Unidos , Adulto , Anciano , Neutropenia Febril Inducida por Quimioterapia/etiología , Neutropenia Febril Inducida por Quimioterapia/economía , Neoplasias/tratamiento farmacológico , Neoplasias/complicaciones , Aceptación de la Atención de Salud/estadística & datos numéricos , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Adulto Joven , Adolescente , Antineoplásicos/efectos adversos , Antineoplásicos/economía , Seguro de Salud/estadística & datos numéricos , Seguro de Salud/economía , Recursos en Salud/estadística & datos numéricos , Recursos en Salud/economía
6.
Medicina (Kaunas) ; 60(5)2024 Apr 29.
Artículo en Inglés | MEDLINE | ID: mdl-38792927

RESUMEN

Background and Objective: The aim of this study was to analyze trends in surgical and non-surgical service utilization for common shoulder disorders in Korea from 2010 to 2019. Methods and Materials: This retrospective, cross-sectional, descriptive study utilized National Patient Sample data from the Health Insurance and Review Assessment Service (HIRA) of Korea. These data constitute a 2% sample out of the entire Korean population and include data for a variety of parameters instrumental for health care research. Patients with at least one medical service use for rotator cuff syndrome or tear, impingement syndrome, or adhesive capsulitis between January 2010 and December 2019 were included. Trends in healthcare utilization by disorder type, patient demographics, seasonal service use, and treatment details were examined. Results: There was an upward trend in the total number of patients and costs for shoulder disorders, from 35,798 patients and USD 5,485,196 in 2010 to 42,558 and USD 11,522,543 in 2019, respectively. The number of patients aged ≥60 and hospital visits increased. March had the highest number of claims. Physical therapy was the most common non-surgical procedure, while nerve block claims more than doubled. Opioid prescription rates also tripled. Surgical treatments were dominated by shoulder rotator cuff repair and acromioplasty. Conclusions: There was a significant increase in healthcare utilization for shoulder disorders, marked by rising costs and patient numbers. The use of nerve blocks and opioids notably increased. These data are valuable for clinicians, researchers, and policymakers.


Asunto(s)
Aceptación de la Atención de Salud , Humanos , República de Corea/epidemiología , Estudios Transversales , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Anciano , Aceptación de la Atención de Salud/estadística & datos numéricos , Lesiones del Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/terapia , Adolescente , Síndrome de Abducción Dolorosa del Hombro/cirugía , Síndrome de Abducción Dolorosa del Hombro/terapia , Seguro de Salud/estadística & datos numéricos
7.
BMC Nephrol ; 25(1): 162, 2024 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-38730393

RESUMEN

BACKGROUND: Although approximately 25% of Brazilians have private health coverage (PHC), studies on the surveillance of chronic kidney disease (CKD) in this population are scarce. The objective of this study was to estimate the prevalence of CKD in individuals under two PHC regimes in Brazil, who total 8,335,724 beneficiaries. METHODS: Outpatient serum creatinine and proteinuria results of individuals from all five regions of Brazil, ≥ 18 years of age, and performed between 10/01/2021 and 10/31/2022, were analyzed through the own laboratory network database. People with serum creatinine measurements were evaluated for the prevalence and staging of CKD, and those with simultaneous measurements of serum creatinine and proteinuria were evaluated for the risk category of the disease. CKD was classified according to current guidelines and was defined as a glomerular filtration rate (GFR) < 60 ml/min/1.73 m² estimated by the 2021 CKD-EPI equation. RESULTS: The number of adults with serum creatinine results was 1,508,766 (age 44.0 [IQR, 33.9-56.8] years, 62.3% female). The estimated prevalence of CKD was 3.8% (2.6%, 0.8%, 0.2% and 0.2% in CKD stages 3a, 3b, 4 and 5, respectively), and it was higher in males than females (4.0% vs. 3.7%, p < 0.001, respectively) and in older age groups (0.2% among 18-29-year-olds, 0.5% among 30-44-year-olds, 2.0% among 45-59-year-olds, 9.4% among 60-74-year-olds, and 32.4% among ≥ 75-year-olds, p < 0.001) Adults with simultaneous results of creatinine and proteinuria were 64,178 (age 57.0 [IQR, 44.8-67.3] years, 58.1% female). After adjusting for age and gender, 70.1% were in the low-risk category of CKD, 20.0% were in the moderate-risk category, 5.8% were in the high-risk category, and 4.1% were in the very high-risk category. CONCLUSION: The estimated prevalence of CKD was 3.8%, and approximately 10% of the participants were in the categories of high or very high-risk of the disease. While almost 20% of beneficiaries with PHC had serum creatinine data, fewer than 1% underwent tests for proteinuria. This study was one of the largest ever conducted in Brazil and the first one to use the 2021 CKD-EPI equation to estimate the prevalence of CKD.


