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4.
East Mediterr Health J ; 26(2): 206-211, 2020 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-32141599

RESUMEN

Background: Achieving universal health coverage is a strategic goal for the Government of Jordan. Estimating the cost of expanding health coverage to vulnerable Jordanians under the Civil Insurance Programme (CIP) is an important step towards achieving this goal. Aims: This study aimed to estimate the cost and fiscal impact of expanding health insurance coverage to vulnerable Jordanians. Methods: We identified and quantified vulnerable Jordanians and estimated their utilization and cost of health services provided at Ministry of Health facilities using allocation and macrocosting approaches. We calculated the annual actuarial cost per person and the fiscal impact of the expansion. Results: It was estimated that 4.9% of Jordanians were vulnerable. On average, a vulnerable Jordanian used 1.25 ambulatory visits and 0.027 admissions fewer annually than a person insured by CIP. The annual cost (US$ 79 million) and fiscal impact (US$ 73 million) of expanding coverage to vulnerable Jordanians were due to more ambulatory services (20%) and hospitalizations (80%). Conclusion: A combination of additional resources and improvement in system efficiencies may fund this expansion.


Asunto(s)
Seguro de Salud/economía , Cobertura Universal del Seguro de Salud , Poblaciones Vulnerables , Servicios de Salud , Humanos , Jordania
5.
JAMA ; 323(9): 863-884, 2020 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-32125402

RESUMEN

Importance: US health care spending has continued to increase and now accounts for 18% of the US economy, although little is known about how spending on each health condition varies by payer, and how these amounts have changed over time. Objective: To estimate US spending on health care according to 3 types of payers (public insurance [including Medicare, Medicaid, and other government programs], private insurance, or out-of-pocket payments) and by health condition, age group, sex, and type of care for 1996 through 2016. Design and Setting: Government budgets, insurance claims, facility records, household surveys, and official US records from 1996 through 2016 were collected to estimate spending for 154 health conditions. Spending growth rates (standardized by population size and age group) were calculated for each type of payer and health condition. Exposures: Ambulatory care, inpatient care, nursing care facility stay, emergency department care, dental care, and purchase of prescribed pharmaceuticals in a retail setting. Main Outcomes and Measures: National spending estimates stratified by health condition, age group, sex, type of care, and type of payer and modeled for each year from 1996 through 2016. Results: Total health care spending increased from an estimated $1.4 trillion in 1996 (13.3% of gross domestic product [GDP]; $5259 per person) to an estimated $3.1 trillion in 2016 (17.9% of GDP; $9655 per person); 85.2% of that spending was included in this study. In 2016, an estimated 48.0% (95% CI, 48.0%-48.0%) of health care spending was paid by private insurance, 42.6% (95% CI, 42.5%-42.6%) by public insurance, and 9.4% (95% CI, 9.4%-9.4%) by out-of-pocket payments. In 2016, among the 154 conditions, low back and neck pain had the highest amount of health care spending with an estimated $134.5 billion (95% CI, $122.4-$146.9 billion) in spending, of which 57.2% (95% CI, 52.2%-61.2%) was paid by private insurance, 33.7% (95% CI, 30.0%-38.4%) by public insurance, and 9.2% (95% CI, 8.3%-10.4%) by out-of-pocket payments. Other musculoskeletal disorders accounted for the second highest amount of health care spending (estimated at $129.8 billion [95% CI, $116.3-$149.7 billion]) and most had private insurance (56.4% [95% CI, 52.6%-59.3%]). Diabetes accounted for the third highest amount of the health care spending (estimated at $111.2 billion [95% CI, $105.7-$115.9 billion]) and most had public insurance (49.8% [95% CI, 44.4%-56.0%]). Other conditions estimated to have substantial health care spending in 2016 were ischemic heart disease ($89.3 billion [95% CI, $81.1-$95.5 billion]), falls ($87.4 billion [95% CI, $75.0-$100.1 billion]), urinary diseases ($86.0 billion [95% CI, $76.3-$95.9 billion]), skin and subcutaneous diseases ($85.0 billion [95% CI, $80.5-$90.2 billion]), osteoarthritis ($80.0 billion [95% CI, $72.2-$86.1 billion]), dementias ($79.2 billion [95% CI, $67.6-$90.8 billion]), and hypertension ($79.0 billion [95% CI, $72.6-$86.8 billion]). The conditions with the highest spending varied by type of payer, age, sex, type of care, and year. After adjusting for changes in inflation, population size, and age groups, public insurance spending was estimated to have increased at an annualized rate of 2.9% (95% CI, 2.9%-2.9%); private insurance, 2.6% (95% CI, 2.6%-2.6%); and out-of-pocket payments, 1.1% (95% CI, 1.0%-1.1%). Conclusions and Relevance: Estimates of US spending on health care showed substantial increases from 1996 through 2016, with the highest increases in population-adjusted spending by public insurance. Although spending on low back and neck pain, other musculoskeletal disorders, and diabetes accounted for the highest amounts of spending, the payers and the rates of change in annual spending growth rates varied considerably.


