Voice of the Customer: Factors Impacting Beneficiary Choice of Programs in TRICARE.

Little is known about how a consumer would choose a health plan if cost was not an option such as in the Military Health System. We sought to identify how to recruit TRICARE beneficiaries into new pilot programs challenged by low recruitment. We developed a semistructured interview guide by adapting a framework established by Klinkman to assess factors in choosing a health plan. Using social media platforms, we recruited TRICARE Prime and Select beneficiaries to participate in key informant interviews from October to December 2022. We conducted inductive thematic analysis to determine key areas of concern. We interviewed a total of 20 TRICARE Prime and Select beneficiaries. The majority were women, above age 40, had a master's degree, a sponsor in the US Army and of senior officer rank. Four overarching themes emerged: (I) patient choice; (II) access to care; (III) quality of care; and (IV) cost. This evaluation of TRICARE beneficiaries explores how to motivate high-quality value-based care in a traditionally fee for service system.

The Rubik's Cube of Manufacturers' Coupons: Making the Case for Sneetches.

Description Asthma maintenance inhalers are inordinately expensive, inhibiting patients from affording their medication and compromising compliance and adherence and optimal health outcomes. The objective of this article was to examine and highlight the competitive world and challenged opportunity of manufacturers' coupons discounting the inordinate cost of respiratory inhalers and asthma treatment. The cost of asthma treatment, in particular the cost of respiratory medicines, even with health insurance, can be prohibitive (upwards of $700 per month for one inhaler). Medication costs restrict medication access. Compliance and adherence suffer attested by monthly maintenance inhalers being filled less than 50% of the time. Pharmaceutical manufacturers of branded drugs competitively offer and market discount programs designed to help offset out-of-pocket medication (copay or coinsurance) costs. However, these programs vary depending on the manufacturer and are contingent on the parameters of individual insurance plans and their respective pharmacy benefit managers (PBMs). In an attempt to gain market advantage, manufacturers, coupons frequently change criteria making the opportunity of savings for patients and prescribing clinicians difficult to discern, implement and sustain.

Physician patient sharing relationships within insurance plan networks.

OBJECTIVE: To quantify shared patient relationships between primary care physicians (PCPs) and cardiologists and oncologists and the degree to which those relationships were captured within insurance networks. DATA SOURCES: Secondary analysis of Vericred data on physician networks, CareSet data on physicians' shared Medicare patients, and insurance plan attributes from Health Insurance Compare. Data validation exercises used data from Physician Compare and IQVIA. STUDY DESIGN: Cross-sectional study of the PCP-to-specialist in-network shared patient percentage (primary outcome). We also categorized networks by insurance market segment (Medicare Advantage [MA], Medicaid managed care, small-group or individually purchased), insurance plan type, and network breadth. DATA EXTRACTION: We analyzed data on 219,982 PCPs, 29,400 cardiologists, and 22,745 oncologists who, in 2021, accepted MA (n = 941 networks), Medicaid managed care (n = 293), and individually-purchased (n = 332) and small-group (n = 501) plans. PRINCIPAL FINDINGS: Networks captured, on average, 64.6% of PCP-cardiology shared patient ties, and 61.8% of PCP-oncologist ties. Less than half of in-network ties (44.5% and 38.9%, respectively) were among physicians with a common organizational affiliation. After adjustment for network breadth, we found no evidence of differences in the shared patient percentage across insurance market segments or networks of different types (p-value >0.05 for all comparisons). An exception was among national versus local and regional networks, where we found that national plans captured fewer shared patient ties, particularly among the narrowest networks (58.4% for national networksvs. 64.7% for local and regional networks for PCP-cardiology). CONCLUSIONS: Given recent trends toward narrower networks, our findings underscore the importance of incorporating additional and nuanced measures of network composition to aid plan selection (for patients) and to guide regulatory oversight.

Navigating the Complex Web of Prescribing Amyloidosis Therapeutics: A Primer.

Advancement in the diagnosis and treatment of transthyretin amyloid cardiomyopathy has made great strides in recent years. Novel therapeutics for transthyretin amyloidosis such as tafamidis, patisiran, and inotersen have shown significant benefits in a not-so-rare disease but come with high listing price tags ranging from a quarter to more than a half million dollars per year. These costs create significant financial barriers for the majority of patients, especially those with existing Medicare insurance plans. Of 72 patients reviewed, 67% were Medicare beneficiaries. Financial assistance was explored for the majority, and 37 (51%) patients with Medicare Part D received financial assistance that reduced their copayments to $0. Only one-third of our patients were able to afford these medications without any forms of financial assistance. Of these patients, 4 (6%) had the highest copayments ranging from $13 000 to $15 000 per year. To navigate the complexities of prescribing and affordability in amyloidosis, a multidisciplinary team including a dedicated clinical pharmacist is crucial in guaranteeing patients' success to secure these novel therapeutics. In this article, we discuss our experiences with prescribing, acquiring insurance authorizations, and financing these life-saving medications based on patient-specific insurance plans and socioeconomic status.