Asunto(s)
Creatinina , Insuficiencia Renal Crónica , Humanos , Masculino , Femenino , Brasil/epidemiología , Persona de Mediana Edad , Adulto , Insuficiencia Renal Crónica/epidemiología , Creatinina/sangre , Prevalencia , Anciano , Vigilancia de la Población/métodos , Adulto Joven , Adolescente , Seguro de Salud/estadística & datos numéricos , Proteinuria/epidemiología , Tasa de Filtración Glomerular
8.
PLoS One ; 19(5): e0303997, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38781252

RESUMEN

BACKGROUND: The Chinese government has been promoting commercial medical insurance (CMI) in recent decades as it plays an increasingly important role in addressing disease burden, health inequities, and other healthcare challenges. However, compared with developed countries, the CMI is still less fledged with low coverage. OBJECTIVE: This study aims to explore the factors associated with enrollment in CMI, with regards to explicit characteristics (including sociodemographic characteristics and family economic status), latent characteristics (including social security status), and the global incentive compatibility index (including health status), to inform the design of CMI to improve its coverage in China. METHODS: Based on the principal-agent model, we summarized and classified the factors associated with the enrollment in CMI, and then analyzed the data generated from the Chinese General Social Survey in 2015,2018 and 2021 respectively. A comparison of factors regarding sociodemographic characteristics, family economic status, social security status, and health status was conducted between individuals enrolled and unenrolled in CMI using Mann-Whitney U test and Chi-square test. Binary logistic regression analysis was used to explore factors influencing the enrollment status of CMI. RESULTS: Of all individuals, the proportion of enrolled individuals shows an increasing trend year by year, with 8.7%,11.8% and 14.1% enrolled in CMI in 2015,2018 and 2021, respectively. The binary regression analysis further suggested that the factors associated with the enrollment in CMI were consistent in 2015,2018 and 2021.We found that individuals divorced, obese, who had a higher level of education, had non-agricultural household registration, perceived themselves as the upper social status, conducted daily exercise, had more family houses, had a car, had investment activities, or did not have basic health insurance were more likely to be enrolled in CMI. CONCLUSIONS: We identified multidimensional factors associated with the enrollment of CMI, which help inform the government and insurance industry to improve the coverage of CMI.


Asunto(s)
Seguro de Salud , Humanos , China , Seguro de Salud/economía , Femenino , Masculino , Adulto , Persona de Mediana Edad , Encuestas y Cuestionarios , Factores Socioeconómicos , Adulto Joven , Adolescente , Anciano , Estado de Salud
10.
BMC Public Health ; 24(1): 1309, 2024 May 14.
Artículo en Inglés | MEDLINE | ID: mdl-38745323

RESUMEN

BACKGROUND: The National Drug Price Negotiation (NDPN) policy has entered a normalisation stage, aiming to alleviate, to some extent, the disease-related and economic burdens experienced by cancer patients. This study analysed the use and subsequent burden of anticancer medicines among cancer patients in a first-tier city in northeast China. METHODS: We assessed the usage of 64 negotiated anticancer medicines using the data on the actual drug deployment situation, the frequency of medical insurance claims and actual medication costs. The affordability of these medicines was measured using the catastrophic health expenditure (CHE) incidence and intensity of occurrence. Finally, we used the defined daily doses (DDDs) and defined daily doses cost (DDDc) as indicators to evaluate the actual use of these medicines in the region. RESULTS: During the study period, 63 of the 64 medicines were readily available. From the perspective of drug usage, the frequency of medical insurance claims for negotiated anticancer medicines and medication costs showed an increasing trend from 2018 to 2021. Cancer patients typically sought medical treatment at tertiary hospitals and purchased medicines at community pharmacies. The overall quantity and cost of medications for patients covered by the Urban Employee Basic Medical Insurance (UEBMI) were five times higher than those covered by the Urban and Rural Resident Medical Insurance (URRMI). The frequency of medical insurance claims and medication costs were highest for lung and breast cancer patients. Furthermore, from 2018 to 2021, CHE incidence showed a decreasing trend (2.85-1.60%) under urban patients' payment capability level, but an increasing trend (11.94%-18.42) under rural patients' payment capability level. The average occurrence intensities for urban (0.55-1.26 times) and rural (1.27-1.74 times) patients showed an increasing trend. From the perspective of drug utilisation, the overall DDD of negotiated anticancer medicines showed an increasing trend, while the DDDc exhibited a decreasing trend. CONCLUSION: This study demonstrates that access to drugs for urban cancer patients has improved. However, patients' medical behaviours are affected by some factors such as hospital level and type of medical insurance. In the future, the Chinese Department of Health Insurance Management should further improve its work in promoting the fairness of medical resource distribution and strengthen its supervision of the nation's health insurance funds.