Asunto(s)
Enfermedad/economía , Gastos en Salud/tendencias , Seguro de Salud/economía , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Gastos en Salud/estadística & datos numéricos , Estado de Salud , Humanos , Lactante , Seguro de Salud/tendencias , Masculino , Persona de Mediana Edad , Distribución por Sexo , Estados Unidos , Adulto Joven
6.
Infect Dis Poverty ; 9(1): 14, 2020 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-32019611

RESUMEN

BACKGROUND: Despite the availability of free tuberculosis (TB) diagnosis and treatment, TB care still generates substantial costs that push people into poverty. We investigated out-of-pocket (OOP) payments for TB care and assessed the resulting economic burden and economic consequences for those with varying levels of household income in eastern China. METHODS: A cross-sectional study was conducted among TB patients in the national TB programme networks in eastern China. TB-related direct OOP costs, time loss, and coping strategies were investigated across households in different economic strata. Analysis of Variance was used to examine the differences in various costs, and Kruskal-Wallis tests were used to compare the difference in total costs as a percentage of annual household income. RESULTS: Among 435 patients, the mean OOP total costs of TB care were USD 2389.5. In the lower-income quartile, OOP payments were lower, but costs as a percentage of reported annual household income were higher. Medical costs and costs prior to treatment accounted for 66.4 and 48.9% of the total costs, respectively. The lower the household income was, the higher the proportion of medical costs to total costs before TB treatment, but the lower the proportion of medical costs patients spent in the intensive phase. TB care caused 25.8% of TB-affected households to fall below the poverty line and caused the poverty gap (PG) to increase by United States Dollar (USD) 145.6. Patients in the poorest households had the highest poverty headcount ratio (70.2%) and PG (USD 236.1), but those in moderately poor households had the largest increase in the poverty headcount ratio (36.2%) and PG (USD 177.8) due to TB care. Patients from poor households were more likely to borrow money to cope with the costs of TB care; however, there were fewer social consequences, except for food insecurity, in poor households. CONCLUSIONS: Medical and pretreatment costs lead to high costs of TB care, especially among patients from the poorest households. It is necessary to train health system staff in general hospitals to promptly identify and refer TB patients. Pro-poor programmes are also needed to protect TB patients from the medical poverty trap.


Asunto(s)
Gastos en Salud , Seguro de Salud/economía , Pobreza , Tuberculosis/economía , Adulto , China , Femenino , Financiación Personal , Costos de la Atención en Salud , Humanos , Renta , Masculino , Factores Socioeconómicos , Factores de Tiempo
8.
Int J Equity Health ; 19(1): 17, 2020 01 31.
Artículo en Inglés | MEDLINE | ID: mdl-32005237

RESUMEN

BACKGROUND: As elsewhere in low- and middle-income countries, due to limited fiscal resources, universal health coverage (UHC) remains a challenge in Cambodia. Since 2016, the National Social Security Fund (NSSF) has implemented a social health insurance scheme with a contributory approach for formal sector workers. However, informal sector workers and dependents of formal sector workers are still not covered by this insurance because it is difficult to set an optimal amount of contribution for such individuals as their income levels are inestimable. The present study aims to develop and validate an efficient household income-level assessment model for Cambodia. We aim to help the country implement a financially sustainable social health insurance system in which the insured can pay contributions according to their ability. METHODS: This study will use nationally representative data collected by the Cambodia Socio-Economic Survey (CSES), covering the period from 2009 to 2019, and involving a total of 50,016 households. We will employ elastic net regression analysis, with per capita disposable income based on purchasing power parity as the dependent variable, and individual and community-level socioeconomic and demographic characteristics as independent variables. These analyses aim to create efficient income-level assessment models for health insurance contribution estimation. To fully capture socioeconomic heterogeneity, sub-group analyses will be conducted to develop separate income-level assessment models for urban and rural areas, as well as for each province. DISCUSSION: This research will help Cambodia implement a sustainable social health insurance system by collecting optimal amount of contributions from each socioeconomic group of the society. Incorporation of this approach into existing NSSF schemes will enhance the country's current efforts to prevent impoverishing health expenditure and to achieve UHC.