La incapacidad temporal como beneficio de la seguridad social: una revisión de literatura / Sick leave as a social security benefit: A literature review / Licença médica como benefício da previdência social: uma revisão de literatura

La incapacidad temporal es el beneficio asistencial y económico que se le reconoce a trabajadoras y trabajadores cotizantes del sistema de seguridad social por la afectación en su capacidad laboral e implica ausentismo y asistencia para el retorno al trabajo. El objetivo de esta revisión es explorar las concepciones, los sujetos y las situaciones protegidas por esta prestación en diferentes países. Se realizó una revisión de literatura en bases de datos y sitios web oficiales de Colombia, Argentina, Chile, Perú, Ecuador, México, España y Portugal. Para el análisis se diseñaron matrices y un cuadro descriptivo con identificadores normativos; los hallazgos se organizaron en categorías. Se encontraron semejanzas en los elementos conceptuales, eventos y sujetos de protección. Las diferencias están en los requisitos y duración. La incapacidad temporal es un beneficio universal y finito reconocido como un derecho laboral y de la seguridad social. Por su impacto económico y social, debe ser estudiada desde la gestión en salud y de los riesgos laborales para el diseño de planes y programas, así como de estrategias regionales con enfoque de equidad, considerando la ocupación y el ámbito laboral.

Sick leave is an economic and support benefit of a social security system for workers who contribute to it, when their work capacity has been impacted. It implies absenteeism and assistance to return to work. This review aims to explore the conceptions and protected subjects and events of this benefit in different countries. A literature review was carried out on databases and official websites of Colombia, Argentina, Chile, Perú, Ecuador, México, Spain, and Portugal. For the analysis, matrices and a descriptive table with normative identifiers were designed. The findings were organized into categories. Similarities were found in conceptual elements and the protected events and subjects. The differences include the requirements and duration. Sick leave is a universal and finite benefit recognized as a labor and social security right. Due to its economic and social impact, it must be studied from health and occupational risks management to design plans and programs and regional strategies focusing on equity, considering the occupation and the work environment.

A licença médica é o benefício assistencial e econômico que é reconhecido aos trabalhadores e trabalhadoras contribuintes do sistema de previdência social pelo impacto na sua capacidade para o trabalho e implica absentismo e assistência no regresso ao trabalho. O objetivo desta revisão é explorar as concepções, temas e situações protegidas por esse benefício em diferentes países. Foi realizada uma revisão da literatura em bases de dados e em sites oficiais da Colômbia, Argentina, Chile, Peru, Equador, México, Espanha e Portugal. Para a análise, foram elaboradas matrizes e uma tabela descritiva com identificadores normativos; os resultados foram organizados em categorias. Semelhanças foram encontradas nos elementos conceituais, eventos e temas de proteção. As diferenças estão nos requisitos e na duração. A licença médica é um benefício universal e finito, reconhecido como direito trabalhista e previdenciário. Devido ao seu impacto econômico e social, deve ser estudada a partir da gestão em saúde e dos riscos trabalhistas para o esboço de planos e programas; bem como das estratégias regionais com foco na equidade, considerando a ocupação e o ambiente de trabalho.

Carve-out plan financial requirements associated with national behavioral health parity.

OBJECTIVES: To examine changes in carve-out financial requirements (copayments, coinsurance, use of deductibles, and out-of-pocket maxima) following the Mental Health Parity and Addiction Equity Act (MHPAEA). DATA SOURCE/STUDY SETTING: Specialty mental health benefit design information for employer-sponsored carve-out plans from a national managed behavioral health organization's claims processing engine (2008-2013). STUDY DESIGN: This pre-post study reports linear and logistic regression as the main analysis. DATA COLLECTION/EXTRACTION METHODS: NA. PRINCIPAL FINDINGS: Copayments for in-network emergency room (-$44.9, 95% CI: -78.3, -11.5; preparity mean: $56.2), outpatient services (eg, individual psychotherapy: -$7.4, 95% CI: -10.5, -4.2; preparity mean: $17.8), and out-of-network coinsurance for emergency room (-11 percentage points, 95% CI: -16.7, -5.4; preparity mean: 38.8 percent) and outpatient (eg, individual psychotherapy: -5.8 percentage points, 95% CI: -10.0, -1.6; preparity mean 41.0 percent) decreased. Probability of family OOP maxima use (29 percentage points, 95% CI: 19.3, 38.6; preparity mean: 36 percent) increased. In-network outpatient coinsurance increased (eg, individual psychotherapy: 4.5 percentage points, 95% CI: 1.1, 7.9; preparity mean: 2.7 percent), as did probability of use of family deductibles (15 percentage points, 95% CI: 6.1, 23.3; preparity mean: 38 percent). CONCLUSIONS: MHPAEA was associated with increased generosity in most financial requirements observed here. However, increased use of deductibles may have reduced generosity for some patients.