Asunto(s)
Antineoplásicos , Costos de los Medicamentos , Seguro de Salud , Humanos , China , Antineoplásicos/economía , Antineoplásicos/uso terapéutico , Costos de los Medicamentos/estadística & datos numéricos , Seguro de Salud/economía , Seguro de Salud/estadística & datos numéricos , Neoplasias/tratamiento farmacológico , Neoplasias/economía , Femenino , Masculino , Negociación , Gastos en Salud/estadística & datos numéricos , Persona de Mediana Edad
11.
BMC Psychol ; 12(1): 271, 2024 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-38750576

RESUMEN

BACKGROUND: Little research has investigated predictors of specialty substance use treatment gaps among Black adults. This study examined differential odds of experiencing self-reported, past-year treatment gaps among Black adults with respect to sexual minority status and health insurance coverage, accounting for social cofactors. METHOD: This cross-sectional study comprised 36,098 Black Americans aged 18 and older who completed the 2015-2019 National Survey on Drug Use and Health (NSDUH) and provided responses for all selected survey items. Design-based multivariable logistic regression models were used to examine predictors of drug and alcohol treatment gaps. RESULTS: Sexual minority Black adults reported greater odds of experiencing treatment gaps to specialty treatment (i.e., inpatient hospital, inpatient/outpatient rehabilitation facility, or mental health center) compared to Black heterosexuals in adjusted models (Gay or lesbian: AOR = 2.01, 95% CI = 1.39-2.89; Bisexual: AOR = 2.35, 95% CI = 1.77-3.12), with bisexual Black women experiencing the greatest odds (AOR = 3.10, 95% CI = 2.33-4.14). Black adults with no health insurance were significantly more likely to report substance use treatment gaps relative to their peers with health insurance coverage (AOR = 50, 95% CI = 1.26-1.78). CONCLUSION: The results suggest a critical need for more investigations into patterns of specialty substance use treatment gaps within Black populations and for developing sexual identity-affirming mechanisms for closing the disparity gap, particularly for Black sexual minorities and those who lack health insurance coverage.


Asunto(s)
Negro o Afroamericano , Cobertura del Seguro , Minorías Sexuales y de Género , Trastornos Relacionados con Sustancias , Humanos , Femenino , Masculino , Adulto , Trastornos Relacionados con Sustancias/etnología , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapia , Minorías Sexuales y de Género/estadística & datos numéricos , Negro o Afroamericano/estadística & datos numéricos , Estudios Transversales , Cobertura del Seguro/estadística & datos numéricos , Persona de Mediana Edad , Estados Unidos , Adulto Joven , Adolescente , Factores de Riesgo , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Anciano
12.
J Prim Care Community Health ; 15: 21501319241255542, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38769775

RESUMEN

OBJECTIVE: To estimate and compare the proportion of foreign-born Middle Eastern/North African (MENA) children without health insurance, public, or private insurance to foreign- and US-born White and US-born MENA children. METHODS: Using 2000 to 2018 National Health Interview Survey data (N = 311 961 children) and 2015 to 2019 American Community Survey data (n = 1 892 255 children), we ran multivariable logistic regression to test the association between region of birth among non-Hispanic White children (independent variable) and health insurance coverage types (dependent variables). RESULTS: In the NHIS and ACS, foreign-born MENA children had higher odds of being uninsured (NHIS OR = 1.50, 95%CI = 1.10-2.05; ACS OR = 2.11, 95%CI = 1.88-2.37) compared to US-born White children. In the ACS, foreign-born MENA children had 2.11 times higher odds (95%CI = 1.83-2.45) of being uninsured compared to US-born MENA children. CONCLUSION: Our findings have implications for the health status of foreign-born MENA children, who are currently more likely to be uninsured. Strategies such as interventions to increase health insurance enrollment, updating enrollment forms to capture race, ethnicity, and nativity can aid in identifying and monitoring key disparities among MENA children.