Asunto(s)
Gastos en Salud/estadística & datos numéricos , Seguro de Salud/economía , Seguro de Salud/organización & administración , Cambodia , Composición Familiar , Humanos , Renta/estadística & datos numéricos , Modelos Económicos , Evaluación de Programas y Proyectos de Salud
9.
JAMA ; 323(6): 538-547, 2020 02 11.
Artículo en Inglés | MEDLINE | ID: mdl-32044941

RESUMEN

Importance: Privately insured patients who receive care from in-network physicians may receive unexpected out-of-network bills ("surprise bills") from out-of-network clinicians they did not choose. In elective surgery, this can occur if patients choose in-network surgeons and hospitals but receive out-of-network bills from other involved clinicians. Objective: To evaluate out-of-network billing across common elective operations performed with in-network primary surgeons and facilities. Design, Setting, and Participants: Retrospective analysis of claims data from a large US commercial insurer, representing 347 356 patients who had undergone 1 of 7 common elective operations (arthroscopic meniscal repair [116 749]; laparoscopic cholecystectomy [82 372]; hysterectomy [67 452]; total knee replacement [42 313]; breast lumpectomy [18 018]; colectomy [14 074]; coronary artery bypass graft surgery [6378]) by an in-network primary surgeon at an in-network facility between January 1, 2012, and September 30, 2017. Follow-up ended November 8, 2017. Exposure: Patient, clinician, and insurance factors potentially related to out-of-network bills. Main Outcomes and Measures: The primary outcome was the proportion of episodes with out-of-network bills. The secondary outcome was the estimated potential balance bill associated with out-of-network bills from each surgical procedure, calculated as total out-of-network charges less the typical in-network price for the same service. Results: Among 347 356 patients (mean age, 48 [SD, 11] years; 66% women) who underwent surgery with in-network primary surgeons and facilities, 20.5% of episodes (95% CI, 19.4%-21.7%) had an out-of-network bill. In these episodes, the mean potential balance bill per episode was $2011 (95% CI, $1866-$2157) when present. Out-of-network bills were associated with surgical assistants in 37% of these episodes; when present, the mean potential balance bill was $3633 (95% CI, $3384-$3883). Out-of-network bills were associated with anesthesiologists in 37% of episodes; when present, the mean potential balance bill was $1219 (95% CI, $1049-$1388). Membership in health insurance exchange plans, compared with nonexchange plans, was associated with a significantly higher risk of out-of-network bills (27% vs 20%, respectively; risk difference, 6% [95% CI, 3.9%-8.9%]; P < .001). Surgical complications were associated with a significantly higher risk of out-of-network bills, compared with episodes with no complications (28% vs 20%, respectively; risk difference, 7% [95% CI, 5.8%-8.8%]; P < .001). Among 83 021 procedures performed at ambulatory surgery centers with in-network primary surgeons, 6.7% (95% CI, 5.8%-7.7%) included an out-of-network facility bill and 17.2% (95% CI, 15.7%-18.8%) included an out-of-network professional bill. Conclusions and Relevance: In this retrospective analysis of commercially insured patients who had undergone elective surgery at in-network facilities with in-network primary surgeons, a substantial proportion of operations were associated with out-of-network bills.


Asunto(s)
Procedimientos Quirúrgicos Electivos/economía , Honorarios Médicos , Financiación Personal/economía , Cobertura del Seguro/economía , Seguro de Salud/economía , Anestesiólogos/economía , Deducibles y Coseguros , Femenino , Humanos , Masculino , Persona de Mediana Edad , Asistentes Médicos/economía , Estudios Retrospectivos , Cirujanos/economía , Estados Unidos
10.
BMC Health Serv Res ; 20(1): 26, 2020 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-31915003