The Mental Health Parity and Addiction Equity Act evaluation study: Child and adolescent behavioral health service expenditures and utilization.

This study explores possible associations of the Mental Health Parity and Addiction Equity Act (MHPAEA) with child access to behavioral health (BH) services (preimplementation = 2008-2009, transition = 2010, and post = 2011-2013). The study sample included children aged 4-17 years in self-insured "carve-in" plans from large employers. In "carve-ins," BH and medical care are covered through the same insurance plan. The unit of analysis is the person-month (N = 61,823,533). This study employs an interrupted time series model allowing for intercept and slope changes for the transition and postparity periods. Outcomes included total, plan and patient out-of-pocket (OOP) expenditures, and several categories of service utilization. Generalized estimating equations were used to account for clustering. There were significant increases in total and plan expenditures postparity. To illustrate, in July 2012, mean per-member-per-month total expenditures were predicted to be $5.65 without parity but $8.72 with parity. Patient OOP costs did not change significantly. Significant overall increases were seen for utilization of most outpatient services but not intermediate or inpatient services. Our findings suggest that the introduction of MHPAEA was associated with an increase in specialty BH service access for children without a commensurate increase in financial burden for families.

Effects of the Affordable Care Act's enhancement of Medicare benefits on preventive services utilization among older adults in the U.S.

Since 2011, the Affordable Care Act (ACA) requires the provision of certain recommended clinical preventive services without cost-sharing for individuals in Medicare. We re-visited the effects of the ACA on preventive services utilization under Medicare, using data from the Medical Expenditure Panel Survey (MEPS) and examined the ACA's longer-term effects on preventive services utilization among Medicare beneficiaries. We analyzed nationally representative data on non-institutionalized Medicare beneficiaries (n = 27,124) from the 2006-2010 and 2012-2016 Medical Expenditure Panel Survey. Preventive services of interest were cholesterol test, blood pressure test, flu shot, endoscopy, blood stool test, clinical breast exam, mammography and prostate exam. We estimated propensity score weighted difference-in-difference (DID) models to test for differences in preventive services utilization based on Medicare insurance status. Nationwide, among beneficiaries with traditional Medicare only, who stood to gain the most from eliminating cost-sharing for preventive services, the percentage of women receiving clinical breast exams rose post-reform (Δ = 8.1%; p < 0.015) as compared to Medicare beneficiaries with supplemental private coverage, while at the same time the percentage receiving other preventive services did not change post-reform (all p > 0.05). Based on this analysis of MEPS data spanning 2006-2016, the ACA's enhancement of Medicare coverage had only modest effects on the percentage of beneficiaries receiving a range of preventive services. Medicare beneficiaries should be better informed of the availability of these services and encouraged by their physicians to avail the no cost-sharing incentive of these reforms.

Foot Deformities in Women Are Associated with Wearing High-Heeled Shoes.

BACKGROUND The aim of this study was to assess the association between foot deformities and type of shoe regularly worn at work. MATERIAL AND METHODS We studied 150 employed women ages 30-40 years and divided them into 3 groups according to type of footwear worn: women in Group I wore flat-soled shoes, women in Group II wore mid-heeled shoes (heels 4.0±0.5 cm), and women in Group III wore high-heeled shoes (heels 10.0±0.5 cm). We used the CQ-ST podoscope for measurements. RESULTS We found significant differences in right foot γ angle between Groups I and III (p=0.033) and between Groups II and III (p=0.040). For the left foot, differences were noted between Groups I and III (p=0.012). Group III subjects had higher values of alpha angle compared to Group I (p=0.000) and Group II (p=0.000). Significant correlations were also found between specific type of footwear worn and the incidence of hallux valgus of the right foot (p=0.010) and left foot (p=0.000), and the varus deformity of the fifth toe (ß) of the left foot (p=0.015). CONCLUSIONS The feet of women wearing high-heeled shoes were significantly flatter transversely, with a more laterally flexed hallux, as compared to those wearing low-heeled or flat-soled shoes. Wearing high-heeled shoes was associated with higher incidence of hallux valgus. The incidence of varus deformity of the fifth toe was associated with wearing high-heeled shoes.

