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1.
Urol Clin North Am ; 47(2): 193-204, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32272991

RESUMEN

Although infertility is now recognized as a disease by multiple organizations including the World Health Organization and the American Medical Association, private insurance companies rarely include coverage for infertility treatments. In this review, the authors assess the current state of care delivery for male infertility care in the United States. They discuss the scope of male infertility as well as the unique burdens it places on patients and review emerging market forces that could affect the future of care delivery for male infertility.


Asunto(s)
Prestación de Atención de Salud/métodos , Prestación de Atención de Salud/tendencias , Infertilidad Masculina/diagnóstico , Infertilidad Masculina/terapia , Cobertura del Seguro/legislación & jurisprudencia , Seguro de Salud/legislación & jurisprudencia , Comorbilidad , Prestación de Atención de Salud/estadística & datos numéricos , Predicción , Política de Salud/legislación & jurisprudencia , Humanos , Infertilidad/diagnóstico , Infertilidad/economía , Infertilidad/terapia , Infertilidad Masculina/economía , Infertilidad Masculina/epidemiología , Masculino , Estados Unidos/epidemiología
7.
Occup Environ Med ; 77(1): 32-39, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31792081

RESUMEN

OBJECTIVES: To determine the impact of legislative changes to the New South Wales (NSW) workers' compensation scheme on injured workers access to benefits, insurer claim processing and work disability duration. METHODS: Population-based interrupted time series study of workers' compensation claims made in NSW 2 years before and after legislative amendment in June 2012. Outcomes included incidence of accepted claims per 100 000 workers, the median and 75th percentile insurer decision time in days, and the median and 75th percentile of work disability duration in weeks. Effects were assessed relative to a comparator of seven other Australian workers' compensation jurisdictions. RESULTS: n=1 069 231 accepted workers' compensation claims were analysed. Claiming in NSW fell 15.3% following legislative reform, equivalent to 46.6 fewer claims per 100 000 covered workers per month. This effect was greater in time loss claims (17.3%) than medical-only claims (10.3%). Across models, there were consistent trend increases in insurer decision time. Median work disability duration increased following the legislative reform. CONCLUSIONS: The observed reduction in access to benefits was consistent with the policy objective of improving the financial sustainability of the compensation scheme. However, this was accompanied by changes in other markers of performance that were unintended, and are suggestive of adverse health consequences of the reform. This study demonstrates the need for care in reform of workers' compensation scheme policy.


Asunto(s)
Reforma de la Atención de Salud , Seguro de Salud/legislación & jurisprudencia , Indemnización para Trabajadores/legislación & jurisprudencia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia , Femenino , Política de Salud , Humanos , Análisis de Series de Tiempo Interrumpido , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
11.
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
12.
Tex Med ; 115(8): 18-19, 2019 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-31369142

RESUMEN

TMA went into this session looking to attack insurer network inadequacy and health plans' use of care-impeding prior authorization demands. On both fronts, medicine scored solid legislative wins that will make it easier for patients and physicians to know who's in network, and provide needed transparency on preauthorization requirements. And on surprise billing, medicine turned what could've been a disastrous bill into something more palatable.


Asunto(s)
Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Seguro de Salud/legislación & jurisprudencia , Humanos , Autorización Previa/legislación & jurisprudencia , Texas
13.
Plast Reconstr Surg ; 144(3): 560-568, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31461002

RESUMEN

BACKGROUND: New York State passed the Breast Cancer Provider Discussion Law in 2010, mandating discussion of insurance coverage for reconstruction and expedient plastic surgical referral, two significant factors found to affect reconstruction rates. This study examines the impact of this law. METHODS: A retrospective cohort study of the New York State Planning and Research Cooperative System database to examine breast reconstruction rates 3 years before and 3 years after law enactment was performed. Difference-interrupted time series models were used to compare trends in the reconstruction rates by sociodemographic factors and provider types. RESULTS: The study included 32,452 patients. The number of mastectomies decreased from 6479 in 2008 to 5235 in 2013; the rate of reconstruction increased from 49 percent in 2008 to 62 percent in 2013. This rise was seen across all median income brackets, races, and age groups. When comparing before to after law enactment, the increase in risk-adjusted reconstruction rates was significantly higher for African Americans and elderly patients, but the disparity in reconstruction rates did not change for other races, different income levels, or insurance types. Reconstruction rates were also not significantly different between those treated in various hospital settings. CONCLUSIONS: The aim of the Breast Cancer Provider Discussion Law is to improve reconstruction rates through provider-driven patient education. The authors' data show significant change following law passage in African American and elderly populations, suggesting effectiveness of the law. The New York State Provider Discussion Law may provide a template for other states to model legislation geared toward patient-centered improvement of health outcomes.


Asunto(s)
Neoplasias de la Mama/cirugía , Disparidades en Atención de Salud , Cobertura del Seguro , Seguro de Salud , Mamoplastia , Mastectomía/estadística & datos numéricos , Adulto , Anciano , Femenino , Disparidades en Atención de Salud/legislación & jurisprudencia , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Seguro de Salud/legislación & jurisprudencia , Mamoplastia/legislación & jurisprudencia , Mamoplastia/estadística & datos numéricos , Persona de Mediana Edad , New York , Atención Dirigida al Paciente/normas , Estudios Retrospectivos
14.
Med Care ; 57(8): 567-573, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31299024