RESUMEN

BACKGROUND: Iran's Parliament passed a Law in 2010 to merge the existing health insurance schemes to boost risk pooling. Merging can be challenging as there are differences among health insurance schemes in various aspects. This qualitative prospective policy analysis aims to reveal key challenges and implementation barriers of the policy as introduced in Iran. METHODS: A qualitative study of key informants and documentary review was conducted. Sixty-seven semi-structured face-to-face interviews were conducted, with key informants from relevant stakeholders. Purposive and snowball sampling techniques were used for selecting the interviewees. The related policy documents were also reviewed and analyzed to supplement interviews. Data analysis was conducted through an existing health financing World Bank framework. RESULTS: This study demonstrated that for combining health insurance funds, operational challenges in the following areas should be taken into account: financing mechanisms, population coverage, benefits package, provider engagement, organizational structure, health service delivery and operational processes. It is also important to have adequate cogent reasons to "the justification of the consolidation process" in the given context. When moving towards combining health insurance funds, especially in countries with a purchaser-provider split, it is critical for policy makers to make sure that the health insurance system is aligned with the policies and Stewardship of the broader health care system. CONCLUSIONS: Implementation of major reforms in a health system with fragmented insurance schemes with different target populations, prepayment structures, benefit packages and history of development is inherently difficult, especially when different stakeholders have vetoing powers over the proposed reforms. Solving the differences and operational challenges in the main areas of health insurance system generated in this study may provide a platform for the designing and implementing merging process of social health insurance schemes in Iran and other countries with similar situations.


Asunto(s)
Administración Financiera/organización & administración , Política de Salud/legislación & jurisprudencia , Seguro de Salud/economía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Seguro de Salud/organización & administración , Irán , Masculino , Persona de Mediana Edad , Formulación de Políticas , Estudios Prospectivos , Investigación Cualitativa , Seguridad Social/organización & administración , Participación de los Interesados/psicología
11.
Plast Reconstr Surg ; 145(2): 545-554, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985657

RESUMEN

BACKGROUND: Following bariatric surgery, patients develop problems related to lax abdominal skin that may be addressed by contouring procedures. Third-party insurers have subjective requirements for coverage of these procedures that can limit patient access. The authors sought to determine how well third-party payers cover abdominal contouring procedures in this population. METHODS: The authors conducted a cross-sectional analysis of insurance policies for coverage of panniculectomy, lower back excision, and circumferential lipectomy. Abdominoplasty was evaluated as an alternative to panniculectomy. Insurance companies were selected based on their market share and state enrolment. A list of medical necessity criteria was abstracted from the policies that offered coverage. RESULTS: Of the 55 companies evaluated, 98 percent had a policy that covered panniculectomy versus 36 percent who would cover lower back excision (p < 0.0001), and one-third provided coverage for circumferential lipectomy. Of the insurers who covered panniculectomy, only 30 percent would also cover abdominoplasty. Documentation of secondary skin conditions was the most prevalent criterion in panniculectomy policies (100 percent), whereas impaired function and secondary skin conditions were most common for coverage of lower back excision (73 percent and 73 percent, respectively). Frequency of criteria for panniculectomy versus lower back excision differed most notably for (1) secondary skin conditions (100 percent versus 73 percent; p = 0.0030), (2) weight loss (45 percent versus 7 percent; p = 0.0106), and (3) duration of weight stability (82 percent versus 53 percent; p = 0.0415). CONCLUSIONS: For the postbariatric population, panniculectomy was covered more often and had more standardized criteria than lower back excision or circumferential lipectomy. However, all have vast intracompany and interpolicy variations in coverage criteria that may reduce access to procedures, even among patients with established indications.


Asunto(s)
Abdominoplastia/economía , Cirugía Bariátrica/economía , Contorneado Corporal/economía , Cobertura del Seguro/economía , Seguro de Salud/estadística & datos numéricos , Abdominoplastia/estadística & datos numéricos , Dorso/cirugía , Estudios Transversales , Humanos , Aseguradoras/economía , Aseguradoras/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/economía , Lipectomía/economía , Lipectomía/estadística & datos numéricos , Cuidados Posoperatorios/economía , Estados Unidos
12.
Nurse Pract ; 45(2): 38-47, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31977621

RESUMEN

Workforce and reimbursement data were collected from a 2018 survey of Washington state advanced registered nurse practitioners (ARNPs). Survey results will be used to improve workforce planning and advocate for payment parity legislation requiring health plans to pay ARNPs the same as physicians for the same service.