The socioeconomic impact of Korean dental health insurance policy on the elderly: a nationwide cohort study in South Korea.

PURPOSE: The purpose of this retrospective study was to investigate the relationships of types of dental insurance coverage in Korea with sociodemographic characteristics and the prevalence of systemic and oral diseases, as well as to evaluate the socioeconomic impact of Korean dental insurance policies. METHODS: Sample cohort data from 2006 to 2015 were obtained from the National Health Insurance Service. Patients were divided into 2 groups. The exposed group comprised patients who received insurance benefits for complete dentures, removable partial dentures, and implant care, while the control group comprised patients who did not receive these benefits. The type of insurance coverage and the prevalence of systemic and oral diseases were compared between the 2 groups. RESULTS: Patients who received benefits in the form of complete dentures, removable partial dentures, and implants had similar sociodemographic characteristics in terms of sex, age, income quintile, and type of insurance coverage to the control group. The prevalence of hypertension, anemia, renal disease, rheumatoid arthritis, osteoporosis, asthma, and cerebral infarction was higher in the exposed group than in the control group (P<0.05). The prevalence of periodontal diseases and dental caries was also higher in the exposed group. CONCLUSIONS: Korean dental health insurance policy has been beneficial for the medical expenses of low-income and elderly people suffering from a cost burden due to systemic diseases. However, since there is a tendency to avoid invasive interventions in older patients due to the high risk of systemic diseases, insurance coverage of dentures may be more helpful from a socioeconomic perspective than coverage of dental implant treatments.

Benefícios previdenciários por transtornos mentais e comportamentais em trabalhadores do Piauí em 2014 / Social security benefits for mental and behavioral disorders among workers in Piaui, Brazil, in 2014

INTRODUÇÃO: Os benefícios previdenciários mudaram de características ao longo dos anos, em decorrência da modificação do padrão de organização do trabalho, que provocou novas vulnerabilidades sociais, nas quais emergiram questões mais evidentes relativas à saúde do trabalhador, como os transtornos mentais e comportamentais. OBJETIVO: Descrever os benefícios previdenciários temporários concedidos pelo Instituto Nacional do Seguro Social (INSS) para trabalhadores com transtornos mentais e comportamentais do estado do Piauí, no ano de 2014. MÉTODOS: Trata-se de estudo descritivo, de corte transversal, com coleta retrospectiva, realizado na cidade de Teresina, Piauí, Brasil, a partir de dados do INSS coletados no mês de novembro de 2015, referentes ao ano de 2014. RESULTADOS: No período foram concedidos 1.473 benefícios, dos quais 50,4% dos trabalhadores eram homens, a maioria procedente da capital, com atividade urbana. Destes, 47,7% afastaram-se por transtornos do humor. O tempo médio de benefício foi de 112,6 dias. Houve diferença significativa entre o tempo de benefício e o tipo de auxílio (p<0,012), a clientela (p<0,015) e o sexo dos trabalhadores afastados (p=0,010). CONCLUSÃO: A principal causa de afastamento por transtorno mental e comportamental decorreu dos transtornos do humor, cujo benefício caracterizou-se por ser previdenciário. Observou-se que houve diferença significativa entre o tempo de benefício e o tipo de auxílio, a clientela e o sexo dos trabalhadores afastados.

BACKGROUND: The characteristics of social security benefits changed over time as a function of modifications in the patterns of work organization. This process gave rise to new social vulnerabilities which include aspects visibly related to occupational health, as is the case of mental and behavioral disorders. OBJECTIVE: To describe temporary social security benefits granted by the National Social Security Institute (INSS) to workers with mental and behavioral disorders in Piaui, Brazil, in 2014. METHODS: Crosssectional, descriptive and retrospective study based on INSS data collected in November 2015 relative to 2014. RESULTS: 1,473 benefits were granted along the analyzed period, 50.4% of which corresponded to male workers. Most beneficiaries resided in the state capital and had urban jobs. Mood disorders accounted for 47.7% of sick leaves. The mean duration of benefits was 112.6 days. There was significant difference in the duration of benefits according to their type (p<0.012), urban versus rural jobs (p<0.015) and sex (p=0.010). CONCLUSION: Mood disorders were the most frequent reason for sick leaves due to mental and behavioral disorders and the affected workers were granted social security benefits. The duration of leaves significantly differed as a function of the type of benefits, urban versus rural jobs and sex.

Social security benefits for mental and behavioral disorders among workers in Piaui, Brazil, in 2014.