Asunto(s)
Negro o Afroamericano , Seguro de Salud , Pacientes no Asegurados , Humanos , Niño , Masculino , Femenino , Seguro de Salud/estadística & datos numéricos , Estados Unidos , Preescolar , Adolescente , Pacientes no Asegurados/estadística & datos numéricos , Lactante , Negro o Afroamericano/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Medio Oriente/etnología , Cobertura del Seguro/estadística & datos numéricos , África del Norte/etnología , Población Blanca/estadística & datos numéricos , Modelos Logísticos , Recién Nacido
13.
BMC Musculoskelet Disord ; 25(1): 406, 2024 May 23.
Artículo en Inglés | MEDLINE | ID: mdl-38783258

RESUMEN

BACKGROUND: Health services utilization related to hip osteoarthritis imposes a significant burden on society and health care systems. Our aim was to analyse the epidemiological and health insurance disease burden of hip osteoarthritis in Hungary based on nationwide data. METHODS: Data were extracted from the nationwide financial database of the National Health Insurance Fund Administration (NHIFA) of Hungary for the year 2018. The analysed data included annual patient numbers, prevalence, and age-standardized prevalence per 100,000 population in outpatient care, health insurance costs calculated for age groups and sexes for all types of care. Patients with hip osteoarthritis were identified using code M16 of the International Classification of Diseases (ICD), 10th revision. Age-standardised prevalence rates were calculated using the European Standard Population 2013 (ESP2013). RESULTS: Based on patient numbers of outpatient care, the prevalence per 100,000 among males was 1,483.7 patients (1.5%), among females 2,905.5 (2.9%), in total 2,226.2 patients (2.2%). The age-standardised prevalence was 1,734.8 (1.7%) for males and 2,594.8 (2.6%) for females per 100,000 population, for a total of 2,237.6 (2.2%). The prevalence per 100,000 population was higher for women in all age groups. In age group 30-39, 40-49, 50-59, 60-69 and 70 + the overall prevalence was 0.2%, 0.8%, 2.7%, 5.0% and 7.7%, respectively, describing a continuously increasing trend. In 2018, the NHIFA spent 42.31 million EUR on the treatment of hip osteoarthritis. Hip osteoarthritis accounts for 1% of total nationwide health insurance expenditures. 36.8% of costs were attributed to the treatment of male patients, and 63.2% to female patients. Acute inpatient care, outpatient care and chronic and rehabilitation inpatient care were the main cost drivers, accounting for 62.7%, 14.6% and 8.2% of the total health care expenditure for men, and 51.0%, 20.0% and 11.2% for women, respectively. The average annual treatment cost per patient was 3,627 EUR for men and 4,194 EUR for women. CONCLUSIONS: The prevalence of hip osteoarthritis was 1.96 times higher (the age-standardised prevalence was 1.5 times higher) in women compared to men. Acute inpatient care was the major cost driver in the treatment of hip osteoarthritis. The average annual treatment cost per patient was 15.6% higher for women compared to men.


Asunto(s)
Osteoartritis de la Cadera , Humanos , Masculino , Femenino , Osteoartritis de la Cadera/epidemiología , Osteoartritis de la Cadera/economía , Osteoartritis de la Cadera/terapia , Persona de Mediana Edad , Hungría/epidemiología , Anciano , Adulto , Prevalencia , Costo de Enfermedad , Anciano de 80 o más Años , Adulto Joven , Adolescente , Bases de Datos Factuales , Costos de la Atención en Salud/estadística & datos numéricos , Seguro de Salud/economía , Seguro de Salud/estadística & datos numéricos , Atención Ambulatoria/economía , Atención Ambulatoria/estadística & datos numéricos
15.
Front Public Health ; 12: 1370563, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38799684