Asunto(s)
Enfermería de Práctica Avanzada/economía , Seguro de Salud/economía , Médicos/economía , Mecanismo de Reembolso/legislación & jurisprudencia , Estudios Transversales , Fuerza Laboral en Salud/organización & administración , Humanos , Mecanismo de Reembolso/estadística & datos numéricos , Encuestas y Cuestionarios , Washingtón
13.
Nat Hum Behav ; 4(3): 255-264, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31959926

RESUMEN

Health and social scientists have documented the hospital revolving-door problem, the concentration of crime, and long-term welfare dependence. Have these distinct fields identified the same citizens? Using administrative databases linked to 1.7 million New Zealanders, we quantified and monetized inequality in distributions of health and social problems and tested whether they aggregate within individuals. Marked inequality was observed: Gini coefficients equalled 0.96 for criminal convictions, 0.91 for public-hospital nights, 0.86 for welfare benefits, 0.74 for prescription-drug fills and 0.54 for injury-insurance claims. Marked aggregation was uncovered: a small population segment accounted for a disproportionate share of use-events and costs across multiple sectors. These findings were replicated in 2.3 million Danes. We then integrated the New Zealand databases with the four-decade-long Dunedin Study. The high-need/high-cost population segment experienced early-life factors that reduce workforce readiness, including low education and poor mental health. In midlife they reported low life satisfaction. Investing in young people's education and training potential could reduce health and social inequalities and enhance population wellbeing.


Asunto(s)
Crimen/estadística & datos numéricos , Prescripciones de Medicamentos/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Hospitales Públicos/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Salud Mental/estadística & datos numéricos , Bienestar Social/estadística & datos numéricos , Factores Socioeconómicos , Heridas y Traumatismos/epidemiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Análisis por Conglomerados , Crimen/economía , Bases de Datos Factuales , Dinamarca/epidemiología , Prescripciones de Medicamentos/economía , Escolaridad , Femenino , Hospitalización/economía , Hospitales Públicos/economía , Humanos , Lactante , Seguro de Salud/economía , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Satisfacción Personal , Bienestar Social/economía , Heridas y Traumatismos/economía , Adulto Joven
14.
BMC Health Serv Res ; 19(1): 966, 2019 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-31842861

RESUMEN

BACKGROUND: Although public medical insurance covers over 95% of the population in China, disparities in health service use and out-of-pocket (OOP) health expenditure across income groups are still widely observed. This study aims to investigate the socio-economic disparities in perceived healthcare needs, informal care, formal care and payment for healthcare and explore their equity implication. METHODS: We assessed healthcare needs, service use and payment in 400 households in rural and urban areas in Jiangsu, China, and included only the adult sample (N = 925). One baseline survey and 10 follow-up surveys were conducted during the 7-month monitoring period, and the Affordability Ladder Program (ALP) framework was adopted for data analysis. Negative binomial/zero-inflated negative binomial and logit regression models were used to explore factors associated with perceived needs of care and with the use of self-treatment, outpatient and inpatient care respectively. Two-part model and logit regression modeling were conducted to explore factors associated with OOP health expenditure and with the likelihood of incurring catastrophic health expenditure (CHE). RESULTS: After adjusting for covariates, rural residence was significantly associated with more perceived healthcare needs, more self-treatment, higher probability of using outpatient and inpatient service, more OOP health expenditure and higher likelihood of incurring catastrophic expenditure (P < 0.05). Compared to the Urban Employee Basic Medical Insurance (UEBMI), enrollment in the New Rural Cooperative Medical Scheme (NRCMS) or in the Urban Resident Basic Medical Insurance (URBMI) was correlated with lower probability of ever using outpatient services, but with more outpatient visits when people were at risk of using outpatient service (P < 0.05). NRCMS/URBMI enrollment was also associated with higher likelihood of incurring CHE compared to UEBMI enrollment (OR = 2.02, P < 0.05); in stratified analysis of the rural and urban sample this effect was only significant for the rural population. CONCLUSIONS: The rural population in Jiangsu perceived more healthcare needs, had a higher probability of using both informal and formal healthcare services, and had more OOP health expenditure and a higher likelihood of incurring CHE. The inequity mainly exists in health care financing, and may be partially addressed through improving the benefit packages of NRCMS/URBMI.


Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Programas Nacionales de Salud/economía , Adulto , Anciano , Atención Ambulatoria/economía , China , Femenino , Disparidades en Atención de Salud/economía , Humanos , Seguro de Salud/economía , Modelos Logísticos , Masculino , Persona de Mediana Edad , Población Rural , Población Urbana
15.
Int J Equity Health ; 18(1): 198, 2019 12 21.
Artículo en Inglés | MEDLINE | ID: mdl-31864355

RESUMEN

OBJECTIVES: The function of pooling and the ways that countries organize this is critical for countries' progress towards universal health coverage, but its potential as a policy instrument has not received much attention. We provide a simple classification of country pooling arrangements and discuss the specific ways that fragmentation manifests in each and the typical challenges with respect to universal health coverage objectives associated. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. METHODS: The paper is based on a review of published and grey literature in PubMed, Google and Google Scholar and our information gathered from our professional work in countries on health financing policies. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. FINDINGS: We propose eight broad types of pooling arrangements: (1.) a single pool; (2.) territorially distinct pools; (3.) territorially overlapping pools in terms of service and population coverage; (4.) different pools for different socio-economic groups with population segmentation; (5.) different pools for different population groups, with explicit coverage for all; (6.) multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6.), (7.) fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) complementary or supplementary voluntary health insurance. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. CONCLUSION: Pooling arrangements set the potential for redistributive health spending. The extent to which the potential redistributive and efficiency gains established by a particular pooling arrangement are realized in practice depends on its interaction and alignment with the other health financing functions of revenue raising and purchasing, including the links between pools and the service benefits and populations they cover.


Asunto(s)
Financiación de la Atención de la Salud , Equidad en Salud , Política de Salud , Humanos , Renta/estadística & datos numéricos , Seguro de Salud/economía , Cobertura Universal del Seguro de Salud
16.
Curr Med Sci ; 39(5): 843-851, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31612406

RESUMEN

Throughout the duration of the New Cooperative Medical Scheme (NCMS), it was found that an increasing number of rural patients were seeking out-of-county medical treatment, which posed a great burden on the NCMS fund. Our study was conducted to examine the prevalence of out-of-county hospitalizations and its related factors, and to provide a scientific basis for follow-up health insurance policies. A total of 215 counties in central and western China from 2008 to 2016 were selected. The total out-of-county hospitalization rate in nine years was 16.95%, which increased from 12.37% in 2008 to 19.21% in 2016 with an average annual growth rate of 5.66%. Its related expenses and compensations were shown to increase each year, with those in the central region being higher than those in the western region. Stepwise logistic regression reveals that the increase in out-of-county hospitalization rate was associated with region (X1), rural population (X2), per capita per year net income (X3), per capita gross domestic product (GDP) (X4), per capita funding amount of NCMS (X5), compensation ratio of out-of-county hospitalization cost (X6), per time average in-county (X7) and out-of-county hospitalization cost (X8). According to Bayesian network (BN), the marginal probability of high out-of-county hospitalization rate was as high as 81.7%. Out-of-county hospitalizations were directly related to X8, X3, X4 and X6. The probability of high out-of-county hospitalization obtained based on hospitalization expenses factors, economy factors, regional characteristics and NCMS policy factors was 95.7%, 91.1%, 93.0% and 88.8%, respectively. And how these factors affect out-of-county hospitalization and their interrelationships were found out. Our findings suggest that more attention should be paid to the influence mechanism of these factors on out-of-county hospitalizations, and the increase of hospitalizations outside the county should be reasonably supervised and controlled and our results will be used to help guide the formulation of proper intervention policies.


Asunto(s)
Prestación de Atención de Salud/economía , Gastos en Salud/estadística & datos numéricos , Hospitalización/economía , Seguro de Salud/economía , Salud Rural/economía , Teorema de Bayes , China , Prestación de Atención de Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Seguro de Salud/estadística & datos numéricos , Salud Rural/estadística & datos numéricos , Población Rural , Factores Socioeconómicos
18.
Medicine (Baltimore) ; 98(39): e17376, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31574887

RESUMEN

This study aimed to compare the catastrophic health expenditure (CHE) and impoverishment of type 2 diabetes mellitus (T2DM) patients between 2 ethnic groups and explore the contribution of associated factors to ethnic differences in CHE and impoverishment in Ningxia Hui Autonomous Region, China.A cross-sectional study was conducted in 2 public hospitals from October 2016 to June 2017. Data were collected by interviewing eligible Hui and Han T2DM inpatients and reviewing the hospital electronic records. Both CHE and impoverishment were measured by headcount and gap. The contributions of associated factors to ethnic differences were analyzed by the Blinder-Oaxaca decomposition technique.Both the CHE and impoverishment of Hui patients before and after reimbursement were significantly higher than those of Han patients. The ethnic differences in CHE and impoverishment headcount after reimbursement were 11.9% and 9.8%, respectively. The different distributions of associated factors between Hui and Han patients contributed to 60.5% and 35.7% of ethnic differences in CHE and impoverishment, respectively. Household income, occupation, and region were significant contributing factors.Hui T2DM patients suffered greater CHE and impoverishment than Han patients regardless of reimbursements from health insurance. Differences in socioeconomic status between Hui and Han patients were the main factors behind the ethnic differences.