BACKGROUND: The characteristics of social security benefits changed over time as a function of modifications in the patterns of work organization. This process gave rise to new social vulnerabilities which include aspects visibly related to occupational health, as is the case of mental and behavioral disorders. OBJECTIVE: To describe temporary social security benefits granted by the National Social Security Institute (INSS) to workers with mental and behavioral disorders in Piaui, Brazil, in 2014. METHODS: Cross-sectional, descriptive and retrospective study based on INSS data collected in November 2015 relative to 2014. RESULTS: 1,473 benefits were granted along the analyzed period, 50.4% of which corresponded to male workers. Most beneficiaries resided in the state capital and had urban jobs. Mood disorders accounted for 47.7% of sick leaves. The mean duration of benefits was 112.6 days. There was significant difference in the duration of benefits according to their type (p<0.012), urban versus rural jobs (p<0.015) and sex (p=0.010). CONCLUSION: Mood disorders were the most frequent reason for sick leaves due to mental and behavioral disorders and the affected workers were granted social security benefits. The duration of leaves significantly differed as a function of the type of benefits, urban versus rural jobs and sex.

INTRODUÇÃO: Os benefícios previdenciários mudaram de características ao longo dos anos, em decorrência da modificação do padrão de organização do trabalho, que provocou novas vulnerabilidades sociais, nas quais emergiram questões mais evidentes relativas à saúde do trabalhador, como os transtornos mentais e comportamentais. OBJETIVO: Descrever os benefícios previdenciários temporários concedidos pelo Instituto Nacional do Seguro Social (INSS) para trabalhadores com transtornos mentais e comportamentais do estado do Piauí, no ano de 2014. MÉTODOS: Trata-se de estudo descritivo, de corte transversal, com coleta retrospectiva, realizado na cidade de Teresina, Piauí, Brasil, a partir de dados do INSS coletados no mês de novembro de 2015, referentes ao ano de 2014. RESULTADOS: No período foram concedidos 1.473 benefícios, dos quais 50,4% dos trabalhadores eram homens, a maioria procedente da capital, com atividade urbana. Destes, 47,7% afastaram-se por transtornos do humor. O tempo médio de benefício foi de 112,6 dias. Houve diferença significativa entre o tempo de benefício e o tipo de auxílio (p<0,012), a clientela (p<0,015) e o sexo dos trabalhadores afastados (p=0,010). CONCLUSÃO: A principal causa de afastamento por transtorno mental e comportamental decorreu dos transtornos do humor, cujo benefício caracterizou-se por ser previdenciário. Observou-se que houve diferença significativa entre o tempo de benefício e o tipo de auxílio, a clientela e o sexo dos trabalhadores afastados.

The socioeconomic impact of Korean dental health insurance policy on the elderly: a nationwide cohort study in South Korea

PURPOSE: The purpose of this retrospective study was to investigate the relationships of types of dental insurance coverage in Korea with sociodemographic characteristics and the prevalence of systemic and oral diseases, as well as to evaluate the socioeconomic impact of Korean dental insurance policies. METHODS: Sample cohort data from 2006 to 2015 were obtained from the National Health Insurance Service. Patients were divided into 2 groups. The exposed group comprised patients who received insurance benefits for complete dentures, removable partial dentures, and implant care, while the control group comprised patients who did not receive these benefits. The type of insurance coverage and the prevalence of systemic and oral diseases were compared between the 2 groups. RESULTS: Patients who received benefits in the form of complete dentures, removable partial dentures, and implants had similar sociodemographic characteristics in terms of sex, age, income quintile, and type of insurance coverage to the control group. The prevalence of hypertension, anemia, renal disease, rheumatoid arthritis, osteoporosis, asthma, and cerebral infarction was higher in the exposed group than in the control group (P<0.05). The prevalence of periodontal diseases and dental caries was also higher in the exposed group. CONCLUSIONS: Korean dental health insurance policy has been beneficial for the medical expenses of low-income and elderly people suffering from a cost burden due to systemic diseases. However, since there is a tendency to avoid invasive interventions in older patients due to the high risk of systemic diseases, insurance coverage of dentures may be more helpful from a socioeconomic perspective than coverage of dental implant treatments.