RESUMEN

The Trump administration terminated cost-sharing reductions (CSRs) payments to health insurers in 2017, while still required insurers to provide CSRs to eligible enrollees in the Marketplace. Marketplace administration data reveals that, in response to this termination, insurers raised premiums to compensate for their loss. Consequently, premium increases led to more advanced premium tax credits for enrollees in the Marketplace. To investigate the impact of CSRs payment termination on low-income consumer insurance plan choices, I leverage variations in state price regulations and employed a difference-in-differences design. In a robustness analysis, I utilized differences in county income distributions to examine the effects of the termination on insurance choices. The results indicate that after the termination, more low-income enrollees opted for cheaper bronze plans, and fewer chose silver plans. These results suggest that alterations in subsidy channels may inadvertently encourage low-income individuals to purchase less expensive health insurance plans, highlighting an unintended consequence of the termination of cost-sharing subsidies.


Asunto(s)
Seguro de Costos Compartidos , Intercambios de Seguro Médico , Seguro de Salud , Seguro de Costos Compartidos/economía , Humanos , Seguro de Salud/economía , Seguro de Salud/estadística & datos numéricos , Estados Unidos , Intercambios de Seguro Médico/economía , Intercambios de Seguro Médico/estadística & datos numéricos , Conducta de Elección , Pobreza
16.
PLoS One ; 19(5): e0303493, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38739628

RESUMEN

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic exhibited several different waves threatening global health care. During this pandemic, medical resources were depleted. However, the kind of medical resources provided to each wave was not clarified. This study aimed to examine the characteristics of medical care provision at COVID-19 peaks in preparation for the next pandemic. METHODS: Using medical insurance claim records in Japan, we examined the presence or absence of COVID-19 infection and the use of medical resources for all patients monthly by age group. RESULTS: The wave around August 2021 with the Delta strain had the strongest impact on the working population in terms of hospital admission and respiratory support. For healthcare providers, this peak had the highest frequency of severely ill patients. In the subsequent wave, although the number of patients with COVID-19 remained high, they were predominantly older adults, with relatively fewer patients receiving intensive care. CONCLUSIONS: In future pandemics, we should refer to the wave around August 2021 as a situation of medical resource shortage resulting from the COVID-19 pandemic.


Asunto(s)
COVID-19 , Bases de Datos Factuales , Seguro de Salud , Humanos , COVID-19/epidemiología , Japón/epidemiología , Adulto , Persona de Mediana Edad , Anciano , Masculino , Femenino , SARS-CoV-2/aislamiento & purificación , Recursos en Salud , Pandemias , Hospitalización/estadística & datos numéricos , Adulto Joven , Adolescente , Revisión de Utilización de Seguros
17.
JAMA Netw Open ; 7(5): e2410763, 2024 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-38739390

RESUMEN

Importance: Individuals with congenital heart disease (CHD) are increasingly reaching childbearing age, are more prone to adverse pregnancy events, and uncommonly undergo recommended cardiac evaluations. Data to better understand resource allocation and financial planning are lacking. Objective: To examine health care use and costs for patients with CHD during pregnancy. Design, Setting, and Participants: This retrospective cohort study was performed from January 1, 2010, to December 31, 2016, using Merative MarketScan commercial insurance data. Participants included patients with CHD and those without CHD matched 1:1 by age, sex, and insurance enrollment year. Pregnancy claims were identified for all participants. Data were analyzed from September 2022 to March 2024. Exposures: Baseline characteristics (age, US region, delivery year, insurance type) and pregnancy-related events (obstetric, cardiac, and noncardiac conditions; birth outcomes; and cesarean delivery). Main Outcomes and Measures: Health service use (outpatient physician, nonphysician, emergency department, prescription drugs, and admissions) and costs (total and out-of-pocket costs adjusted for inflation to represent 2024 US dollars). Results: A total of 11 703 pregnancies (mean [SD] maternal age, 31.5 [5.4] years) were studied, with 2267 pregnancies in 1785 patients with CHD (492 pregnancies in patients with severe CHD and 1775 in patients with nonsevere CHD) and 9436 pregnancies in 7720 patients without CHD. Compared with patients without CHD, pregnancies in patients with CHD were associated with significantly higher health care use (standardized mean difference [SMD] range, 0.16-1.46) and cost (SMD range, 0.14-0.55) except for out-of-pocket inpatient and ED costs. After adjustment for covariates, having CHD was independently associated with higher total (adjusted cost ratio, 1.70; 95% CI, 1.57-1.84) and out-of-pocket (adjusted cost ratio, 1.40; 95% CI, 1.22-1.58) costs. The adjusted mean total costs per pregnancy were $15 971 (95% CI, $15 480-$16 461) for patients without CHD, $24 290 (95% CI, $22 773-$25 806) for patients with any CHD, $26 308 (95% CI, $22 788-$29 828) for patients with severe CHD, and $23 750 (95% CI, $22 110-$25 390) for patients with nonsevere CHD. Patients with vs without CHD incurred $8319 and $700 higher total and out-of-pocket costs per pregnancy, respectively. Conclusions and Relevance: This study provides novel, clinically relevant estimates for the cardio-obstetric team, patients with CHD, payers, and policymakers regarding health care and financial planning. These estimates can be used to carefully plan for and advocate for the comprehensive resources needed to care for patients with CHD.