RESUMEN

BACKGROUND: Every year, millions of Americans lose their health insurance and remain uninsured for various reasons, potentially impacting access to medical services. OBJECTIVE: To examine trends in health insurance loss in the periods shortly before and after implementation of Patient Protection and Affordable Care Act (ACA) and to assess the association of past-year health insurance loss with access to health services and medications. RESEARCH DESIGN AND SUBJECTS: Trends in health insurance loss were examined in 176,961 nonelderly adult participants of the National Health Interview Survey 2011-2017-a representative cross-sectional annual survey of US general population. Multivariable logistic regression models were used to examine access to health services and medications. MEASURES: Loss of private insurance or Medicaid in the past year; use of emergency room services and hospitalizations; contact with medical providers; affording medical care or medications; cost-related medication nonadherence. RESULTS: Private health insurance loss decreased from 3.9%-4.0% in 2011-2013 to 2.7% to 3.1% in 2014-2017 (P<0.001); Medicaid loss decreased from 8.5%-8.9% to 4.6%-6.4% in this period (P<0.001). Nevertheless, as late as 2017, ∼6 million uninsured adults reported having lost private insurance or Medicaid in the past year. Loss of either type of health insurance was associated with lower odds of accessing medical providers, but higher odds of not affording medical care and poor adherence to medication regimens to save costs. CONCLUSIONS: Implementation of ACA was associated with lower risk of health insurance loss. Nevertheless, health insurance loss remains a major barrier to accessing health services and prescribed medications.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Pacientes no Asegurados/estadística & datos numéricos , Patient Protection and Affordable Care Act/estadística & datos numéricos , Adolescente , Adulto , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Hospitalización/estadística & datos numéricos , Humanos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/legislación & jurisprudencia , Modelos Logísticos , Masculino , Medicaid/estadística & datos numéricos , Pacientes no Asegurados/legislación & jurisprudencia , Persona de Mediana Edad , Estados Unidos , Adulto Joven
18.
S Afr Med J ; 109(7): 498-502, 2019 Jun 28.
Artículo en Inglés | MEDLINE | ID: mdl-31266576

RESUMEN

BACKGROUND: Prescribed Minimum Benefits (PMBs) in South Africa (SA) are a set of minimum health services that all members of medical aid schemes have access to regardless of their benefit options or depleted funds. Medical aid schemes are liable to pay for these services. However, ~40% of all complaints received by the Council for Medical Schemes (CMS) are in relation to PMBs. Individuals/stakeholders who are unsatisfied with judgments on their complaints are allowed to appeal. OBJECTIVES: To determine and describe the pattern of PMB appeals from 1 January 2006 to 31 December 2016. METHODS: This was a descriptive cross-sectional study that utilised the CMS Judgments on Appeals database. Data for PMBs, levels of appeal, judgments, appellants, respondents and medical scheme types were extracted. The CMS's lists of chronic conditions, PMBs and registered schemes were used to confirm PMBs and to categorise schemes as either open (i.e. to all South Africans) or restricted (i.e. only open to members of specific organisations). Data were extracted and frequencies were calculated using Stata software, version 14. RESULTS: All eligible appeal reports (N=340) were retrieved and 123 PMB appeals were included in the study (36.2%). The median number of PMB appeals per year was 11 (interquartile range 9 - 27). Open schemes accounted for 82.1% of all the PMB appeals. Half of the total appeals (50.4%, 62/123) were by medical aid schemes appealing their liability to pay for PMBs, and of these 69.4% (43/62) were found in favour of members. The remaining half (49.6%, 61/123) were appeals by members appealing that schemes were liable to pay, and of these 80.3% (49/61) were found in favour of the medical aid schemes. Treatment options that were scheme exclusions constituted 34.4% (21/61) of reasons why schemes were found not liable to pay. Various types of cancers and emergency conditions constituted one-quarter of all PMB appeals. CONCLUSIONS: While the pattern is unclear and the extent of the problem is masked, this study shows that a quarter of the conflict resulting in PMB appeals was due to various types of cancers and emergency conditions. Medical schemes should revise their guidelines, policies and criteria for payment of these two services and improve their communication with healthcare providers and members.


Asunto(s)
Seguro de Salud/legislación & jurisprudencia , Estudios Transversales , Humanos , Seguro de Salud/economía , Sudáfrica
20.
Health Serv Res ; 54(4): 730-738, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31218670

RESUMEN

OBJECTIVE: To investigate how changes in insurer participation and composition as well as state policies affect health plan affordability for individual market enrollees. DATA SOURCES: 2014-2019 Qualified Health Plan Landscape Files augmented with supplementary insurer-level information. STUDY DESIGN: We measured plan affordability for subsidized enrollees using premium spreads, the difference between the benchmark plan and the lowest cost plan, and premium levels for unsubsidized enrollees. We estimated how premium spreads and levels varied with insurer participation, insurer composition, and state policies using log-linear models for 15 222 county-years. PRINCIPAL FINDINGS: Increased insurer participation reduces premium levels, which is beneficial for unsubsidized enrollees. However, it also reduces premium spreads, leading to lower plan affordability for subsidized enrollees. States responding to cost-sharing reduction subsidy payment cuts by increasing only silver plans' premiums increase premium spreads, particularly when premium increases are restricted to on-Marketplace silver plans. The latter approach also protects unsubsidized, off-Marketplace enrollees from experiencing premium shocks. CONCLUSIONS: Insurer participation and insurer composition affect subsidized and unsubsidized enrollees' health plan affordability in different ways. Decisions by state regulators regarding health plan pricing can significantly affect health plan affordability for each enrollee segment.


Asunto(s)
Intercambios de Seguro Médico/organización & administración , Aseguradoras/economía , Seguro de Salud/organización & administración , Seguro de Costos Compartidos/economía , Seguro de Costos Compartidos/legislación & jurisprudencia , Intercambios de Seguro Médico/economía , Intercambios de Seguro Médico/legislación & jurisprudencia , Humanos , Aseguradoras/legislación & jurisprudencia , Seguro de Salud/economía , Seguro de Salud/legislación & jurisprudencia , Estados Unidos
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