Frequency of ocular diseases among recipients of disability benefits in the metropolitan region of Recife, Brazil / Incapacidade para o trabalho por doenças oculares na população segurada da Previdência Social da região metropolitana do Recife, Brasil: um estudo de frequência

ABSTRACT Purpose: To identify the frequency of ocular diseases among recipients of disability benefits in the metropolitan region of Recife, Brazil. Methods: A review was performed of 217,221 cases of disability benefits granted between 2010 and 2015 by the executive managerial department of the Brazilian National Institute of Social Security (Instituto Nacional do Seguro Social [INSS]) in Recife, which encompasses 14 municipalities of the metropolitan region, including the capital. The frequencies of the identified cases of ocular morbidity were then determined according to their group in the International Classification of Diseases, 10th Revision (ICD-10), their cause, the age, sex, and income of the recipient, and the type and duration of the benefit. Results: Of all disability benefits granted, 5,324 (2.5%) were due to ocular disease, the majority (91.1%) consisting of sick pay. Most of the beneficiaries (64.6%) were males, were 20 to 59 years of age, and 61.2% earned the minimum wage or less. The principal ocular diseases for which sick pay benefits were granted were cataract (24.5%), conjunctivitis (21.1%), and pterygium (8.8%). Blindness and low vision were the principal ocular diseases in cases of accident indemnity and disability retirement. Conclusions: The results highlight the magnitude of the problem of ocular diseases to the social security system, with serious economic and social losses, and emphasize the need for measures aimed at their prevention. Moreover, integration between the national departments of health and social security needs to be improved.

RESUMO Objetivo: Identificar a frequência das doenças oculares entre os segurados com benefícios por incapacidade. Métodos: Estudo retrospectivo de 217.221 benefícios por incapacidade concedidos pelo Instituto Nacional do Seguro Social (INSS) da gerência executiva de Recife, que engloba os 14 municípios da região metropolitana, incluindo a capital, no período de 2010-2015. Os casos de doenças oculares foram avaliados quanto à frequência considerando seu grupo na CID-10. Foi feita ainda uma análise do perfil dos benefícios concedidos por estas doenças com relação à causa, idade, sexo, faixa salarial, espécie e duração do benefício. Resultados Do total dos benefícios concedidos, 5.324 foram decorrentes de doenças oftalmológicas (2,5%) e entre estes, a maioria como auxíliodoença (91,1%). Houve predomínio do sexo masculino (64,6%), faixa etária dos 20 aos 59 anos e valor de até 01 salário mínimo (61,2%). Entre as concessões de auxíliodoença a principal causa foi a catarata (24,5%), seguida pela conjuntivite (21,1%) e pterígio (8,8%). A cegueira e baixa visão foi a principal causa de auxílio-acidente e aposentadoria por invalidez. Conclusões: Os resultados destacam a magnitude do problema das doenças oculares para a Previdência Social, com graves perdas econômicas e sociais, e enfatizam a necessidade de medidas que visem sua prevenção e maior integração entre os serviços de saúde e o INSS (Instituto Nacional do Seguro Social).

Trajectories of disposable income among people of working ages diagnosed with multiple sclerosis: a nationwide register-based cohort study in Sweden 7 years before to 4 years after diagnosis with a population-based reference group.

OBJECTIVES: To describe how disposable income (DI) and three main components changed, and analyse whether DI development differed from working-aged people with multiple sclerosis (MS) to a reference group from 7 years before to 4 years after diagnosis in Sweden. DESIGN: Population-based cohort study, 12-year follow-up (7 years before to 4 years after diagnosis). SETTING: Swedish working-age population with microdata linked from two nationwide registers. PARTICIPANTS: Residents diagnosed with MS in 2009 aged 25-59 years (n=785), and references without MS (n=7847) randomly selected with stratified matching (sex, age, education and country of birth). PRIMARY AND SECONDARY OUTCOME MEASURES: DI was defined as the annual after tax sum of incomes (earnings and benefits) to measure individual economic welfare. Three main components of DI were analysed as annual sums: earnings, sickness absence benefits and disability pension benefits. RESULTS: We found no differences in mean annual DI between people with and without MS by independent t-tests (p values between 0.15 and 0.96). Differences were found for all studied components of DI from diagnosis year by independent t-tests, for example, in the final study year (2013): earnings (-64 867 Swedish Krona (SEK); 95% CI-79 203 to -50 528); sickness absence benefits (13 330 SEK; 95% CI 10 042 to 16 500); and disability pension benefits (21 360 SEK; 95% CI 17 380 to 25 350). A generalised estimating equation evaluated DI trajectory development between people with and without MS to find both trajectories developed in parallel, both before (-4039 SEK; 95% CI -10 536 to 2458) and after (-781 SEK; 95% CI -6988 to 5360) diagnosis. CONCLUSIONS: The key finding of parallel DI trajectory development between working-aged MS and references suggests minimal economic impact within the first 4 years of diagnosis. The Swedish welfare system was responsive to the observed reductions in earnings around MS diagnosis through balancing DI with morbidity-related benefits. Future decreases in economic welfare may be experienced as the disease progresses, although thorough investigation with future studies of modern cohorts are required.