Asunto(s)
Enfermedad Catastrófica/economía , Diabetes Mellitus Tipo 2/economía , Gastos en Salud/estadística & datos numéricos , Seguro de Salud/economía , Pobreza/economía , Anciano , China , Estudios Transversales , Diabetes Mellitus Tipo 2/etnología , Grupos Étnicos/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Socioeconómicos
19.
Obes Facts ; 12(5): 509-517, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31618737

RESUMEN

BACKGROUND: The prevalence of obesity and its related costs has increased over the past decades. In Germany, obesity-related costs are merely covered by statuary health insurance. Within the statutory health care system, the health insurance contributions do not differ between people with and without health issues, such as being obese. This study aims to investigate the public's opinion about whether people with obesity should pay a higher proportional health care contribution than people of normal weight. METHODS: We conducted a pilot study and collected thereof data of a convenience sample. In total, 179 participants who perceived themselves to be of normal weight (51.40% female; mean age = 32.46, SD = 5.74) were surveyed using a questionnaire. Within this questionnaire, the participants had to rate how high the proportional health care contribution for people with and without obesity should be. Moreover, we assessed participants' antifat attitudes by applying the Fat Phobia Scale and the Implicit Association Test. RESULTS: A paired t test revealed that participants suggest a significantly higher proportional contribution for health insurance for people with obesity compared to people with normal weight (t(178) = 4.51, p < 0.001). Logistic regression analysis indicates that people with stronger explicit (OR = 8.77, p < 0.001) and implicit stigma (OR = 1.06, p = 0.018), and higher BMI (OR = 1.27, p = 0.04) are more likely to suggest an increased contribution rate for people with obesity. CONCLUSION: Although we found that participants suggested higher contribution rates for people with obesity, overall only one-quarter of the participants suggested higher contribution rates for people with obesity, whereas almost three-quarters of the participants did not distinguish the contribution rate for people with and without obesity. Moreover, we found that the participants called for higher insurance premiums for people with and without obesity. Therefore, future studies should consider giving more information about the statutory health care system or the health care contribution rate before asking participants about their opinion.


Asunto(s)
Peso Corporal/fisiología , Seguro de Salud/economía , Seguro de Salud/estadística & datos numéricos , Obesidad/economía , Opinión Pública , Adulto , Femenino , Alemania/epidemiología , Gastos en Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Proyectos Piloto , Prevalencia , Estigma Social , Encuestas y Cuestionarios
20.
Schmerz ; 33(5): 443-448, 2019 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-31478141

RESUMEN

BACKGROUND: Since March 2017 the law amending narcotics and other legal regulations has made it possible for doctors to prescribe cannabis and cannabis-derived medicines. The introduction of § 31 para 6 of the Social Code Book V (SGB V) allows that patients can be treated with cannabis-derived medicines at the expense of the statutory health insurance if they have a severe illness. COURT DECISIONS: The law requires the approval of a prescription of cannabis for medical purposes by the health insurance before the granting of benefits. Due to denied permission, numerous cases are pending before the social tribunals. The article presents which legal issues are decided and why there is still no case law from the Federal Social Court on the essential questions. OUTLOOK: The possibility of prescribing cannabis as medicine at the expense of the health insurance is an important advance in social law. The § 31 para 6 SGB V should be evaluated as soon as possible. The provisions of SGB V for the reimbursement of off-label treatment should be harmonized with § 31 para 6 SGB V.


Asunto(s)
Cannabis , Seguro de Salud , Médicos , Prescripciones , Prestación de Atención de Salud/legislación & jurisprudencia , Alemania , Humanos , Seguro de Salud/economía , Seguro de Salud/legislación & jurisprudencia , Médicos/legislación & jurisprudencia , Prescripciones/estadística & datos numéricos
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