Asunto(s)
Costos de la Atención en Salud , Cardiopatías Congénitas , Seguro de Salud , Humanos , Femenino , Embarazo , Cardiopatías Congénitas/economía , Adulto , Estudios Retrospectivos , Seguro de Salud/estadística & datos numéricos , Seguro de Salud/economía , Estados Unidos , Costos de la Atención en Salud/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto Joven , Complicaciones Cardiovasculares del Embarazo/economía , Complicaciones Cardiovasculares del Embarazo/terapia
18.
BMC Geriatr ; 24(1): 439, 2024 May 18.
Artículo en Inglés | MEDLINE | ID: mdl-38762460

RESUMEN

BACKGROUND: Universal Health Coverage has been openly recognized in the United Nations health-related Sustainable Development Goals by 2030, though missing under the Millennium Development Goals. Ghana implemented the National Health Insurance Scheme programme in 2004 to improve financial access to healthcare for its citizens. This programme targeting low-income individuals and households includes an Exempt policy for older persons and indigents. Despite population ageing, evidence of the participation and perceptions of older persons in the scheme in cash grant communities is unknown. Hence, this paper examined the prevalence, perceptions and factors associated with health insurance enrollment among older persons in cash grant communities in Ghana. METHODS: Data were from a cross-sectional household survey of 400 older persons(60 + years) and eight FGDs between 2017 and 2018. For the survey, stratified and simple random sampling techniques were utilised in selecting participants. Purposive and stratified sampling techniques were employed in selecting the focus group discussion participants. Data analyses included descriptive, modified Poisson regression approach tested at a p-value of 0.05 and thematic analysis. Stata and Atlas-ti software were used in data management and analyses. RESULTS: The mean age was 73.7 years. 59.3% were females, 56.5% resided in rural communities, while 34.5% had no formal education. Two-thirds were into agriculture. Three-fourth had non-communicable diseases. Health insurance coverage was 60%, and mainly achieved as Exempt by age. Being a female [Adjusted Prevalence Ratio (APR) 1.29, 95%CI:1.00-1.67], having self-rated health status as bad [APR = 1.34, 95%CI:1.09-1.64] and hospital healthcare utilisation [APR = 1.49, 95%CI:1.28-1.75] were positively significantly associated with health insurance enrollment respectively. Occupation in Agriculture reduced insurance enrollment by 20.0%. Cited reasons for poor perceptions of the scheme included technological challenges and unsatisfactory services. CONCLUSION: Health insurance enrollment among older persons in cash grant communities is still not universal. Addressing identified challenges and integrating the views of older persons into the programme have positive implications for securing universal health coverage by 2030.