Public social security burden of musculoskeletal diseases in Brasil-Descriptive study

SUMMARY BACKGROUND: To present data on the social security burden of diseases of the musculoskeletal system and connective tissue (DSOTC) in Brasil in 2014, and evolution of these social security expenditures between 2009 and 2014. METHOD: Compilation and analysis of data on the granting of disability pensions and sickness benefits in the year 2014, available on the official website of Social Security, classified according to ICD 10. It was evaluated the evolution between 2009 and 2014, using the F test to compare the curves with the growth of the active age population (PIA). RESULTS: Among the 22 disease groups classified according to ICD-10, the DSOTC group led benefits grants in 2014, with 19% of the sickness benefits and 13.5% of the disability pensions. The main causes of sickness benefit and disability retirement were, respectively: dorsopathies (43.3% and 41.2%), soft tissue diseases (27.3% and 19.7%), osteoarthritis (7.6% % And 27.8%) and chronic inflammatory arthropathies (2.8% and 7.9%). In the evolution of the number of sickness benefits granted between 2009 and 2014, both INSS and DSOTC totals showed an increasing tendency (35.9 and 35.3%, respectively, with p = 0.000 for both). As for disability retirement, there was a 5.9% increase in the INSS total (p = 0.039), while for the DSOTC there was a decrease of 7.6% (p = 0.005). CONCLUSIONS: These data point to a progressive increase in the granting of sickness pensions and disability benefits in the country, superior to the growth of the PIA, as well as a high participation of DSOTC in these benefits.

RESUMO OBJETIVOS: Apresentar dados sobre o ônus previdenciário das doenças do sistema osteomuscular e tecido conjuntivo (DSOTC) no Brasil no ano de 2014, e sua evolução entre 2009 e 2014. MÉTODO: Compilação e análise de dados sobre a concessão de aposentadorias por invalidez e auxílios-doença no ano de 2014 disponíveis no portal oficial da Previdência Social, classificados segundo o CID 10. Avaliação da evolução entre 2009 e 2014, utilizando-se o teste F para comparar as curvas com o crescimento da população em idade ativa (PIA). RESULTADOS: Entre 22 grupos de doenças classificados de acordo com o CID 10, o das DSOTC liderou as concessões de benefícios em 2014, com 19% dos auxílios-doença e 13,5% das aposentadorias por invalidez. As principais causas de concessão de auxílio-doença e aposentadoria por invalidez foram, respectivamente: dorsopatias (43,3% e 41,2%), doenças de partes moles (27,3% e 19,7%), osteoartrite (7,6% e 27,8%) e artropatias inflamatórias crônicas (2,8% e 7,9%). Na evolução do número de auxílios-doença concedidos entre 2009 e 2014, tanto o total do INSS quanto o do grupo DSOTC apresentaram tendência crescente (35,9 e 35,3%, respectivamente, com p = 0,000 para ambos). Já para aposentadoria por invalidez, houve aumento de 5,9% no total do INSS (p = 0,039), enquanto que para as DSOTC houve um decréscimo de 7,6% (p = 0,005). CONCLUSÕES: Verificou-se uma elevação progressiva na concessão de auxílio-doença e aposentadoria por invalidez no País, superior ao aumento da população em idade ativa. As DSOTC foram o grupo com maior participação relativa nesses benefícios.

Benefícios por doenças cardiovasculares na cidade do Recife, Pernambuco, no quinquênio 2011­2015 / Benefits granted due to cardiovascular disease in Recife, Pernambuco, Brazil, 2011­2015

Introdução: Os benefícios previdenciários refletem o impacto socioeconômico gerado pela incapacidade ao trabalho por motivo de doença. As doenças cardiovasculares (DCV) são as principais causas de mortalidade e morbidade no mundo. Objetivo: Avaliar, clínica e economicamente, os benefícios previdenciários concedidos por DCVs no Recife, Pernambuco, no quinquênio 2011­2015. Métodos: Estudo descritivo, de corte transversal, com coleta de informações e análise dos benefícios por incapacidade pelas DCVs na gerência executiva do Instituto Nacional do Seguro Social no Recife, por intermédio do Sistema Único de Informações de Benefícios. Resultados: No quinquênio 2011­2015 foram concedidos 186.058 benefícios. Destes, 8.968 (4,8%) foram por DCVs, entre os quais 6.049 (67,5%) foram selecionados por serem as doenças mais frequentes. Dos beneficiários, 78% são masculinos e 63,8% estavam na faixa etária entre 45 e 59 anos. O acidente vascular encefálico (AVE) e a insuficiência cardíaca (IC) foram responsáveis pela maior duração de afastamento ao trabalho (entre 135 e 138 dias) e pelo maior valor do benefício (próximo de R$ 3.900 mensais). Conclusão: Embora a hipertensão arterial sistêmica não acarrete um afastamento tão longo e não seja tão dispendiosa, ela deveria ser prevenida, por ser causa importante de AVE e IC, duas das principais DCVs responsáveis por maior custo e número de dias de absenteísmo. A melhoria da qualidade de vida da população visa à atenuação do impacto na Previdência Social, no mundo do trabalho e na sociedade como um todo.

Background: Social security benefits reflect the socioeconomic impact of work incapacity by disease. Cardiovascular diseases (CVD) are the main cause of mortality and mortality worldwide. Objective: To evaluate benefits granted due to CVD in Recife, Pernambuco, Brazil, from 2011 to 2015, from the clinical and economic perspective. Methods: Cross-sectional and descriptive study which collected and analyzed data on benefits granted for disability caused by CVD by the executive management of the National Social Security Institute in Recife, via the Unified System of Information on Benefits. Results: 186,058 benefits were granted from 2011 to 2015, 8,968 (4.8%) corresponded to CVD, of which 6,049 (67.5%) were selected for analysis because they corresponded to the most frequent diseases. About 78% of the beneficiaries were male and 63.8% were within age range 45 to 59 years old. Stroke and heart failure (HF) accounted for the longest sick leaves (133 to 138 days) and highest benefit amounts (about BRL 3,900.00 per month). Conclusion: While hypertension does not result in as long leaves and costs, it should be prevented for being a significant cause of stroke and HF, both of which account for longer sick leaves and higher social security costs. Improving the quality of life of the population seeks to reduce their impacts on the social security system, the world of work and society at large

Impact of early systemic lupus erythematosus on work disability-results from the Finnish nationwide register 2000-2007.

Objectives of this study were to examine work disability (WD) and its leading causes in incident SLE patients. Data were derived from the Finnish nationwide registries to identify all non-retired, 18 to 64-year-old incident SLE patients between 2000 and 2007. Sick benefits and WD pensions and the causes for them were monitored until the end of 2008. A total of 446 working-aged, incident SLE patients available for work force (mean age 42 ± 13 years, 89% females) were found. During the follow-up (median 5.3 years), WD pension was granted to 27 patients. The most common cause was SLE itself (14 patients, 52%), with cumulative incidence of 3.4% (95% CI 1.9 to 5.8) in 5 years and 5.0% (95% CI 3.0 to 8.5) in 8 years, followed by musculoskeletal and psychiatric causes. The age- and sex- adjusted incidence ratio for WD pension in SLE patients due to any cause was 5.4 (95% CI 3.7 to 7.9) compared to the Finnish population. The mean number of WD days was 32 (95% CI 28 to 35) per patient-year among all SLE patients during the follow-up. The study concludes that SLE patients have an increased risk for WD already in early course of the disease.

Trends in the utilization of dental outpatient services affected by the expansion of health care benefits in South Korea to include scaling: a 6-year interrupted time-series study.

PURPOSE: This study utilized a strong quasi-experimental design to test the hypothesis that the implementation of a policy to expand dental care services resulted in an increase in the usage of dental outpatient services. METHODS: A total of 45,650,000 subjects with diagnoses of gingivitis or advanced periodontitis who received dental scaling were selected and examined, utilizing National Health Insurance claims data from July 2010 through November 2015. We performed a segmented regression analysis of the interrupted time-series to analyze the time-series trend in dental costs before and after the policy implementation, and assessed immediate changes in dental costs. RESULTS: After the policy change was implemented, a statistically significant 18% increase occurred in the observed total dental cost per patient, after adjustment for age, sex, and residence area. In addition, the dental costs of outpatient gingivitis treatment increased immediately by almost 47%, compared with a 15% increase in treatment costs for advanced periodontitis outpatients. This policy effect appears to be sustainable. CONCLUSIONS: The introduction of the new policy positively impacted the immediate and long-term outpatient utilization of dental scaling treatment in South Korea. While the policy was intended to entice patients to prevent periodontal disease, thus benefiting the insurance system, our results showed that the policy also increased treatment accessibility for potential periodontal disease patients and may improve long-term periodontal health in the South Korean population.

Why employers are offering more choices in health plans next year.

It's a tight labor market and employer surveys show a modest but steady uptick in employer health benefit spending for the coming year-about 5% on average. Much of that increase will go toward specialty drugs, the benefit with the biggest price hikes.