Asunto(s)
Seguro de Salud , Humanos , Ghana/epidemiología , Femenino , Estudios Transversales , Masculino , Anciano , Persona de Mediana Edad , Anciano de 80 o más Años , Prevalencia , Cobertura Universal del Seguro de Salud/economía , Accesibilidad a los Servicios de Salud , Programas Nacionales de Salud/economía
19.
Front Public Health ; 12: 1372821, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38770361

RESUMEN

Background: Due to the expanding coverage of medical insurance and the growth of medical expenses, the ability to assess the performance of designated medical institutions (DMIs) in supporting the delivery of high-quality patient care and the standardized use of funds represents a priority in China. Despite such interest, there has yet to be an operable standard and labor-saving method for assessing DMIs in China. Objective: The main objectives include two aspects: (1) establishing an evaluation index system for DMIs based on contracts; (2) designing and developing an online evaluation platform. Methods: A group of 20 experts with theoretical and practical expertise in medical insurance regulation and performance evaluation were invited to select available indicators. A combination weighting method based on analytic hierarchy process and entropy method was used to determine the weight coefficient. Shanghai was taken as the sample area, and 760 DMIs were included in the empirical research. The test-retest reliability method and criterion-related validity method was used to test the reliability and the validity of the evaluation result. Results: An assessment index system that included 6 domains and 56 indicators was established in this study. Furthermore, we developed an online platform to assist in the implementation of the assessment. The results showed that the average score of assessment was 94.39, the median was 96.92. The test-retest reliability value was 0.96 (P ≤ 0.01), which indicated high stability of the assessment. In addition, there was a significant negative relationship between assessment score and the penalty amount of DMIs (R = -0.133, P < 0.001). After adjusting for the basic characteristics of medical institutions, the number of visits and revenue, the negative relationship was still significant (B = -0.080, P < 0.05). These results are consistent with expectations, indicating that the assessment had good criterion-related validity. Conclusions: This study established an operable assessment measure and developed an online platform to assess the performance of DMIs. The results showed good feasibility and reliability in empirical research. Our research findings provided an operable Chinese solution for DMI assessment that saves manpower and time, which would have good enlightening significance in other regions of China and in low-income and middle-income countries internationally.


Asunto(s)
Seguro de Salud , China , Humanos , Reproducibilidad de los Resultados , Internet
20.
BMJ Open ; 14(5): e081989, 2024 May 03.
Artículo en Inglés | MEDLINE | ID: mdl-38702082

RESUMEN

OBJECTIVES: This study was conducted to assess financial protection and equity in the healthcare financing system among slum dwellers with type 2 diabetes (T2D) in Iran in 2022. DESIGN: Cross-sectional study. SETTING: Primary care centres in Iran were selected from slums. PARTICIPANTS: Our study included 400 participants with T2D using a systematic random sampling method. Patients were included if they lived in slums for at least five consecutive years, were over 18 years old and did not have intellectual disabilities. PRIMARY AND SECONDARY MEASURES: A self-report questionnaire was used to assess cost-coping strategies vis-à-vis T2D expenditures and factors influencing them, as well as forgone care among slum dwellers. RESULTS: Of the 400 patients who participated, 53.8% were female. Among the participants, 27.8% were illiterate, but 30.3% could read and write. 75.8% had income below 40 million Rial. There was an association between age, education, income, basic insurance, supplemental insurance and cost-coping strategies (p<0.001). 88.2% of those with first university degree used health insurance and 34% of illiterate people used personal savings. 79.8% of people with income over 4 million Rial reported using insurance to cope with healthcare costs while 55% of those with income under 4 million Rial reported using personal savings and a combination of health insurance and personal savings to cope with healthcare costs. As a result of binary logistic regression, illiterate people (adjusted OR=16, 95% CI 3.65 to 70.17), individuals with low income (OR 5.024, 95% CI 2.42 to 10.41) and people without supplemental insurance (OR 1.885, 95% CI 0.03 to 0.37) are more likely to use other forms of cost-coping strategies than health insurance. CONCLUSIONS: As a result of insufficient use of insurance, cost-coping strategies used by slum dwellers vis-à-vis T2D expenditures do not protect them from financial risks. Expanding universal health coverage and providing supplemental insurance for those with T2D living in slums are recommended. Iran Health Insurance should adequately cover the costs of T2D care for slum dwellers so that they do not need to use alternative strategies.


Asunto(s)
Diabetes Mellitus Tipo 2 , Áreas de Pobreza , Humanos , Femenino , Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/terapia , Estudios Transversales , Masculino , Irán , Persona de Mediana Edad , Adulto , Financiación de la Atención de la Salud , Gastos en Salud/estadística & datos numéricos , Anciano , Seguro de Salud/economía , Seguro de Salud/estadística & datos numéricos , Encuestas y Cuestionarios
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